Gobble, Gobble ~ Vietnamese style

Happy Thanksgiving to you all!  I am sure many of you have been up preparing turkeys for today's holiday and I hope you are all giving thanks with your families and friends!!

I cannot help but think of David on this special day, as his presence in my life is something I continue to be so grateful that I was given.  I feel so happy I was able to share my life with him and that he was able to share his life not only with me but so many others!!

Thanksgiving was always his favorite holiday, especially in the past number of years ~ and not just because of all of the wonderful food (although, he loved that part too).  I think he really enjoyed connecting with family and being a part of a family ~ either his in Wisconsin or mine in Nebraska ~ and that sense of family really meant a lot to him.  In many ways this year's Thanksgiving is quite different.  Not only for the obvious reasons of David's physical absence, but also my 'temporary' absence from celebrating with family while here in Vietnam.  I think in some ways this is a good way to spend my 1st Thanksgiving without him.  I look forward to celebrating future Thanksgivings with my family and friends and cannot express how thankful I am for all of my good fortune and good health!

I still haven't found the rooster that is outside of my window, but I will keep searching.  He's a noisy bugger!!

Yesterday, we began our 1st day at Benh Vien Nhi Dong 1 (Children's Hospital #1) in Ho Chi Minh City (HCMC).  We delivered our final 4 totes of supplies via a very large taxi and not only we were happy to have them delivered to the hospital, so was the hotel staff that so graciously stored them in the lobby/kitchen for us on Tuesday night.  This saved the 'muscle' man of the place from schlepping them up 3 flights of stairs ~ boy, was he happy ~ and for this we were also grateful!!

The staff at the Children's Hospital was excited to see us and had made the most lovely 'welcome' sign ever!!  They cut-out the letters of our names (first and last) and these were placed on long sticks, sticking out of window boxes placed upon the wall when we entered the department.  So adorable and sweet!!  Just lovely!

Welcome, Ms.

Stacy Lerner

Amy Levin

We then presented our supplies to Giao (pronounced, 'Yao'), the new director of the Therapy Department.  Miss Yen, who had been the director for many, many years, had to retire in June (as is the rule here in Vietnam when people turn 55 years of age), so Giao, who had previously been the assistant director, is now the director.  Yen still is involved in the department as a consultant, as well as has been asked to take part in a new Graduate Diplomate program in Speech-Language Pathology at the main medical University here in HCMC.  This is a huge deal, as this program is being taught in conjuction with the Australian Speech-Language Pathology Organization and the folks who complete this 2 year program then will be able to become teachers/professors for training Speech-Language Pathologists here in Vietnam.  This is a 1st for Vietnam to have a program of such specialization in the therapy field.  Previous to now, their therapist's education is one of very general physiotherapy knowledge, but beginning in 2 years, when Yen and her classmates (about 20) graduate, they will be the teachers and continue to expand the number of speech therapists here in Vietnam.  Very exciting and impressive for her to take this on at this point in her career.  She is a physiotherapist and this would be like me now going to graduate school to become a speech therapist.  Crazy...a lot of work!!

The therapy staff is essentially the same, with the addition of 4 newer, younger therapists.  They are all much more readily excited to speak to us in English and are encouraged to practice their English skills with us when presenting their patients.  There fluency has improved greatly since we were last here and for us, certainly, it makes things a lot easier.  We continue to be grateful to have Giao and Yen to translate for us...a great gift, as our Vietnamese fluency isn't coming along as quickly as the Vietnamese therapist's English fluency is...shocking, I know!!  ;)

So...we arrived, presented the supplies and then we were off to the races...seeing some kiddos they had arranged for us to see.

This 27 month old little girl presented with cerebral palsy and exhibited athetoid-type movements.  She was wearing this super-snazzy 'Spio-like' bodysuit, which provided her with increased input into her body, improving her awareness of her body.  The family had this suit made by a tailor in HCMC and she wears it every day.  Her family commented that it really helps her and they see a big difference in her movement when she's wearing it vs. when she's not wearing it.  I worked with her therapist and father on improving her strength and knee control when in standing.

Yen visited Amy and me in Chicago in 2008 and also spent time with Jeanine Graefen, an OT and a great friend, and Jeanine showed Yen this style of bodysuit and took her to a fabric store to look at the fabrics that would be best.  Yen then returned to HCMC and began implementing this with many children seen in her department.  :)  So great!!

These were her little AFOs, which she uses when standing.  The therapists at the Children's Hospital do the casting for the splints and then those casts are sent out to an orthotist who makes the braces.  These were fantastic!

A side-view.  The braces are ready-to-wear without shoes, as people in Vietnam wear mostly slip-on/slip-off type of shoes (as they take their shoes off when entering a room, a home, etc.).  So these braces are worn without additional shoes required.  The bottoms have a small tread for walking.

This 28 month old boy has a diagnosis of autism.  He was functioning at quite a low level and Amy was able to demonstrate for the staff how a treatment session can be structured for this child.  He mostly wandered about the room, but liked to jump, so Amy was able to get his attention by counting to 3 (in Vietnamese...well-done!) and then lift him up and he very much liked this game.  They played this game for much time, causing Amy to work up a sweat!
Autism diagnoses are on the rise in Vietnam and compared to 3 years ago they are more correctly diagnosing the children.  Previously, we experienced children with an autism diagnosis that were simply mentally retarded and not autistic.  So their diagnostics seem to have improved. 

This 2 year old has cerebral palsy as well.  His muscle tone is very high and so walking is difficult ~ although he wants to walk very badly!  In Vietnam now there are some medications available that help reduce muscle tone, so I recommended this child see a neurologist to decide if they feel these medications might help him.  I think if his muscle tone can be reduced, then he will be able to take some steps in a walker and perhaps longer distances.

He was very determined and his PT was awesome!  There are several men who work in the therapy department and the kids, especially the boys, love them!!

This cutie is 2 1/2 years old and has cerebral palsy as well.  He was a total chatterbox and kept telling his mom and the therapists gathered to watch that he was sitting with a foreigner (me) and wondered where I was from.  2 1/2...yep!  He was doing great ~ his family had taken him to Johns Hopkins in early 2010 for evaluation and Botox was injected into some muscles near his groin to improve his walking, which it did.  He uses a walker and is very independent.  His family has great resources, including a pool at home, so they are going to start doing some pool therapy with him as well to augment his current therapies.  He is learning both English and Vietnamese and sang, "Twinkle, Twinkle, Little Star" for me!

His PT also was great ~ again...the little boy pointed out while we were working together that I was not a boy, but a girl and why wasn't his therapist working with him?  So great!!

Lunchtime...Banh Mi sandwiches...pickled vegetables...and little, yummy bananas!  There was lots of pork on the sandwich, so Amy and I politely removed it and added lots of veggies and they also provided us a little fromage (cheese).

Lunchtime is preceeded by the directions, "Now we must wash our hands and then we will eat."  So, we wash our hands, then eat and then at the conclusion of lunch we are told, "You must take a rest now."  So we sit on lawn chairs with the lights off and we both read our books for an hour.  Nice!!

The afternoon of day 1 was filled with adorable little toddlers, all with hemiplegia (meaning 1 side of their body is affected) and was meant for me to do some kinesiotaping and this was being videotaped for a lecture on this topic that I am presenting on Friday.

This little girl was 14 months and although she occasionally expressed her displeasure with some of the more challenging activities I expected from her, we got along beautifully!  She was very spunky and opinionated...my favorite kind of kiddo.  She is working on learning to creep and is pulling to standing.

She will return tomorrow as a child on which I will demonstrate some kinesiotaping.  Hopefully we will continue to be 'friends!!'

A little boy who was 15 months old with hemiplegia.  He did not want to use his left hand at all and got very made when I encouraged him to do so.  He lives in an orphanage in HCMC and was very cute.
His muscle tone is very high on the left side of his body and would benefit from some medical management of his muscle tone.

He really loved that drum...got very mad when I wouldn't let him bang it with his right hand.  :)

I saw 1 other little 15 month old boy with hemiplegia, but don't seem to have a photo of him.  He was quite a challenge, as he was very used to not having to use his right hand at all, but we were able to make some improvements in his use of the the right side of his body after some treatment.

We then prepared to leave the hospital for the day.  In past years, Yen arranged for us to travel via cyclo with 2 of her most trusted and rules-abiding staff.  We were prepared to hop on the cyclos, but they told us we would be taking a taxi back to our hotel.  In the past 2 years there is now a helmet law in Vietnam when riding scooters, so we suspect they don't have helmets available for us, so this is why we are taking taxis.  Amy and I have speculated that they took 1 look at the size of both of our heads and thought there is no helmet in Vietnam that would fit these noggins!!  ;)  So, by taxi we go...

Yen invited Amy and I to dinner with her alone last night and we had such a wonderful time!  She is such a lovely host and the conversation was stimulating and the time together was so special.  She has been to Chicago and spent time with both Amy/Robert and David/me, so I think our bond is much tighter as a result.  I was very happy to have that evening with her!!

Today was day #2...and we started at 8a today.  We got going shortly after arriving and it was another full morning of patients, which was great!

This little, 27 month old girl was very interesting.  She has cerebral palsy and the primary concern was that she tends to 'fall forward' with her head going toward her lap.  Well, after watching her movements for a little while, we highly suspect she is having seizures that have gone untreated.  In the 45 minutes we were with her, I counted 40 'seizures'...not good!  She apparently had seen a neurologist in the past who felt she was fine (???), but formal testing for seizures wasn't done, so we recommended her grandmother take her to a neurologist the hospital has and request an EEG (test for seizure activity) asap!! 

Amy then got to see this 4 year old girl with autism ~ check-out her super-snazzy 'Spio-like' compression suit.  Amy and I decided that there should be a little cape attached to the back and that a big S should be on the front for "Super Girl!"  So fantastic!!
She too was very low level, but responded well to Amy's great treatment.  She attends the hospital's day care center for children with special needs and the staff was very receptive to Amy's treatment recommendations.

We will see her tomorrow afternoon in the day care as well!

She LOVED jumping into the ball pit!  Can you find the little girl hiding in the balls???  :)

This 16 month old was so cute...with cerebral palsy that affects mostly his legs and trunk.  He is pulling to standing though and is very interested in many toys, books, etc.He has made good progress to date and I was able to give the therapists and his mom some direction on how to proceed with him to encourage his independence.  In Vietnam, the expectations of infants/children are very different.  There is a great dependence on the mothers for everything when they are young, so for this boy I wanted to try and encourage his mom to let him be independent...because he wanted to be!!

This 5 year old boy had meningitis at the age of 10 months and has significant motor impairments.  He also has pneumonia right now, so that explains his IV in his left wrist...he is getting antibiotics.  His mom was awesome...managing such a difficult situation and had great instincts and strategies for handling her son's needs ~ feeding, positional and all others. 

He has significant difficulties with eating, as his tongue is always pushing forward and his muscle tone is greatly significant into extension.  With his therapist we were able to find a nice flexed position for him to sit in and his muscle tone dramatically decreased and he was able to breathe better, close his mouth and actually smiled several times.  :)

Such a special little guy!!


We then had a yummy lunch of vegetarian Vietnamese spring rolls, homemade by one of the staff members for us!!  Delish!  Unfortunately, I forgot to take a photo...but trust me they looked as great as they tasted.  Pineapple, dragon fruit, papaya, and watermelon were also served and then the little, yummy bananas.  We learned the bananas come last, because you always eat the sour fruits before the sweet fruits.  Good wisdom!

Amy then had a little 'coffee klatch' of therapists that work mostly on speech therapy/feeding issues with the kids, during what was supposed to be our 'nap time.'  She started out with a small group and the numbers grew!

The small group...for Ask Amy!!

The group size then proceeded to grow...

A bigger group!

Then, the entire group came into the stuffy, yet warm room for Amy's planned lecture on PECS ~ which is a communication system used with children who are non-verbal and/or have autism which uses pictures to communicate rather than words.  She did a great job and a lively discussion was had by the staff, asking great questions.  Tomorrow, Amy will demonstrate this system with a couple of kiddos in their day care and I will be her assistant.  :)

It rained insanely hard this afternoon and into the evening.  We had 2 days of sunshine the past couple of days, but otherwise rain has been persistent during our visit.  We were invited to a thank you dinner with some of the staff of the Children's Hospital tonight and despite getting a bit damp on our way to our cab we were able to stay mostly dry.  Thank goodness we brought raincoats!  (bring on the ponchos!!!)

Our dinner was super-lovely and there were 8 of us dining together.  We talked about Thanksgiving and it was nice to celebrate this day of being with folks who are special with the lovely staff of the hospital.  We definitely feel that our commitment to their department/hospital has solidified our relationships and it was such a nice night!  Thanksgiving...Vietnamese style!  Of course, Amy and I both forgot to take photos, but in this instance, that's ok...it was about being with friends!!

Tomorrow is our final day of working!  Wow!!  Cannot believe this phase of the trip is nearly complete already!  I will be doing a lecture tomorrow morning and also some treatment demonstrations as well.  Giao informed me tonight that there are 30-40 therapists attending and also 2 instructors from the PT school at the local University.  Eek!  I hope it goes well!

Time to sleep.  Gobble...gobble!!

xoxo
Stacy