Help is on the way

Deepa Bharath

Yu Pirush’s voice was pitched like the soft gurgle of the

Kahlua-colored river that flows through his neighborhood in the deep

Amazon.

The Achuar Indian’s caramel skin wrinkled up like leather when he

smiled and his wild black hair with streaks of gray rested

reluctantly on his shoulders as he spoke the language of his tribe.

For two months, Pirush had waited in Macas, a little town on the

edge of Ecuador’s rainforest.

Home, for Pirush, is far, far away -- a 20-day trek through the

thick wilderness or an hour’s journey in a bush plane.

He had waited in Macas for the “North American doctors” to rescue

him.

He wanted to show them the hole in his hand.

When Pirush peeled off the bandage that covered his mangled hand,

the air filled with the stench of his pain. The back of his hand,

missing most of its skin, looked like a cage of bones rent by disease

and infection. It looked like a poster for a horror movie.

Two yellowing bones stuck out, exposing a mushy, decaying wound --

an agony that remains for Pirush after a snake bit him in the jungle

more than five months ago.

His fingers were stiff like cardboard and he held out his hand

almost as if someone had ripped it out and then hastily glued it back

on.

“Just put some flesh on the hole,” he said, repeatedly, in his

native tongue.

Pirush hoped that Huntington Beach plastic surgeon Larry Nichter

and his team of doctors and nurses from Hoag Memorial Hospital

Presbyterian could work their magic on his traumatized hand.

One of many in need

Pirush wasn’t the only one with that hope. When the seven-member

team from the Plasticos Foundation arrived at the hospital in Macas

that afternoon in August, more than 200 people waited in the dimly

lighted corridor.

The team of medical professionals from the Huntington Beach-based

nonprofit -- consisting of one plastic surgeon, one general surgeon,

three nurses and two coordinators -- had traveled for almost a day to

get to Macas. It was a long and arduous journey. But the plane trip

was like a drive to the neighborhood supermarket compared to what

they had to achieve in a week’s time.

They were on a mission to help as many people as they possibly

could, to cure as many helpless people as the laws of science and

medicine would allow. They would have to dig deep into their

collective experience and stretch the boundaries of their knowledge.

They would need to improvise, think quickly and explore untapped

resources.

In anticipation, the team had packed in an entire operation

theater into 14 large red suitcases embroidered with the foundation’s

logo on them. They even brought along a portable anesthesia machine,

just in case.

Team members lugged the heavy bags through domestic and

international airports and waited in lines for hours before reaching

their destination -- the picturesque town nestled in the rambling

folds of the Amazonian rainforest.

As the bus that carried the team screeched to a stop outside --

kicking dust off the streets -- hopeful eyes including Pirush’s

peered out.

The waiting room

They packed the hospital’s 20-foot-by-5-foot corridor. Those who

couldn’t fit flowed out into the halls and outside the doors. They

waited, leaning against flaked and peeling lime-green walls, their

feet planted firmly on the dull, mosaic floor.

Waiting in that line was a boy so badly burned that his face

looked like a melted rubber mask, a man whose fingers were

incapacitated by a jungle machete, a woman whose angry husband had

bitten off a chunk of her nose in a drunken rage and a little girl

who was born with her two middle fingers fused together.

For about seven hours that day, Nichter and Newport Beach general

surgeon Robert Burns screened more than 70 patients. Several had to

be turned away at the door because their problem was not plastic

surgery-related.

“We’re only trying to do surgeries no other surgeons can do here,”

Nichter said. “We’re trying to do surgery on people with functional

problems, not cosmetic problems. We don’t have a whole lot of time.

We need to prioritize.”

For the doctors, the crowd was overwhelming.

“As fast as they come in, they keep filling up the hall,” Burns

said, shaking his head, as he looked at the bulging corridor.

“This is a lot more patients than I see in months in my office

back home,” Nichter said.

The team had less than a week to perform about 50 complex

surgeries, many of which involved several surgical procedures.

“It’s sad that all these people came from far off places,” Nichter

said. “But the truth is we can’t help everyone.”

The pain of rejection

Among those who returned disappointed was Shiki Chumpu, a

48-year-old farmer who walked for three days and then waited five

hours to take a seven-hour bus ride to get to Macas. He came all the

way from Tumbaem, a jungle community of about 33 Shuar Indian

families.

Chumpu couldn’t bend the fingers of his right hand. He depends on

that hand to use the machete, to plow the soil, plant corn and milk

his cow. He said that months ago, a snake about 9 feet long bit him

on the hand when he was climbing a tree looking for construction

wood.

“We won’t be able to help him,” Nichter said after the examination

that lasted about a minute.

The muscles of Chumpu’s arm had died, the surgeon said.

Chumpu mostly spoke Shuar, but he seemed to understand the gist of

what Nichter was saying. He had made a harrowing journey across the

jungle for days only to meet more hopelessness on the other side.

There were others like Chumpu in the dark, damp alcoves of the

jungle, who lacked the means to cross the formidable forest that

surrounds their little bamboo huts.

So Nichter and his team headed out to the jungle. They traveled by

bush plane to two jungle communities -- Tukupi and Morona. Nichter

picked two patients from the Tukupi clinic. The team was ready to

begin its mission.

They had 50 patients and a little over five days to do surgery.

Danilo’s story

When Danilo Ujupma smiled, the gray hospital room with cracked,

dust-covered windows got a little brighter.

It was a full smile, with a wide open mouth that stretched across

his face, making his cheeks pink and his eyes dance.

But just as quickly as the 12-year-old Shuar Indian boy could

produce that 1,000-watt smile he could shut down and go to a dark

place where no one else could go with him.

Danilo was born with a right hand with three of his middle fingers

fused together. He could move his thumb and little finger, but his

three middle fingers looked like a little, fleshy bundle tied up in a

knot.

The boy was waiting his turn for surgery. Danilo’s hope was that

he would have at least two normally functioning fingers in his right

hand after it was all done. Wearing a green hospital gown, he was

fiddling with his black, silky hair that fell down to his shoulders.

He chatted with other children who were waiting with him. But he

always hid his deformed right hand. He would push it inside his gown

or slide it under his thigh so no one could see it.

“Danilo is not happy,” said his mother, tears welling up in her

eyes. “Other kids tell him things that don’t make him feel very good.

I can’t bear to see him like this.”

Danilo’s eyes started to fill up as he listened to his mother

talk. He bent his head way down, pressing his chin to his chest.

“This is very embarrassing for me,” he said softly, without

looking up.

“The kids treat him badly,” his mother says, choking up. “They

talk bad.”

Danilo eats and writes with his left hand. They had taken him to

several doctors in the area, but no one could help him. Danilo and

his mother rode a bus for more than a day to come to Macas from their

hometown of Cochenzo.

“There were no other doctors who could do it,” the mother said.

“We heard the North American doctors were coming. We came as soon as

we could.”

Nurse Jane Collins, who was near the boy, hugged him as he broke

down and cried.

“It’s going to be OK, Danilo,” the recovery room nurse said,

comforting him and gently rubbing his back. “You’re going to be

fine.”

But as Danilo lay on the operating table under anesthesia,

surgeons Nichter and Burns launched into a discussion.

“We can’t do two sides of his finger at the same time,” Burns

said. “The arteries run on either side of the finger. There’s the

risk of both arteries going into spasm and if that happens, the

finger could die.”

So they decided to do “half the surgery,” which meant Danilo would

get two new, functional fingers, instead of three.

“In a few days, the bandages will come off and he’ll have two good

fingers,” Nichter said, smiling. “I wish I could see the look on his

face then.”

As Nichter worked on separating the fingers, Burns did a skin

graft by removing a patch of skin from Danilo’s abdomen and covering

his “new fingers” with the “new skin.”

“The skin has different thickness in different parts of the body,”

Burns explained. “The skin on our abdomen is the same thickness as

the skin on our fingers.”

As Danilo was getting started, 7-year-old Maritza Mayorga was

recovering from her fifth surgery to correct her cleft palate, which

left her with an opening in the roof of the mouth.

Taunted and teased

Maritza had her first surgery when she was an 11-month-old baby.

“Basically, she has an open palate,” Nichter said. “So she can’t

enunciate words or make plosive sounds like ‘puh’ or ‘tuh.’ So her

speech is not clear.

“Hopefully, this will be the last surgery she’ll ever need.”

Maritza’s mother Carmen Wampash hoped so.

“Maritza’s friends tease her,” she said. “Her teacher says she

can’t understand what Maritza’s saying.”

Relatives give her a tough time too.

“They all have their theories about why she was born this way,”

Wampash said. “All I wish is for it to be fixed so her speech

improves.”

Nichter said he closed the gap in the oral and nasal side of her

palate.

“That will also prevent liquids from squirting out her nose when

she drinks something,” he said.

As 2-year-old Kevin Coro lay on the table to get his cleft palate

fixed, Burns was a tad nervous.

“We’re running out of anesthesia,” he said.

On the first day of surgery hospital staff had realized that the

anesthetic they were about to use had expired five years ago.

“They told us they had enough,” Burns said. “But this morning

there was about a quarter of an inch of liquid in that bottle.”

So, the doctors were waiting for someone to go to a nearby town

called Sucua and buy a few bottles.

“Hopefully the machine won’t dry out before they arrive,” Burns

said. After a few anxious moments, one bottle did arrive from Sucua

and the surgeons proceeded with their work.

Call for creativity

The operation room nurses had to innovate almost every day.

“We didn’t have tourniquets for the hand surgeries,” said Virginia

Burns. A tourniquet is a cloth that helps cut off blood circulation

to the hand before surgery to prevent excessive bleeding.

So, Fodor and Burns, came up with a substitute. They cut off a

piece of cloth from the blood pressure monitor and wrapped it up

tightly around the patient’s hand.

“Whatever works, works for us,” Fodor said.

Recovery room nurse Collins’ job was different. She took care of

patients after the surgery. Collins often dealt with patients waking

up from the anesthesia. While children bawled because of the

uncertainty about where there were and what happened to them, adults

were disoriented and often tried to pull out their oxygen tube or get

out of bed.

“It’s quite normal for them to feel that way,” Collins said, as

she held her patients tightly, sitting by their side.

“It’s all right,” she would tell her patients in Spanish, as their

drowsy eyelids fluttered. “Your operation just got over. It’s OK.

You’re going to be fine.”

Collins didn’t have much trouble with Katherine Fajardo, a

2-year-old girl with a double cleft lip, who woke up peacefully after

the surgery. Before she went into surgery, Katherine’s upper lip

looked like a shapeless piece of pinkish-red Jell-O. The girl, who

was abandoned by her mother, was brought in to the hospital and cared

for by a family member.

“This is a very dramatic surgery,” Nichter said.

It involved a three-step process. First, Nichter had to

reconstruct the inside of the lip.

“Then, I reconstruct the muscle so the child is able to do things

like kissing or whistling,” he explained. “The last step is to

reconstruct the outside of the lip.”

Meanwhile, Brigit Aray, who was waiting her turn outside, was

scared.

“Don’t poke me,” she cried, tears streaming down her face.

“Mommy!”

The 7-year-old, who minutes earlier was chatting away with nurses

and darting all around the hospital lawns, hugged her mom tightly as

she sensed something was happening around her.

Most of Brigit’s right thumb was missing from birth. But that

never stopped her from climbing trees, playing soccer, hanging out

with friends, smiling at total strangers -- and just being Brigit.

The language barrier

As she was taken away to the operation room, little Brigit’s cries

got louder.

“Don’t hurt me,” she cried out in Spanish as the nurses made her

lie down on the table. “Don’t poke me.”

“Brigit, we’re not going to hurt you,” nurse Fodor told her in

English.

“Don’t hurt me,” Brigit cried out in Spanish.

“Listen, Brigit,” Fodor said, tenderly, continuing to speak in

English. There were tears in Fodor’s eyes now.

“Oh my God,” Fodor turned away, helpless.

“This is so frustrating,” she said, wiping away tears from under

her surgical mask. “I want to help. I want to tell her she’s going to

be OK. And I want to tell her we’re not going to poke her.

“I hate it when I can’t communicate with the patients.”

But, within seconds, Brigit was asleep. Nichter saw the bone of

her hand was in tact and made a separation between her deformed thumb

and the second finger, creating an illusion of a longer thumb. Burns

carved off some skin from her abdomen to attach to her thumb.

“It’s not just for appearance,” Nichter said. “She can actually

move her thumb and use her hand better.”

Burns and Nichter also operated on patients with tumors and burn

scars. Nichter’s longest surgery lasted about four hours when he

worked on a man with a machete injury that had left him without being

able to bend three fingers in his right hand.

“God gave us 85% of us an extra tendon in each of our arms and

legs just so we can perform this surgery,” Nichter joked.

What he was about to do was remove one tendon from the man’s arm,

cut it to three pieces and use each piece in each of the invalid

fingers so he could bend them again.

“We need only one of those two tendons for normal function, which

is what makes this surgery possible,” Nichter explained.

When it was all done the doctors and nurses had worked on 47

patients on whom they had performed 74 surgical procedures over five

days. Each day of surgery was 12 to 16 hours long and each day began

and ended with the doctors’ rounds when they visited their patients

to monitor their recovery and give instructions to hospital staff

about their diet, care or discharge from the hospital.

When the team visited Danilo, who was recovering from his hand

surgery, he was quiet, but seemed relaxed.

“I can’t feel anything inside the bandage,” he said, trying to

look inside.

“Keep his hand up,” Nichter instructed Danilo’s mother.

“You have two new fingers now,” Nichter told him through a

translator.

Danilo smiled.

Mission accomplished

Like a toddler with a mischievous grin on his face, thoughts of

home played “peekaboo” with team members.

Their walk had gotten a little slower. There was talk of going

back home. About seeing “the kids.” The nurses were talking about

their schedules and shifts at Hoag Hospital.

The excitement had, sort of, died down.

They began to dismantle equipment and pack up supplies. The team

was going to donate about $40,000 worth of goods to the hospital.

That included a boom box with a compact disc player that Burns had

bought at an electronics store in Downtown Macas.

“You need to make work more fun,” surgeon Burns told the smiling

Ecuadorian doctors.

They also donated anesthetics sufficient for about 100 surgeries,

intravenous fluids, dressings, staples, sutures and a set of

laparoscopic instruments.

As team members presented these items to hospital staff, Nichter

told them that Macas was very much in Plasticos’ future.

“This is our second step in a long journey of what we’d like to

accomplish,” he said.

Nichter talked about his vision of having a “much more expanded

operation,” teaming up with local plastic surgeons in Ecuador “who

will converge in Macas.”

“We want to help the indigenous people,” Nichter said. “Especially

those who can’t afford medical treatment.”

He thanked the hospital staff for their cooperation and for

teaming up with Plasticos.

“These are memories we’ll keep an entire lifetime,” he said.

A sad farewell

It was bittersweet for team members.

“I’m ready to go,” Fodor said. “But it feels sad at the same

time.”

Ruth Ann Burns was looking forward to go home and scoop her

15-month-old granddaughter into her arms.

“But I feel horrible leaving all these people behind,” she said.

“It feels like they’re part of our families too.”

Recovery room nurse Collins was tearful as she hugged Alba

Sarmiento, a nurse at the hospital in Macas.

“We exchanged e-mail addresses and mailing addresses,” Collins

said, wiping away tears.

“Oh, Alba, I’m gonna miss you,” she said, hugging her friend

again.

Collins gave her jungle boots to Sarmiento, who lives by the river

in the outskirts of the town, with her husband and daughters.

“She needs it more than I do,” Collins said.

The 14 red suitcases that traveled with the team were all packed,

weighed and piled in the back of two trucks.

“This is not the end,” Nichter told his team and hospital

officials. “It’s only our second step in a long, long journey.”

Seven-year-old Brigit Aray had her hand still bandaged, but she

had her smile back. Nichter had operated on her thumb.

“Are they leaving, daddy?” the little girl asked her father

Orlando Chica.

“Yes, they have to go a long way,” he replied.

“Will they be back?” Brigit asked, seemingly anxious.

“Yes, my daughter,” he said, hugging her as she giggled.

“They will come back.”