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  • Donald R. Laub, M.D.

Spreading my Ecuadorian Dream: Palacios Part III

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

Post-op burn grafty

Looking back I don’t know how we did it because we had nothing. We had nurses, who were high school students in uniform. They did the cleaning and putting on bandages. We all had to get in the shower together to clean the burn victims because we did not have a “Hubbard” treatment tub. Now it is like an American burn unit, state of the art. What we did have we paid for by advertising during every major event in the city. We asked the people of the city to donate. We also had an influential supporter. The nephew of the president had a prominent position in government and he designated an amount, 7% of every cultural event ticket in Guayaquil, to help the burn patients in the hospital. So with that we made the burn unit. And after the hospital, he saw all this and said, “You can, you must help the burn patients because the patients belong to the hospital.” Then we received a donation of land from the people.

We built the burn unit as part of the hospital and they provided medicine for the patients. We made an agreement that they would nominate me as the director, to be paid through the foundation. But I never charged the foundation because they had no money. And the people who really wanted to work with me applied and they came to work in the burn unit for free. My private surgery helped just to pay an intensive care doctor and chief nurse there. Other than that, no doctors charged anything.

The years passed this way, and eventually I did surgery on a prominent lady in the city, whose husband was a permanent guy in the junta. She respected me a lot and she said, “Jorge, they have annually an event for the debutantes, the girls, and they do this for the city and they get a lot of money. We want to help you and your burn unit. We decided you won, and that is right now.”

So the hospital gave me another responsibility, to be the chief of the traditional plastic surgery department. One of the things that now we wanted was to create a burn center. The burn center would be much bigger, allowing us to treat more than 10 patients. The new burn center would include ten beds for acute burns, intensive care burns, for kids, women, and men. Then there is the intermediate area with five beds, for those patients who are beyond primary attention and are ready for grafts. This is their second place. And there is another operating room, so this is where we grafted and patients can stay there ten days more or less. Then they may move to the advanced treatment area, where there is another surgery room. They will be taking care of those patients whose grafts are really weeping, and those new patients with sequelae. So that needs twenty beds.

To accomplish this, we did an agreement with a corporation, a big corporation that wanted to buy a piece of land. We didn’t want to sell, but we came up with a 20 year agreement. Part of the land will include the burn center, the other part will be their store. We had the land and the space, but still needed the people and equipments: patients, monitors, respirators, lab equipment, means for arterial gases, beds, clinicians, surgery instruments. The burn unit materials would stay at the hospital, so we had under 2 years to collect everything. The burn unit would stay open in the hospital, and the government would pay us to train them.

Out vision was to create various treatment options for different levels of burns. Staff palacios quotefrom the burn unit would monitor burns in the community, if needed they would treat burns at the hospital, and if the case is very serious send the patient to the burn center. The hospital burn unit would be funded by the government, while the burn center would be funded by local enterprises. We went to the bean company, the oil companies, El Cemento Nacional companies and other big corporations and made the case that this was part of their responsibility to the community. We put together a big budget and presented to each. Next, we built a cleft lip center on the land. It shared one operating room with the burn sequelae patients and had another of its own. The center included surgery, speech therapy, nurses, orthodontics, and orthognathic surgery.

We created the need, we created the dream, then we began to walk, to run towards it. We opened doors, and found more closed doors and kept going in spite of it all. It’s the coincidence by God that helped us achieve everything. The burn unit was the first step. It felt impossible, but it was the first step in creating this system, before I even knew the system was needed. I look back now and can’t believe I took all those steps.”

The teaching program is a key part of the system we created. The students need to believe that things are possible as well. Many of them say I inspired them to go out of the country and pursue more education. Every time they do this it’s incredibly difficult because they didn’t have the money, it was too expensive. So I said to one of my former residents, “We must help the residents. They are the new doctors, they are people with skills. We may be wasting resources if they can’t go outside. I don’t want them to be only part of that kind of plastic surgery.” And they never are. So we decided to create a first postgraduate program in plastic surgery at the Catholic University.

I interview all the students in order to get a sense of how they work. Each one of them wants to help, they just don’t know how. All 3 levels of students travel. The first year residents are going just to see how things are. They begin to understand about poverty and why we are going. The second year residents have seen the poverty and they feel it more in the gut; now they are learning and working hard. At third year level they do the surgeries. The purpose being to created motivated people before they practice the surgery. They must understand the principles, concepts, and motivation to really understand how to do it. We teach them through lectures.They must also do free burn surgeries for a specified period after graduation.

Our students graduate and receive the best positions because they are very skilled and motivated people. That is what we wanted. They are respected in their community. They are signing contracts even before they are graduated because they are very good. Many of them go to the Roberto Gilbert Children’s Hospital which now also has a burn unit. Then they asked me to be the Chief of Plastic Surgery Department at the hospital. I accepted, but only if they would let me bring my own people. I stay a few hours a day and do the most difficult cases.

Most people think that plastic surgery is frivolous; it is only to gain money, only to do breast implants or face lifting. It’s true that is part of it. I survive from that but I also gain the resources in order to do the other things, to achieve the dream.


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