ORTOPEDIA HANOI

UN VIAJE INCREIBLE, AL VER LA CARA DE LA GENTE PODIAMOS PERCIBIR LA ESPERANZA QUE TIENEN EN NOSOTROS, ESTO ME HACIA SENTIR CHIQUITO, PUES DESPUES DE QUE TIENEN MUCHOS AÑOS ESPERANDO LA OPORTUNIDAD DE TRATAR A SUS HIJOS Y QUITARLES EL ESTIGMA DE LA DEFORMIDAD, , FINCAN SUS ESPERANZAS EN NOSOTROS, Y SOLO SOMOS MEDICOS DEDICADOS A NUESTRA ESPECIALIDAD Y ESTAMOS SUJETOS A LAS ESTADISTICAS MUNDIALES EN CUANTO A EXITOS, COMPLICACIONES, , SECUELAS, Y DEMAS, SENTIA QUE ERA POCO EL TIEMPO QUE PERMANECIAMOS EN LOS HOSPITALES, Y AL VER QUE ANOCHECIA , Y TODAVIA HABIA MUCHAS PERSONAS ESPERANDO QUE EL SIGUIENTE SERIA SU PACIENTE, , Y AL TERMINAR LA JORNADA, Y SALIR DEL HOSPITAL LA SENSACIÓN DE QUE LAS HORAS ERAN INSUFICIENTES PARA TRATAR A LA GENTE QUE ESPERABA.Y A PREPARARSE PARA EL DIA SIGUIENTE.
I C R E I B L E E X P E R I E N C I A ¡¡¡¡¡¡¡¡¡¡¡¡¡

A changing of the teams

Team one has left Vietnam after 2 very busy weeks. We spent time at 3 hospitals, Dien Bien Phu, Orthopaedic Rehabilitation Institute in Hanoi and Viet Duc. At Dien Bien, 21 surgical cases were done; at ORI 36 and Viet Duc 6 for a total of 63 cases in 2 weeks! We saw at least 119 patients (I don't have all the Viet Duc patients counted seen with Dr. Toan). Friends were made and emails exchanged. This years teams are international representing the increasing international presence of AOFAS.

This week, Dr. Barouk from France and Dr. Rippstein from Switzerland are going to Thai Nguyen, northwest of Hanoi and will return to work at Viet Duc. They have come wiht the wives and daugters. From Vietnam, they are going to see more of Aisa. The second week of Team 2 will be Dr. Blasier from Little Rock and Dr. Salamon from Sacremento. They will spend time in Hai Phong, northeast of Hanoi on the ocean. Zan Lofgren with AOFAS is in charge of everyone.

I would like to say "thank you" to Team One beginning with Dr. Mario Adames from Brazil who works quietly and competently while teaching the Vietnamese surgeons. I think he would prefer to be in the OR then anything else. His experience and expertise treating difficult clubfeet was obvious. Dr. Angel Arnaud came with his daughter Andrea. He was also incredible in the operating room. Andrea added a spark to the team, translating for her father and taking pictures. She looked forward to the "shopping". Teaming up with Fulya, from Turkey, they contributed greatly to the Vietnamese economy! Fulya has just finished medical school and was thrilled to be seeing patients in clinic and to be assisting in the OR! This project would not work without the hard work and dedication of Rose and her niece/assistant Vin Anh. Others who helped this year include Duc and Yin. Rose asked to work with us and they were a big help. Dr. Toan and his residents at Viet Duc are very busy. His clinics are a textbook of orthopaedic pathology. Despite his schedule, he is always welcoming and incorporates our visits into teaching for his residents. Dr. Dong translates at the seminar and when not working, will join teams as we go to different hospitals. His presence is always appreciated.

A special thank you to all!

The Seminar

Saturday was the 10th annual seminar held this year at the Melia Hotel. This is an educational forum and exchange between the Vietnamese and the AOFAS participants. Walking into the hotel is stepping into an international business class hotel. Quite a change from the Lucky! Escalators wisk us up to the second floor where a large exhibit with locally made medical braces is set up. Peter Salamon, from California, who came to speak at the seminar and then is headed to Cambodia for a week at a children's hospital prior to returning for the second week of Team 2, focused on a abduction foot orthosis (Dennis Brown) for clubfoot treatment. This is very lightweight and he thought it was well made. He discussed with the owner several minor adjustments to make. Participants for seminar arrived steadily and Rose, Vin Anh, Yin and others handed out badges, seminar books and bandage scissors with AOFAS/OEF labels as a small gift to each participant. We started the seminar a few minutes late as it was difficult to pull the 150 participants away from the coffee, fruit, pastries and socialization. Dr. Toan opened the seminar with a few remark

s and then Zan gave a 10 min presentation of 10 years of the AOFAS, POF and Vietnam project. Then we began the scientific presentations. Questions and discussion was lively, particularly after the clubfoot presentations. At the break Dr. Nimh, a young resident Vietn Duc, approached me with X-rays and would I see a patient! This was a 6 year old with a bad hip. I found Dr. Salamon and introduced him to his first Vietnamese patient. The young boy has Perthes disease but good motion and gait. He should get better with time. The examination was held on the stage, surrounded by doctors! HIPPA does not exist in Vietnam! One of the Vietnamese presentations was by young Dr. Toan on the first 2000 arthroscopies/500 ACL's at Viet Duc Hospital! Many of the Vietnamese presentations ended with questions for the AOFAS doctors. From AOFAS, Dr's Mario Adames (Brazil), Angel Arnaud (Mexico), Peter Salamon (USA), Samuel Barouck (France), Pascal Rippstien (Switzerland) and myself presented quite an international contingent. Lunch was a great buffet. The afternoon continued and we rearranged the schedule as we were running late due to all the questions. At 3:45, the conference ended with presentation of certificates, a small gift and flowers to the speakers. Picture taking is mandatory and cameras flashed! Rose has some ideas for next years seminar. We presented Rose with an engraved crystal star for 10 years of assistance and guidance with AOFAS!

Heading Home

I love technology. I love the internet...especially when it is working. I typed out a whole blog about the seminar today and when I pushed publish, error and it vanished. It has taken an hour to get back on the internet...so I suspect there is some problem. None of the "common" computers will connect. So, I am sitting in Ba Noi, the Ha Noi airport awaiting my flight to Tokyo and then to Dallas and then to Wichita. Home sweet home...my own bed, no honking vehicles and certainly no loudspeakers broadcasting music at 545 am as was the case this morning. I will miss my Vietnamese friends and certainly the food! I leave the trip in good hands. Zan is here and will be the facilitator for 2 awesome surgeons, Dr Barouk from France and Dr Rippstein from Switzerland. Dr. Toan is in heaven, they both speak French! I will try and post more when I arrive in Tokyo but must go to my gate...Back to the USA..

Fulya's story

As membership chair of RJOS (Ruth Jackson Orthopaedic Society-named in honor of the first woman orthopaedic surgeon in the US...names..yes you guessed it..Ruth Jackson), I get to review all the membership applications. I am always amazed by the variety and quality of the young woman who are interested in Orthopaedics. 2 years ago in New Orleans, I had the opportunity to meet Fulya. She told me that the male Turkish Orthopaedic surgeons at the meeting were all asking where her husband was (he is an orthopaedic surgeon) and she proudly told them "I win scholarship". I had the chance to sit and talk with her several times. This let to an exchange of email addresses and then an exchange of emails. I have become a mentor/advisor for her. Much to my surprise, she thought Vietnam was more exciting then Wichita!!!. She has an excellent command of English and an absolute joy of living. We should all approach life with her enthusiasm. She was my roommate..can reset a wireless router, bargain for goods, shop til she drops (and I don't think she reached that point!) and make friends with everyone. Her orthopaedic knowledge is incredible for someone completing medical school. She will make a great resident for which ever program is fortunate enough to accept her. This week, she saw pathology, sutured and ...held a scalpel! I wish her luck..and she added much to this trip. Her new sister is Andrea from Monterrey Mexico. Her story will follow!

An Introduction to My Story in Vietnam (By Fulya)

I would like to introduce myself to the people who did not have a chance to meet me. My name is Fulya and I am a brand new doctor from Istanbul/Turkey. I graduated from Istanbul University Cerrahpasa Medical faculty (www.ctf.edu.tr) and awaiting to start my ortho residency. I can hear you saying what are you doing there and how do you know Dr.Shields. Please be patient. All your questions will be answered.

Ever since I started med school I dream about the day I become an orthopaedic surgeon. All through the school I spent most of my free time volunteering in the ER or in the clinic to get some more bone and joint stuff in my life. In 2007 by chance I meet my current advisor Dr.Muharrem Inan  and it was one of the best things that happened to me through my journey. The other is to meet Dr.Shields. After meeting him my interest became more serious and I started to be a part of the research projects that he is doing. I also spent some time in US at different institutes where I did some research and also learned a lot from those experiences.

I am a student member of Ruth Jackson Orthopaedic Society (www.rjos.org). Their main goal is to support and promote women`s role in orthopaedics. In 2010 I received a medical student travel grant from them to attend their meeting and also a workshop which was held in New Orleans. I had the chance to listen to Dr.Shield`s talk at the meeting and the day after I had the chance to meet her at an AAOS meeting which I literally sneaked in with Dr.Alvin Crawford`s help. She was really nice, friendly and supportive which is an attitude that I am not really used to. We talked all night and we exchanged our email addresses. After that I wanted to do an elective at KU in Wichita and she was really helpful about that. Unfortunately it took some time to complete all the requirements and I ended up not doing it because there was a conflict between our schedules. At some point I learned that she will be going to Vietnam to volunteer and I asked her if I can. She said yes without hesitation and after a lot of emails and arrangements I found myself in Hanoi operating with all these wonderful people.  Now I am having a life changing experience which you are reading through our blog.

Here I am with the members of the team and director of Orthopaedic Research Institute with flowers from lovely mothers of our patients.

Tired

Okay, we have done 4 cases, 9 cases, 10 cases and 10 cases at the Ortho Rehab Institute. We have seen over 50 patients in clinic. Mario and Angel stayed this afternoon to complete some cases and I went over to Dr. Toan's typical Thursday clinic at Viet Duc. At 7, I asked if we could leave. The group was to go the water puppets at 8 and I was hot, tired and done. They still had I don't know how many patients to see. Fulya and I walked back to the hotel and then she went to see about getting a custom dress made. The price proved to be too much so we went to a store with "good prices". She bought multiple scarfs, purses and a lot of other stuff for a very good price (I can NOT reveal as her husband might find out!!)


Rose, Zan, Angel, Andrea and Mario arrived from the ORI. The decision was dinner not water puppets. We went to a buffet type restaurant that I have eaten at before. The food is good. Unfortunately, we arrived late and all the shrimp was gone. Fulya has been on a "high" all week. She has been in the OR, gotten to scrub, suture and even had the knife in her hand for a bit. Angel is now her teacher and Mario, her uncle. Andrea is her sister and I am her mother! For orthopaedics that is. Tomorrow, we are dividing forces. Angel and Mario will go to Viet Duc. A resident will "pick them up" at 7 am and walk them to the hospital. I will head to the Orthopaedic Rehab Institute to operate with Dr. Trung on I think 5 patients. Andrea and Fulya will head to some "SHOPPING" at Bat Trang, a local ceramics village. Fulya tells me she will come to the OR as soon as she can. Zan and Rose will head to the airport where the next team members are arriving from France and Switzerland. This year is truely international. For me, bed awaits! Naomi

A look at the Orthopaedic Rehabilitation Institute

This hospital is part of MOLISA, the Ministry of Labor, Invalids and Social Affairs. MOLISA is responsible for treatment and care of the disabled.The MOLISA hospitals are primarily for rehabilitation and not for trauma. Funding seems to be less then that of the trauma hospitals such as Viet Duc.

To get to ORI takes about 30-40 minutes in rush hour traffic from our hotel.Then we turn off a busy street into a dead end alley that is not wide enough for 2 cars. This gets interesting when a car is trying to leave and another comes down the alley. Vietnamese stand off! Won by the larger vehicle as the other backs up between the bicycles, scooters, stores, and pedestrians. The entrance to the hospital is gated and upon going through the gate, there is a large courtyard, half filled with scooters and a small open garage on the left for more scooters and cars. The building is 3 sided and currently 4 stories with a 5th being added. A tile saw cuts continuously during the day adding a loud whine to the honking din from the street and the cacophony of voices from the wards.The floors have an open hallway facing the courtyard. Wide enough for a stretcher, lined with chairs and filled with people.The first floor is mainly wards. We go up the stairs to the second where there is a small clinic room with a table and chairs upfront, a row of lockers and behind the lockers a sleeping bed for a doctor. There is a table against the wall for examining patients. In the morning, the chairs are filled with doctors and nurses and their table stacked with charts as they complete the paperwork that never ends in medicine. Passing by this room, there are 3 wards filled with beds.The beds are metal frames with a bamboo mat laid upon it. Families care for their children. There is a male and female bathroom at the end of the hallway with a toilet that does not flush. The floor is wet as this room also is the shower that hangs from the wall by the sink. A plastic bucket sits by the sink to fill with water and flush the toilet. Stairs go up/down at both ends of the hallway. As we turn to the right, we approach the OR. A small room “the command center” has lockers, a few scrubs, a clothing tree from which hang the clothes of the doctors and nurses, a sink, a small table and a few chairs. It has a window, a large ceiling fan that sounds like it will take off when you turn it on and an AC unit! Looking through the window it is about 3 feet to the wall and window of another building. The window lets in some light and some fresh air. The next room on the left is the OR laundry, instrument sterilization and pre op area. The children come walking or carried by their mother, they are weighed on a small scale and given an IM injection. The mother then sits holding them waiting ever so patiently. A shoe rack with mismatched rubber “OR” sandals sits in the hall across from this room. If you try to enter the OR wearing anything but these, excited Vietnamese breaks out. Even the children must leave their sandals and put on a pair of these!

Stepping through glass doors on the left is the first OR followed by a small holding room and the 2nd OR. The scrub sink is down the hall on the right and at the very end a small room with a water bath that boils instruments between cases. As surgery is completed, patients are wheeled into the holding room or the hallway and casts applied. They stay in the hallway sometimes for hours until they disappear to the ward. Occasionally a nurse is with them but often, they just lie on the stretcher until the effects of anesthesia have worn off.

Anesthesia here is primarily Ketamine. They have an anesthesia machine but it appears to be broken and the one general anesthesia case was done with manual ventilation. A piece of gauze with a few strands pulled out is taped to the nose as a visual breathing monitor.

The OR nurses are very good and anticipate well once they understand what is needed. Instrument pans sit on a counter along the wall and the tops are lifted off and selected instruments removed to the sterile OR table. After the cases, instruments that will be reused are washed and boiled for a variable amount of time.Asking for equipment is done with a combination of our poorly pronounced OR Vietnamese, English and hand gestures. Often smiles and giggles erupt when we attempt to pronounce an instrument. Then, several people will go in different directions bringing what they think we want. When there is no understanding, we get Rose to translate or today Duc who speaks English well. He is a biomechanical engineering student at the University of Iowa home for the summer who has volunteered his time to be with us in the OR (or been shanghaied by Rose!)

Coming from the OR back towards the “command center”, a wall of waiting parents and patients per intently towards the OR. Entering the command center, our room attendant studies her English use of propositions and watches over our belongings and instruments. The table has bananas, Vietnamese cookies and water on it for us. This is an oasis of calm for a few brief minutes between cases. Today, we did 10 cases all of which went well. Anesthesia was getting patients ready and turn over time was almost non existent. I saw some additional patients for clinic and we now have 7 patients selected for surgery tomorrow and 7 on the waiting list for one of the next teams or next year. As we were leaving this evening, 5 mothers came up with flowers for us to thank us for operating on their children!

The laughter of children

Yesterday was  spent at the Orthopaedic Rehabiliation Center.  It was a day of starts and stops.  First we learned there was only 1 anesthesia person.  The 2nd had not come in.  The first patient was a difficult anesthesia.  The mother was in the room in her street clothes holding him while they tried to start an IV!  We ended up starting about 1030 with 11 cases on the schedule!  We asked if Angel could do a block on a patient for the second room.  That was agreeable so with a small baby on a stretcher at the door recovering from a procedure done by one of their doctors, Angel put in a popliteal block and started working.  By 1230 we had 3 cases done and did we want to go to lunch.  We suggested that we needed to keep working.  Rose and another woman "a volunteer per Rose" went off and came back with metal cafateria trays with "baby bamboo, rice, morning glory greens, tofu, egg and chicken and fish sauce!".  We sat in the changing room 'command central" and ate, hearing the sounds of children playing and construction.  For the afternoon, we had 2 rooms for a short period of time and then the Vietnamese surgeon wanted to do some cases in one room.  Back to 1 room.  We operated on 2 brothers, 14 and 16, who had some type of muscular dystrophy or neurologic disease.  We had done the older brother and at 6 brought the 14 year old into the OR.  Then a discussion, anesthesia only wanted us to do one side.  I basically said, we should either do both sides or not at all and that since we had done his brother, I felt we should do both.  Both Angel and Mario scrubbed in and each doing a foot finished in the time it would have taken to do one side.  Everyone is happy.  The nurses were working hard cleaning equipment and keeping up with everything.  They are very good. Throughout the day as we walked from OR to OR and to command central, the laughter of children playing could be heard.

We changed clothes, called a taxi, said our good byes and went through the standing crowds in the hall way.  A thank you from many of the parents of the children was given.  We went down the stairs, around the construction replacing much of the courtyard parking and waited for a taxi.  A small TV was playing next to the kitchen/restaurant for the patients and families.  Sitting on rows of small stools and peering through the doorway at the TV were about 30 adults and children, many wearing blue hospital clothing.  Racing around in and out of the courtyard gate were about 10 children, laughing, screaming and kicking a plastic ball.  Their faces lit up with big smiles and they yelled "hello!" when they saw us.  Asking our names and where we were from, they swarmed around us.  We started taking pictures and showing them.  They really hammed it up!  Laughing, running around and providing a great end to the day.  Pictures will be posted later.  Taxi waiting

Một hai ba*

Now we are back in Hanoi! Tomorrow is the big day because we will be at Ortho Rehab institute. We will have the clinic in the morning and OR time in the afternoon. 

It is always an exciting experience to see how others practice medicine. All the doctors have their own perception of health and illness and the best way to understand this is to watch them while they are seeing their patients. As doctors we learn from each others and most of the time we do this unvoluntarily. I know it is a great oppurtunity for me to spend this whole week with the incredible team of surgeons. I will continue to keep you posted with the details of the trip. Wish us luck!

* One two three in Vietnamese

My experience in Vietnam

I came as a volunteer program in the AOFAS / OEF Vietnam toward fulfilling a dream of working collectively and in a country with conditions far below what I have in my country.

I was surprised with the facilities worn by time and simplicity of the people who suffered though, are extremely happy and friendly.

I was extremely surprised at the ability of the orthopedic surgeon (DR. Tuan) who had contact, and assisting in surgeries in Dien Bien, we perform a total of 22 surgeries in three days, although he did not have all the technology we have but he has an ease and a great interest in new knowledge

The mountains in the northern town of Sapa and its surroundings are fantastic! Places to go hiking, but you need patience with the locals trying to sell something at all costs.

The trip up to Sapa from Hanoi by train is overnight but with beds and comfortable, I point out to everyone you know about this picturesque kugar

And I also invite all colleagues who may have a period of one day to join us in this volunteer program, because this is the best experience of the life in my career of orthopedic

big hugs to a fellow partner Angel and her daughter Andreasl, Naomi is restless and a woman who I admire and long for its simplicity and humanity and Fulya that enchants us with joy and warmth

hugs my friend

Mario Adames - Florianopolis Brazil

Sapa trekking

Angel and Mario ready to go

New bags with the maker!

Lunch at the fresh air restaurant!

Fulya, Andrea, Angel, Mercedes, Marianne, Mario and Naomi at lunch

China is to the top! We came into Lao Cai and went to Sapa on the left

Waiting for us to exit the hotel

Black Hmong walking with us

Working the loom

Adjusting the rice in the water powered pestle

Sewing and selling

Trouble on the move

Blankets for sale

Waterfall at the bottom of the CatCat trek

Grilled eggs, corn and sticky rice

Small birds for grilling

Fulya - 2 thumbs up for the grilled corn

Preparing the rice paddy

Working in the paddy with a baby on her back

Strutting his stuff

Holding tight to 500 Doung (20,000=$1)

Nap time in a store

Fulya with her new headscarf

TaVan village

Rice paddies

Andrea and her new dress (Thanks Dad!)

Imagine standing looking over a valley with rice paddies, small houses, fields and trails.  Throw in mountains towering around you with a veil of mist and clouds with occasionally the sun peeking through.  Add in steps, rocks, clay and the water..now you are beginning to see Sapa.  From our treks: