Charity Work | Zwiebel Center for Plastic Surgery

Denver Plastic Surgeon, Dr. Zwiebel, Discusses Pre- and Post-Op Visits in China

Aug 12:Each day, I meet new children for preop evaluation, brought by smiling family members huddled at bedside in the Pingliang People’s Hospital. In the faces of the parents, I see a combination of fear, concern and hope.

Cleft Palate Patient Although I anticipate the answer, speaking with them through an interpreter, I ask what they want me to do for their child. Rather than reply verbally through the interpreter, the answer is almost always made by pointing to the obvious cleft of the lip, or by opening the child’s mouth to point to the gaping opening of the roof of the mouth, a cleft palate.

It is so easy to feel a bond with the patients. Even though we do not speak the same language, the instinctual parental sense of attraction and desire to protect and nurture is irresistible. This seems common among my fellow American teammates who continually comment “how cute” the children are and the nurses are quick to want to hold the babies and play with them. These seem unusual, even extraordinary and unexpected reactions to a child with such an obvious facial deformity.

Denver Plastic Surgeons Working on a Patient Later, I notice those same feelings manifest in how the crew is playful and caring for the baby as we bring the baby into the operating room and prepare to begin the surgery. My mind shifts to focus on the steps of preparation, administration of anesthesia and the technicalities of the reconstructive procedure. With cleft lip surgery, the challenge is in the planning. I wear magnifying lenses as I measure and mark with needle and ink the relevant anatomic points that are crucial to the precision of the ensuing incisions and surgical rearrangements of the repair. It is a unique sort of puzzle: finding the hidden pieces and moving them to complete the aesthetic solution.

An hour passes without my notice, my consciousness engulfed in the conceptual and technical challenge before me. Finally, we place the last stitch and pull back the drapes.

Denver Plastic Surgery Patient in China Then, I see the cute little baby, again.

Only now, without deformity the cute baby can be seen by every one.

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Travel

Charity Work

Denver Plastic Surgeon, Dr. Zwiebel, Continues His Visit To China For Cleft Lip Reconstruction

August 6: Dealing almost daily with the unexpected and with schedule changes are the rule on surgical trips to underserved areas. Each trip is unique in the nature of the challenges.

Communication is always a challenge in remote parts of the world with different languages, dialects and cultures. I particularly remember a time in Ziwane, Kenya. We accessed a remote village using 4-wheel drive trucks traversing dried river beds and wash-outs, over 45 minutes from the nearest road of any form. The clinic was set-up in a 2-room structure with a dirt floor. Each of the blankets we spread on the floor was a separate “treatment area.”

My patient was an elderly man, age unknown: below his head dress, his deeply lined and sun-weathered face featured a scraggly beard dyed a deep red color more typically seen streaking the hair of attention grabbing adolescents at an urban mall. I had a translator who spoke Kiswahili, the language dominant in Kenya; my translator brought another translator who spoke a local dialect different enough from Kiswahili. When I asked a question, my English-Kiswahili translator translated to her translator who spoke to the patient; however, translator#2’s dialect was different enough from that of the local tribe, that my patients very young daughter translated one more time for my patient.

You can picture the scene: I sat patiently as many words passed in sequence in our small circle. The time it took for the response to make its way back to me was longer than the delay in sending messages up to a satellite in outer space and back, again. Though the distance traveled by our Kenyan question and answer was infinitely shorter than words bouncing off a telecommunications satellite, the reply I received from my series of translators was much more garbled and totally irrelevant to my initial question.

Cleft Lip Reconstruction Patient Somehow, here in Pingliang, China, it is not because of esoteric dialects. Here it seems more “administrative.” One of our greatest obstacles has become having our patients ready for surgery. Unfortunately, some of the local caregivers independently overrule our preoperative orders, resulting in surgery cancellations for the day, and leaving us with gaps in our schedule. Some of the babies have been postponed three times! Imagine the frustration of the parents/family who cannot understand why “the doctors inexplicably keep changing things!”

Each day, we try different things to assure best direct communication and coordination, but still so much is “getting lost in translation.”

Yet, thoughts about communication problems vanish when I complete a cleft lip repair that reveals just how cute these babies are.

The smiles on the parents’ faces are wordless expressions that require no form of translation.

Catagories:

Travel

Charity Work

Denver Plastic Surgeon, Dr. Zwiebel, Visits China For Cleft Lip Reconstruction

August 3: I just finished the first case of our schedule here in Pingliang, China, reconstructing a cleft lip and nose deformity in a 12 year old girl. The team is relieved that the case went well: there is a tension until we get the first case done and know we work well as a team and with the local hospital staff.

As is typical for these surgical trips, the schedule doesn’t go as planned. Most of the scheduled cases for the morning are delayed for a variety of reasons. Adapting to the conditions and the unexpected is critical and never-ending: even as I write this, I overhear one of the nurses, “The boy for the next case has a cold.”

The hospital here in Pingliang is much nicer than expected: the nicest medical facility in which I have worked on any mission trip.

China is certainly exotic and the realization that I am half-way around the world (14 time zones!) still strikes me as remarkable, even after the 28 hours of travel time to get to this north central location in China, just south of Mongolia. There is not a chance I will begin to have the slightest understanding of the language during this 3 week trip. The cultural differences are intriguing, and I am grateful for the very tolerant hospitality and good humor of our hosts.

Some of the differences are in the realm of medical procedures and protocols: for example, here, proper operating room attire is to wear plastic flip flops with bare feet!

Yet, through this interaction of this international/intercultural group of patients, families, nurse and doctors, I quickly feel less the stranger with fewer barriers of any significance between us.

Catagories:

Travel

Charity Work

Dr. Zwiebel’s Contribution with Haiti Disaster Medical Relief

I received a phone call, late Wednesday night requesting I join International Medical Relief team going to Port au Prince,Haiti. We left Friday night, encountering an obstacle,Saturday morning, with security refusing to let our team board our connecting flight from NYC. Apparently, they lost authorizing paperwork. We were diverted to Santo Domingo, Dominican Republic and took a 10 hour van ride to get to Port au Prince.

My role here has been as a primary care doctor and as a reconstructive surgeon tending to wounds of varying complexity.

Dr. Zwiebel assisting in Tent City Hospital

Our first two days were in the field, going to a displaced person’s camp (‘tent city”). We saw and treated about 450 people the first 2 days. Lots of dehydration, diarrhea, headaches, and wounds. Water and food is scarce: we each packed our own provisions for the 10 days.

We camped on the grounds of a church. After a full day of treating patients, my son Elie and I assisted a group of 13 others unloading 2 truckfuls of rice (55 tons!) into the basement of the church for the next day’s food distribution. It took the 15 of us 3 hours in the dark to carry the 55 pound bags with a large American flag proudly emblazoned on one side!

These last 3 days, I have been at a MASH Unit located on the grounds of the Port au Prince airport and United Nations compound. My primary focus has been wound repair, but also assisting Orthopedic and Neurosurgeons with surgery on very complex injuries. Yesterday, I assisted a Neurosurgeon repair a 10 year old boy with a badly fractured skull.

The Haitian people are so grateful for the help from the US and to the people who have come to provide assistance. The country has little in the way of resources except for the great spirit of the people. In the absence of any government since the earthquake, the day to day civility of the hungry, thirsty and injured Haitian people is an inspiration.

Dr. Zwiebel with a Hatian Child

I am thankful that as a plastic surgeon, I can contribute.

Catagories:

Travel

Charity Work