Day 1 and Day 2

Greetings from overcast CanTho!  It has been very hot and humid, but each afternoon it has been quite rainy as well.  Let's just say that the hair clips (in all varieties) my sister, Leah, always encourages me to bring along have been employed!  You know it's humid when my relatively straight hair becomes instantly fluffy and curly!!  (pictures & proof to follow)

We have completed our 1st 2 days at the new, and improved CanTho General Hospital.  Gone (literally...it's totally a huge pile of rubble) is the old hospital, which was about 40-50 years old, and the new hospital is about 3 years old now.  It was completed/opened just after we were here in 2007. 

It is quite large, although I am not sure of how many beds it has (I would guess at least 300-400) and it is quite a maze.  There are several staircases that seem to stop/start on different floors and allow one to access different 'wings' of the hospital, which makes things very confusing.  I spent a little time today just 'strolling' the halls trying to get myself back downstairs from the 5th floor to the 1st floor clinic space.  During my 'walk' (or more correctly stated...while I was lost), I got to meet several families and patients who marveled at my height, as well as my shoe size.  It seemed quite a fascination for a group of ladies who proceeded to place their (very tiny) shoes next to my relatively larger shoes.  Great laughter was had by all!!

The new hospital does have an elevator bank of 6 elevators to service the 7 floors...what a sign of modernization!!  Not all of the elevators were in service, as they only use a few at a time (to save electricity, perhaps), but in each elevator there is a 'elevator lady' who sits upon the tiniest, silver, rectangular stool I have ever seen and takes you from floor to floor.  Very fancy!!

We arrived about 15 minutes early and so Bac Si Tan (Bac Si = Doctor) led us to the back side of the cafeteria (where the staff sits) and provided the group with drinks.  The main options were ~ a young coconut (with puncture hole/straw for drinking the water), cold LaVie water (with straw attached to the outside with a rubber band) and Cafe' Sua Da (a thick/syrup-y boiled coffee with condensed milk served over ice).  Everyone was happy!

Then we were off to our audience with the Director of the hospital.  This takes place in a formal conference room with a dais and the obligatory Uncle Ho (Ho Chi Minh) statue surrounded by lovely artificial flowers.  We are all given cold bottles of LaVie water (with straws attached) ~ a luxury item.  And then, basically this meeting goes like this...the Director says a few words about how grateful and happy they are to have us back at their hospital, then Bruce (one of our docs) says some nice words and introduces our team, then the Director says a few more nice words, then we all clap and then we all take a group photo.  This is also an opportunity for us all to greet and catch-up with our Vietnamese colleagues that we have all gotten to know a bit ~ Bac Si Tan, Bac Si Em, Bac Si Hue, Bac Si Huong and others whose names I cannot remember.  Then the meeting is adjourned and we are then able to start working.

We then proceeded to receive a tour of the Orthopedics floor, which, as in previous years, is a very interesting and sobering experience.  Seeing the multitude of patients in their wards (4-6 beds per room) with their various fractures/trauma injuries/etc. is quite a lot to see.  Their families are right there by their sides, either lying in the same bed as the patient, or on a thin mat upon the floor.  It's so interesting.

All of our supplies ~ both surgical and Amy's and my therapy supplies ~ were transported from the airport on Sunday to the hospital, so we spent a few minutes sorting through a few boxes to get our supplies for the screening clinics.  Once we found our things, we were off to see the nearly 100 patients gathered to see the doctors/me for evaluation for surgery. 

Well, as in previous years, it was quite an overwhelming site and experience walking through a throng of people ~ babies, little kiddos, teenagers, and adults of all ages ~ who once they saw our group congregated in the doorways of the 2 assessment rooms assigned to us.  Wow...even though I have done this 2 previous times...this is still such a crazy moment. 

Amy, Tina, and Bob (our Mr. Fix-it/photographer) + Thuy (pronounced 'Twee'), our wonderful translator set up their 'administration/registration' desk and began registering the throng of folks who were in need of evaluation.  From where I sit, I could not imagine doing this job, as it takes great patience and organization and energy to get everyone set-up and coordinating with the Vietnamese medical students/nurses who are also assigned to help us with organizing the patients.  Hats off to this crew!!!  Well-done!!

Then...let the games begin...

Our medical team is quite solidified at this point in time...this is the 3rd trip we have all had together.  The team consists of ~ Dr. Bruce Lehnert (from San Francisco/Palo Alto), Dr. Jeff Spanko (from San Jose), Dr. Jonah Mullens (from Palo Alto), Dr. Meir Nyska (from Israel), 2 residents (Diane and Jane), both from CA, and I am the Physical Therapist.  All of the surgeons soley specialize in foot and ankle surgeries and Dr. Lehnert, because of his work here in Vietnam, is considered in the US one of the experts in addressing lower extremity/foot/ankle deformities due to polio. 

Dr. Nyska is an orthopedic surgeon from Israel, so he will address other orthopedic problems we encounter.  I have joked with Dr. Nyska that he will, by coming on these trips, become a pediatric orthopedic surgeon, but he very clearly says, 'No...no...no.'  He is great with the kiddos and many years ago during his residency he considered doing pediatrics, but said their crying made him too sad.  He's such an amazing doctor to work with...I am very lucky!  He, like Dr. Lehnert, is considered the expert in Israel in dealing with the effects of polio due to his work here in Vietnam.  A great group of surgeons. 

We also have Tina, Theresa and Jenny, who are all nurses and work with the Vietnamese nurses to set-up the operating rooms and all of the supplies and equipment needed for the surgeries and then after the surgeries (medications, crutches, walking boots, etc.).  It's a great group!

On day 1 (Monday) we saw 53 patients for evaluation and then on day 2 (Tuesday/today) we saw an additional 48 patients for evaluation!  A record # of patients evaluated for our mission!!  This year I would estimate that nearly 40-50% of the patients that were seen for evaluation were children.  This has dramatically increased from previous years.  I think this can be explained by the fact that Vietnam has now had the polio vaccine for nearly 10-12 years now, so there is less new deformity than in the past.  The increase in neuromuscular deformity is explained, I think, because Vietnam's care of premature infants is improving slowly so more preemies are surviving and we are seeing the effects of this through the children with CP. 

The 1st patient we saw on Monday was a 10 year old boy with cerebral palsy, who was a bright, social boy.  He does some walking with assistance/support, but appeared to have some untapped potential and had significant foot/ankle deformities, so the surgeons asked me to place him in 2 long leg casts (from mid-thigh to above the ankle) for a couple of days to see if given that support at his knees if he could support his body and initiate walking.  If he is able to do some more walking, they will do surgery on his feet to correct some deformities that are impeding his walking, but if not, then they will not do any surgery. 

So, I got to go and visit my 'friends' in the Bo Bot department (Bo Bot = Casting).  Bac Si Hue walked me down to their new casting room and when I walked in and he told them I was going to put casts onto this boy, instantly there were about 15 employees (all males) in the room to watch.  No pressure, though.  :)  I had done some casting with these gentlemen during previous trips and it's always an interesting experience.  I started putting the padding on the patient and they asked me how long I had been casting.  When I told them I have been doing this over 17 years, they all gasped and then laughed.  Not sure how to interpret this, but oh well...we got the casting done and the patient was comfortable, so that's what matters. 

We have found an 'orthotist' (someone who fabricates special braces for children/adults) here in CanTho and he has made some amazing braces for a few of the patients we have seen in the past.  If they decide to do surgery on this boy, then he will be seen by this 'orthotist' to fabricate braces to help him keep his knees straight and maintain the alignment he would attain from having surgery while walking.  I hope it works out for this kiddo. 

Here's an example of a brace this 'orthotist' made for one of the kiddos that previously had surgery in 2007 and has a funky lower extremity congenital deformity...

The patients presented with a variety of musculoskeletal and neuromuscular issues ~ primarily lower extremity/foot/ankle deformities caused by the effects of polio, club feet, cerebral palsy, polydactyly (extra fingers/toes), congenital amputations/deformities, brachial plexus injuries, unknown syndromes, etc.  We also saw 2 children we suspect have a diagnosis of spinal muscle atrophy (not good) and 1 woman we suspect has multiple sclerosis.  Those are difficult things for the Vietnamese to assess/diagnose, so we can only recommend they see a neurologist for further assessment, but it's kind of sad when those things are suspected as the problems.  It was quite a varied group this time around.

As in previous trips, I have found the ingenuity of the Vietnamese people to be such an amazing thing.  Here is a photo of a man's crutches that his father constructed out of bamboo...

For many of the children we saw, there weren't surgical solutions to their issues, so I am having about 13-15 kiddos come to the children's hospital here in CanTho on Thursday, as Amy and I will begin our work there with their therapy staff.  Some of these children just need some therapy services, some need further evaluation to determine if surgery will benefit their functional abilities and some just need to be connected to the pediatric health system.  So, these kiddos + the kiddos the children's hospital will have waiting for us, will provide us with a busy day of activity and teaching opportunities. 

The surgeons will be starting to operate tomorrow and I believe they have 30 patients currently scheduled for surgery.  This will keep them very busy for nearly the next week. 

Tomorrow morning, Amy and I will return to the general hospital and will tour their new Physical Therapy department with Bac Si Tan.  Bac Si Tan, during our meeting with the Director, said to us that because they now have a larger Physical Therapy department at the general hospital we no longer need to go to the children's hospital.  :)  He laughed loudly and is quite a jokester!!  So tomorrow we will go and see what type of work they are doing. 

The remainder of the day will be preparing our things for our time at the children's hospital in CanTho and also preparing a lecture for our time in Saigon...on kinesiotaping.  So...a mixed-bag tomorrow. 

It's been fun so far...lots of great kiddos and adults and nice families too.  I have, as in years past, gotten lots of grandmothers grabbing my arms and then putting their hands on my cheeks for good luck and lots of babies being handed to me to hold.  It's all good though...such a great culture!

Finally...today, as I mentioned, it rained again and quite hard.  When we returned from the hospital, this is what we saw when we looked up into the 'ceiling' of the lobby of our hotel...

Due to the rain, they had a large leak and the entire ceiling collapsed.  The ceiling is missing from the front door of the hotel spanning to nearly the back door of the hotel, on the 2nd floor.  We aren't sure if anyone was hurt, as we could not find out this information, but it was quite a mess earlier in the day.  Unbelievable!!

Time to shower, read a bit and then to sleep!!  Thanks for reading!!

xoxo
Stacy