Medical Mission in Vietnam: Surgeries, Day 1

After a day to celebrate the arrival of 2020, it was time to get down to business. For those of us who have been here multiple times, we quickly dove into our routines when we arrived a Can Tho Central General Hospital. We set up in the two operating rooms assigned to our team and I commandeered a stray gurney for a desk and established my "office" in the hallway. 

The new team members quickly figured out the most complicated part of the system: the shoes! When you arrive at the operating room staff area, you take off your street shoes, put on hospital shoes, put on scrubs, go down the hall, change into operating-room shoes, and go into the sterile area. There's a lot of shoe-changing on surgery days. Unlike in the United States, you wear your scrubs only in the OR area. Any time you need to leave the area, whether to have lunch in the canteen or visit patient wards, you change back to street clothes (and shoes!).

Our surgical techs, Jean and Phil, each managed an operating room while the doctors, residents, and nurses moved between them based on the needs for the specific surgeries. The operating rooms aren't quite next to each other, so people are constantly flowing between rooms.

The team completed eight surgeries on Thursday, four bony cases and four soft-tissue cases. The bony cases typically take more than an hour, while the soft-tissue cases are often as quick as 15 minutes. Thursday's patients included:
  • 6-year-old girl: soft-tissue procedure
  • 7-year-old boy: soft-tissue procedure
  • 10-year-old boy: soft-tissue procedure
  • 13-year-old girl: bony procedure
  • 18-year-old girl: bony procedure
  • 25-year-old man: bony procedure
  • 35-year-old man: bony procedure
  • 47-year-old woman: soft-tissue procedure
The most common soft-tissue procedures are to lengthen the Achilles' heel or release tension in the calf muscle, or gastrocnemius. Patients who receive these procedures typically have equinus, which means they're unable to put their heels to the ground when they walk, so they walk on their toes.

Bony procedures are more varied and address a broader spectrum of conditions. Two of Thursday's patients had neglected clubfoot. It doesn't seem as prominent in many countries because it's addressed in infancy. However, in both Vietnam and Namibia, we see cases that have been untreated long into adulthood. The treatment is more complex, but can still provide significant benefit in addition to allowing the patient to do something as simple as wear shoes.

For me, the hardest part of the day related to one of the younger patients as he woke up from the surgery. Pediatric patients are cared for by the nurses in both the pre-op and post-op areas and typically don't see their parents immediately before or after their procedures. This little guy woke up angry and inconsolable, crying for quite some time in the recovery area. Coming out of sedation can be very confusing for both kids and adults. They often don't know where they are and what has happened, and without a parent nearby, they don't have a familiar person to reassure them. I don't think this boy realized that he'd have a cast on his foot and he definitely didn't like it. The thing that finally helped calm him? An iPad. Some things are universal...

Thank you to the orthopedic doctors and nursing team for caring for our patients. (And Cindy Ngo for bringing great goodies for the kids!)