Phan Rang, Ninh Thuan, Vietnam 2009

Teaching in Phan Rang

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Phan Rang, Vietnam-Kathy Yates, Interplast board member.

We are joined by Dr. Do, a Vietnamese anesthesiologist from Tam Ky, who met our team leader, Dr. Richard Gillerman, when Dr. Gillerman was in Vietnam on an Interplast trip several years ago. Dr. Do sent one of his patients to see us last week, and has decided to join us himself for hands-on participation. Teaching local practitioners is a core aspect of the Interplast mission and Dr. Do has come to avail himself of the opportunity to learn from the three other anesthesiologists on the trip. It is disappointing that there are not more local surgeons or anesthesiologists who have come to observe. That may be due to the fact that this is a new location for Interplast (this is only our second year visiting this location.) It typically takes several years to develop the appropriate level of infrastructure and relationships for a mature Interplast teaching program with full participation from local hospital staff and doctors. Local doctors want to confirm that it is worthwhile to take days or weeks out of their own practice schedules to work side-by-side with the Interplast team. That happens over time, as repeated exposures to the local community and observations of patient outcomes over an extended period build Interplast’s positive reputation.

As early representatives for Interplast, we are all aware of our visibility and the need to be good ambassadors for the organization. This is part of the reason why a veteran team was assembled to come to Phan Rang and help establish a positive relationship with the site.

Fraternal Twins

Phan Rang, Vietnam-Kathy Yates, Interplast board member.

A very young baby was brought in for surgery today. At first glance I thought he was a girl. All dressed in pink, he was a beautiful child; sadly he was born with a cleft lip.

              I was puzzled to see him dressed in girl’s  clothes.  After asking why I found out he has a fraternal twin sister and was borrowing her sweater and hat for his trip to the hospital. We asked the mother to bring her to the hospital so we could see them together. Now that he has had his surgery, they are a nicely matched set!

It's Never Too Late

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Phan Rang, Vietnam-Kathy Yates, Interplast board member.

Throughout our visit, we have been accompanied by a representative of the People's Commitee of the Vietnamese Socialist Government. We are here with the official sanction of the government, and the local People's Committee has been active in spreading the word about our visit. It was because of the Committee that another of our patients found us. A 63-year-old man, he has lived with a pronounced cleft lip all his life. After our clinic on Monday, a member of the Committee from another city heard that we were in town and contacted the man’s wife to tell her she should have her husband come down. He came in on Tuesday and just walked into the areas where we were keeping our records. He spotted one of our surgeons, Dr. Duke Hagerty, who was sitting on a bench taking a break from the surgeries of the day. The Vietnamese gentleman, Mr. Tran, came and sat down right next to Dr. Hagerty. There was no translator present. Dr. Hagerty just looked at the man and nodded his head, “Yes, we can help you.” Today Dr. Hagerty repaired the man’s lip. Twenty minutes of surgery, and the man was transformed. We brought in his wife. She liked what she saw! Due to his age the surgery was done under local anesthetic and Mr. Tran was discharged directly from the recovery room. The team had only a few minutes to admire the enormous change the surgery made to the man’s face, but all of us were a little misty-eyed when Mr. Tran and his wife walked out the door.

An Unexpected Visitor

Phan Rang, Vietnam-Kathy Yates, Interplast board member.

We were visited today by a 15-year-old girl who had been treated by Interplast last year, and came back to show us her hand and thank the doctors for helping her. She had suffered a burn contracture and lost use of her right hand. Last year, she heard about Interplast through a TV announcement and came to see if she could be helped. The burn contracture was released and she has regained full functionality of her hand. When she heard that we were coming back (also through a TV announcement,) she wanted to come see the surgeon who had helped her, to show him how well she was doing, and to thank him again for changing her life. She was very disappointed that the doctor who saw her last year was not here today, but one of the surgeons took a look and praised her for her consistent work since the surgery—flexing her hand and massaging it to help the tissue heal. Post-operative therapy makes all the difference, and this girl was very conscientious.

After seeing the surgeon, we thanked her again for coming and said our goodbyes. She didn’t want to leave. There was clearly something else she wanted to say. Hoa, our interpreter, asked if she had any other questions or complaints. The girl was very quiet and looked down. “What’s wrong?”  Hoa asked her. Still, she wouldn’t speak. Finally, she softly told Hoa that she had come to see how she could volunteer for Interplast. That brought a big smile to all of us! Hoa spent some time with her, explaining that Interplast always needs volunteers who can help us translate, so we look forward to meeting her again when she has learned English.

Beautiful Children

Phan Rang, Vietnam-Kathy Yates, Interplast board member.

Today was girl day at the hospital.  By luck of the draw, our schedule was filled mostly with beautiful baby girls, all with cleft lips and palates for repair. The surgeries went well, though the girls were all shy and cried whenever any of us came into the room. This was disappointing because we wanted to get some pictures of their beautiful smiles.

The children are beautiful and very sweet. In the midst of the girls, there was a 3-month-old boy, extremely healthy and chubby, who came in for his cleft lip to be repaired. Unlike the girls, he was very calm and happy to have his picture taken. All of them went home today. They will come back next week for a final scar check, and by then, maybe they’ll all be smiling!

Suong’s Surgery

Phan Rang, Vietnam-Mike Flynn, Interplast volunteer anesthesiologist.

It is hot and sticky at 7:30 am as we make our way across the park to the hospital. We are carrying packs with surgical scrubs, our favorite pieces of equipment and, above all, some apprehension on our first day as a team operating in a strange environment.  Dr. Duke Hagerty, Interplast volunteer plastic surgeon, is very concerned about his first patient, a little 2-year-old girl named Suong. He had discussed her with our other surgeon Dr. Shankar Man Rai, Interplast surgical outreach director in Nepal, and an expert on lips and palates.

The situation was unique in that Suong was the only child of an elderly couple. Her parents had desperately tried to have a child for 11 years and Suong was their jewel. Unfortunately, she was born with an extremely severe lip and palate deformity. So severe that she really lacked enough skin to bring the lip together.

The operation was the third of the day and as Dr. Hagerty made the incision, he quietly said, “We have to make this perfect.” He struggled with the lack of tissue, removed and replaced sutures. Finally, he asked Dr. Rai for his opinion and only when he was fully satisfied that he had the best result with the available tissue, did he relax a little and give permission to wake the patient.

Late that night I was with the team on post-op rounds. A smiling grateful couple sat next to their child fanning her to keep her cool. They were almost overwhelmed with gratitude, feeding sips of water to their little hero. Dr. Hagerty with his usual reserved self, smiled and said “next.”

Communication and collaboration

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Phan Rang, Vietnam-Kathy Yates, Interplast board member.

Suong came in this morning for her bilateral cleft lip surgery. Dr. Richard Hagerty, who performed her operation, wanted to make sure it was repaired as perfectly as possible. He was extremely careful and sought the advice of his colleague, Dr. Shankar Man Rai, Interplast’s surgical outreach director in Nepal who treats clefts on a daily basis. Together, they determined the best way to preserve her tissues and create an intact lip. In the end, she came out with a beautiful face.

It is apparent that one of the unique things about Interplast is the way the teams assemble from various places around the world and, never having worked together, start collaborating and cooperating to make surgical magic happen.

Interplast has been informally studied by medical teams in other countries. How do they do it? Communication and collaboration are the foundation. It’s all part of the Interplast mission: to identify the leaders in the field of reconstructive plastic surgery and bring them together to provide these vital services while also teaching and collaborating with local hosts.

Our first patient

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Phan Rang, Vietnam-Kathy Yates, Interplast board member.

This 2-year-old girl will be our first surgery tomorrow. She suffers from a pronounced bilateral cleft palate and lip. She is very small for her age—a condition that is very common in cleft palate patients because of the difficulty they have in sucking and gaining nutrition. We saw several adolescent patients today who had repairs made to their cleft lips, but their palates were not fully repaired. Due to their age their speech has been affected by their cleft palates. This little girl is however is lucky; her age will enable her to develop her speech properly after her operation. She’s protesting now, but when she is older she will be very thankful that her parents brought her to our clinic today.

Trung

Trung
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Phan Rang, Vietnam-Dora Rusin, Interplast volunteer services coordinator.

Today at clinic we met 14 year-old Trung. While attending a children’s festival, Trung was accidently burnt with an oil torch causing severe burns to his chest, neck and arms. His injuries caused him to drop out of school for two years before arriving to the Interplast clinic in 2008. He was operated on by Dr. Jorge Palacios, Interplast’s surgical outreach director in Ecuador, during his visit to Vietnam last year. Today, Trung has almost full mobility of his neck and was able to return to school after surgery. He was very happy to see Hoa, one of our translators whom he had met last year. He is scheduled to have release of burn contracture on the fingers in his left hand which will enable him to write.

Clinic Day

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Phan Rang, Vietnam-Dora Rusin, Interplast volunteer services coordinator.

Today we saw 118 patients and scheduled 59 for surgery. There were a variety of cases that included cleft lips and palates, burn contractures and hand cases. A few of the team members did most of the clinic while others set up the operating room and the recovery room. This way the team will be able to start the surgeries tomorrow early in the morning.