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Outstanding Team


  Outstanding Team 
  Originally uploaded by interplast

Quang Ngai, Vietnam-Nicole Friedland, Interplast Staff. Photo by John Urban.

Here's a picture of the incredible volunteers who made all this work possible. These individuals give up two weeks of their lives, work under exhausting circumstances and often give up pay at home to be in Vietnam. They have operated on about 80 patients and dramatically changed hundreds of lives. The tears of gratitude from patients really have said it all. What a team!

The Kindness of Our Patients


  The Kindness of Our Patients 
  Originally uploaded by interplast

Quang Ngai, Vietnam-Nicole Friedland, Interplast Staff. Photo by John Urban.

To will be staying with her aunt who lives nearby for the next few nights. (To, her aunt and I are pictured here.) Her aunt is beautiful and likes to play shy with the photographer, playfully punching his arm when he manages to sneak a shot.

They will return for To's check-up on Friday. She will then have a two-day journey home. Each time To sees us, she reaches out her hand to take ours.

A Thankful Patient


  A Thankful Patient 
  Originally uploaded by interplast

Quang Ngai, Vietnam-Nicole Friedland, Interplast Staff. Photo by John Urban.

To is feeling very happy today. She was excited when they finished the surgery and she was eager to see the results. Dr. Del Mount gave her a mirror and said it was a wonderful moment. She had very little skin between her top lip and nose, so the restoration is fairly tight. The Interplast doctors told her to come back next year, when the skin will be more loose, for a revision.

Translators Have a Difficult Job


  Translators Have a Difficult Job 
  Originally uploaded by interplast

Quang Ngai, Vietnam-Nicole Friedland, Interplast staff. Photo by John Urban.

Lien is one of our translators / coordinators. In addition, she is a nurse educator, so she is uniquely skilled at working with the patients. The other translator is Kim, whose had an extensive career working with cardiologists. I'm pretty sure the translators have the hardest job on the trip. They are pulled in every direction and have to function in two cultures and languages. They not only take care of the patients and translate important information about procedures and care, but they coordinate and care for all of the logistics relating to team members. From getting food brought in for lunch breaks to prepping patients for surgery, making rounds with the doctors, reassuring anxious parents and discharging patients with proper instruction and medicines, Kim and Lien have worked non-stop and been true heroes.

Here you see Lien in the post-op ward discussing care with Quyen, who had her wrist contracture released.

Before Cleft Repair


  Before Cleft Repair 
  Originally uploaded by interplast

Quang Ngai, Vietnam-Nicole Friedland, Interplast staff. Photo by John Urban.

Huynh was another adorable baby whose cleft lip was repaired by the team.

A Thankful Mother


  A Thankful Mother 
  Originally uploaded by interplast

Quang Ngai, Vietnam-Nicole Friedland, Interplast staff. Photo by John Urban.

Her mother was happy to have her daughter's hand repaired. She had a good time trying to teach several of us how to say 'Thank You' and 'Hello' in Vietnamese. It's harder than you think!

Repaired Hand


  Repaired Hand 
  Originally uploaded by interplast

Quang Ngai, Vietnam-Nicole Friedland, Interplast staff. Photo by John Urban

This sweet 12-year-old girl burned her fingers when she was 3 years old.  Her family was making caramel candy and she fell right into it, burning the last three fingers of her right hand.  Her fingers fused together and contracted.

A Mother's Love


  A Mother's Love 
  Originally uploaded by interplast

Quang Ngai, Vietnam-Nicole Friedland, Interplast staff. Photo by John Urban

Off to surgery he went, and after about an hour, I went out to bring the mother back to PACU.  Nurse Lynn Fronk held up baby for mom to see and she just burst in to tears.  Dr. Mount had repaired the lip and while the baby will need future surgery, this simple procedure made a dramatic difference in the child's appearance.  About an hour later, we went down to the ward and I found the mother holding her baby and still crying.

Dramatic Difference


  Dramatic Difference 
  Originally uploaded by interplast

Quang Ngai, Vietnam-Nicole Friedland, Interplast staff. Photo by John Urban

After a restful weekend, the team was re-energized and looking forward to a full day of patients today.  Our first case was a baby, 7 months old, with a significant cleft palate and lip running all the way to his nostril.  This little baby was adorable - a love bug.  As we talked to him and his mom, he kept laughing and smiling.  What a
sweetie!  His gum line was protruding out of his mouth, almost like a little snout, and if he'd had his teeth in they would have been sticking straight out.  As a mother, it must be terribly hard to have such an adorable baby whose face may repel others.  We could tell he was such a sweet and loving child.

Giang Now with Dr. Deb Rusy


  Giang Now with Dr. Deb Rusy 
  Originally uploaded by interplast

Quang Ngai, Vietnam-Nicole Friedland, Interplast staff. Photo by John Urban

Giang’s parents remember Dr. Deb Rusy, our anesthesiologist who also was on the trip two years ago.  I'm excited that we're able to help Giang continue in her healing.

Giang Two Years Ago


  Giang Two Years Ago 
  Originally uploaded by interplast

Quang Ngai, Vietnam-Nicole Friedland, Interplast staff.

As we keep talking, I learn that she was an Interplast patient two years ago.  The surgeon, Dr. Jorge Palacios (who is also directs Interplast Surgical Outreach Center in Ecuador) did two skin grafts on her face to release contractures.  As I look more closely, I see two patches of smooth skin, one under her right eye and one near her mouth.

Face Burn


  Face Burn 
  Originally uploaded by interplast

Quang Ngai, Vietnam-Nicole Friedland, Interplast staff. Photo by John Urban

This 8-year-old girl, Giang, has burn scars on her face, arms and hand.  She's beautiful and loves to come and stand by me.  She keeps trying to talk to me, but I speak no Vietnamese.  With the help of Lien, one of our nurse translators, I spoke with her mother and father today.  They said when she was 5 years old, she fell in to a pile of trash her grandfather was burning.  She's had one operation to release the contracture on her hand.

Quynh


  Quynh 
  Originally uploaded by interplast

Quang Ngai, Vietnam-Nicole Friedland, Interplast staff. Photo by John Urban

Quynh is a beautiful 6 year old girl. Her family raises pigs. By 9 months old, she was already walking.  One day, as they were cooking food for the pigs, she walked near the fire and stuck her hand in to touch it.  Of course, she was badly burned.  The surgeons completed two procedures on her: a burn contracture release and a skin graft.  This will significantly approve her mobility.

The Sadness of Living with a Disabling Burn

Quang Ngai, Vietnam-Nicole Friedland, Interplast staff. Photo by John Urban

Rahn is an 18-year-old girl.  She's very shy, although she did agree to let us take pictures of her elbow, finger and wrist contracture.  Another mountain person, she came in late to clinic but the team squeezed in time to attend to her elbow contracture.  She'll also be encouraged to return for more work next year.  It's unclear exactly how this contracture happened, but we're told it happened on her first day of life.  It was either from boiling water or an insect bite that became badly infected. 

She was only treated with local herbal medicine and never saw a doctor.  When we asked how it has been for her to live with this disability, she simply started crying.

Lim's Story


  Lim's Story 
  Originally uploaded by interplast

Quang Ngai, Vietnam-Nicole Friedland, Interplast staff. Photo by John Urban

Lim’s home is 100 kilometers from Quang Ngai.   To get to the hospital, they walked down the mountain in the rain to get to a paved road and catch a local bus.  He's very quiet and hard to interview.  His father, who has brought him in for the surgery, shares that he was badly burned as a 6 month old baby.  The family lives in a platform house.  They had a fire burning underneath the house for warmth and Lim fell off the platform into the fire.   

Lim has burns all over his body including bad contractures on his toes and one finger.  Today, the surgeons will be treating him for one of his contractures. He'll be encouraged to return next year for more work; his injuries can't all be attended to in one session.

Lived with Burn Injury for 27 Years


  Lived with Burn Injury for 27 Years 
  Originally uploaded by interplast

Quang Ngai, Vietnam-Nicole Friedland, Interplast staff. Photo by John Urban

Quyen is very quiet and stoic.  She is from the mountains and her primary language is a dialect so she speaks little Vietnamese.   Her arm was burnt in a fire when she was 6 months old.  She doesn't know how it happened.  Although she didn't go to school, she's gone on to live a productive life.  Her handsome husband is attending to her after the surgery.  He grows trees for wood and they have a 5 year old.  Although the surgery is hard on her, she feels very happy.

Burned During the War


  Burned During the War 
  Originally uploaded by interplast

Quang Ngai, Vietnam-Nicole Friedland, Interplast staff. Photo by John Urban

This  man came during clinic day and was the most severe burn case amongst the patients.  He told us that he had been burned during the war and that although he'd sought treatment before, no group would accept him. He had difficulty moving his head in any direction and his arm movement was restricted.  He was scheduled for surgery today but he did not show up.  We wonder if he was too frightened to go through with the surgery.

Orphan Patient Visits Team


  Orphan Patient Visits Team 
  Originally uploaded by interplast

Quang Ngai, Vietnam-Nicole Friedland, Interplast staff. Photo by John Urban

This little boy  had his cleft repaired by an Interplast team last year.  He's an orphan who was left at the orphanage door, assumedly because of his cleft lip.  The nuns were happy to hear we were visiting so they brought the little boy for a visit.  Since they were here, the doctors were happy to quickly examine him and assure them that he had healed well. They invited the team to visit their orphanage which is in town.

Mom Crying


  Mom Crying 
  Originally uploaded by interplast

Quang Ngai, Vietnam-Nicole Friedland, Interplast staff. Photo by John Urban

The team is busy getting the patients ready, starting the anesthesia, operating, making rounds, discharging patients.  Sometimes it is easy for me to forget the magnitude of what we're doing.  This morning after medicating the first baby, the nurses efficiently took the patient off for surgery.  As I lingered in the waiting room, I saw the baby's mother turn her face to the wall.  She had tears running down her cheeks and she was clearly anxious about her baby going in to surgery.  I can imagine the emotions for any parent - relief at knowing their precious baby will have the surgical care they so desperately need, as well as the anxiety about the unknown outcome of anesthesia and surgery.

It was lovely to be in the recovery room when mother and baby were reunited.

A Burn's Lasting Damage Is Repaired


  A Burn's Lasting Damage Is Repaired 
  Originally uploaded by interplast

Quang Ngai, Vietnam-Nicole Friedland, Interplast Staff. Photo by John Urban

Thuong is 17 years old and lives about half an hour from Quang Ngai.  His father is a farmer whose wife died a year after Thuong was born.  Since then, he has raised four children on his own: Thuong is the youngest.  When Thuong was 12 he started having seizures.  At 14, while he was cooking for his father, brothers and sisters, who were all working in the fields, he had a seizure and fell into the fire.

He burned his right forearm and part of his hand.  A thick scar covers his entire forearm and the skin has contracted at his wrist, pulling his fingers back towards his forearm.  He said he's not afraid to have surgery today.  I last saw him in the operating room.  Dr. Les Proctor had anesthetized him and Dr. Jim Wallace had released the contracture and was grafting skin onto his wrist.

It Runs in the Family


  It Runs in the Family 
  Originally uploaded by interplast

Quang Ngai, Vietnam-Nicole Friedland, Interplast Staff. Photo by John Urban

Nguyen Duy is 14 years old.  He's a handsome boy who lives about an hour away from Quang Ngai.  His mother is a farmer and his father is a carpenter.  Like most teenage boys, he's shy and monosyllabic.  He suffers from a congenital birth defect that fuses his middle, ring and pinkie fingers on both hands.  A small protuberance extends from each pinkie.  This deformity runs in his paternal family; his father and grandfather both had it.  He is one of four children, and two of his siblings also have the problem.  His young niece also has it.

Duy's brother had the surgery years ago and he's encouraged Duy to come see the Interplast team.  His brother told us that when he'd had the surgery, the doctors just numbed his hands and sliced him open.  Small wonder then, that his older sister is too scared to come for surgery.
Duy says his friends at school tease him a lot, pointing at his hands and laughing at him.  We asked him what he does in response and he shyly says, "I tell them 'Leave me alone!'"  He said he was very scared to come to the clinic but today, his surgery day, he feels ready.  I see him later as he's led into surgery.  He smiles and looks strong.

Dr. Deb Rusy administers anesthesia, and surgeon Del Mount cuts a zig-zag section through the skin encasing the fingers and separates the digits.  This year, they do his right hand.  He will be encouraged to return to have his left hand operated on next year.

The First Day of Surgery


  The First Day of Surgery 
  Originally uploaded by interplast

Quang Ngai, Vietnam-Nicole Friedland, Interplast Staff. Photo by John Urban

The first day of surgery is over after 12 long hours.  The group has worked out many kinks and established a routine.  After dinner, a small group returns for rounds at 9 p.m. 

The recovery ward is one medium-sized bare room with wire-framed beds lined with flat wood planks.  Our patients lie on the "beds" accompanied by a mother, father, an aunt or brother.  Although it is hot, they are covered in blankets and each quietly waits for the doctors, whose language they don't speak.  The nurse coordinator translates.  Are they drinking water?  Have they peed?  Do they have pain?   Do they have questions for the doctors?  Most of them don't smile because they are tired, and many have their lips or palates stitched, but several reach out to hold our hands, and their eyes convey their gratitude.

It is a joy to watch the nurses with their charges.  They are so caring and patient.

Teamwork


  Teamwork 
  Originally uploaded by interplast

Quang Ngai, Vietnam – Nicole Friedland, Interplast Staff. Photo by John Urban

Imagine if you can, 12 individuals who have never before worked together.  They arrive in a foreign country and set up shop in hospitals in varying states of development.  They are committed to helping disadvantaged people live better, more productive lives.  The help they offer is highly specialized and often unavailable to poor people in developing countries.

The hospital has its own challenges:  plugs that don't work, cold water only, which runs intermittently, toilets we really don't want to talk about, a recovery room without air-conditioning...the list goes on.  It is challenging to mix 12 strangers together, put them in a new and very different environment and ask them to perform at peak level.  But that is exactly what they are doing here, for two intense weeks.

The local doctors and nurses are pleased to have us here.  The Vietnamese nurses scrub in and assist the American surgeons.  The local surgeons come to observe difficult cases.  The hospital has requested the team give some lectures.

The first child comes in for surgery and I am sobered.  Lives are at risk.  There is an energy in the air as the team gets ready and anesthesia is administered.

Dignity in the Face of Adversity


  Dignity in the Face of Adversity 
  Originally uploaded by interplast

Quang Ngai, Vietnam – Nicole Friedland, Interplast Staff & photos by John Urban

As the clinic continued, we noticed an older woman, spine straight and head up, with a   severe bilateral cleft lip, her teeth permanently displayed.  There was a murmur among the group as we contemplated living with such a profound disfigurement for so long.  I was struck by the dignity with which she sat, patiently waiting her turn as the hours passed.

I was thrilled when the surgeons examined her and determined that she was a candidate for surgery.  Here is her story:

To lives on a remote island.  She heard that the Interplast team was coming, so she traveled for two days to reach Quang Ngai.  She grows onions and garlic and is a wife and mother.  We were surprised that she had been able to marry with her disfigurement, but she shared that her husband was deformed from Agent Orange.  She proudly told us that she has four healthy children.  Her eldest daughter has finished high school and is now studying accounting in DaNang.  To’s aunt, who had accompanied her to Quang Ngai, chimed in that To's daughter was very beautiful.

To say her life had been hard, and that she has been teased and shunned.  She found school painful and dropped out in 2nd grade.  When she was nine, she had the chance to have her lip fixed by a visiting team, but they told her she would have to have skin grafted to her lip, and she was too scared to go through with the surgery. 
She felt very ready for the surgery this time, and was feeling happy.  She repeatedly shook our hands and smiled.  Her husband is aware she was coming in hopes of having surgery but she says it will be a surprise for her children.  She looks forward now to attending their weddings with her reconstructed lip.

Palpable Joy


  Palpable Joy 
  Originally uploaded by interplast

Quang Ngai, Vietnam – Nicole Friedland, Interplast Staff, photos by John Urban

When we returned from visiting with Lan, the OR and PACU were buzzing.  The surgeons and nurses were excited to tell us that two new patients had arrived while we’d been gone.  Two families had walked for two full days, coming down from the mountains to seek help for their babies with cleft lips.  They were clearly extremely poor, their clothes dirty and torn and their teeth stained with betel.  It was also clear to see their joy and love for their children.  We visited with them and they laughed and smiled freely, knowing that their long journey would have a happy outcome.  Both of their children were scheduled to receive surgery the next day. 

The two kids came from neighboring villages, where their families live as farmers, growing rice, wheat and vegetables.  The villages are home to 27 families and 128 people.  The father told us “it was very, very harsh to make the journey but because of the kids we had to take the chance and come.” 

We took Polaroid pictures for the charts and then gave them each a Polaroid photo of their family.  As we walked back to the OR we heard joyous laughter ring down the hall.

A Lot to Smile About


  A Lot to Smile About 
  Originally uploaded by interplast

Quang Ngai, Vietnam – Nicole Friedland, Interplast Staff  & photos by John Urban

Lan was treated for a severe cleft lip by an Interplast team about six years ago.  She is featured in The Gift, a Phil Borges book about Interplast, and her photos are profound.  I remember the first time I saw her photo.  I was astounded to think that an adult woman could have lived her entire life with such a deformity on her face.  The pictures are haunting and you see the deep pain and shame in her eyes as she struggles to take her hand from her mouth and show the disfigurement of her cleft lip. 
We were excited to learn that Lan was willing to visit with us so I went with a photographer and interpreter to her home village, about 30 kilometers away.  The taxi driver pulled off the road and indicated a dirt lane to reach her house.  Lan was waiting for us, and quickly welcomed us into her home that she shares with her brother and his wife.
Lan says her life has been transformed by her surgery.  She said before the surgery she stayed home almost all the time; she hadn’t gone to school or made friends.  Since the surgery she’s become an adventurer!  Within a year of her surgery, she decided to make a significant change.  She had earned her living as a farmer in a rural area, but she bravely chose to go to Saigon, on her own, to find a job and change her life.  Her family was very worried about her, but when she came back to visit them a year later they found her to be much healthier and displaying a great deal of confidence.  In Saigon, she had a job as a nanny, and she was making friends in the big city. 
Caring for the children helped convince Lan that she wanted to have a child of her own.  She says ten years ago, because of her deformity, she could not have imagined being a mother.  With shy happiness she touched her belly and shared that she was three months pregnant.  She had recently returned from Saigon to have her child in the care of her family.  She hopes to return to Saigon after the baby is born.
We asked her if she had anything to say to the volunteers and donors who helped make her surgery possible and she said very clearly, “Thank you.”

Arriving in Quang Ngai


  Arriving in Quang Ngai 
  Originally uploaded by interplast

Quang Ngai, Vietnam – Nicole Friedland, Interplast Staff & photos by John Urban

Our team arrived in Quang Ngai late on Sunday night.  The trip was grueling for the 12 surgeons, anesthesiologists and nurses–some of whom traveled for more than 36 hours to volunteer for this trip.  We arrived at 8:30 p.m., set up the hospital, and went to bed.
Awake at 6:30 a.m. we had the first team meeting and made our way as a full team to the hospital.  We were told that about 250 patients were waiting for us and, as we made our way in to a large room, we saw indeed that hundreds of patients and their families we’re patiently waiting for our arrival.  The group, made up of two surgeons, three anesthesiologists, four nurses and one pediatrician, is a seasoned group, having completed many past trips for Interplast. They quickly set up three stations where patients were screened, first by our local partner and pediatric anesthesiologist, Dr. Hien, our two surgeons, and finally by the pediatrician and trip anesthesiologists.
Every patient is initially screened to determine if they have a need for reconstructive surgery.  This is an important first step because many hopeful parents will bring children with a variety of ailments, such as blindness.  Our pediatrician examined everyone, but the specialty of this trip is reconstruction.  After the first screening each patient was examined by the surgeons.  If they determined that surgery was needed, the patient would receive his or her final examination by the pediatrician and anesthesiologist to determine that they were healthy enough for anesthesia.  Patients with colds or malnutrition are at high risk under anesthesia and Interplast is, first and foremost, committed to the safety of the patient.
The hours passed and the group of waiting patients slowly diminished.  At the end of our long first day, we had more than 80 patients scheduled for surgery over the next two weeks.  An exhausted team made its way back to the hotel for some sleep before the first day of surgery.

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