SANTIAGO DEL ESTERO, Argentina — Mercedes Paz tries to make herself invisible. Head tucked down, hands covering her twisted mouth, body curled inward, the 18-year-old sits on a roughhewn bench in the waiting room of this medical outpost.
Like others at the clinic, she waits to be able to eat and breathe easier. To have a smile.
They wait to be seen by a team of medical volunteers who have just arrived in this remote northwest corner of Argentina. The vast majority of the patients are children who, like Mercedes, have congenital deformities affecting the mouth and face, conditions that would be repaired routinely in infancy in the United States.
If he could, Newport Beach plastic surgeon Michael Niccole would mend them all, one by one. But in 10 days, there won't be time, even with the international team he assembled of more than 30 surgeons, anesthesiologists, pediatricians, nurses and support staff to work at the rudimentary regional hospital nearby.
Niccole's team--with the help of more than three dozen volunteers from this city of 200,000--will see a steady stream of patients, 204 in all. For nearly every patient who is treated, another must be turned away. By the time the team leaves in early June, it will have performed 151 surgeries on 106 patients, most of them young children.
The surgical team is one of numerous humanitarian missions organized each year to bring medical care to poor or geographically isolated parts of the world. Many focus on repair of cleft lip and palate, conditions that occur worldwide, but strike especially often in South America and parts of Asia. There, the incidence can be as frequent as one in 500 births, double the number found in other countries.
Each mission requires international cooperation and the support of many individuals and local community groups, and often the driving force of a team leader. On this trip, that person is Niccole.
In this work, he says, there is "gratification you don't get in your office. . . . You know you won't get anything in return except hugs or tears, or maybe a fresh mango."
Most of the people in the waiting room in Santiago del Estero heard about the medical team's visit through doctors and public service announcements months in advance. They have arrived on foot and by bus. Those who will have surgery will stay with their families in a nearby barracks to recuperate, most for a few days before a departing checkup to remove stitches.
Often, the children's lives evolve as Mercedes' has. She dropped out of school in the third grade because she was ashamed of her face--a cleft lip and crooked teeth protrude from her malformed mouth. Her speech is so impaired she rarely tries to speak. She doesn't have a palate, so she suffers when she eats, often choking and gasping for breath.
The disfigurement has made her a recluse, isolated even from her family. At home, she takes her meals alone so no one can see when she is unable to swallow her food.
A Change of Pace
for the Surgeon
At home, the kind of surgery Niccole performs is usually elective--procedures such as face lifts and breast implants. He is the founder of CosmetiCare, a plastic surgery center that has grown and prospered in the Southern California climate. As he built his practice, though, the 54-year-old father of four donated time and expertise to those who could not afford needed reconstructive surgery--the less publicized, less glamorous side of plastic surgery.
Niccole grew up in Huntington Beach and studied medicine at UC Irvine. His volunteer medical work began in the early 1980s with the Santa Clara-based "Flying Doctors." Once a month, he would hop a twin-engine plane with other surgeons and head for backwater towns in Mexico. There they would repair deformities and treat injuries that might otherwise doom children to lives as outcasts.
Later, Niccole joined the World Health Organization on similar mercy missions to Alamos, Mexico. And by 1987, he created the Magic Mirror Foundation, a nonprofit program providing free reconstructive surgery for scores of low-income patients across Southern California.
But this mission to Santiago del Estero, the second for Niccole, was financed and supported by Rotaplast, an offshoot of the Rotary service club. The $80,000 tab, most of it for transportation costs, was split between U.S. and Argentine Rotary groups.
Rotaplast was organized five years ago to support international medical missions and has sponsored volunteer teams primarily headed for South America. Nine missions already have been financed for September 2000--including another to Santiago del Estero.
Other medical relief organizations that help people with congenital facial disfigurements or who have suffered burns or other injuries include Operation Smile, which sponsors 60 missions a year, and Interplast, which does about 40 a year. All are staffed with volunteers from the medical community--including many plastic surgeons.