U.S. Doctors Take Skills to Croatia : Aid: Physicians recruited by a Southland hospital administrator spent 2 1/2 weeks treating victims of that nation’s civil war. ‘If you’ve saved one life, you’ve saved the world,’ organizer says.

SPLIT, Croatia —  The locale was a 400-bed hospital by the sunny Adriatic seaside where, in more peaceful times, bemedaled pensioners from the Yugoslav army used to fret over their hearts or livers.

Ivica Trogrlic was a different kind of casualty in a different Croatia. Lying anesthetized on the operating table, the brown-haired, sallow-skinned 22-year-old had had his left upper arm shredded by shrapnel while fighting the Muslims in Bosnia-Herzegovina’s civil war.

The surgeon in steel-rimmed glasses and Dutch clogs scrutinized the immobile Croat’s mangled musculature. He had plenty of experience with battle wounds. He practices medicine, after all, in inner-city Detroit. “I’ve just gone from one disaster zone to another,” Dr. Mehul Mehta, 35, said jokingly through his gauze mask.

Under a medical aid program for victims of the Balkans war organized by a hospital administrator who lives in Orange County, Mehta and a dozen other American doctors flew to Croatia last month for 2 1/2 weeks of operating, consulting and helping organize better health care.

“I’m not Doctors Without Borders; I’m just one person,” said Sonja Hagel, associate administrator at Century City Hospital and the mastermind behind the effort. “But I think if you’ve saved one life, you’ve saved the world.”

Hers was an ambitious agenda not without problems, some attributable to cultural clashes and physicians’ dueling egos. Earlier this year, the Austrian-born registered nurse organized the placement of 19 medical evacuees from war-ravaged Bosnia in U.S. hospitals, fighting U.N. red tape and the reluctance of some profit-conscious U.S. hospital managers to treat victims of a distant conflict for free.

“It took so long to put it together,” Hagel said. She had hoped for many more evacuees.

This time, she brought the healers to the infirm, instead of the other way around.

The core of the program, baptized “Operation Second Chance,” became a disparate band of doctors, including half a dozen plastic and reconstructive surgeons. Their volunteer scalpel work and suturing on people mutilated in the fighting that has raged in the former Yugoslav federation, Hagel said, “proves there’s more to the field than doing ‘boobs and tubes.’ ”

The long operation that began shortly after 9 a.m. in the operating theater of Split’s Krizine Hospital was one vivid example. Mehta and a colleague, John Young of Kansas City, Mo., set out to remake young Trogrlic’s arm.

The surgeons cut the latissimus dorsi muscle on his upper back. Then, using tools that looked like elongated clamping scissors, the surgeons passed the strip of healthy tissue, about eight inches long, through a gash cut in the patient’s side, then wrapped and packed the flesh around the bone of the upper arm.

Known as a “muscle transfer flap,” the operation did not restore working muscles to the wounded section of the arm, but packing the latissimus dorsi around the bone will protect it from the air and give the limb a more normal appearance, the doctors explained later.

“It’s camera time!” Mehta said as he drew back from work he was obviously proud of.

Plastic surgeons and microsurgeons, orthopedists, a retina specialist and a dental surgeon answered the call, spread through professional journals and word of mouth, to come to Croatia at no gain to themselves. Some elected to join while between jobs, but the reasons were as varied as the participants.

“One good reason--no beeper for two weeks,” quipped Mehta, who elected to work on some challenging, intellectually rewarding cases instead of accompanying his wife and three children to Michigan’s Upper Peninsula for a vacation.

“I guess it gives me a sense of purpose, of meaning, in my life,” said Dr. Jann Johnson, 43, a plastic surgeon who is moving to Sausalito in Marin County, and who accompanied Hagel on a previous trip to Croatia last January.

“In the U.S., people expect you to do cosmetics (cosmetic plastic surgery), but I’ve never liked that,” she said. “Also, the Croatian doctors are basically burned out, so overwhelmed by the numbers of acute wounded and the lack of supplies that they don’t have time to think about reconstructive surgery.”

The needs are enormous, said Croatian physicians in Split who had their own casualties to worry about during Croatia’s one-on-one war with the Serbs. They are treating the wounded brought in by helicopter or ambulance from Bosnia.

“There are so many casualties,” a tired Dr. Radoje Persic said as he rested in a physicians’ lounge at Krizine Hospital. “Our capacity is such that we can provide for keeping people alive, but not for the final, fine operations that require more time, more materials, etc.”

Dado Brajcic, the overworked chief of plastic surgery at the hospital that once belonged to the Yugoslav national army, said he has had 15 days of vacation in the last three years.

Despite such grueling workloads and manifest signs of job burnout among the Croats, it did not take long for the American doctors, who had already performed a series of operations and other volunteer work in the Croatian capital of Zagreb, to sense that they were unwelcome at Krizine and Firule, Split’s other major hospital.

“Some of the doctors here don’t want to talk to us,” Dan Zinar, 37, chief of orthopedic trauma at Harbor-UCLA Medical Center, said a few days after arriving in this ancient port city on the Dalmatian coast. “They feel threatened by all these Americans arriving.”

“I gather they’re frankly not too happy to have us here and trying to operate,” said Dr. J. Paul Harvey Jr., 71, professor emeritus in the Department of Orthopedics at USC Medical School.

The Americans said top hospital administrators skipped out without seeing them.

Plastic surgeon Robert Winslow, 56, who is moving his practice from Raleigh, N.C., to South Lake Tahoe, took to reading a Serbo-Croatian phrase book because he found that he was “twiddling his thumbs” otherwise. “I came here not because I’m a nice guy, but because I like to operate,” Winslow said.

When some of Johnson’s patient records disappeared at Krizine Hospital, some of her colleagues smelled sabotage.

It took a high-level complaint to hospital authorities during a morning meeting to break the ice.

“I can understand their point of view,” Harvey said. “All these young people want to come in and operate. It just doesn’t sell. First you talk. Then you say, ‘Here, let me show you.’ ”

Along with the other orthopedic surgeons, the jovial Harvey seemed to spend much of his time in consultations in which a patient was wheeled in and doctors traded suggestions for treatment. “It’s great fun,” Harvey said, beaming.

It also was less of a challenge to the competence and authority of the hosts.

The Americans brought 60 cartons of medical and other supplies that Delta Airlines and the Croatian national carrier shipped free. About 40 boxes, containing items ranging from kits for operations on the vitreous humor of the eye to stuffed animals for hospitalized tots, were unloaded in Split. Hagel estimated the value of that share of the cargo at $50,000 to $60,000.

For doctors used to the frenetic speed of operating theaters in U.S. hospitals, the more leisurely pace of medicine here was a shock. Unlike in the United States, no new operation was started here after 3 p.m., they said.

The doctors were put up in a “Category B” hotel by the Adriatic coast, not far from the harbor where Roman Emperor Diocletian built the lavish palace he retired to.

Split surgeon Dr. Ante Kraljevic never minced words when criticizing how the Americans were welcomed to this city or the failings of Croatian medicine. But he said there is a crying need for “better contact, better organization” before more American physicians return.

“We didn’t need so many orthopedic people this time,” the stocky, gray-haired Croatian trauma specialist said. “We need a better balance in the type of surgeon,” possibly more reconstructive experts and those who specialize in chest and abdominal operations.

Even that will not be satisfactory for some Croats, who expect war again soon with the Serbs.

As Kraljevic made his way through the disinfectant-scented wards at Firule Hospital, patients tugged on his white pajama-like uniform. “Why are the Americans sending us surgeons?” some asked. “They should be giving us tanks and planes to defend us.”