“It’s the same delight for me to help a beauty queen to have more perfect curves, and then see her being happy, as seeing a small Bangladeshi child finally moving his arm, and then smiling at me” – says Dr. Pataki. He wasn’t tired even at half past eight on a Friday night to hang his white coat on, and tell about the stereotypes circling plastic surgery, his charitable mission, and the so-called gratuity – which is a certain amount of money paid to the doctors by the patients in public health care in Hungary and many more countries.
– When I mentioned the term “plastic surgery mission” to a friend, she clapped her hands with joy and said that how cute of you to give free silicone breasts to Southeast Asian women.
– Almost. We are operating on children born with birth defects, victims of accidents, and people with burn injuries for free. These are mainly reconstructive surgeries.
– Why Bangladesh?
– Because it was obvious. I always wanted to establish a mission like this. We knew that the plastic surgery service is scarce there.
In a country which has a smaller habitable area than Hungary, there are 160 million residents. It’s only a few meters above the sea level, thus constantly exposed to natural disasters.
If a hurricane comes, the sea level rises, and the villages will be flooded. If it rains in the Himalayas, the water comes through the river Brahmaputra, and will soak them as well.
Earthquakes are frequent, too, and they are also affected by the tsunami. In our materialistic eyes, Bangladesh is one of the poorest countries on Earth, but I’m sure that one of the happiest and the most cheerful, too.
“Plodding for 20-30 dollars a month, even when pregnant.”
– But with a population density and living conditions like this, not only Mother Nature can run its course…
– Yes, diseases and industrial accidents run their course as well. The case of Rana Plaza was a terrible example of the latter, where nearly 1,200 people died two years ago. An ill-based, hospital-sized building collapsed with people working inside on a public holiday. I went there later, and there is still a huge pit on its place. Especially young women became victims of the tragedy. They made clothes for starvation wages – clothes that we buy for good money from international brands. Not uncommon for these women to work day and night, even when pregnant, for a salary as low as 20-30 dollars a month.
“The husband goes to pick up his wife from work with his small rickshaw – in a Muslim country!”
– It sounds like you haven’t just read it somewhere, but saw with your own eyes.
– We visited these factories with our missionary team two years ago, because we were curious about the working conditions. Many young women brought small children to us with joined fingers (syndactyly), with missing ones (symbrachydactyly), even with underdeveloped forearms (clubhand). At first, we didn’t know what might cause these problems in such unusually high rates, then we realized that all the mothers are working at the same factories. They had to earn money during their pregnancy as well, so slept next to the dangerous fabric and textile paints besides other chemicals. Once they touched them without gloves, the toxic compounds got into their bodies. So when pregnant young mothers took a short break next to the sewing machine, their fetus became damaged.
For real, these are the factories of companies whose products are sold here, in our shopping centers. With the Western consumerist approach, that we buy a new one from everything every week, a special demand comes into life which keeps whole nations in slavery. On the other hand, we can contribute to the reorganization of their society from the distance, since a significant portion of people is unemployed there, so these women have become the main breadwinner in their family. More and more independent of men, facing the possibility to decide whether they want children, and if yes, when do they want it. The husband goes to pick up his wife from work with his small rickshaw. In a Muslim country!
Despite the poverty and disasters, there are so many smiles and so much laughter in Bangladesh that I never saw from sober people in Hungary. While we follow the principle of “bigger, more, faster” in our crazy consumer society, it’s difficult to find pure happiness, Bangladeshis are able to find it in simple life and close family ties.
“The ambassador literally began to sob…”
– But why do we hear the name of the country only in the news about disasters?
– Unfortunately, Hungary has only minimal economic and political relations with Bangladesh.
– Is this a conscious refusal, or…?
– I think it’s unintentional, and the relationship between the two countries should be taken to another level. Bangladesh is developing enormously from year to year due to its current leaders. During our last mission, Prime Minister Sheikh Hasina invited us to help with the foundation of a national institution specializing in burn victims. So we’re important to the local health policy decision makers. It’s crucial to bring the latest technology, logistics and dare to help there.
Last time they had actually called us because there were many burn victims in the bombings. So it came out of the blue to go for two weeks from Good Friday. Since there’s no Hungarian Ambassador in Bangladesh – only in New Delhi –, Thomas Prinz German Ambassador came to visit our team, when he heard of us in the local news. He came to the hospital. We introduced him to the patients who were after or before the surgery. His interest came so naturally. A diplomat who has been around a lot, but when asked to stand up and say a few words to the hospital staff, began to sob – literally and inconsolably.
“What we’re doing is a drop in the ocean.”
– I guess you won’t like it, but there is something superhero-ish in what you do.
– If you’re a body ironer, for example, you get used to it after a while. Only some children may stare at you, thinking what a great thing to weld. We “weld” as well, but tissues instead of cars. This is our job, that’s why we learned for at least 15 years. Others are learning and working as well.
– How much can you help?
– The mission is designed not only to give people fish but also to teach them the process of fishing. In addition to the medical care of patients, we also give lectures to our colleagues and show them the latest techniques. They could learn from us, for instance, the practice of fat grafting (autologous fat transfer), which helps a lot to improve the quality of life of the patients in numerous cases.
The few hundred patients, who we helped in the recent years, are not much overall. In fact, what we do is a drop in the ocean, but might have a multiplier effect. It’s great when the colleagues send feedbacks and pictures of healing patients, or they cure hundreds of people with the methods we have introduced. Besides this, if the health care politicians get the message, there will be more effective prevention campaigns. The idea of a burn center in Dhaka was also suggested by us, as it works well both in Hungary and Germany.
“1 000 people were lying on 300 beds, or rather under it.”
– What conditions prevail in a Bangladeshi hospital?
– Largely depends on the area. Once, we got into the jeep and at the end of the twenty-eighth village, in the middle of a rice field, there was the hospital waiting for us. The burn department of the capital, where we went last time, is among the best-equipped institutions: it had 75 beds in 2014 but have been extended to 300 last year. On these 300 beds were lying 600 patients, plus 400 relatives. Just imagine that if you walk down the halls and through the crowded classroom-like hospital rooms with 50-60 patients, all beds have more people in it, and many lies beneath.
– Their immune system is so well-adapted?
– Yes. Although, the toughest and most terrible bacteria may occur in a burn unit! Notwithstanding, infection rates are much lower in Bangladesh than you would think because non-resistant pathogens – coming from the street – mingle with resistant ones in the hospital. This mixture responds better to the treatment. People are really well-adapted to the circumstances there, their immune system is extremely strong.
In wound healing, the primary stage is absolutely different and spectacular, but the scarring is worse than in European patients. Recovery of Bangladeshis is faster in the fist two weeks, even though stray flies are buzzing in the operating room, and wounds are touched sometimes without gloves. It was a great challenge for us to explain the operating room sterility rules without being offensive, but we felt it our duty – especially coming from “the country of Semmelweis”.
Working with 40°C fever and 60 years old anesthetic machine…
– Then I suspect not the stray flies caused the biggest problem in the operating room…
– Compared to the local conditions, the operating room of the hospital in Dhaka was a good standard. In previous years, we worked in much worse places. It’s hard to talk about it because I don’t want to offend my colleagues there. Even an operating table is a big deal to them. In many places, it’s like going back in time up to 40 or 50 years. In fact, sometimes we use 60 years old anesthetic machines, where you have to push the balloon manually. Our Hungarian anesthesiologist worked with one of them now. Luckily, Head Physician Eva Varga got accustomed to these, because she had already been to Afghanistan, South Sudan, and the Indonesian tsunami-hit areas.
The split air conditioners of the Bangladeshi operating rooms are constantly making the situation worse: they blow in the contaminated air from outside – if they are working. Since the hygiene is more important than the temperature, usually we ask to turn it off. Last time I got Legionella infection because of these machines, so I operated with 40°C fever. Colleagues wanted to make me have a rest, but I worked so intensely that I didn’t even realize the problem.
– I suppose you didn’t fix yourself with local medications…
– There are medications in Bangladesh, too. But who knows, when did they arrive with an aid package – so may be expired a long ago. We bought Propofol (a soy-based sterile soporific) once, but it turned to be diluted because ten times as much was needed. Our baggage is never lightweight since we always bring so much material that take up a half room: electrical dermatomes, surgical microclips, antibiotics, and threads.
“We operate from early morning until late at night.”
– What does an average “missionary” day look like?
– Getting up at dawn, then heading to the hospital. Anyway, traffic conditions are astounding in Bangladesh. Everyone comes from the opposite direction – even by bicycle! –, so a fifteen-minute trip may take one hour and a half. Upon arrival, we take a look at the patients operated on the previous day, then start the surgeries as early as 8:00, and finish late at night.
– How is it decided who will be in your hands?
– It’s usually announced that foreign doctors are coming. After hearing this, a lot of people go to the hospital, even from a very long distance. Local colleagues are pre-selecting patients suitable for surgery. They do their job well. We see fresh and years-old injuries, too. Patients often travel hundreds of kilometers. Our duty is to examine and rank them. Besides the registration of their name, we should also take pictures, because their name is often the same.
– Everyone is Ali?
– Many, though Ahmed and Muhammad happen to be more frequent. There are very cute little kids who don’t even have a last name. So we identify most of them like “he has a birthmark on his face and two fingers missing on his right hand”. As far as the order of priority is concerned, we perform more difficult surgeries at the beginning of the mission, to allow time for follow-up treatment. Simplest of the cases are left to the end.
Medical success: sole from back!
– What counts as “difficult”?
– We performed such a surgery last time, that is a rarity even at home: a free autologous tissue transfer. Once we implanted abdominal flap for breast reconstruction of a burn-injury patient. And we worked on a 15-year-old boy who had bone-deep tissue deficiency on his sole because of electrocution. He couldn’t even walk. We implanted there a free flap from his back, which ensured the stability and softness of the tissues, so he could stand on his feet. Such interventions are done with magnifying glasses or head microscopes and takes up to 5-6 hours. Electricity went out really often – then we operated in the lights of headlamps and flashlights.
“Women turned away in tears, unwilling to show their injuries.”
– Do you have personal contact with these patients?
– The classic doctor-patient relation is working, as we examine and operate on them. Their problems are obvious. Words are don’t really needed, but if they do, the local colleagues are happy to interpret. This isn’t internal medicine, where we would have to understand the symptoms based on what the patients say. We deal with clearly visible external injuries.
But it’s very difficult when women aren’t willing to take off their clothes for an examination, or they turn away in tears, pulling up their clothing just quite a bit.
Once I made the mistake that I wanted to transfer skin tissue for the reconstruction of a burn-injured breast from the lady’s abdomen, but during the surgery, it became obvious that she was burnt there, too – because of her flammable clothing. She was just afraid to show it. Finally, I managed to get intact tissues from her groin.
“There were only 20 plastic surgeons in the whole country!”
– How should we imagine the situation of the doctors in Bangladesh?
– They’re very nice and ambitious, but working for a low salary. Most of them would like to get a scholarship to Europe, but many won’t get out of the country. The medical training is good, but in practices there’s no chance for modern instruments and devices. When we went there for the first time, Bangladesh had only 20 plastic surgeons for 160 million people and has 46 now. Approximately 1,200 plastic surgeons would be needed, but there’s no one in rural areas. A general surgeon is not able to treat plastic surgery cases properly. It helps a lot that 300 dollars are enough to the medical care of 20 patients. That’s why we can do ten times as much good with a certain amount of money and time during a two-week mission.
– What kind of scene was waiting for you in places without a single plastic surgeon?
– Many people live in a clay and straw mortar or shuck house covered with a tin plate. This is a graphic example of the general living conditions. I even saw a school, which was literally a stall under a palm tree. On the top of this, a burn victim’s quality of life is a disaster without treatment. A girl with burnt chest may be never going to have a husband – her parents don’t dare to endow her because they’re afraid of failure. After a successful surgery, she can marry. And a young man, whose hand was injured in an accident, will get back his ability to work and his whole life when he’s able to use his hand again. If these inventions don’t happen, people like them may find themselves in a terrible physical and mental state. Unfortunately, they are a burden for their families.
School-age children were carried to us in their parents’ arms, as their skin was burnt several years ago. They became mummy-like with shrunken limbs and other body parts or stiffened joints. We could treat them with appropriate plastic surgery techniques, including skin tissue restructuring. During free Fridays, we visited villages in North Bangladesh with a population over 120 000 (!), and in some of them, the mayor could collect dozens of burnt children within a few minutes. These youngsters were never seen by a doctor, and sometimes their limbs grew distorted as a result of the contraction. Some of the handicapped children couldn’t even move. Families are hiding them, so they have to live their lives in the absence of any help. Therefore, Bangladesh needs far better burn care system. Our future task is to help to establish it.
“Some people came to take photos, then they went home.”
– How common is the Western help there?
– A local surgeon told me that he basically always eyed “Western people” with suspicion, lumping them together. He saw a group of doctors who came to take photos, then went home after two days. Others put teddy bears into the hands of the injured children, posing with them, then disappeared and never came back. There are also supporters, who are always generous with donations of money, never facing with the situation personally. We went there once, twice, three times, four times… and worked from dawn until late at night. The colleague has never seen such a thing, and at first didn’t really understand why we do it. Told me that he went through an internal catharsis when he discovered: there shouldn’t be any generalizations.
“I help my country as well, and I don’t accept gratuity envelopes for that.”
– Fellow countrymen don’t understand your motivations either. Charity is considered a luxury, just like plastic surgery. Some people hearing your story would ask why don’t you help gypsy children from the poorest parts of Hungary instead of Bangladeshis.
– Those children can come to the plastic surgery unit of St. John’s Hospital Department of Pediatric Surgery in Budapest. I have a small mission in Hungary, too, which aims to give the most advanced care to children with burn injuries or malformations. Many were burnt 10-15 years ago, so they need secondary and tertiary reconstructive surgery now. I don’t accept gratuities. If an envelope with money is forced in my hand, I’ll give it back.
I don’t expect anything for the days spent with this and get the minimum salary of public employees. While I could perform cosmetic breast surgeries or facelifts during this time, these special consultations have a certain uplifting extra in them. And feel free to write down that my work in the St. John’s must be backed financially as well: the hospital’s monthly lint budget is less than 700 dollars. When I have an operation there, I bring my own instruments and threads very often, so more can remain for others. Some of the revenue of my aesthetic surgery company goes to the “poorest gypsy children of Hungary”. Anyway, skin color is utterly indifferent to a doctor. There are lighter and darker shades in Bangladesh, too, but it doesn’t matter at all.
“I don’t see myself as cost-of-living breast maker.”
– So you help on a yearly basis, on a daily basis, on a national level, on an international level… This purpose stems from what? Because it’s highly unusual compared to the typical Hungarian mentality. Most people would rather “take out” from their jobs, pursuing individual benefits… and we can’t even blame them since they haven’t seen another kind of examples.
– This is very interesting. Honestly, I don’t know where does it come from. I feel it’s obvious. The Bangladesh mission is financed by the Action For Defenceless People Foundation, which was brought to life by me back in 2002 after I saw comatose patients as a newly graduated doctor. Their vulnerability and defencelessness were really touching. In the following decade, we managed to get medical devices and appliances for nearly 100 medical and social institutions, including many hospitals. Upon becoming a plastic surgeon, I felt such a knowledge came into my possession that my plain duty is to benefit others.
Acquiring this qualification is not easy neither in Hungary nor in abroad because it requires a lot of studying and training: 6 years of university, 6 years of surgery, followed by 3 years of plastic surgery. Training comes on the top of these. At least 15, but rather 25 years to do this profession properly. We may learn only one new stitch technique on a congress – and have to travel to the other side of the world for that. (I never put a breast implant above the pectoral muscle, then say “let it be”, rather try to get things done as nicely as possible, with long-term benefits.)
I like performing all branches of plastic surgery besides the aesthetic and cosmetic interventions: reconstructive plastic surgery, burn victims’ care, hand surgery, pediatric surgery, and modern regenerative medicine – such as fat grafting. We share this view, all of us who regularly return with our mission to Bangladesh. This is a beautiful, fast developing profession that can be entirely used to serve humanity.
“It’s not only about the appearance.”
– Considering this, it’s particularly a pity that plastic surgery is associated with superficial happiness even these days…
– But the harmony of body and soul is far from being a superficial topic! If an individual lives with this kind of union, gets on well with their environment. Patients become more confident, more accepting towards themselves and others, and will be accepted better by others. So the whole microenvironment changes, improving their quality of life. The plastic surgeon is also a psychologist: heals, beautifies, and provides service at the same time.
It’s a misconception that plastic surgery would be the privilege of beauty queens and the wealthy. Many people come to me after saving for years for a particular intervention. For example, there was a bus driver living with feminine breasts (gynaecomastia) since adolescence, and as a result of the reconstruction, his inhibitions dissolved as well. Or a middle-aged woman, who came for a “simple” breast augmentation, told me later that she had an orgasm for the first time in her life, as she became liberated with her recovering body image. So all of these are associated with very complex mental processes.
Plastic surgery not only makes people beautiful “from the outside”, but from the “inside”, too. Important to mention that the “magic” is done not by the surgeons themselves, but rather with the opportunities offered by science.
Can’t be judged when an accident victim would like to live with a more symmetrical nose, or a woman wants to get back her firm belly after having children. A minuscule thing may also disturb the patient. If they don’t have the body that belongs to their self-image, it can cause severe psychological damage.
– What was the most extreme request during a consultation?
– I had to refuse many requests for extremely large breasts. This is always a consequence of body image problems. However, there are cases where a psychologist’s opinion also supports the fact that a huge implant is the key to the patient’s happiness. But it happens only in one case out of a thousand, and more common abroad.
– If we have already been talking about free surgery: how do famous people and celebrities find you? Do they pay for your help?
– They come based on recommendations, just like the vast majority of our patients. We also have celebrities here, but – unlike in many other places – all of them pay the price of the surgery.
– And if there’s no free breast surgery, maybe a cheap cosmetic surgery?
– Manipulating with low prices is dangerous because the best technology and materials can’t be expected in these cases. Neither up-to-date knowledge. Pushing business tactics, active (and unfounded) persuasion, or unethical advertising like “one breast for half price” or “breast augmentation with free hair removal” are degrading and patient-threatening promotional activities. These are already banned in many countries by the local plastic surgery society, but in Hungary unfortunately not yet.
“Pulling the strings has a huge role in Hungary.”
– Where did you get from this international approach?
– As a child, I spent two years in Germany and the Netherlands, and a half in France and the United States with my family. We came home when I was going to high school. I attended university mostly in Hungary but spent a semester in the Netherlands. As a medical student, I went to Brazil with a scholarship, then began to learn plastic surgery in Germany.
After graduation, I applied together with 14 local colleagues for a plastic surgeon position, and they chose me. So I got a job and spent years abroad again. In Hungary, backstairs influence is enormously important, but in Germany, my experience as a hand surgeon could mean a lot.
I like the German work ethic. I had to learn to work with their precision first, then to work quickly, finally to combine these two. It was also appealing that they haven’t even heard of gratuity.
When I founded the Hungarian Resident Doctors’ Association with 9 of my colleagues – I was the chairman for 2 years –, we tried to abolish the gratuity system with sword and fire because it messes up the relationship between doctor and patient. In cosmetic surgery, everything has a fixed price, and that’s evident. However, in public health care (for example, with a burn victim child or a woman giving birth) it’s not an acceptable approach to expect money from the patient, and do the job properly only after getting that.
– Fair enough, but what about the cost of living?
– That’s the problem! Salaries of doctors should be raised to a level which allows them to be independent of gratuity. I had 14 classmates in the university, 13 of them are working abroad. No coincidence. Hungarian health policy makers haven’t been paying attention to the salaries of doctors and care workers. The entire approach must be changed.
“The German and Hungarian mentality complement each other.”
– Then no coincidence either, that you made the dream of the mission to Bangladesh come true with a German friend and colleague.
– At first, we were a team of two with my friend, Christian Schmitz, performing operations with the help of the local surgical staff in 2010. The second mission was the same, and we had the Hungarian team by the third. That’s how the first Hungarian-founded plastic surgery mission teamed up. With the support of my foundation, we created an organization called Interplast Hungary, which works together with Interplast Germany in Bangladesh. The team of two grew into two four-member teams, each including an anesthesiologist, a scrub nurse, and two plastic surgeons to operate in two rooms simultaneously.
Differences between the German and Hungarian ways of thinking can be seen through a nice example, that actually happened to us. We worked in Bangladesh from early morning, and everything had its own order. Patients came to follow-up exams, there were a lot of people: about 20 of them waiting outside. But the names and the faces became mixed up on the list of the Germans. In Hungary, we call this phenomenon “a speck of dust in the machine”. They were so helpless that started mulling over what to do. I told them firmly that “guys, let’s move on, do our job, replace the bandage of the one who has arrived”. It was obvious that the patient was operated on his hand. At the end, it cleared up who should have come instead of him.
These two ways of thinking complements each other very well during a mission like this. Fantastic results are turning out of it! Almost as fantastic as they would if we did free breast augmentations to rejoice Southeast Asian ladies…