The Dallas-based Life Enhancement Association for People (LEAP) Foundation is a non-profit organisation dedicated to providing free surgical care to children and adults born with severe facial or body deformities. Focusing on cleft lip and palate, their volunteers also undertake craniofacial, hand, and ophthalmologic surgery, as well as eye prosthetics and orthodontics. I had the pleasure of speaking to Dr Craig Hobar about what motivated him to create the Foundation in 1991, the work they have accomplished in countries around the world, and how they are now assisting those affected by the conflict in Syria.
‘I didn’t create LEAP, it was a gift,’ Dr Hobar tells me when I ask him why he felt the need to create the Foundation 23 years ago. He tells me it began with a volunteer trip he and his wife took to the Dominican Republic, they were both so moved by the lack of medical support they decided they had to help. The following year, Dr Hobar returned to the Dominican Republic with other volunteers from the US.
‘It was supposed to be a single trip, but there was so much passion and commitment from our fellow volunteers that it really developed a life of its own. I think we all recognised the overwhelming need for help and if we’re not there to do it, it probably wouldn’t get done.’
From this single mission trip the LEAP Foundation slowly grew, returning to the Dominican Republic every year since. For the first 20 years volunteers would perform elective surgeries focusing on cleft lip and palate, but have now begun to perform more complicated surgeries.
The ability to expand on the surgeries their volunteers are able to offer is one of the benefits of such a long-term project. Returning to the Dominican Republic for over 20 years has given Dr Hobar and the LEAP Foundation the ability to treat many patients, as well as educate local surgeons to perform cleft lip and palate surgeries themselves.
‘Plastic surgery is extremely specialised. For example, most craniofacial surgeons need 8 years of surgical training after medical school. In developing countries they’re struggling to meet the everyday needs of children dying of diarrhoea, dehydration and lack of medicine. So they are not far along enough to develop the level of expertise in their surgeons to do what we do. Therefore, we are building something they don’t have. That’s the great thing about a long-term relationship. We’ve seen the Dominican Republic develop some great surgeons and now we can go on and do the more difficult procedures,’ explained Dr Hobar.
Besides educating local surgeons, Dr Hobar and LEAP have continued to return to the Dominican Republic in order to care for patients throughout their lengthy treatment process.
‘A child affected by a cleft lip and palate would need multiple surgeries over the first 15–17 years of their life. We want to be there for the child for the whole time, not just for the first surgery.’
This dedication to improve lives and medical expertise in the Dominican Republic has earned them some much warranted recognition. Dr Hobar and the LEAP team were invited to the Dominican Republic’s National Palace where President Leonel Fernandez honoured them for their service to his grateful country.
The next mission
While the Dominican Republic was the first country visited by LEAP, other countries now benefit from yearly volunteer missions. The desire to build long-term relationships and see patients throughout the treatment process are the core concerns when deciding where they should visit next.
‘It’s usually through a personal request we’re asked to visit a country. We then send in a team to assess the area and find out whether they really need us. We’re not trying to cover every country in the world; we’re trying to identify countries that really need us and establish long-standing relationships.’
Through this assessment process LEAP added yearly volunteer missions to Belize, India, Zimbabwe, Laos and Haiti, as well as a planned trip to Ecuador later this year.
The ability to undertake missions in so many countries wouldn’t be possible had it not been for the increased volunteer numbers the Foundation has received over the years. With little marketing, the LEAP Foundation has grown from a Dallas based organisation to a truly international foundation. Dr Hobar puts this increase down to the innate desire in people to help others and feels a great deal of satisfaction in providing a platform for people to do such great work.
Disaster relief in Haiti
The 2010 earthquake in Haiti was the beginning of a new development in the work the LEAP Foundation would provide. Seeing the devastation on the news with his wife, Dr Hobar knew he and the Foundation had to help. Speaking to contacts in the neighbouring Dominican Republic, Dr Hobar was able to get a team on the ground on day 4 of the disaster.
‘It was absolutely devastating. We had to perform amputations on kids and put them back on the streets because there were so many more people to see.’
While they were out there, Dr Hobar was contacted by Dr Renato Saltz, President of the American Society of Aesthetic Plastic Surgery (ASAPS), who asked for help to coordinate surgical teams of over 100 medical volunteers from all over the world who wished to travel to Haiti to assist in the relief effort.
‘It was because of our mission experience of visiting remote areas and taking everything we needed for up to 6 months that really prepared us far better than the larger organisations in Haiti. After Dr Saltz’s request, we organised 20 teams over the next 6 months and performed more than 400 major reconstructive surgeries. One of the things that made us so effective was that we were small, focused and flexible, and we were also self-sufficient. There were a lot of other well meaning people who came, but because they didn’t have the full package they often became a disruption to the system,’ he explained.
Surgical relief teams
From his experience in Haiti, Dr Hobar understood there was a need for rapid‑response disaster relief that wasn’t being met. The International Society of Aesthetic Plastic Surgery (ISAPS) also recognised this need and approached Dr Hobar to work with them to create the ISAPS–LEAP Surgical Relief Teams (SRT).
‘When ISAPS contacted us I knew it was a fantastic opportunity. We had a desire to provide disaster relief across the world and here was ISAPS with nearly 3000 surgeons in 96 countries, which would allow us to create a platform to reach a disaster within 48 hours and prevent the majority of needless deaths that occur from injuries in the first 10 days following a disaster. We would also have people who have the language and cultural skills to be valuable in the places we need to go.’
The conflict in Syria
As LEAP evolved to meet the needs of those affected by the earthquake in Haiti, SRTs have already evolved to assist those affected by the conflict in Syria. Originally designed and put together to offer rapid disaster relief, the Syrian conflict was not something the SRTs were designed to be involved in. Unfortunately, those injured in conflict have very little — if any — access to surgical treatment and there was again a need Dr Hobar couldn’t ignore.
However, sending volunteers to Syria in the middle of an armed conflict was not something Dr Hobar or ISAPS were prepared to do. An alternative option came to light on a trip Dr Hobar and his wife took to Jordan to see the refugee camps of Syrians who had fled the conflict. While he was there, he met with the ISAPS Jordanian leaders and came across a hospital in Amman in which Syrian physicians, displaced by the war, were given control of a section of the hospital to treat the Syrian refugees. Dr Hobar realised that while it was out of the question to send SRTs to Syria, they could certainly send teams to treat Syrian patients in Jordan.
The first teams were sent in October 2013 to assist local physicians working for the ‘Treating the Wounded Syrian Program’ at the Dar Al Salam Hospital in Amman. Subsequent teams were sent in early 2014 from the US and Saudi Arabia. In total, these volunteers have evaluated 196 patients, and selected 62 for surgery across the full surgical spectrum, including traumatic blast and gunshot wounds to the extremities, hands, and face. Over the next 6 months, ISAPS–LEAP Surgical Relief Teams will send an additional nine plastic and reconstructive surgical teams from around the world to treat wounded Syrians.
‘I think our efforts in Syria really demonstrate the power of Surgical Relief Teams. When we decided we wanted to go and help, our Jordanian partners stepped up and supported us so we could get our teams there. They worked with the ministry of health and got supplies for our teams so we wouldn’t be depleting the Jordanian systems. We have partners all over the world who can use their connections, their leadership and their knowledge of the local culture, and help us get our teams in and direct us in the way we can be of most use.’
Dr Hobar is confident that despite the ever‑increasing work load, the LEAP Foundation’s many years of experience, and the support network offered by ISAPS and their other partners around the world, will allow them to stay committed to their current missions, and assist in future relief efforts wherever they may arise.
‘We have three different branches now; we have our elective missions in the Dominican Republic, Belize, Haiti, Zimbabwe, and India; we have our landmark programme, where we take a select few patients to the US for complicated procedures, which we couldn’t perform in the developing country; and the third branch is disaster relief. With Surgical Relief Teams we are willing to go wherever disaster happens and are committed to helping people wherever we can.’
While Dr Hobar recognises the great support the SRTs receive, there is a need for additional support in the form of funding as all volunteers are currently financing the trips themselves. This becomes a problem as some potential volunteers from smaller or poorer countries may not be able to afford to volunteer at a time when they may be best placed to assist in a relief effort. Dr Hobar believes the solution to this problem not only comes from marketing themselves to the general public, but government funding will also be more accessible the longer they can go on demonstrating the necessity of having plastic reconstructive surgeons at the scene of a disaster.