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!

Bamako, Mali 10/07/2010

The trek home...

The OR boxes were picked up in trucks. Everyone packed and moved into two rooms - mine and Deb's large room for the women, and Jacques and Richard's room for the men. Pam and Barbara stayed in their room, and Kristin alreadly left last night, so it was not too crowded.

After relocating, we all had to get our bags packed and downstairs to get weighed and loaded to take to Air France in town. We rode taxis to Air France to get our bags checked in. Those of us going to SFO had to check in our own bag and 2 of the large OR boxes. Everyone else checked in their own bags.

There were many last minute jaunts - to the museum, to the river, to the market. Several of our co-workers from the hospital came by the hotel to say goodbye. Most of us had dinner at the bar, final packing, and then onto the hotel shuttle at 7:45 pm. Last minute forgotten items, jumping on and off the bus, and then off to the airport. Still much lightening all around, and very slow traffic.

The airport was a-buzz, as usual. Oumar met us all their and said his goodbyes, as did Jacques, who will be staying for another week with Pam.







Since rebuilding a new airport, the many shops that were there with local music and items were gone, replaced with duty free, perfumes, and expensive import items. Too bad! We got our iPods out, put on our ted hose, drank the last of our water, and fine-tuned for the long trip.



We were finally all herded downstairs to another security point, the piled into an Air France bus. This sat for a long time with the motor running (diesel fumes) in the humid heat, and after about 1/2 an hour, it was getting very uncomfortable. Finally the bus pulled ahead, made a u-turn, and stopped at the plane, which was about 100 feet away. Ridiculous! One poor woman had to step aside on the tarmac and got sick to her stomach. It was quite a scene.

We left at 10:45 pm for Paris. It was interesting to look out the window and see how Bamako ends and then it is dark in all directions. Not a light anywhere!

Five hour flight to Paris, which was very empty, then a long layover for most of us. Barbara left to get the Chunnel to London, and Deb had a gate remote from the rest of us, so we lost her too.

The remaining nine of us moved on to the gate area, got some breakfast, and took naps. Marion found a center piece at the cafeteria that suited her nicely.



Richard left for NY, and Scott went on to Boston. The SFO Seven got on an Air France flight that was PACKED and left late. Ten fatiguing hours later we were spit out at SFO, over two hours late. That left Marion and I late for our flights, so we grabbed our bags and ran. I don't know how things fared for Marianne, but I missed my flight. While I was in line, Sarah showed up - she had missed hers too. I got booked onto a 7 pm flight.

Finally I got to the gate, got on an earlier flight as the last standby, and my bag made it too. When I got home, the door opened, and the misty, cool, and sweet air of the redwood forests by the sea greeted me. I closed my eyes and drank it in and my journey had ended. I was met by my son and my parents, and we had a meal of Chinese food - salad, tofu, and greens. YUM! I finally got to see my dog and cat - a very furry and kissy reunion.

Then I had that feeling - it was over so fast! Did it even happen? The dream-like state of memories. I hope these musings and photos will help us remember the time, energy, and gratification of what we get to do, and the many people who came as patients to give us that privilege. Looking forward to the next trip, but this team really raised the bar and will be a tough act to follow. Thank you all!

Bamako, Mali 10/06/2010

Our last day. A few simple patients, packing up, banquet, and goodbyes to our hosts.



For our last day, we had a few "simple" patients that we feel comfortable leaving after their surgery. Two were cleft lips, one was a finger release, and as one of our surgeons got sick, she is taking down time and we canceled a couple of cases. Two patients needed dressing changes, and then we began to close down.



Pam will stay for another week and do dressing changes. She is our hand therapy specialist and has had several patients of her own that were not surgical, as well as forming the splints and care plans for some of the hand surgery patients. This young patient is a few days post-op and is having her dressing changed and wounds checked.



Pam and Moussah at work. Moussah became essential to our work, helping with instruments, getting oxygen, cleaning up, and running errands. I like that this photo has a glow around him; he does have an aura about him!



The young patient who was having her dressing changed was there with her mother, who was covered in a black burka with only a slit for the eyes. I did not notice her for quite awhile; she was both quiet and nearly invisible with her total covering. It really seemed like the burka put her in stealth mode. I felt bad to have not spoken to her while talking to her child. I was truly astonished at how unnoticeable it made her.

There have been alerts regarding increased terrorist concerns in Europe, and supposedly it has been in part caused by the ban on burkas in France. If a woman wears a burka in public, covering her face, she will be fined 150 Euros. If a man is found to have forced a woman to cover her face, he will be fined 30,000 and a jail term. There seems to be much support for this across Europe; we'll see where it all goes. Supposedly in an attempt to protect women, but what about religious freedom? Very complicated.



This is a photo of the child's leg that had an abscess down to bone and needed a gastrocnemius (calf muscle) graft. It is healing very nicely.



Adios, Bamako!



Our great circulators Sarah and Marion kept the autoclaves humming, and organized most of the pack-up, among other feats of nursing amazement.



The ORs have been broken down, the patients have been safely tucked away, and now to our thank-you banquet. This is a photo of our pediatrician, Scott, and our hand therapist, Pam.



Recovery nurses Vickie and Lorry.



Roommates nurse Sara and coordinator Manon.



Wisconsin anesthesiologist Deb and surgery fellow Richard.



Richard and other surgeon Kristin (Barbara still recovering).



Coordinator extraordinaire Jacques!



Certificate awards for our helpers.



Anesthesia team: Deb, Diede' (local resident), Bonnie, and Steve.



Oumar and Bonnie, after his recognition.



The friendly guard at the gate, seeing us out.



Several of us went to La Terrasse afterwards and continued to visit. Lightning all around, but no rain. The air felt wonderful and cool.



The guys - Scott, Steve, and Jacques (missing Richard).



Anesthesia team again: Bonnie, Steve, Deb.