Dr. Prabhat Bhama, a surgeon, and his wife, Trish Bhama, a nurse practitioner, stand in the yard at their Mukilteo home before this week’s medical mission for children with microtia in Guatemala. They are part of a nationwide team on a mission sponsored by the New York-based HUGS Foundation. (Ryan Berry / The Herald)

Dr. Prabhat Bhama, a surgeon, and his wife, Trish Bhama, a nurse practitioner, stand in the yard at their Mukilteo home before this week’s medical mission for children with microtia in Guatemala. They are part of a nationwide team on a mission sponsored by the New York-based HUGS Foundation. (Ryan Berry / The Herald)

All ears: Mukilteo couple provides surgery for kids born without ears

Dr. Prabhat and Trish Bhama are part of a HUGS volunteer team providing treatment for microtia in Guatemala.

MUKILTEO — Ears are a big deal, especially if you aren’t born with them.

What’s up with that?

Dr. Prabhat Bhama, a surgeon, and his wife, Trish, a nurse practitioner, are in Guatemala this week on a HUGS Foundation mission for children with microtia, a congenital deformity of small or missing ears.

“Just made our first ear!” he wrote in an email to The Daily Herald on Monday.

The new ear is constructed from pieces of the child’s rib cartilage.

There are 33 microtia surgeries planned for the week. Each surgery takes about five hours with two or three specially trained surgeons at the helm.

“It’s one of the most complicated surgeries in plastic surgery,” Prabhat Bhama, a facial plastic and reconstructive surgeon at Providence Medical Group, told the Herald before the trip.

In the United States, the complex procedure can cost $40,000 or more and is covered by most major insurance carriers for children with microtia.

In impoverished Guatemalan villages, few if any children would get the microtia surgery if not for teams such as Help Us Give Smiles or HUGS, which also does cleft lip and palate surgeries. Other missions by the New York-based nonprofit are in Ecuador and Vietnam.

Dr. Prabhat Bhama performs surgery on a child with microtia in a Guatemalan hospital with a team of New York-based HUGS Foundation medical volunteers in 2016. Bhama is a facial plastic surgeon at Providence Regional Medical Center in Everett. His wife, Trish, is a nurse practitioner with experience in assisting with general surgery and aesthetics. They are part of a nationwide HUGS team working for a week in Antigua to provide free reconstructive ear surgery to children, many who travel for miles and wait days for a chance at a surgery they would otherwise not get. (HUGS photo)

Dr. Prabhat Bhama performs surgery on a child with microtia in a Guatemalan hospital with a team of New York-based HUGS Foundation medical volunteers in 2016. Bhama is a facial plastic surgeon at Providence Regional Medical Center in Everett. His wife, Trish, is a nurse practitioner with experience in assisting with general surgery and aesthetics. They are part of a nationwide HUGS team working for a week in Antigua to provide free reconstructive ear surgery to children, many who travel for miles and wait days for a chance at a surgery they would otherwise not get. (HUGS photo)

Another HUGS team will do 61 cleft surgeries this week at the Guatemala hospital. HUGS volunteers bring the needed medical supplies and travel at their own expense to Obras Sociales del Santo Hermano Pedro in Antigua, about 25 miles from Guatemala City.

The care is provided at no cost to patients and their families.

“They are very happy and always very thankful,” Trish Bhama said.

“They will literally walk for miles and wait for days,” Prabhat Bhama said.

Think of that next time you get testy waiting 30 minutes on a medical visit.

Dr. Prabhat Bhama with a patient in Guatemala after ear reconstructive surgery in 2016. (HUGS photo)

Dr. Prabhat Bhama with a patient in Guatemala after ear reconstructive surgery in 2016. (HUGS photo)

The microtia surgery goes like this: A template is created of the child’s “normal” ear using X-ray paper (in most cases, the other ear develops normally). Then, with the child under general anesthetic, the surgeon removes rib cartilage, which is living tissue, and carves a new ear structure using the template as a guide. The new ear is positioned under the scalp to live and grow with the child. The following year, a second operation lifts the ear above the skin like a typical ear.

“The outcomes are amazing,” Prabhat Bhama said.

People without microtia take their ears for granted. Ears do more than hold up eyeglasses and gleam with jewelry.

“Microtia patients often suffer from significant mood disorders and social difficulties,” he said. “They are often bullied and ostracized by their peers, and will even wear hats to disguise the missing ear. Reconstruction will often give them back their confidence and self-esteem.”

Example of an ear created from cartilage harvested from a patient’s rib. At left is the template used to create the ear. (HUGS photo)

Example of an ear created from cartilage harvested from a patient’s rib. At left is the template used to create the ear. (HUGS photo)

Being a father of two children, daughters Neviya, 7, and Maya, 9, he can only imagine what these parents must feel.

“It solidifies my passion to do it,” he said. “I get the whole picture. This family is suffering.”

The prevalence of microtia varies geographically from about 1 to 17 per 10,000 births, he said, and is more common in Hispanic, Asian, Native American and Andean populations. It can range from a lump of tissue to a partially formed ear. Hearing loss often results.

KISS guitarist and frontman Paul Stanley had microtia.

“When you have something physical that sets you apart from people it makes you really a target of unrelenting scrutiny and sometimes ridicule. And, quite honestly, the idea of becoming famous was a way to push it in people’s faces and go, ‘You see, you should have been nicer to me,’” Stanley told Dan Rather in an interview.

Pre-operative facial markings are used for surgical planning for the operation where an ear is created using cartilage harvested from the patient’s rib. (HUGS photo)

Pre-operative facial markings are used for surgical planning for the operation where an ear is created using cartilage harvested from the patient’s rib. (HUGS photo)

Prabhat Bhama got involved with HUGS in 2014 as part of his fellowship at Harvard Medical School. This is his sixth HUGS mission. Trish Bhama, who has worked in pediatrics and trauma care, joined him in recent years.

“We start at the hospital at 6 or so in the morning and stay until 6 or 7 at night,” she said. Or later. “It all depends on how fast they are at making ears.”

She helps run the post-anesthesia care unit, the PACU, at the Guatemala hospital.

“You walk in and you feel this whiff of bleach. That’s what they use to clean everything,” she said.

Most on staff don’t speak English, so the medical workers communicate using Google translate.

“For the nurses, they supply the scrubs. Some days it says I’m a dental hygienist, other days it says I’m a doctor on my scrubs. It all depends on what they’ve got,” she said.

The patients are resilient.

“They don’t go to a pharmacy to get their medication. You give them their going-away pack and they’re on their way back to the village,” she said.

The children also get gifts and treats brought by the HUGS volunteers.

The Bhamas met in Seattle. She is from Yakima and he grew up in Detroit. He did his medical residency in otolaryngology/head and neck surgery at the University of Washington School of Medicine from 2006 to 2012, followed by a fellowship in advanced facial plastic and reconstructive surgery at Harvard and the Massachusetts Eye and Ear Infirmary.

The couple lived in Alaska and Hawaii before moving to Mukilteo two years ago.

Immediate result following placement of reconstructed ear underneath soft tissue of the scalp. (HUGS photo)

Immediate result following placement of reconstructed ear underneath soft tissue of the scalp. (HUGS photo)

He remains on staff in Alaska to do facial reconstruction surgery through a tribal health consortium in Anchorage.

In Everett, most surgeries he does are for conditions such as skin cancer, nose reshaping, sinus disorders and facial paralysis.

The HUGS mission trips are focused on microtia.

“Being in (adult) aesthetics now, it’s a way for me to keep my heart in the game and help the little guys out there,” Trish Bhama said.

The benefits are reciprocal.

“I do this to help people, but I gain a lot from this,” Prabhat Bhama said. “When I see those kids come out and their parents are crying, it makes me feel emotional about what I do. It’s a cliche, but it’s why we went into medicine.”

Andrea Brown: 425-339-3443; abrown@heraldnet.com; Twitter: @reporterbrown.

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