My Tho, Vietnam 2007 Surgical Trip

Daily Life

  Whole Family On One Motorbike 
  Originally uploaded by interplast.

My Tho, Vietnam - Hafiz Miraly, pediatrician:  Walking to and from the hospital each day, the streets are a busy maze of motorbikes. The motorbikes often carry families of four, including babies. Crossing the street is an adventure. We've quickly learned that the key is to walk at a steady pace, without slowing down or speeding up, and the bikes will avoid us. The city comes to life at about 5 AM daily as everyone comes out for their morning exercise. The markets open and the city is abuzz with activity throughout the sweltering heat of the day and late into night. The people are friendly and always smile as we pass by. The city is actually one of the cleanest I have ever seen in a developing country. As we come to the hospital, many of us will buy a café sua da (ice coffee) from the street vendors to start our day. Then off to see the patients and take them to the O.R. Thus far, this has been an incredible experience and I look forward to more such trips in the future.

Cleft Lip Repaired

  After The Twin's Cleft Repair Surgery 
  Originally uploaded by interplast.

Tina Cerruti, PACU nurse:  Having three year old twin granddaughters myself, I think it will be even more difficult for her as she gets older and is compared to her twin. Her parents are farmers with three other children at home and would never have been able to afford having have her lip repaired if not for Interplast.

We repaired her cleft lip, and I hope that she will be able to come back and have her palate repaired by Interplast next year.

Immediate and Lasting Impact

  The Unlucky Twin 
  Originally uploaded by interplast.

Tina Cerruti, PACU nurse:  Repairing a cleft lip has such an immediate and lasting impact on a child’s life. Here in Vietnam, a child born with such a deformity is often times shunned by their community and destined to a life of shame and hardship.

Thank You, RMHC!

  Little Girl Coloring 
  Originally uploaded by interplast.

Here is one of our patients, a little girl with ptosis, using Ronald McDonald crayons and coloring sheets to pass the time while she waits for her surgery. Ronald McDonald House Charities (RMHC) is one of Interplast's greatest financial supporters, having given more than $3 million in grants over the years. Thank you, RMHC! Our work would not be possible without this support.

Generous Donation From Palm

  Using the Palm 
  Originally uploaded by interplast.

In this picture, I am working with one of our team's translator/coordinators, Lan, to enter patient data into our handheld Palm Zire computer. Palm, Inc. donated these devices to Interplast to use as part of our patient care improvement project. The Palms make it possible for us to track all of our cases as we work and then download the information into a database upon return from each trip. Our sincerest thanks go out to Palm!

Successful Cleft Surgery

  Cleft Lip Repair One Year Onward 
  Originally uploaded by interplast.

This little boy had his bilateral cleft lip repaired by the Interplast team in My Tho last year. You can see how well it has healed and how great he looks. He came in this year for his cleft palate repair, which was a complete success. It's always so rewarding when we can finish the care we started and make a child completely functional.

Pediatric Mentorship Program

  Pediatric Mentorship Program 
  Originally uploaded by interplast.

This being my first trip with Interplast, I have been fortunate to have a great mentor in Dr. Ken Bloome. He is a pediatrician from Santa Cruz and has been on many Interplast trips throughout the world. Ken is the team leader on this trip and has done a great job of organizing the day-to-day logistics in addition to showing me the ropes. He has a wealth of knowledge and stories from his many travels, and has been a great resource in understanding some of the challenges of providing health care in the developing world.

Hafiz Miraly: Inspired and Humbled

  Hafiz Miraly and Patient 
  Originally uploaded by interplast.

Hi, I'm Hafiz Miraly. I'm a pediatrician at Kaiser Permanente in San Jose, California and am participating on my first trip with Interplast. Being in Vietnam in a medical capacity has been an extraordinary experience. The country is beautiful and the people are gentle and friendly. On our first day we screened numerous patients ranging from 3 months old and up. In addition to seeing many children with cleft lips and palates, we also saw a host of patients with ptosis (drooping eyelids) and severe burn scars. As a pediatrician, I was responsible for doing a primary physical examination and getting a complete medical history on all patients, and essentially making sure that they were all healthy enough to undergo surgery. Subsequently, we make sure that everything goes smoothly post-operatively as well, until the patients are ready to go home. The entire team of nurses, surgeons and anesthetists has been really great. We have all been inspired and humbled by the gratitude and joy of the patients and their parents.

Bilateral Cleft Patient After Surgery

  Bilateral Cleft Patient After Surgery 
  Originally uploaded by interplast.

It's hard to believe that this is the same baby with the bilateral cleft lip and protruding teeth, but trust me, it is! Obviously, Dr. Richard Siegel did an incredible job repairing the lip - she looks completely different and absolutely normal. And what a cute little girl she is!! Needless to say, her mother was thrilled with the result.

Relatively Lucky

  Bilateral Cleft Patient 
  Originally uploaded by interplast.

This young mother brought her baby to the Interplast team because, as you can see, the little girl has a bilateral cleft lip. Just imagine the ridicule she would have faced throughout her life with her teeth protruding like that. This was an unusual case because the girl had no palate defect. Most babies born with a bilateral cleft lip also have a cleft palate, but this little one was relatively lucky.

Ptosis patient after surgery

  Ptosis patient after surgery 
  Originally uploaded by interplast.

This is the same 9 year-old boy, after his surgery. You can see that his eyes are now symmetrical and once the incision spot heals he will look like any other young boy.

Ptosis patient before surgery

  Ptosis patient before surgery 
  Originally uploaded by interplast.

This boy is suffering from ptosis, a congenital birth defect which causes the eyelid to sag. Ptosis is not only a cosmetic problem - it can cause visual impairment and, in the worse cases, blindness. This boy can still see out of his left eye but he is very embarrassed about his deformity and he gets made fun of a lot at school.

Dien After Her Surgery

  Dien After Her Surgery 
  Originally uploaded by interplast.

This is Dien, who I wrote about a few posts ago. You can't see the finger that was operated on because of the bandage she's wearing, but you sure can see how happy she is. Look at that huge smile! Surgeon Chris Conner, MD also released a burn contracture at the corner of Dien's eye, so that she can open it fully and have a more symmetrical face. Dr. Conner had only planned on operating on the hand, but decided that the eye procedure, which was simple and quick, would give Dien a lot more confidence and perhaps help her in her pursuit of marriage, which is very important to women in Vietnam. She was so excited to wake up from anesthesia and find out that her face had been improved as well as her hand.

Burned Fisherman

  Tuan: Burned Fisherman 
  Originally uploaded by interplast.

This is Tuan, a fisherman from Phang Rang. He was burned in July 2006 when he bought a container of gasoline for his fishing boat engine and set it next to a kerosene lantern in his home. He does not have electricity where he lives, so these lanterns are the only means he has of lighting his house. He immediately went to the hospital in and was transferred to a hospital in Ho Chi Minh City. He stayed there for 2 weeks until they operated on him, removing the burned tissue from his back and grafting on skin from his leg. Still, Tuan’s arm contractures have not been released and he can only lift his arm this high. This means that he has not been able to work since the accident, as fishing involves throwing and pulling in huge nets, requiring full functionality in both arms.

Tuan’s wife tends a small shop outside their home, selling fruit and snacks. Tuan will need to have both arms operated on before he can go back to work and help his wife support their two daughters.

The Interplast team will operate on his right arm, giving him increased range of motion. We will also encourage him to return to My Tho or Phan Rang to see Interplast again next year so that we can release the contracture on his left arm.

Head To Toe Assessment

  Head To Toe Exam 
  Originally uploaded by interplast.

 Hi, I’m Suzanne Wolansky, nurse educator on the Interplast team in My Tho, Vietnam. On Wednesday I had the privilege of interacting with the local PACU (recovery room) nurses in a hands-on education session. The nurses asked me to demonstrate a physical “head to toe” assessment and plan of care for a particularly challenging patient that they had in the recovery room. I really enjoyed this opportunity to see that nursing is such a universal language. The patient goals are the same despite drastic differences in resources. The local nurses were very receptive to me – many of them staying on after their shift had ended to participate in the session.

Learning By Collaborating

  Cleft Lip Surgery 
  Originally uploaded by interplast.

Dr. Richard Siegel, long-time Interplast volunteer surgeon, performed a bilateral cleft repair with the help of Dr. Lephong Vu, a local maxillofacial (oral) surgeon. The local doctors learn a great deal by assisting Interplast volunteers on these cases.

Thank You To Woodside Middle Schoolers

  Boy Wearing No-nos 
  Originally uploaded by interplast.

A father comforts his little boy in the recovery room just after the child’s cleft palate repair. The child is wearing “no-no”s – simple arm restraints that keep the patient from picking at his stitches. The “no-no”s for this trip were made by students at Woodside Middle School in Woodside, CA. We thank these students for volunteering their time and skill to make “no-no”s, which are a great help to us during the kids’ recoveries.

Clinic Day Stories: "Why Would Anyone Want To Marry Me?"

  Dien 
  Originally uploaded by interplast.

We awoke early for breakfast and were at the hospital by 7:00am. Patients were already lined up waiting for us. The local hospital employees were incredibly helpful, organizing the patients so that those who were seen last year and told to come back got to be screened first. The clinic was run very well and was not at all as chaotic as I had imagined it would be. Each patient was seen first by the two surgeons, Dr. Richard Siegel and Dr. Chris Connor, to see if their case was one that we could operate on. It is always tragic to turn a patient away, but some come with very minor problems or cosmetic issues that they want fixed. Many parents bring their children back after they’ve had a cleft palate repair because they can still see a very small hole in the roof of the child’s mouth. This hole is a perfectly normal thing to have after a palate repair, and as the child grows the tiny hole slowly closes up. The surgeons and translators explained this to the parents and these cases were sent home. One very sad case was a young woman with elephantitis of the hand (extremely swollen/oversize hand). Repairing this deformity requires very specialized surgery which unfortunately our surgeons are unable to perform. We will try to send a hand surgeon on the next trip to this site so that this patient can be treated.

We saw a huge number of ptosis cases, several burns, and a number of cleft lips/palates. As this is a very “mature” Interplast site (i.e. we have been here many times before) we are seeing a lot of kids who have had their cleft lip repaired but have returned for palate repair or revision of the lip or palate. One young woman in particular captured my heart…

Dien is 26 years old, although she is so small and youthful she looks like she is only about 15. When she was less than one month old she was burned in an accident. She was sleeping under a mosquito net when a strong wind blew through her house and knocked over a kerosene lantern. The mosquito net caught fire and fell in flames on top of Dien. She has a tremendously beautiful face despite the scars that she will always bear. Dien went to school until the 5th grade. Her family was very large and one of the children needed to drop out of school and start working to help support the family. Since Dien was not happy at school and had to suffer the ridicule of her classmates every day, she volunteered to give up her education to help her family. Now she is a farmer, and her little finger contracture on her right hand bothers her when she is working in the fields. The Interplast team will release this contracture for her, and hopefully ease some of this discomfort for her. When asked if she was married she responded, “No. I am so ugly why would anyone want to marry me?” It’s ironic, since her physical beauty had caught my eye from the beginning, and the more she smiled and talked the more enamored I was with her. It’s so tragic that she doesn’t think anyone sees her true beauty.

Cleft Baby After Surgery

  Cleft Baby After 
  Originally uploaded by interplast.

Thanks to Interplast surgeon Dr. Chris Connor and his team of anesthesiologists and nurses, this little girl will grow up to lead a normal life, free from ridicule and stigma.

Cleft Baby Before Surgery

  Cleft Baby Before 
  Originally uploaded by interplast.

This 3 month old baby girl came in with a unilateral cleft lip.

Nurses Come From Canada

Where Nurses Come From
Originally uploaded by interplast.

Recovery room nurse Deb Golka and a local woman got to chatting about where they come from. Deb was trying to explain that she is from Canada, not America. In the end, she drew this map to show her. The woman promptly added Vietnam to the map (top right corner)! This is a great example of the little cultural exchanges that happen during the short breaks in our work.

Arrival In My Tho, Vietnam

Banner Welcoming Interplast
Originally uploaded by interplast.

Hi! I'm Devon Watts, associate director of foundation and corporate relations at Interplast and team member on the My Tho, Vietnam surgical team trip. I'll be blogging for the next two weeks, so check back frequently for updates.

The team arrived safely in Ho Chi Minh City, Vietnam on Sunday. When we left San Francisco, the airline couldn’t guarantee that all of our boxes of medical supplies and equipment would make it onto our flight, so all we could do was cross our fingers that some of them wouldn’t have to be sent on the next flight, which would arrive 24 hours later. Fortunately, upon arrival in Ho Chi Minh City we found all 28 boxes at baggage claim… whew! We loaded up all our bags and boxes onto a truck and after a nice lunch in HCMC we drove the 40ish miles to My Tho. After we checked into the hotel we walked down the street to the hospital to drop off the boxes and explore the facility.

Tien Giang General Hospital is a modern and clean facility, although it still doesn’t compare to our standards in the U.S. The surgeons were satisfied with the operating room setup as were the nurses with the recovery room. Team leader Ken Bloome, MD called the first meeting back at the hotel. We discussed the logistics of clinic day, where we screen and schedule the patients. Roles were determined and all agreed on the process. After nearly 24 hours of travel and a long first day, we finally went to bed.