April 2002 Bulletin

Looking for a few good teachers

Orthopaedist committed to sharing knowledge, restoring hope to disadvantaged

"Give a man a fish and you feed him for a day. Teach a man to fish and you feed him for a lifetime."

That familiar Chinese proverb illustrates not only Dr. Mark N. Perlmutter’s own philosophy—it’s also a guiding principle behind "Hands Healing Hearts," (HHH) the nonprofit organization he founded ten years ago.

The group’s core mission is to provide free medical care to disadvantaged people in Third World countries, while at the same time sharing their medical knowledge with local doctors.

Volunteer medical teams operate to correct overwhelming congenital deformities, traumatic deformities and developmental deformities of the face, hands and feet. Nearly 3,000 children in Mexico and Ecuador have been operated on, and HHH will soon expand its mission to Vietnam.

While Dr. Perlmutter founded HHH ten years ago, the inspiration to take it to the "next level" occurred a few years later when he and his wife Karen traveled to Mexico to adopt a child. Mexican children with disabilities cannot be adopted, so correcting a birth defect on an orphan can drastically change a life. While in Mexico, he operated on a number of children, and the experience inspired the Perlmutters to do more.

"My wife’s expertise is in running nonprofits, so she restructured HHH to be a nonprofit organization so we could raise funds to operate on more children," he explains.

Birth defect capital of the world

HHH returns to Mexico every year, but as a hand fellowship-trained orthopaedist, Dr. Perlmutter soon became attracted to Ecuador because of its high number of hand defects.

"The number of congenital deformities among the people of Ecuador is astounding," he says. "There are tens of thousands of people with congenital deformities in every village—it’s the birth defect capital of the world." According to Perlmutter, "a pediatric orthopaedist with a talent for fixing clubfeet could operate there 12 hours a day for 20 years and never make a dent in the population."

The extraordinary number of birth defects in Ecuador is the result of inbreeding—generation after generation of consanguineous marriages, Perlmutter explains. "You can even identify what region some people are from according to their birth defect."

Unfortunately, not only do these people have no access to corrective surgery—local customs and superstitions result in people with deformities being ostracized from the community and prevented from employment.

"In Ecuador, an hour in the operating room can truly transform a life," Perlmutter says.

Education is the key

While the surgical operations performed during HHH missions are clearly life changing for patients and deeply satisfying for the doctors, Dr. Perlmutter is equally passionate about the organization’s teaching mission. "The medical education aspect of these trips is crucial," he says. "By putting time and effort into teaching local surgeons, nurses and physical therapists, much-needed care can continue well after our departure."

In fact, the HHH charter requires them to "put themselves out of business" at any given hospital within five years. "We accomplish this goal by returning to the same hospital for a couple years and training one or two of their docs intensively," he says. "We’re now on our fifth hospital."

Of course, devoting time to teaching leaves the visiting doctors with less time to operate, Perlmutter admits. "We may perform 200 operations rather than 300. But by the time we return, 2,000 more children will have been operated on."

American-style residency training program

"Ecuador has the doctors willing to do the work, the facilities to accommodate the work, and the social network to support it," Perlmutter says. "Every piece of the puzzle is in place now—except for the training."

To supply that crucial missing piece, HHH is attempting to create an American-style residency-training program there. Perlmutter is currently recruiting medical teams who are willing to travel to Ecuador to teach. "We fly the docs down there for free, so they have virtually no expenses," he says. "We make all the arrangements. All they have to do is show up, do their God’s work and then go home."

How does the program work?

Prior to the mission, each medical team picks procedures for the week. HHH has equipped the hospital with Internet-ready computers and digital cameras, so the local staff e-mails patient photos to the team in advance.

Then, just prior to the team’s arrival, patients are cleared by pediatricians and triaged and the surgical schedule is set. Once on-site, teams work from sunrise to midnight, focusing intensely on the pre-selected procedures.

"For instance, we’re going down there on July 20th," Perlmutter says. "We plan to focus on skin flaps, flap coverage of burns, complex syndactyly repair, radial club hands, and microtia—missing ears. And those are just the orthopaedic topics."

The rewards volunteers derive from the experience are immense, Perlmutter says. Not only are the patients hungering for your help, so are the ‘students.’ "Our students are actually highly talented practicing surgeons," he adds. "They’re technically skilled specialists who are yearning for knowledge—they just don’t have the means to acquire it."

It costs more to fly from Ecuador to the U.S. than these doctors make in a year, Perlmutter explains. "In that society, a policeman makes more than a surgeon, so the people who become doctors are truly dedicated to medicine for its own sake. You can’t help but appreciate their sincerity and the desire they have to help their own people. I can’t imagine medicine in a more pure form than it is in Ecuador, because it’s all about the patient."

Educational opportunities for visiting Americans are exceptional, as well, he says. "I saw more birth defects in my first hour in Ecuador than I saw in my entire residency at Dupont Institute for Children in Delaware. For any American physician interested in pediatric orthopaedics, the learning opportunities are outstanding."

Opening his heart and home

Dr. Perlmutter not only opens his heart to the people of Mexico and Ecuador, he also opens his wallet and his own home on a regular basis. When on-site surgery is impossible, he often brings Mexican or Ecuadorian children and their relatives to the U.S.—at his own expense—to stay with his family in Pennsylvania. They live with them as long as necessary to prepare for surgery and to recuperate afterwards.

"One young fellow just returned to Ecuador," Perlmutter says. "He required a leg lengthening, but he was living in total squalor there. He and his mother had taken a five-hour donkey ride to see me, but with such a non-hygienic home environment, I didn’t feel comfortable leaving him with a wound I couldn’t control. So we brought them both to live with us."

The experience has been a "fantastic, enriching" one for his entire family, he says.

"All three of my children are now fluent in Spanish," he reports. "My oldest daughter has accompanied me to Ecuador and Mexico several times. This year, both of my daughters are going, and later my son will join us, too. The experience just can’t be equaled."

Immeasurable Rewards

Calling HHH "the charge of my life," Dr. Perlmutter spends an hour each day answering HHH e-mails, pursuing donations, and talking with doctors in Vietnam, Ecuador and Mexico on the "Doctor to Doctor" chat-room on the HHH web site.

How does he describe the two weeks he spends each year in Ecuador? In one word: "Nirvana".

"You’re healing children who would literally be ostracized otherwise," he says.

"As adolescents, they would become beggars. They’d never get a job, never marry. Their access to health care is virtually zero. But with a dollar’s worth of plaster, you can turn them into a normal human being. The reward for that is immeasurable."

Wanted: volunteers, sutures, textbooks

As a smaller organization, it can be difficult for HHH to get noticed, Perlmutter says. The organization is currently endeavoring to become part of Health Volunteers Overseas, but so far to no avail.

In the meantime, Dr. Perlmutter is working to recruit more medical teams. "It would be fantastic if a whole academic surgical team would like to get together to volunteer at our hospital system," he says. "We also have a desperate need for people who are adept at fixing clubfeet. I do a solid B to B+ job. We’d love to recruit people who can do an A+ job."

HHH also is in lacking in orthopaedic textbooks and surgical supplies—sutures in particular, he says. "There have been times near the end of a mission where we’ll see child who needs an operation, but we just can’t do it because we don’t have the right suture."

Dr. Perlmutter notes that conditions under which surgery is performed can be rather primitive and any and all donations for basic equipment and supplies would be gratefully accepted. "In some cases, we have had to construct operating tables out of doors on sawhorses and use surgical headlights for operating lights, " he recounts.

For more information on HHH, check out their web site at www.handshealinghearts.org. If you’d like to contact Dr. Perlmutter directly, he can be reached in Berwick, Penn. at (570) 759-5069. HHH’s other ‘core surgeons’ include Eric Weiss, MD, of Jacksonville, Fla. (904) 215-5800; and Francis Collini, MD, of Shavertown, Penn. (570) 674-6525 or (800) 291-0335.

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