Plastic Surgeons Making a Difference

Plastic surgeons are commonly thought to practice a vain type of medicine. Similarly, plastic surgery patients are considered to be superficial. However, this is not the whole story. While it is true that people seek plastic surgery to alter their cosmetic appearance, some seek it to help restore function to bodily parts that have been damaged. Plastic surgeons can make a profound difference in people’s lives.

Dr. Jeffrey Hammoudeh of Children’s Hospital Los Angeles is one such plastic surgeon. He and Amel Najjar head the Children of War (CoW) foundation, an organization that helps children of war torn areas receive medical care. CoW helped a young Afghani, Abdul, in 2010. He suffered major injuries from a rocket blast.

Sam Habernathy of Rhinoplasty Surgeons interviewed Dr. Hammoudeh about his work with CoW and Abdul.

Rhinoplasty Surgeons: Children of War is an organization that facilitates medical care for children of war torn areas. Did you expect to be doing this type of work when you first got into medicine?

Dr. Hammoudeh: Working with children from war torn areas is something that when I started medical school really was not on the radar. You know, when you go to medical school, you’re just thinking about trying to find a career that can have the most meaningful impact and, you know, you have certain versions, but they don’t really come into fruition until you finish medical school, finish residency, and then actually start working in whatever field.

And so, I would say for Children of War Foundation, that was long after Medical School. Probably two to three years after residency completed, and that’s when the vision of Children of War Foundation really had its inception.

RS: About that moment of inception, what was that defining moment? Can you elaborate on that story?

DH: I just finished residency and fellowship training. It was my wife and I. We were still living kind of in a small one-bedroom apartment and we were looking for ways to really, you know, have an impact, a more meaningful impact than our day-to-day routine. And what happened was there was this kid in the Middle East that was a victim of one of the conflicts, and my wife was trying to get the child here to the United States for treatment. And it started essentially with just an idea of how do we get this child from the Middle East to the US to undergo care.

From there, we really started to spawn the Children of War Foundation, because just by trial and error we realized the challenges that come with trying to bring a child from a foreign country internationally to the United States. Visas. The politics. The finances. And you really needed an infrastructure to do it. So, we were actually unsuccessful in getting that first child here, but we were successful in really setting our foundation and an infrastructure for the organization, which essentially came about to be Children of War Foundation.

And so, even though we weren’t able as an entity to provide care for that child, that child essentially got care with another organization, but what that brought to us was, like I said, the foundation to develop the organizational skills, the connections, and really the infrastructure to be able to run an organization.

RS: And one of the children I read about that Children of War was able to help was Abdul.

DH: Right.

RS: I was wondering what the specifics of his story are and what kind of procedures he needed.

DH: Well, Abdul. I actually just had dinner with one his orthopedic surgeons. Just finished with that meeting. You know, Abdul’s story is a dichotomy of sadness and, on the other side, success. Kind of the face of, you know, conflict and, at the same time, on the opposite end, you know, how you could take a very unfortunate situation and try to make the best of it. Essentially his injuries were from a rocket blast, where he lost his lower extremity, and it was – like I said, his life was saved, you know, by one of the US soldiers that was there, and then they took him in, in Afghanistan, into the green zone. Provided, you know, urgent care, emergent care, stabilized him, and then really just kind of left with: “Okay, now what? What do we do?” You know, they’re in a war zone. They stabilized the child, and so that soldier kind of took upon herself to try to reach out to as many organizations as possible to see what can we do for that child.

And so, she eventually got a hold of Amel Najjar who is our Chief Executive Officer. I mean that kind of started the ball rolling, and now you enter the logistics, the politics, the finances, and we were – essentially, to make a long story short, we were able to overcome a fair amount and really secure funding, support, and care for him to come to the United States. And he eventually got a – he had an above-the-knee amputation, which really – you really are looking at a disarticulation or removal of the entire leg and really being wheelchair-bound or essentially walking with one leg and a prosthetic for the rest of your life.

So, he came here and ended up seeing the orthopedists, the plastic surgeons at Shriners Los Angeles. Ended up getting a procedure that would allow for stretching of the residual bone stuff. And then, after it got stretched, it was made long enough to support a prosthetic, so he could actually walk. And that whole process I would say has been probably a year of treatment, probably close to four to five operations, and he’s doing phenomenally well at this point. And now we’re in the process of starting to get the ball rolling to reintegrate the children, or for Abdul, back into Afghanistan.

So, it’s a process of getting him here. There’s a psychological process, a social process, adaptation, schooling, and that is just one small part. And then you’ve got the operations. In the meantime, they learn English. They make friends here. And now you’ve got to start the readaptation and the reintegration process back to get them back home.

RS: And there’s no way to reintegrate him into the US? Is that an impossibility?

DH: Yeah. I mean yes, there is, but you know, for him to stay in the United States, you know, in the Afghan culture, he’s got a dad back in Afghanistan. His dad would like him back.

RS: No, of course.

DH: So, is there a process? Sure, there is a process, but the laws are quite complicated and you have to be respectful of the Afghan culture as well. It’s not like you could say, “Okay, we want to put Abdul and let’s see if a family will adopt him in the United States.” You know, that is counterintuitive, counterproductive in terms of his culture, his family. So, is there a risk of going back to Afghanistan? Absolutely, there’s no doubt about it. It’s still not a secure, safe place that we would want our children growing up in and living out the rest of their lives, but you know, the reality is, is that he’s got a dad back there and he needs to get back.

RS: I absolutely understand.

DH: Yeah.

RS: There’s a kind of like an internal sort of struggle, where on the one hand, you recognize that it’s a dangerous situation for him to reintegrate into, but on the other, he’s got a dad and he’s got a family.

DH: Yeah, it’s a huge, huge struggle when it comes time to leave on both ends for the kids, for our staff, for the organization, because you bond with these children. They’ve been here for a year, a year plus, and now it’s time to go back. But in reality, it is a good thing for them to be reunited with their family. And it’s not like the opportunity is not there for them to come back. The opportunities for Abdul to come back for prosthetic revisions, to replace his prosthesis, for further rehab – the door is open. And if, at some point, he decides he wants to attend, say, high school or college in the United States, I think that door is always open, but that needs to come as a family decision and not us making the decision that will make us happy and say, “Okay, we brought kids out of the war zone. We treated them and we’re going to keep them here in the United States,” because that really isn’t.

That would be more selfish on our part, and so we have to take on a risk as well of saying, “Wow, you know, we could do all this work and these children can go back,” and the reality is they can be injured again. They could die, but that’s really – you know, that’s part of it and you have to accept that when you decide to bring kids here for care.

RS: And I suppose the sort of nice thing in a way – I know this sounds strange, but there’s so many other children that need help.

DH: It’s a bittersweet situation.

RS: Yeah, exactly.

DH: He’s going to go back and he’s going to say, you know, “I met a lot of people in the United States,” and I think the perception isn’t what we think the perception is. So, it’s a learning process for us and it’s a learning process for him, and he’ll go back and he’ll tell people, you know, “I went to soccer games. I went to baseball games. I went to Disney.” And so, you know, it’s definitely positive from our end and as well as from his side that he had this experience and he’ll be able to share it, but I suspect he’ll be back at some point at least for revisions or secondary reconstruction, and I think he’s, you know, slated.

It may be a year from now, where he’ll come back.

RS: Great.

DH: Is there going to be a time where, if he does well enough in school or if he has a sponsor here, he has an opportunity to go to college here, that would be great. I think that would be phenomenal, but it has to be done down a systematic approach and a family decision versus what we think is best for you, Abdul, or whoever the child is.

RS: Absolutely. Absolutely. Can you tell me specifically on the plastic surgery end what procedures, what operations were there plastic surgery-wise for Abdul?

DH: For Abdul, he had local flaps. He had plastic and orthopedic procedures, and most of them were orthopedic. A process called distraction osteogenesis for actually taking the stump of bone that was remaining and making it longer so it could support a prosthetic. Otherwise, you would have to do what’s called a hip disarticulation or just remove the entire leg as well, up into the hip. And so, his left foot and left leg were shattered as well, so now you’ve got someone who essentially is not ambulatory.

When he came here, actually just came in a wheelchair. He was non-ambulatory. Now he’ll leave here, walking. So, you know.

RS: It’s amazing.

DH: His procedures were mostly orthopedic, getting a treadmill out. Distraction of the leg.

RS: Did you operate on him?

DH: No, my partners did.

RS: Okay.

DH: My partners, but then that’s part of the thing in these organizations. You know, you can’t be selfish about them. Everyone has to do their role. And sometimes I will operate on children. Sometimes I’ll be involved in the process of getting them here. Everyone’s got a role in the organization and everyone does that role very well and we stick to it. So, if I was going to operate on every child that we brought here, then, you know, the children just wouldn’t be getting the most optimal care.

So, we bring them here and we say, “Who’s best suited to do the orthopedic procedure? What institution? What doctor? What team can we build around this child?” And if it’s a plastic procedure that I do, then it’s great. Then we do it, but if it’s mostly orthopedic or urologic reconstruction, neurosurgical, prosthetic eye, we help build a team around the patient.

RS: This is an amazing story. Thank you for your time, Dr. Hammoudeh.

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