Department of Plastic Surgery International Outreach
While we are based in Kansas City, our department's work does not stop here. We are passionate about international outreach and proud of the relationships we have built in the communities we are fortunate enough to serve.
Our international outreach is driven by our surgeons' passion for international volunteerism, our sense of duty to provide services and care to an area otherwise without access and our desire to expose trainees to the fulfillment that surgical trips can provide.
Thanks to relationships we have been able to build with critical parterns here in Kansas City, members of our department took the first trip to Guatemala in 2018. A small scouting team visited medical schools, hospitals, clinics and orphanages in the central highlands. We met with individual clinicians, deans of medical schools, health ministers and some very charismatic politicians. We traversed miles of roads that were more potholes than road, helped push a coconut truck up a hill and sat in a rural traffic jam for hours and hours. We were also introduced to the incredible hospitality of the people of Guatemala and the pride and love that they have for their country. The quintessential example of this was a local physician, Dr. Rafael Tun, who has dedicated his life to serving the community of San Lucas Toliman. After spending time with him, in his hospital, we knew that this was going to be the meaningful and lasting relationship that we were hoping to find.
About Our Program
For the residents of San Lucas Toliman, the nearest national hospital is located is 2 hours away by car. Even at the larger hospitals in Guatemala City and Quetzaltenango, which are many more hours away, options for specialty services are limited. There are few plastic surgeons in the country, and most of them focus on cosmetic, not reconstructive surgery. Even if access were more readily available, the economic hardships are often insurmountable. A patient may face charges of Q3000 ($400) at a minimum. Considering the average farmer makes only $7.50 per day, seeking medical care is impossible for many.
Knowing the incredible need for reconstructive services in this area, we are dedicated to providing care for ailments from burns to hand trauma to clefts and underdeveloped ears. For us, the key is to do this work in a socially responsible way. By establishing a site where we can collaborate with the local physician and hospital, we can continue to return to the same location and tend to the same patients over time. Initially, we had planned to return annually. After the success of our first trip in August 2019, we were invited and emphatically accepted the offer to return twice yearly. This allows for even closer follow up of some of the complex operations that we are able to perform. All of these patients are either established patients of the hospital or directly referred to Dr. Tun from the surrounding communities. In between trips, Dr. Tun continues to follow all of these patients and we keep in close touch with him and the patients through photos and video conferencing.
It can be hard to describe the incredible fulfillment we derive from international volunteerism. To see the smiles on the faces of the patients and families we care for brings warmth to our hearts. The days are long and the trips are often physically exhausting, but these experiences recharge our spirits. We bring veteran travelers and newbies on each trip, to ensure that we are able to expose more surgeons, trainees, nurses, and students to these incredible opportunities. Every chief resident in our residency program has the opportunity to participate in one of these biannual trips. In doing so, we hope that they will continue to participate in their own trips.
Funding and Support
We have established the KUMC Plastic Surgery International Endowment to pay for these trips and ongoing care of the patients. This has been funded by the surgeons within the department and very kind philanthropic partners and donors who believe in what we are doing. Patients pay nothing for the surgeries or supplies that we provide. Currently, all participants are supported through the endowment to help pay for a portion of their trip, in addition to purchasing the necessary supplies and medications.
Our goal is to grow this endowment to the point that no participants will have to pay for their travel or lodging expenses. All participants are volunteers and all money donated goes directly to funding the biannual trips. If you have an interest in donating, any amount you give will help us to continue this incredible service for those truly in need of our help.
San Lucas Toliman
The community where our program is based, San Lucas Tolimán, is a municipality in the Sololá department of Guatemala. The town of 17,000 people sits on the southeastern shore of the beautiful Lago de Atitlán. There is a population of about the same size living in the surrounding villages. At 1,700 metres (5,600 ft) altitude the town offers "eternal spring" with annual temperatures ranging from 50-80 degrees F. The area is free of malaria due to its elevation, which ranges from 1,562 metres (5,125 ft) along the lake to 3,144 metres (10,315 ft) at the summit of Volcán Tolimán. Volcán Tolimán is just south of town.
San Lucas Toliman natives are predominately Mayan Indian in origin, which constitutes 70% of the population of Guatemala. As a result Spanish is not their first language. There are two main Mayan dialects, and in the central highland region, Kakchickel is typically spoken. This area is primarily agricultural with coffee and avocado being the predominant cash crops.
Hospital Monsenor Gregorio Schaffer/Friends of San Lucas
The local hospital where our surgeons work during our visits is the Hospital Monsenor Gregorio Schaffer, a free-standing hospital that was built in 1994. It is run by the Friends of San Lucas, a charitable organization based out of New Ulm, MN. The 32-bed facility serves as the primary source of health care for San Lucas Toliman and the surrounding area. Roughly 50-100 patients are seen daily in the clinic. The hospital has continued to evolve over time and has become a center for the region with regards to medical care, especially surgical specialties. Medical care is primarily delivered by a local physician, Dr. Rafael Tun [Link to tab], who serves as both a primary care physician for the city and region and coordinator for subspecialty groups to come to and serve the community. Multiple general surgery, gynecology and orthopedic surgery trips have taken place over the past 10 years, but no plastic surgery trips until our department forged a relationship and started attending in August 2019.
The hospital has two fully operational anesthesia machines and a table top unit. The OR has capacity for two general anesthesia operations being performed simultaneously and a procedures room used for regional and local anesthetic operations. There is a lab which has capacity for basic lab tests, while pathologic specimens are sent to one of the hospital centers in the larger cities. Their radiology suite is equipped with an x-ray machine that has a digital reader and c-arm fluoroscopy for intraoperative needs. There is a full-time radiology tech on site. There is a four-bed recovery unit and three wards for inpatients stays (mens, womens, pediatrics), each of which can handle eight patients. Additionally, the hospital has a three-bed ER, four clinic offices and a fully stocked pharmacy.
Dr. Rafael Tun
The hospital's medical director, Dr. Raphael Tun, is an incredible partner.As the only physician tending to the hospital on a regular basis, he has conducted very basic clinics every day since 1997. He strives to care for those who have difficulty reaching government hospitals, due to distance or age.
From children who are less than a year old to adults in their later years, we treat patients across a broad spectrum of ages and conditions. This is a comprehensive reconstructive endeavor. This area of the world is endemic with both congenital craniofacial abnormalities and burn injuries. During each trip, we see typically 60-80 clinic patients, who are either there for surgery or have been operated on during another trip. We are typically able to perform 40+ operations and procedures, running two OR tables with general anesthesia and a local procedure room. Thecomplexity of the operations is vast: from simple things like scar revisions and small skin cancer removals to fixing noses that have been broken and crooked for years and providing continued cleft care for kids who were born with cleft lips and palates.
As the hospital has a fully functional ER, we have also treated acute hand injuries, so patients don't have to travel hours to the nearest national hospital and spend money that they likely do not have. Without a doubt the most impactful operations that we have done have been on burn survivors and children and adults born with underdeveloped ears (microtia).
On our first trip, we met a 16-year-girl who had been badly burned as a child. Catarina traveled 13 hours to see us, as there had been no one up to that point in her life that could help her regain function. She had an elbow contracture that was so dramatic that her elbow stayed full flexed and her hand was deviated off to the side. Through two operations six months apart, she has regained most of the extension in her right arm and use of the hand. An extremely stoic young woman, she never complained, never grimaced in pain, but also never smiled. After the second surgery, right before taking the long journey back home, she lit up the room prettiest smile.
A fairly rare condition, microtia, is the underdevelopment of an ear, usually just on one side. There are many ways to approach this in the USAbut some of those options are not viable due to cost and access to resources in Guatemala. The alternative is a very complex operation consisting of multiple stages that requires harvesting cartilage form the ribs and placing it under the skin behind the ear, then coming back to the OR two more times, 6 months apart, to release and skin graft the new ear and rotate it into appropriate position. Due to this complexity, most patients go without having anything done and then live with stigma for the rest of their lives. To date, we have been able to perform 10 of these operations, and we have more waiting. Our patients have ranged from 7-34 years old, and their outcomes have been highly successful. The patients have been overjoyed with their new ear, new look and new life without the stigma of disfigurement. We are proud to lend a hand or a scalpel to help those who are less fortunate, and we are committed to continuing to provide these important experiences for our residents to learn in an environment so far from our campus in Kansas City.