MISSION OF MERCY

Dr. Domingo Alvear has operated on casualties of war, the poorest of the poor and generations of children.

At 74, the veteran midstate surgeon continues to lead 'Ihe World Surgical Foundation, a Cumberland County-based charity he founded in 1997 to provide care to people in developing nations around the world, including countries in Asia, Africa and Latin America. The foundation has provided more than 6,500 free surgeries since its inception.

Not even a stroke suffered in 2016 on a mission to his native Philippines can tie Alvear down: He plans on journeying to Honduras later this month as part ofa surgical mission.

After 20 years of foundation work, however, Alvear acknowledges that the time to hand over the reins is nearing, but not imminently.

"It will be at least two years. I am trying to recruit people to take over," he said.

While Alvear is anxious to find the right person, there is no shortage of interest in charitable work of the sort performed by the foundation, known as short-term medical missions.

"liiere is no central monitoring agency, and estimates of mission participation and impact vary. A 2014 paper in the American Journal of Public Health said conservative estimates place the annual expenditures at $250 million. According to 2015 research by the journal BMC Health Services Research, the U.S. is the leading origin nation for missions, which are an unregulated - and often grassroots - means of providing direct medical aid to low- and middle-income nations, provided by both faith-based and non-faith-based groups.

A doctor's story

War, revolution and family ties helped shape Alvear as a physician and as a volunteer.

Some of his earliest exposure to the world of medicine came as a child in the Philippines, where Alvear accompanied his physician uncle on patient visits.

After initial medical training, Alvear received a dramatic introduction to the world of trauma surgery in the 1960s, working at the Clark Air Base hospital, an American military facility near Manila that treated both civilians and military personnel who had been injured in action in Vietnam.

"I was involved in 3,000 operations in two years," Alvear said.

He and his wife, Dr. Veneranda Alvear, an anesthesiologist, went from treating Americans at home to learning from Americans. In 1966, the couple moved to Philadelphia for postgraduate studies, where Alvear did his medical residency at what is now Penn Presbyterian Medical Center, followed by a pediatric surgery fellowship at St. Christopher's Hospital for Children.

"The Alvears hadn't intended to stay in the U.S. permanently, but events at home intervened. Unrest duringthe presidency of Ferdinand Marcos was followed by years of martial law and violence in the Philippines. Alvear's family suggested that it probably wasn't the best time to come home.

"Our parents told us, maybe you should stay there until things settle down," Alvear recalled.

So the couple stayed in America, where their children were born. Marcos stayed in power until 1986, when he was driven out by revolution.

By that time, the couple had long since moved from Philadelphia to Harrisburg, where Alvear says he was the area's first dedicated pediatric surgeon when he arrived in 1973. They were drawn to the area partly byaconnection with Dr. Lewis Patterson, a surgeon whom Alvear had met when Patterson was chief of surgery at Clark Air Base. Patterson had moved on to a position in Central Pennsylvania.

It was a time when specially' medicine was not as prevalent in the region, before Penn .State Health Milton S. Hershey Medical Center had become a major presence, and before area facilities had neonatal intensive care units.

"When I was a fellowin Philadelphia, two interns from Harrisburg brought a baby that had a major malformation," Alvear recalled, telling him there really was no one in the area equipped to treat the child.

"It turned out that pediatric surgery was needed here," he said.

During his years as a surgeon, Alvear says he has treated more than 10,000 children. He can gauge that number at least partly based on how many teddy bears he has given away. The stuffed animals have become his hallmark, so much so that fellow volunteers presented him with one in green medical scrubs as a token of goodwill as Alvear was recovering from his stroke.

"It started with a patient who was 6 or 7 years old," Alvear recalled. "The family gave mea teddy bear, and I thought, 'it should be the other way around."'

More than giving

A drive to give back to those in need prompted Alvear to begin volunteering overseas, initially with the Society of Philippine Surgeons in America. 'Ihat involvement led him to recognize other needs - first, that he wanted to "think global" and help multiple countries.

Alvearalso began to feel that the model of traditional missionary programs - treating patients during relatively brief visits - was a good start, but not good enough.

Observers and critics of the short-term medical mission model have questioned their long-term benefit to local communities. Alvear has long shared those concerns.

"You provide a service, and sure, you feel good, but then there are 100 more people waiting and you can't take care of them, because you run out of time," he said.

The foundation's mission encompasses treating patients in poor and remote areas, but also training local medical providers in new techniques and complex surgeries, as well as providing medical equipment such as hospital beds and surgen' kits, so that the benefits continue after foundation volunteers head home.

The foundation travels abroad several times each year, with volunteer surgeons, nurses and support staff performing up to 200 free surgeries during each five- to- 10day trip. They work with host groups in the destination countries to identify needs and treatment sites.

In addition to raising money from corporate and individual donors, the foundation receives donations of equipment, supplies and medication from hospitals, nursing homes, doctor's offices, medical suppliers and pharmaceutical companies.

Many of the medical professionals who volunteer for trips solicit donations of materials and medicine as part of their participation, as well, Alvear said.

"We have people locally, as well as volunteers from all over the countiy and Canada," he said. "We're going to Nigeria in November and we already have 80 volunteers."

Corporate, community support

Before that trip, ardent supporters of the doctor and the foundation will take time this month to honor both for their efforts. A Sept. 17 celebration at the Whitaker Center for Science and the Arts in Harrisburg, sponsored by UPMC Pinnacle (formerly PinnacleHealth) and Harsco Corp., will pay tribute to the foundation and Alvear, who spent much of his working life as a pediatric surgeon at Pinnacle.

"Asa health care system, we recognize the global value of WSF, and thank Dr. Alvear, not only for his service to PinnacleHealth, but for his contributions to local and global health communities," said UPMC Pinnacle spokeswoman Keria Meals.

The gratitude is felt at all levels of the organization.

"Dr. Alvear is a pioneer in pediatrics for our community. We are the beneficiaries of his vision for better health for children locally and throughout the world," said UPMC Pinnacle president and CEO Phil Guarneschelli.

That vision would not have become reality without the support of physicians who volunteer their time, as well as from corporate donors, such as Harsco and its former CEO, the late Derek Hathaway, who have provided funding for the foundation.

Harsco, an industrial conglomerate based in Wormleysburg, Cumberland County, was the foundation's first corporate sponsor, and continues to support its work, company spokesman Ken Julian said.

"As Dr. Alvear was developing the concept of the World Surgical Foundation, he started reaching out to prospective sponsors," Julian said. "Mr. Hathaway was both receptive and responsive to the doctor's project."

Julian believes the dedication of Alvear and his volunteers made an impression on Hathaway, who died in 2016.

"It's just remarkable, the selflessness of the people who participate, Julian said.

It also hasn't been lost on Harsco officials that foundation volunteers are serving in some of the same countries where the company has operations.

"We can certainly relate to the nature of the need that exists in some of these other countries," Julian said.

When an earthquake and tsunami devastated South Asian coastal communities in December 2004, Alvear and the foundation headed to Thailand to assist.

Their work was supported by $50,000 from Harsco, Alvear said, including some out of Hathaway's own pocket.

"We were able to deploy, and buy them an ambulance," he said, in addition to staffing a local hospital so overworked local doctors could have some relief.

According to its most recent federal 990 financial form available on the Guidestar, org charity' database website, the foundation had $185,637 in net assets at the end of 2015. hike many nonprofits, however, expenses were greater than revenues, underscoring the importance of donations.

The foundation reported revenues of $191,176, which included nearly $115,000 in contributions and grants. Total expenses were slightly higher, at $193,912.

Risks and rewards

Such work is not without danger. Alvear stresses two points for potential volunteers.

The first: Don't wander off; stay in contact with your local hosts.

While Alvear does not recall any serious injuries to volunteers during missions, he said participants have encountered potentially dangerous situations when traveling alone in areas away front the main mission site - such as in Ethopia, which has been riven by war and civil unrest.

Violence is not the only peril, however, as Alvear himself is aware. In addition to taking care of their own routine health needs, including necessary vaccinations, Alvear cautions that volunteers should be aware of their insurance coverage.

He was giringa lecture in the Philippines in early 2016 when he collapsed due to a stroke. Alvear counts himself lucky' in two critical respects: First, that he was speaking at a medical school.

"Fortunately', all of their specialists were there, and they were able to diagnose my predicament," Alvear said.

The second blessing: Alvear and his wife had purchased supplemental medical insurance that covered transportation back to the U.S. for treatment.

"It's not expensive, it's like $750 a year for the two of us, and we travel a lot," he said.

Alvear has largely recovered, and although he still walks with a slight limp, he feels strong enough to make the upcoming Honduras trip.

"I started traveling again six months after my stroke," he said.

Alvear also continues to seek a successor. He has had talks with a number of potential leaders - many, like him, immigrants wito came to America to study and practice medicine, and who have volunteered for WSF.

Even that transition likely'won't spell the end of Alvear's involvement.

"If I can still walk and my mind is still there, I'm sure I cart still help, even in the background," he said.