Perhaps of interest:

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"The whole idea was that we weren't just going to operate and then
leave, but let's show them how we do these things. It's the whole
expression that you can teach a man to fish rather than giving him
fish," says Dr. Adamson."

http://www.theglobeandmail.com/servlet/ArticleNews/TPStory/LAC/20051227/HOPERATI
ON27/TPHealth/

Serving forgotten children
Russian orphans with facial deformities get help from visiting Western
doctors

By JERED STUFFCO

Tuesday, December 27, 2005 Page A17

Special to The Globe and Mail

Peter Adamson was performing facial reconstruction on an orphan in a
Russian hospital when the unspeakable happened -- the respirator that
was keeping his young patient breathing stopped working.

Instead of panicking, the Russian doctor who was assisting Dr. Adamson
reacted calmly by unplugging the machine and grabbing a plastic tube.

"He kept the kid alive for 20 minutes by blowing in the tube," recalls
Dr. Adamson, surrounded by pieces of Innu art in his plush offices in
downtown Toronto.

And what if the Russian doctor had a pair of faulty lungs?

"The child would have died. He said the machine was tired and needed a
rest . . . it had overheated."

In Toronto, Dr. Adamson has run a successful plastic surgery clinic
since 1981. He's considered a leader in nose jobs, face lifts and Botox
treatment. His clients pay him thousands of dollars to look beautiful.

But in recent years he has made an annual journey to Russia, where he
operates on penniless orphans in under-equipped operating rooms.

Such is the dichotomy of the Face To Face Mission Project, which sees a
team of Western surgeons fly to the Bonum Centre in Yekaterinburg,
Russia, to operate on the area's poorest and most vulnerable --
forgotten children born with facial deformities who are often called
"unadoptable."

Born with cleft palets, deformed ears and wide-set eyes, many of these
kids stand no chance of ever being adopted.

"They use the word orphan a little differently in Russia than we do in
the West," notes Dr. Adamson, a silver-haired man who smiles
mid-sentence and speaks in warm tones.

Since the project's inception in 1992, the teams have operated on more
than 600 children and offered consultations to about 1,000 kids.
Spearheaded by the American Academy of Facial Plastic and
Reconstructive Surgery (AAFPRS), the Face to Face Missions have helped
many of the orphans find homes.

"So, there has been a real impact," says Dr. Adamson, a former
president and board member of the AAFPRS.

Along with offering medical service to the children, another integral
aspect of the Face To Face Mission is to provide the region's doctors,
who are often starved of the latest in medical advances, with new
techniques and improved technologies.

"The whole idea was that we weren't just going to operate and then
leave, but let's show them how we do these things. It's the whole
expression that you can teach a man to fish rather than giving him
fish," says Dr. Adamson.

When the Berlin Wall fell, the Frank Adoption Agency -- a North
Carolina-based organization which had a mandate of helping Eastern Bloc
orphans find homes -- contacted the AAFPRS about the plight of these
Russian orphans.

And with such high numbers of orphans with facial deformities at the
Bonum Centre -- which Dr. Adamson describes as a massive children's
hospital attached to a rehabilitation centre and an orphanage -- the
doctors began making their annual trek.

While recent trips have focused on problems like microtia -- deformed
ears -- and other birth defects like cranial-facial syndromes which
create large gaps between a child's eyes, the most recent trek -- which
took place in October -- saw the eight-plus squad of doctors focus on
retinopathy of the premature, an affliction that causes blindness in
premature babies.

"The big thing for me, I can magnify our impact by getting other
surgeons who can operate in different areas," Dr. Adamson says. "So,
it's not about what I can do, I'm really being a facilitator [and]
saying, 'We need some burn specialists. We need some eye specialists.'
"

One of the specialists who made the trek was Peter Kertes, a
vitreo-retinal surgeon and associate professor of ophthalmology based
at Sunnybrook and Women's College Health Sciences Centre in Toronto.

"He actually taught them how to diagnose these children," says Dr.
Adamson, who added that Dr. Kertes also spent considerable effort
lecturing on prevention and treatment.

"There are going to be many, many children over there -- maybe even
hundreds of children -- who may well not go blind. So the impact is
really significant."

While retinopathy of the premature is a rare and relatively
easy-to-treat condition in Canada, Dr. Kertes says the problem is still
rampant in many parts of Russia.

"There were a lot of kids going blind prematurely, and the doctors
didn't have the wherewithal to deal with it. They didn't really know
how to screen these babies.

"I was overwhelmed to see how many of these toddlers were blind. It was
very sad. You just don't see that," in Canada, says Dr. Kertes.

The proper development of the eye, which usually isn't complete until
four weeks after birth, is dependent upon the proliferation of blood
vessels on the interior of the retina. However, in premature babies,
the blood vessels sometimes develop in the wrong areas of the retina.

Scar tissue also develops, and together this growth can cause the
retina to detach itself, causing blindness.

Dr. Kertes recalls inspecting one infant who desperately required the
hour-long vitrectomy surgery needed to fix the problem, but the Russian
anesthesiologist expressed concern about putting the child unconscious
for longer than 10 minutes.

"It was back and forth and back and forth, and he finally acquiesced,
and it took an hour [to perform the operation]. I'm hoping that they
come to understand what constitutes adequate treatment."

Indeed, Dr. Adamson believes medical conditions are improving.

"First of all, the equipment they have there now isn't the greatest,
but they have identified certain pieces of equipment that they'd like
to get, particularly when they see what we bring over. And there are
some areas, ironically, where they have some great equipment, and it's
sitting next to something that's 50 years old, and you think, 'My
heavens, where did that come from?' "

Plus, the surgeons in Russia -- despite a lack of new Western ideas --
are an exceptional lot, says Dr. Adamson.

"In the surgical trade, we'd say a lot of these guys are 'great
cutters,' but they [haven't been] exposed to Western ideas. That's what
we brought. We brought Western ideas and thinking, because they'd been
very parochial in their international thinking."

Besides, the Russian surgeons aren't the only ones who benefit from the
experience, says Dr. Adamson.

"I think most of us go into medicine because you care about people and
you want to help people.

"And that's what medicine is about. It's a caring profession. Although
my work here is cosmetic surgery -- and I love the cosmetic surgery
that I do -- this is always something that's been important to me, to
experience this different side of medicine. And it's wonderful."

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