“In a gentle way, you can shake the world.”
Mahatma Gandhi
Dr. M. Samuel Noordhoff (1927–2018) ([Fig. 1 ]) came to Taiwan in 1959 as an Iowa-born missionary surgeon, and his humanitarian
lifestyle drastically and definitively modified the face of medical care in this country.
He and his family have dedicated their lives to improving the lives of the Taiwanese
people. Dr. Noordhoff wrote a few years ago, “It is the people in the medical field
of Taiwan that have worked hard to develop Taiwan’s medical community into the world-renowned
community it is today.” This quote demonstrates the seminal teamwork-centered value
he has spread over the decades providing and improving health care in Taiwan.
Fig. 1 Dr. M. Samuel Noordhoff, photo taken in 2011.
Dr. Noordhoff was a true pioneer who recognized the need for the treatment and rehabilitation
of patients with different conditions and started several programs in Taiwan:
First polio rehabilitation center.
First suicide prevention center.
First burn center.
First intensive care unit.
First plastic and reconstructive training program.
First cleft lip and palate team and center.
First craniofacial treatment center.
The now-legendary Chang Gung Memorial Hospital (delivering comprehensive health care
services, employing over 5,000 health care professionals, having over 10,000 beds,
managing over 1.1 million inpatients and 3.5 million outpatients a year, treating
over 167,000 surgical patients a year, and receiving around 10,000 international patients
a year) was established in 1976, with Dr. Noordhoff named the first superintendent.
The evolving history of this hospital is based on a true friendship and lifelong collaboration
between Noordhoff and Kimma Chang, a man who came from a family of fishermen and was
strongly influenced by Noordhoff, who sent him to the University of Michigan in the
mid-1960s and subsequently received a degree in hospital administration.
Dr. Noordhoff is unquestionably the father of plastic surgery in Taiwan and certainly
a giant of the specialty worldwide. He was inspiring and a true visionary for establishment
and evolving of this specialty as well as all other subspecialties at Chang Gung Memorial
Hospital. He constantly acted as a standard of leadership and a core role model at
this hospital from the origin of the plastic surgery program, even after his retirement
and retuning to Michigan in 1999. Through his leadership, innovation and vision, the
now world-renowned Chang Gung Plastic Surgery Department was established in mid-1970,
with the cleft–craniofacial and microsurgery fields becoming one of the largest such
programs worldwide ([Fig. 2 ]). The Chang Gung Craniofacial Center, for example, has treated more than 40,000
patients with clefts over the past four decades. His principles and values have guided
the evolving care in these fields of plastic surgery practice, including constantly
improving patient-centered outcomes and creating a culture of safety by mitigating
problems that might cause harm to patients and their families.
Fig. 2 Dr. Noordhoff with all the members and alumni of Plastic and Reconstructive Surgery,
Chang Gung Memorial Hospital. In the left side of bottom row were Dr. Fu-Chan Wei
and Dr. Yu-Ray Chen, first students and now masters in microsurgery and craniofacial
surgery.
Standing on the shoulders of a giant, all technical details which could assist the
treatment planning and execution, improve the results, and alleviate the burden of
care have been meticulously compiled to compose the current management protocols at
Chang Gung Plastic Surgery Department. The surgical-related outcomes that matter for
patients, their families, and treating surgeons have been systematically measured
over the years, with modifications provided accordingly. Dr. Noordhoff was permanently
strict with himself and to all those under his supervision, especially in terms of
patient treatment by continually putting the patient first. He called the junior surgeon
once when he found a dehiscence after cleft palate repair in his clinic and asked
him to review and improve the technique. He demanded perfect results from each of
the surgeons but also listened to them, if they had evidence to show that some particular
procedure or maneuver was not useful in their hands or experience. For example, the
soft palate repair was performed together with primary cleft lip repair, with the
full palate repair being performed later on at 18 months of age. Based on the measurement
and later-published study showing that this combined soft palate and lip repair did
not result in narrowing of the hard palate in our patients, Dr. Noordhoff was convinced
and abandoned the practice of the combined posterior palatoplasty.
Dr. Noordhoff wrote, “Be a teacher. Never be afraid that your student will be better
than you.” He truly ensured and encouraged that the younger generation of Taiwanese
plastic surgeons rose to provide high-quality care in accordance with the evolution
worldwide. Many current leaders in different fields of plastic surgery were formally
stimulated by him to travel overseas to acquire new skills and return to expand plastic
surgical activities and delivery of care in Taiwan. It was based on his conviction
in human beings as the major transforming factor of society and medical care; his
model was to invest in young surgeons, send them to receive training under leaders
in their fields of practice, and support them personally and financially while doing
so. He also expected the multidisciplinary team members and trainees to regularly
attend and present at local and international meetings, encouraging them to publish
in best peer-reviewed journals as well as organizing international meetings in Taiwan.
The Taiwanese Chinese name of Dr. Noordhoff’ (Luo Huei-Fu–羅慧夫, which means “man of
wisdom”) absolutely represents his legacy among the many subspecialties of the Chang
Gung Plastic Surgery Department.
Over more than five decades, Dr. Noordhoff was a surgeon, researcher, teacher, and
advocate in the field of cleft surgery, with tremendous contributions and many ideas
that were revolutionary at the time. Many of his seminal articles in peer-reviewed
journals contributed significantly to the scientific body of knowledge, to enhance
the discussion needed for evolving of care and research, to support the expansion
of patient care facilities and research initiatives, and to spread surgical technical
details and health care delivery particularities across the frontiers of Taiwan. To
name just a few groundbreaking surgical advancements and contributions, in mid-1990,
Dr. Noordhoff produced an outstanding cleft-specific book and video to spread primary
cleft lip repair by using key anatomical landmarks, turbinate flap, vermillion triangular
flap, and primary rhinoplasty with meticulous dissection and without a perialar incision.
Dr. Noordhoff received many civilian and governmental honors for his humanitarian
services:
“Maliniac Lecturer,” American Society of Plastic Surgeons.
“The Honors of the Association,” American Cleft Palate–Craniofacial Association.
“Sir Harold Gilles Lecture Award,” British Association of Plastic, Reconstructive
and Aesthetic Surgeons.
“Outstanding Medical Contribution Award,” Taiwan.
The “Order of Brilliant Star with Violet Grand Cordon” Presidential decoration of
Taiwan.
“9th Presidential Cultural Award,” Taiwan.
Dr. Noordhoff’s assistance and influences were definitively not restricted to Taiwan;
his attention was continuously to provide care for all the regions where cleft–craniofacial
care was needed. The Chang Gung Craniofacial Center acted as a truly cleft-specific
high-level “training camp,” receiving hundreds of international visitors, observers,
and long-term fellows from many countries. Dr. Noordhoff was also founding member
of Medical Board for the Smile Train, actively assisting the Smile Train to establish
guidelines for providing cleft care as well as to recognize and establish cleft centers
worldwide. Based on his personal donation, the Noordhoff Craniofacial Foundation was
established in 1989 to help patients with cleft–craniofacial abnormalities receiving
holistic, high-quality care, to sponsor training and research, and to improve public
awareness and social acceptance of patients. The founding of the Noordhoff Craniofacial
Foundation deeply transformed the craniofacial-cleft care in Asia as well as in many
other countries around the globe. Based on the motto “nurturing local seed physicians,”
the Noordhoff Craniofacial Foundation and Chang Gung Craniofacial Center have been
essential in establishing many multidisciplinary cleft teams in different countries,
with a positive impact on the life of thousands of patients with craniofacial and
cleft deformities over the past three decades of missionary actions ([Fig. 3 ]). The slogan of the Noordhoff Craniofacial Foundation, that is, “Love makes whole,”
truly symbolizes a life dedicated to treat and teach how to treat patients with cleft–craniofacial
abnormalities who require not only advanced surgical care but also love, compassion,
kindness, and affection. In fact, this slogan is not a simple tokenism, as people
genuinely love Dr. Noordhoff because he genuinely loved them.
Fig. 3 Dr. Noordhoff was actively involved and participated in providing the service and
training in cleft care. The photo taken in 2000 showed a cleft mission in Manila with
the local team, the seed surgeons trained in Chang Gung Craniofacial Center.
Dr. Noordhoff’s core values, attitudes, beliefs, and aspirations certainly facilitated
and culminated in the establishment and development of cleft–craniofacial care around
the world. He patiently and sensibly guided different generations of young surgeons
to overcome obstacles to provide multidisciplinary care in economically underprivileged
regions, exactly what was the beginning of history in Taiwan compared with its current
modern high-technological advances. Not only the treatment of physical component was
regularly highlighted during Dr. Noordhoff-led teaching sessions, but also the psychosocial
element was consistently emphasized as paramount in achieving the complete rehabilitation
of patients with cleft and craniofacial deformities into society. He continuously
motivated our as well as other teams to reach optimal performance in terms of efficiency,
safety, and positive outcomes for the patient, pursuing the excellence in plastic
surgery and cleft–craniofacial care.
Dr. Noordhoff’s charming simplicity, truthfulness, talent, honesty, and ethics alongside
his understanding of human being, social responsibility, organizational skills, and
leadership made him an amazing force in the development of plastic surgery in its
broad field of practice. He is clearly a hero in Taiwanese plastic surgery and an
archetype for achievement for all to emulate. He will be remembered as a dedicated
teacher for the hundreds of surgeons he trained. He was obviously happiest in the
operating room and loved teaching young surgeons. His enthusiasm, passion, and devotion
for plastic surgery has crossed generations of surgeons, as multiplied in several
centers worldwide. His philosophies are constantly “flourishing” in different parts
of the world. His legacy will certainly be forever “blooming” and active in the minds,
hearts, and attitudes of all plastic surgeons who trained directly or indirectly under
his core values and principles. His students, residents, fellows, and admirers are
sure to thank Dr. Noordhoff for initiating and disseminating this philosophy of life
based on truly helping others without thinking of any reward for it ([Fig. 4 ]). The reward, no doubt, is in the sincere smile of each patient treated.
Fig. 4 The students visited Dr. Noordhoff and Lucy in Grand Rapids, Michigan, in 2017. Last
row from the left were Lun-Jou Lo, Jui-Pin Lai, Pan-Yun Chou, and Fen-Hwa Wong.
May our dearest teacher, mentor, and role model for life rest in peace. He absolutely
shook the plastic surgery world. His life is unquestionably a message for the next
generation of plastic surgeons. The future directed by Dr. Noordhoff’s legacy will
definitely be valuable for patients with congenital and acquired abnormalities around
the world.
Financial Disclosure Statement
None of the authors has a financial interest in any of the products, devices, or drugs
mentioned in this manuscript.
Financial Support
None.
