The Ingenuity of Care: Treating the Scars of Medical Insecurity WorldwideApr 26, 2023 03:02PM ● By Daisy Hutzell-Rodman
Photo by Bill Sitzmann.
Debra Reilly, M.D., a fellow of the American College of Surgeons, works part-time at Children’s Hospital & Medical Center in Omaha, and part time at Mary Lanning Healthcare in Hastings, Nebraska. However, her client base extends far beyond these community fixtures—it spans the entire globe.
Around 30 years ago, Reilly met two women from Germany who professed that women around the world sacrifice their own health and privilege that of their children. Particularly low on the priority list are surgical procedures, especially for concealed issues like burn scars hidden by clothing.
“There are 160-some organizations for cleft palette,” Reilly said. “These women had a different plan.”
That plan was to bring reconstructive surgery to women across the world. In the mid-1990s, Reilly began traveling internationally with this aim in mind, and she hasn’t looked back.
Her practice has taken her to India, Bangladesh, Pakistan, East Africa, and Haiti—places where treatment often involves creative solutions. Such procedures, whether on men or women, have brought patients relief and greater quality of life.
Reilly is no stranger to ingenuity; in fact, creative problem-solving is one of the aspects of plastic surgery that drew her to the field, which ranges from breast-reconstruction for cancer survivors, to opening the nasal passages of those suffering from chronic sinus infections, and beyond.
My first trip to Kenya, I was working at the big hospital,” Reilly said. “I had no clue how bad the conditions would be. There was nothing…nothing. I broke down in the hallway. Then I said to myself, find one thing you can do, just one thing, and I found two.”
This included teaching, a pursuit that allowed her expertise to have a ripple-effect across the places she visited. She taught area medical staff how to dilute a specialized soap, or how to properly prep a patient.
In Mexico, a patient required an arm board for treatment, and any form of sterile, $500-plus padded restraint was thousands of miles away. Reilly made due with available materials: a standard board, automotive upholstery, and a basic clamp acquired from a hardware store. Four hours later, Reilly successfully performed the operation.
Providing comfort is one goal of reconstructive surgery, whether in the US, Kenya, or Bangladesh. In more remote places, however, that comfort takes on different forms.
“If you can take away a barrier to get help, that’s great,” Reilly said. “What we hope to do is make the woman more comfortable. Fixing a scar, that’s a stigma. A lot of the women in saris, the burns are in the breast area.”
The burns Reilly speaks of are often from in-law burnings, a practice that persists despite legal and cultural change. According to the The Dowry Prohibition Act of 1961, the government prohibits the giving or taking of dowry in India. Still, according to the data collection platform Statista, 6,800 dowry-related deaths were reported in the country in 2021 alone.
“Our teams look for opportunities to raise awareness about the prevalence of this problem through press conferences and social media,” Reilly said.
To further the awareness of domestic violence by burning in countries such as Pakistan, Bangladesh, and India, Reilly was among three female plastic surgeons who founded Reconstructing Women Internationally in 2007. She was also part of a team that has educated the first plastic surgeon in Rwanda, and she helped train the first plastic surgeons in Uganda and Zimbabwe. Kenya has gone from zero to 24 plastic surgeons since Reilly began her regular visits to the country.
“Sometimes, one woman will bring her sister in here saying, ‘Here, please help,’” Reilly said. “To me, that’s meaningful, when women will speak up.”
That said, the scale and scope of surgical procedures is dependent on a given area’s existing medical infrastructure.
“You have to think, what’s the biggest bang for the buck,” Reilly said. “A little scar may be turned away. If I only have five days, I’m going to take care of a patient who can’t move his neck, who can’t unfurl his hands from his palm.”
The team is essential, Reilly said: “It’s not just surgery, it’s nursing staff. They need to know their role. I go with a small team. Nursing staff and residents have been a boon.”
Doctors such as Reilly must also consider post-operative care. A surgery that requires secondary surgeries or extensive post-operative therapies may not be performed because there may be few, if any, qualified to perform the procedures once Reilly and her team have departed.
Pain management is another important factor. Narcotics cannot be brought into other countries, even by a board-certified doctor, so pain medications are often relegated to acetaminophen or ibuprofen. This decreased reliance on pain medications has translated to Reilly’s practice stateside. She may never need to use potato peelings to dress a wound at Children’s Hospital & Medical Center, but, where once she would have put a patient under for a smaller reconstructive job, she now weighs the benefits of local, regional anesthetics.
“The biggest surprise is that the patients are so grateful,” Reilly said. “We can only do small versions—an operation we know is successful. An operation that makes a scar more functional. They are grateful for that.”