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EDITORIAL: EDITORIALS

Plastic Surgery as a Weapon of Foreign Policy

Gorney, Mark M.D.

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Plastic and Reconstructive Surgery: December 2005 - Volume 116 - Issue 7 - p 2030-2032
doi: 10.1097/01.prs.0000191215.28365.ba
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I recently returned from Havana, Cuba, where I spent 10 days working with the surgical team from the charitable organization Austin Smiles. As with all such voyages of good will, the camaraderie, the kids, the memories, and, above all, the exhilaration of once again having done what I set out to do so many years ago more than validated my time away from work and the expenses involved.

As one grows professionally in almost any field, the pressures and stresses of life begin to blur our sense of what is really important and meaningful. In plastic surgery, we seldom stop to consider that we may have an eloquent and powerful weapon to countervail the wave of anti-Americanism sweeping the world today. Even better, the U.S. Government can avail itself of this weapon at virtually no cost.

I was putting things in order recently when I ran across a 40-year-old photograph that I took from the fantail of the hospital ship Hope as it was pulling away from the dock in the port of Salaverry, Peru. It set me off on a nostalgic voyage, but also brought home to me that half a century later we are validating Santayana’s credo that those who do not heed the lessons of history are bound to repeat it.

In 1961, I volunteered for a tour of duty on Hope’s first long-term voyage of any permanence in one country—this time in Peru. I had not been in practice very long, but an announcement that a plastic and reconstructive surgeon, who had a native ability to speak Spanish, was urgently needed overwhelmed the stark reality that I could hardly afford to leave for that long.

I flew to Lima and then joined the staff on the ship anchored in the port of Salaverry, a few miles south of the regional capital of Trujillo near the border of Ecuador. I understood immediately why the call had gone out. When I walked in to my first clinic, I was confronted by a small sea of broken faces packed into and overflowing from the waiting area on the lower deck. There were dozens of children, ranging from newborns to teenagers, with unrepaired, gaping cleft lip and palate deformities—the small ones sitting on the laps of parents with dark Inca faces with looks of desperate anticipation. There was also a scattering of bad postburn contractures, malformed ears, posttraumatic and craniofacial deformities, and other problems. I had never seen so many kids so badly in need of help in one place.

In the face of such a backlog, I was allowed the use of one of the ship’s operating rooms and a full-time anesthesiologist for one week, and twice weekly after that. We picked out the most urgent and began a nonstop marathon of reparative surgeries that almost imitated an assembly line. I had never before felt so totally exhausted, and so totally exhilarated, by the end of the day. By the end of launch week, we had repaired 54 kids and, miraculously, only incurred one minor postoperative problem.

It was only in the second week, when we began to see the first surgeries returning to afternoon clinic for checkups, that I gradually became aware of the indescribable emotional impact that all of this was having on the families. Instead of the somber, anxious expressions, I saw smiles. For the first time in my life, I found myself awkwardly trying to resist, as gently as I could, someone trying to kiss my hand. I did not know what to say when most parents handed me some token of their gratitude—a small huaco (a pre-Columbian figurine), a silver trinket common to that area, or some other possession. One person gave me a blackened U.S. silver dollar. I am sure they had no idea what it was or what it was worth. I am equally sure it was the most valuable thing they owned (I still have it in my curio cabinet).

All this, with a backdrop of inadequate care for the poor, wretched social status of the underclass, plus the government’s indifference, suggested an unintended but effective laboratory for the realpolitik of the U.S. foreign policy. Although this was long before the murderous shenanigans of Senedero Luminoso (Shining Path), any observer could sense that, in a country notable for a legendary imbalance between the haves and the have-nots, it was only a matter of time before the lid went off. (Seventy-five percent of all the arable land at the time was in the hands of 35 families, largely expatriates.) The serial political upheavals of the ’80s and ’90s that made headlines in Peru, even before the tender mercies of the Central Intelligence Agency, were a foregone conclusion.

Having been raised in Latin America because of my father’s job, I had already sensed and shared the innate suspicion among all Latinos of any yanqui intentions, no matter how seemingly worthwhile. The question in my mind was whether this very impressive “grande geste” we were making would have any impact as a major, directly visible demonstration of good will, of innate charitable kindness by Americans of all sorts. Might this have some effect on improving their attitude toward the United States? Would they continue to like us as individuals and still hate the government we represented? Would the truth shine? Would the desire to help, the helping without expecting anything in return (“Because I have much and you have little, not because I want to buy your friendship, dammit, but simply because it’s the right thing to do.”) make any difference? In a totally unexpected fashion, I soon got my answer.

In April of 1961, we learned in Peru of the Bay of Pigs assault by the Florida-based Cuban expatriates with the backing of the Central Intelligence Agency and President Kennedy. It ended catastrophically. Those old enough to remember the details may recall it generated, almost without exception, a huge wave of anti-American protests all over Latin America. It was no different in Peru. As in almost any country in the world, university students are the shock troops. Police in full riot gear were the order of the day from Punta del Fuego to the Texas border. There were smashed windows at the U.S. embassy; flying nightsticks, fire hoses, bonfires, overturned cars, and graffiti were everywhere—Peru was no exception. The military governor of the province immediately threw a cordon of troops around the dock where our ship was moored. But you know what? It was totally unnecessary. Nobody showed up at the port.

It gets better! One of our doctors, who had more courage than sense, managed to get into the town with his camera to watch the mayhem. Fortunately, he had the good sense to wear his white coat with the “Project Hope” emblem on his chest. He filmed all the violence (including some of the medical students involved in the protests, all of whom waved and smiled at him). The point of all this, however, is that he managed to also photograph a large protest sign chalked on the side of a building that said, “Fuera Yanqui—Hope quedese!” (Yankees out! Hope stay!)

I am convinced that in sacrificing a small amount of time and income in exchange for the good we do, we truly fulfill Kennedy’s historic challenge, “Ask not what your country can do for you, ask what you can do for your country!”

From that experience, and in all of my annual charitable surgical expeditions over 35 years all over the earth, I remain firmly convinced of the infallibility of individual Americans, or those working in small groups, to succeed as efficient (and certainly inexpensive) weapons of foreign policy—more so for those of us blessed with the ability to work in direct people-to-people ventures. Plastic surgery is in a particularly enviable position to do that compared to others in medicine. Our results are immediately obvious. They are physically obvious, but they are even more obvious in the souls of the patients we benefit—since most are children. It is likely that as the years pass, attitudes toward Americans are far less likely to deteriorate under political pressures. Most importantly, all beneficiaries of our charitable services will know us for what we are and not as we are painted. Pity the State Department has never understood that.

On the day of the ship’s departure several months later, in a political climate by then vibrating with anti-Americanism, and on a midweek workday, approximately 150,000 ordinary people (there were only 250,000 in the whole province) showed up at the dock to see us off (Fig. 1).

Fig. 1
Fig. 1:
U.S.S. Hope, having finished its 6-month stay in Peru, casts off on its home voyage. Note the capacity crowd standing on the pier to wave goodbye.

They festooned the ship with colored ribbons, repeatedly embraced their doctors and nurses, and heaped flowers on the ship. After the horn sounded and the lines were cast off, with the band playing “La Golondrina,” a sad farewell song, they stood there, most of them weeping and waving. The ship pulled away from the dock while we stood on the fantail with lumps in our throats waving goodbye. The majority of the crowd was still just standing there in an eerie silence until the fluttering Stars and Stripes disappeared around the harbor light.

©2005American Society of Plastic Surgeons