- Donald R. Laub, M.D.
Living My Ecuadorian Dream: Palacios Part II
Updated: Nov 14, 2018
Based on an interview conducted with Dr. Palacios by Anne Oh, a student of Stanford Course Surgery 150: Principles and Practice of International Humanitarian Surgery
I went off and did my residential program in a year, and after that I had to wait. I didn’t find the scholarship for the plastic surgery training so I had to wait. But I understood that I wanted to do plastic surgery. I spent my time in the jungle. Six years passed because I was doing three years in general surgery residence and two years as chief resident, and one year as chief of emergencies. But I had no opportunity to go outside the country to do plastic surgery.
Finally, Dr. Malbec of Argentina came to Ecuador to give a lecture in the hospital, so I went to talk to him. After I made the connection, I was finally able to start my training in plastic surgery. I went to Argentina to do my training there. I was so lucky. Sometimes life gives you opportunities, and you must be ready to catch them. It was during these studies that I tried to connect with Dr. Laub. As I mentioned previously, I was referred to him by a childhood friend. I did not get a chance to meet him until we coordinated an Interplast trip to Quito after my return as a plastic surgeon. Dr. Laub and Dibbell taught me the value of facial reconstructive surgery for cleft lip patients.
When I came back to my country and the hospital, the Hospital General Luis Veneza in Ecuador, and their big hospital there there was the director with another boss of the organization because it did not belong to the government. It belonged to a charity foundation that was very powerful because it owned the lottery, the national lottery. They had the national hospital, the gynecology hospital, maternity hospital, children’s hospital, the best children’s hospital on the west coast of South America, a modern hospital. One of them was my professor when I was a resident in the hospital. He called me and said, “Jorge, we need to create a department of plastic surgery in the Hospital Luis Vernaza. So I think that you could do this.” There were two other plastic surgeons around, but they didn’t work for the hospital, they only came when there was a patient who would pay.
I was a bit nervous, and these two doctors had been there before me. I thought I should have a bit more time in the hospital before having such a responsibility. I went to speak with them and get their opinion. They were not interested. They only treated people who could pay. So I said, “Okay,” and I told him, “I do not want to be chief. I want to be friends who work together in a program.” But they said, “No no no no no.” And they said, “Okay, you go ahead and you create your program.”
So I began to work alone. Nobody. No resident. No intern. Nobody. And I began to see the patients, burn patients. There were at that time children staying in the hospital, so I began to see many other things. And I saw there were patients who needed care for burns. The way the hospital was, the burn patient wasn’t taken care of. They put him in a bed with a mosquito net, because the mosquitos always came because it was very hot, and the nuns, only the nuns, on Saturday would come and clean. So I began to think about all that. About teaching them how to do it, because I had learned about that in Argentina. So that begins another part of the story.
I had a patient who came to me from another hospital. He was a burn victim so I did a skin graft and asked him to return in three weeks for additional surgeries. The guy disappeared. Next time I see him he is on TV asking for money to pay for the surgeries. There was no charge for the surgeries. People sent him money and he drank it away. He was a drunk.
So I called the newsman about the program, how we give the people this opportunity and some of them didn’t use it very well. So that night he invited me to talk about it. One lady called me the next day. She wanted to talk with me just to help in my ideas about creating a program to help the poor. We created the Foundation Para Los Quemados, Foundation for the Burned. And the lady, in order to get funds, created the first burn unit in the hospital. So finally we created the first burn unit in the Luis Vernaza Hospital. I am talking about 1986.
I was finally doing what I wanted to do, but I still faced a few struggles on my path. I was not admitted to the PRS Professional Society of Ecuador because I was consorting with the gringos. I had allowed Dr. Laub and his Interplast group to enter the country and repair cleft lips. The elites of the surgery society believed this reflected poorly on the work they were doing. It was their county, and they would fix the cleft lips. Jealousy happened. Dr. Jorge Bracho was the president of the society, as well as the cleft lip surgeon. He did not appreciate the gringos on his turf.
Thankfully, women have incredible influence. My wife, Miss Ecuador, knew the
president of Ecuador’s wife. President Fabres was influenced to award the highest medal of Ecuador, the Medal of Merit, to Interplast for performing over 2500 free surgeries. Dr. Bracho was tasked with placing the medal on Dr. Laub. This piece of humble pie motivated Dr. Bracho to accept me into the society of plastic surgeons. I eventually became president of the Ecuadorian Society of Plastic Surgeons, and we brought high level surgeons from all areas of the world to Ecuador for wonderful surgery symposia.
Dr. Laub and his team returned to Ecuador, to Guayaquil, to participate in the symposia. In the spirit of inclusivity we included North American, South American and Caribbean plastic and reconstructive surgery societies. Each society was represented by delegates. Even Dr. Orticochea attended. He gave a presentation to over 250 eager listeners regarding a breakthrough sphincter construction he invented. It was a wonderful opportunity to host these brilliant minds in camaraderie.
When I make a resume of what I do with my time, I understand that yes, we must do cosmetic surgery because it’s the only way to get resources to live, to have my income. This is called the Robin Hood Theory: obtain the finances from the rich by which you help the poor. Because that’s the surgery you do in the hospital. That’s the challenge, to work and to do, and to prove that I came to do this. It is an excellent example for the cosmetic patients of the humanitarian aspect of our work. It also is a beautiful demonstration to the cosmetic patients that “their doctor” has the sensitivities to help the others in the country who do not have access