The medical specialists delivering life-changing gifts
THEY will be waiting, 100 or so women from the hills and plains surrounding Uganda's Rwenzori Mountains, as Dr Hannah Krause emerges from the four-wheel-drive.
They'll shuffle their feet in anxious expectation, watching as Krause heads to her room after a rough, eight-hour drive on the red dirt roads of central Africa.
She'll drop her bags, splash some water on her face, assemble her gear and head out to meet the women.
Each woman will hold a chart that tells of her trauma. Of prolonged, agonising childbirth that has left their bodies torn and disfigured; of stillborn babies; of decades of living with labour wounds so difficult to manage they have become outcasts of their village.
Krause and fellow urogynaecologists who have come to volunteer at Kagando Hospital, in western Uganda, will examine them that afternoon.
"Then we'll start operating the next day and we'll just go, go, go," says Krause before leaving Brisbane earlier this week for her 10th trip to Kagando in eight years.
She'll spend 10 days using her skills to fix their injuries, giving these women an extraordinary Christmas gift.
Which means that Christmas Day for Krause will be spent at Entebbe Airport, in Uganda's capital, Kampala, waiting for a flight to get home to Brisbane.
To Krause, the question is not why she continues to make these trips. It's why not? "I would find it hard not to go back," she says. "I can't not go back. I have got the skills, I am able to be helpful and I just feel that that is what I should do."
Krause, 50, first saw the horrific childbirth injuries endured by women from developing countries in 1995, soon after the University of Queensland medical school graduate had decided to specialise in gynaecology.
The former Nashville High and St Margaret's Anglican Girls' School student was working at the Royal Brisbane Women's Hospital, when a senior registrar, the now Professor Judith Goh, was organising a six-month trip to help out at a hospital in Sodo, in Ethiopia.
She invited Krause. "It was very confronting. I saw a lot of women dying, a lot of babies dying," recalls Krause. "I really could see what was going on in the world in the absence of appropriate obstetric care."
The women were poor and lived hours away from medical care. They laboured in their grass or mud huts, in crippling pain. Sometimes, they were carried to the hospital by their husbands. But by then, the damage was done.
Krause met women who had endured labour for four days and lost the baby.
They were left with a fistula, a hole between the vagina and bladder and/or bowel, caused by the death of tissue after the constant pressure of a baby's head against their pelvis.
She saw women with ruptured uteruses, their dead baby inside their abdomen, not uterus. She saw large prolapses where women's internal organs protruded from their vaginas. "We would see quite the end stage of everything," she says.
At least, though, these women received care soon after the birth trauma. Many throughout Africa and Asia don't.
Later that trip, Krause would go to the Addis Ababa Fistula Hospital in the nation's capital and meet women who had lived for decades with a fistula.
"They leak urine, and/or faeces, continuously, there's no pads or showers to even partially manage things," Krause says. "They can't live in the family home. The husband often rejects them. People think they're cursed. They end up living in a hut by themselves… very abandoned, socially isolated."
It's the knowledge that this suffering can be fixed relatively simply that has driven Krause ever since.
"I've operated on a 60-year-old and it was just the most ridiculously easy fistula to repair, it probably took 30 minutes," says Krause, who adds that an average fistula operation takes about an hour.
"You can totally transform a woman's life. It breaks my heart, the older the patient is; I think, oh dear, she's lived with this for 30 or 40 years."
Since 1995, Krause has been on more than 30 overseas missions to places such as Bangladesh, Liberia, Sierra Leone, the Democratic Republic of Congo and Ghana.
A fulfilling part of her work is that her time in Congo has ended after a successful "train the trainer" program, giving local gynaecologists the skills to do the surgery.
Goh and Krause are rolling out similar programs in hospitals in Yangon, Myanmar and in Phnom Penh, Cambodia.
Krause is now in practice at Brisbane's Greenslopes Private Hospital with Goh, who continues to go on missions and administers the charity Medical Training in Africa and Asia through the Health and Development Aid Abroad Australia Fund, or HADA.
Both women have been made an AO, or an Officer of the Order of Australia, for their work in Africa and Asia.
The money raised goes towards the women's surgery, their transport to the hospital, and to their meals. None of it goes to the Australian surgeons, who pay their own way. Krause has not had a real holiday in years. If she's lucky, she gets a day off while in Uganda to go to a game reserve.
Right about now, Krause will be at the start of a long schedule of surgeries. In an operating theatre with the windows shut.
No air-conditioning. In a plastic apron, gloves and mask with "every single bit of my clothing sopping wet". And she will change a woman's life.
"I'm not trying to save the world," Krause says. "I'm just trying to help this patient and then this patient. And tomorrow, this patient."
PUTTING A SMILE ON PATIENTS' FACES
Making his patients just another face in the crowd is all plastic surgeon Dr Richard Lewandowski wants.
He's not offering supermodel looks, no standout implants. His aim is as mundane as it is profound - to give underprivileged children the ability to eat and speak properly, to smile, to get a job, to get married.
His patients through the charity Operation Smile Australia have cleft lips and palates. In Australia, a child born with these malformations of the mouth will be operated on before they turn two. The path for poor kids born with the conditions in countries such as the Philippines or India is far more rugged.
"If you don't have it treated," says the 60-year-old Lewandowski, "you'll never speak properly. What you can eat and drink will be fairly rudimentary and if you have a cleft lip, you'll be mocked by people, or considered cursed, ostracised and alienated."
Only seven per cent of children living with unrepaired cleft conditions reach the age of 20.
If Lewandowski and his team of medical professionals make it to a child's village or city, lives can be changed by a 45-minute operation. And not just those of the children.
If a father with a cleft condition arrives to have his child treated, Lewandowski will operate on him, too.
Why just the fathers? "You rarely see an unoperated cleft mother. Fathers, yes, they're still marriable with a cleft lip, but women, no."
Lewandowski had finished his plastic surgery training in Brisbane and Perth and moved to Virginia, US, in 1994 to do further study when he met Bill Magee, the founder of Operation Smile. Magee asked him along on a surgery mission to Colombia. (If this sounds a similar start to international volunteer work as with Krause, here's another link: Lewandowski also went to Nashville High.)
Missions to Kenya, Gaza and the Philippines followed and after returning to Australia, Lewandowski and his wife, Sue, established Operation Smile Australia in the late '90s.
It now runs about two overseas clinics every month and last year spent more than $100,000 evaluating 4118 patients and operating on 2514.
Lewandowski recently returned from a trip to Iloilo on the Philippine island of Panay, where he and the rest of the medical team screened patients and operated for five days.
"That's with five teams, on five operating tables, and a 'floater' in each of the specialties in case someone has a post-operative bleed in the ward, for example," he says. By the end, of the week 191 people with cleft conditions were screened and 108 surgeries done.
As important as the operations are, Lewandowski finds more reward in training local surgeons (both in their own countries and here) to do Operation Smile Australia out of work. That's happened in Vietnam. After 20 years of missions, the charity is no longer needed.
"You should be training; the mark of a good program is redundancy," he says.
His other passion is "world care" operations, where children with disfiguring craniofacial growths are brought to Australia to have them removed.
He first saw the change such operations could bring when he helped operate in the US on Tina Disuma, a 15-year-old who was born with a large, avocado-shaped growth in the centre of her forehead.
"She was locked away, didn't go to school, the family had been cursed. [The operation] took four hours. Not only did she go to school, she became school vice-captain and went on to university."
He has since helped 50 other children, beginning with Princess-Lyn Quines, an 18-month-old from the Philippines, who was operated on in Brisbane in 1997.
There is now a small team administering Operation Smile Australia out of offices at the Mater Hospital, South Brisbane, including Jason Benham, the chief executive, who negotiates the vagaries of medical visas and licensing to ensure none of the hundreds of volunteer medicos - or the patients and their families - fall foul of foreign laws.
Lewandowski fits running the board, the world care work and a couple of cleft surgery missions each year around his private practice and teaching medical students. He's never contemplated not doing benevolent work.
"Proper clinical practice is a balance," he says. "Some teaching, some public work. It's like a minestrone, you throw some ingredients in and if it tastes OK at the end, then that's what it is. It's all part of your practice."
He's also squeezing in a master's degree through the University of Queensland to quantify the impact of these operations. It's a scholarly stocktake of something he already understands in his gut.
"It changes kids' lives, that's absolute," Lewandowski says. "But you also see parents who have struggled for so many years with their child's deformity and all of a sudden that weight is taken away from them. It benefits the child, the parents and the community because they become outgoing people, add value to society; the women can get married, the men can get a better job. It's a big deal."
THE BITTER WITH THE SWEET
It was enough to set a dentist's teeth on edge - a school tuckshop in Dili, the capital of Timor-Leste, consisting of two long tables "with nothing but lollies and biscuits".
Then Dr Malcolm Campbell set up his folding dental chair, unfurled the tools from his portable dentistry kit and examined the schoolchildren's teeth.
"I got the shock of my life."
How bad? There's an index dentists use called DMFT, says Campbell, 56. Decayed, missing, filled teeth.
In Brisbane, the average for 12-year-olds is less than one; the World Health Organization has a target of no more than three. At Dili's Marcelo 2 School, it was 5.2. "Every kid had decay; some had 20," Campbell says.
The "tuckshop" is no more. Campbell and his team saw to that. It's now a tooth-brushing station.
"And we instituted oral health classroom education," Campbell adds. "That's going to do lots more in the long run than us pulling out 300 teeth in a week and going back the next year to pull out another 300."
Still, there's plenty of dental work to be done before oral health education stops the rot.
What began as a reconnaissance mission in 2013 has grown to two dental teams using a $15,000 kitty from fundraising to do the equivalent of $A120,000 worth of work in Timor-Leste this year.
Next year, the plan is to take three teams, one of which will include students from Griffith University's school of dentistry.
Training of local dental nurses to improve their skills is also in the mix, with an application to the Australian Department of Foreign Affairs and Trade for funding, and negotiations with Timor-Leste's Ministry of Health also under way.
Campbell's foray into Timorese dental care began when his Uniting Church minister and director of the Timor Children's Foundation, Reverend John Ruhle, asked him to visit the Samaria Children's Home in Dili.
Ruhle knew that Campbell not only had a practice in Brisbane's Mary St (with clientele that includes the Premier, Annastacia Palaszczuk), but was also the co-creator of Moviliti Dental Care, which provides dental care to aged care residents on site.
With specialised mobile dentistry equipment at hand, Campbell was well-placed to offer dental care to the home's 25 children in a country where there are only 13 permanent dentists or dental specialists.
The children's diet and oral hygiene was controlled by the home, making the degree of decay manageable. "I'm happy to say when we went back this year, there were no extractions, [and only] a couple of fillings."
The same could not be said for the school. Campbell visited Marcelo 2 in 2016 after word got out there was a dentist in town.
The North Rockhampton High and University of Queensland graduate, who has worked in remote parts of Queensland, had never seen need like it. Mothers came to him in tears, pleading for help for their children whose decayed teeth were causing them agonising pain.
Campbell, now a co-director of the Timor Children's Foundation, says malnutrition is a big problem in a poor country still recovering from years of conflict and upheaval.
But he believes the biggest issue is an influx of sugary foods as Timor-Leste's economy slowly improves.
"As soon as you get a little bit of wealth coming in, parents want to treat their kids," says Campbell. "They think, 'Oh, we can buy these lollies for them', stuff the parents never had."
Roadside stalls once offering cassava and bananas now bulge with sweets.
"The decay rate has just gone through the roof in the last four of five years," Campbell says. "So has the sugar consumption."
And the requests for help keep growing. This year, one team of professionals from Griffith University spent a week at the school, giving care to close to 200 of the 900 children, while Campbell and another team went to the village of Lospalos, about 250km east of Dili.
"Even though it's 250km, it takes eight hours to drive there," Campbell says. He finds a photograph. It's of him and oral surgeon Dr Mark Tuffley, lying on the dirt, changing a tyre after it blew on the rocky road to Lospalos. The back wheel guard of the four-wheel-drive is held on with surgical tape.
The conditions at the medical clinic the team take over are significantly less salubrious than Campbell's Mary St practice, which has "Netflix on the ceiling and screens and air-conditioning".
Drills and suckers and mirrors are contained in the mobile kit, which resembles a tough suitcase. Without enough proper dental chairs, the dentists stand for hours on end, stooping over patients, or sometimes stack plastic chairs on each other for extra height to sit down.
Infection control is treated seriously, with gloves and masks part of the deal. All in 30-degree heat and sweltering humidity.
Most of the patients at Lospalos were adults who lined up on the veranda as the clinic's doctor sorted through the worst cases.
"It's like, 'You're in pain, go in and see Malcolm'. And I'll go, 'OK, we've got to pull these three out, that one's pussy, but we can do a filling in that one'."
Fillings are a rare luxury in Timor-Leste. "We tell them we do more than just pull teeth out, we can save teeth by doing these fillings."
They could be saving lives, too - if an abscess develops, "infection can go systemic and you can die from it".
Campbell says there's also a link between dental decay and rheumatic heart disease, of which Timor has a very high incidence. Gum disease is linked with heart disease, stroke and arthritis.
Like Krause and Lewandowski, Campbell is motivated by a desire to "give back".
And like Krause and Lewandowski, training locals to take over the work is Campbell's ultimate aim. "We can do some work, very economically, very effectively and relieve some immediate pain," says Campbell. "But it's not the answer long-term; the answer is empowering the Timorese to look after it themselves."
In the meantime, though, moments like the day Petrus Tallo got his tooth back cannot be underestimated.
Last year, the team removed one of Tallo's decayed front teeth. This year, Dr Vanessa Reher from the Griffith University's dentistry school prepared a relatively inexpensive false tooth in Brisbane and took it to Dili. Tallo, a council member of the church that facilitates the school dentistry, took a seat and the team got to work.
It's not a massive operation, not life-saving, not world-changing. But there's a series of photos showing Tallo's joy and the affection between him and the team.
It's enough to make you smile. ■