VIPS and the soul of plastic surgery
I want to begin by thanking you for giving me the opportunity to serve as The Plastic Surgery Foundation president. This past year has been both stimulating and eventful, and I'm pleased to be a part of The PSF effort largely because its core responsibilities are vital to the future of plastic surgery.
The PSF supports the principles that prompted many of us to become plastic surgeons - a desire to do good for others and a fondness for inquiry. A personal example illustrates how profoundly impactful those principles can be.
The powerful impact of one patient
During a medical mission trip to rural India early in my career, I met a patient who clarified for me why I became a plastic surgeon. Our medical team was performing surgery in a volunteer camp for children and adults with clefts of the lip and palate, and on the day of our intended departure to return to the United States, a different patient walked in. He had a massive burn injury of his face, chest and extremities. He had survived the initial injury, but he was obviously cachectic and very ill.
Through interpreters, we learned he had been burned six to eight months earlier in a house fire but wasn't able to receive any in-hospital care. This resulted in a gruesome facial appearance, which affected him and his family (a wife and two children) both directly and indirectly. Because he worked as a day laborer and was significantly disfigured and limited in his movements, employers would not hire him.
Unfortunately, this was a consistent pattern, and it led to a loss of all financial support for his family. Without money to buy food, he became malnourished. His situation had expanded to the point where he was not strong enough to ward off tuberculosis. This meant that he was not able to be anesthetized because he would die of pulmonary complications - but if we didn't operate on him, his lack of work would lead to his death from malnutrition, and his family would follow.
We rapidly documented that he did have tuberculosis and concluded we would give him the opportunity to have the procedure done under local anesthesia. And, yes, we had run out of sedative as well.
The patient readily accepted this option. We performed what would normally be a very painful surgical procedure - that is, repeated local anesthetic injections into his scarred neck, chest and face, as well as the donor site at his lower abdomen. The dissection went to deeper structures of the neck and contractures were released, then a skin graft applied. He was left with anti-TB medication and food for him and his family during his recovery.
Ultimately, he was able to get a job, and we saw him a year later - with a much-improved facial appearance and general health - as he sought additional work related to burn contractures of his upper extremities.
Our treatment team improved the quality of his life through surgery, as we've done when repairing an unrepaired cleft lip or doing breast reconstruction for breast cancer. It made us feel very good.
Exporting care, importing character
A common perception among people who enter the plastic surgery specialty as a career is that we get to improve the quality of life of people visibly, measurably and profoundly in both young and old, male and female. Plastic surgery has an incredible potential to provide lasting benefit for relatively minimal cost. Moreover, we can "export" our skills to areas of special need internationally. This is central to The PSF's Volunteers in Plastic Surgery (VIPS) program.
In its most simple form, VIPS provides an avenue to help coordinate efforts among the many international volunteer organizations in plastic surgery. Many of them are household names - Operation Smile, The Smile Train and Interplast (now ReSurge International), to name a few. What's probably not as well recognized is how influential this international experience has been in developing the character of the new generation of plastic surgeons.
Surprising mission work
It may be surprising to some that many candidates for plastic surgery residency indicate that they've had an international experience - participating in a team that performed volunteer work in a developing nation. They've also indicated that the experience was so meaningful that they wished to devote their professional lives to similar work.
These young doctors were helping people who were truly in need, with the only compensation being the satisfaction of knowing they were making the life of the treated person better for years to come.
These programs provide an opportunity to work with very talented international medical professionals in many parts of the world, because it permits educational exchange from both "directions." Very underrated, however, is recognizing an essential benefit: making the connection to why these volunteers decided to become physicians. This potentially can exert profound effects upon the way people develop in their personal lives - and in residency and in post-residency clinical practice.
I know this may sound naïve and "Pollyannaish," but these experiences have considerable influence on goals and practices for a lifetime - in both our professional and personal lives. In short, we work in a very special and, generally, emotionally fulfilling field of medicine. VIPS is like no other professional program, and The PSF is proud to support excellence and compassion, wherever it may take us.
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