Almost made it through without a flood of tears

Just when you think you are going to be able to complete the mission without a flood of tears taking over, you arrive at clinic to this amazing young girl. I remembered her from 2013, when we treated her for post-polio syndrome. Carried in by her mother, muscles rigid and face wincing in pain, we began our evaluation. Last year we made a recommendation for her to get a brace to fit her back, which would assist in her walking by herself and help with the rigidity. During our manipulation, our patient cried in uncomfortable pain, sending waves of emotion through my body. Still holding it together, Bac Si Ha injected her and promptly asked me to straighten and stretch her limbs. Feeling how rigid her arms and legs were, I was hesitant. However, after gentle stretching, I sensed her trying so hard to follow along with my motions. Her face was determined to completely stretch her limbs. When she finally did, and the movement was easier for her, the slightest smile came to her face. My heart absolutely broke. At that point I had to excuse myself from the clinic for a few minutes of quiet crying. I cried because there was little I could do and felt helpless, even though the look on her face became one of gratefulness.
My hope is that her mom complies with our recommendation this year. We will prepare next year to purchase certain types of braces for the different aliments that could have been helped.

Sweet Revenge as Promised

2014 Mission landed us three birthday celebrations. Dhimo, Ngoc and Chi (belated and Happy Graduation). During each, the tradition of cake smashing was prominent. As anticipated, my team laid low, waiting for few very perfect times to take revenge. First was at one of our evening Karaoke nights, where a surprise cake was delivered and quickly smashed into my face. Thanks Ngoc!!!
Second was on our final night in Saigon. A very shrewd team planned an important meeting to discuss the following days activities, Anticipating one last revenge, I knocked, stood to the side of the door and waited. When nothing happened, I entered and got too at ease. Eventually after a subtle knock on the door, I opened it to Dhimo and a handful of shaving cream!!!!   BY THE WAY, WHO BOUGHT MENTHOL!!!!!!

All in good fun, my new family took pleasure in covering me from head to toe!!!

JOB WELL DONE!!! It was well deserved!!!!

Charity donations and revisiting school

Our one day off during this medical mission takes us to a familiar place. Each year so far we have visited this church on the outskirts of Can Tho, which is also a school for the poorest children in this area. In order to qualify to attend this school, you must fall very much below the poverty line. Tuition for each child is $2 USD per month. So when one of you donate as little as $25.00 and apologize for not being able to donate more, you have just provided a years worth of education to a needy child. Historically at this school, the children have to share text books for learning. About 1 set of books per 10 children. Not the best way to learn. We decided to purchase a full set of text books for each of the 180 students who attend this school. Costing approximately $1200.00 USD, we transported the books from a small dirt road, by motor boat through a canal, and arrived to find the children eagerly awaiting our arrival. A favorite is them to sing to us, play games with us and interact with us. Well this year, more than years past, we were prepared. For the previous 4-5 days, on our 45 minute bus ride to clinic in Phuong Dien, we were taught to sing one of the popular Vietnamese Children's songs: "Bon Phung Choi"! After persistent, listening, practice, practice, practice, practice, (with nights dreaming of Bon Phung Choi) our team finally was able to sing the song. The basic premise to the song talks about "4 corners of the world coming together without boundries to help each other, regardless of background".

At this school, 3 years ago I met Thai. The by with the voice of an angel. (See blog crinvietnam.blogspot.com). I was hoping he would be there and yes, 3 years later he is grown into a mature young boy, who remembered sitting on my lap in 2012.

I was also blessed to see Nguyen, who I met last year. (See blog crinvietnam2013.blogspot.com). She also remembered me and zI was strategic to place myself in position to make sure I distributed the years worth of books to Nguyen.

Success today and success for a years worth of learning for our favorite children.

22-year old persistent medical student

Over the past 3-years, I have never treated one individual patient as many times as I have this 22-year old medical student from Ben Tre. This student was born with scoliosis, causing daily pain and suffering. Never able to find adequate relief other than periodic pain medication, she turned to our clinic for help. Treatment started with viewing her x-ray, and assessing how best to manipulate her spine to relieve some of her pain. After multiple injections of lidocaine and me pulling her legs, Bac Si Ha started to physically manipulate her spine in attempt to straighten it. After one treatment I was skeptical how much our treatment would really make a difference. Turns out this woman returned daily to our clinic in Ben Tre for treatment. After each, describing significant pain relief. Our clinic mover to Phoung Dien, and this patient traveled hours to continue to be seen. Almost every morning, She would get my attention, and I would wisk her into the the treatment room as the new patient were being checked. Finally our clinic mover to Can Tho, which no surprise, I found this patient eagerly awaiting as many treatments as possible before out time in Vietnam ended. Before and after X-Rays show about 80% improvement of her condition. Her symptoms are described as 90% improved. Most important she describes her quality of life 100% better thanks to our persistence and her willingness to continue to seek out treatment.

Previous surgery gone wrong

This 23-year old man presented to our clinic with 100% paralysis of his right arm. After questioning, he described a vehicular accident 2 years ago, upon which he underwent surgery to attempt to fix a badly damaged right arm. Unfortunately the surgery did not go well, and a major nerve was severed and not reattached, leaving this otherwise healthy young man without use of his right arm. Wishing to find a solution, a cure, a glimmer of hope he traveled miles to our clinic. This is one of the many examples I have seen over this mission of local surgery gone wrong. Risks not explained, procedures lacking expertise, and very few patient rights describe what I have witnessed. Bac Si Ha, with the proper environment and time said he could attempt to correct the previous surgery, but that will have to wait until another time.
With nothing to do for this young man, I watched his glimmer of hope fade to a gloomy sadness. Feeling so terrible that we could not help him, I hesitated to even take his photo. His story meant so much to me that I actually removed myself from the clinic and literally ran down the hallway to the street where I found this dejected young man ready to walk miles home. I respectfully asked if I could document his case, which he agreed. Then I touched his shouklder, shook his hand, looked him in the eyes and said Xin Loi Ban Toi! (Im sorry my friend!)

Bullet Wound from "50" years ago

This patient presented to our clinic today with a chief complaint of non-radiating lower lumber pain and pain in bilateral knees. (Typical presenting symptoms). So when the student was doing her physical exam, she discovered what looked like an infected wound on his lower right leg. There was a 2 inch opening in the skin, surrounded by a 3 inch demarcation of redness and warmth. Inside the wound was a puss filled cavity. Upon further examination, when flexing and extending his ankle, you see through to the tendon which would move with each ankle movement. Turns out, the guy described this wound as a result from a bullet shot occurring "50 "years ago.  He said he periodically goes to a local hospital to get antibiotics. Either there was something wrong with our translation, or the medical care is even worse than expected. Either way, we decided that his original complaint could wait, and we needed to start the treatment of this wound ASAP and get him the best care possible. Without at least standard of care, within a few months he will have such a bad bone infection, that the only cure will be a below the knee amputation. Again, doing whatever we can, I put a surgical mask on and started to sterilize both Bac Si Ha's equipment and got the wound cleaned and prepped for debridement. We then started to cut away the dead skin, and immediately saw fresh blood supply that will bring healthy blood cells and nutrients to the wound. This will begin the healing process. We provided him with 2 weeks of a strong antibiotic. We are going to see this patient again in 3 days to check the efficacy of the antibiotic and perform another debridement. At that point, we will provide him with a 2-3 month course of antibiotic and will refer him to a local clinic. This is an example of why it is vitally important to provide care for more than 3-4 weeks a year in this area of Vietnam. As frustrating as it is, currently we have to provide the best care possible, but ideally we would stay here longer and provide better, more sustainable care.

Assisting wherever its needed

Although our strength is in Pharmacy, Intake (Physical Assessment), and the Medical Clinic, our team joined this mission with open eyes, and willingness to help in any way we can. One of the purposes of this mission is to help fit prosthetics for patients who have loss limbs due to silent land mines from the  war, Vehicle accidents, trauma, and diabetes. With little to no formal training, our team of pharmacy students rotate through the prosthetics clinic every few days. The patients here are very resourceful. They make prosthetics from tree trunks, tire rubber, homemade straps etc... Their artificial limb typically weighs about 4-5 Kg. In The United States, a average prosthetic may cost between $4000 to $5000 USD. Our team fits patients with lightweight prosthetics for approximately $200 USD and weigh about 2 Kg. It takes a very talented biomedical engineer's mind and insight to properly fit a prosthetic and our team has experts who can fit almost any case.
It also take hard labotr, cutting, sawing, drilling, measuring, etc... Today we fit an all time record of 37 patients, 1 bilateral for a grand total of 38 limbs. Although my mind is not as mechanically inclined as others, a few of my students have been very successful in assisting with the fittings. There is nothing like seeing the look on the patients face as they walk out (Sometimes run out) of the clinic after an all day fitting with a new, lightweight leg. We are providing  a new lease of life!!!