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La Jolla surgeon expands on charitable surgery

Amanda Gosman with a young patient following his surgery to repair a cleft palate.
Amanda Gosman with a young patient following his surgery to repair a cleft palate.
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While a heartfelt thanks and admiration is in order for those who perform surgeries on children with birth defects and/or injuries in underserved countries, La Jolla surgeon Amanda Gosman has found a way to take treatment a few steps further.

Gosman has worked with UC San Diego and Rady Children’s Hospital for the better part of 10 years. She has been UCSD’s director of craniofacial and pediatric plastic surgery since 2006, and joined Rady Children’s Hospital as program director of the craniofacial and pediatric plastic surgery fellowship in 2013, among other appointments.

Putting her expertise to good use, Gosman founded a 501(c)3 called ConnectMed International in 2010, which uses “tele-medicine” to provide much-needed follow-up and pre-operative assessments to those in other countries who undergo surgery to repair cleft palates, burns or other injuries, as well as provide ongoing educational partnerships with their healthcare providers.

“Here in San Diego, when we treat someone with a cleft palate, we provide them with ongoing care using a whole team approach, including orthodontists, speech therapists, audiologists, psychologists and follow-up examinations. We have a team of 10 people who focus on these different areas,” she said. “What we’re trying to do is replicate that experience in other parts of the world.”

Before and after photos of a young patient with a repaired cleft palate.
Before and after photos of a young patient with a repaired cleft palate.
Courtesy

Although carried out with good intentions, Gosman said the lack of follow-up after performing surgery on those with birth defects or injuries can cause complications later on. “When surgeons go international, they might fix a cleft palate, but don’t always see how these kids do in the long run. For example, speech therapy is critical for those with repaired cleft palates, and while these countries might have trained surgeons, they might not have trained speech therapists,” she said.

Enter ConnectMed International. Using tele-medicine in the form of live video conferencing or exchange of video files, physicians with expertise in needed fields from the United States can connect with medical teams in countries where those resources are limited or not available. She said she and her team have studied whether there is a difference in outcome with speech therapy care via tele-medicine or in person, and haven’t found any.

As an added bonus, Gosman said this type of international outreach is a “great opportunity” for UCSD students. “Medical students in training can learn about using technology and treating international patients, which also helps get them interested in humanitarian work,” she said. “We have had students come together for tele-conferences to talk to a group of patients or watch a surgery live.”

Gosman herself has had a longtime interest in international work, starting when she was in high school. Born in Louisiana but raised in Ohio, Gosman started her international exploration with a trip to Guatemala and the Amazon to assist on a mobile surgical truck. “That was my first exposure to tele-medicine. We were able to screen patients in advance and follow up, even though it was just through radio at that time,” she said. “I learned about medical disparities throughout the world.”

For years, Gosman traveled the world, performing surgeries on those in need, but the lack of follow-up always bothered her. Her first-hand experience prompted the formation of ConnectMed International. Now, she is looking to the future of ConnectMed and how to improve services even further.

“We’re working on developing a tool to measure outcomes and changes in quality of life following a procedure. But they need to be developed with appropriate language for difference cultures, so we’re developing one in English and in Spanish so patients can report quality of life changes, which is one of the most important components and a lot of our justification for doing surgery,” she said. “We get to use technology to overcome a lot of international barriers and strengthened a lot of medical systems.”

While previous missions took her to India or countries in Africa, Gosman is staying a little closer to home since the birth of her daughter, Xara, now 4. “From a logistics standpoint, after I had her, it was harder to be farther away for longer periods of time … so I’ve focused on more local partners or working down in Mexico,” she said. Such partnerships have included surgeons in Baja and Tijuana, Mexico and tele-conferencing with medical facilities in those areas.

“San Diego has such incredible opportunities for collaboration in our backyard and across the border,” she said.