April 24, 2001
Magic scalpels versus bad spells Prof Dr Narong Nimsakul, pillar of Smile Thai Operation Project, is working hard at giving a new life to people born with congenital deformities. Picture by SOMKID CHAIJITVANIT Being born with the congenital defect that is a cleft lip or palate does more than disfigure the face-those afflicted often suffer lives of torment and social exclusion-but one doctor is dedicated to repairing the damage Story By Wanphen Sreshthaputra Aged 19, Wa, is a shy yet appearance-conscious teenage girl. A first-year student of Ramkhamhaeng University's Faculty of Arts, she still can't get over the fact that a few boys have a crush on her. It is unbelievable to her because her life so far has been a tough struggle and trying to attract boys was the least of her worries. Wa (her nickname) was born with a cleft lip and it is only recently that she started enjoying life; precisely after undergoing reconstructive surgery and being given a new face. Not a stunning new look relying heavily on implants, peels or liposuction but simply her true face, devoid of the congenital deformity which caused her so much suffering since birth. "I had no self-confidence. I was always ill-at-ease and would never dare to speak. Throughout my life, I have had very few friends and used to plague my mother, asking her why did you make me like this?" remembers Wa, under the gaze of her mother's melting eyes. "Most of the time, strangers would laugh at her and that would make Wa very angry or rather, very sad," said her mother. "I would not even dare to look for a job. Once I presented myself for a position in a fast-food company and they told me blatantly: 'We don't take people with a face such as yours,"' Wa remembers with understandable bitterness. Hopefully, all these tortured feelings now belong to the past, a tiny scar on Wa's upper lip being the last vestige of those nightmarish days. Last year, Wa, having heard about the Smile Thai Operation Project (Stop) from a television programme, was referred to Prof Dr Narong Nimsakul, the director of the Institute of Modern Medicine, President of Thailand's Anti-Ageing Society, President of the Pacific Society for Laser Medicine & Surgery and pillar of the Stop programme. Like some 100 or so patients who have so far benefited from the project, Wa enjoyed free-of-charge corrective surgery provided by Prof Narong and a team of plastic surgeons, anaesthetists, nurses and handful of other volunteers. All of them-and invariably Dr Narong-devote a few days per month to charity work at Decha Hospital on Sri Ayutthaya Road-an establishment which charges the modest price of 5,000 baht for use of the operating theatre. Inspired by HRH the Princess Mother's mobile clinics which operated a lot in the Isaan region some 20 years ago, particularly on patients affected by chronic infections of the middle ear, a disease that can lead to deafness and requires very complicated micro-surgery, Smile Thai Operation Project carried its first operation on April 3, 2000 to mark the 100th birthday of the Princess Mother. But the starting point of the project goes back much further. Apart from Dr Narong's altruism, Stop is the outcome of years of experience in providing free medical service to the rural poor; often in collaboration with Dr Salayawet Lekakul and the Rural ENT Foundation, with the Foundation of Medical Research and Handicapped Persons (Forhap) or Duang Kaew Foundation. "Over the years, I have seen that in Bangkok itself, as many families have come to the city from rural areas, there were many unfortunate children suffering from severe deformities. Sometimes, their disfigurement is linked to the poor standard of the reconstructive surgery they underwent earlier," said Dr Narong, born the fourth among seven children in a modest Chiang Mai family. Having strived to pursue higher education in Bangkok and then overseas, Dr Narong ended up spending 32 years of his life in Japan, as a student of Chiba University's School of Medicine and Yokohama City University Hospital and later as the head of a modern clinic for reconstructive surgery, equipped with the latest laser medical tools and devices. These years made a lasting impression on Dr Narong's life, who is known to his many Japanese patients as "Dr Rambo". "Japan has a very good and unique policy as far as such types of inflictions are concerned. It is one of the only countries in the world to offer such an assurance that people born with deformities, regardless of their financial background, are entitled to undergo reconstructive surgery in the hospital of their choice-whether private or public-billing the government for the cost," Dr Narong explained, who carried out many such charitable operations in Japan, as well as in Vietnam and the Philippines. Returning to his native Thailand in the year 1976, Dr Narong used Japan's generous medical coverage ethos as a model and great source of inspiration for his scheme. "We care about quality and aim to perform perfect work. I discovered in Thailand that patients from poor families have mostly undergone poor quality surgery, their cleft lip or cleft palates closed in a rush and left looking very bad. Only rich patients can afford a well-done surgical operation," Dr Narong said. "My belief is that whatever the type of operation, be it for charity or not, plastic surgeons have to do perfect work." Dr Narong has truly set his heart on this precise goal, all the more impressive in that corrective surgery is "much more difficult and challenging than cosmetic surgery", but the most rewarding, if one believes the practitioner. "By correcting patients' facial anomalies, we are giving them back a normal life, even a new life. In some cases of male patients, we are giving them the chance to be ordained monks, within just a single operation. This is a great way of making merit!" comments Dr Narong, encouraging kind souls to volunteer for the association. Having been reared with the dream of becoming a soldier in uniform-embodying the values of power and honour-Dr Narong has found the same values in a different guise. By simply wanting to come to the rescue of children and adults born with deformities, he also takes on age-old, deeply rooted attitudes and beliefs. Top: Taladon, nicknamed Pop was born with a double cleft lip and underwent surgery under the Stop programme. "Some 10 years ago, among hilltribe people in northern regions such as Phanga and Mae Hong Son, a mother giving birth to a child with such a malformation would be asked to throw her baby into a ravine. She would also be forbidden to talk to other villagers for a period of 100 days, as a punishment for having brought 'evil' into the village," explained Dr Narong. He emphasised that it took around five years to weaken this belief in Thailand, which is still rooted in some areas of Africa and India, and convince remote communities of the validity of corrective surgery. By now, the work accomplished has borne fruit. When surgeons of the Smile Thai Operation Project visit the remotest areas of Thailand, it is not rare to see people camping out around the hospital, or "walking for two days in a row" to benefit from the gracious treatment. In Kanchanaburi last year, Dr Narong and three other surgeons took turns around the operating table for two days, providing surgery for some 60 patients. "Those kids would have to endure the torment of congenital disfiguration for the rest of their lives, but it doesn't have to be that way. Whoever comes across children or adults with severe malformations should get in touch with me," said the tireless doctor, whose income is mainly generated by the practice of cosmetic surgery in his private clinic in Sukhotai Mansion, Sawankalok Road. In the muffled and sterile atmosphere of the operating theatre, lying asleep under a handful of assiduous practitioners in green coats, Chachanop, 21 years old, is undergoing reconstructive surgery. Above: Pop, now 11 months old, completely recovered, is seen in the arms of his mother. In the room next door, a couple of young parents, Nantiya and Niphon from Sakhon Nakhon province, watch lovingly over their dosing one-year-old child.. A few months earlier, the little boy, nicknamed Pop, underwent surgery for a double cleft lip. "I got a shock when I saw him first, at birth. But I got used to it and never thought he could look different," explained his shy young mother. But things are different now. Thanks to the good doctor, their baby is spared the painful prejudices people with cleft lips must suffer. "This is my way of giving back something to society," said Dr Narong. The nature of the problem In the early weeks of development, long before a child is born, the right and left sides of the lip and the roof of the mouth normally grow together. Occasionally however-in about one of every 2,500 babies in Thailand according to Dr Narong Nimsakul, those sections don't quite meet. A child born with a separation in the upper lip is said to have a cleft lip. A similar birth defect in the roof of the mouth, is called a cleft palate. Since the lip and the palate develop separately, it is possible for a child to have a cleft lip, a cleft palate, or variations of both. A cleft lip can range in severity from a slight notch in the red part of the upper lip, to a complete separation of the lip extending into the nose. Clefts can occur on one or both sides of the upper lip. First surgery is recommended after the child is 12 weeks old. According to information supplied by Dr Narong, 15 to 20 percent of cases have unknown causes, while heredity accounts for 20 percent of the cases and inappropriate use of drugs and medicine (ingested by the pregnant lady) for 30 percent. Info for donations: - Name of organisation: Smile Thai Operation Project - Address: Decha Hospital - Contact: Marketing Department - Tel: (02) 246-01-37 - Fax: (02) 247-2089 - Savings Account: At Bangkok Bank, Warachak Branch, account number 121-0-41 353-8, in the name of Miss Tipavadee Upaty for Smile Thai Operation Project Or send a cheque payable to the Post Publishing Public Company Limited. Address it to Kusuma Mintakhin, (mentioning the Smile Thai Operation Project) Editorial Manager, 136 Na Ranong Road, off Sunthorn Kosa, Klong Toey, Bangkok 10110. Her telephone number is 240-3700 ext 3224-5. Please include your name and address with your cheque so we can send you a receipt. - "We care" is a fortnightly series honouring people who believe in giving. In addition to supporting these causes, you can let us know about people who unselfishly help others so we can make more people aware of their efforts. Fax "We care" on 240-3668 or call 240-3700 ext 3208 or 3212. 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