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Local nurse joins organization in helping children around the world

Cupertino--Since 1993, Ann Heinlen has been on five trips to countries in Latin America and South East Asia. These trips, however, haven't been simple vacations but, rather, volunteer missions to assist doctors perform needed facial surgeries for children whose families can't afford it.

Heinlen has traveled with other nurses and doctors to such countries as Ecuador, Nepal, Vietnam, India and Peru to perform cleft lip and cleft palate surgeries on children. They also treat children who have suffered severe burns or other crippling injuries. These surgeries are performed for free, mainly due to a nonprofit organization called Interplast Inc., which has been providing free facial reconstructive surgery for children in developing nations since 1969.

Heinlen, who is a nurse at the Lucile Packard Children's Hospital, went to Piura, Peru in May on her fifth trip with Interplast. The trips usually last two weeks, during which the 12 to 15 volunteer doctors and nurses stay in the same area of the country in local hotels and work in local hospitals.

Heinlen said the volunteer nursing staff that goes on these trips must have recovery room or operating room experience, must be very adaptable and able to work well as a team.

"When you get to these countries, you hit the ground running. You can't be delayed by being in different surroundings," Heinlen said.

Heinlen spent two years in the Peace Corps in Kenya before returning to California to get her nursing degree. She said this international experience has been beneficial for her experiences with Interplast.

Interplast schedules up to 40 surgical trips each year, and provides 75 to 100 surgeries per trip, approximately 3,000 surgeries annually. Parents come from miles away to the hospital where the Interplast staff is working, bringing their children who are in need of this facial surgery.

"There was a father who brought his son to Piura who had walked for two days and traveled one day on a bus to get there," Heinlen said. "They can come from anywhere in the country."

Mary Spillane, director of communications for Interplast, went on the May trip to Peru as part of the team that was filming a documentary for the Ronald McDonald House Charities, a major sponsor of many Interplast trips.

"It was quite something. The first day, 150 to 200 people were there, just waiting for the doctors to arrive," Spillane said. "You can only imagine what they've gone through to get to the hospital."

Spillane said many of the parents that have traveled to the hospital have nowhere to stay while their child is recovering from surgery.

"The parents wait while their child is in the hospital, many camp out at the hospital because they have nowhere to stay," Spillane said. "They're willing to do anything for their kids. It's a very humbling experience."

Ross Zbar, a plastic surgeon based in New Jersey, has been on at least 15 trips with Interplast, most in the last year. Zbar recently completed a year-long fellowship with Interplast, traveling to different countries to perform surgeries and educate local doctors about the facial surgeries. Zbar said a cleft lip, or cleft palate, is a birth defect that affects approximately one in 600 children in Peru.

A cleft lip, or palate, occurs when the upper lip is not closed. This condition can affect the nose, gums and can also extend into the head or soft palate. Zbar said clefting can severely affect functions such as speech, articulation and swallowing, along with hearing. The facial deformation is also associated with social stigma.

"Those who are 'unrepaired' are essentially forced to hide or withdraw from society," Zbar said.

Clefting is caused by genetics and environment, and is race-related, according to Zbar. He said the defect is more common among children of Native American or Asian descent.

The cleft lip and cleft palate surgeries performed during the Interplast trips would normally cost approximately $5,000 in the United States. The surgeries performed during the Interplast trips are funded by donations from individuals, foundations and corporations. Spillane said, as part of a global initiative called Changing the Face of the World, the Ronald McDonald House Charities gave Interplast a $1 million grant two years ago to sponsor 25 trips over three years. Interplast does not accept government funding.

"The support has been tremendous," Spillane said. "In addition to this donation from the Ronald McDonald House, we depend on donations from individuals. Everything is possible because of donations and the generosity of the people in the Bay Area."

Spillane said 90 percent of the time, every person on an Interplast trip is a volunteer. Although Interplast pays for all the expenses of the trip, such as airfare, lodging and supplies, every volunteer is required to pay $325 per trip to help with these costs. Zbar said he decided he would rather go on the Interplast trips than start his private practice after he completed his training in plastic surgery.

"At the end of my training, I saw the position advertised to go on the trips for one year, and I knew I wanted to do it," Zbar said. "It's been the best experience of my life."

Zbar said on the first day of a trip, the hospital or clinic is swamped with adults and their children, with many of the children hiding behind their mother's skirts. By the time the children recover from surgery, he said they are happy, not scared, and are running around, playing and laughing.

"You go from the first day of abject fear to the last day, when there are happy kids," Zbar said. "They've been brought back into society, and the parents are beaming. It's a life-altering experience for the patients and the volunteers."

One of the goals of Interplast is to not only perform surgeries for children in need, but to provide educational training to the host-country's medical personnel to enable them to improve their level of medical care. The doctors in these countries already perform the cleft lip and cleft palate surgeries, but may not have learned the latest techniques and related patient care. Zbar said the Interplast trips not only help with the volume of surgeries the local hospitals perform, but also give the surgeons hands-on experience, enabling them to become more comfortable with the procedure. This gives them the reassurance that they can perform the surgery after the volunteer surgeons have left.

"This is a very specific surgery, and difficult to do well," Zbar said. "We're able to show the doctors there what we find helpful so they can improve their treatment methods."

Heinlen said Interplast volunteers return to the same site many times, as well as going to new towns in the same country.

"It takes more than one trip to train the doctors," Heinlen said. "The goal is not just to do the surgery, but to get the host countries to do it."

Heinlen said most physicians in the host countries will perform some free surgeries, but they can't afford to do all surgeries for free. However, she said one doctor in Ecuador did start his own cleft lip and cleft palate surgery foundation, and performs those surgeries for free.

Spillane said a cleft lip repair surgery takes about one hour to complete. "That one hour of surgery can really change a child's life," Spillane said.

For more information about Interplast, call 650.962.0123, or go to www.interplast.org.
Melissa Matchak

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Web extra to the September 21-27, 2000 issue of Metro.

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