Quang Ngai, Vietnam 2012

Working Together After 22 Years

Quang Ngai, Vietnam -- Marion McGovern, ReSurge board member

Dr. Nguon first met Dr. Bill McClure 22 years ago when Dr. Nguon was a surgical resident and Dr. McClure was one of the plastic surgeons on a ReSurge trip to Vietnam. Now, for the first time since Dr. Nguon was his student, he and Dr. McClure are working together as plastic surgeons in Quang Ngai. 

While operating together Dr. McClure showed Dr. Nguon the latest techniques for certain procedures. By around lunch time, Dr. Nguon told Dr. McClure that he may be learning more on this trip than he learned 22 years ago. 

Expertise sharing is the cornerstone of the ReSurge model, which revolves around not only bringing reconstructive surgery to the poor in developing nations, but also bringing the requisite skills to local plastic surgeons to enable them to perform such surgeries on their own. 

Clinic Day in Quang Ngai

Quang Ngai, Vietnam -- Marion McGovern, ReSurge board member

 

“The good news is he doesn’t need surgery today."

Bill, our surgeon and team leader, said this a lot today.  Today was "clinic day,” when patients arrive to be evaluated by the ReSurge team. The hospital auditorium was filled to the brim with families, anxious yet hopeful that today would be a day that would change the life of their child. It was a patient and largely orderly crowd (with the exception of many of the toddlers, of course). In the United States, people would have been on cell phones, or on a laptop or reading while they waited.  But the clinic families just watched erect and alert, waiting their turn to see the U.S. doctors.

The ReSurge team is a hybrid team on this trip.  We have one "table" of American ReSurge doctors.  Our Vietnamese partner, Dr. Hien, put together a second "table"' of a plastic surgeon, anesthesiologist and paediatrician from Vietnam. In the small world department, the Vietnamese plastic surgeon, Dr. Nguon, first trained with our trip leader, Bill, back in 1990.  Now 22 years later, he and Bill together did the initial assessment of each case.  It was clear from their diagnosis of each patient that the teaching was to continue, as Bill explained some of the more complicated procedures that would be performed in the days ahead.

The tough job on clinic day is to prioritize the patients who would be seen in the next two weeks.  I worked with Bill at the main intake table.  It was clear to me that the infants with the cleft palate and/or cleft lips would become candidates for surgery.  The pediatrician, Alice, might find in the next step of the process, that the child was not healthy enough for surgery so some would be deferred; but nonetheless, most of those cases would be addressed. 

There were many children who were retuning after a prior cleft operation.  In some cases, their lip or nose was askew, requiring a "revision.” This is a very normal procedure that would also happen in the U.S. Some of these were scheduled for surgery, but many were not, since the child still needed to grow some more before the next procedure.  Some of the parents seemed disappointed when they heard their child could not have surgery; others seemed relieved.  Regardless of the determination, all were appreciative of the opportunity to have the ReSurge team evaluate their child.

In some cases, there wasn't much that a surgical procedure could do to improve the life of the patient.  Bill and his Vietnamese colleague took pains to explain this to the parents who, like parents everywhere, want to do whatever they can to help their children.

The tougher discussions were often with burn survivors.  When a burn is untreated, the skin contracts, creating a contracture, which can hinder the mobility of joints.  Plastic surgeons need to release the burn scar contracture to provide mobility.  Many burn patients will be seen in the next two weeks in Quang Ngai; however, several were turned away.  These were typically children or adults with unsightly scar tissue, but full freedom of movement in the scarred area. As sad as it was, Bill had his Vietnamese colleague explain that there was not really anything that could be done right now.

But many things could be done, much to the joy of so many patients: the 23-year-old boy with an electrical burn across his torso will soon regain the use of his left arm; the 58-year-old napalm burn survivor will have his eye repaired; a "tongue-tied”18-year-old young man will have the very simple procedure done to free his tongue and enable speech; and an 8-year-old boy will have a burned foot repaired. Many children will have cleft repaired to improve their ability to speak.  Many others will have procedures to correct drooping eyelids, which can obscure sight. All in all, 80 patients will have their life changed in the next two weeks. For them, the good news is, that they will be having surgery soon. 

 

Little Pho

Quang Ngai, Vietnam -- Marion McGoven, ReSurge board member

Little Pho learned how to walk early, so early, in fact, that her parents didn't know she could. One day when she was 8 months old, she followed her mother into the kitchen, she reached up and pulled some recently boiled water from the table and was severely burned on her feet. Her right foot had a serious burn scar contracture, where the untreated burned skin had shrunk. This caused the toes on her feet to be squashed into a configuration where her middle toe sat on top of her second and fourth toe.  Dr. Bill McClure released the contracture, took a skin graft from her groin and reconstructed her foot, so that her toes were actually aligned in order.  

In a few weeks, she will be able to walk and run like a 4-year-old girl should.

 

The Gift of Speech

Quang Ngai, Vietnam -- Marion McGoven, ReSurge board member

Tho is 18 years old and has never really spoken a word in his life. He was born with a condition commonly referred to as being "tongue tied." This is when the tongue is connected to the bottom of you mouth so it cannot move.  

All over the world a 10-minute operation called a “frenulum release” helps free the tongue of any infant born with this condition. However, Tho grew up in a very small village to very poor parents. His family just assumed he could not talk and never would.

Tho heard about a ReSurge team coming to Quang Ngai and came to see if they could help him and they could!  His procedure was less than a half an hour long and was done using local anesthetics. 

Tho can now stick his tongue out and move it left, right, up and down. He should now be able to learn how to talk.

In fact, as he left the hospital, he nodded his head to say thank you to his doctors.  He nodded emphatically when asked if he would promise his surgeon, Dr. Bill McClure, to learn how to actually say those words.

 

Top Ten Skills for a ReSurge Volunteer

Quang Ngai, Vietnam -- Marion McGoven, ReSurge board member

As a non-medical volunteer on the ReSurge trip to Quang Ngai, I have an outsider's view of the process.  As such, I feel I have gotten some insights this week into how medical teams work in general and how ReSurge teams work in particular.  So, with apologies to David Letterman, I offer the following list based on my observations of the Top Ten Skills for a ReSurge volunteer.

1. You need to want to work hard.  The ethic here in Quang Ngai is to see as many patients as possible.  So, if someone comes in late in the day, having only just heard that the American doctors are here, chances are, if the case is one where we can make a difference in the life of the individual, the patients will get added to the schedule.   What is even more impressive about this work ethic is that many of the volunteers are on vacation, using their paid time off to accommodate the trip in their work schedule. How many vacations have you taken where you worked amazingly hard and came home exhausted at the end of the day?
2. You need to be flexible.  Operating, literally, in a foreign environment means  some things are out of your control. Maybe you will have local nurses to help, maybe not.  Maybe you will be able to understand all the dialects of the patients, maybe not.  Maybe you see cases similar to those you have seen in the US, maybe not. Every day is different.  Bill, our surgeon trip leader, says every trip is different; he should know since he has been on 63 trips.
3. You have to love screaming children.  Many of our young patients will come into the operating room calm as can be … many will not.  It is scary for them, to be taken from their parents, brought into a bright place with strange looking equipment and people dressed in blue and green clothes wearing masks and funny hats. (I would scream too.) Similarly, coming out of anesthesia, you have the strange bizarre environment, plus some pain.  The volunteers take it in stride.  So many times I saw Bonnie the anesthesiologist or her Vietnamese counterpart, Dr. Hien, cradling the children in their arms while administering the sedatives in order to comfort them as much as possible.
4. You need a sense of humor.  Every member of the ReSurge team has made me laugh.  For example, Weldon, the PACU nurse, is always good for a one-liner.  Alice, the pediatrician, has a great sardonic wit coupled with terrific timing; when a young patient, finally calmed down after receiving some post-operative pain killers, Alice smiled and said, "better living through chemistry."
5. You need to be a teacher.  In two days of observing surgeries, I have been taught so many things.  Frankie, the OR nurse, taught me the basics of maintaining a sterile field. Bill, the surgeon, painstaking explained details in many procedures from skin grafts to palotoscopies.  And Catherine, our translator, has taught me how to say a few key things in Vietnamese, or should I say she has tried....
6. You may need to be a bit OCD.  Several of the team members volunteered that they were control freaks.  Bonnie, the anesthesiologist, was the first to make the admission, but for an anesthesiologist, being in control is a good thing.  Frankie, the OR nurse, also confessed to being a bit anal; in fact, she timed our walk to the hotel from the hospital the first time we walked to ensure we knew what time to leave the next day.  That said, though, she runs an awfully tight ship in her OR. In an environment that needs to run efficiently, that command and control orientation is a great skill.
7. You need to be culturally sensitive. As a ReSurge volunteer, you are working at a host facility treating people who may have different values.  Wendell, our PACU nurse, explained that on one trip to Vietnam, there were many children who had extra digits on their hands. When these digits were removed, they were given back to the parents for burial.
8. You need to be able to stand for long periods of time.  Given our desire to see as many patients as possible, the ReSurge team spends all day in surgery.  Lunch and breaks are taken on the fly, which means the surgeons and the OR nurse are on their feet most of the day.  Thanks goodness for the tunes in the OR.
9. You need to be willing to deal with paperwork.  There is a lot of paperwork required in order to perform these surgeries.  ReSurge has strict medical record requirements consistent with our emphasis on the highest quality of medical care. Many of our funders also require procedure specific paperwork.  And then there is the local paperwork required of the Vietnamese host.  And that is just the medical paperwork; there are also documents for the families to sign, releases, and pre-surgical exam forms.  It was wonderful to see the doctors and nurses conscientiously completing the necessary paperwork, with the spirit that it's what we need to do to deliver our life-changing surgeries.
10. You need to be able to smile through your eyes.  Since you spend so much time in a surgical mask, the connection you have is often your eyes.  All of the medical volunteers, especially as they are bringing a baby to or from the operating table, smile broadly and deeply with their eyes. It makes sense that they do that, though, since they are all so dedicated to this compassionate work and so generous with their time.

 

Resourceful Father Finds Surgery for His Daughter

Quang Ngai, Vietnam -- Marion McGovern, ReSurge board member

This is Vy and her dad.  She is 2 1/2 years old and comes from a small town far in Quang Ngai province, so small everyone has the same sur name. She was born with a cleft palate, so her dad took her to Ho Chi Minh City for cleft palate surgery when she was 8 months old. Without such surgery, a child will never be able to speak correctly.

Her father was told she was too young, and sent home.  He tried again the next year to no avail.  Desperate to find a solution for his daughter, he did what any dad would do -- he searched the Internet. There he learned about ReSurge, and there he discovered there was to be a trip to Quang Ngai.

Little Vy now has a repaired palate.  In time, she will be able to say thank you to her dad and correctly pronounce every word. 

28 Boxes

Pictured above: Dr. Alice Truscott, ReSurge volunteer pediatrician; Elizabeth Shea, ReSurge donor and supporter; and Marion McGovern, ReSurge board member, USF professor and co-founder of M2 Consulting Inc.

Quang Ngai, Vietnam - I am an experienced global traveller, so I didn't really think about how different traveling on a ReSurge trip to Vietnam might be.  I didn't think anything about it when I was emailed the Vietnamese entry papers complete with a very official looking red seal. I didn't think anything about it when I was told to meet the group at the EVA counter three hours before our midnight flight, rather than the normal two hours.  I didn't even think about it when I heard the ReSurge staff would be meeting us at the airport with the boxes.  But, when the boxes arrived, I knew it was different.

My friend Elizabeth and I had arrived at the airport early.  Like me, Elizabeth was also a non-medical helper on the trip. A ReSurge board member for many years, I had never been able to schedule a trip, since the trips always conflicted with my teaching schedule at the University of San Francisco. (It's just one class, but the problem is, you need to be in the classroom.) This year I teach on Mondays, and the Quang Ngai trip was over a Monday holiday.  I had been told for years how life changing a ReSurge trip could be, so I asked Elizabeth if she would like to come too.  She and her husband, Bill, had become great friends to ReSurge, providing auction lots to our gala, fundraising advice and generous donations, so this was a chance to say thank you in a meaningful way.  I was thrilled when she said yes and became my traveling partner.

As we walked into the terminal at 8:45pm, we saw a petite Asian woman standing by the then empty EVA ticketing area.  I asked if she was Catherine, our translator, and indeed she was.  You see, we had met out fellow teammates in a conference call the prior week.  Bill, the plastic surgeon from Napa, California, was the team leader, who impressed us all when he mentioned that he had been on 62 trips. The rest were veteran volunteers as well: Bonnie, the anaesthesiologist, was from Arcata; Alice the pediatrician, was from Berkeley; Frankie, the surgical nurse, was from Seattle; Wendell the PACU nurse, was from Sacramento; and Catherine, the translator was from Campbell. Bill mentioned how critical Catherine would be to the team. At the time, I didn't think anything about it.

Catherine smiled and said how glad she was to meet us, since she really needed our help. As she explained further, the others began to join us. Several of them, like Frankie and Wendell, had worked together on prior trips, so there were warm reunions of old friends and introductions of us rookies. Shortly thereafter, Jim arrived from ReSurge.

I recognized Jim from a board meeting, and others in the team knew him as well. He waved to us in acknowledgement, and then headed to the counter to coordinate the baggage.  Arrangements made, he told us they had given us a special place to load everything up, and asked for help with the boxes. I headed outside to assist.

There on the sidewalk was a mountain of boxes of all different shapes and sizes.  There were more than a dozen large plastic containers called pelican boxes, flanked by at least as many large cardboard cartons.   We took turns wheeling the boxes into the airport and carefully unloading them by the ticket counter.  I asked Frankie, who was managing the unloading inside, what was in all of these. "Our instruments, the anesthesia kits, an autoclave, I think..just wait until you see all the stuff we have to bring."

"Have you ever lost the instruments on a trip?” I asked.

"There was one time in Peru," Alice volunteered, "where they sent our boxes to Lima by mistake...or at least that is what they said.  We got it all a few days later; it just delayed our start.” 

How sad to think that such a delay could mean that some children might not receive the life-saving, life-changing surgeries the team was there to provide.  I will never think about the inconvenience of lost luggage in the same way again. And, I desperately hoped this precious cargo would be delivered intact.

As I shook my head, I saw Catherine managing our ticketing process.  She had all of those official looking entry papers and was reviewing them with the gate supervisor, matching each of us to our passport and entry permit.  She handled it all with a ready smile and grace, something I imagine we will be seeing a lot of on the trip ahead. Meanwhile Frankie was keeping track of all the luggage tags for our 28 boxes, while Bob and Bill negotiated the excess baggage charges with the airlines.  The team was fully at work and we hadn't even left the ticket counter.

Yes, I never really thought about how different it would be to be on this trip.  But, by the time we headed to security two hours after we arrived, I knew it would not be like any trip I had taken before. 

Note to Quang Ngai Team Prior to Departure

Bill McClure, ReSurge volunteer plastic surgeon and team leader.

In just a few days, we'll be meeting at SFO to begin our trip to Quang Ngai.  I want to thank each of you in advance for volunteering to join this team. We ask a great deal of our volunteers and understand that it is a burden to leave family and jobs to work in a difficult and foreign environment. I will do my best to make this a rewarding experience for each of you and keep you volunteering for future trips. The team at ReSurge also want you to have a memorable visit.

The true leader of this team is our Vietnamese counterpart, Dr. Hien, whom some of you have met. I first met Hien at Pediatric Hospital #1 in Ho Chi Minh City in 1990 where she worked as the head anesthesiologist. She and her staff got so bitten by the then-Interplast "bug" over the course of five trips to her hospital, that by 1993, they were ready to form their own team. Using the ReSurge model, Hien and her boss Dr. Trai, the pediatric surgeon, raised money, put together a local team, and traveled to the provincial hospital in Quang Ngai to operate on children and teach. This was the first of many trips that Hien organized to different provincial hospitals where there was a tremendous need. Hien worked tirelessly on these trips doing all the prep work and organizing, as well as the anesthesia.. Hundreds of ReSurge volunteers have met Hien over the years and have all been impressed by her. ReSurge honored Hien at the 2011 gala with the Donald R. Laub Humanitarian Award.

 This Quang Ngai trip is very special to me since I was part of that first 1993 Quang Ngai trip. For our 2012 trip, Hien has put together a great volunteer group of Vietnamese medical professionals to work with us. Like us, they are taking time away from their families and jobs. One of the Vietnamese volunteer surgeons is a young man (old now) who I had helped train back in the early 1990s. He jumped at the chance to work with us again. We will completely integrate the teams, which will give us the chance to work truly as partners. This is the Resurge ideal. 

Bev has put together a fine team. Though we will be working very hard, we will have time to get to know each other, sight see, and enjoy time together. Though I've been on more than 60 trips, I still get as excited for each new trip as I did for the first. I got bit by the bug very early in my career when I was a resident. There are so many things to love about this kind of work, but the best part for me is getting to know new team members, renewing friendships with former team members, and forging long lasting relationships with our hosts. 

A final thought to share. A year ago, while sitting down to write Christmas cards, I realized that outside of my family, most of the people I've grown to care about and consider to be friends, in the deepest sense of the word, have been those I've met doing this volunteer work. We share a common bond that is difficult to explain to those who don't give of themselves in this way. This act of volunteering puts you is a special category -- a small select group of persons who have made the commitment to help those who otherwise would be left behind. Because of people like you, each mission has become a special moment in my life, a highlight that stands out from the day-to-day work. Each of you has a quality that I will remember long after we return to our everyday lives. I know now, even before this trip begins and meeting you, that come March 2 when we have said our goodbyes at SFO, I will already be missing you. 

See you soon!