Published: August 31, 2015

Rebuilding ears, self images, and hope in Cambodia: the first collaboration between Face to Face and Operation SmileExpanded from the print edition

As we walked into the Khmer Soviet Friendship Hospital in Phnom Penh, Cambodia, in February, Kathleen Sie, Sie, MD, pediatric otolaryngologist at Seattle Children’s Hospital, turned and quietly reminded me to look carefully in the ICU so we might be mindful of what our potential highest level of care would look like.

cambodia1By Scott E. Bevans, MD, head and neck oncology, microvascular surgery fellow at University of Washington Medical Center, Seattle


8 cleft lip repairs or revisions
7 stage I microtia reconstructions
1 stage II microtia reconstruction
2 cleft palate repairs
5 scar revisions (3 noses, scalp, and face)
1 parotidectomy, gold weight, facial nerve to masseter nerve anastomosis
1 otoplasty

cambodia2As we walked into the Khmer Soviet Friendship Hospital in Phnom Penh, Cambodia, in February, Kathleen Sie, Sie, MD, pediatric otolaryngologist at Seattle Children’s Hospital, turned and quietly reminded me to look carefully in the ICU so we might be mindful of what our potential highest level of care would look like. Family members were accompanying each patient. There were no ventilators. Blood was hard to come by. A chest X-ray costs $6. There were mattresses and bed frames (a step up from the hospitals I had seen in rural western Cambodia), but there was nothing superfluous. The safety net that our wealth of consultants, capabilities and infrastructure provides here in the U.S. did not exist, but we were preparing to embark on a week-long quest to perform and teach microtia, cleft, and other reconstructive surgeries. We climbed the four flights of outdoor stairs to the simple, but clean operating room suites. They felt cool after our modest ascent in the humidity, and the natural light streaming in made them even more beautiful, as if quietly resting in preparation for the busy week ahead.

The equipment provided by Operation Smile transformed these simple ORs. They brought modern electrocautery, anesthesia machines, and supplies. It was still striking to see the paper gowns getting re-sterilized, and multiple OR beds with simultaneous surgeries being performed in a the same operating room. And even with all that Operation Smile and Face to Face teams brought, the constant requirement of ingenuity and adaptability was profound. Instead of asking for a specific instrument or suture, one would instead verbalize the function they were trying to complete and allow the team of surgeons, nurses, and techs find a solution together.  (“I need something to retract this or close that …”)

The teamwork that this process fostered was immense. And what a team it was! The roster reads like a “who’s who” in the worlds of pediatric otolaryngology and facial plastic surgery: Sam Most, MD, Craig Murakami, MD, Dr. Sie, Amit Bhrany, MD, and Jonathan Sykes, MD. Added to them were two anesthesiologists, a pediatric intensivist, two nurses, and two other facial plastic surgery fellows, Julie Ames, MD, and Matt Lee, MD. This was the ninth time Face to Face (the AAFPRS humanitarian foundation) had been in Cambodia. It was to be the first partnership with Operation Smile here in Cambodia. It would be my fourth trip to Cambodia for medical mission trips, but my first as an operating surgeon; something I had dreamed of be able to do since I first traveled to this beautiful, but torn, country.

The first day the entire floor of the hospital was full of patients seeking help for maladies and deformities. Each was provided a number and evaluated in turn. While seeing them, we prioritized those to whom we would reasonably be able to offer surgical intervention. That rough schedule was finalized the night before, and when it was posted, families would crowd around the window where it was displayed. Some looked on with elation, others disappointment. Despite the language barrier, each patient and their families placed an incredible amount of trust in our team. We could see in their faces they knew the gravity of their choice, and that trust made it all the more impacting to be able to perform safe surgery. The reunions in PACU were repeatedly beautiful: child was returned safely, lip repaired or ear constructed, held by tearful and grateful parents. It did not all go smoothly. While we mitigate risk, we cannot eliminate it (either in the U.S. or Cambodia). But we dealt with complications swiftly and as a team. And each event (small or large) was a reminder of why we train and operate with focus and diligence, and why it is so important to have a team worthy of our trust.

Many of us enter medicine with some humanitarian goal of participating in events like these. However, the barriers to entry can be large (cost, time, contacts, experience, etc.). I am grateful to the AAO-HNSF Humanitarian Efforts Committee for helping clear some of that hurdle with the travel grant. The relationships forged in preparation for and during a trip like this one are possibly the most valuable take-away. Serving these patients with the (sometimes cumbersome) western medicine “stuff” stripped away was a perfect reminder of why I’ve been in training in more than a decade. Despite the hard work and jet-lag, I stepped back on sovereign soil both refreshed and motivated.



More from September 2015 - Vol. 34 No. 08

Products from the new AcademyU® Learning Platform
Foundation copublishes two books with Thieme As part of an ongoing agreement with Thieme Publishers, the Foundation has just added two more titles to its book and eBook collection. The first book, Otolaryngology Lifelong Learning Manual (OLLM), is an update to the Maintenance Manual for Lifelong Learning. Through the hard work of the eight education committees, under the leadership of Education Coordinator Sonya Malekzadeh, MD, this will become a valuable resource for all otolaryngology clinicians. OLLM serves as a great resident resource and certification study guide. Practicing physicians can use it for a refresher on a topic and for recertification through MOC. Nonphysician clinicians will also benefit from the comprehensive scope of the book. The second book, Geriatric Otolaryngology, was edited by Robert T. Sataloff, MD, Michael M. Johns III, MD, and Karen Kost, MD. This book is much more than a revision to the previous book of the same title. It is a comprehensive and timely discussion of the otolaryngology concerns of the elderly population. Both books are available in print and eBook formats and can be ordered through the Thieme website at You can search by specialty or title. The AAO-HNS Foundation is proud to have worked with Thieme on these two essential otolaryngology publications and looks forward to continuing its copublishing partnership. AcademyQ® CME: otolaryngology knowledge self-assessment tool AcademyQ® CME offers learners the opportunity to hone their knowledge skills through a series of otolaryngology-head and neck surgery-specific self-assessment questions. Derived from the 800 knowledge assessment questions available in the AcademyQ® app for Apple and Android, this activity provides the opportunity to enhance knowledge of otolaryngology-head and neck surgery with hundreds of study questions to test recall, interpretation, and problem-solving skills while earning CME credit. Drawing on the same questions released on the Academy® app in 2012 and 2014, nine modules contain 50 questions specific to each specialty. The physician learner will read and analyze otolaryngology-specific questions and rationales developed by otolaryngology experts. Included in each module is thorough feedback for each question, additional reading references, and appropriate images and videos to enhance the learning experience. Pediatric Otolaryngology eLectures Pediatric Otolaryngology eLectures, coproduced by the American Society of Pediatric Otolaryngology (ASPO) and AAO-HNSF, offer learners education opportunities designed to address pressing patient care concerns facing pediatric and general otolaryngologists. The webinars in this series are: Recurrent Respiratory Papillomatosis Diagnosis and Management of Vascular Malformations Update on Allergic Rhinitis—A Burdensome Disease Down Syndrome: Otolaryngologic Manifestations Evaluation and Management of Sialorrhea in Children Hearing Tests and Hearing Aids: More Interesting Than You Thought Complications of Acute Rhinosinusitis in Children Otitis Media Update Assessment and Management of Velopharyngeal Dysfunction Evaluation of Pediatric Sensorineural Hearing Loss Unilateral Hearing Loss In Children Caustic Ingestion Management of Pediatric Vocal Fold Immobility Head and Neck Masses in the Pediatric Population Quality and Safety in Surgery: How to Become a Better Surgeon Choking and Aspiration in Children: Evaluation and Management Pediatric Sleep Medicine 2014: A Roundtable Discussion Eustachian Tube and Evolution Social Media—A Blessing or a Curse for the Otolaryngologist Genetics and Pediatric Otolaryngology These archived recordings are be available for AMA PRA Category 1™ credit. ENT for the PA-C eLecture Series The annual ENT for the PA-C Conference is jointly presented by the American Academy of Otolaryngology—Head and Neck Surgery Foundation and the Society of Physician Assistants in Otorhinolaryngology/Head & Neck Surgery. The primary audience for the conference is nonphysician clinicians, especially physician assistants, and nurse practitioners who specialize in otolaryngology-head and neck surgery. This eLecture Series, recorded at the 2015 ENT for the PA-C Annual Conference, includes the following presentations: Healthcare Reform Audiogram Interpretation: 10-minute Dizziness Evaluation Evaluation and Management of Facial Nerve Paralysis Everything You Ever (and Never) Need to Know About Salivary Glands Differential Diagnosis and Management of Conductive Hearing Loss Non-otologic Sources of Otalgia Diagnosis and Treatment of Anaphylaxis Evaluation and Management of Pediatric Neck Masses OSA: Improving Treatment Outcomes Vocal Fold Paralysis Diagnosis and Treatment Assisting in ENT Procedures These archived recordings will be available for AAPA CME credit. Visit for these new activities along with the entire catalog of education opportunities offered by the AAO-HNS Foundation.