My Tho, Vietnam Surgical Trip

Joe: Le Thi Hong

On Thursday, March 17, the surgeons operated on Le Thi Hong, a 54 year-old woman who lives in the village of Huyen Cai Lay, about 30 km from My Tho. Her left leg was badly burned when she was 15, and over time contracted to the point where it became frozen in place at an angle of almost 90 degrees. The leg also atrophied to about a quarter of the diameter of a normal leg. As a result, her body listed at a severe angle; when she walked, the right leg was two or more feet longer than the left. It was excruciating for us to watch her walk.

For thirty years, she labored in the rice fields, until two years ago, when she could no longer get around enough to continue working. Because of her leg deformity, no man would consider marrying her.

Her injury occurred in 1972 during the war. On a day when there was bombing and fighting all around the village, she and her mother took refuge in a hole in the floor of their house which served as a makeshift bomb shelter. A fragment of a bomb hit the house, which caught fire and burned to the ground. As she and her mother fled the house, her pants caught fire and, by the time her mother snuffed the fire out, her leg was severely burned. Her mother was slightly injured. At some point, she was bandaged up by a South Vietnamese paratrooper who was part of a unit that parachuted into the village following the bombing. She was taken to her sister's house where the only care she received was from some kind of case workers who visited her periodically. From the time of the injury until the present, she lived with the deformity caused by the burns.

The surgeons were able to open the back of her knee, and release the leg enough to give her perhaps 30 degrees more extension of the leg. They then performed a skin graft to cover the area opened behind the knee. She will need to have the knee joint evaluated by an orthopedic surgeon to determine whether she can gain more extension through further surgery. The release that occurred through the surgery done last week will give her much more mobility.

Rowan Hardy: Stoicism and Cheeky Good Humour

It is such a privilege for me to be involved in this trip - especially as the only non-US representative!  The principles of Interplast come across very strongly, that we are here not only to treat people but also to teach so as to strengthen the local medical team, aiming for future autonomy.

The Interplast team here is outstanding and has been consistently providing care of an excellent standard. Of course, limitations in equipment and facilities mean that lots of ingenuity is needed sometimes, which adds to the fun!  But, never have standards been allowed to slip.

The patients and their families have been a delight to meet and to treat.  Their stoicism and cheeky good-humour has been a great example to us all. Our Vietnamese interpreters (Li Ha and Tue Thu) have looked after us with amusement and kindness.

Overall, this is a wonderful and valuable experience and I will be taking recommendations back to my colleagues in the UK!

Susan: Giang

  Giang 
  Originally uploaded by interplast.

13-year old Giang and his mother came to the Interplast clinic from Cai Lay, about 2 hours' bus ride from My Tho. At age 11, Giang was playing with an older boy one afternoon. There was no power in their home at the time, and so the older boy lit a candle with alcohol. A huge flame burst forth, and instinctively reacting, the boy threw the candle away from him, in Giang's direction. It burnt Giang very badly, causing a large contracture and keloid scar on his right cheek, and burning badly his neck, chest, and arms. It also severely deformed his ears, which developed additional disfiguring keloids.

Translator Le Ha and I had a conversation with the boy as he sat alone and unsmiling, waiting for his surgery. I asked him if he went to school, and he replied that he stopped one year ago. Le Ha asked why and he answered because the children make fun of him. Giang's father left the family long ago, and Giang's mother is a rice farmer. Now Giang helps her in the fields instead of attending school.

Susan: Giang's Get Well Card

  Vietnam Get Well Card 
  Originally uploaded by interplast.

Interplast plastic surgeon and team leader Alan Harmatz treated the boy with a procedure which will improve his range of motion and make him more comfortable. Susan spoke to Giang and his mother after the procedure and told his mother what a fine boy she thought Giang was and that she hoped he would eventually return to school.

Sara Hirsch and I presented the boy with a homemade get-well card made by a boy at the Van Trang Vietnamese culture and language school in San Jose and explained to Giang where the card came from. Giang was very pleased to receive it and read the card aloud, inside and out, perfectly.

Susan: A Pleasant Surprise

A Vietnamese-American couple, originally from My Tho but now living in Orange County, California, were at our hotel, saw the Interplast team and inquired about us.  This morning, the couple came over to our breakfast table and presented me with a large contribution for Interplast!  They also gave us another contribution they solicited from their friend! 

These nice people come back to My Tho each year to help those less fortunate, buying them food, etc. They were absolutely lovely and were glad to find a group like ours helping poor people in My Tho.  They were absolutely lovely.  It is the kindness and support of donors like these that make Interplast’s work possible, since no financial support is solicited or accepted from government agencies.

Susan Hayes: Restoring Hope

  Susan and Burn Patient 
  Originally uploaded by interplast.

Hi. I am Susan Hayes, President of Interplast, and it is my pleasure and privilege to be accompanying the My Tho, Vietnam team for the first week of its work here. On our first day—“clinic day”—our doctors and nurses saw and screened some 130 individuals, both from My Tho, and from great distances. Many were babies, some were children, and a few adults came to us for help; but for each of them and their families, there was the unifying factor of hope. Hope that through the Interplast team and our valued colleagues here in My Tho, their disfigurements can be repaired, their function restored, their lives changed.

Our team members hail from all over the United States and beyond: from California, Maine, Washington, South Carolina, Oregon, New Hampshire, and even Great Britain. Many of our team members are new to Interplast, and the team is balanced by a number of “veterans,” making for a wonderful mix. It is always amazing to me to watch a team come together. It begins at the airport when they meet as strangers, and less than 48 hours later are fast friends, roommates, and operating professionally as a well-oiled machine—as if they had worked together for years. They are unified by their desire to help.

My Tho is an outstanding Interplast site. Every day the operating room is filled with doctors and nurses from the My Tho hospital observing, asking questions, learning, and working hands-on with our team. Interplast’s ultimate goal is to hand the scalpel over, to provide sufficient support, medical education and training that Interplast doctors and nurses will no longer be required to perform surgeries on the poor in My Tho, or any other site, because we will have worked successfully to increase the surgical capacity of that site, and the needs will be taken care of locally. Given the high level of motivation and skill of the My Tho medical personnel, that will surely happen here.

Susan: Bravery, Grace, and Love

  Mother and Baby with Cleft 
  Originally uploaded by interplast.

It takes many hands and many hearts to make an Interplast trip possible. Our local partners and hosts in My Tho work hard to prepare for us and to recruit and screen patients. Interplast volunteers leave home, hearth, and often income behind for 2 weeks to work hard, under difficult conditions, to care for the poor. On this trip is Interplast board member Russell Hirsch and his wife, Sara. Russell’s and other board members’ contributions to Interplast cannot be overestimated; they are the guiding and governing force of our organization. And of course Interplast donors make all this care possible through their commitment and their financial support. We are very pleased to have My Tho trip sponsors Joe and Carol Wishcamper on this trip.

But we all gain our inspiration and motivation from the patients and their families. Dealing with the daily difficulties of poverty, they brave the challenges and obstacles necessary for them to get to the hospital, wait long hours, patiently, to be seen, show great stoicism in the face of people and a hospital environment foreign to them, and display enormous thanks, happiness, and gratitude for the care they receive. For all of us on the trip, their bravery, grace, and love for their children sends us back to our homes with renewed gratitude for all we have of material value, and a vow to spend more time appreciating our lives and loving our friends and families.

As Interplast CEO, I spend a great deal of my working life in an office, dealing with budgets, raising contributions, and putting the things in place designed to make our organization strong, relevant, and lasting. But it is watching and participating in trips like this one that “fuels” me. I always return reinvigorated, and can’t wait to return to work, carrying with me the faces of our tiny patients and their families. I have the best job in the world.

Carol: Wanting to Cheer and Weep

 
Alan Teaching His Vietnamese Counterparts 
  Originally uploaded by interplast.

I feel like I have crossed a border into two foreign countries. One, the country of Vietnam, where I am overwhelmed by the gracious, open friendliness of the people toward us, and two, the world of medicine. I have spent the last two days doing something I never would have imagined would be available to me: witnessing up close a surgical team at work - actually two surgical teams as the operating room has two tables with two teams operating simultaneously. I have observed cleft lift and cleft palate repairs, as well as burn grafts and ptosis repairs.

I have so many impressions of these two new worlds I have entered. One overriding impression is my profound mutual admiration for the Interplast team of medical professionals and their Vietnamese counterparts. The Interplast volunteers came together for the first time on the flight over and by Day 2 of the trip were functioning as a high performance team in the operating room. Not only were they adapting agilely to working with each other for the first time, they were performing surgery jointly with their Vietnamese colleagues, communicating via a translator. A key component of an Interplast trip is to enhance the surgical expertise of the in-country medical personnel. One of the first cases was very complex and difficult; the two doctors worked together to figure out the best resolution for the 10 month old patient. When they completed the surgery and shook hands across the patient, I experienced a full gamut of emotions, wanting to both cheer and weep.

Carol: Reunion of Parent and Child

  Carol: Released Burn Contracture 
  Originally uploaded by interplast.

Another impression I want to capture is the tender beauty of the reunion of parent and child in the recovery room. As soon as the child is awake from the anesthesia, the mother or father is brought in to hold and comfort the child. The patients are then moved to the wards where their families stay with them until their discharge.
The courage and bravery of the patients and their families has been inspirational.

The trip secretaries are also the interpreters. They not only keep the whole process organized and running smoothly, they do the critical and sensitive work of interpreting between the patients and the medical staff as well as instantly and clearly interpreting the critical information the doctors must quickly communicate to each other as they decide, moment to moment, how to best serve the patients best interest.

There are so many educational aspects to this trip…these are just a few… being here with these talented and generous-spirited people and witnessing the miraculous work they do, I feel like my cup runneth over.

Joe: Quality Professionals

  Duke Teaching Vietnamese Counterparts 
  Originally uploaded by interplast.

My wife Carol and I are along as observers and documentarians. This is the third day here in My Tho; the first was a clinic day evaluating 130 cases and selecting about 50 patients for surgery (the others were turned away because they were either not well enough or their problem was not operable.) Yesterday and today were surgery days with 15 procedures performed. The Interplast team is impressive: they are quality professionals and deeply committed. Dr Hagerty returned to the hospital last night about 8:30 for rounds after having just done rounds only three hours earlier; he was just concerned about the patients.

We are staying at a government-owned hotel on the Mekong River in My Tho, a secondary city of about 160,000 people. It bustles with people and motorbikes. In three days, I have seen one car and several thousand bicycles and motorbikes, often with three people aboard on each one.

Life starts early; the markets are open by 5 a.m., as are the loudspeakers which are omnipresent. People are friendly and polite, but life seems a bit more formal than in our country. People are well-dressed and everyone looks to be educated. It’s a poor place; we have been told several times that the people are somewhat undernourished due to the poverty. The only signs of the developed world are computers and cell phones, which are everywhere. Few people speak English, even though they stopped teaching French and switched to English in the schools some time ago.

Mary McLin: A Good Mix

  Mary McLin
  Originally uploaded by interplast.

My name is Mary McLin, and I am the head nurse for the My Tho trip. I’ve been an Interplast volunteer since 1999, and this is my fifth trip. This trip is special because it gives me many opportunities. The reason I come on I. trips is to work on behalf of the people who need help, but also to combine the experience of seasoned Interplast volunteers with the awe that is evident in the face of our new volunteers. It is so good to see a novice volunteer learn and adapt to the challenges of OR (operating room) nursing in the developing world. Even with a few novice volunteers, the team has coalesced very quickly and has already provided excellent, efficient care.

Anne Thomas: Immediate Change

  Immediate Change 
  Originally uploaded by interplast.

My name is Anne Thomas. I am a pediatric anesthesiologist and this is my 2nd trip with Interplast, and my first trip to Vietnam. I am really impressed with the graciousness and the warmth of the people with whom we have worked. During the time that we’ve been here our hosts have gone out of their way to treat us with respect, and have honored us with about as much assistance and access to their facilities and as much wonderful food as we can eat! I have to say that I’m becoming an addict for the rich, creamy white coffee that is to be found here in Vietnam. I admit with some guilt that I had three today.

I’m also pleased with the quality of the team members, and although there is a high level of focus on the work at hand people seem to get along well and truly enjoy each other’s company. We’re mostly managing to stay well, and I wish to assure friends, family and well-wishers that we’ve all gone out of our way to avoid talking to strange birds! Our first day of surgery has gone remarkably smoothly. I think that one of the things I enjoy most is seeing how our efforts immediately bring the prospect of changing the course of someone’s life. The parents of our patients seem to be lovely people who go out of their way, through our translators, to thank us for our efforts. It feels so good to be able to help. Everybody wins here.

One final thought: I don’t think I’ve ever seen such an amazing abundance of exotic and often bizarre fruit. Today I ate a small hairy red fruit which I am told is related to a lychee; it was sublime!

Sara Hirsch: Personailities

  Mother and Child 
  Originally uploaded by interplast.

My name is Sara Hirsch, and I have had the privilege of accompanying my husband, Interplast board member Russell Hirsch, on this My Tho trip. I think most surprising to me today was just the personality that comes out of all of these children. You look at their damaged faces, and you see through their eyes and their smiles how real and alive they are. As they sit here for this many hours, you see the energy and the fear in them — all the emotions beneath the surface. They are different, but they are just children, like any children. I am also touched by the parents; they are so dedicated to having their children repaired no matter what it takes, and you can see the energy they put into making sure they’re child is given a chance for a life-changing surgery.

It was a little overwhelming when we walked into the courtyard this morning, with all eyes on us, and it was interesting to me the reactions the parents had to the camera, and they pushed their children up to the camera. They seemed to believe that if we took their child’s picture, we might select that child for surgery.

Carol Wishcamper: Emotions

  Cutie 
  Originally uploaded by interplast.

My name is Carol Wishcamper. My husband Joe and I are proud sponsors of the My Tho trip this year. This is my first exposure to an Interplast trip, and I don’t have an emotion or a nerve ending that hasn‘t been touched today. When I walked into the courtyard at 7:00am, I saw hundreds of people already waiting, some of whom had walked for hours and hours, even days, to get here. Little children were running forward with their mothers running behind them. Some mothers pushed their children forward so that we could see their child’s deformity, and other mothers rushing forward to pull their eager children back. The contrast of that with the solemnity of the greeting from our hosts at the hospital, with tables set up like the U.N., speeches of welcome and thanks from both sides, and lots of official ceremony, was quite stark.

Carol: Each Child, Each Parent, Each Story.

Each child, each parent, each story. A range of deformities from cleft lips and palates, to deformities I have no name for, disfigurement from burns, hands, feet, webbed digits, Each one getting five or ten minutes with the doctors. Probably the most outstanding impression I have of the day is the way the two doctors who came together for the first time making quick but appropriate decisions according to Interplast guidelines, which are safety, quality, and can the patient be improved. How hard it was to witness patients who had to be turned away, whose conditions were too complex to be handled at this particular time and in this particular place.

The other memory I’ll carry from the day is the grace with which the disappointed parents took their disappointments, bowing to the surgeons and quickly leaving to deal with their emotions. And as I write this the stream continues. It’s four o’clock in the afternoon and the patients continue to come, and except for lunch the doctors and nurses haven’t had a break all day.

Joe Wishcamper: Love and Dignity

  Janice on Clinic Day 
  Originally uploaded by interplast.

My name is Joe Wishcamper, and like Carol, I was overwhelmed walking into the courtyard of the hospital this morning to see probably 300 or more people waiting for us and prepared to sit outside in the heat patiently to be seen or to have their children seen.

I’ve had so many impressions and emotions today and the strongest have been around the love that the parents have for the children and the dignity of the parents and the children. Its heart breaking to see the deformities and to imagine the impact they’ve had on all these lives. And I found my emotions lifting or dropping precipitously depending on whether the person was accepted for surgery or sent away. Not once today did anyone complain or show upset at being turned down, but they must have felt many times sadder than I did, and I felt so much disappointment myself. It seemed as though there was a sea of people all around throughout the whole day and I found myself feeling overwhelmed a number of times.

Dr. Janice Richards, a pediatrician, is shown here examining a child to see if he or she will become an Interplast patient.

Joe: Increasing Our Capacity for Compassion

  Janice Counsels a Mother 
  Originally uploaded by interplast.

I was struck by the equanimity of the team including the doctors and the other volunteers, dealing with such organized chaos and all the emotions they must have been feeling.

At this moment its 4:00pm and the clinic is full of people being seen and evaluated. There are still probably 30 people waiting outside, and the pace and the energy here in the clinic is just as high as it was at the beginning of the day. So already I can start to understand what motivates these medical professionals to do this work. It’s a very emotional experience and one which clearly increases our capacity for compassion.

For me, the experience of being in a foreign country so different from ours and working with people who have so little and who are so desperate to help their children really feels like an opportunity to gain an understanding and perspective that I would never have otherwise gotten.

Here Janice is examining a baby to see if he or she is capable of handling surgery.

Dr. Hung, Susan, and Alan

Dr. Hung, Susan, and Alan
Originally uploaded by interplast.

Dr. Hung, a surgeon and oncologist is pictured here with Susan Hayes, president and CEO of Interplast, and Dr. Alan Harmatz, a surgeon and Interplast board member.

In the background, you can see children and families waiting in the courtyard to be seen by the team on clinic day.

Duke Haggerty: The Patient Comes First

  Alan, Tue Thu, and Duke 
  Originally uploaded by interplast.

My name is Duke Hagerty, and I’m a plastic surgeon from Charleston, S.C. This is my first Interplast trip. The clinic was extremely well organized and the patients seemed very appreciative, and I am enthusiastic about my next two weeks.

What attracted me to Interplast was the fact the organization’s strategy has evolved to make inclusion of the host country’s doctors an integral part of the experience. The patient comes first. Hopefully this experience will not only have the short term effect of helping the patients, but will have a lasting effect in the understanding and sharing of ideas between cultures.

Joe, Hien, Carol, Dr. Hung Vi, and Patients

Joe, Hien, Carol, Dr. Hung Vi, and Patients
Originally uploaded by interplast.

Joe Wishcamper is the tall guy in the back, and is next to Hien, Interplast's anesthesia partner in Vietnam, who is in front of Carol Wishcamper.

On the far right in the white coat is Dr. Hung Vi, the director of the hospital, who is not to be confused with Dr. Hung, a surgeon and oncologist at the hospital.

They are pictured with lots of children who are hoping Interplast will operate on them.

Carol: Ptosis Patient

  Ptosis Patient 
  Originally uploaded by interplast.

Before clinic on Monday, I had never heard of ptosis which is a condition where the eyelid muscles don’t function. In most cases, the sagging upper eyelid results in a loss of the superior (upper) field of vision. In severe cases, ptosis may be present at birth and, if left untreated, can permanently damage vision by forcing the unaffected eye to do all the work while letting the affected eye degenerate. The repair is made by removing a ligament from the wrist and threading it through the eyelid, attaching it to the frontal muscle on the forehead. By raising the eyebrows, the eyelids can then move.

Today Susan Hayes and I went on a shopping excursion to buy sunglasses and baseball caps with visors for the 20 ptosis patients when they are discharged. Most of them will travel home on the back of a motorbike or bicycle and we needed to devise a way to keep their healing eyes protected from the dust and dirt of the road.

The Team

The Team
Originally uploaded by interplast.

Here is the Interplast team and the Vietnamese host doctors.