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AOFAS project to Vietnam emphasizes fellowship, learning and treatment
The volunteers treated traumatic motor vehicle injuries, residual deformities from polio, etc.
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Members of the American Orthopaedic Foot & Ankle Society recently returned from the organization’s Overseas Outreach Project to Vietnam. Participants say that the program gives them an opportunity to teach and learn from their Vietnamese colleagues while providing much-needed patient care.
Naomi N. Shields, MD, participated in the project this year and has visited Vietnam eight times since the program’s inception. “It is a different way of practicing from what we have in the United States,” Shields, told Orthopedics Today. “You are in a different setting often without much of what we take for granted here. The Vietnam physicians are hungry to learn. They are doing amazing things with limited supplies. We have a chance to go over and both learn from them, but also to teach them some of the newer treatments [and] to show them some different ways of doing things.”
The project collaborates with the Prosthetics Outreach Foundation, the Vietnamese Ministry of Labor, Invalids and Social Affairs and the Vietnamese Ministry of Health, and is funded by donations from members, corporations and the society’s Orthopedic Education Fund.
Participants spend 2 weeks working with Vietnamese surgeons at orthopedic rehabilitation facilities and hospitals throughout the country. The volunteers traveled in two groups with different itineraries. The first group included first-time participants, Dale Blasier, MD, and Keith L. Wapner, MD, who traveled to Vinh City and Hai Phong. The second group visited BaVi and Thai Nguyen and included first-time participants, Paul L. Hecht, MD, and Francis X. McGuigan, MD, and Shields. Both groups also visited Hanoi.
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Images: Blasier D |
Traveling miles for a chance
The volunteers treated patients who were not covered under the government’s health care system. Many were women, children and those with disabilities, Shields said.
“For many of the patients that we are seeing, it is us or no one because they cannot afford to be in their own health system,” she said. She noted that of the number of disabled children and young adults in the area served by the Vinh City hospital, only 1 out of 100 would never see a physician or have the opportunity to have their problem corrected.
Despite the adversarial relationship between the governments of Vietnam and the United States in the past, Blasier said that the Vietnamese patients showed no resentment towards the U.S. surgeons. “I think one of the primary things on our mind since we all grew up with the Vietnam War was that there going to be some sort of resentment, but we never found any,” he said. “The war is completely behind the Vietnamese. They were glad that we were there. They were just like us. They want the same things that we want for our kids and many have a problem paying for care, just like we do. [There are] similar personal situations, just different politics.”
Some of the patients were chosen from local pre-screening clinics and traveled thousands of kilometers for the chance to have surgery. “In Vinh, you have a clinic that, in theory, is scheduled for 55 [patients] and maybe 200 show up with their families and entourages,” Shields said. “Some of them may have ridden for 5 days on a single-speed pedal bike to be seen.”
“Making do”
The surgeons treated adult and pediatric patients with traumatic injuries from motor vehicle accidents, lower extremity deformities from residuals of polio, rickets, congenital deformities and cerebral palsy.
The volunteers noted that the operating room environment and sterilization requirements were vastly different than those in the United States. Blasier said that in our nation and most of the first world, medical care relies on disposable equipment. “Everything that we use; the gowns, needles, syringes, a lot of the instruments, left over sutures, they are tossed in the trash,” he said. “In Vietnam, everything is recycled. If we did not use an entire suture, they would save it and store it in alcohol and bring it out for the next patient. The gowns are all recycled. There are no throw-away drapes. Everything is reused.”
Many of the ORs lacked modern equipment, such as C-arms, and methods for rapid imaging. Blasier noted that the Vietnamese surgeons used due diligence to make up for their lack of complex technology.
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“In some ways, it was like a trip back in time for us,” Wapner said. “We were seeing things like polio, things you do not see in the United States anymore. The conditions in the hospital, especially when we were in Vinh, it was almost like working in a U.S. hospital in the 1930s with the level of equipment. I think that you learn to appreciate what you have here and how much easier it is to work here.”
Overwhelming injuries
McGuigan was impressed with the efforts of the Vietnamese surgeons, especially the surgeons in Hanoi. “The sheer volume of multiligament and multiple bone injuries of the lower extremity that they were seeing from the motor scooter accidents was overwhelming,” he said. “In fact they had 17 or 18 critical patients admitted on one of the days that we visited. We treated some of those individuals side- by-side with the Vietnam surgeons. But just the sheer volume of the work that they are doing, when you do not have C-arm visualization and considering the equipment that they are using, I was very impressed with their skills considering their limitations.”
Working side-by-side with the Vietnamese surgeons allowed Hecht to learn more about his own capabilities. “I learned about myself and challenging the limits of what I am capable of doing in a situation with limited resources,” he said.
“We jokingly say that MD stands for making do,” Shields said. She recalled one year bringing in some Tylenol to a hospital that had very little pain medicine. “You would have thought it was gold. We take a lot of granted.”
McGuigan brought several ring fixators and Taylor spacial frames on the journey. “We treated a couple of significant deformities with those,” he said. “One was a congenital deformity in a young 13-year-old boy who had a posterior lateral bow. We treated that with an external fixator and, from what I have been able to hear from the surgeons who are following him, he is doing pretty well.”
Fellowship
The volunteers also attended a scientific meeting with Vietnamese surgeons and health care workers to share ideas and build new relationships. Some of the volunteers gave presentations on club foot treatment, tendon transfer, transtibial amputation and midfoot fractures. “We just really liked rubbing elbows together and asking each other questions,” Blasier said. “[I] hate to get sappy, but it was wonderful fellowship.”
“The most rewarding part of it was the relationships that we established with the patients and physicians over there.” Hecht said.
McGuigan said that he was humbled by the experience and that it impacted his attitude towards volunteerism. “[Volunteerism] does not have to be hopping on a plane,” he said. “It can just be your own local donation of your time and your skills to people who might not otherwise be able to benefit from them.”
For more information:Reference:
- Dale Blasier, MD, can be reached at Arkansas Children’s Hospital, 800 Marshall St. Sturgis 363, Little Rock, AR 72202; 501-240-6173; e-mail: BlasierRobertD@uams.edu.
- Paul J. Hecht, MD, can be reached at Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756; 630-650-5155; e-mail: Paul.J.Hecht@Hitchcock.org.
- Francis X. McGuigan, MD, can be reached at Georgetown University Medical Center (G-PHC), 3800 Reservoir Road NW, Washington, DC 20007; 202-444-6012; e-mail: FXM122@gunet.georgetown.edu.
- Naomi N. Shields, MD, can be reached at Advanced Orthopaedic Associates, 2778 N. Webb Road, Wichita, KS 67226; 316-631-1600; e-mail: nshields@pol.net.
- Keith L. Wapner, MD, can be reached at Penncare-Pennsylvania Orthopaedic Foot And Ankle Surgeon, The Farm Journal Building 5th Fl, 230 W. Washington Square, Philadelphia, PA 19106; 215-829-5684; e-mail: wapnerk@pahosp.com. All are spokespersons for the AOFAS.