Originally published in the
Mississauga News, June 2004

By Rob Beintema

Dispatches from the Orient, part II

Approximately 1 in 1,000 children in the world will be born with a cleft lip or palate deformity. With over 30 million births each year in China, it is estimated that there will be 30,000 new cases.

Daunting numbers, but one man at least has tried to make a difference.

Dr. Joseph Wong, a facial plastic surgeon from Mississauga's Credit Valley Hospital, is leading a Smile China team of surgeons and nurses to make a small dent in those numbers and, more importantly, to pass on the skills and techniques to local doctors and surgeons.

Nurses and Children

Lanzhou, in the geographical heart of China, is a city of three million, but it is also a gateway to poorer rural communities. Every morning we drive to The People's Hospital of Gansu Province. The hospital is as old as I am - also born in 1954. I like to think I'm holding up better than it is, but I haven't had as much hard use. A brand new impressive building has not quite been finished yet so they are continuing in the old part of the facility.

Picture the ward where the children wait for their operations.

There are large rooms with up to eight beds, some of them subdivided into smaller rooms with shoulder high walls, usually two beds in each, two kids and families to a cubicle. Everyone is crammed into these tight quarters but there are no comnplaints. I can't say enough about the staff's dedication, working under these conditions and the children's parents who have sacrificed everything and traveled long, hard distances just to get this one chance.

Happy Mom

There have been stories of past patients, including one family who had just enough money for train travel. They arrived weeks in advance just to get a spot on the list, and then subsisted on flour cakes while they lived on the street outside the hospital.

Every morning the day's patients file into a small party room, festooned with balloons and tinsel, where Dr. Wong checks the children, explains procedures to the parents in Chinese and gets clearance forms signed. Over the background murmur of Chinese and English, the hall P.A. grates the bluegrass soundtrack of Oh, Brother Where Art Thou and a cellphone rings a complete rendition of Christmas carols. Just another surreal note in the cross-cultural flow of the day.

But we are getting into the routine, entering the surgical department through the old wooden double-doors, changing into O.R. scrubs quickly in the locker room, thanks to the funk from the hole-in-the-floor toilet, then donning hats, masks and booties before heading to the operating rooms.

Smile China works out of three operating rooms supported by local medical staff.

Dr. Wong and Dr. Toni Zhong prepare for surgery

Dr. Wayne Larrabee and Dr. Travis Tollefson usually work together. Dr. Sykes has more experience with cleft lips and palates and works solo, sometimes popping in to check on the other operating rooms. He is sort of the cowboy of the group, working quickly and expertly, "eyeballing" his operations, joking and moving around the room.

Dr. Joseph Wong's experience shows in the attention Chinese doctors pay to his skills and technique. There is usually a classroom full of doctors following his televised operations from another room. Dr Wong is often assisted by Dr. Toni Zhong, plastic surgery resident at the University of Western Ontario. But the teams shift and flow changing members and trading techniques.

Two operating room nurses from the Credit Valley Hospital, Cecilia Cheng and Brenda Barnes, add their expertise to local nursing staff.

Arthur Uyeyama and Kevin Dimitroff, the audio visual team from Credit Valley Hospital are documenting the mission with video and stills.

Kevin and Arthur

They have been here before and I am following their lead, riding on the coattails of the goodwill they have built up with the staff here. As a result, I have been given carte blanche access, following the doctors on their initial rounds and wandering in and out of the operating theatres at will. Sometimes I will follow one of the children being wheeled out of the operating room and down the long dark hall to where anxious parents are waiting. I'm trying to capture the joy of that first moment when they see their children's new faces, but I am admittedly a little too intimidating in scrubs and O.R. gear. Being 6-foot plus, obviously foreign and with the only grey hair and goatee in sight, doesn't help.

They openly gawk at me. I can see them try to avert their eyes but they can't help themselves and just keep staring. I'm reluctant to go into the wards by myself because when they see me parents stand up, clutching their hands together, as if I might have the power to decide who goes next. I need a big sign that says "I am not a doctor".

Nurses and Gurney

But I go anyway, following the gurneys or, in the case of smaller infants, following a blanket-wrapped medical cart. The patients are lifted into their beds. Nurses roll large oxygen tanks into the room and fashion simple cone masks from a piece of paper.

I take pictures of it all. The hard part is trying to identify the patients in my photos. I have a system. I just start talking to the nearest nurse, who will scurry off to find a staffer that speaks some English - usually Helen - and she reads the name off the chart to me, sounding it out several times. Between the two of us we guess or invent the spelling.

You can only take so many operating room pictures. The ward is where the story is. The anxious moments before, the worry, the wait. And the exhilaration and relief of the parents after, when they finally see a chance for their children's future.

Tomorrow, who knows? Maybe another 200 photos.

Click to read:
Dispatches from the Orient, part III