Fresh Start: Redefining Giving
Physician Magazine Cover & Article

A Life-Changing Gift
by Mike Yorkey

 About five years ago, Dr. Jim Brantner, a plastic surgeon from Johnson City, Tenn., was scanning the seminar schedule at a medical conference held on the Oceanside campus of the University of California at San Diego in La Jolla, Calif.

One of the seminars looked promising: an endoscopic browlift course with a faculty including Dr. Dennis Nigro (pronounced Nighgrow) of San Diego.
"Dennis may not have been one of the big names showing their results," Dr. Brantner says, "but when I sat in on his course, I said to myself, This is one guy whose brain I want to pick. He had developed a facelift with minimal visible incisions. The cuts are made inside the mouth, one under the chin, and others for the endoscope. I watched him perform several, and he had the ability and knowledge to take a complicated technique and make it simple for me to understand, plus he was designing an absorbable screw that would make the endoscopic browlift much easier. His results blew me away, so I corralled him afterward."


More than a year ago, Dr. Brantner, who is a founding board member of the Tennessee Physicians Resource Council, picked up a copy of World magazine in his waiting room, and who was on the cover! Why, it was Dr. Nigro, profiled for founding an at home medical missions organization called Fresh Start Surgical Gifts. The article outlined how Dr. Nigro and a host of surgical specialists were treating dozens of young patients on a benevolent basis seven to eight times a year during marathon "Surgery Weekends."

The story caught Dr. Brantner's eye, not only because he knew Dennis Nigro, but also because of his recent missions trip to Mexico, "I came back from Mexico with a feeling of dissatisfaction," Dr. Brantner says. "We were in an Indian village about four hours from Mexico City, and I did three or four cleft lips. But I spent most of my time doing procedures that any second year surgery resident could have done. It's not that the surgeries weren't worthwhile, but it seemed awfully inefficient to take two weeks out of my practice to help so few people. When Dr. Nigro described what Fresh Start was doing, I called the organization to learn more."

What Dr. Brantner discovered is that Fresh Start is a way for specialized surgeons to do ministry in the most time effective manner, meaning that participating doctors don't have to travel to a Third World country. "This is like doing missions work at home, where it's a much more efficient use of our time and efforts," Dr. Brantner says. "Believe me, it's more effectual having the patient travel to the surgeon than having the surgeon travel to the patient."

Surgery Weekend

The reception area is what you'd expect, for one of San Diego's most successful plastic surgeon practices, located in a series of upscale medical office buildings.

Stepping inside the posh surroundings, the mauve-and-green walls are sponge-painted to a glossy faux finish, and a three-foot tall marble replica of Venus de Milo stands on a base, illuminated by tasteful track lighting. The seating area is outlined by plum-colored couches. Molto classico.

On this Saturday morning, however, the waiting area is not home to an aging socialite seeking her second facelift or an anxious yippie couple opting out of their HMO because 3-year-old Missy received a nasty facial scar.

Instead, there's 8-year-old Eleanor "Elly" Baranov, playing with her Barbie doll and wearing hand-me-down clothes given to her by an area church. Elly, who just flew in from Russia, was born with pigmented hairy nevus across 40-percent of her body, much of it covering her upper torso and the back of her neck. This will be her eighth surgery with Dr. Nigro.

O n another couch, Donna Agaser, a 19-year-old from the Philippines, waits her turn for her third reconstructive surgery, following the necessary debulking of the massive neurofibroma that hung from her face. Her surgery will last four hours.

In all, Dr. Nigro will perform seven operations on this grueling Saturday, starting at 7 a.m. and not tying off the last suture until 8 p.m. Two of the seven patients are Americans: 5-year-old girls, Callie Daughtery and Tara Balady.

Everyone is a volunteer, from the clerical staff to the surgical nurses, scrub techs, anesthesiologists and recovery room nurses. Fresh Start was founded by Dr. Nigro in 1986 after he traveled to Mexico on a medical missions trip. Frustrated that he did not have all the surgical tools of his trade available, Dr. Nigro knew there had to be a better way: bring the indigent patients to San Diego. Dr. Nigro recruited other local doctors and nurses to volunteer their time at his surgery center in Encinitas. One of those doctors was Brian Daly, M.D., a plastic surgeon in San Diego. "Plastic surgery is one of the specialties amenable to this type of program," he says. "Many other surgeries require hospitalization, but the type of surgeries we and orthopedic specialists do such as correcting deformities of limbs and removing cysts and moles works very well in the Fresh Start model," Dr. Daly says.

Outside the clinic, Dr. Wayne McKinney, a retired pediatrician from Palm Springs, Calif., paces the parking lot. Elly's surgery is about an hour away.

Dr. McKinley discovered Elly Baranov while participating in a medical missions trip to Russia in the spring of 1992. He was helping identify orphans suitable for adoption in Zelenodolsk, a small town about 450 miles east of Moscow in the Republic of Tatarstan. The head of the orphanage was Rosa Baranov, married to Valeri. When she learned an American doctor was in her midst, she asked him to look at her 18-month-old daughter.

What the American doctor saw horrified him. Dr. McKinley had come across nevi in his practice, but this was extreme: the nevus afflicted Elly's upper chest, back, hips, buttocks and legs, with scattered pigmentation on all extremities.

"The problem with nevi, which occur in one in 500,000 births, is that they often convert to cancer," Dr. McKinley says. "The skin is thick, black and hairy like that of a gorilla."

The Russian medical system was in shambles following the fall of communism in late 1991. Doctors told Rosa they could do nothing for Elly. "Go home and have another child," they said. As for Elly, she was doomed to virtual imprisonment in their small apartment the rest of her life.

"In Russia, they hide the disabled and handicapped," Dr. McKinley says. "They are not 'main streamed' into life at all. The neighborhood kids, who could be curious and cruel, called Elly the 'Little Monster.' "

Dr. McKinley returned to the United States determined to do something for the toddler who tugged at his heart. A Los Angeles area hospital agreed to do the surgery, and friends and churches stepped up to help bring Rosa and Elly to the U.S. for several plastic surgeries. An older Los Angeles couple, John and Mary Mosley, agreed to "adopt" the mother and daughter during their surgical trips. When the Baranovs returned to Russia, the Mosleys' church collected and shipped hundreds of pounds of food, clothing and medical and school supplies to their hometown.

Elly needed more surgeries, and when funds dried up, Dr. McKinley informed Dr. Nigro about her. Then Fresh Start began the preview process. (Dr. McKinley estimates that Elly has received more than $600,000 in free medical care.) On this particular Saturday, Elly is about to under go her 14th operation, and Dr. McKinley is grateful. "God rescued this child," he says.

As Elly awaits her turn, Rosa tells the story about the time Elly was 4-years-old and in the United States for another operation. Rosa, trying to find something to take Elly's mind off the impending surgery, purchased a toy telephone for her. Later that day, Rosa overheard her daughter "calling" God and asking Him to make the surgery go fast and not hurt so much.

Elly's surgeries are painful. Dr. Nigro must remove the nevus and start over with grafts. Although she is a brave and compliant patient, Elly usually cries for two to three weeks, then limps for four or five. "I'm going to be beautiful," says the small Russian girl.

At a pre-op examination, Dr. Nigro examines the back of Elly's neck, which is the last part of her body covered with the nevus.

"Mom, I want Dr. Nigro to take off my bad skin. I want to have normal hair," Elly says in Russian. Rosa's eyes glisten.

Dr. Nigro continues to peer at the back of her neck. "No webbing that I can see. That's good," he notes. "She looks good. Let's do a full thickness skin graft from the left groin to the right ear and put in an expander, 300 cc, and start advancing it."

After Elly has left the room, Dr. Nigro discusses his young Russian patient. "She's compliant, she's mature, and she's scared," he says, "but technically, this will be an easy operation. Believe me,:it's a pleasure to be able to do something like this. I'm on the getting end as well as the giving end. From my stand point, it's a two-way street."

Dr. Nigro, who encounters many malformations and physical afflictions, is asked if anything in God's creation is imperfect. "Well, I am," he replies, implying his human nature, and he's off to the next Surgery.

The Eastern Branch

Meanwhile, in Tennessee, Dr. Jim Brantner is talking about his Fresh Start Surgery Weekend held last spring. "I didn’t want to reinvent the wheel," he says, "so I asked Fresh Start if I could start a branch office in the Eastern United States. The board agreed, and after a year of administrative planning, we had our first Surgery Weekend."

Dr. Brantner performed three operations: "One was a reduction mammoplasty for a 15-year-old girl who fell through the cracks of the medical system. Her family made too much money for Medicaid, and this was not a minor breast reduction.

"Then I did an otoplasty on an 11-year-old boy that involved pinning his ears back, which were protruding out of his head at a 90-degree angle. As little as 10-years ago, insurance carriers would have paid for the operation, calling it a congenital condition, but now they won't, calling it a 'cosmetic' procedure. The boy was very self-conscious about his ears, and afterward, his grandfather said he underwent a remarkable personality reversal.

"Finally, I operated on a 5-year-old girl from New York City with congenital nevi on 80-percent of her body, but the one that bothered her most covered half of her face. The Lord was smiling on us the entire mole came off in one procedure.

"When parents ask me, 'Why do you do this!' I always reply, 'Because I love Jesus’ and if I can use the skills He has given me to minister to kids that don't have all the advantages of other kids, then I'm being obedient. When I operate on a child, I have the immediate attention and interest of the family. While I'm not the pushy type, as soon as somebody asks why I'm doing this, it gives me an opportunity to share my faith.
"At some point, we are all going to stand in front of a white throne, and we will be held accountable for what we have done and what we have failed to do. God has made it easy for us with Fresh Start. When you do something like this, you feel terrific. It's the biggest upper going."