DEPARTMENT OF PLASTIC SURGERY
International Outreach
Plastic and Reconstructive Surgery News
Department of plastic and reconstructive surgery reaches underserved populations with the help of new director of international outreach
April 26, 2001 LLUMC TODAY
Left: On an operation Good Samaritan trip to Nepal in 2000, Robert Hardesty, chief of plastic surgery and Todd Mirzai, resident, smile for a "before" picture with a child whose cleft lip and palate they will repair. Right: The same child following his lip surgery
To enhance its ability to serve needy populations, Linda D'Antonio, PhD, has been named director of international outreach for the Department of Plastic and Reconstructive Surgery of the Department of Surgery at Loma Linda University School of Medicine.
Dr. D'Antonio is a speech pathologist who specializes in evaluating and treating children with cleft palate. She has worked in many developing countries helping to set up interdisciplinary team care for these children.
The repair of cleft lip and palate comprises a large portion of the department of plastic and reconstructive surgery's international outreach work.
The term "plastic surgery" comes from the Greek word meaning "to mold." The essence of plastic surgery is to take the unwhole and make it whole.
One part of plastic and reconstructive surgery is cosmetic surgery, which makes the normal better. Reconstructive surgery takes the abnormal and makes it normal. A significant portion of the work of the division of plastic and reconstructive surgery focuses on the treatment of disfiguring birth defects, particularly cranio facial anomalies such as cleft lip and palate.
In developing countries, these reconstructive surgeries are often not available. The department of plastic and reconstructive surgery has a commitment to providing free surgery for children who were born with terrible disfigurement that they would otherwise be destined to endure their entire lives.
These free surgeries are provided through a program called Operation Good Samaritan. Following the tradition of the University and the department of surgery, the department has placed a strong emphasis on international medical work. Through Operation Good Samaritan, the division is dedicated to providing whole person care for patients in underserved national and international communities.
The division has made 30 trips since the program began in 1986, visiting countries such as Mexico, Argentina, the Philippines, Peru, India, and Nepal. Although the surgeons treat many different deformities during these outreach trips, the most common ones addressed are cleft lip and palate, birth defects involving the hands, and deformities from burns.
As director of international outreach, Dr. D'Antonio will provide coordination for the program.
"The department of surgery at Loma Linda University has a tradition of outreach service to developing countries around the globe," says Leonard L. Bailey, MD, chief of the department of surgery. "This service has been provided in the form of working teams, individual mentoring and conferences, symposia, or specifically targeted lectures. Objectives have been to create good will, give confidence and training to local physicians, surgeons, and other health-care workers, and to exemplify the love of Christ. Dr. D'Antonio, in her outreach role and with her affiliation with Operation Good Samaritan, continues this important mission of the surgery department in harmony with the goals and objectives of the University. I believe she is creating an important opportunity to carry the process to a new level of effectiveness in Asia and elsewhere."
Currently, the surgeons participating in Operation Good Samaritan trips pay their own travel expenses. Any money raised pays for supplies and for residents, nurses, and other health professionals to travel with the team. Although residents receive plentiful experience at LLUMC, all residents graduating from the program participate in at least one trip to learn more about needs in other countries. In this way the division hopes to perpetuate this type of service to underserved populations.
In her new position, Dr. D'Antonio will also facilitate fundraising for future Operation Good Samaritan trips and projects.
Increased funding will enable the surgeons to accept more of the numerous invitations they receive from developing countries and to provide additional services in some of the locations visited.
To this end, the division is seeking to endow a chair in international medicine to continue and expand its mission work. The Don Sargeant Fund was established with a generous donation from William and Bonnie Colson in honor of Mrs. Colson's father Donald J. Sargeant, MD, a plastic surgeon who graduated from Loma Linda in 1944 and dedicated his later life to mission work.
"Dr. Sargeant exemplifies the value of service that we want to instill in our residents and attendings through our mission trips," says Robert Hardesty, MD, professor and chief of the division of plastic and reconstructive surgery.
Another of Dr. D'Antonio's primary goals for Operation Good Samaritan is promoting the idea of a team approach to address the varied needs of children with cleft lip and palate.
"The repair of a cleft lip normalizes a child's appearance and decreases the social stigma associated with clefting," Dr. D'Antonio says. "However, severe speech disorders often occur in unrepaired cleft palates and, in many cases, even following cleft repair. These speech disorders can result in abnormal speech quality and poor speech intelligibility, which frequently perpetuate social stigma and isolation."
In developed countries, the discipline of speech-language pathology addresses these speech disorders associated with cleft palate. However, in most developing countries, palatal clefts may not be repaired or may be repaired later in life. In both of these situations, severe speech disorders frequently occur. When a child with an open cleft begins to develop speech, air escapes through the nose and severely distorts speech quality.
The child will attempt to compensate for the open palate and develop abnormal speech sounds and speech patterns that will continue even if the palate is repaired later in development. The speech disorder in a child with an unrepaired, incompletely repaired, or late repaired palate can be quite abnormal and disabling. In many instances, the child may be nearly or completely unintelligible to unfamiliar listeners. For these children, speech therapy is necessary to eliminate the abnormal speech patterns. And, for some of the children, further surgery is also needed to provide adequate anatomy to develop normal speech.
Unfortunately, in most developing countries, the discipline of speech-language pathology does not exist or is in its infancy. Therefore, children with severe, disabling speech disorders associated with cleft palate remain isolated because of their inability to communicate.
"We don't want to be what's referred to as a parachute team," Dr. D'Antonio says. "We don't want to jump in, do surgery, and leave. We want to leave training behind. We want to work toward our colleagues learning from us and eventually providing services without us. But most especially, we want to focus on complete rehabilitation of our patients abroad."
In addition to her new role, Dr. D'Antonio will continue in her position as speech-language pathologist and professor for the department of surgery.
For more information about plastic surgery and reconstruction, see the website: www.llu.edu/medicine/plastics/.