Chau Doc, Vietnam Surgical Trip

Almost Sold Into Slavery

  Twin and Grandma 
  Originally uploaded by interplast.

Seth Mazow, Interplast staff: This is truly an amazing story.  During my tenure at Interplast, I have never heard a story like this.  This little girl was born with a cleft lip, while her twin was not.  The parents wanted to sell the twin with the cleft for 20,000 dong, less than $2. Listen to this interview with Dr. Tim Sproule, the plastic surgeon who performed the life-changing operation.

Traditional Vietnamese Medicine: Cupping

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Traditional medicine is found alongside modern techniques here in Chau Doc, even right in the hospital. One common technique that people use is “coining”- rubbing coins on the skin until a red welt is raised, and “cupping” where heated glass jars are placed on the skin to “draw out” the evil humors inside the patient. We were able to witness one of these treatments right outside the pediatric ward of the hospital. The woman apparently was suffering from a headache.

Post-Operative Ward

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The care of our patients has been really good, both by our team and by the local doctors and nurses. The post op ward is air conditioned, which is really important for these little patients. They lie out on beds, cots or even on the floor with their families along one wall. The rest of the room is filled with post op adults and people with a variety of other ailments. There is little monitoring equipment, but sometimes sophisticated treatments. One night we observed a sick man on the other side of the ward having a CVP (central venous pressure) taken by the old open manometer tube method. He had a dopamine drip running! Another time we observed a young man being treated for a GI bleed with gastric lavage. Tragically he ended up dying before the night was out.

Post-Op Unilateral Lip

  Post-Op Unilateral Lip 
  Originally uploaded by interplast.

Here he is after the surgery! It's hard to see because of the tape and the stitches, but he's going to end up looking just like any normal boy.

Pre-Op Unilateral Cleft Lip

  Pre-Op Unilateral Cleft Lip 
  Originally uploaded by interplast.

This little guy has a pretty straightforward unilateral cleft lip. As you can see, the cleft extends from the lip up to the nose. When he eats, the much of the food may come out of his nose, and he is more prone to infections and malnutrition, not to mention speech impediments.

Matt With Post-Op Hemifacial Microsomial Boy

  Matt With Post-Op Hemifacial Microsomial Boy 
  Originally uploaded by interplast.

Matt is shown here with the boy after his successful hemifacial microsomia surgery.

Pre-Op Hemifacila Microsomia

  Pre-Op Hemifacila Microsomia 
  Originally uploaded by interplast.

Yesterday, Amanda operated on a boy with hemifacial microsomia, a congenital condition which left him with a misshapen, shrunken and misplaced ear as well as a type of cleft lip called macrostomia, where the left corner of the lip doesn’t end at it’s usual location and instead extends out on to the cheek towards the ear, making it difficult for the child to eat. Surgically fixing the mouth cleft is fairly straightforward. It is also possible to correct the ear, but not with the resources that we brought with us on this trip. The boy’s grandmother asked us if she could donate her own ear for her grandson…We had to say no. But at least we have made his mouth deformity a little better. They are grateful for that.

Six Year-Old Post-Op

  Six Year-Old Post-Op 
  Originally uploaded by interplast.

We have been able to correct her palate. Hopefully she also will have an opportunity to live a more normal life, and have the speech to take better advantage of her intelligence.

Bojan Gassing Six Year-Old Girl

  Bojan Gassing Six Year-Old Girl 
  Originally uploaded by interplast.

A six year-old girl, with a cleft palate, is, according to her mother, very bright and does well in school. But she comes home most days in tears: she is teased by other kids because of her abnormal speech.

The Rolling Stones

  The Rolling Stones 
  Originally uploaded by interplast.

This has been probably the most experienced team I have worked with. In particular we have experience in our OR nurses. I discovered Jogi is 72 years old- yet she works tirelessly, putting those 1/2 her age to shame. Likewise Bojan has been on over 30 Interplast trips, and runs the OR with ruthless efficiency. We think they can be likened to the Rolling Stones, those great icons of Rock and Roll, whose music was undoubtedly playing here in Vietnam way back during the war. Joji is the ageless Mick Jagger, while Bojan is definitely Keith Richards. In any event, they are a total pleasure to work with.

Bojan: "It Happens!"

  Bojan and Matt Admisistering Anesthetic 
  Originally uploaded by interplast.

One week has passed since we came to Chau Doc. I got called “in” at the last minute, because somebody was unable to go. It happens!

I had no idea who was going. Did not know a single person on the team. That did not faze me. I should be used to it by now. This is my 62nd trip, half with Interplast and the rest with other organizations.

It didn’t take long before we all knew each other. We joined in airports, talked, drank coffee and learned each others names.

We are a great team!! We have a wonderful leader that keeps us all in line. Anesthesia has yet to leave anybody asleep too long. The translators have a job I wouldn’t want for any money in the world! They are everywhere, all the time, helping with everything, regardless if it is their job or not. Patients are well cared for by the pediatricians. They are ready for us in the morning so we can start our day.

We are an international group of medical people. We do medicine the same way all over the world. At least five countries are represented. You should listen to us talk!!

We are blessed with good help in the operating room. Scrub people from the hospital are doing a great job. They are interested in learning, helping with turnovers and end of day cleaning.

We have had a great patient load so far. Cleft palates and lips every day. A surgeon’s dream!! Still, we are not able to do all the patients, so we are all looking forward to coming back next year and do some more.

It’s a good feeling to be able to help children all over the world. It’s a never ending job and I am glad to be part of the team.

All Great People On The Team

  The Team Cutting Up Invitations 
  Originally uploaded by interplast.

The team I have had the pleasure to work with are all great people. Without a thought they throw themselves into helping out with whatever is necessary, whether it be carting a patient to the ward or cutting up wrong sized invitiations to the party we wish to throw for our hosts.

Bird Flu Poster

  Bird Flu Poster 
  Originally uploaded by interplast.

Interestingly, the bird flu is not without concern here to the Vietnamese. They have a fair idea of the dangers and have posters distributed around the hospital that illustrate safety precautions. I myself have not felt in any greater danger from bird flu than any of the other myriad of infections and afflictions that are possible in a place that is unfamiliar.

Post-Op Bilateral Cleft Lip

Post-Op Bilateral Cleft Lip
Originally uploaded by interplast.

Fortunately, we can do a pretty good job of making these look better.

Pre-Op Bilateral Cleft Lip

Pre-Op Bilateral Cleft Lip
Originally uploaded by interplast.

Chau Doc, Vietnam - Tim Sproule, plastic surgeon:We have probably only 2 operating days left. The time has gone by quickly. Several cases stand out in my mind as being particularly meaningful.

There has been a much higher percentage of bilateral cleft lips than on most trips I have been on in the past. I wonder about whether this is because of some environmental contamination such as agent orange, which I know was sprayed extensively in these parts during the Vietnam war.

Working So Hard With So Few Resources

Local Vietnamese Kids
Originally uploaded by interplast.

David Norton, pediatrician - Steven, the other pediatrician, and I visited the pediatric ward again today, and have arranged to have sort of an educational round table tomorrow. As I have an interest in infectious disease (ID) and vaccines, I mentioned to the pediatrician that we might discuss these topics, and he said he was very interested in treatment of infectious disease, but less in prevention, as he works in the treatment unit... wow, there are professional culture gaps I hadn't even considered! The pediatric ward is SO busy... 100 patients for 50 beds, and patients with such complicated diseases... meningitis, encephalitis, dengue fever, lots of dehydration and severe respiratory disease. It is so impressive how hard these physicians work, with so little resources... I hope the time they take with us tomorrow is fruitful for them-- I know we will learn from them...

This is such a welcoming town... everywhere in the hospital and on the streets people of all ages wave, say "hello" and beam smiles at us-- making a walk to work such a delight...

We All Work In Sync

The Team
Originally uploaded by interplast.

David Norton, pediatrician - We are into our second week, and as one of the PACU nurses stated today, we now have the flow down…new place, new people, but we all work in sync ... Today was particularly satisfying, as we had 4 children with brand new clefts, all under two... their new smiles were only outdone by those of their parents and grandparents!

Happy Families and Bright Smiles

Ineke at work
Originally uploaded by interplast.

Ineke van Zundert, anesthesiologist - For me, going on an Interplast trip always starts with dual feelings. Of course it’s great to have the opportunity to help people who are less privileged, but before leaving home I wonder if I will meet nice people to work with, if we will have “enough” patients (because it feels good to be needed), how the country will be, the food, the hotel….And always, and this time again, after 1 day, I realize that I shouldn’t have worried about anything. After 7 trips I still enjoy working with those “funny” Americans (I’m Dutch) and from the start it is very rewarding: in the clinic people come to us with the hope on their face that we can do something for them or for their children. Unfortunately, we always have to disappoint some of them. On the day of surgery parents full of trust hand over their child to us, but the kids themselves are less happy at that moment: some of them are crying and screaming when we put the anesthesia mask to their nose and mouth, but after a couple of minutes they are quietly asleep and after 1-2 hours we can already see the result.

Air-Conditioning In The Ward
Originally uploaded by interplast.

In the recovery room mothers (but also fathers and sometimes grandmothers) take care of and comfort their children, looking around with bright smiles on their faces. Like I said: it’s very rewarding to make people a little bit happier.

Trying To Appreciate Each Moment

Joyce and Hien at work
Originally uploaded by interplast.

Joyce Phillips, anesthesiologist - Today is our third operating day in Chau Doc. Now that some of the logistical questions have been answered and we have two successful days under our belt, the team is beginning to gel. I am already aware that my time spent with this group of people in this amazing environment is limited and I must try to appreciate each moment.

We rise early each day, partly because we are still adjusting to the time change and partly due to the laughter coming from the tennis courts behind the hotel. We understand that the courts are used from 4 am on. We rise early also in anticipation of the day ahead. After breakfast in the hotel lobby I head out on foot to the hospital. The streets are bustling with men, women and children traveling by bicycle or motorcycle to school or work. It is amazing what can be carried on a two wheeled object. We have seen long pipes, panes of glass and trays of hot food. The hospital is located across from the river. When we arrive there are already patients in the lobby. We make quick rounds to assess yesterday’s patients. Fortunately all are making progress. One small child recovering from a cleft lip repair has had some fever and breathing problems and will be kept another day. Overall, I am thankful that so far things have gone smoothly.

Morning on the Mekong
Originally uploaded by interplast.

At the end of another OR day we are one day closer to home. Having the opportunity to work in an environment that is so strikingly different and being to able to share human values such as love of children and access to health care for those in need makes one feel that the world is smaller than one might think.

It Is A Joy

Happy Mom and Dad
Originally uploaded by interplast.

David Norton, pediatrician - When packing for Chau Doc, my 13th Interplast trip, part of me wondered if perhaps something about these trips might become routine. Would the magic of working with a dozen or so like-minded colleagues in a more than out of the way part of the world still charge my at-times drained professional battery? The answer is yes… the children and families arrive with their smiles and energy, and they are infectious. These parents, as caring and worried as those I see at home, cross the gaps of culture, language, economy and health care access to allow us to care for that which is most precious to them—and it is a joy. Their own doctors and nurses seem also to be spurred to enthusiasm and work side by side with us to give these children the kind of care we might take for granted for our own children.

There seem to be a very large number of new cleft lips and palates in this area… so many babies and toddlers who have not been treated before. One grateful grandmother told us today she was thrilled… she recounted how she and her daughter had wept when her grandson was born… and both were thrilled with the child’s new smile.

Patient on Clinic Day
Originally uploaded by interplast.

One aspect of these trips that always excites me is the wonderful support group formed by the families… who can share the challenges, watch each other and teach. This morning on rounds, when discharging a young child, the other mothers were quizzing the mother on the timing and dosing of pain medication, to make sure she got it just right…

Our team translators are quite the pair… sisters! They are both SUCH a joy to work with, tripping over each other to help and balancing their tasks in a way that only siblings could. They are taking very good care of us, and making it so easy to care for the children and work with the local health care staff…

I'd also like to thank the Danellie Foundation and the Million Dollar Round Table Foundation for their generous grants which make this trip possible. The Danellie Foundation, a New Jersey family foundation, supports services for the disadvantaged, including children’s and social services. The Million Dollar Round Table (MDRT) Foundation is the charitable arm of MDRT, the premier association of financial professionals.

The Amazing Hien

Tim Sproule, plastic surgeon- The amazing Hien - dedicated and skilled anesthesiologist in a child’s body – met us at the airport to help us through customs…

loading the boxes
Originally uploaded by interplast.

We have arrived. The famous jumbled train of airport carts piled high with Interplast supply boxes combined with our own luggage proceeds towards customs. But we hit a snag. Some part of the paperwork is screwed up, or maybe the official is just corrupt or obstructive. Lian asks me to get on my cellphone because hers is “out of money”- amazingly it works just fine- and I call Hien, who is supposed to be there waiting for us. (Not for the first time I think of our incredible shrinking world thanks to technology. The phone signal presumably goes from my phone through the Vietnam exchange to an international exchange then to Toronto, then back to international, and back to Vietnam to find Hien’s cell phone. Truly incredible) Hien answers her phone. She is allowed in, and is soon able to sort out whatever was a problem. We are on our way.

Dr. Hien
Originally uploaded by interplast.

Most Interplast teams that come to Vietnam meet up with Hien. Those that do not know her are initially surprised. Who is this diminutive woman in jeans and a t-shirt who acts with such paradoxical confidence as she cuts through red tape and miscommunication? She looks nothing like what she is, which is nothing less that one of Vietnam’s best anesthesiologists. Her selfless dedication to improving the quality of life of the poorest people in Vietnam through her involvement with Interplast is an amazing testament. As long as there are people like Hien in the world, I will continue to have hope...

How I Almost Missed My Flight To Vietnam

Flying Into Hanoi
Originally uploaded by interplast.

Tim Sproule, plastic surgeon - How tenuous our lives all are. Even with what seems to be the most careful preparation, the human factor can screw things up…There I was, relaxed and confident, looking forward to the next couple of weeks of intensive experience, sleeping in my hotel room at the San Francisco Marriott, dreaming of cleft repairs. The phone rings. It’s Amanda. Great! I wanted to meet her before we left. But why am I so tired? What time is it? Where am I?

Amanda clarifies: ”Tim, we are all waiting for you in order to check in the boxes. When are you coming over?” I look at the clock. 11:45. What? Could I have slept 9 hours straight? I haven’t done that in years! I stumble out that “I will be over in 15 minutes” and throw on my clothes. As I rush out the door of the hotel, I am totally disoriented. It’s still dark. Was Amanda playing a joke on me? Mystified, I rush over to the terminal to meet her. On the way I try to figure out what’s going on. It’s dark out! I ask the cabbie what time it is. He looks at me strangely and says “about midnight.” Midnight? I am totally dumbfounded. As I fumble with my ticket and passport, I try to understand. I look at my ticket, closely this time. And the truth is staring me in the face. The plane leaves at 1:20AM, on April 8th. Not, as I had assumed, 1:20PM on April 8th.

Amanda Operating
Originally uploaded by interplast.

I check through, apologize to Amanda, and then rush on to meet the rest of the team and get on the plane. So how could I be so stupid? My anesthesiologist, pediatrician and nurse friends would say it’s because I am a stupid surgeon, all action and overconfidence and no thought, but I think there were a few factors to be fair.

First, in staid conservative Toronto, planes are never allowed to leave in the middle of the night because of some noise ordinance, so I wasn’t expecting a takeoff at 0120am from San Fran. Second, Interplast had booked a hotel room for me at the airport. “Why would they do that if I wasn’t staying overnight?” I had assumed. Third, and most importantly, I just didn’t look closely at my ticket. You would think that I would know better. I am a fairly experienced traveler, having worked with Interplast for well over 10 years. We are all on such tenuous leashes. As Amanda and I walked through the boarding lounge to our gate, she just happened to check for her boarding passes. Nowhere to be found! We doubled back and found them on the floor just past the X-ray machines. So, the team came close to leaving without either one of its surgeons!!!

Blogging From Chau Doc, Vietnam

Tim Sproule, plastic surgeon - Hi. I'm Tim Sproule, a plastic surgeon from Toronto, Canada. I am volunteering for two weeks on an Interplast surgical team trip to Chau Doc, Vietnam, one of the poorest places in all of Vietnam. Stay tuned as I and other team members share our stories about our experience!