40 Years INTERPLAST-Germany

"It is not our fault to be born into a world of prosperity and optimal medical care. It is not their fault to grow up with a deformity or burn consequences in a developing country where there is no plastic surgery for the poor. Let's try to compensate for this injustice of nature" - as far as it is within our power.-
This is the motivation for many humanitarian organizations to become active in developing countries. In addition to other medical disciplines, plastic surgery is particularly suitable for achieving optimal surgical results even under minimal technical conditions due to its low diagnostic effort. In many nations, plastic surgeons have therefore organized themselves to bring help to those who do not have access to plastic surgery in their own countries.

INTERPLAST-Germany e. V.
Impressed by the idea of direct plastic surgical aid in developing countries, Gottfried Lemperle founded INTERPLAST-Germany in Frankfurt in 1980 and was himself amazed at how quickly the spark spread to his senior physicians. Many colleagues in Germany and soon in Europe organized teams themselves, turning the INTERPLAST idea into a self-runner. In the first 10 years, nearly 50 teams operated on more than 3200 patients in developing countries.
In contrast to Interplast-USA, where strict centralization determines and organizes all missions from the team composition to the last swab, in Germany each team leader has always been personally called upon to determine his mission location, to organize his team, to beg for suture material and medications, and to give presentations for further donations after the mission is completed. This personal responsibility unquestionably increases motivation to optimize one's own missions, while INTERPLAST-Germany e.V. provides insurance, additional funding, and adherence to the general conditions in the background.
Since 2020 Andre Borsche in Bad Kreuznach organizes and leads Interplast-Germany a second time as chairman to many missions and worldwide help. All personnel activities are carried out on a voluntary basis without any expense allowances. Only the INTERPLAST secretary receives a small salary, whereby she invests many times more time out of personal enthusiasm for the "good cause".
We are committed to our many donors, large and small, and keep administrative costs to less than 5% . This includes the printing of the annual magazine with a circulation of almost 5,000 copies, which acts as a forum and official flagship of our association. We resist any commercialization and recruit donations through individual campaigns and personal donor care. In the age of "donation mailings", it is precisely the "unprofessional" nature of our donation philosophy that is often perceived as appealing and honored by many loyal donors.

INTERPLAST-Symposium
Since 2001, an INTERPLAST symposium has been held every year in March in Bad Kreuznach, which has meanwhile developed into a popular meeting place for internationally active activists. The idea of cooperation is becoming increasingly important here, and the symposium offers an ideal platform for integrating doctors from different specialties as well as nurses and caregivers for the benefit of the aid projects. Only in this way can we build on longer-term cooperation and promote the sustainability of our work.
And so André Borsche is pleased about 180 congress participants who discuss with commitment and express how important the trusting exchange of experiences in a friendly atmosphere is to them, since we can all only learn from each other.

INTERPLAST-Akademie
On the initiative of its former senior physicians Dietmar Scholz and Nuri Alamuti in Wiesbaden, experienced INTERPLAST members will offer internal training and preparation for those interested in deployment. This academy was held for the first time in 2008 in Wiesbaden on the topic of "Burns" and will be continued on a regular basis due to the great demand. With the printing of a small English paperback book "Camelbook" by the Dutch operating room nurse Greta Hesseling on techniques of plastic surgery, we also give interested nursing staff, students and learning doctors in the countries of operation something in hand to deal more closely with our specialty for the first time.

INTERPLAST-Struktur
In contrast to Interplast-USA, where a strict centralization determines and organizes all missions from the team composition to the last swab, in Germany each team leader has always been personally called upon to determine his mission location, to organize his team, to beg for suture material and medication, and to give presentations for further donations after the mission has been completed. This personal responsibility unquestionably increases motivation to optimize one's own missions, while INTERPLAST-Germany e.V. provides insurance, additional funding, and adherence to the general conditions in the background.

INTERPLAST-Sektionen
INTERPLAST's decentralized association structure in Germany is reflected in the establishment of 12 sections, each of which oversees its own projects for which it is responsible. They take care of the donation income and are supported by the INTERPLAST main account when needed. In this way, enthusiastic outreach team leaders became committed section leaders who grouped INTERPLAST sympathizers around them in their personal circles. Thus, after the Stuttgart Section under Werner Widmaier, the Munich Section under Heinz Schoeneich, the Duisburg Section under Peter Preissler and Jürgen Toennissen, the Frankfurt Section under Hermann Lampe, Marianne Wolters and Ortwin Joch, the Eschweiler Section under Hans-Elmar Nick, Wolfgang Buntenbroich and Matthias Gensior, the Nepal Project in Hennef under Hein Stahl and Gottfried Lemperle were founded in 1988, the-Bad Kreuznach Section under André Borsche, the-South Baden Section under Günter Zabel / Schopfheim and Martin Schwarz / Freiburg, the-Vreden Section under Arnulf Lehmköster, the-Siebengebirge Section under Michael Schidelko / Bad Honnef, the-South Bavaria Section under Andreas Schmidt / Murnau, the-Baden-Baden/Rastatt Section under Rüdiger Herr, and Dieter Voy from Hattingen, who founded his own support association "pro-Interplast Ruhrgebiet".

INTERPLAST Activities
INTERPLAST-Germany organizes about 60 missions per year in which more than 4000 patients are helped free of charge through plastic-reconstructive surgery. The places of operation are spread over Africa, Asia, South and Central America and are chosen independently of race, religion or political convictions. The sole aim is to provide direct help to socially disadvantaged patients and to support the local medical staff in the sense of helping them to help themselves. The average cost of treatment per patient is currently E150.
While Interplast-USA sends organizers for the mission in advance, and then pediatricians, social workers, psychologists, speech therapists and orthodontists, aftercare assistants, etc., i.e. teams of 16-20 active people, we deliberately make do with much less. As guests, we do not want to bludgeon the hosts with our presence, but rather integrate ourselves into the inviting hospital with respect. Thus, our teams consist of 4 to a maximum of 10 participants, usually including 2 experienced surgeons, 2 assistants, 2 anesthesiologists, 2-3 nurses and 1 student.
In any case, we are happy to involve the local staff and also to include them in the responsibility of the aftercare of our common patients. However, this can only be accomplished by consciously striving to do so and encouraging colleagues to participate in the success of the mission. As a rule, an INTERPLAST deployment of 2 weeks comprises 10 operating days, on which up to 12 hours of surgery are performed on 2 tables. Towards the end of the assignment, times for dressing changes and possible revisions must be included in the schedule.

Operations in Germany
Patients who require complex reconstructions or multiple operations are also treated in Germany in exceptional cases, provided that the question of costs, entry logistics and responsibility are clarified. Thanks to the progress in microsurgery, the intensive medical possibilities and the secured aftercare, patients with large defects or tumors, severe burns, noma or neurofibromatosis could be treated optimally. Sometimes it is even possible to provide highly specialized care in developing countries themselves, as Wolfgang Mühlbauer managed to do in Myanmar with craniofacial surgery for meningocele.
In awareness of the comparatively extremely high treatment costs in Germany, it is also important to consider the socio-psychological aspect of an only temporary stay with us. Patients from the poorest regions of the world are then suddenly confronted with our prosperity, care and culture. Back home, they have to cope with reintegration and find their way again with the limited possibilities. Also, too high expectations of the hoped-for success of treatment may be disappointed, especially in the case of severe burns.

Help for self-help
"Give a man a fish - and he has food today. Teach him to fish - and he can feed his family himself". Donald Laub had written this Chinese saying on his banner; however, he soon had to realize that training surgeons in developing countries is extremely arduous. On many missions, colleagues look on with interest on the first day, but after that they are no longer seen. Nevertheless, there are always hopeful examples that practice training local doctors as an extremely useful part of the mission.
In Sikkim, Myanmar and Vietnam, for example, we met colleagues who were very eager to learn how to perform lip and palate operations themselves by the time of the team's next visit, and who proudly demonstrated their progress to us.

Highly specialized further training is then gratefully accepted when motivated specialists on site express a genuine interest.
In 1989, for example, a "clubfoot program" by Ortwin Joch in Thailand met with a great response - as did a "hip prosthesis program" by the Heidelberg orthopedic surgeons in Cochin/South India, and the "meningocele program" of the Munich section in Burma. After 25 years and almost 100 missions by Interplast teams from Stanford, plastic surgeons in Ecuador were the first country to take free care of their poor compatriots into their own hands.

Guest doctors from developing countries
During the missions we meet again and again mostly young, interested and helpful assistants who share our idealism and commitment. We therefore invite them to our departments in Germany for a few months of short training in plastic surgery - and often we wonder later where they have gone.
Of the more than 15 surgical colleagues from India and Africa whom we invited to Frankfurt for 3-6 months, only a few stayed : e.g. Prakash Chhajlani from Indore/India, who accompanied several Interplast teams and has been running a cleft clinic in Indore for 20 years on the side, which makes operations possible even for destitute patients. Or Prof. Pius Agbenorku, who built up a plastic surgery department at the university in Kumasi, Ghana, where German doctors are now interns.
Many other guests, however, remained stuck in Arab countries for good salaries or opened private practices at home. This is by no means a condemnation, but an explanation for the slow development of humanitarian aid in their own countries. It is all too human that the fulfillment of one's own standard of living takes precedence over turning to one's sick neighbor.

Pro-Interplast Seligenstadt
The INTERPLAST spark also spread to a former patient of the Markus Hospital in Frankfurt, Mrs. Waltraud Huck. In 1989, she and her friends in Seligenstadt founded the "pro-Interplast" support association. At Christmas markets, birthdays, weddings and company parties, as well as among judges and prosecutors, they collected more than 4 million Euros in donations in 30 years, financed more than 300 teams and an additional 145 operations in the Nepal Hospital, as well as the operations of 65 children in Germany - with an administrative expenditure of 0.8 % ! Hats off to this woman ! In Buxarah near Calcutta, the first pro-Interplast house for 100 handicapped children is currently being built. In the meantime, Mrs. Reinhilde Stadtmüller and her team have taken over the chairmanship of pro-Interplast.

Ebersberger Förderverein Interplast
Hajo Schneck, a passionate INTERPLAST anesthesiologist from Ebersberg, also founded a support association in Bavaria in 2002, which has since helped to finance missions on a regular basis. We also have him to thank for the strong representation of the field of anesthesia at INTERPLAST, and as an expert advisor he is a member of the extended board. When it comes to the safety of our operations under sometimes very improvised conditions, anesthesia bears a great responsibility. Difficult situations can only be mastered in close cooperation with colleagues.

INTERPLAST-Hospitals
The 1st INTPLAST hospital was established by Werner Widmaier and his whole family from Stuttgart in 1992 in Coroatà in the state of Maranhao, the poor district in the northeast of Brazil, at the request of the bishop there. Carried by the Christian idea of giving thanks for a contented life, Werner and Gretel Widmaier organized a total of 35 medical aid missions in Tanzania, Cameroon and Brazil. Their hospital is still regularly visited and filled with life by German-Brazilian mission teams.
The 2nd Interplast Hospital was founded by Ortwin Joch, trauma surgeon from Frankfurt, in 1995 in Jalalabad /Afghanistan, after he had treated Afghan refugees in 2 hospitals in Peshawar / Pakistan since 1989 together with 18 Interplast teams. However, the termination of financial aid by the EU - and the takeover of the hospital by the Taliban put an abrupt end to this extremely effective mission in 1999.
After preliminary work by Hermann Lampe and Marianne Wolters from Frankfurt, the 3rd INTERPLAST-Hospital was built in 1997 by Gottfried Lemperle from an abandoned small Dutch leprosy station in Sankhu, 18 km east of Kathmandu / Nepal. Lemperle's brother-in-law Hein Stahl, a retired Air Force General, has since developed it into one of the most beautiful and best equipped hospitals in Nepal. It bears the name Sushma Koirala Memorial Hospital in memory of the former prime minister's wife, who burned to death in her Sahri. A trust of the same name is INTERPLAST's local partner.
The first medical director and emeritus maxillofacial surgeon of the University of Cologne, Dieter Pape brought Nepal-wide recognition. He was succeeded in 1999 by Andreas Settje, who with admirable courage held the fort during the political unrest by the Maoists and significantly expanded the project. His successor then further trained the doctors at the hospital in plastic reconstructive surgery in 2008, so that from 2009 the medical management could be placed in Nepali hands. Thanks to the support of other organizations, the hospital is now well equipped and with 5 surgeons and over 2000 operations per year, it is one of the most active hospitals in Nepal and a developmental showcase project.
A 4th INTERPLAST hospital, the REHEMA (Mercy) Centre Medical in the 2 million city of Goma, in the east of the Democratic Republic of Congo has been under construction since 2021 by Gottfried Lemperle in collaboration with the Church of the Nazarene there and is expected to be operational in spring 2022, attracting many INTERPLST teams.
INTERPLAST-Germany continued to be involved in the foundation of Noma hospitals in the Sahel zone. The AWD-Stiftung Kinderhilfe in Hannover established in 1995 in Sokoto / Nigeria, the Noma Children Hospital - and the relief action "noma" in Regensburg a hospital in Niamey / Niger. Both have since been visited by INTERPLAST teams at regular intervals. In addition, the Munich Section supported the Department of Plastic Surgery at the University of Mbarara / Uganda from 1999-2005 and its director Ralf Sautter, who moved to the Noma Children Hospital in Sokoto in 2005. The Munich Section also helped to expand the provincial hospital in Kentung / Myanmar (formerly Burma), where today local specialists successfully operate on clefts and burn contractures.

INTERPLAST-Europe
Inspired by the American example and the involvement of foreign colleagues in our German teams, other national INTERPLAST organizations were formed. Leo Rozner, who founded Interplast-Australia in 1984, and Charles Viva, who founded Interplast-UK in 1986, followed our example. Gottfried Lemperle and Donald Laub flew to Adana, Turkey in 1987, where an old friend and comrade-in-arms, Sabri Acatuerk, founded Interplast-Turkey. The German-French friendship was underlined with the foundation of Interplast-France in 1989 by Remy Zilliox in Lyon, who experienced part of his plastic surgery training in Franfurt. Then in 1990 Interplast-Holland with B. De Jong and Rein J. Zeeman and Interplast-Italy with Paolo Morselli in Bologna were able to expand the European INTERPLAST community.

INTERPLAST-Foundation
The INTERPLAST Foundation was established in 2004 to support long-term projects, including the Nepal Hospital and Heinz Schoeneich's initiative in Burma. While a non-profit association is required by law to use donations promptly, i.e. to implement them in actions within 2 years, a foundation, on the other hand, can accumulate endowment capital through tax-free "endowments", the interest from which can be used to support projects regularly over many years. www.interplast-germany.info

INTERPLAST-Members
Time and again, it is amazing how many doctors, nurses, caregivers and helpers are attracted by the fascination and challenge of providing truly effective help under the simplest of conditions. They sacrifice their vacations or use the time after retirement to pass on their practical experience, to revive it and to use it for the benefit of people in developing countries. For a membership fee of only 30E per year, they join INTERPLAST and are insured on their mission. And so our association now has over 2400 members who either want to be active themselves or support us financially as sustaining members.

Motivation of Teammembers

• Operational Self Realization
• Escape from German administrative constraints
• Meaningful and immediate action
• Socio-political responsibility for developing countries
• Gratitude for a full life
• Christian love of humanity

And what comes next ?
Where is this going to lead? For 30 years, INTERPLAST-Germany has been able to help over 100,000 patients through plastic reconstructive surgery in more than 1,500 missions. In addition to their willingness to help, team members must have a talent for improvisation and professional skills. While in the past we were able to achieve a great deal with simple plastic surgery measures, medical possibilities have also expanded in developing countries.
As the level of education and self-confidence of the host countries grows, the expectations of the mission teams become greater and more differentiated. In addition to the desire to help as many people as possible in the short time span of the mission, the quality of the aid must not suffer. The colleagues on site usually know this quite well themselves. Increasingly, contractual agreements are also expected as a prerequisite for our volunteer work in countries such as Namibia.

So we hope that despite the size of our association and the necessary stronger structuring, the individuality of our help and commitment will not suffer. We would like to thank all members who have contributed to INTERPLAST. We will continue to count on your commitment, inventiveness and professional specialty. With INTERPLAST, plastic surgery in Germany can also set an example internationally !

André Borsche und Gottfried Lemper