Father-and-son team provide free medical aid in Philippines

by Princine Lewis

Children and adults afflicted with facial deformities such as cleft lip and cleft palate many times confront not only cosmetic issues, but also problems hearing, eating and speaking and the psychological effects of being alienated by their peers.

Dr. Nick Sieveking and his father, Nicholas Sieveking, clinical psychologist and director of Vanderbilt's Psychological and Counseling Center, recently traveled to the Philippine Islands to treat children with facial deformities. The younger Sieveking repaired a cleft lip of the child pictured.

Medical professionals -- plastic surgeons, speech pathologists and clinical psychologists -- can provide invaluable aid to patients with these deformities.

Dr. Nick Sieveking, a plastic surgeon and Vanderbilt alumnus, and his father Nicholas Sieveking, clinical psychologist and director of Vanderbilt University's Psychological and Counseling Center, recently traveled to Leyte, a province in the Philippine Islands, as part of a 15-member volunteer medical team to provide these needed services. Interplast, a nonprofit organization that provides free reconstructive surgery for children in developing nations, coordinated the trip.

Interplast sends teams of medical volunteers to 18 countries each year to treat children with congenital deformities such as cleft lips, cleft palates, or those who have suffered severe burns or other crippling injuries. Cleft lip occurs when the tissues that form the upper lip do not join in the middle. Instead, a gap occurs in the lip, usually below one of the nostrils. Cleft palate occurs when the tissues that form the palate do not join in the middle of the roof of the mouth, which leaves a connection between the mouth and the nose.

"Everyone is not cut out to participate in work in other cultures. You have to possess specific qualities or traits, such as a certain amount of empathy and a desire to understand other cultures, to be effective"

-- Nicholas Sieveking Director,
Vanderbilt's Psychological and Counseling Center

This trip marked the first time that an Interplast team has gone to Leyte. The trip was also the first time that Nicholas Sieveking saw his son, Nick, in action in the operating room.

The medical team spent two weeks at Leyte Provincial Hospital, where the younger Sieveking and two other plastic surgeons performed life-changing surgeries on 44 children and six adults. There are currently no plastic surgeons practicing in Leyte. However, the Interplast team worked closely with the general surgeons and anesthesiologists at the hospital to perform the surgeries and provide follow-up care to the patients. Interplast places an emphasis on training local medical professionals.

Both Sievekings had stories, heartbreaking and uplifting alike, about the people they saw at the hospital. Dr. Nick Sieveking spoke of a 9-year-old girl who had suffered from paralysis on one side of her face since early childhood. Her older sister brought her to the hospital to see if doctors could "make her sister smile again." The patient had not smiled, looked into a mirror, or even left home since she was old enough to be hurt by others' reactions to her. Excited about the prospect of receiving help, the young girl found the courage to leave home and to look directly at the bus driver as she paid the fare for her journey to the hospital.

In a one-hour procedure, the medical team created a static reanimation of the girl's paralyzed face, giving her a smile. After the surgery the patient kept a mirror in her hand to admire her new appearance. Dr. Sieveking plans to initiate major reconstructive surgery with this patient on his next trip to Leyte. He will then perform cross-facial nerve grafts from functional nerves. Later, he hopes to work with Interplast to bring the girl to the United States, where he plans to use microsurgical techniques to bring healthy muscle to the paralyzed side of her face to enable spontaneous and dynamic smiling.

Potential patients were recruited by government health-care workers and missionaries, and through print and broadcast media. The medical team screened the potential patients at the hospital to determine those who were the best candidates for surgery.

According to Dr. Sieveking, cleft lips and cleft palates are strongly genetic. However, nutritional deficiencies during the critical stages of pregnancy are also believed to contribute to the deformities.

"Those suffering from cleft lips and cleft palates many times cannot eat properly which may lead to malnutrition," Sieveking said. "Children with cleft palates also have recurrent ear infections, which many times cause hearing loss.

"Many people do not realize that to correct these deformities it is not just a matter of closing a hole in the lip or palate. There is a deficiency of tissue, muscle and bone in these areas that has to be reconstructed."

People of Asian descent seem to have the highest incidence of cleft lips and cleft palates with 2.2 people in 1,000 suffering from these deformities. Among African-Americans and Caucasians the rates are .4 in 1,000 and 1 in 1,000 respectively.

While his son concentrated on the physical health of his patients, Nicholas Sieveking provided psychological services to those selected for surgery and to their families. The elder Sieveking also worked with those who were not chosen for surgery, meeting with the person suffering from the deformity and with his or her family, and sometimes communicating with school officials to discuss adaptation issues.

While he provided some therapeutic services, the psychologist primarily studied Filipino culture to help medical team members better understand their patients and their beliefs. He will use his findings to create cultural orientation materials that include information such as how to interact in Filipino society and understand Filipino values in the health-care context on future medical team visits to the Philippines. He will also create materials that will help people determine whether or not they should volunteer for these types of missions.

To conduct his work, Sieveking talked with Filipinos in Nashville, including Vanderbilt professors and graduate students, before he made the trip. Once in Leyte, he interviewed patients and families at the provincial hospital, academicians, psychologists, anthropologists, missionaries in rural areas, and local doctors and nurses.

Sieveking discovered that there are several superstitions in most cultures, including the Filipino, about the causes of cleft lip and cleft palate.

"The existence of these superstitions and the reasons for them are very important pieces of information when determining the best way to educate the public about the real cause of cleft lip and cleft palate," Sieveking said.

"The beliefs about the causes of these deformities range from being a punishment from God for sin, to superstitions such as a mother eating too many of a certain type of rice cake that has a cleft along the top. These beliefs can be so ingrained in certain of the less-educated sectors of the population that it is important not to dispute them directly. A better method of education is to create a campaign separate from these beliefs that focuses on the real causes," Sieveking said.

"Despite having these superstitions, most of the families I met with seemed eager to learn about and accept a scientific explanation of cleft lips and cleft palates. It is almost as if the superstitions and science can exist side by side. Perhaps they must for some time yet," Sieveking added.

Sieveking specializes in studying the personal characteristics that are desirable for people working with other cultures, the dynamics of culture shock, and cultural differences and values. He has also served as a consultant on these issues to corporations in the health-care, engineering and construction industries working in Europe, the Middle East and the Far East.

According to Interplast, psychologist Nicholas Sieveking and his wife, Sue, sponsored the surgical trip to the Philippines. They now plan to work to encourage more people to become similarly involved.

"One of the things that really interested us in Interplast is that it is a cause where an investment of funds can have such a significant impact on so many lives. By virtue of the medical team volunteering their time, the cost per unit of surgery is so low that surgeons can perform many more surgeries in these developing nations than you could in the United States," Nicholas Sieveking said.

Four months prior to traveling to the Philippines, Dr. Nick Sieveking participated in a medical mission to Laos where he and three other surgeons performed 105 surgeries in nine days. In Laos, the volunteer medical team had more operating rooms and inpatient beds than they had in Leyte.

As far as what is next for the Sievekings, Nicholas will continue his work on the cultural training materials for Interplast volunteer medical teams in addition to his duties as director of the Psychological and Counseling Center, which provides personal and family therapy as well as career choice and educational skills counseling for Vanderbilt students, faculty and staff. The center is currently expanding its work to further understanding of racial and cultural diversity on the University's campus, which he said is closely related to his work in the Philippines.

Nick, a 1990 graduate of Vanderbilt, recently finished his residency at Stanford University and will soon travel to Rio de Janeiro and Santos in Brazil to study with two internationally known cosmetic surgeons. After he completes his time in Brazil, and a probable Interplast trip to Bolivia, he plans to move back to Nashville and start his own cosmetic and reconstructive surgery practice.