Tuesday, March 24, 2015

Patient Screenings in Can Tho

The patient screening days are always full of activity. The first day is especially busy as we figure out basic things such as where we will meet with patients and how much space we have for examinations. Space is always limited. This time, we ended up screening off an exam space in the hallway so the team could break into smaller groups to evaluate patients more quickly.

Although the hospital pre-screens many patients, our team never knows what to expect -- beyond the fact that it will be a very busy two days. 

The doctors spent Monday and Tuesday screening patients ranging in age from five years old to adults in their sixties. Some cases are fairly straightforward, while others are complex and involve more detailed examinations. 



We start by working with translators to gather background information from each patient, including as much history as we can get about their condition or deformity. Many patients were born with deformities or issues that became apparent as they learned to walk as children. Some describe their condition as occurring after a fever as a child -- something that often turns out to have been polio. Others have been in accidents and have continued difficulties from their respective injuries.

It's very rare that the patients we see, whether children or adults, complain of any pain, even when it seems obvious to us that their conditions must be painful. So, when patients do report pain, there's little doubt that they are living with significant discomfort. Many patients have lived with foot and ankle deformities, such as clubfoot, for 40 years and only now have the opportunity for surgery.

The children show an amazing resiliency, even in situations where their deformities are severe. One of the little girls the team evaluated on Tuesday had a significant deformity of one leg, but was one of the most cheerful kids you might ever meet. She cannot walk, but she can hop faster than anyone I've met. 

Another little girl had the best laugh I've heard in ages. Most of her giggles were reserved for Fletcher, our documentarian. 

Stacy Lerner, a physical therapist on the team, participates to provide perspective not only on therapy options, but also to identify when a surgical procedure intended to resolve one problem may cause others based on how the patient has adapted to his or her deformity over time. Her expertise is invaluable on several levels, including post-operative plans and non-surgical suggestions for the patients for whom the IEP team won't be able to provide surgery. 

The most difficult cases are often those when the doctors have to tell a patient or family that there isn't a surgical solution that they can provide. 

Day 1: 49 patients screened, 18 identified for surgery
Day 2: 57 patients screened, 17 identified for surgery

Surgeries begin tomorrow with six scheduled for the first day. Most of the team will be at the hospital by 7a.m. to prepare the two operating rooms for the first cases. 

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