‘I know that look … it was what I wore’: Sam Squiers on the experience that changed her
The moment Fox Sports journalist Sam Squiers caught the eye of a terrified young mother in a far-flung country, she knew the look all too well. But she also knew she could help, thanks to the deeply emotional experiences that brought her here.
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I know that look. I’m standing with a young couple, both in their 30s, their baby boy slung over his mum’s back in a striped, handmade wrap. We may be from different countries, different worlds and different circumstances, but I know that look so well.
It’s the look of fear, of the unknown, of anxiety, exhaustion … and hope.
I know that look because it was what I wore on my own face when my youngest, Elle, was diagnosed with a cleft.
That was 2020.
I’m now in Bhutan.
I’m travelling with a team of surgeons and medical specialists with Interplast, for which I’m an ambassador. The team is here for just over a week performing life-changing surgeries on a range of conditions; burns victims, facial and hand reconstructions, victims of bear attacks, but most commonly, kids with clefts.
I’m now meeting and talking to the families, recognising on their faces the range of emotions I saw in my own reflection for a long time.
I show them photos of me and Elle when she was born, their faces relax, their eyes grow wide, they point, “You, same!”. I show them photos of Elle now, her cupid-like face, big eyes and glorious smile. Their own mouth widens, tears well in all our eyes.
Neither of us speaks the other’s language, but shared experience transcends all barriers. Different worlds, different circumstances yet a universal bond.
It’s not just clefts the team is working on here, burns are a huge part of the work Interplast does in Bhutan. This country is known as the happiest place on Earth, the only country to implement a Gross Domestic Happiness Index, yet it remains a developing country, graduating just two years ago from the UN’s list of Least Developed Countries.
There are positives to Bhutan’s limited modernisation; its culture remains embedded in its foundations and also its constitution. There are no golden arches here – no fast food chains at all, television was banned up until 1999 and there are no advertising billboards anywhere.
Many still wear the traditional dress of the kira for women and gho for men, and the architecture remains intrinsically Bhutanese.
Yet, the negative is that some medical practices, including the treatment of burns, are yet to be modernised.
“Unfortunately in Bhutan most of the burns here are managed in a fairly old-fashioned way, letting them heal by themselves which means they develop severe contractures (burn scars which thicken and tighten the skin which causes problems functionally and aesthetically) and to try to correct those contractures and other complications becomes much more challenging,” Dr Michael McCleave tells me.
McCleave, from Royal Adelaide and Calvary Adelaide Hospital, has treated a number of burns victims this week.
We meet a young monk, Karma, his right hand a ball of tissue. He tells me when he was seven months old he was left near an open fire and his hand was burnt. Living in a remote village, his family didn’t have money to travel to the city to have it treated, so the local medical team wrapped his hand up in bandages.
The skin healed over his hand, trapping his fingers under the scar tissue that grew over the top. It has remained that way for decades, until today, as McCleave works without scans or X-rays to release some of the fingers to give him movement and grip back to his hand.
I meet a young mother of two, Singye, who has severe facial burns after being trapped in a house fire.
It wasn’t treated with skin grafts and she now suffers from burn contractures which are pulling her lip down and fusing part of her neck. She hides her face with a scarf.
There’s also the bright and bubbly teenager Ngawang, who was boiling water using an element she was holding when it electrocuted her. Her hand gripping the rod was stuck and her instinct was to use her other hand to assist and then both were stuck on it causing her to fall down and the element to land on her chest badly burning her.
This is her second procedure with McCleave, who treats Ngawang (and also Singye) with the latest burns treatment technology in BTM (a dermis substitute product developed by the CSIRO and PolyNovo).
I’m warned by doctors the first day on Interplast trips can be overwhelming as many locals hear that the team of surgeons from Australia is coming and swarm the hospital hoping to be seen.
One family I meet moved to the area three months before we arrive to avoid missing out, one nurse tells me on a previous Interplast visit, a dad, who, without money for a car or public transport, walked with his three-year-old for three days just so his son could be seen by the team.
The team comprises two plastic surgeons, McCleave, a hand, burns and reconstructive specialist, Dr Mark Moore specialising in craniofacial and cleft surgeries, an anaesthetist Dr Todd Maddock, two scrub nurses Vanessa Dittmar and Josie Luke and occupational therapist Megan Fitzgerald.
All five have used their holiday leave and precious time off to provide Bhutanese people access to their skills, and we in Australia have the privilege of utilising.
Now seeing everything I have over this week, I realise we all take this access regrettably for granted.
Moore has completed over 100 similar trips to developing nations over 25 years.
“One of the privileges of doing the work, and doing the work over a long time, is that you can see the patient change over time and do second and third surgeries. It’s being a part of their lives,” he says.
This team could be using their holidays to travel anywhere in the world and to the most luxurious of locations. Yet they have a real, genuine sense of responsibility to provide the skill they possess to those whose lives would be greatly impacted by it.
The team performs up to 12 surgeries combined a day for six days straight, some of these are complex microsurgeries of nerve and tendon grafts.
They’re also without the state-of-the-art, first world facilities and resources they’re used to in Australia. At one stage a fly is buzzing annoyingly around the theatre as the surgeons operate. Being a Buddhist country, it’s forbidden to kill any creature, so the nurses and staff start moving frantically around the room trying to cup it carefully in their hands to release outside.
Despite the schedule and conditions, the team tells me the hardest part of what they do isn’t within the theatre, but outside.
The decision on who they can operate on and who they must turn away is the cruellest part of the job. “For me the biggest thing is not what you do but what you can’t do,” Moore says. “Patients often come from very far away. Sometimes it’s the only chance in their life, they’ve travelled 12-18 hours by car or bus and maybe that’s the only money the family has to get the treatment and if you come on the wrong day, you don’t get the surgery. So when teams come here you have to know a bit about the country so you can think ‘Oh, that patient has come from so far I really have to find a way to do this’.”
There are however, only so many hours in a day and only so many days in the trip.
“It’s those that you have to turn away or those who maybe have a disease or condition that’s so advanced that you can’t do anything for, that is the biggest challenge,” Moore says.
A couple of babies they had hoped to operate on have presented with colds and are too risky for surgery and to be under anaesthesia. The look of despair on the families’ faces that their one opportunity that year to see these surgeons is gone, is haunting.
The work, in another way, does extend past a sole visit every year. Interplast’s other role here is to train, inform and develop Bhutanese staff, surgeons and specialists with the best practice used in Australia. Every step the team takes they’re explaining, educating and informing their Bhutanese equivalents on the latest practices and techniques. It’s not a one-stop effect they want to have, but a long-term strategy to see their influence extend beyond this one trip.
Interplast has also been involved in the development of Bhutan’s first plastic and reconstructive surgeon. Dr Sonam Jamtsho was completing his general surgery residency when Interplast first visited Bhutan and has worked closely with the team every visit.
Through Interplast he also undertook specialist training programs and completed his plastic and reconstructive fellowship at the Queen Elizabeth Hospital in Adelaide. Jamtsho has been working closely with McCleave on this trip, who has become a mentor to him. Their connection extends beyond this trip, the pair is in constant dialogue, even when Jamtsho is in the middle of a complex case.
“With this close relationship with the (Interplast) team we can reach out to them at any time,” says Jamtsho. “I remember many instances I would call him from the theatre and do a video chat and get his help and sometimes change the plan there on the table.”
Back on the ward, an aunty of one of the cleft babies the team has operated on breaks down in tears when I see her.
“So happy, so grateful,” she says.
My daughter, Elle, has many more surgeries to go on her cleft journey, but we’ll never take the access to care we have in Australia for granted.
On the final day, the doctors tell me that leaving is the hardest, but being back home for me will never be the same. ■
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