Maxillofacial Surgery in Milot: Restoring Hope, Resurrecting the True Person

Dental-1By Kyley A. Wood, DDS

A missionary maxillofacial surgeon and friend of mine, Dr. Gary Parker, is fond of saying “I have heard it said that for hope to be credible in the future, it must be tangible in the present. The healing that our patients experience today can become the seeds of hope for a better future for themselves, their families and their communities.”

By volunteering our skills and knowledge in northern Haiti, we are giving hope to those we are privileged to encounter. This hope is not fleeting or philosophical, it is personal and real. It is the type of hope that requires sacrifice and energy on our part. It is emotional and sometimes heartbreaking. It is the type of hope that will transform us and our patients.

It has been almost 14 years since I first stepped foot on the grounds of Hôpital Sacré Coeur in Milot, Haiti. I am not a believer in coincidence and this was certainly a divine appointment that would help shape my perspective on service for years to come.

I was in Haiti for the first time as a chief maxillofacial surgery resident from Indianapolis. My wife and I were asked to join a dental group that was coming down to set up a makeshift dental clinic near Milot. When we arrived, we got word that a small hospital had a dental chair they were willing to donate to our little project. I jumped in a truck with a bunch of guys and we took off for the local hospital.

Dental-2It was a much simpler place at the time. A sister from the Daughters of Charity met us at the door and gave us a quick tour. I remember wondering how they got by with so little. We loaded the battered dental chair in our truck and before we left, Sister Martha handed me a medical chart belonging to a young girl named Malory who was in desperate need of a major jaw reconstruction. Malory was the sister of the hospital pharmacist and she had lost the majority of her mandible in a previous tumor resection and subsequent failed reconstruction attempt in the Dominican Republic.

Sister Martha asked me if I could help this girl and I remember feeling so inadequate. There were certainly more qualified people available to care for this patient, but God seemed to be saying at the time that “those people are not here so what are you going to do.” This moment started a journey that has transformed me from the inside out.

We brought Malory to the States on four separate occasions and rebuilt her face. Through this process I kept wondering why we couldn’t offer these types of surgeries in Haiti to give the same hope that Malory was receiving to many more people. This is when I remembered the little hospital in Milot.

Dental-3Many of the medical problems that people experience can be easily hidden from site. A massive facial tumor or cleft lip is not one of these types of problems. In the third world, people with these afflictions are many times considered cursed. They are outcasts in society that people do not even want to touch. They almost always come to the hospital with their head wrapped in a cloth to hide their burden. The cloth, however, does not hide the smell or the flies that are attracted to the sometimes infected mass.

Many of these tumors have been growing for years until society only sees the tumor and not the person. People only see the grotesque mass while the person behind the mass is crying to be loved. These people come to Milot truly hopeless.

Remember, hope “must be tangible” and the first glimmer of hope we see comes when we look past the tumor and acknowledge the person. We do this by touching someone who may not have experienced touch for many years and we follow up by removing their burden and exposing the true person.

Dental-4Maxillofacial pathology is very unique. The tissue left behind from tooth formation usually remains dormant in most people. However, this tissue has the potential to form specific types of benign cysts and tumors that are found nowhere else in the body. One of these tumors is called an ameloblastoma. It is a benign but aggressive tumor that if left untreated, will continue growing until the patient dies of suffocation. This is certainly one of the most terrifying ways to die and it saddens me that people in Haiti are still dying of benign disease.

Treating these tumors requires a hospital that has the capability to perform major surgical procedures and provide the appropriate environment to care for these types of high maintenance patients with potential airway compromise. The hospital also has to have a staff with the appropriate skills and compassion that are willing to step out of their comfort zone and treat some very challenging patients. I have found all this and more at Hôpital Sacré Coeur.

Over the years, we have developed a process for the resection and reconstruction of massive facial tumors. When a mandibular or lower jaw tumor is removed, we perform an initial and temporary reconstruction with a titanium plate and if necessary a temporary prosthetic jaw joint. This process restores the patient’s facial form and allows them to function and eat without causing a significant risk of post-operative infection. The result is always so beautiful to watch. Even through the fog of anesthesia, every patient wakes up the same way. Their hands immediately go to their face to make sure the tumor is gone.

Dental-5The patients then return the next year for a permanent reconstruction procedure. Bone from the hip is harvested and grafted to the mandible and over time, this graft develops into a new jaw bone. If the jaw joint is sacrificed during the tumor removal process, the temporary prosthetic joint is replaced with a harvested rib graft. This process ensures that the jaw will remain strong and function appropriately for the patient’s lifetime.

Compliance is never an issue. Our resection patients almost always return the next year for further reconstruction and yearly thereafter for follow-up. We see patients from every area of Haiti and many travel days to receive treatment. It never ceases to amaze me that they know when to come and are always there on time. I wish I could say this about all my patients in the States.

Dental-6Maxillary or upper jaw tumors are resected and reconstructed with regional muscle flaps. In the States, these types of post surgical defects are reconstructed with maxillofacial prosthetic devices. These devices are unfortunately not available in Haiti, so we use the muscle flaps to close the communication between the mouth and nose that results from removing these tumors. This allows the patients to speak and eat normally.

Our team is fortunate to have a very dedicated and truly skilled anesthesia provider who has been volunteering with us since we started coming to Milot. His skills in pediatric anesthesia have allowed us to perform multiple cleft lip and palate surgeries over the years. We have seen devastated parents who have watched their children struggle to eat have their hope restored through a relatively short operation that would be performed shortly after birth in the developed world. We have also seen young adults who have lived with the stigma of a cleft lip throughout their childhood and teenage years cry uncontrollably when shown their new face for the first time after surgery.

Dental-7Even though our faith is continually strengthened through the victories we are privileged to witness, the struggles we have experienced in Haiti continue to teach us perseverance. The sad fact of the matter is that we are unable to help many of the people we screen for surgery. As a type “A” surgeon who is used to being able to tap into a health care system that is second to none, this is simply unacceptable. The patients we see with malignancies come to us desperately looking for hope and we have to gently tell them that their disease is going to take their life because surgery alone will not provide adequate treatment.

There are still limits concerning what we can accomplish in Haiti without available treatments such as radiation therapy or chemotherapy. This is why our struggle is not yet finished and every time I look into the eyes of these patients it provides me with the resolve to persevere. This is why the CRUDEM Foundation and the hospital staff are not satisfied with the status quo and it is why the leaders of this organization continue to partner with mission oriented hospitals like the Holy Name Medical Center.

None of us will be satisfied as long as the people of Haiti continue to die of treatable diseases. My missionary friend says that “the uniform that is put on people with terrible deformities is that you’re rubbish, you’re worthless, you’re spiritually cursed … No one in our world is rubbish.”

Adeline-1I would like to share one struggle in particular that turned into a victory through the help of this organization and the staff in Haiti. Two years ago, a young girl named Adeline presented with a large facial mass. Clinically, the mass resembled a malignancy so we decided to perform a biopsy to determine if we could treat her in Haiti. To our surprise, the biopsy showed that the mass was an ameloblastoma. The patient returned a year later for treatment and even though the mass was larger, our team was encouraged that we would be able to help Adeline.

She was taken to surgery and we quickly realized that Adeline’s tumor had likely invaded one of the branches of her carotid artery and developed a blood supply of its own. The blood loss we encountered from the tumor itself was enormous and unexpected. We simply did not have enough blood in the hospital blood bank to continue. We had to make the better of two bad decisions and stop the surgery.

Adeline-2Adeline woke up the same way all our patients wake up. Her hands immediately went to her face and her tumor was still there. As she recovered, I have never seen such hopeless faces than that of Adeline and her family. Hôpital Sacré Coeur was their last hope.

I never have to trust God more than when I am operating in Haiti. There is no back up. No helicopter is going to come and take your patient to a bigger and better equipped hospital if things go wrong.

After stopping Adeline’s surgery, the love of the hospital staff for their patients was never more apparent. They all kept asking “what can you do?” and even though our team felt inadequate at the time, God was saying the same thing. We were the ones there and Adeline was our patient. We decided to regroup and come back a few weeks later.

Adeline-3-post-opEven though the hospital schedule is packed with visiting physicians and surgeons, they made room for us to come back and operate over a weekend. Everyone sacrificed for this one patient. The hospital and Adeline’s family filled the blood bank, the staff worked overtime, and we cleared our schedules for another trip because Adeline is not rubbish. She is a child of God who deserves our very best. The same group came together a few weeks later more prepared and stronger in faith and when Adeline woke up this time, her tumor was gone and her hope was restored.

Over the years, my partner, Dr. Matt Monesmith, and I have brought both large and small teams to Milot. It amazes me that God always places the right people on my team every year. When I have needed a pediatrician or internist, they were there. When I got tired of using a portable Gomco suction unit in the operating room, a team of engineers and contractors came with me to design and install the hospital’s central suction system. When I have needed the expertise of a dermatologist or the skill of nurses, they were there. In the same respect, when multiple orthopedic and plastic surgeons needed anesthesia support to perform hundreds of surgeries shortly after the earthquake, we were there.

 
It was not a coincidence that our team, with an anesthesiologist and two anesthesia trained surgeons, was scheduled to be in Milot two weeks after the devastating earthquake in Port-au-Prince.

The specialists that have always been a part of my teams over the years are the wonderful and skilled general dentists who have volunteered their time to come and help in the hospital’s dental clinic.

Dental disease is one of the most common causes of pain and deadly infection in the third world and Hôpital Sacré Coeur has been committed to meeting this need over the years. Through the help of the hospital staff and volunteers, Holy Name Medical Center and my friend and volunteer dentist Dr. Jeff Harmon, the hospital is poised to open a new state of the art dental clinic to better meet the needs of the people of Haiti and help train future Haitian dentists. I look forward to the advances we will continue to see as Hôpital Sacré Coeur continues to grow and improve for the people of Haiti and I am privileged to be able to play a small role in this process.

Wood-FamilyDr. Kyley Wood is an Oral and Maxillofacial Surgeon, who trained at Indiana University Hospital and Methodist Hospital in Indianapolis, Indiana. He is currently in private practice in Jasper, Indiana. Dr. Wood is active in medical missions in Haiti and Africa. He is married to Dr. Shannon Wood and they have 7 children (3 biologic and 4 adopted from Haiti, Guatemala, and Ethiopia).

 
 
 
 


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The teensiest of cavities can fell the burliest of men from sheer agony. Imagine going through life without a dentist. Unfortunately, in Haiti, dentists are few and far between. Fortunately, Hôpital Sacré Coeur has a rare, full service dental clinic.

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