2017 Mr Ian Holten, cleft palate before and after, As seen in Warrnambool Standard Cropped for Blog

Dr Ian Holten. Plastic Surgeon saving lives in Vanuatu

For over a decade plastic surgeon Ian Holten has been visiting Vanuatu with Interplast. The Warrnambool Standard’s KATRINA LOVELL talked to Dr Holten about the lives he has changed through his work in developing countries.

Patients in Vanuatu will queue for miles just for the chance to see plastic surgeon Ian Holten and his team.

“They get there by hook or by crook. I’ve had people literally piggyback their grandparents on their backs for four days,” Dr Holten said.

If they’re wealthy enough, they might fly from one of the nearby islands. Others will come by boat or canoe. But the wait means sitting on a concrete floor, sometimes for days. There is no air-conditioned waiting room with a TV. “They wait for days and they sleep on the ground outside,” Dr Holten said.

For many Aussies, a trip to Vanuatu is filled with memories of cruise ships and cocktails by the beach. But for Dr Holten and Warrnambool nurse Sue McMillan their thoughts often turn to those whose lives they’ve changed…or even saved.

2017 Mr Ian Holten, Sue and Natalie, Image The Warrnambool Standard

Warrnambool Skin Face and Body nurse Sue McMillan, Dr Ian Holten and nurse manager Natalie Lambden. Picture: Amy Paton

“It’s a funny irony. There’s cruise ships there all the time. In the main street people are paying for coffees the same as here and people are paying for their meals the same as here. But then you go one street back and you see this abject poverty,” he said.

Dr Holten, a Geelong-based surgeon who has been seeing patients in Warrnambool for over 15 years, and Ms McMillan have just returned from a 10-day trip to Vanuatu with Interplast.

For Ms McMillan, it was her third trip to Vanuatu in five years and just looking at the photos of patients brings emotions to the surface. “It’s the gamut of emotions. You do become teary looking at it on the screen,” she said.

There are some patients that just stick in your mind. On this trip it was a five-year-old girl born with her foot growing sideways halfway down her calf. They decided to amputate the foot and bring the sole over the top of the bone so she could be put in a prosthetic. “Hopefully now she will be able to run around,” she said.

Another was a teenage girl who had fallen into a fire and when they found her, her face was “just a blob of scar”. Surgery has made a huge difference, but at 15 she is so self-conscious and has dropped out of school because of the bullying.

Burns patients are all too common in Vanuatu. “There’s lot of Malaria in Vanuatu and one of the chronic effects of malaria is you can get epilepsy because you get brain calcification. So they get epilepsy and they fall in fires and hot water,” Dr Holten said.

Burns victims who don’t get the treatment they need will get terrible contractions of the skin, especially in children where the skin is so plastic. Dr Holten said that operating on some of the scars was like cutting through concrete. Mr Ian Holten, treats burns victim, Image Warrnambool Standard

Young patient: Dr Ian Holten and his team see a lot of burns patients on their trips to Vanuatu.

Ms McMillan said most of their work in Vanuatu is with babies who are born with a hair lip or cleft palate – an operation which takes 45 minutes and costs $300 to $400.

They also see a lot of congenital conditions such as finger and toe webbing.

“So we might amputate an extra finger or remove fingers that don’t work or make the hand a bit more practical for them for writing or catching balls,” she said.

“There’s lots of trauma there. Broken bones, compound fractures of their legs or arms. Sometimes the fractures don’t heal properly and the skin above them becomes vulnerable and they develop chronic ulcers and they just don’t heal very well. We might debride that and put a skin graft over the top.

“Sometimes it’s quite shocking what we’re presented with.”

Dr Holten has been visiting Vanuatu for over a decade in his role as country coordinator for Interplast and it was on one visit last year that he came across a 14-year-old boy who had been run over by a speedboat and left to die.

“When a tourist boat would come into the island, he’d duck dive to get the chain. He surfaced and another speedboat rushing to get to the tourists ran over him,” he said.

The boy had been in hospital for about a month and there was infected brain coming out the top of his head. “They were just going to let him die because they thought they couldn’t do anything about it,” Dr Holten said.

After talking to the family through a translator, he decided to operate. “I’ve never done that operation. I’m not a brain surgeon, I’m a plastic surgeon. I know principals and everything like that.”

Lifting up a section of the skull bone, Dr Holten removed all the dead bone, operated on the brain, replaced the bone plate and stitched him up. Days later the boy was sitting up in his hospital bed and is now back at work.

“There’s a whole gamut of emotions. You feel elated, rewarded, fulfilled. It’s a great thing to do but you also feel really frustrated,” he said.

Despite tourist boats constantly in the harbour and money flowing through the casino, funding doesn’t filter down to the health system.

“There’s still so much to do,” Dr Holten said. The aim of the trips to Vanuatu is to train up local professionals to be self-sufficient.

And it’s not just Vanuatu where people need help. Dr Holten has worked in many third world countries – operating in theatres in monsoonal rains with water dripping on his head and cockroaches scurrying across the floor.

At work: Dr Ian Holten trains medical staff in Vanuatu.

At work: Dr Ian Holten trains medical staff in Vanuatu.

It was while walking the back streets of Vietnam’s Hi Chi Minh City during a huge thunderstorm that Dr Holten came across a young boy whose thigh had fused to the side of his stomach when he was burnt as a baby. He had never walked.

“We brought him out to Geelong and just basically kept cutting and ratcheting out that foot and the leg,” he said.

They had to make extra skin for the boy by putting a ‘bubble’ under the skin on his stomach and inflating it. “His foot touched the ground for the first time ever,” Dr Holten said.

“I’m telling you about what I do. It’s not just me. It’s the team. It’s the nurses, the anaesthetists. There’s a huge team.

“I’ve done stuff for Moira Kelly and these little ones coming through from Palestine.

“China just blew me away. I’d never seen anything like it.

“China with its one child policy. If a baby was born with a deformity, or if it was female, they’d just dump in this orphanage.

“So they all appeared in one day all these gorgeous little bubbas,” Dr Holten said pointing to a photo of four babies with cleft paletes.” He flicks to a photo of a mother with a baby that had its cleft palate fixed. “Very rare. That was the only mum we saw all week. The rest were orphans.”

On one trip to Sri Lanka back in 2000, he was walking back to his hotel after a workshop when a suicide bomber blew himself up in the nearby market.

Dr Holten flicks to a photo of a hospital in Ghana where the coffins were lined up outside – some are traditional, but others are in the shape of fish, kangaroos or a Mercedes Benz. “So when you get the call saying ‘Fred’s died’, you’ve got to buy the coffin on the way through and you put him in the coffin and carry him out.”

There are photos of children who tug at the heart strings, but if there is one case that upsets Dr Holten the most, it is a women who received horrific burns when she set fire to her cheating husband’s clothes.

Mr Ian Holten, Plastic Surgeon volunteers for Interplast Picture: Amy Paton

Warrnambool Skin Face and Body’s Dr Ian Holten. Picture: Amy Paton

“She got dreadfully burnt. They left her to die basically, she had such terrible burns. The family didn’t have any money, so they let her rot,” he said.

“She was begging on the streets. She was fused. Keloid scar was like mesh. She was encased in this self-imposed straight jacket. She couldn’t feed, she couldn’t wipe her bottom, she couldn’t do anything.

“She was begging on the streets and the nuns took her in.”

A sister of one of the nuns, who lived in Adelaide, asked Dr Holten to help. It wasn’t easy. Her bottom lip was fused to her chest, her hands stuck to her stomach by the scars. “Every time we operated on her we thought we were going to kill her, so we just basically just started to freeing her up from this case of scar.”

They used skin from her back to create new armpits and free her arms. Forty major operations later, and too many dressing changes to count, and Dr Holten was able to give her a new life.

“She’s got her son back, she’s a mum again,” he said.

“She’s on the motorbike roaring around. She’s self-sufficient. She’s now making turmeric. She’s holding a job, she’s independent, she’s got her life back.

“That’s why I do what we do.”

To donate to Interplast and support the good work done by Interplast Australia & NZ, please visit: www.interplast.org.au

Article as appeared in The Warrnambool Standard, Saturday 27th May, 2017