Finding our groove

This morning several of us had a morning eye-opener with a good breakfast and a walk to work.



Breakfast is pretty good - a dozen or so foods to choose from, as well as bread, fruit, and drinks. Most of the entrees have meat, so I end up with bread and fruit or oatmeal from home. Enough for all to fuel up, and we get a few moments of social time before a full day of work.



Dr. Nguong, one of our surgeons, and Phi our translator. I was told that Phi was a biochemical engineer for years before joining in to pamper us all. The fascinating pasts of all our team members are surfacing, and are very interesting.

Once while passing through the recovery room, I caught this photo of many of the nurses piled on one bed having their siesta. The nurses who help us in the OR simply disappear after lunch, and this must be what they are doing. These folks have a great work ethic, but also priorities. Lunch and nap are essential parts of the day.









One child became very dehydrated, as his parents took the "nothing-by-mouth" rule to an extreme. The children can have clear liquids up to two hours before surgery. For some reason, this child had had nothing by mouth from 6pm the night before, and it was now 20 hours later. In this heat, he was becoming lethargic and you can imagine how dry and uncomfortable. We started an intravenous and began to give him an IV "drink" before he came in to surgery. I sat with him for a bit to examine him and then just watch him. He rolled his head over and looked at me, and then in a universal gesture, he flopped his left arm over to me with the palm up and his fingers reaching a bit. We held hands, and in spite of my tears welling up at his sweetness, I got this photo.
















I caught this photo of Frankie having a moment of respit in the OR. She is amazing. As the only operating room nurse, she has organized the central supply area, prepares for each surgery, sets up equipment, makes sure we have the right patient, gets both surgeons what they need as the cases progress, cleans up after we leave, reorganizes and sterilizes the sets, and much, much more. As the day progresses, she is cheerful, funny, and seems to have boundless energy. But I caught her with some much deserved down time, and it was nice to see this brief rest come her way. In the U.S., we would have about six people doing her job. Our extra volunteers have jumped right in and help her when then can, but she is still unbelievable!












This is a shot of Dr. Nguong and Dr. McClure, working together. They are doing great things and we are very lucky to be able to support them as they work their way through the lists of patients we have.













Crowded elevator. It is much faster for us to take the stairs, and more comfortable. The problem is getting lost - the hospital is a maze of linking wings that are interchangeable, and we don't know how to ask for directions. So we push our way into the squeeze as best as we can and hope for the best...












Hmmm. Very unhappy...















Very happy and smiling as best as she can with a bilateral cleft...















... and undecided ...
















Here is Hien with one of our sweet patients. Before ...












...and after, with happy mom.





Another adorable face.












And another...






And another!









And Phi, with a skeptical patient.

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Elizabeth and Marion in the OR, watching and waiting for a way to help. Both amazing women with endless energy and good questions.











We see the post-operative patients in the morning to decide who goes home, and then in the evening to see the patients for the next day, and anyone who has had surgery. The surgeon and pediatrician always go, with translators and extra team members when we can.












Peekaboo!












Lady Catherine at the table she has set up for us - snacks, tea, coffee, fruit, and good cheer. Thank you, Catherine, Phi, Marion, and Elizabeth - our lifelines!













Dr. Bill McClure at work with his Vietnamese team. He is learning words for each of their instruments, and they all work very well together. He has been very pleased with the help he is getting from the assistants. Volunteering themselves, the scrubs and workers we have added to the team from the local work force have been so essential to our daily success.













All-Vietnamese team - scrub, surgeon, anesthetist.





Dr. Bill and Frankie (probably offering to help...).













Catherine translating at rounds. Always smiling!












I hope this is not too graphic, but these shots show a good example of the work we do and the quality of our surgeons. The magical difference here makes meaningful change in a child's potential in life. Kids especially can be cruel to those who are different, and a change like this makes a big difference in day to day life, not only in speech and feeding, but in socialization and acceptance.

First "real" day

The first day of actually caring for patients on a Resurge trip is the true test of a team. If everyone has done their due diligence and paid attention to the details, it ought to hum like a good machine. This day for our team hummed and then some.

Everyone gathered in the lobby after an early breakfast to catch a ride to the hospital. Hien and Thao had already started walking (and beat us all there). The rest of us got to the hospital early and began final checks and set up. It is almost like a Space Shuttle launch - Houston was buzzing!

We had a run through of the emergency scenarios, just to remind everyone who may not have thought of each possible need: where the fire extinguisher is and who to call if blood is needed. Then the first patients were brought down to be readied for surgery.

Since all the patients had been admitted to the hospital the day before, we did not have the typical problems that plague us in the states when patients come from home. No one was late, no one had eaten, and we knew where they were.

The anesthesia team was ready. We pounced on the first patient and without a hitch, we got to work. He was an adorable toddler, with a beautiful and very concerned mother. Children can be so enchanting!














Thao induced, I held, and Hien got the IV. Then I started my case, Hien did the IV, and away we went! It was only by working side by side with this incredible team that I learned how lucky I am to be here with them.























I don't know what my camera did here, but this sweet young man is not photoshopped! He needed a revision and had a beautiful result from our local associate, Dr. Nyuong. Dr. Hien got to use the Glidescope.



























Our team is held up on the shoulders of some amazing people. One of our translators and support persons is Phi. Here she is, having set up a table of snacks, fresh coffee, and tea for us. She also provides wonderful hugs and a sunny smile throughout the day. How can success not happen with people like this in the process!















We had two teenage girls toward the end of the day, with the same teen energy and issues seen anywhere around the world. This girl was very anxious and had trouble letting herself trust our care. But you can see, a few doses of medication later, she was like a warm puppy. I love my job!















One thing that always hits us in the face is how good care can be delivered with so little fuss and mandates. Without the extreme encombrances of JCHAO, unions, Medicare mandates, and litigations, things flow and we can just do what we do without computers, paperwork, and arbitrary policies. We get to see another system at work each place we travel, and with how little the locals can do so much. The recovery room that we share here has about 18 beds, the patients are monitored with very large font displays, and a few nurses watch from a side station. They simply cannot provide 1 nurse per patient in this busy place. It is fascinating to watch from our end of the room.








No one walked home today; the weary legs were ready to rest. We took our bus to the hotel, showered off the dust and fatigue from the day, and stepped next door to a restaurant for dinner. The table next to me reminded me how fortunate we are in California to have no-smoking laws - there were about six men smoking during their dinner, which was not only strange to see, but a nuisance to have to smell during our dinner. Smoking while eating seems to be a regular hobby here.

Back to the rooms - horizontal position - next stop, Wednesday!

Monday, February 20, 2012 Clinic

Somehow everyone managed to crawl out of bed in time to get breakfast at 6:30 a.m. and then off to the hospital to set up the OR, recovery room, store- and processing room, and see patients to select the candidates for surgery. The breakfast spread was impressive, including soups and noodle dishes, fresh-prepared eggs, fruit and bread.

We rode taxis to the hospital, and as with most locations we visit, we were met with curious gazes and comments. Our wonderful hosts helped us find our way through the maze of halls to the area we needed to set up.

Frankie, Wendell, and myself found ourselves working on set-up while the rest of the group went to the busy clinic. Thao, one of the nurses who will be helping with the cases, jumped right in and helped me get everything organized. She is a real self-started, clearly very bright, and was most helpful. It always amazes me how a fully functioning OR, processing unit, and recovery room can spring out of all these boxes. Not unlike a crystal garden - add water and it grows!













I had wanted to go to clinic earlier and help with screening, but I got lost in the maze of hospital halls as I tried to find my way over. Finally, with the help of Hien and Thao, I walked over to the clinic later in the day. It was held on a stage in a large seating hall of some kind, and the seating area was full of potential patients and their families. The usual buzz of Resurge was happening - various tables and medical workers screening and interviewing patients with interpreters and extra local help hard at work. The cases are put on a master schedule as post-its before things are finalized. This makes it easy to rearrange a day's cases to a more sensible flow. Our surgeon Bill told us a total of 152 patients were seen, 87 were accepted for final procedures and most of them made it through to get on the schedule. We will be doing about 11 cases per day.


















At the end of the day, we went to the ward to see the patients for tomorrow. All the next day's patients will be admitted to the hospital the night before; a luxury we lost long ago in the U.S. They will also stay as long as needed after their procedures, so we will be able to follow them closely and make sure all is going well. Hien, our Vietnam anesthesiologist, instructed the patients about the timing of the last food and drink so that no one comes to surgery at risk of getting food in his or her lungs. I don't understand what she said, but she definitely made her point!



















After everyone was packed up to head back to the hotel, four of us decided to walk. Marion had her handy phone GPS to guide us back. It was our first real look at the town we are working in. Not the density of traffic some other Vietnam cities have, but the same lovely, hard-working people.























And of course our equally lovely and hard-working Resurge workers: Elizabeth, Frankie (my roommate), and Marion.











We did get a bit lost, phone notwithstanding, because the building numbers had a way of going up or down in a kind of random way. We had to pass a crowd of children doing some variety of marshall arts. After our third time passing, they began to wave and shout "hallo". Kids are all programmed the same!

Travel - 2/17-2/19/2012

February 17, 2012

What does it take to get from Arcata, California to Quang Ngai, Vietnam?

A long time.

On Friday, PST, I got a bit of a sleep in, a gift from the pets. Somehow they decided it would be OK to eat an hour after the sun came up instead of an hour before. I needed that.

Finished packing, cleaning, dropped off Ollie the cat at my parents, and give Chuck a tour of the house and the neighborhood. He has generously offered to dog sit. He doesn't know yet how generous an offer he has made, but Pepper will soon put him to the test... ;o)

3pm into the car, off to the airport, bag check and security clearance. Herded onto the flight. Offload at SFO; I got here more than six hours before my next flight, so had to get my bag back and tote it around. I guess I am glad about that; less chance it could disappear and it is packed full of medical gear. I was entertained by the salesperson at the Brookstone store in the international terminal with a wireless helicopter. He sent it over to scout me out, but I guess I didn't look like I needed rescue yet, so it flew away.

9pm met up with the small team and 28 huge cartons of medical supplies, monitors, anesthesia vaporizers, drugs and equipment. We gave our passports and checked in ourselves, our personal bags, and our mountain of stuff.

The flight to Taipei left at midnight, 14 hours duration (crossing the International Dateline). The plane was a 747-400, which had a 3-4-3 seating configuration, with about 300 people in economy - FULL. The aisle was like a one-lane bridge - if someone started walking my way, I had to back up to let him by. There was a team of well-orchestrated infants who handed off the baton throughout the night, guaranteeing rarely-interrupted atonal serenades. Packed in like sardines, the options for sleep positions were within 2 dimensions - up, slouched, or down - nothing sideways. My row was like a Rube Goldberg machine - I slouched, moved my leg and the lady next to me popped her head up from her table, and then the guy on the aisle swung his arms out and smacked the flight attendant. But EVA air flight attendants took care of everyone with grace and poise, a welcomed courtesy.

We landed a bit late in Taipei, so had 20 minutes to run through security and to our connection gate. We were escorted by a nice EVA agent and all made it fine. The plane stayed on the ground for quite a bit longer, presumably to be loaded with our many boxes and bags. Our flight to Ho Chi Minh City (formerly Saigon) was 3 1/2 hours and uneventful. We had to apply for VISAs at the airport, which took some time, then clear customs and get our baggage cleared as well. This can be a painful process with this much equipment, depending upon the level of suspicion of the agents working at the time. Luckily this time went very smoothly.

After an hour wait, we took the bags to the domestic carrier for our next leg. We left our things and went to lunch in town with Hien. It became quite an outing; we also stopped for coffee and then walked back to the domestic terminal. We found a spot with WiFi and everyone dived onto their computers and phones to connect with home. No Facebook though; too much potential trouble for the government. Oh well!

We left HCMC for Da Nang 8 hours after our arrival; about a 1 hour flight. Gathered everyone, bags and boxes together for transport to Quang Ngai; a bus for the group and a truck for the boxes. I was about a 2 1/2 hour ride down the coast from Da Nang, but unfortunately in the dark. We arrived in Quang Ngai Sunday night about 11pm local time, waited for the bus with our bags, and got to bed to rest for clinics and operating room set up Monday. Amazingly, our travel went as planned - no delays, cancellations, misunderstandings, and all our bags and boxes are here.

Internet here is spotty, and slow at night, but I'll do my best to get photos up as they are generated. For today, it's been mostly the inside of transportation vehicles and cloudy skies anyway...

Total time? 42 hours. Good Vietnamese coffee - 30,000 VN Dong. Bed with clean sheets - priceless.

Team meeting

One of the strong suits of Resurge is communication and their good organizing skills. Before each trip, the team has a conference call. Part of it is scripted and read by each chief, bringing us all up to the same expectations for each aspect of our work. It also gives us a chance to "meet" one another and share some information about our pasts. Our call went well and everyone seems excited to begin.

The unique partial-team model of this trip will be a challenge. The familiar aspect is that we are bringing information, organization, and teaching from our part of the globe to initiate very specific care for those who need it. The difficult part is to do so while maintaining equity among all members of an multinational team. We want to be sure everyone is working at the same level and with the same set of rules to maintain the standards and expectations of Resurge and its donors, yet respect the abilities and gifts brought to the table by our Vietnamese colleagues. We have all made these volunteer trips before, and it would be easy to fall into our usual mode and just get to work. But we must resist and take the time to share, even if it slows us up. It will not only be about how many cases we can do and patients we can help, but also about how many connections we can make and relationships we can foster among our new colleagues. I am excited by this opportunity to be a useful consultant where I can, a tactful facilitator when necessary, and at all times a grateful and humble guest.

"Tact is the art of making a point without making an enemy."
Isaac Newton

Vietnam and area

I love going to Vietnam. It has many features that make it feel like a Pacific Island, yet exotic features (to me as a Westerner) that feel more Asian.
Many spell the name Viet Nam, but it is more commonly one word, one capital letter: Vietnam. This is a small country that wraps around the coast of the Southeast peninsula of Indochina, surrounded clockwise by the East Sea (South China Sea), Cambodia, Laos, and China.

With a population of about 91 million squeezed into a land mass about the size of New Mexico, Vietnam is the 13th most populous country in the world. It is a little longer than California, but skinny coastline for the most part. The density of the population is about 672 per square mile, compared to 84 in U.S. You could get the same density by moving everyone in California into Kentucky!

Vietnam has a rich cultural history of over 20,000 years. In modern history, it has been occupied and colonized by many countries, most recently France and Japan. After WWII, political upheaval put an end to the monarchy and Vietnam became a republic. Most memorable to Americans is the Vietnam war, which divided our country as it ravaged theirs. The US withdrew in 1973, and Saigon in the South (now Ho Chi Minh City) fell to the Communists in 1975. In 1976, the country became the Socialist Republic of Vietnam. There were about 3 million Vietnamese dead and 4 million injured in this war, as well as about 1 million who fled the country after the take-over. US losses were great with over 200,000 dead or injured, but the losses to Vietnam were huge.

I am surprised at the youthfulness of the population; in fact almost 1/2 the population are teenagers or younger. Not many people are left who even remember the war, although stories abound that they are willing to share. The history aside, these people are warm, friendly, kind and generous.

Most developing countries give priority to basic health care for most people, eradicating infectious and parasitic diseases, and promoting family planning. When someone has a scar or birth defect that renders him or her abnormal in appearance or function, it is not usually treated, as it is not life threatening and the numbers afflicted are overwhelming. But in reality the impact upon the person's life is enormous, as that child or adult is often ostracized as possessed or evil, even being sequestered outside with the animals. Procedures we take for granted are simply not widely available.

Resurge makes an effort to set up two-week clinics in various parts of the world, integrating as many local health providers as possible to partner in the delivery of plastic reconstructive surgery to those without access to such care. This trip is a new model with only section chiefs being sent, with Vietnamese nationals filling in the gaps. Where there is usually a U.S. team of 16 or so, our group is a surgeon, anesthesiologist, two nurses, pediatrician, and translator. The rest of the team will be Vietnamese and will join us there.

Our specific site for this trip is Quang Ngai. Quang Ngai is in Quang Ngai Province, which is almost exactly in the middle of the Eastern coastline of Vietnam. About 100 miles south of Da Nang, it was a stronghold of the Vietcong during the war, and was the site of several massacres, including My Lai in 1968. It is a poor province, with mostly farming of rice, sugar, coconuts, and peanuts; as well as cattle, fishing, and some light industry.

Quang Ngai,Vietnam Resurge 2012

January 28, 2012

This is a return trip for Resurge (formerly Interplast) to this location. However, this time the team size is much reduced, with the expectation that there will be Vietnamese doctors and nurses who will join our team at the site. This is a new model for Resurge, and it will be interesting to see how well we can make it work.

At this point I am making arrangements for my dog Pepper (thanks, Chuck), my cat Oliver (thanks, Camp MacEvoy), and getting myself slowly packed. It is not too difficult to get everything ready to go, but I like to check a couple of weeks early to be sure I am not missing something essential - like valid passport!