Thursday, January 31, 2013

I Went to Vietnam without Expectations

Drs. Meir Nyska and Sahra Sellers
I went to Vietnam without expectations. Even so, my mind was blown by the experience.

I knew that we would see foot and leg deformities that I'd only seen in textbooks, but I didn't expect that the patients would be so easy to work with. To be honest, we saw deformities that I don't think have ever been described in writing. (And I won't even attempt to try).

It was amazing to see the creativity that patients have used to function despite their deformities: wearing shoes backward, using sticks as crutches, and family members literally carrying each other. I expected that every surgery to correct the severe deformities would be long, complicated, and difficult. I was absolutely amazed at the number of people we were able to help with relatively simple procedures.

When we first arrived at Can Tho General Hospital, it seemed like there were people absolutely everywhere. I was excited and anxious to get started with the evaluations while we waited for the full team to arrive. The patient evaluations on our first two days are best described as organized chaos, especially on the first day as everyone figured out their roles.

Tuesday, January 29, 2013

How I Spent My Winter Vacation -- Volunteering in Vietnam

Smiling faces at the ceramic temple, Mekong Delta
Michelle is one of the high-school students who traveled with us and participated in the work at the hospital. She answered all of my post-trip questions with great details! ~K

I decided to go on this trip with the International Extremity Project for the chance to volunteer but also to experience an operating room setting. I really enjoy helping people and I figured that this trip would be a great way to help people that really needed it. Along the way, I could use the experience as a little "diagnostic test" for my ability to be a doctor. (The operating room may not be where I'm destined to work :) )

I expected that going to Vietnam would be a lot scarier than it was. When I thought of Vietnam, the communist country from my textbooks came to mind, but when I got there, everyone was much nicer and more hospitable than I expected.

When we first arrived at Can Tho General Hospital, I was surprised to see how many people were there, and how accommodating the nursing staff was. It was interesting to see how nearly everything was outside -- waiting areas, pharmacy, open hallways -- considering how much rain the area gets during the stormy season.

Thursday, January 24, 2013

Why I Keep Going Back to Vietnam

Bruce Lehnert, DPM
I go back to Vietnam again and again because of my connection with the people of the Mekong Delta. Meeting up with the doctors in Vietnam whom I've now known for more than a decade is really wonderful.

Our medical mission has become much larger over time. It started in 1998 with just two residents and myself. This year, our mission team grew to 34 people with more doctors, nurses, physical therapist, documentary filmmaker, donors, writer, and children of team members.

This year we were a well-oiled operation and it worked perfectly. The biggest challenge is always the language barrier. No matter how many times we do these trips, we can never learn Vietnamese.

Saturday, January 19, 2013

Michelle's Perspective: 2013 Trip

Michelle is one of the students who traveled with us and participated in the work at the hospital. She kept her own blog during the trip and took great pictures. Here are excerpts and links to her posts.

Day One/Two: Departure from San Francisco and Arrival in Vietnam

We all arrived safe and sound in Can Tho, Vietnam (pronounced Can Tuh) after a wild 24 hours of traveling. Our flight from SFO to Taipei, Taiwan was a 14 hour roller coaster ride. A good portion of the ride was pretty bumpy, but luckily I was able to sleep through most of it. Upon arriving in Taipei, Taiwan, we all got to wander around the airport to enjoy some duty-free shopping, and then it was back on the plane, which unfortunately was delayed for two hours with everyone already boarded due to a computer that needed to be replaced. We finally arrived at Ho Chi Minh City, and after gathering the 32 boxes of supplies and the rest of our baggage, the group loaded up a bus and made the 4 hour trek to Can Tho.

Day Three: First Day of Work

Monday, January 14, 2013

Julia's Perspective: Patient Surgeries, Day 1

Julia is one of the high-school students traveling with us and participating in the work at the hospital. She's doing a great job of journaling her experience. Here's a slightly edited version of her account of the first day of surgery.
Our team's nursing director asked me if I wanted to help in the operating rooms. In short order I learned a long list of things, including how to:
  • Help the surgeons tie up their surgical gowns
  • Track surgery start/end times and patient weight on the patient record
  • pen sterile packages and put the contents onto a sterilized table without contaminating the area
  • Angle the overhead lights for the surgeons
The early part of the day passed by in kind of a haze of excitement. I got the bone saw for one case and fetched the casting material for several patients. I saw most of the team's surgeons and residents operate during the day. I helped whenever I could, watching in amazement when there was nothing I could directly do to help.

Sunday, January 13, 2013

Day 7: Happiest Guy in the Operating Room

Pre-surgical x-ray.
Near the end of our second day of screening, we met a young man with lower-extremity deformities on both legs, crutches that seemed to have turbo boosters on them, and the most positive energy anywhere.

His legs were short and his toes pointed down and inward, forcing him to walk on the outside edges of his feet. His feet and ankles could not flex to 90 degrees. When we gathered his information, he said he could walk independently for a short distance, but had little stability and it was very painful.

One of our translators related to us that he's a very accomplished competitive swimmer. If flying down streets and hallways on crutches was a competitive sport, he'd be a medalist.

Saturday, January 5, 2013

Julia's Perspective: Patient Screenings

Julia is one of the high-school students traveling with us and participating in the work at the hospital. She's doing a great job of journaling her experience. Here's a slightly edited version of her chronicles of the patient screenings. (Ed. Note: Article has not been fact checked.)

Cerebral Palsy. Congenital defects. Post-polio syndrome. I’ve learned over the past two days that these are the most common cases that the International Extremity Project team sees, indeed these are among most common lower-extremity problems in the third world. Yet the US hasn’t seen a polio case in nearly 30 years thanks to the development of the Salk vaccine.

The hospital we work with -- Can Tho General Hospital -- is beginning to do a better job of pre-screening the patients that are obviously unsuitable for surgery before our team’s screening process begins. Still, we screened 42 patients today, and just 16 are scheduled for surgery. That statistic isn’t quite as bad as it sounds. A few of the 42 were follow-up patients from two years ago, stopping in to express their appreciation while also confirming they don't need additional treatment. Other new patients required definite treatment such as bracing and/or physical therapy, but not surgery.

Diane Encounters a Previous Patient

Diane's first morning of patient evaluations started off with a very clear reminder of why we are here.
At the 2010 IEP trip, one patient was especially memorable. He was the first patient we screened on the first morning, and the last patient Jane (Giang) Nguyen, my co-resident partner-in-crime, and I saw on post-op rounds the last morning at the hospital.

Completely as a surprise to me, he was the first patient I recognized the first day of screening on this trip. His face lit up when I smiled at him, and he immediately stood up.


Friday, January 4, 2013

Day 4: Second Day of Surgeries

First Patient of the Day
We are at the Can Tho General Hospital for the second day of surgeries. I arrived with the medical team and wasn't sure what I would do today. The hospital nurses decided for me by immediately handing me scrubs and ushering me into the women's locker room to change.

That's the good thing about not setting expectations -- it's easy to go with the flow.

Going with the flow in this case equated to participating in the operating room by helping to gather supplies prior to the procedure, taking photos, and calming the patient. The patients are not completely anesthetized, but have a spinal block and some amount of medication to calm them.

OR #1
  1. 27-year-old male: metatarsophalangeal joint (MTPJ) fusion; polydactyly, cunieform;
  2. 20-year-old male: FDL tendon lengthening, possible toe repair

Reflections on Patient Evaluations

Our home base for screening days.
First, the hospital. It's considered fairly modern here, but then again I am in a third-world country. The Can Tho General Hospital building has six floors and is shaped like a square 8 or capital B with outdoor balcony hallways around much of the interior. These hallways also double as waiting areas. The first 2-3 floors have small exam rooms and the higher floors have patient wards.

The patients are evaluated by the surgeons (Lehnert, Spanko, Nyska, Mullens, Koshumine, Sellers, and Ip) and team physical therapist (Stacy Lerner). To be added to the surgical list means that the surgeons and PT all believe that the surgery will improve the person's quality of life and will not negatively affect any other physical functionality. Many of the surgical patients will be referred for bracing post-operatively.

Wednesday, January 2, 2013

Day 3: Surgeries Begin

The surgeons, residents, nurses, and our surgical technician headed out to Can Tho General Hospital to start the first day of surgery. There were originally eight patients scheduled, but that may shift to seven. A bit more detail on the surgeries follows:

Operating Room #1
  1. 8-year-old girl: tendon transfer
  2. 6-year-old-girl: bilateral TAL (Achilles tendon lengthening)
  3. 30-year-old woman: TAL, lateral closing wedge
  4. 7-year-old boy: bilateral TAL, posterior capsule release

Day 2: Patient Evaluations

Return patient from 2007 and 2010.
After a day off for the New Year holiday, we returned to Can Tho General Hospital on Wednesday morning to do the second round of patient evaluations.

The scene felt a bit more chaotic. The hospital was much busier and crowded because the clinics were open to see patients and people were generally curious about what we were doing. We had fewer exam rooms compared to Monday, so our own evaluation space was more condensed. The exam rooms are small and the waiting rooms are essentially the outdoor hallways on the interior and exterior perimeter of the building.

The doctors evaluated 45 patients, about a third of whom were identified for surgery, bringing our totals to 87 screened and 34 surgical candidates. Like Monday, Wednesday brought a range of patients in terms of age, physical complaint (again, several polio and clubfoot cases), and our ability to help them.