By Rui Sergio Monteiro de Barros, MD

Hand surgery was born in the Amazon region, precisely in the city of Belém, whose name in the Portuguese language is the translation of Bethlehem. It is located in the north of Brazil, beside the oriental part of the jungle, surrounded by large rivers, all of them tributaries of the Amazon River near its estuary. In the 1940s, Belém, the capital of the state of Pará, was an isolated city from the rest of the country, and consequently isolated of the world too, as its access was only by the ocean, through the Amazon River or by the air, using the old Val-de-cans airport.

As the U.S entered World War II, Belém received a great amount of military forces, because of its strategic location with Africa and because of the rubber cycle in the region that could be used for the efforts in the war (especially because the resources of Asian rubber were in the enemy’s hands). Large constructions of infrastructure were made in Belém. Not only at the airport, which were used as bases for the massive aircrafts, B-17, B-19, B-24 and B-25, but also the macro drainage of the half of the city, building long dykes that crossed the entire city, in order to prevent soldiers passing by on the way to the front from becoming ill with malaria. The crossing of the American troops through Belém created a great impact on our quality of life that surely reverberates to this day.

 Hand surgery initiated with my arrival as well as my colleague Dr. Reginaldo Moura in the beginning of the 1990s, when we started performing advanced procedures, such as replantations, free flaps, and toe-to-hand transplants. Both of us were born in Belém and graduated in medicine from Universidade Federal do Pará – UFPA. We took different paths to Pos Graduation concerning hand surgery. I went to the state of Rio de Janeiro and Dr. Moura went to the city of Belo Horizonte. My training in Rio de Janeiro occurred with Dr. Henrique Bulcão, chief of infirmary 11C of Rio de Janeiro’s Santa Casa Hospital, who had a significant influence on my career due to his great interest and dedication in the treatment of hand problems, always working with high standards of ethics and morality. When young, Dr. Bulcão participated, as a volunteer, in World War II in the Air force, in the Brazilian campaign in Italy. As a soldier, he worked as a nurse and translator at a campaign hospital, where he established many contacts and incentives for his future post-graduation in the USA. After his graduation in medicine in Rio de Janeiro, he decided to refine his skills in the U.S and did his training in Boston, and posteriorly hand surgery with Dr. Raymond Curtis, one of the pioneers in that area, with much of his practice based on injuries from World War II. He returned to Brazil five years, and in 1959, he founded the Brazilian Society of Hand Surgery. After the conclusion of my training in Rio de Janeiro, I had the grateful opportunity to do a fellowship training with Dr. Kleinert in Louisville, where I learned important technical refinements, including attending to wounded military personnel from the 1991 Kuwait war at the Fort Knox Hospital military base, where Dr. Kleinert was a consultant.

Meanwhile, Dr. Moura did his training with Dr. Arlindo Pardini Jr., who did a lot of his trainings in the USA, with Drs. Swanson and Flatt, and in England with Dr. Campbell Reed. During his time in the USA, he was invited to work on service members who sustained hand injuries in Vietnam, where he remained until those nervous last minutes of the withdrawal of American troops in Saigon.

Although we have no military experience or participated in any war, we obtained results from the courage of Brazilian Hand Surgeons who fought with American troops in different international conflicts and enriched their knowledge with the teachings of honorable American surgeons, who we thank and we dedicate this report.

Despite the consistent advances we have achieved since the 1990s, including the creation of a microsurgery laboratory and a medical residency program in Hand Surgery, our current battle is focused on finding solutions to overcome the main deficiency of Hand Surgery in the Amazon, modern techniques for treating injuries to peripheral nerves and brachial plexus, which have been growing at a marked rate in recent years as a result of the expressive increase in the use of motorcycles in our region.

REFERENCES
http://paramazonia.com.br/
http://www.sixtant.net/2011/index.php
https://www4.infraero.gov.br/aeroportos/aeroporto-internacional-de-belem-val-de-cans-julio-cezar-ribeiro/sobre-o-aeroporto/historico/
“Allied espionage in Brazil at World War II”