December 10, 2003

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Palo Alto Online

Mending lives

by Jocelyn Dong

When ophthalmologist Thomas Tayeri traveled to Kenya to do volunteer work in September, he brought with him three boxes of medical supplies, enough to get him through 50 eye operations. But once he got to the hospital in Nakuru, two hours outside of Nairobi, he found far more than 50 patients waiting for him.

He and the hospital staff stretched the supplies -- even sterilizing and reusing disposable blades.

"The nurses said, 'This is Africa. Nothing's disposable here,'" Tayeri recalled. "The blades got dull towards the end, but we were able to get through."

During the nine-day visit, he and a Kenyan doctor performed 114 sight-restoring surgeries.

Learning how to make the most of supplies is a rare concern for doctors accustomed to advanced medical technology. But physicians like Tayeri who have volunteered abroad say the skill is one of many important lessons learned during their charitable missions.

By the dozens, and perhaps in even greater numbers, local doctors and medical personnel travel each year to do charitable work in countries where medical access and training are scarce. The experiences, they say, are arduous -- but deeply satisfying. Due to the sizable need, physicians are in surgery 10-14 hours a day, working assembly-line style to make the most of their time.

In return, the doctors come back with changed perspectives and a hunger to keep volunteering, year after year.

Tayeri's trip was his first medical mission, although he'd gone into ophthalmology more than a decade ago specifically because he wanted to pursue this kind of volunteer work. About 90 percent of his patients in Kenya were completely blind, the result of cataracts and glaucoma. Two patients were just one-and-a-half years old.

"The day after (the babies' surgeries), it was an amazing experience. They were reaching out for things, seeing their mothers' faces for the first time, and the mothers were crying," said Tayeri, who has a private practice in Palo Alto.

Often in Third World countries, physical ailments are not just medical problems but social ones too, impacting a person's chance at work, marriage and schooling. Podiatrist Bruce Lehnert has volunteered since 1998 in Vietnam through Mission Peace, operating on people with foot problems, many caused by polio.

"Here (in the United States), people are in pain, but there's no social stigma," Lehnert said. "In Vietnam, if you have a deformity, (you're viewed as an) embarrassment to your family."

Lehnert has seen former patients, once virtually shunned, start to lead normal lives following their operations. One man even went on to attend and graduate from a university and is now enrolling in law school.

Going abroad allows physicians to develop new skills in treating problems so unusual that they're rarely seen here. One ailment, called a fistula, is the focus of the Eritrean Women's Project, the work of Stanford's department of obstetrics and gynecology. Last year, four Stanford gynecologists spent two weeks on the East Coast of Africa, repairing a gynecology problem only seen in women who have prolonged, obstructed labors. Because of women's lack of access to medical care, some are in labor for days before reaching a hospital. The result, after childbirth, is a hole between the woman's vagina and bladder. Women end up in pain, ostracized by family, frequently divorced and in poverty.

Dr. Amreen Husain, assistant professor of gynecologic oncology (cancer), was part of the team that operated on 37 women. About two-thirds of the surgeries have been completely successful.

Husain said the experience was "one of the best things I've done." The team expects to return to Eritrea early next year to continue its work.

All the physicians interviewed spoke with great respect for the doctors they met on their trips. In many cases, the volunteers not only performed surgeries, but instructed their host medical staff.

"Camaraderie with the doctors there is one of my foremost memories," Lehnert said. "We have a great relationship with them -- mutual admiration. They're genuine people trying to go about their lives like we are."

Dr. Lorry Frankl, director of critical care services at Lucile Packard Children's Hospital, is a veteran medical volunteer and a member of the board of directors of Interplast. He's been going on charitable trips since 1984.

"I learn a lot from my colleagues in the jungles of Peru about quality care and compassion for patients and doing what's best with limited resources," he said. "There are so many wonderful physicians" around the world.

The colleagues, and the experiences, taught him early on to rely on "fundamental skills in medicine" -- deductive reasoning, making appropriate diagnoses and doing without blood banks, laboratories and other First World resources.

Among the biggest impressions that physicians have from their volunteer work is of the appreciation of their Third World patients.

"The gratitude is unbelievable. They have nothing and want to give you so much. They'll bring you a crocheted blanket, or fruit they've cut from the jungle. They're so grateful, so appreciative that someone cares," Frankl said.

Appreciation goes both ways, and the doctors say the trips open their eyes to this country's abundance -- both in terms of healthcare and material wealth. Whereas a doctor here can use the latest technology to get the best result for a patient, the physician in a basic medical setting will focus solely on the patient's survival.

Like the other physicians, Frankl already has his next trip planned. In February, he'll lead a team to India for a week to teach doctors and care for patients with complex heart problems. Then he'll spend two weeks in Vietnam.

"I think it makes me a better person. I learn about different cultures and tolerance -- not to be so judgmental. If you live in our society, you can become closed in," he said. "The real world exists for a reason. The medical trips are a great opportunity to participate in the real world." For more information about the organizations sponsoring medical missions contact: SEE International, www.seeintl.org; Mission Peace, www.missionpeace.org; Eritrean Women's Project, e-mail Dr. Mary Lake Polan at polan@stanford.edu; Interplast, www.interplast.org. E-mail Jocelyn Dong at jdong@paweekly.com.

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