A man with a mission
30 May 2018
The difference an open-hearted person—or a whole team of them—can make, is evident today in the smiles of thousands of Southeast Asian children, thanks to the work of Santa Ana, California (US) oral and maxillofacial surgeon Sanford L. “Sandy” Ratner.
For nearly 20 years, Ratner has been taking on volunteer teaching missions to support pediatric facial deformity patients in Vietnam and Nepal. That undertaking—known since 2007 as the Open Heart Project—began with a focus on children with cleft lip and palate deformities and has expanded in recent years to include treatment of oral and maxillofacial pathology, trauma and other craniofacial deformities.
Can’t say ‘no’Ratner, an AO North America faculty member, describes the first 17 years of his career as “going to the office and operating room every day” to practice oral surgery. One day, though, he got a call from the Project Vietnam Foundation (PVNF).
“They invited me to do cleft surgery,” says Ratner, admitting with a chuckle, “I’m not a person who usually says ‘No’ to anything. If I think I can do a good job, I’ll do it.”
In 2001, he took his first trip to Vietnam in support of PVNF’s mission of providing free dental care—emergency, diagnostic, preventive and restorative treatment—to rural Vietnamese children who otherwise would have no access to dental care. After several medical missions, Ratner had a realization.
"The trips I was taking, weren’t exactly what I thought they should be. I would go to a small town, take over the OR, bring in seven surgeons and see 100 patients over the course of a week,” he explains. “We didn’t include the local doctors, so there was no one to follow up with these patients. I thought, ‘That’s not right.’”
Birth of the Open Heart ProjectThe Open Heart Project, which Ratner founded in 2007 with Vietnamese expat orthodontist Dr Christopher Nguyen, includes local surgeons every step of the way toward returning patients to normal function.
Twice a year, Ratner and Nguyen—along with team members Dr Ben Walline, Dr Heena Chandra and Dr Alex Kim, as well as volunteers for the University of California, Los Angeles oral and maxillofacial surgery residence program and pre-med and pre-dental students—travel to Vietnam and Nepal, where they have established strong relationships with hospitals.
At those hospitals, the Open Heart Project team does more than impart knowledge to local surgeons; it typically brings US $10,000 worth of donated bone plates and screws, as well as educational materials—essentials that too often are in short supply in those hospitals. Furthermore, the Open Heart Project funds the hospital stays of patients treated during the its missions.
“We spend a lot of time in triage with hospitals’ local surgeons, making plans for surgery, talking about the deformity in question and its etiology. We trace everything out before surgery,” says Ratner. “Then in the OR, we scrub together, and I do one half of the surgery and the local surgeons do the other half. I try to talk them through the surgeries so that they get the maximum hands-on learning experience.”
The importance of the Open Heart Project’s work and Ratner's skill as a teacher is clear: In the US, the incidence rate of cleft lips and palates is about one in every 1,000 people; in Vietnam, Ratner says, the incidence is one in every 500 people.
"By educating a few surgeons each year, thousands of patients have been reached over the years."
‘Can you be here tomorrow?’
Among those patients was Deepak, a nine-year-old patient whose subsequent life trajectory illustrates the difference an open heart—and intervention by skilled surgeons—can make. It was a Monday in March 1999 when Ratner got the call from a surgeon in Manila.
“He had a patient in the hospital who could not open is mouth at all. [Deepak] was flown to Manila from Nepal to receive surgical care for his condition,” Ratner recalls, explaining that five years earlier, the child had suffered a traumatic accident that left him with an unrepaired fracture to his left femur and progressive loss of the use of his lower jaw. “The doctor called to discuss my possible involvement in treating this boy. I volunteered to correct his ankylosis and invited them to send the boy to California.”
The phone went silent. Then the surgeon in Manila explained that his hospital had competed for the right to treat the child and, if it couldn’t render appropriate treatment, it would have to send the patient to Japan for treatment, thus “losing face” and appearing incapable of gaining future honors.
“When I questioned him regarding the timing, he replied, ‘Can you be here tomorrow?’” Ratner says.
He landed in Manila two days later, carrying his own instruments and computer and discovered an emaciated, malnourished Deepak who, nonetheless, had a huge smile. Over the next two days, the young patient was fed a high-calorie liquid diet in preparation for surgery.
On the day of the surgery, 20 doctors crowded into the OR and another 100 doctors watched via closed circuit video in an auditorium. Once Deepak was prepped and draped for surgery, Ratner harvested the fifth rib and prepared it for transplantation. He moved to the head of the operating table, exposed the ankylosis and asked for the power drill.
“I was given a sterilized Dremel drill, the same kind you purchase at a hardware store to use around the house,” he says. The drill bit didn’t reach the mass of bone deformity, so Ratner was forced to complete reduction with a hammer and an osteotome.
When the ankylosis was finally broken down, clapping and cheering arose from the auditorium microphone. The rest of the surgery, with restoration of a new temporo-mandibular joint, was uneventful.
‘His smile was electric’
The next day, the patient could open his mouth to about 20 mm. Ratner recalls that his face was swollen and his chest was sore, “but his smile was electric.”
“This was the first international outreach I had taken, and it filled me with great joy and pride,” he says.
Six years later, while visiting the National Dental Hospital in Kathmandu, Ratner reconnected with Deepak, who had walked a full day from their village to see him.
“The reunion was enormously fulfilling,” he says. “I saw a robust 15-year-old boy wearing the same beautiful smile and moving his lower jaw with grace and ease—one of the most memorable events in my 34 years as a surgeon.”
That experience drives Ratner's continued travel as a conduit of care for underserved children throughout Southeast Asia.
“Every trip has given me the same feeling of usefulness—as a person, as an educator, and as a surgeon.”
‘Friends forever’Ratner's medical missions dovetail with the AO Foundation’s own mission of advancing patient care. Like many young surgeons, he took an AO Principles course during his residency. Later, an acquaintance suggested that Sandy might enjoy joining the AO faculty—and he has, indeed, enjoyed the experience.
“The people I’ve met through the AO will be my friends forever and that’s definitely due to the ‘AO spirit,’” he says.
About Dr Sanford L Ratner
A native southern Californian, Dr Sanford L “Sandy” Ratner practices the full range of oral and maxillofacial surgery in Orange County. He graduated from Northwestern University Dental School in 1977, earning the Clive Hadlow award for excellence. He is a member of the craniofacial team at Children’s Hospital of Orange County and is on the staff at the University of California, Los Angeles School of Dentistry, Department of Oral and Maxillofacial Surgery.
He is a fellow in the American College of Surgeons, an AO North America faculty member, and an American Board of Oral and Maxillofacial Surgery examiner as well as serving as co-chairman of Section II of this board.
More information about the Open Heart Project here.