INTERPLAST DEUTSCHLAND missions are geared towards training local surgeons and

upgrading their facilities while providind specialist care for the needy.

The Mingaladon Hospital mission ,which I started in 1999, fulfills these goals but at a very specific level, since it is based on the collaboration with Professor thet Hta Way and his team, Dr Myint Myint Khaing and Dr Tun Tun Aung , both surgeons.
Professor Thet Hta Way was formerly Head of the Department of Plastic Maxillo-Facial and Oral Surgery at Yangon General Hospital , and, after having retired from his post, joined the Mingaladon Hospital as Consultant Plastic and Maxillo-Facial Surgeon.

Having trained with Professor Manchester in New Zealand and having continued his training in France and in England ,on his return to Myanmar he pioneered the establishment of a Maxillo-Facial Surgery Unit in Yangon and became an expert in cleft lip and palate surgery..

Which means that he expects foreign surgeons to come and perform operations on patients he has personnaly selected for problems outside his field of excellence.The resulting collaboration ‘’between equals ‘’ has so far been one of the most exciting, fruitful and challenging ones I have know over now 35 years of annual missions to S.E.Asia, a collaboration where a maxillo-facial surgeon and a plastic surgeon join their experience and their knowledge to find the best solution for a specific problem in facial surgery.

In February 2001, I was joined by Professor Jacques Baudet of Bordeaux ,a world renowned hand surgeon , who came under the banner of INTERPLAST DEUTSCHLAND.
Subsequently, Professor Baudet , was joined the following years by Prof Paolo Persichetti of Rome ( Italy ) and Dr Bruno Alfandari. of Bordeaux .

Professor Baudet did not come in 2005..

The January 24 – February 5, 2005 mission at Mingaladon Hospital began after stepping out of the plane from Bangkok and a 16 hours trip from Brussels for such is the rythm followed by Professor Thet Hta Way.

23 old boy - lip and nose reconstruction

25 patients were selected for the operative program of the following 2 weeks , 3 or 4 operations a day ,no more , to respect the established pattern of work at the hospital and be able to teach Dr Myint Myint Khaing and Dr Tun Tun Aung in a relaxed fashion as it allows to strive for perfection,

I do not believe indeed that focussing on operating the maximum number of cases in the shortest possible time is conducive to excellence to the extent that , and I wrote about it already, the poor patients of less privileged countries than ours deserve the same time attention and care than our wealthiest private patients at home.

The list of operations performed with The Mingaladon Hospital team was ;

• 1 incomplete cleft lip ( for demonstration of the Millard technique to Dr Tun Tun Aung as Professor Thet Hta Way is an adept of the Tennyson repair )
• 1 incomplete bilateral cleft lip
• 1 complete cleft lip with nasal deformity ( Fig 1 )
• 2 secondary cleft lip deformities ( 1 unilateral, 1 bilateral )
• 4 secondary cleft lip nose deformities ( Fig 2 )
• 4 nostril deformities ( 2 defects, one corrected by a ear composite graft )
• 4 traumatic scars of the face
• 2 facial depressions( corrected by carved silicone implants )
• 2 burn scar lip retractions ( corrected by a full thickness skin graft )
• 2 burn scar contractures ( corrected by thick split thickness skin grafts )
• 1 cheloid of the shoulder
• 1 gigantomastia ( 2,3 kgs on R.side and 3,2 kgs on L. side of breast tissue removed )

As can be seen on the list, these are cases with no obvious clearcut solution where experience is needed

All these operations were performed in a completely local setup, myself being the only foreigner. Ward rounds were planned every morning to check all operated on patientsbefore the operative program , changing dressings and removing sutures if warranted.

Because it is my philosophy that a foreign surgeon, who volunteers to do surgery in an humanitarian mission ,must be totally responsible and accountable for every one of the patients he has operated on, from admission to hospital till discharge from hospital..

If we remember that our presence is only justifiable if we show operations which our local colleagues do not perform and that their postoperative care is not known, pursuing a maximum number of cases goal does not allow for the proper postoperative care of the patients , as it implies leaving it to the nursing staff whose competence, whatever its goodwill ,can be variable in the absence of a training which can only be

given by the visiting surgeon doing his ward round with his local counterpart , the only one who is able to translate the instructions being given.

It means also that, once a program is begun, it is to be continued year after year ,until our local colleagues , having progressed at their own rythm ,do not deem necessary to continue it because the teaching has covered their needs.

It is then time to move to another hospital.

Christian C. Dupuis, Brussels