It was just about noon on April 25, 2015, when the earth split open in Nepal.
A 7.8 magnitude earthquake erupted from a stressed fault line five miles below the surface and shook the South Asian nation for 50 seconds. In that time, the densely packed capital of Kathmandu crumbled into itself. Country villages set against mountainsides sunk into nothingness instantly and wordlessly – each one a small Atlantis. The human tolls were staggering: nearly 9,000 dead, 22,000 injured and 3.5 million left homeless.
Eight thousand miles away, Dr. Pravin Dugel was asleep in his Phoenix home. When he woke up the next morning, a Saturday, the texts came like aftershocks, every few minutes. Did he see the news? Is his family OK? What happened? It wasn’t until he turned the television on to CNN that he faced the sobering facts. And then he realized what he had to do.
“I’m going,” the board-certified ophthalmologist recalls thinking to himself.
The next few days were a blur of travel and preparation as Dugel assembled a trauma team that would make the pilgrimage to what remained of Kathmandu. It was not his first time in the city, located 100 miles southwest of Mount Everest in the foothills of the Himalayas. Dugel was born in Nepal and lived there before fleeing to London with his family when he was 4. Later, the refugee family moved to America.
Even before his wheels touched down in Nepal in 2015, Dugel couldn’t take his eyes off the C-130 relief planes swarming the Tribhuvan International Airport like honeybees. It was the first of many visions from the trip he would not be able to forget.
Dugel belongs to a select, selfless breed of Valley physicians who leave our desert metropolis for small tropical towns and mountain villages in search of even longer hours, more challenging cases and more rewarding work.
No precise annual data exists on how many American doctors volunteer their medical expertise abroad, but they number in the thousands, and the trend has been rising for decades. A 2007 article in the Journal of the Association of American Medical Colleges noted that the number of medical students who had an international health experience grew from 6 percent in 1978 to 22 percent in 2004. More than 3,000 doctors from multiple countries volunteer through Doctors Without Borders alone every year.
Whatever their number, work abroad is unique for every doctor – some correct cleft lips and palates, others provide trauma care to car accident victims, more cure cataract-ridden vision. But there are rhythms to mission work that echo among them all.
First: Identify a region of need. Sadly, this is the easiest step. Earlier this decade, the National Intelligence Council identified more than two dozen countries with “unsuitable” medical care capabilities that “heavily depend on humanitarian organizations” for tertiary care – mostly in Africa, but also in Suriname, Haiti and other hemispheric neighbors. Dozens more countries received “poor” grades.
After months of planning, the doctors and their carefully selected teams arrive – an ark of doctors and nurses, of course, but also anesthesiologists, audiologists and technicians. Owing to cost and limited time away from their hospitals and practices, they usually have just one week to work. During the first day or two they screen hundreds of potential patients, some who have walked for days just for the small chance of care. Then begin the madcap surgical days, fitting in as many patients as possible. Their schedules are so packed with surgeries that they often begin at 7 a.m. or earlier and stretch on into the night. Then, almost as soon as they arrive, the teams fly back home – straight into the busy schedules of their normal practices.
They each return with memories alongside their physical souvenirs: a story of challenge and recovery packed next to a woven bracelet, a teaching moment tucked beneath a photograph of them with a patient in the ward.
“Every surgical trip there are going to be two or three stories,” Dr. Duane Pitt, a Scottsdale-based orthopedic surgeon, says. His practice at the Desert Institute for Spine Disorders, P.C., helps fund both a monthly, part-time practice in Bermuda as well as regular trips to the Dominican Republic through the nonprofit he collaboratively founded in 2010, the International Surgical Foundation.
Through the foundation, Pitt straightens spines bent over the years by scoliosis and tries to repair what he can of those broken in traumatic accidents, such as car crashes.
During his last trip to the Dominican Republic in September 2016, the orthopedist treated a young man who seemed, like a cat, to have nine lives. First, he happened to break his spine in a car accident right as Pitt’s team arrived on the island. That would have meant certain paralysis or even a death sentence on a typical afternoon in the Dominican; but now he had a chance. Following surgery, the patient survived a bacterial Klebsiella infection that swept through the contaminated hospital.
Months later in December, Pitt received a text message with an attached video. When Pitt opened it up on his phone, he was shocked: it was the same young man, once paraplegic, walking. And all without the aid of physical therapy or pain medication any stronger than Tylenol.
“We’re wimps [in the United States],” Pitt says with a laugh.
Years ago, Scottsdale-based plastic surgeon Dr. Lewis Albert Andres met a family in Colombia with a little girl with a cleft palate. Cleft lips and palates, besides hindering the ability to eat or speak, may leave a child shunned by society in many cultures – in this case, her father abandoned her, believing she was cursed. The girl’s mother walked and took buses through the Amazon to get care. Andres corrected the child’s cleft lip and, when he returned a year later to fix her cleft palate, the family made the journey again, this time with an additional member. Seeing her smile for the first time, the father re-entered his daughter’s life.
It was far from the first or last time Andres changed a child’s life. He first traveled abroad for a medical mission to Nicaragua as a resident in 2007 with Operation Smile, and continues to do so three or four times a year with various organizations. Over 30-odd trips, he’s completed at least 1,000 procedures, primarily repairing clefts on young children.
“The surgical part is the easy part. It’s really the treating these people that’s the most rewarding part of it,” Andres says. “It humbles me as a physician, as a person.”
Dr. Nick Morrison is also a long-time mercy doc. When he’s not correcting spider veins and painfully ulcerated skin lesions at the Morrison Vein Institute in Scottsdale, the vascular surgeon volunteers through the nonprofit he and his wife, registered nurse Terri, helped found in 1989, Amigos de Salud. The Morrisons travel to the coffee town of Matagalpa, Nicaragua, once a year with a team of about 30 volunteers. There, Dr. Morrison treats vascular ailments more severe than those he sees in the Valley – large, open sores and swollen veins that bleed and can cause one leg to outgrow the other. “We’ve seen some young patients with these venous malformations that are not only disfiguring but very impactful on their lives,” the physician says. “We’ve been able to... get them back to a more normal life.”
In two decades of international volunteer work, Morrison has seen things that would make a sailor weep. Fourteen years ago, working as a general surgeon, he treated a 5-year-old boy with fresh, hot burns so severe he was conscious yet not in pain, and beyond saving for Morrison’s team. But there has also been joy. In 1993, he treated a 9-year-old girl with a severe stoma – an opening through her abdomen to the intestines – created by an appendectomy gone wrong. With no access to ileostomy bags, the family substituted used grocery bags, resulting in infection. But Morrison was able to “put her back together again,” and before his eyes she turned around and recovered. In a hallway at the Morrison Vein Institute just outside his office there’s a photograph displayed of Morrison standing at her bedside.
Morrison’s trips to Matagalpa in the month of December – when the town “erupts” as coffee production kicks into high gear – are also pleasant and memorable. However, learning about the picking and roasting and packing of millions of pounds of coffee beans is solely an intellectual pleasure for the physician. “I don’t drink coffee,” he says.
Fresh off the plane in Kathmandu following the deadly Nepalese earthquake, Dugel would amass a few indelible memories of his own. By and by, his team met with Dr. Sanduk Ruit, the founder of the Himalayan Cataract Project. When Dugel goes abroad, it’s typically with this organization, which empowers him to perform dozens of corrective eye surgeries; and with Orbis International, through which he teaches local physicians in Vietnam, India and other countries ophthalmology techniques.
But this trip to Nepal was different. There would be no organized clinics or teaching hospitals. They were there to fill in wherever they were most needed.
The team trucked up mountain roads for eight hours in a convoy toward a rural aid outpost on the Nepal-Tibet border. At first, the drive was a peaceful reprieve from the chaotic ruins in Kathmandu. The weather was perfect. The countryside was pristine and silent. Dugel marveled at how far out into the distance he could see. Then it hit him. “You can see for miles and miles because there are no buildings. They’ve all been destroyed,” he recalls.
As they rolled up to the outpost, the team was met by dozens of people lined up on the side of the road in their most beautiful, brightly colored ensembles – they had grabbed their best clothes before escaping their collapsing homes. Among them were the most vulnerable, poor people in Nepal – many of whom had walked for days on broken legs and ruined backs to find food. Even still, the outpost was incredibly calm and orderly.
The realization hit Dugel like a sheet of ice: The stunning scenery set against the village and the serene disposition of the wounded was undercut by the distinct odor of human rot.
The team returned to Kathmandu. They slept in open spaces in tents every night, knives beside them in case they had to cut their way out, because they never knew when one of the 459 aftershocks that followed the quake would come.
On the afternoon of May 12, Dugel was wrapping up a surgery on the top floor of Ruit’s Tilganga Eye Hospital. Just before 1 p.m., Dugel was descending the stairs when the ground began to shake. An aftershock just .5 points lower than the original April 25 earthquake ripped through Kathmandu. Dugel rushed down the steps and out of the building as the hospital shook. Cracks cleaved their way through the walls and solar panels fell and shattered against the ground. But the hospital stood, compromised but not destroyed, and the patients were unharmed.
Escaping the Tilganga Eye Hospital on May 12 was as close to death as Dugel feels he’s ever been. He thought of his wife and daughters thousands of miles away. While hundreds more died in that single aftershock, Dugel believes the emotional toll of living for weeks on edge, besieged not by invading armies but by the earth beneath their very feet, struck people even harder.
“There’s a certain point when human beings realize we have no control,” he says. “And there’s nothing more terrifying than having no control whatsoever. People breaking down, and essentially just a situation where all hope, all control, all destiny has been lost.”
Later that night, everyone was on edge and surrounded by chaos. Dugel was surprised when their Nepalese host came to fetch his team. They followed their host to a relative’s house, where a small dinner party waited for them. The family had used whatever food they had to feed the volunteers, even finding beers.
“That says an enormous amount about the spirit there, which is that in the midst of this incredible disaster, where we should be looking after them, their main thought was, ‘What about our guests?’” he says.
“It’s a duty to go”
As a refugee and immigrant from Nepal, Dugel can’t imagine living anywhere without reaching out to a global community, and the choice to do pro bono relief work abroad was never a conscious one.
“It’s a difficult question for me to answer because it’s almost like [asking], ‘Why is it important to breathe?’” he says.
That need to give back and to connect is a common motivation among globetrotting M.D.s.
For Morrison, there’s no better way to empathize and understand a people and their culture than to render care to their patients. He estimates the trips cost anywhere between $75,000 and $100,000, some raised from donations but mostly from his own pocket – a chunk of change that could make quite the impact on its own, he acknowledges.
“You could still do a lot of good if you wrote a check, but that’s no fun for us,” he says.
For many volunteer docs, the dedication to service beyond the horizon is scripted in their genes. Whether they are first-generation Americans, immigrants or refugees, their connection to an ancestral homeland impels them to action.
Pitt says he was supposed to be a carpenter. Growing up on the island of Bermuda, he was the product of a family tree that included generations of accomplished woodworkers and boat builders. Though Pitt knew he wanted to work with his hands, he aspired to more than wood and nails. His grandfather told him about orthopedic surgery.
“Because our population here has access, because no one here has to go without emergency medical services, we basically have to focus our attention on places that have nothing or very little,” the first-generation American says. “It’s a duty to go.”
Andres is another first-generation American doc whose family history pulls him toward service – in this case, across the Pacific Ocean to the Philippines. Starting when he was a child, his parents would take the family back to perform general mission work after the island republic was hit by a regular typhoon or earthquake. The trips inspired him for the rest of his life. “We all take a responsibility to contribute what we can to help others and make the world a better place,” Andres says.
This dedication can land docs in uncomfortable or challenging situations off the operating table, such as navigating a country’s ethically unsound customs systems.
“When you go to these countries, corruption is always a problem,” Morrison says. His team once shipped a donated ambulance in a container packed with supplies before a mission. Once it hit customs, it was never seen again.
Pitt has also tangled with customs. When his team lands in the Dominican Republic, customs almost always wants money under the table before handing over essential tools. Most of the time, delivering on bribes means Pitt has to cancel one of his trip’s surgical days. Patients with serious spine issues have to wait until they return.
“It doesn’t matter that we may be operating on their own child or their friend’s child or their cousin, they hold things up for usually more than two days,” he says.
Now Pitt keeps as many instruments and fluids as possible permanently in the Dominican Republic in a rented condo with the A/C blasting year-round to limit the holdup as much as possible.
Not all Phoenix docs who do pro bono medical work cross borders to do so. Several serve those desperately in need of care right in our backyard.
Dr. Todd Hobgood, a Scottsdale-based plastic surgeon, lends his skills to local domestic violence victims through the American Board of Facial Plastic Surgery’s Face to Face program. He’s seen how domestic abuse can affect anyone, such as a physician who came to him with a collapsed cheek and broken eye socket that left her with double vision, unable to do her job and a daily reminder of her trauma.
“Every time they look in the mirror, every time they see that individual injury, it’s quite literally post-traumatic stress,” he says.
Dr. Joyce Bassett has brought her dentistry expertise for years to Central Arizona Shelter Services and the homeless men and women there who would never be able to afford dental care otherwise. Through the American Academy of Cosmetic Dentistry, she also helps domestic violence victims, reconstructing their smiles in more ways than one.
“When they’re done, they’re not the same,” she says.
When trauma in their home country pushes immigrants to seek asylum in the United States, their fate often falls on humans rights and immigration lawyers who establish what case there is, if any, for amnesty.
That’s where Tempe-based psychologist Dr. Libby Howell comes in. Working through HealthRight International, she drives down to Eloy Detention Center east of Casa Grande where she counsels detained migrants, usually young men fleeing gang violence in Central America, for several hours. Many have been beaten or had their faces lacerated for belonging to a rival gang, or being gay, or being a child from a previous marriage. Her psychological reports about the significance of their trauma may be the key to a new life.
“Their driven-ness oftentimes bowls me over, and the courage that many people have to live,” she says.
After surviving a major aftershock and more than a week of intense trauma care, Dugel had to face one last challenge: the Tribhuvan International Airport. Flights were getting canceled and planes grounded. The airport completely shut down. He wondered if soldiers leaving battlefields felt the same desperation he did to make it back to their families in one piece.
He didn’t stop worrying until the wheels left the runway and a broken but healing Nepal faded away. For the first time in days, after constant fear and anxiety, he felt relief.
Nevertheless, he says the trip did nothing to discourage him from working abroad. It only reaffirmed his commitment to a global community – now more than ever.
“As the political climate shifts, if there was ever a time to say, ‘Who are we? Where are we going? How do we affect humanity regardless of the field that we have chosen?’ Now is the time,” Dugel says.
And to him, there is no more intimate way to foster global connections than medicine. That doesn’t make it easy: Many physicians who are capable never move past talking about what they would do, Dugel says. The reasons to not go are innumerable – which make the people who follow through all the more impressive.
“I really do admire them, because what they’ve done is say, OK, I’m going to forego a significant amount of income. I’m going to go ahead and put in my own funds. I’m going to take a lot of time. I’m going to put myself in very uncomfortable situations, unfamiliar situations, possibly dangerous situations,” Dugel says. “But I’m going to do this because my belief for doing this is that strong.”
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