Global Health Column

Amanda A. Gosman, MD
Global Health Chair

Faculty Commentary

by Dr. Mark Brzezienski

At its core, the choice to become a plastic surgeon is really no different from many professions featuring high-profile services that attract talented young people. Yet, our mentees are motivated to choose the long hours and years of training to become plastic surgeons instead of becoming business executives, lawyers, or any number of inviting alternatives. Many of us attribute our choice to an exposure to a life-changing reconstructive surgery, a transformative aesthetic procedure, or a global mission experience.

Plastic surgeons learn to manipulate anatomy to enable improved function and define physical identity. The future of our discipline will be brighter if it is entrusted to with drive, passion, imagination, and the ambition to improve the quality of life of others. In fact, the American Society of Plastic Surgery’s primary publication to introduce the next generation of plastic surgeons to the field, Plastic Surgery Essentials for Students, reminds us that "the limit of the specialty is bound only by the imagination and expertise of those in its practice" and our vocation is "open to those who wish to be challenged."

As the saying goes...if it were easy...well, you know the rest... But, this does not mean that those of us who have made the climb can't inspire the next generation - who ARE watching and listening - to start their own...


By Kristopher Day, MD/PGY6
University of Tennessee Plastic Surgery; Chattanooga, TN

George Mallory might have been justified in his terse depiction of his obsession with Mt. Everest: "because it's there. "The same celebration of brevity is seldom afforded to medical mission work participants, who are often asked, "why do it?" This response seems natural enough; it’s expensive, can be uncomfortable or even somewhat dangerous, often burns vacation time and may require time away from family. These considerations don't even include the tough arguments regarding: patient follow-up, hegemonic relationships with host cultures, a patchwork approach to bigger systemic problems, and the old standby refrain of skeptics: "can't the same "good" be done in your own backyard?" Medical mission work tends to quickly escalate into a hot-button topic within medical communities, like childhood education amongst a group of tiger moms or greatest-player-ever debates amongst sports journalists. In fact, it might be simpler to just examine cases in which mission work has made an impact…like mine, for example.

There are many reasons offered for participating in medical missions. Many say the experience reorients doctors' perspective of cost (e.g., the role of expensive imagery), offers a test of one's abilities with limited resources, allows detachment from taxing bureaucratic demands, and allows a profound sense of autonomy and purpose, not to mention the chance to serve those in greatest need. I wish I could say I was imbued with such single-minded determination when as a bright-eyed senior medical student I flew to Guatemala for a cleft palate repair mission. In truth, I had just read Paul Farmer's Mountains Beyond Mountains and maybe was instead excited and thirsty for adventure, perhaps not unlike the eternal Mr. Mallory himself. Yet in answering what at that time seemed like a calling, it also introduced me to a less-considered byproduct of mission work: enrollment.

After travelling to a dozen interviews and finally having reason to anticipate becoming the general surgeon I thought I was destined to be, I packed for a different kind of trip with a prominent and engaging professor on a cleft lip and palate repair mission. One international flight, two medical Spanish review books, and a few treacherous bus routes later I found myself part of a surgical team in Quetzaltenango, a city named for a Mayan expression meaning "under ten mountains." Dr. Jon Canady then demonstrated the first cleft palate repair I had ever seen, and I became witness to the magic of plastic surgery. I'd never seen such immediate physical and emotional transformation. Children that were ostracized became members of society in the span of hours. I was hooked. Just a short surgery residency later, I now enjoy the opportunity to train in plastic surgery. All told, this trail might be described as a mountainous journey. It will still be a few more years before I discover if I will become one of the lucky few that call themselves craniofacial surgeons, but it's a journey I don't regret whose base camp was a medical mission.

Since that experience in the Guatemalan highlands, I have witnessed things in medicine and even in the world of cleft repair that has been less inspiring...turf wars, insurance hurdles, and the like. Interestingly, mission work still seems to be the perfect antidote; the chance to provide care that will change a life in a place where no one else can. Isn't that what really describes the spirit of medical mission work? At their most basic level doctors want to help people, and medical mission work might be one of the purest forms of that possibility. It certainly was the right setting to witness life-changing care in a setting that fostered one-on-one mentorship in a beautiful and stimulating environment free from life’s mundane tasks and daily distractions. And that was plenty to sign me up.

So the next time you hear a passionate denouncement of mission work for its impracticality, needless expense, risk, or other Mallory-esque critiques, remember that the next generation is watching, listening, and learning. Why not inspire the climb...because it's there.