Friday, November 26, 2010

Heading Home

We are done, all in all the IEP team performed  37 surgeries.  We have donated most of the equipment to Can Tho General Hospital and have packed up a few of our essentials--mostly manual surgery instruments. 

This has been the most successful mission I have completed in my 12 years of work in Vietnam.  We are already planning the next trip--it was just that good this time.

A big thank you to all our donors.~Bruce Lehnert

Thursday, November 25, 2010

Finishing Up in Can Tho

It's the last morning in Can Tho and Jane and I just returned from rounding on our post-op patients. Our last patient coincidentally was the first person we began our screenings with on the first morning. It was a great way to round out our trip.

Everyone is doing well, and the expressions on the faces of our patients and their families is very uplifting and gratifying. The past two weeks have been full of various challenges that we were able to overcome with some ingenuity and cooperation between our team and the local staff. It has been an experience that I will never forget. The procedures that we performed were nothing short of miracles for many of these patients. 

The attending physicians on our team have also been very knowledgeable and have shared their experience with us in so many ways. It is a very collaborative learning environment that they have built through the IEP missions. I am very proud to have been a part of the team.  The nurses have also supported us greatly throughout the two-week period. We joke that they are like the mother hens of the group. 

This has been a very eye-opening experience. I have a great respect for our profession and for everyone who takes time out of their busy schedule to make this mission happen. I hope that I can be a part of the team again on future missions. 

Thank you International Extremity Project and Can Tho General Hospital! ~Diane M. Koshimune, DPM-PGY3

Wednesday, November 24, 2010

Scenes from the Operating Room

Dr. Jeffrey Spanko, getting ready to
make a difference.
Patients receive the best care from a
collaborative, international team.
The pictures here show a glimpse of what has happened over the past week in Can Tho. But there's so much beyond the images. Logistically, performing 26 surgeries in five days has required Herculean mental and physical effort from the medical team. The local support teams have had to support the scheduling, supplying, staffing, and care for the patients.

Some procedures are so complex that they require several of the surgeons working in concert to provide the complex solutions the patient needs. As you look at the images consider the efforts these people have put forth to bring their special skills and gifts to people in need.

Many hands working together.
At a surface level, it's easy to say "they're changing lives." But consider that statement and the environment in which the patients and their families live. In the rural environments from which many of these patients have traveled to get to Can Tho, physical abilities and strength are a far greater necessity than most of us can imagine. The changes the IEP team is making in the lives of these families is also far greater than most of us can comprehend from the comfort of our living rooms, scrolling down a web page to spend a few minutes with these pictures.~Kim Austin

Dr. Meir Nyska outside the OR.

The OR is where the miracles begin.

Drs. Mullens and Koshimune casting a young patient's leg.

Complex procedures require an
experienced team approach.

Drs. Spanko and Lehnert in the OR.

The team reviews cases in the recovery area
to outline post-op care.

Leaving Can Tho

We depart Can Tho in an hour. And I am very sad to leave. Working with IEP and the Vietnamese doctors here has been one of the greatest experiences of my life. I have learned so much through this mission. Being Vietnamese-American has certainly brought a new dimension to this experience.

Words can't express all my feelings but I hope the pictures speak for themselves. I encourage everyone to participate in some type of charity work because not only are you giving, but you are definitely receiving much more in return.

Thank you to the International Extremity Project team and to the team at Bệnh viện Đa khoa Trung ương - Cần Thơ for the opportunity of a lifetime.~Jane Nguyen

Tuesday, November 23, 2010

Memorable Case: Ectrodactyly

One of the most memorable cases of the 2010 mission will very likely be the case of a young man with what is often called "Lobster-Claw Syndrome" due to the visual aspect of the resulting deformities. From Wikipedia's definition of ectrodactyly:
Ectrodactyly, sometimes referred to as the “Lobster-Claw Syndrome” involves the deficiency or absence of one or more central digits of the hand or foot and is also known as split hand/split foot malformation (SHFM). The hands and feet of people with ectrodactyly are often described as "claw-like" and may include only the thumb and one finger (usually either the little finger, ring finger, or a syndactyly of the two) with similar abnormalities of the feet.
This is a case where the before and after pictures are dramatic, but the images are only one view of the story. (More pre-surgery photos here.)

What we see in photographs is far less dramatic than the positive change possible in this young man's life after Monday's surgery, performed by Dr. Bruce Lehnert.

Reviewing post-op films.

Letter from a Patient's Family

Dear Doctors, Nurses, Donors, and the members of the USA group coming to Cantho Hospital to help operate the numerous clubfoot patients in the Mekong Delta,

Thank you greatly for your kindness to us. In fact, you have given us an unforgettable memory by operating such many clubfoot patients, especially my niece Nguyen Thanh Loan, 36 years old.

You can’t imagine how happy she is after being operated, though now she feels a great pain from surgery, but I think it is normal after such an operation. I can see on her face a great joy thinking she will be able to walk correctly soon. She herself suggested I write to you and thank you for her.

You can also see all the happy faces in this room B512 tonight with the operated clubfoot patients and their families. I am really touched and I share their happiness.

Thank you so much indeed for helping the poor people here. You have returned them the joy to become normal as other people. Those children will be able to go to school as other children. Those adults will be able to find a suitable job and a happy life as others!  

How wonderful you are!  How wonderful God has done great things for us through you!  May you be always blessed.  May God reward you and grant you happiness, success, and all you need for your life. 

As Christmas and the New Year are coming, I wish you Merry Christmas and Happy New Year 2011, to you, to your family and to your Country of USA.

Sincerely yours,
Sister Mary Alexandra

Day 10: 26 Surgeries Completed

I cannot believe we are at the eve of our last night of surgery. We have completed 26 life-changing surgeries in five operating days. There have been more than a few marathon sessions! We have one more day of surgery and then we need to prepare the discharge plans for our patients.

Tonight, our international team got together and shared lectures. Assembled, we represent the United States, Israel, and Vietnam, so we have plenty to share about protocols in different parts of the world.

We will soon bid goodbye to the Can Tho doctors and patients, but not farewell. Our plan is to return in the next one or two years so we can continue our good work. ~Bruce

Saturday, November 20, 2010

Stacy's First Week in Can Tho

All smiles. New therapy equipment from the IEP team looks like fun!

Wow...our 1st week is complete! And what a week it was!

My role this week was two-fold, which keeps me quite busy. Earlier in the week, I assisted the surgeons during the screening clinics at the general hospital. In screenings, my role is to evaluate each patient, consider  their current functional abilities, and evaluate how any recommended surgery may impact their current function--from both a positive and negative point-of-view.
Because this is the third trip the IEP medical staff has been together, this year's screenings went quite smoothly, but the days are always challenging. This year, we saw many more children than in the past year's screening clinics. These children range in age from 2 months old to 12 years old and presented with a variety of neuromuscular challenges, including:
  • cerebral palsy
  • clubfoot deformities
  • developmental delays
  • mental retardation
  • brachial plexus injuries
  • spina bifida
  • polydactyly (additional fingers/toes)
For many of these children, surgery wasn't an option and would not benefit them, so I invited many of them to come to the Children's Hospital in Can Tho on Thursday to be seen by Amy Levin, Speech-Language Pathologist, and myself, a Physical Therapist, with the Vietnamese therapists as well.  Excitingly, 11 of the 13 children I invited actually came to see us and we were able to give each family a set of activities and exercises to work on with their infant or child. 

We were also able to demonstrate many treatment techniques and answer the many questions of the Vietnamese therapists at the Children's Hospital, as well as see a number of their own regular patients. They were quite excited with the toys and therapy equipment we brought for them to keep. 

After spending Monday at the Can Tho Children's Hospital, Amy and I will travel back to Saigon to spend three days working at the Pediatric Hospital #1.

It has been a great trip so far and as always, I feel I have learned so much not only from the other IEP team members, but most importantly from the Vietnamese families and children and the staff at the hospitals. ~Stacy Lerner

Diane's First Week in Can Tho

Caring for a post-op patient.
This first week with International Extremity Project has been quite the whirlwind! It started out rather emotionally, as we evaluated 101 patients over a two-day period.

It was difficult to see some of the young children with debilitating deformities... and even more difficult, having to tell them that there wasn't much that we could do for them was heartbreaking! But, the looks on the patients' faces when we were explaining what we could do to better their situations just about made up for it:  They were grinning from ear to ear!
Reviewing post-op films and discussing care instructions.
It was especially gratifying to see the returning patients and listen to how the previous interventions have impacted their lives. It was also very interesting to see how much the human body can adapt. Despite their deformities, many of the patients we met lead very full lives. The biggest thing I noticed: They almost never complain of pain. Amazing.

Reassuring a patient.
The next few days of surgeries were an eye-opening experience. Although we were in the new operating rooms -- which I understand are quite an improvement compared to those used in previous missions -- it didn't change the fact that we still had to be quite resilient and ingenious when it came to the actual surgeries.  We didn't always have the equipment that we needed -- and couldn't always communicate exactly what we needed -- so it was a great learning experience, watching the attending doctors use their creativity to get the job done.

I am looking forward to another week of surgeries and seeing the post-operative patients before we leave.
I am so very grateful for this opportunity. I cannot believe that a whole week has gone by. But then again, I cannot believe how much we've accomplished already! ~Diane Koshimune, DPM - PGY3

Reflections on the First Week in Can Tho

Today is a day of needed rest. The screening days were tough. There were scores of new patients who required the whole team for evaluation and management. Some patients from previous trips returned to show us their outcomes, which were uniformly excellent.

Imagine a small non-airconditioned room with: 
  • 4 International Extremity Project (IEP) doctors
  • 2 IEP residents
  • 1 Vietnamese doctor
  • 1 Vietnamese resident
  • 3 Vietnamese students
  • our IEP nurses and their local nurses
But wait, there's more! Then add in the patient and family, which number at least three more people for each evaluation. Two full days of working in the sauna was tiring.

Since we were here last, they've built a new hospital in Can Tho. The new hospital's operating rooms are nice and the operations have gone smoothly. We have done at least 18 surgeries in the last three days. The patients are recovering well, two to a bed, and have their pain controlled. We have had to remove a couple of casts because they were too tight.

We are all working well together--both new and old IEP team members. I am especially proud of the residents, Jane and Diane. They are taking on a lot of responsibility and following through just perfectly. 

The team is tired but looking forward to next week. ~Bruce Lehnert

Friday, November 19, 2010

Day 6: At the Hospital

Dr. Meir Nyska and a local colleague ready for work
The team's dedication and the love they show to the people here is inspiring for me. I wish every one of you could be here to witness it with us.

It has been so busy here it is hard to find time to write. All of the action has been happening at the big hospital so far. But today, the therapy team will be going to the children's hospital to catch up with the other part of our teem. Stand by for pictures of that. ~Bob Heimer

For more information about the young man in these pictures, see the post "Memorable Case: Ectrodactyly."
This is a face of hope.

On Monday, this will change.

The surgical team hard at work in the operating room.

Local docs teach IEP doc Bruce Lehnert new tricks.

The local team, busy and smiling.

Changing a life

Wednesday, November 17, 2010

Day 4: More Patient Evaluations

The International Extremity Project team spends the first few days in Can Tho evaluating patients for surgical procedures. Each mission more people learn about the team, so the number of people who arrive in Can Tho in hopes of being seen and chosen for surgery grows.

As you look at the pictures, you're first captivated by the faces of the children -- their smiles, their eyes. When you look at the whole picture, you can only imagine the challenges some of these children have faced with their deformities. They smile despite the challenges they've faced their entire lives -- imagine the size of the smiles once they've been given the gifts of repairs to their deformities. ~Kim

Drs Lehnert, Spanko, and Giang collaborate on
a patient consultation.

Tuesday, November 16, 2010

Day 3: First Patient Evaluation Day

A hopeful surgery candidate.

Our first day was quite emotional for me. When taking pictures on this mission it's hard not to connect with the people and their hope. Just one day into this experience, I am already a much more grateful person for what I have and the way I live.

Drs Spanko and Lehnert evaluate a potential surgical candidate.

IEP keeps the local nurses busy!
Lollipops are a universal smile.
A big thank you to all the donors out there that made this mission possible. To our supporters, I say look closely at the people's faces and see the hope that you've made possible. ~Thanks, Bob

For more great pictures from Bob, check out the International Extremity Project on Facebook!

Sunday, November 14, 2010

International Extremity Project Video

Days 1 & 2: Travel to Can Tho

This probably won't fit under the seat in front of Bruce...
After quality time at the terminal in San Francisco, the California contingent flew 18 hours to Ho Chi Minh City. Following a few challenges in customs, they were on their way to Can Tho, where the real work begins.

Jenni Lehnert, all smiles late at night at SFO.

Clearing customs entering Vietnam.

Curbside. We cleared customs!!!
Driving through Ho Chi Minh City.

Family transportation safety standards are a little
different than they are in the United States.

Happily landed and fed.

The fish wasn't so happy.

Off we go to Can Tho!

A different country, a different kind of traffic.