Oregonian Article: Hope, from halfway around the world

Posted by on Sep 30, 2007 in Press | Comments Off on Oregonian Article: Hope, from halfway around the world

NEWSPAPERS AND MEDIA

Hope, from halfway around the world

By Katy Muldoon

The Oregonian

Sunday, September 30, 2007
Edition: Sunrise, Section: Sunday Features (O!), Page O01

SUMMARY: A Washington doctor and his family, accustomed to working medical miracles overseas, go the extra mile to arrange a boy’s life-altering surgery in the U.S.

Dr. Joseph Clawson was between surgeries when his daughter, Jennifer Trubenbach, rushed into the operating room and demanded he follow her.

“You have to look at this boy,” she remembers telling her father, a semiretired physician from Longview, Wash.

That day one year ago, the 15-year-old boy had walked into Harare Central Hospital children’s ward in Zimbabwe’s capital. His head hung toward his chest. He proceeded slowly down a hall to where Clawson’s volunteer surgical group had set up temporary shop.

Trubenbach remembers the child’s eyes as sweet and intelligent. The rest of his face was a twisted mess of scar tissue.

Five years earlier, when he was 10, the boy inadvertently put an explosive –no one is sure if it was a land mine, a blasting cap or something else –into his mouth. It blew away part of his jaw, most of his teeth and his lips.

African surgeons tried to reconstruct his mouth using muscle from the boy’s stomach, but results were poor. He had difficulty eating and speaking. His school asked his mother to keep him at home because it was too upsetting for classmates to look at him. The child rarely went out in public because when he did, horrified stares followed.

Clawson examined him, then turned to his daughter.

“Lady,” Trubenbach remembers him telling her, “you raise the money, and we’ll get this done. We’ll get him to the States.”

* Clawson has an unruly mop of graying hair and the tanned, creased face of the 75-year-old farmer he is at heart. He’d have been one, too, but after growing up in Montana with parents who struggled to scratch out crops during the Depression, Clawson decided that college and medical school were a more reliable bet.

He specialized in general surgery, facial plastic surgery and otolaryngology, then set up his private practice in Longview, where a fellow physician had told him he was needed.

As a kid on the farm, he remembers, he figured out ways to repair nearly anything that broke. The same held true in the operating room. For the next two decades, Clawson corrected deformed face bones, fixed cleft lips and smoothed bad scars.

In the late 1980s, he frequently used his vacation time to travel with a missionary ship that had a small operating room. He’d perform free surgeries on desperate patients in poor countries. With another group, he traveled to Ecuador to repair cleft lips and palates among indigenous people where incidence of the deformity is high.

Back in Longview by the early 1990s, Clawson says, the paperwork and bureaucratic muck of mainstream U.S. medicine had taken all the fun out of it.

So he quit.

Clawson left private practice and formed Operation of Hope, his own nonreligious, nonpolitical medical mission. He persuaded facial surgeons, anesthesiologists, nurses, medical students and others to volunteer, and traveled repeatedly to Ecuador and other countries, mostly to repair cleft palates and cleft lips in infants and older children.

Cleft palates occur when the two plates of skull that form the hard palate, or roof of the mouth, are not joined. Cleft lip refers to gaps or indentations in the upper lip. The deformities show up in between 1 in 600 and 1 in 800 births. Genetics are a chief cause, but scientists are studying whether such environmental factors as a mother’s diet or pesticide exposure may play a role.

In the United States, babies with cleft palates or lips typically have reconstructive surgery in their first few months. But in countries where few surgeons have the expertise to repair clefts, children live with them. They routinely have trouble eating and speaking. They’re prone to ear disease. Their social skills and self-esteem suffer.

Clawson knew he could fill the niche, literally and figuratively. In the operating room, he could change the lives of four or five children every day –just what he had in mind when chose a life in medicine.

* Trubenbach, Clawson’s 48-year-old daughter who grew up in Longview, knew she had to choose her words as precisely as her father makes incisions. If she promised the boy she’d met that day in Zimbabwe too much, then couldn’t deliver, he’d be crushed.

The boy’s old wounds were too extensive to repair in Harare’s hospital, which was clean and efficient, but low on such basics as antibiotics and pain medication. Many of the strife-torn country’s doctors had fled –the reason Operation of Hope was there. Besides, this patient would require a surgeon with specific reconstructive experience. He might need two operations or more. Recovery would be long and painful.

“When I get home,” Trubenbach remembers telling the teen, “I’m going to do my best to see what we can do.”

Trubenbach had left a career as a consultant developing programs and processes for large companies when her daughter entered middle school. The job required too much travel; her family obligations, she says, trumped it.

Given her newfound free time and skills as a super organizer, her ever-persuasive father asked whether she could spend a few months streamlining Operation of Hope. Just as in his private practice, he hated the administrative side of his traveling medical show. If she could iron out schedules, coordinate plane and hotel reservations, find easier ways to transport medical supplies, push fundraising and other details –all as a volunteer –Clawson could stick to what he does best: surgery.

Trubenbach agreed. Seven years later, she’s still at it.

Trubenbach runs the nuts and bolts of the nonprofit’s twice-yearly foreign surgery missions from her home in a Southern California suburb. Last year, on an annual budget that runs between $75,000 and $130,000, she says, Operation of Hope performed 143 surgeries at no cost to the patients or their families. In the United States, a typical combined cleft lip and palate surgery runs about $80,000.

When she returned from Zimbabwe last fall, Trubenbach expanded her to-do list: She had to raise money, enlist a volunteer surgeon and generous medical center, and negotiate the diplomatic hurdles required to bring a boy from Africa to America.

His last name is Jefeti. His first, Beloved –named, in the tradition of his Shona people, after the emotion his mother felt the moment he was born.

* “Since I’ve gotten home,” Trubenbach says, “there wasn’t a day I didn’t think about him.”

Immediately, she searched online for surgeons who might take Beloved’s case at no charge. She e-mailed more than 60 doctors, asking if they could forward the request to anyone who might be up to the task.

Within two weeks, she heard from Dr. Keith Blackwell at UCLA Medical Center, not far from Trubenbach’s home in Lake Forest, Calif. She hooked him up with her father, and the two surgeons spoke at length about Beloved’s wounds and how Blackwell might approach the operations.

Clawson liked what he heard.

Blackwell agreed to operate for free, and the medical center would cover the cost of Beloved’s stay; the first surgery could take 10 hours, followed by five days in intensive-care. The boy could live with Trubenbach, her husband and 17-year-old daughter.

All Operation of Hope had to do was raise enough money to bring Beloved to the United States.

Trubenbach and her 45-year-old brother, Stephen Clawson, who handles Operation of Hope’s marketing through his Southeast Portland firm, did what they always do between medical missions: They shook the trees for money.

A fundraiser in Portland raised some cash, and the World Children’s Fund chipped in.

The money, about $7,000, was enough.

Trubenbach and the Clawsons, though, faced one more hurdle: They had to persuade Zimbabwe to let a 16-year-old boy travel outside the country with his mother’s blessing but without his father’s permission. Trubenbach says the father was disgraced when he couldn’t afford to pay for Beloved’s first surgery. He abandoned the family and was nowhere to be found.

* Trubenbach and her brother returned to Zimbabwe for two weeks last month. They coordinated X-rays and blood work for Beloved, then, determined to get the needed documents, camped out for four days at the passport office.

As she waited, Trubenbach recalls, she showed office workers a photo of Beloved and said, “This is why we need your help to get through to the gentleman who makes the decision.”

They were in.

The official was so moved by Beloved’s story, Trubenbach says, that he signed the documents as if he were the boy’s father and rushed through the passport.

On Oct. 3, the Clawsons, Trubenbach and their entire volunteer medical team will depart for this year’s surgical mission in Harare. The sprawling city of nearly 2 million once was Zimbabwe’s breadbasket. The jacaranda trees, Joseph Clawson says, still bloom brilliantly lavender, and the city retains much of the orderliness from its years as a British colony. But Harare and the nation struggle with one of the world’s highest inflation rates, rampant poverty, food shortages, joblessness and disease.

Clawson and his crew expect that the day they open for business in Harare Central Hospital, at least 500 families will line up, hoping that their children are among the approximately 100 neediest selected for surgery during the team’s stay.

As always, the most difficult part, Joseph Clawson says, will be telling the others: not this time.

The best part might be boarding a plane to come home with a boy who never has flown before.

Or it might be introducing Beloved to Trubenbach’s husband, daughter and mixed-breed dog –his new family during as much as year of surgeries and recovery to come.

Maybe it will be showing him to his new bedroom, so luxurious compared to the room where he and a handful of cousins sleep on a concrete floor in their spartan home.

But more likely, the best part will come down the road, after Beloved’s first surgery at UCLA, scheduled for Oct. 29. The swelling will subside and he’ll look in a mirror to see the results of his own operation of hope.

Katy Muldoon: 503-221-8526; katymuldoon@news.oregonian.com