Medical Mission in Vietnam: Patient Screening

Although it was nice to have an extra day to revive ourselves after the long journey and acclimate to the heat and humidity, everyone was ready for Monday morning. After meeting for breakfast at 6:15am, we headed to the hospital to start the day with a welcome meeting with the hospital team. The hospital director introduced his leadership team and Bruce introduced our team. 

This trip marks 20 years of IEP missions to Can Tho. Dr. Em, head of orthopedics and our main contact, put together a great slide show sharing details and photos from past missions. We have formed strong relationships with his team over the years. It has been nice to see how some of his students have progressed and continue working with him at the hospital after their studies.

Each mission builds on the relationships with the hospital and the community. This year, several of the patients we treated in previous missions came back to share their progress with our team. Many of the parents were excited to report that their children could now run, compared to having trouble walking prior to their surgeries two or four years prior.

The hospital itself is always evolving. We screened in a new area on the first floor, so patients didn't have to use the stairs or elevators to reach us. We had two, large air-conditioned exam rooms. Compared to previous years, this was luxury!

We screened 53 patients on Monday, with another 34 on Tuesday. We expected to see more, but the hospital has begun doing more pre-screening before we arrive so that we can more easily focus on the people for whom we can offer the most help. We will likely see a few more patients on the surgical days and add them to our schedule along the way.

Patients start by checking in with the hospital nursing staff, then come to our team. Working with translators, we collect information from each patient.
  • Why have they come to see the doctors and what do they want to achieve?
  • What is the origin of their deformity or condition -- birth, illness, injury, gradual onset?
  • Have they had previous treatment or surgery for the condition?
  • What is their typical pain level?
Many of our patients have post-polio deformities. I've noticed a change in the years I've been doing the patient intake. In the past, many would explain that they -- or their loved one -- had become ill with a high fever, then had trouble walking afterward. Now, more explicitly identify polio as the source of their issue. Immunization is not as prevalent here and we met several children who contracted polio as infants before they had the opportunity to be immunized. We also see a number of patients with neglected clubfoot deformities -- and, increasingly, broken ankles from scooter accidents. 

After the intake interview, we take pictures of each patient and their feet so that the doctors can refer back to them as needed. After the photos, the patients see the doctors, who team up to evaluate the patients and decide on whether they can treat them, then how they will.

We're not able to help everyone we meet. People come to us full of hope. There are a lot of things that the doctors can address, but some issues can't be resolved through surgery. As I'm gathering the initial information from patients for their charts, I sometimes know that our team won't be able to provide help. When a child arrives in a parent's arms and cannot walk at all, it's likely we won't be able to provide a surgical solution. It's definitely challenging -- and often heartbreaking. 

Stacy Lerner, the team's physical therapist spent extra time with many of these families to provide guidance on therapeutic exercises that the families can do to help. Many of these patients have significant cerebral palsy, which puts their conditions beyond the scope of a lower-leg deformity.

With a day off for the new year, we begin surgeries on Thursday. We'll be running two operating rooms staffed by the surgeons and supported by our two podiatry residents, two surgical technicians, the amazing nursing team, and translators. In addition, we're supported by Vietnamese staff and orthopedic students. I'll be at my usual perch chasing the charts and managing the patient data.