Personal Stories

The Many Faces Behind a Mission

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Dr. Ascherman and Ren Wei

Ren Wei Zhang, an eight-year-old boy from China, was born with a facial cleft. The boy's deformity has made him an outsider for most of his life, a life that has been a difficult one. When he was three, Ren Wei's parents died in a flood. Since then he has lived in an orphanage. At age seven, he was allowed to go to school for the first time, wearing a bandage over the hole, only to be teased by his classmates. Ren Wei had always been defined by one thing-his facial difference.

Jeffrey Ascherman, MD, Assistant Professor of Surgery at Columbia University, met Ren Wei on a humanitarian mission to China in April 2002. Dr. Ascherman has been going on humanitarian missions to China since 1999 through an organization called The Children of China Pediatrics Foundation (www.china-pediatrics.org). A specialist in plastic and craniofacial surgery, Dr. Ascherman typically schedules one trip a year to remote, Chinese towns for a period of ten days. During this time he works with orphanage hospitals to conduct reconstructive surgery on children who suffer from facial malformations and birth defects, such as cleft lips and palates.

He is not alone in his mission. "We take everything, from anesthesia machines to sutures. We have a full team of doctors, nurses, nurse practitioners, medical assistants, and bio-technicians. At least 15 to 20 people volunteer their time to go on each mission," Dr. Ascherman notes.

When Dr. Ascherman and his team met Ren Wei, they very much wanted to perform surgery to close the opening, but they felt the complexity of the facial reconstruction and the need for intensive care facilities post-operatively prevented them from operating in China. Instead, the team launched a long and arduous campaign to bring the boy to The Morgan Stanley Children's Hospital of NewYork-Presbyterian.

Ren Wei Zhang

The campaign began with intensive letter writing, asking the hospital and its staff to volunteer their facilities to Ren Wei, free of charge. Dr. Ascherman put a budget together, assessing the boy's medical expenses. He appealed to his colleagues to provide free care for Ren Wei. The letters and phone calls continued on to the Chinese government, requesting permission to allow him to leave the country. The Children of China Pediatrics Foundation, including President and Founder, Gena Palumbo and Medical Director, Dr. David Roye, joined in the effort, writing letters and making phone calls. A united team formed around a little eight-year-old boy who couldn't speak a word of English. With perseverance, the team succeeded in achieving the first stage of their mission.

Fifteen months later, Ren Wei safely arrived in New York City. Far from his rural orphanage near Harbin, China, he had his first taste of ice cream. He went to the Central Park Zoo. And he waited anxiously for his surgery. The Children of China Pediatrics Foundation made arrangements for him to stay under the care of foster parents, Pat Farrell and Tom Javits. Two surgeons from China accompanied Ren Wei on his journey—Dr. Wei Qi Li, a plastic surgeon, and Dr. Yong Yun Lian, an orthopedic surgeon. They came to observe Ren Wei's surgery and study the latest surgical advancements from Dr. Ascherman and from Dr. Roye, Chief of the Pediatric Orthopedic service at Morgan Stanley Children's Hospital.

Closing Ren Wei's cleft required a highly complex operation. Dr. Ascherman planned to restructure key bones around the eyes and manipulate tissue and cartilage to close the opening and create a nose. "People think of clefts as something that go through the lip or palate, but this was through the face. Facial clefts are rare. Ren Wei had double the normal distance between his eyes, and he was missing the left side of his nose," Dr. Ascherman explains. The operations posed many potential risks, including blindness, brain injury, major blood loss, and meningitis.

On July 28, 2003, Ren Wei underwent the first of three operations. The initial surgery took over 12 hours and Dr. Ascherman laid the groundwork for the operations that would follow. "I moved his left eye approximately two centimeters more toward the middle. This meant cutting and moving all the bones around the front of his eye," Dr. Ascherman describes. "In addition, I had to replace the hole on the left side of his face with a nose. I reconstructed an inside lining for the new nose with the mucosa already lining the hole. The structure of the new nose was made from septal and ear cartilage, and a flap of skin brought down from his forehead was used to provide the covering skin. The surgery also involved cutting bone around his brain. Dr. Neil Feldstein, a neurosurgeon, assisted during this portion of the surgery."

Each of the remaining two operations took about one to two hours and were performed as outpatient procedures. The second surgery took place on August 18 and involved refining the shape of the nose as well as adding more cartilage to its framework. In the final operation on September 8, Dr. Ascherman divided the temporary connection between the new nasal skin and the upper forehead. This connection had initially kept the nasal skin alive, but was no longer necessary once the nasal skin had developed its own blood supply.

Pre Op

Post Op

Dr. Ascherman believes the three operations were very successful. "Ren Wei is doing great. He's very happy, and is playing and running around again as much as any other eight-year-old boy," he reports. "It's going to take a while for the scars to fade. In order to see the final results, it could take up to a year. But so far everything looks very good, and he is healing as well as could be expected." Dr. Ascherman seems most impressed by the boy's spirits throughout the whole process. "Ren Wei is a delightful boy. From the time I met him he has always been laughing and smiling. He has a wonderful personality and he has been terrific throughout this entire process."

Members of Dr. Ascherman's team see Ren Wei's story as a success in more ways than one. "Craniofacial teams going abroad on humanitarian missions want to do as many surgeries as possible to help as many people as possible. In the limited time they have, they're always faced with the challenge—do you help the people or help the infrastructure? The surgeons in those countries are eager to learn, but there's only so much you can do in a week's time. The beauty of this case is that the team achieved both goals. Drs. Li and Lian will probably touch the lives of hundreds of Chinese children now," says Deborah Carson, RN, MPH, Nurse Coordinator, Craniofacial and Cleft Team, NewYork-Presbyterian Hospital.

Jeffrey Ascherman, MD

In early September, Ren Wei returned to his orphanage in China. Dr. Ascherman said he and others are hoping that a family may adopt the boy soon. When asked what has been most memorable about this experience, Dr. Ascherman says, "It's a wonderful feeling to be able to help someone. I'm happy to give Ren Wei a better quality of life, and hopefully enable him to have all the opportunities that other children have. My goal is to always push the limits of what we can safely achieve. In Ren Wei's case, I think we did it—with the help of so many different people."