The words 'plastic surgery' usually conjure up images of 'size 0' celebrities, breast implants and facelifts. But one expert in the field uses his surgical talents to help those who are the antithesis of Hollywood glamour.

Reconstructive surgeon Christopher Johnson is a consultant at International Plastic Surgery Associates in Hamilton, but has also dedicated his life to helping ease the pain of disfigurement among the poor of the Third World.

Through Project Change, his patients are not women seeking physical perfection but adults and children with deformities such as cleft lips and palates, tumours and unsightly burns.

Dr. Johnson volunteers his time to journey to destinations such as Tanzania, accompanied by a medical team from Bermuda. Once there, the crew set up an operating room and carry out an exhausting schedule of corrective surgical procedures to make their patients' lives that little bit easier.

Project Change Bermuda began in 2004 as an extension of Project Change of Massachusetts, which provides plastic and reconstructive surgery to disfigured children and adults in Third World countries.

Founding surgeon Dr. Johnson was inspired by the trips he made to Ecuador and Zaire (now the Democratic Republic of Congo) while studying at the University of Massachusetts Medical School.

Since starting the Bermuda charity with the help of Ianthia Simmons Wade and Sarah Miller, it has travelled to the jungles of Ecuador and Dar es Salaam in Tanzania to change the lives of those ostracised by society due to disfigurement.

Dr. Johnson, from Oklahoma City, has contributed up to $20,000 of his own money towards nurses' flights and other expenses, but with each surgical procedure costing around $1,000, Project Change also relies on donations from individuals, companies and community groups.

Two years ago, a 'Casablanca Casino Night' fundraiser raised $25,000 towards the $50,000 needed for a mission to Tanzania in November of that year. Dr. Johnson then returned to the African nation last November, accompanied on both trips by Deborah Tuzo, a Bermudian orthodontic dentist.

Dr. Tuzo, who also has a degree in public health, organised a series of medical clinics throughout the country as part of the US charity Project Ahead. These identified patients in need of surgery and Project Change then transported them to the capital Dar es Salaam for treatment.

In 2007 the medical team from Bermuda carried out 34 operations and in 2008, another 29. They corrected cleft lip and palate, other head and hand disfigurements, and worked on tumours. The team also helped burns victims many children are scarred by falling into fires in village huts when they are toddlers.

"We see all kinds of things," said Dr. Johnson. "But sometimes we are unable to help them because these children have too much malaria or have parasites, so we can't operate. That's heartbreaking, because we never want a child to die."

But he finds his work "extremely rewarding".

"It's also very nice to work with the Tanzanians because they are such kind and peaceful people," said Dr. Johnson.

In June 2008 he also travelled to Latacunga in Ecuador, accompanied by Bermudian oral surgeon David Dyer, a nurse and an engineer.

"We had no electricity or water but set up an operating room with equipment donated by the Japanese Embassy of Ecuador, and within three days it was up and running," he said.

"We had to get the plumbing and sinks installed, and worked with a back-up generator, but managed to complete 54 surgeries within ten days."

This year will bring a new destination for Project Change with a trip to Burundi this May and November.

The population of the east African nation is still recovering from the trauma of genocide. As in neighbouring Rwanda, neighbour was set against neighbour as Tutsi and Hutu waged a civil war of barbaric proportions.

"They've had one-and-a-half years of relative stability but the medical infrastructure was completely destroyed in the civil war and so they are without anything. Everything was looted," said Dr. Johnson.

The charity's latest mission aims to fully outfit two operating rooms at the Roi-Khaled Hospital and Prince Regent Charles Hospital, both in the capital of Bujumbura.

"The conditions of the operating and recovery rooms in both these hospitals are terrible, completely unacceptable," said Dr. Johnson. "The walls are filthy, they are really very sad places to be sick."

Project Change is also going to carry out eye surgery at the Gandhi Memorial Hospital with the assistance of Bermudian opthamologist Leonard Teye-Botchway.

But it needs to raise $150,000. This is what is needed to kit out the operating rooms and pay for the medical teams accompanying the mission. At least six doctors, six to eight nurses, and up to five support staff are needed.

Dr. Johnson now hopes the community will support a series of fundraisers which include 'Hooray for Bollywood' on February 21, a 'Good Times' disco night on March 7, two tag days and a 'Benefit Weekend' April 16-19.

Back in his Island home, he is also at the vanguard of a push for tougher road safety measures as chairman of the Road Safety Council.

Operating on accident victims at King Edward VII Memorial Hospital, he has to confront the trauma and devastation of the carnage on our roads on a regular basis.

The 49-year-old said his interest in road safety began as a Clinical Fellow in Surgical Critical Care at Cedars-Sinai Medical Center in Los Angeles from 1993-4. Whilst working at the Los Angeles medical centre, he carried out the largest study of its kind into elderly people's injuries from car accidents.

"My interest in road safety started at about that time as I studied accident victims during that fellowship," he said.

"I've always been interested in outcome from injury and then when I moved to Bermuda as a reconstructive surgeon, I was the only one here for some time so I was always in the operating room dealing with people's injuries.

"The Premier asked me to join the Road Safety Council as chairman because of my expertise, and I've been in that role for four years now."

Dr. Johnson said: "I'm able to bring both the clinical part of it and the public health side to the role."

But he says because of the size of the Island, he cannot help but feel involved on a personal level. "I've had so many friends or friends of friends who have died," he said.

"Because Bermuda is a small place it's very hard to have so many people injured or die. Everything resonates that bit stronger here."

Recently the Road Safety Council launched a blitz on encouraging safer driving through a guerrilla poster campaign showing graphic images of bloodied accident victims who died as a result of the trauma.

Last month's campaign followed a record fatality rate last year in which 17 people died on our roads. However, the posters placed in restrooms, bars and restaurants, also attracted criticism for their shock value.

"It has been very controversial and people said it wouldn't work, but the accident numbers are now way down," said Dr. Johnson.

"I don't want to take credit because the Police presence is also up, but we've had one death this calendar year and I want to keep it that way.

"We wanted to shock, and it has been interesting because I've had so many parents come up to me and say things like, 'Thank you, my 15-year-old says she doesn't want to ride a bike now because she didn't realise such injuries could happen'. So that's more children who won't be getting on bikes. It means we are getting somewhere."

However, he says the prime target audience for the campaign is 16 to 25-year-old black males, who statistically have a higher accident rate.

"We don't care what people think, we care about whether the message is getting through to young black males, as that's where most of the injuries and fatalities occur," said Dr. Johnson.

But he said taking criticism onboard, the Road Safety Council has now produced a "toned down" poster which is not so graphic, for bars and restaurants. Instead it shows facial injuries of one accident victim, as opposed to the ripped bloodied limbs of previous posters.

"We are giving these establishments a choice as we want everyone to participate," said Dr. Johnson.

The Road Safety Council is also to propose legislation to Government on tougher drink driving measures.

"We are taking our road safety campaign to the next level now," said Dr. Johnson.

"We want to give the Police the tools they need to tackle drink driving, to bring Bermuda in line with the UK, US and Canada.

"The UK has very strict drink driving laws and we want the Police to be able to test people before they arrest them. Right now, they have to be arrested first so it makes it very difficult. They are only allowed to stop you if they have a high level of suspicion, so we need to have random sobriety checks such as roadblocks with the testing of every fifth car, for example."

He added: "We have other regulations we want to propose, but that's our focus in this quarter right now. We believe it will considerably change the drink driving culture we have in Bermuda."

If you would like to make a donation to Project Change, contact the Bank of Butterfield headquarters, telephone 292-2000, or write to: Project Change, c/o International Plastic Surgery Associates, PO Box HM 3323, Hamilton, HM PX.

n For more information visit www.projectchangebermuda.org