Plastic surgeon Dr. Ron Gemberling has been a volunteer with Rotaplast International since 1999 and has helped more than a 100 children with cleft lips or palates in developing countries lead happier, healthier lives.
Photograph by George Sakkestad
From Tears to Smiles
Dr. Ron Gemberling is among the volunteers who travel the world to repair the faces of children with cleft lips and palates
By Kate Carter
Most parents would do anything to find the best possible medical care for a child born with a cleft lip or palate. Around here, they might choose plastic surgeon Ron Gemberling.
But in other areas of the world, where such deformities are more prevalent, many parents aren't in a position to either find or hire a Gemberling. So instead, once a year he goes to them.
Dr. Ron Gemberling, 54, volunteers for Rotaplast International. The nonprofit organization sends medical professionals to developing countries around the world to help repair the faces and lives of children who have cleft lips and palates. Gemberling, who lives in Saratoga and has private practices in San Jose and Lake Tahoe, says the work he does not only changes the lives of the patients he helps, but has changed his own as well.
"The most challenging thing I do in plastic surgery is this operation," he says. "Personally, it's the hardest work I do in medicine, but it's the most satisfying. What I'm able to do in an hour or two with my hands ... I'm able to see something tangible. The total experience keeps me coming back."
Photograph courtesy of Dr. Ron Gemberling
Ron Gemberling, right, joins his Maracaibo, Venezuela, operating room team with one of their young patients, post-surgery.
Hiding children
A cleft lip is a separation in the lip where the tissue didn't connect when the face was formed. A cleft palate is a separation in the palate, also occurring during gestation, that creates an opening between the mouth and nose. If untreated, these conditions can create a reduced ability to swallow food and speak and can present a greater risk of upper respiratory and ear problems.
In developing countries, a cleft lip or palate can also cause families to hide the affected children or even abandon them. Such children can be seen as sources of guilt in societies that interpret the condition as recompense for sins. Children with cleft lips or palates may have reduced access to already limited educational opportunities and can even be thought of as mentally retarded.
"It's like they're lepers," Gemberling says.
About 250,000 children worldwide are born with a cleft lip or palate--one every two minutes--Gemberling says. About 7,500 of them are born in the United States, and nearly all of those receive immediate and often free treatment valued at about $100,000 over the course of a lifetime.
About 13,000 of those births are in Latin America, and 25 to 30 percent of those babies will never receive any surgical correction in their lifetimes.
"It is an indigent problem," Gemberling says, explaining that, in those countries, there are fewer doctors skilled in and fewer facilities capable of treating cleft deformities. Almost none of those facilities can afford to provide free treatment to all the poor people who need it. "The countries don't always have financing. I've taken care of [Latin American] teenagers who've never had any treatment. You have to go to a foreign country to see how good we have it here."
That's where Rotaplast and other organizations like it, such as Peninsula-based Interplast, come in. Rotaplast, located in San Francisco, was founded by plastic surgeon Dr. Angelo Capozzi and Rotarian Peter Lagarias in 1992. It operated as part of the San Francisco Rotary Club, organizing one trip a year to La Serena, Chile. As it expanded and began taking more trips to other Latin American countries each year, it incorporated as its own nonprofit organization.
"These are pretty intense trips; they're not easy," says Rotaplast Executive Director Anita Stangl. "It's mind-boggling to see what talent these people have and how they're willing to share it. It's a huge gift of love."
The gift is so huge because cleft reconstructions are not simple procedures and, except for those in a few programs that provide the service, most U.S. plastic surgeons rarely perform the operation.
"In one trip, I'll do more than in three careers," Gemberling says.
And plastic surgeons are among the most extensively trained medical professionals, Stangl says, making their skills all the more rare and thus precious for Rotaplast. So the trick for the organization is finding plastic surgeons willing to take time away from their own work and practices--which can mean thousands of lost dollars for them--and spending it working long hours in often difficult conditions thousands of miles from home.
"I think it's pretty altruistic," Stangl says. "This does not add to [Gemberling's] coffers. To his emotional coffers, yes."
Because of that emotional deposit, as well as its extensive network of Rotary districts and clubs and publicity via word of mouth, Rotaplast hasn't had too much trouble finding those surgeons and the other medical and nonmedical volunteers it needs, she says. In fact, because so many have responded to the need, the organization has been able to expand its service. This year, as last year, there are 10 trips scheduled, and for the first time there will be several trips to Asia. Rotaplast has 14 trips scheduled for next year.
Gemberling has been on four trips with Rotaplast, one a year since 1999. He made a trip to Guatemala City, Guatemala, in March and has plans to join the organization's first-ever trip to Vietnam next March.
"He's really dedicated to Rotaplast," Stangl says. "He's a very, very talented reconstructive surgeon."
Gemberling started off participating in Interplast about 15 years ago, he says, and switched over to working for Rotaplast later on, a logical choice given his membership in the Saratoga Rotary Club.
"Part of our mission is not to do just something in the United States," he says. "I wanted to do something like this. This is a natural fit for me."
Sitting in his Bascom Avenue office, Gemberling is a focused and energetic man with a busy schedule--he has just come from surgery and is dressed in blue scrubs. He acknowledges the emotional nature of his Rotaplast work but seems to prefer explaining cleft deformities and how he and others like him work to fix them. He appears amazed by the almost magical procedures that can turn children with startling gaps in their lips and between their mouths and noses into healthy, beautiful children.
Cleft lips and palates arise during the first three months of pregnancy, particularly during the eighth and ninth weeks, when "all the little parts that are going to be the face are forming," Gemberling says. They occur when the lip and palate tissues either do not come together or do not stay together during that time, he says, and after that period is over, it's too late for the body to fix itself on its own.
Instead, doctors must perform reconstructive surgeries, like those done on other physical deformities, serious burns and mastectomies to rectify an unhealthy and physically unappealing situation. (Stangl notes that reconstructive surgery is more demanding and necessary than cosmetic surgery, which includes procedures like tummy tucks, facelifts and nose jobs.)
Plastic surgeons have developed several procedures for cleft lips and palates over the years, and more recent ones can create faces almost indiscernible from those born without the deformities, Gemberling says. One of those surgeons is Dr. Leonard Furlow, well-known in plastic surgery for developing a way to treat cleft palates. Furlow also participates in Rotaplast and is a member of its team, along with Gemberling and Rotaplast co-founder Capozzi.
Rotaplast recognizes the advantage of having such skilled plastic surgeons, and arranges for them to give lectures about cleft lip and palate reconstruction procedures--as well as the importance of volunteerism--when it uses teaching hospitals as facilities for its trips, Stangl says.
Rotaplast also has the world's largest collection of blood samples from people and families with cleft lips and palates, she says. The organization's geneticist takes samples on every trip, and last year she announced she had discovered a correlation between the deformities and a mutation on a particular gene that can inhibit the body's absorption of folic acid. Folic acid is necessary for lips and palates to form completely during gestation.
That data could help explain why between one in 250 and 350 children in Latin America are born with cleft deformities, while there are only about one in 800 in the United States and one in 550 in California. But there are many causes of cleft lips and palates, including bad nutrition and environmental pollution, and no one knows the exact source of the problem.
However, Gemberling says, he sees a direct connection between U.S.-funded and -supported oil and mining work done in Latin America, the pollution that it creates and the poor health of those he sees on his trips. When he went to Venezuela, he says, he visited a village that was home to many of his patients. He saw them bathing and washing in water polluted from a nearby Chevron oil excavation. Viewed that way, he says, the problem of cleft lips and palates can seem almost impossible to solve.
"It's the larger political and financial problem that I can't cure," Gemberling says. "We're just slowly trying to do what we can."
Photograph courtesy of Dr. Ron Gemberling
In addition to performing surgeries on his Rotaplast trips, Gemberling also takes the opportunity to teach local plastic surgeons cleft lip and palate repair procedures.
Making the trips
To that end, international teams--comprising plastic surgeons, nurses, pediatricians, a speech therapist, dentist, orthodontist and a bevy of nonmedical volunteers--head to locations where local Rotary clubs have requested Rotaplast's services. Rotaplast staff must confirm that the locations have the resources and medical facilities to host a visit.
"They have to be able to provide the resources that we need," Stangl says.
Each trip costs Rotaplast or the sponsoring U.S. Rotary organization about $40,000 for nondurable medical equipment--sutures, anesthesia and so on--and the transportation of the medical personnel. (Nonmedical volunteers pay their own way on the trips.)
The groups also bring about $150,000 worth of durable medical equipment--monitors and machines--that will return with the group.
But, Stangl says, each trip really costs about $60,000, a figure that includes the costs of office rental, staff and materials. Each trip also depends on contributions by the local hosting Rotary clubs, which handle all the in-country costs and organization. Rotaplast raises money through contribution campaigns, events and other outreach efforts to get the funding and support it needs, Stangl says, adding that trips are sometimes subsidized by Chevron and local oil companies.
Trips last 12 days, and team members wake early and go to bed late in order to have the time to complete all the necessary chores. The first thing they do is examine all the patients who have come from miles around to receive treatment.
"Many of them have spent their entire life savings just to come to the clinic," Gemberling says.
To receive surgery, patients must be in good health, so occasionally the team won't be able to treat someone.
"It's a sad thing to turn somebody away, but we don't want to hurt anybody," he says.
Once the team has assessed every patient, it then creates a schedule of operations, prioritizing the most severe cases and leaving less severe ones for later in case there isn't time to finish them all.
Then the surgeons go to work and try to complete as many of the cases as skillfully and efficiently as possible. Gemberling holds the organization's record of completing 39 surgeries in a single trip.
Meanwhile, patients receive attention from the speech therapist, dentist and orthodontist, who will help fix problems the surgery didn't and help patients learn to use their new mouths.
At the end of the trip, the doctors check their patients' progress, and then they leave. Rotaplast tries to return every year to the same sites so it can continue to follow patients' progress and provide additional treatment if necessary. But the connection is unlike that which doctors make with their patients in the United States, where they can monitor progress and assess complications more regularly.
Nevertheless, Gemberling says, a bond is created between himself and his Rotaplast patients that doesn't end when he returns home.
"I can't even speak to them because I don't speak Spanish," he says. "The communication is all with your eyes--this mother who has never seen this child's face closed. It's moving; it brings you to tears. I'm hand-delivering my gift to the people that need it. It satisfies something really deep in my heart."
To learn more about or contribute to Rotaplast International, call 408.538.8120 or visit www.rotaplast.org.
Saratoga, California Since 1955
