Interplast: Harnessing Technology to Help Heal

In early 2005, Zambia's sole plastic surgeon was called to examine a newborn in a Lusaka hospital. The three-day-old child was born with a genetic disease known as ichthyosis , an incurable condition that results in severely dry, scaly skin. In serious cases, like the Zambian newborn's, the disease can cause the afflicted person's eyelids to turn outward, impairing his or her vision. The Zambian doctor needed to operate on the infant as soon as possible; but first, he wanted some advice on how best to proceed.

The surgeon posted a photo of the child and a description of its condition to Grand Rounds, a password-protected online discussion board made up of nearly 80 reconstructive surgeons from around the world. Within a few days, he had received a series of replies from an oculoplastic surgeon at Dartmouth College in New Hampshire. Familiar with this particular ichthyosis complication, the American eye specialist suggested ways the Zambian doctor might approach the surgery. This expert advice helped the African doctor successfully operate on the newborn and open its eyes; he later added a post-surgery photo and comments to Grand Rounds to let the Dartmouth surgeon know that the child was doing remarkably well.

The two surgeons in Lusaka and New Hampshire might never have made contact were it not for their affiliations with Interplast , a philanthropic organization primarily focused on providing free reconstructive surgeries to disfigured children and adults with no access to specialized care. Interplast also works to educate local reconstructive surgeons around the world through its Grand Rounds discussion board.

The organization also uses a blog to help publicize its mission and to share the stories of the people it helps with funders and the general public. CEO and President Susan Hayes says that advances in technology and communications have allowed Interplast to finally realize its vision of not only providing direct patient care, but of empowering local reconstructive surgeons to provide that same care themselves.

Changing Lives, One Surgery at a Time

Interplast was formed in Palo Alto, California in 1969 by Dr. Donald Laub, then Chief of Plastic andReconstructive Surgery at Stanford University Medical Center. Each year, Interplast sends a steady stream of expert surgical teams and medical supplies to developing countries all over the world, including Bangladesh, Nepal, Nicaragua, and Vietnam. The teams of volunteer surgeons spend two weeks at each location, performing as many free operations as time permits. By correcting disfigurements resulting from conditions such as cleft lips and accidents like burn injuries, Interplast surgeons help people in developing countries avoid the long-term disabilities and social stigmas they might otherwise face. In a report entitled "Stigma's Impact on Global Health," Interplast explains that people with congenital deformities are often shunned by their communities and barred from educational and employment opportunities.

The organization also sponsors week-long Visiting Educator Workshops, in which reconstructive experts travel to developing countries to offer local doctors hands-on training in advanced plastic surgery techniques. Each workshop focuses on a different area of reconstructive surgery. For example, in spring 2006, Interplast will hold a burn clinic in Sri Lanka, as well as an ear surgery workshop in Brazil.

"The long-term goal of Interplast's Visiting Educator Program is to move a site toward medical independence, so that the poor of the region may have access to the reconstructive care they require year-round, and for generations to come," said Dr. William Schneider, Interplast's Chief Medical Officer.

Technology plays an increasingly vital role in the organization's efforts to expand its outreach while maintaining a high standard of medical care. Through Grand Rounds, surgeons in far-flung corners of the globe can continue to soak up expert knowledge long after the visiting volunteers have returned home.

Interplast Grand Rounds: A Virtual Teaching Hospital

At any given time, reconstructive surgeons from many different nations are sharing case studies and exchanging advice via Interplast's private Grand Rounds site. According to Dr. Schneider, Interplast became interested in using this type of message-board technology after working with an organization that was developing a similar system. Realizing the impact that the tool would have on Interplast's ability to educate and share information with doctors around the world, the organization took on the project as a full-time in-house endeavor.

The organization used DiscusWare Professional software to build the current version of Grand Rounds, which looks and works like most other online message boards. After entering their username and password, surgeons see a list of case summaries on the main page. Clicking into an individual case allows them to view all posts, with the newest entries at the bottom of the page. Whenever a surgeon wants to comment on a case, he or she simply fills in a few text boxes, then clicks a button to post the reply. While the active Grand Rounds board is restricted to participating surgeons, the general public can check out a few example posts on Interplast's site. (Editor's note: Please be advised that these photos depict disfigurements and pre-surgery situations.)

Grand Rounds participants loosely fall into two categories: doctors with a certain level of expertise in various plastic surgery disciplines (most of whom are from the United States), and those primarily there to seek advice. Although most doctors who routinely post and answer questions are Interplast affiliates, the forum is open to any reconstructive surgeon whose work is in line with the organization's philanthropic goals.

Interplast uses Grand Rounds to highlight particularly unusual or difficult cases that doctors in developing countries submit to Schneider via email. Whenever he uploads a new case summary and photos, everyone on the Grand Rounds email list receives a message; emails also go out with each subsequent post. In time-sensitive cases -- like those pertaining to an impending operation -- Interplast marks the email as "URGENT" in the subject line.

Although many of the Grand Rounds participants work in countries that Interplast teams routinely visit, the program also helps educate surgeons from places that the organization can't reach. For example, although current State Department warnings prevent Interplast from sending teams into Nigeria, Grand Rounds allows surgeons in Nigeria to participate via the Web. When Schneider spoke about Grand Rounds at the West African College of Surgeons Annual Conference in 2006, several Nigerian surgeons approached him asking to join the program.

Engaging plastic surgeons from a variety of developing nations has also benefited the Grand Rounds community itself. "What we find when we post some of these cases is that the people…who are working in developing countries really have the best solutions for some of these complicated cases, because some of [the conditions] are things that you simply don't see in a developed country," said Schneider.

Schneider cites a disfiguring disease called noma as an example. Found almost exclusively in Africa, noma infects very young malnourished children, rapidly destroying facial tissue and bone, leaving prominent lesions. "Nobody in the United States has probably ever seen a case," Schneider said. After meeting a Brazilian plastic surgeon who treats noma patients in Africa, Schneider added the surgeon's name to Grand Rounds, where, Schneider notes, he has become one of the board's best participants. Without Grand Rounds, Schneider says, "how could we get a case like [noma] to a guy in Brazil…and give an opinion to a guy in Africa?"

A Never-Ending Mission

For nearly nine months, a young Malawian girllived with a large hole above her upper lip. The victim of a rabid hyena attack in her remote village, the girl's wound would not heal properly without reconstructive surgery. Though Interplast doesn't work directly in Malawi, the organization played a key role in getting the girl the medical care she needed. After a colleague emailed Schneider a photo of the girl's wound, he posted it on the Grand Rounds site for discussion. The case generated suggestions and advice from the Interplast Grand Rounds community, and in earlyMarch of 2006, the organization’s Zambian affiliate successfully performed surgery in Lusaka.

In a little less than 40 years, Interplast and a rotating cast of volunteers have given nearly 60,000 impoverished children and adults a new look -- and consequently, a new lease on life. As always, Interplast continues its in-person humanitarian efforts with a packed schedule of trips and visiting-educator workshops. But the organization's ongoing exploration of different technologies will allow it to educate more surgeons -- and consequently help more people -- than ever before. "Here we are bringing this thing together because of technology," said Schneider. "And I think it's wonderful."