Mission to Lima

The main entrance of the Instituto Especializado de Salud del Niños, a large state-run children’s hospital in downtown Lima, Peru, is chaotic. Parents carry or lead their children past kiosks fronted by vendors hustling stuffed animals and balloons, up the stairs, and into a corporal mass of anxious dark eyes, all waiting to see a doctor. There are a couple of specifically South American phenomena—one charming, the other disconcerting—immediately outside the entrance: a vendor selling aloe fronds with flavored syrup, and guards inspecting bags as people leave. The entire campus was long ago splashed with paint, but the equatorial sun and downtown Lima’s hot, smog-tainted air has thinned the color to a faded sky-blue that futilely masks the institutional sadness of the children’s hospital—all the sick and injured children and their parents, waiting to be seen by somebody, those dark eyes brimming with a mix of resignation and anxiety.

On the fifth floor of one of the hospital’s buildings, a Minnesota-based charity, The Smile Network International, borrows a pair of operating rooms and a few beds in a recovery ward. This week, the charity’s doctors hope to operate on more than 100 children with cleft lips or cleft palates.

Allen Van Beek is one of the surgeons on this Smile Network “mission” to Lima. This week, from Monday to Friday, the surgeons will operate on five or six children a day, spending about an hour to an hour and a half on each cleft lip. As his iPod kicks out Sting, Van Beek looks over the top of his custom-made surgical glasses (there’s a long black microscope attached to each lens) and cracks jokes to the surgical staffers packed into the tiny OR. Today the staff includes two other North American surgeons—Robert Ryan, who is semiretired and is assisting and observing Van Beek, and Srdan Babovic, who is operating at a table four feet from Van Beek—as well as their anesthetists and nurses. Over the music, Van Beek recalls the time his then-teenaged son smashed up the doctor’s Porsche while the doctor was away. Ellie Schnepf, a stunning brunette nurse who works in Van Beek’s plastic surgery clinic back home in Edina, rolls her eyes; she’s no doubt heard the tale before.

“Yup, but kids are so cute when they’re this age,” Van Beek says, referring to the five-month-old girl he’s operating on. But the girl, who was born with a bilateral cleft lip, with gaping holes on either side of her mouth, a stump of moist pink tissue protruding from under her collapsed nose, and four teeth beginning to grow out of the flesh—well, in truth, she isn’t very “cute” at all. But after Van Beek, one of the world’s most respected micro surgeons (he’s been on thirteen training missions to Peru in the past three years and to several medical sites in Asia), is finished butterflying the child’s lip tissue into six different parts, filleting the muscle tissue away from her lip tissue and rotating it across her newly constructed top lip, and then suturing it all back together, she’s as close to cute as she will probably ever be.

Van Beek won’t be completely satisfied with the result—the girl’s “new” nose will look like a nose, but the new lip tissue will pull it down slightly toward the mouth, making it wider and flatter, a common problem called “buckling.” Van Beek shakes his head. “I try to shoot for the three-foot rule,” he explains. “If she’s acceptable to society outside of three feet, I feel like I’ve done a good job. Inside of three feet? Only God can do that one.”