Hoi An - day off

First thing Saturday we packed up in a van with a driver to take us about 2 1/2 hours north to Hoi An. Our first stop was the hospital to see and discharge patients from last week.


























Once underway, we began the drive north over the same road we used to travel from Da Nang after our days of traveling, but that had been in the dark. It is an interesting stretch of road shared with large trucks, vans, scooters, bicycles, pedestrians and animals, but few automobiles.

A few minutes north of Quang Ngai, we stopped at a Memorial for the Massacre at Son My, known as My Lai Massacre. There is an interesting museum with a wall of names, many familiar photos of the incidents and the people involved, artillery shells, and other glass cases of found articles. It was extremely moving to me to see this location, the representative vestiges, recreated homes, and the peaceful, beautiful surroundings of this devastating time in history. There were gardens, home foundations, lists of names, and statues amongst plantings, original trees, rice fields, and a stone walk imprinted with boots and bare feet. A week of caring for our patients put very personal faces upon this memorial and made it hard to process.














































After this very somber detour, we proceeded further north in our van to our destination, Hoi An. A popular destination for tourists, this town is on the China Sea and is an UNESCO World Heritage site. It was for centuries a site of very active trading and a busy port. There still remains an ancient part of town with old buildings with ornate decorations.

Our hotel, Phu Tinh, is a resort-like place with pool, covered outdoor dining, and beds with canopy mosquito netting. It has lovely gardens complete with birds, flowers, and trellised vegetables.
















Let the R&R begin!

























Then there was sight-seeing and shopping...






































And of course the open markets.

End of week one

Friday was another day of cute faces, concerned parents, and hopping work for our team. Unfortunately, this morning two of our Resurge Board support workers left us for their return home. Even though we have all only been working together for a week, they leave a large hole behind and are sorely missed. Bon voyage to Marion and Elizabeth and thank you so much for your help and support.

Also leaving is Thao Do, the nurse who came with Hien to help us. I am not sure I have ever met anyone as reliable or with such a work ethic. She did not understand much of what I said, but was able to use her instincts to anticipate what was needed and just get it done. Also a sweet and caring person. Another loss for our team. We do get another two anesthesia providers for next week, so we have them to look forward to. I have been pampered, while I watch the nurses manage their domains with less help.

Here I am with Thao and Dr. Nguon as she is getting a patient ready for surgery.













And lastly Dr. Nguon left as well to head back to Ho Chi Minh City. Here he is with Dr. Bill McClure:












He was a quick learner, using Dr. McClure as his mentor. He had a ready laugh and tried his best to speak English whenever he could. He asked me to correct him if he said anything wrong, and I did (my sons know that is not something you want to ask the taskmaster to do...). One day Nguon asked me to "tag a bisshur." We went back and forth for awhile with some other words and some sign language, and I realized he meant to "take a picture." We worked on that and he finally got to "take a pisshur," and we left it at that. He told me on the last day that he hoped we could "walk" together again. He meant "work", so he got his final English class with that one.

Part of my job is to look at people upside down as they lay on the table and I stand at the head. I have to confess, I have never seen such long eyelashes in my life!












One adorable little girl was walked back to our lounge to meet with Dr. McClure to confirm which hand we would be doing. She had been badly burned, and both hands needed work. She stopped everyone in their tracks like a movie star in her adorable pajamas and bobbed hair cut.















As she went off to sleep, she helped hold her own mask and counted in Vietnamese with Dr. Hien. She got as far as twelve. "Twelve, always twelve!" was Dr. Hien's comment.












One family reminded me of the many links between our human family, in spite of arbitrary borders and governments. Many families here have been referred to as "mountain people" by our interpreters - families who have traveled a long way and come down from the mountains. The dialect is so different that our interpreters can often not understand what they are hoping to interpret. As I looked closely at this one family, their faces reminded me of the families that bring their children with cleft-lips to our clinics in Peru or other Central and South American countries. Even the woven shawls in which they swaddle their babies are similar. The technique of swaddling, I might add, is very similar to what we see in Mali, West Africa. Women 'round the world, taking care of business.












Here is a post-operative photo. Mom was quite tired after a day of little water and no food, mixed in with all that angst. Some families travel a very long way with no guarantees that we can do more than just see them in clinic. But baby did well and it was all worth it.












Another group shot. We may look cheery and rested, but the wheels have been turning hard all week. This little girl was just about asleep and was to have her fused fingers separated and skin-grafted.












Frankie moving a light that must weigh 200 pounds, all in the base, without swinging the light arm around the top and clipping someone's head. Wendell suggested that she was practicing her pole moves, but no time for that on Friday.















Quotes of the week:
At dinner, "I can't tell what kind of meat that is."
While walking to work, "Hold still, there is something crawling on your leg."

The Team Shines

Thursday. Only 2 other days of cases, and you would have thought we had a team of 20 and years of experience together. We had better hide this model, or it will become the norm for corporate America.

Our hotel is very nice. The staff are patient with their American guests, probably because we provide them with an endless source of entertainment (not intentionally!). There have been various groups that use the facility for meetings, weddings, and various gatherings. I do have to complain about the showers though...

Everything looks fine but somehow, for some reason, all the water ends up on the floor. We have the shower curtain inside and the nozzle directed into the tub, but somehow when we are finished, it looks like a swamp, with about 1/2" of water on the floor. The floor drain is of course uphill, so the water has to be swept into the drain with a towel. We have tried everything, and it defies all physics. It reminds me of the haunted house at Knott's Berry Farm. Which way is up? Just as Frankie and I were at our wits' (and towels') end, we heard that Wendell's room was having the same problem. He had named his bathroom the swamp as well, and I found some comfort in that. If only I had brought my caulk gun, we could probably fix it!

Most of us are walking to the hospital in the morning, and home at night if we finish before dark. The walk offers a good time of decompression and transition from one phase of the day to the next. Also offers a good game of "dodge-the-motorbike" for us and "hit-the-crazy-Americans" for the locals. Vietnamese love to use their horns! At least when we walk, we have some control over our destiny and which side of the road to be on, unlike when riding in a taxi...

One of the perks of this job is good hugs. Here Hien and I get to cuddle patients before they drift off to sleep, and they sometimes cuddle back. Children are not usually this trusting, but Hien radiates a warmth that we all love and the kids pick up on. I don't know what she says as she comforts them in Vietnamese, but it works.



















Here is one of today's best before and after combos:









And one little girl had an extra thumb. It was complete with bone and nail, but got in the way. Thumbs are very important for fine motor tasks, grasping, and just about everything we do, and hopefully hers will be more functional now without its "twin".













Children know how to sleep! It was a hot day, so everyone seemed to splay out. For the locals, this is the cool time of year and all the children come so bundled up and have sweaty hair. It is cool and air conditioned in the OR, so we have to work to maintain body heat. But this girl looks like she is right in her comfort zone.

















Wendell and Alice are our pillars in the recovery room. Wendell never got any local nurses to help in the recovery room, which I can understand as they have this huge hall of beds and about three nurses to staff the 18 beds that are there. Except for the day I caught them napping, they seem to buzz around the room and tend to everyone there.











Somehow Wendell makes me feel like he has all the time in the world to listen to my report, and that he might mix me a drink if I needed one. These patients are not easy to recover - it is hard to comfort them because we look and sound very different, and they are strong when they start swinging their arms! He gets the patients awake, comfortable, and into shape, sending them quickly off to the ward so he can ready for the next adventures. His best weapon is to get the moms in to deal with their children, and the kids usually settle right down. Calm, casual, courteous, and capable - I know the patients are safe with Wendell.

We have had one day so far where it seemed that both cases in the OR finished at the same time and we kept dumping two fresh post-operative patients on poor Wendell. Enter Alice, our pediatrician, who has been recovery person number two, in addition to seeing the immediate pre-ops, putting out fires, and tending to everyone on the ward a few floors away. The patients that come to us have been well screened and are ready to go. When they are not, we hear about it and she has a plan to make things right. She is also our team's doctor if anyone gets sick, and it is nice to know she is there for us. We don't get to see Alice much because many of us are back in surgery, but she is out and about making it all happen and run like a smooth machine. Another superstar!

I must mention that the support staff have a lot to do with the success of the recovery room - Phi, Catherine, Elizabeth, and Marion help transport, hold, change linens, and anything else that is needed to keep the flow going. I can't imagine the trip without them.

Marion and Catherine having a rare sit-down and breather. Marion and Elizabeth leave this weekend, and I fear our days of pampered luxury might be over.



















We had one gentleman today who was the victim of Napalm during the war. He had lost his left hand, many toes, and had a melted look to his face and arms. He could not close his right eye, so a lower lid was constructed for him. We all have memories of those times and the war, which impacted all of us in many different ways. But today I got a new appreciation for how much the war affected many young men for the rest of their lives. Visions of this man will stay with me for a long time; that's why I have no photos of him.

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.