For the past 15 years, Dr. David Brams has been a surgeon for the Lahey Clinic in Burlington, the distance close enough for Brams in good weather to ride his bike to work from his home in Belmont.

Recently the Cedar Road resident traveled 3,200 miles to heal patients whom he had never met and would probably not meet again.

More than likely, neither surgeon nor patients will forget each other soon.

 A 1987 Cornell graduate and a former Navy surgeon, Brams heads up Lahey’s Center for Surgical Weight Loss, which has pioneered bariatric surgery to help obese patients lose weight and improve their health. Brams and his partners have done more than 2,000 procedures since the successful program at Lahey started 10 years ago.

What do surgeons like Brams do on vacation? Like the proverbial bus driver’s holiday, they perform more surgeries, this time in South America, in Ecuador. Developing countries, such as the Philippines and Ecuador, particularly in rural areas, lack enough trained surgeons to keep up with the demand for healing hands.  

Seldom do surgical teams arrive in the morning, after a long flight, to a room full of patients waiting since the night before, and get welcomed with applause. The team stayed five days and performed 50 surgeries of all types.

A few years ago, Brams joined International Surgical Missions (ISM), headquartered in Pueblo, Colorado. In June, ISM sent Brams and a team of 20 other surgeons, nurses, and medical technicians to Machala, Ecuador. 

Brams also took his daughter Cate, a freshman at Belmont High School, who washed equipment and held retractors right beside the nurses and doctors. Not many Americans have heard of Machala, but the next time shoppers buy bananas with a sticker that says Ecuador, the fruit came from the Machala area, and is a chief Ecuadorean export.

Wages for agricultural work -- and work in general -- in Ecuador are low, too low to afford first-rate health care, which most Americans take for granted.  The visiting surgeons face diseases usually treated in the United States, but much earlier. 

For example, the team usually has a plastic surgeon on board to repair cleft palates in youngsters, whose problem palate in America would have been repaired as infants. Brams said that while in the Philippines on another ISM mission he excised breast cancers from women where the tumor had ulcerated through the skin, indicating that the woman waited years for surgical attention.  In America, surgeons often take out tumors the size of grapes; those that are the size of melons are not usual on an International Surgical Missions trip. 

Specialized care

The poor in Ecuador use public health care, which in Machala means emergency surgery for accidents and assaults, but illnesses requiring more skill and experience, such as thyroid surgery, await programs like ISM and surgeons like Brams. 

Goiter surgery, the treatment of enlarged thyroid glands, is one that American surgeons perform often in the Philippines, the site of Brams’ last assignment. The cassava, the staple of the diet as a potato-like vegetable, impacts the normal workings of the thyroid. 

In America, the preferred treatment for hyperactive goiter is removal of the entire gland or radiation therapy to reduce its size, which is not an option in Ecuador, where the disease also occurs.

Thyroid replacement hormone is cheap by our standards, $10 a month, but in Machala, Ecuador, out of reach for a banana picker. In these cases, surgeons leave a small amount of thyroid tissue to provide the necessary hormone.

The watchwords of the ISM program, says Brams, is “make do with less.” The team arrives with its own equipment for surgery, drugs for post-operative care, as well as those for the all-important anesthesiology.

But the team can’t bring blood, nor are there blood banks in the country waiting for requests. Brams remembers a patient in Machala facing prostate surgery and storing his own blood for the procedure. The surgery went well and the blood wasn’t needed.

One of Brams’ other patients, however, required more blood, and happened to be the same type as the man. Brams asked permission from the man and his family to use the extra blood to which they not only agreed, but with an enthusiasm that Brams found “inspiring.”

They told Brams and his team, “Doctors, you are our heroes.”