John Hodges, M.D., and his team earlier performed cleft lip and palate surgery on this Vietnamese child. Photograph courtesy of AAFPRS.

That was 10 years ago.

Today, the hospital is a state-of-the-art, 26-story facility, yet the medical staff continues to struggle to advance their knowledge and incorporate the latest surgical techniques. Dr. Hodges says that surgeons earn a decent wage in a Chinese economy, but their salaries of a few hundred dollars a month preclude them from making trips outside the country to learn about advances in facial plastic and reconstructive surgery.

Last spring, Dr. Hodges, professor of otolaryngology head and neck surgery at the University of Tennessee, Memphis, made his fifth visit to Linyi. He and his colleagues conducted lectures, video sessions, and demonstration surgeries, focusing on cleft lips and palates and cleft lip-nose deformities.

The surgeons participate in the Face-to-Face outreach program, a volunteer effort conducted by the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) to further humanitarian efforts around the world. In the United States, surgeons repair facial injuries resulting from domestic violence. In other, predominantly Third World countries, where access to plastic and reconstructive surgery is limited, surgeons help foreign surgeons as well as patients.

Program participant Minas Constantinides, M.D., a facial plastic surgeon and director of facial plastic and reconstructive surgery in the department of otolaryngology at New York University School of Medicine, New York, says, "We try to educate the local surgical community. We definitely do surgery while at the site, but we also work closely with the local surgeons to bring them up to at least 20th- if not 21st-century standards. We tend to do more representative surgery, focusing on typical types of surgery that they would have to perform. If you educate one surgeon, he can treat hundreds of patients."

Dr. Hodges says most trips include a few days of travel throughout the destination areas. He has seen the Great Wall of China, Tiananmen Square, and the Forbidden City, and shared these experiences with fellow facial plastic surgeons.

In practice for more than 33 years, Dr. Hodges says the excursions offer a sense of fulfillment, wonderment, and peace. "You can have all the money in the world, but when you go and help other doctors or help poor people who otherwise would not get what you're offering them, it brings a sense of accomplishment and contribution. It brings pleasure to your heart."

Because these trips are by invitation only, residents embrace the doctors, Dr. Hodges says. "They take care of us after we get there. They give us transportation and food and lodging. They're so appreciative. They usually shower us with gifts, and it's almost a teary time when you leave the country."

Dr. Constantinides, has represented Face-to-Face on two trips to Vietnam, twice traveling to Ho Chi Minh City. He says that each trip required that he take about two weeks off from his practice at home. Though short in duration, the trip, he says, greatly benefited the Vietnamese surgeons, who struggle with the same limitations as do surgeons in other Third World countries.

"The surgeons are paid so little and it is so costly to travel internationally," he says. "Even an academic surgeon who is paid by the government might only be able to travel once in a lifetime outside of Vietnam to attend a medical conference."

Consequently, many of these surgeons are still using techniques handed down to them from American surgeons during the Vietnam War 40 years ago. Therefore, Dr. Constantinides and other Face-to-Face participants leave any equipment they bring on the trip with the foreign surgeons.

Program participants in Vietnam performed a variety of procedures, including cleft lip and palate surgery in children, revision cleft lip and palate surgery in adults, and major scar revisions. CST