Tuesday, January 16, 2007

We're Home, Let's Go Back!

Mission Peace 2007 is over, but the results represent significant changes in many lives. The team screened 74 potential patients and did corrective surgery on 31 individuals. In the case of the adult patients, this work will enable them to better function in the changing environment of Vietnam. In the case of the children, this work will remove, to some extent, the stigma of growing up with a deformity.

Thursday, January 11, 2007

Day 11: Hello from Amy & Stacy

Hello from the “physiotherapy” part of the Mission Peace group!

We’re attaching some photos of the children that we are working with at CanTho Pediatric Hospital, just down the street from the General Hospital where surgeries are being performed.

We are in the beginning stages of developing a relationship with the pediatric physiotherapy department here; they have only been

Wednesday, January 10, 2007

Days 9 & 10: Update from Steve Warren -- A Record Year!

Tuesday: The Ho Chi Minh revenge is chipping away at us. One-by-one it is knocking us down and keeping us down for at least a day. Poppa Bruce is the latest victim. I understand he was in his room all of today, but is doing better now. Sounds about par for the course with this one.

I hope the bug has had its way with us and moves on to greener pastures. I am not going to mention who has had it and who hasn’t anymore. I don’t want to jinx anybody. I have had my share of it and don’t wish it on anybody else.

Monday, January 8, 2007

Week 2 Begins: Update from Dr. Bruce Lehnert

Today we got our first look at the x-rays and surgical incisions from the first week of work. The x-rays look great and there were no infections. That makes a surgeon happy!

The hospital keeps on adding new patients for us to screen on a daily basis. If this keeps up we will operate on more people in less time than ever before.

What brings me to tears is that some patients cannot be helped with surgery.

A Shout-Out for Our Intepreters

The interpreters who assist Mission Peace in our work here in Can Tho have been an obviously indispensable addition to our team.Van Pham Dan Tuyen and Que Phuong are two very dedicated and talented young women who have gone above and beyond the call of duty for Mission Peace. These women are in the midst of their examinations and have been running to and fro from school to the hospital and back and studying in between.

Without their assistance, we would be unable to work effectively. Most of all, our patients would not understand the explanations given about their diagnosis, the possible solutions, and--for some--the surgery proposed and its implications.

Many of these patients are told not to walk for 4-6 weeks after surgery while their bones heal. This puts quite a burden on not only the patient but their family, too, who are the ones waiting on their loved one during their convalescence. 

I admire and respect Tuyen and Phuong so much for their hard work.~Tina Ratto, RN

Day 8: Weekend Recap from Steve Warren

It’s Monday morning and we are licking our wounds from the weekend. Many of us have been ill from various causes. We have had some illness in the past on our trips, but this weekend has been the worse yet. I was in bed most of the day yesterday, Theresa also had something, and Gurpreet spent the weekend battling the stomach stuff, then Jenni

Sunday, January 7, 2007

Day 7: First Week Recap from Jeffrey Spanko

Hello, Jeffrey Spanko writing some thoughts about the first week of the medical mission to Can Tho. We arrived Sunday afternoon and spent a fun New Years Eve in Saigon (Ho Chi Minh City).

They closed a number of streets and there was a huge crush of people watching music and fashion shows culminating in a classic countdown to New Years Eve. At the stroke of midnight there were fireworks, confetti, music, and dancing in the street. A universal moment for all.

We traveled to Can Tho New Years day and began our preparation for surgery on Tuesday. We screened patients for a long, hot eight hours and saw 37 patients. It was the usual crush of patients and there families hoping to be seen and treated. Wednesday we screened half the day and spent the other half preparing and sterilizing our instruments. 

Saturday, January 6, 2007

Day 6: Update from Poppa Bruce

It’s Saturday and although the operating room does not run, we have patients that were operated on this week and we’re concerned about their well-being. In order to put our minds at ease, Dr. Jonah Mullens made a special trip to the hospital this morning to do rounds (check on the patients).

I spoke with Dr. Mullens on his return and am happy to inform you that all is well.

Some Background 
As part of the Mission Peace project, we carry antibiotics and painkillers that we give to the patients after surgery. In Vietnam, these drugs may or may not be available and may or may not be given to the patients unless they can afford to purchase them themselves. This way of dealing with drugs is very similar to the way a patient receives food. In the case of food, I have seen the families wait outside the ward windows and when I asked why, I was told that they come to feed their family members. It’s just very different than what we have come to expect in the United States.

My family and friends have been following our progress through the website. When I spoke with my wife this morning she told me that she was being asked why I had not sent any updates. Guys, it’s the weekend and other than the special trip that Jonah took, there is simply no medical activity. In order to satisfy this comment, I decided to send you the OR schedule and then take it day by day from there. This information is in “medical speak”.

Monday January 8th
Age    Procedure
  • 5 years    Right PL to PB
  • 5 years    TF TAL EA STJ fusion (Grice-Green) lateral closing wedge Osteotomy Calcaneus
  • 6 years    bilateral Calcaneal screw removal
  • 24 years    Screw removal Tendon trans
  • 22 years    TFR TAL & CTT, possible Steindler stripping
  • 23 years    TFR non union ankle fusion

Tuesday January 9th
  • 20 months    Right T&C
  • 20 years    Triple Arthrodesis TAL; possible STJ fusion/Coleosteotomy
  • 5 years    Left amputation 2nd toe, possible great toe fusion, possible multiple Metatarsal fusion
  • 30 years    Cole osteotomy & TAL
  • 29 years    Right gastro res & CTT
  • 25 years    Right peroneal tenosynovectomy/lysis

Significant Others
Its also time to make special mention of our three RNs: Tina Ratto, Thersa Pineda and Jenni Lehnert. These guys are a very significant piece of the Mission Peace team. They are part of the screening process, keeper of records and schedules, and--more importantly--they support the Docs in the OR, assisting room to room with the occasional side trip to the supply room.

We also must make special mention of our interpreters: Tuyen (TeTee) and Phuong (Fong). Without an interpreter, this mission would be extremely difficult. The Vietnamese language uses our Latin alphabet with a set of accent marks that changes the sound of a particular letter, but the similarity to English ends there. It is based on Chinese and the sound is completely foreign to most Americans. 

These two young women run back and forth translating between the patient and the Doctors doing the exams, between the American and Vietnam Doctors, between the patient and the hospital staff all day long. They are also present in the OR running between the rooms to translate the questions in order to fulfill the needs that arise in these more critical situations. The only way to describe their activity is to imagine having 14 people all calling you at once. To top it off, I have yet to see or hear them utter a negative word or act at all put upon.

Friday, January 5, 2007

Day 4: News from Poppa Bruce

I was specifically asked to attend and document a soft-tissue clubfoot release today. The patient is a one-year-old girl.

There is probably a complete dictionary of terms that would define the activities in the OR, but I don’t know any of them. And to laymen, the correct terms wouldn’t mean much.

The best description I can give is to say that once the tissue was cut and the foot could be properly realigned, the doctors drilled a hole in the bone and inserted a stainless steel rod as a control. They then sutured the tissue internally and then externally – the end of the rod was left protruding at the heel. The foot is then bandaged and put in a cast.

This little person needs to come back to the hospital in 4 weeks to have the rod and the external sutures removed and be placed in a new cast. She'll need to wear the second cast for the next 4 weeks and have it replaced with a third case.This impediment is finally removed at 12 weeks. I sure you get the idea, it controls the foot's position as it heals.

They did the second surgery immediately after the first – this young girl, 13 years old, needed a malformed toe removed.

Thursday, January 4, 2007

Day 3: News from Poppa Bruce

I did not go to the hospital this morning to take photographs of the surgeries that begin today, but have stayed behind in my role as the Gopher (go for). 

This afternoon I will go back to the hospital and help out with whatever?
Stacy and Amy have gone to the CanTho Childrens Hospital. They will do this for the next four days and then go to Ho Chi Minh City to the Saigon Children’s Hospital. These ladies work with kids back home.

I love the faces of little children and tend to be amazed by the smiles you get from everybody.

Wednesday, January 3, 2007

First Days of 2007: Steve's Update

Well, a year’s work gathering supplies is crammed into 26 LARGE cartons and some overflow in our luggage. Everything was hoisted onto two pickup trucks and a van. At the airport all but one carton made it under the weight limit of 70 lbs. each. EVA Airlines kindly provided us with a carton to relieve some of the weight from the heavy one. Just a guess, but I think we had around 1,300 Lbs. of supplies with us this trip. My back thinks so, anyway!

Our 2007 team assembled along with our supplies at SFO. This year’s team came from New Jersey, Chicago, San Diego and the cities of the Bay Area. A couple of new teammates met the veterans and the old timers met with many hugs and handshakes. Then, it was off to the EVA lounge to relax for a bit and renew old friendships.

Our team is not really complete until we meet Professor Nyska and wife Fruma in Saigon.  They travel from Israel to join us in our work.  We departed SFO at Midnight headed for Taipei about 14 hours away, followed by a 3 hour flight to Saigon the morning of the 31st. HAPPY NEW YEAR in Saigon then off to Can Tho on the first.

Everything made it to Can Tho all in one piece, we hope! The hospital had one van waiting for us at the hotel. I don’t think that 13 circus clowns could fit in one van, let alone our medical team. Not a problem. The doctors took off walking and a couple of us took the ceremonial van ride to the hospital.

Once again, old friends met and greeted each other. We headed to the conference room, which has one of the biggest conference tables I have seen. The room and table easily accommodated all of us and all of them. Words of greetings and plans for future meetings are discussed…next year we will work at the new hospital. The new hospital has been a long time coming and will allow the doctors to work in a more modern environment.  The meeting ended with smiles around the entire table.

The doctors were now off to work.  Now the good stuff begins. The doctors made it to the examination area where a crush of patients awaited. The doctors hope to see all of the patients who have had surgery in the past and all of the new patients who have been prescreened by the hospital.

Theresa, Jenni, and Fruma sorted and organized the supplies we carried with us. I wasn’t there, but I heard that the supplies were stored in a little-used room at the end of one of the near by wards. When our ladies opened the door to the storage room, they were greeted by an entourage of nose twitching, gray furry rats. Then, opening a door inside the room cockroaches as big as elephants came pouring out to greet them. Their screams got rid of the rats and there was a mad dash to get toxic chemicals to rid them of the roaches. The roaches over here are really big and they fly, enough said.

Wednesday…The doctors and nurses spent the morning preparing the supplies for the upcoming surgeries. Materials were organized and sent off to the autoclave for sterilization. I heard no more stores or reports of rats or roaches. The afternoon was spent examining those patients not seen earlier. Steve and Mai Khanh spent the afternoon interviewing returning patients for a project that Tina is working on for her studies. Flecher is also filming past patients and interviewing some as well. All of the new and returning patients were seen and surgeries were scheduled. Tomorrow the surgeries begin.

Day 2 - Afternoon Update from Poppa Bruce

When we went to the hospital today we discovered a change to our work plan; examinations would begin at 1 p.m. instead of 9 a.m. The group therefore worked on additional sorting of our supplies and assembled surgery sets for sterilization and the operating room.

We examined an additional 26 patients this afternoon and scheduled 10 for surgery; total surgeries now stand at 26.

The actual operating-room schedule is based on two rooms running with two easier cases in one room and one difficult case in the other room in the morning, and the same logic for the afternoon session. Surgery begins tomorrow, although we somehow have to fit in 10 additional examinations as well.

I will probably take pictures in the OR but I will not include these in any picture sets I forward to the web site. When you witness a foot surgeon using the tools of the trade, scalpels, drills, alignment rods and saws, it can get a little ugly -- amazing but ugly.

It remains hot and very humid, so the OR, which has air conditioning, might become an attractive place to be...

Day 2 - News from Poppa Bruce

Our first day went pretty much as expected, although the weather was a bear – hot and very humid. The single room we were given for examinations was small (I paced off the room, its 10 X 12 feet). Air conditioning is the open front door and a small ceiling fan. 

Prior to beginning, we had to arrange the furniture to control the flow of people into the room, deal with paperwork, and take pictures. Since the patients wait right outside the room this process is very important because everybody wants to be first and they are all interested in seeing what is going on in this crowded area.

Tina and Amy and one interpreter were set up at the door to call each patient, record their information into a laptop, and supply them with name tags and papers for the next step. 

Once inside Devin would take five pictures for reference and then the examination would begin. Although this sounds orderly it can get a little crazy. The average examination takes about 15 minutes, but a potential candidate for surgery needs to be sent for x-rays and return for a second consultation.

It very important that patients who elect surgery are aware of recovery time – these people only stay in hospital a couple of days and must fend for themselves afterwards with recovery times of four to eight weeks and are instructed not put weight on their foot/feet. 

The team worked from 10:30 to almost 5:00, dealt with 37 patients and defined 16 surgeries. In Vietnam lunch starts at 12 noon and the workday ends at 4:30, no exceptions.

While the examinations were taking place Theresa and Fruma were sorting some of the 27 boxes of supplies and equipment that Mission Peace brought to Vietnam. Today the equipment will be separated into working sets and sterilized for the surgeries that will begin tomorrow.

Examinations will continue today and a schedule generated for the operations that will start tomorrow morning.

Just a little background, the Can Tho hospital is 105 years old and a new facility that has been in the works for a few years, is expected to be in operation in approximately 6 months.

Tuesday, January 2, 2007

Let's Get Started

The culmination of Mission Peace 2007 began on 29 December 2006 with travelers from New York, Chicago, and California meeting at the San Francisco airport for the trip to Can Tho, Vietnam. In addition, we have a doctor and his wife coming directly from Israel.

This is actually the ending rather than the start of the mission. It has taken the efforts of all, over the past two years, to gather the resources necessary to fund the trip and assemble the supplies required for a surgical environment that in the past has not necessarily been available in Vietnam.

The schedule for Monday (2 January 2007) calls for a trip to Can Tho hospital with the typical meeting and greetings and then the setup to screen patients. The entire team hopes to have the opportunity to examine former patients to check on their progress as well as a method of evaluating the teams diagnostic and surgical skills.

The tools and supplies that we have brought to Vietnam must be assembled into working sets and sterilized for the operating environment. This activity is the joint responsibility of the Mission Peace medical team and the hospital support staff. Supplies must be sorted and stocked so we can handle all planned or emergency requirements in the most efficient way possible.

We are expecting over 50 new patients this year, all of whom must be evaluated over the course of one to two days, at most. Once the surgical load is determined, the next step is setting the schedule to support two operating rooms that will run for the next three to six weekdays (the hospital OR staff is not available on weekends).

The next couple of days, the most hectic and difficult, form the Mission Peace 2007 caseload. We are all looking forward to a positive and beneficial outcome.

The Mission Peace team includes:
  • Drs. Meir Nyska, Bruce Lehnert, Jeff Spanko, and Jonah Mullens
  • Physical Therapists from Chicago: Stacy Bauer and Amy Levin
  • RN organizers/OR support: Tina Ratto, Theresa Pineda, and Jenni Lehnert
  • President Mission Peace: Steve Warren
  • Cinematographer: Flecher Fleudujon
  • The Gophers: Fruma Nyska, Devin Stubblefield, and Poppa Bruce

Monday, January 1, 2007

Team 2007: The Players

What follows is a list of the Mission Peace 2007 team. I use the term “Players” loosely to describe us because we are a team. We aren’t playing around.  We are serious about the work we have come here to complete. We all hope that you at home will follow our mission and watch as it unfolds. For now, here is a list of this year’s team:

That is the line up for 2007.  Keep up with your favorite players on the blog.  I will be sending a daily report on our progress and some pictures so you all can have a look at our work. It is an extreme pleasure for me to be able to work with such a wonderful team. I hope that all of you fall in love with all of us and our patients.

Steve Warren