Surgical Volunteers International has completed its third trip to the Burn Center in Cho Ray Hospital. The team arrived in Ho Chi Minh City for patient screening on March 31st. As always we stayed at the Bat Dat Hotel which is about 15
minutes walk from the hospital.
The team consisted of 12 volunteers with 2 surgeons, 2 anesthiologists, 1 CRNA, 1 medical student, and 6 registered nurses. Everyone was from the US except for one surgeon who joined us from Egypt.
Cho Ray Hospital is the largest hospital in the South of Vietnam. It has 1700 beds and 2800 patients. The burn center had 112 patients the week were there. Some rooms had up to 10 patients with stretchers parked right next to each other.
Thirty-nine of the patients had been admitted for surgery by the SVI team and the rest were recovering from recent burns. In spite of the crowded conditions the patients all were receiving excellent care from the Vietnamesestaff. Daily baths and dressing changes were the norm. The unit is clean and tidy.
Due to a Vietnamese National holiday on Monday we did not begin operating until Tuesday. Even with the shortened week we were able to provide surgery for every candidate we screened on Saturday.
A total of 39 received life changing surgery during the week. Many patients had severe burn scar contractures of the hand that made it impossible to perform even the simplest of tasks. We also did several neck and axillary contractures.
One patient had burn scars that had left his legs in a sitting position. Hopefully he will now be able to walk.
I would like to once again thank our hosts and the Volunteers. The week was one of hard work,excellent care and compassion for those suffering from debilitating contractures.
On September, 30th 2011, Ain Shams University Hospitals in Cairo, Egypt received the well-trained and enthusiastic Surgical Volunteers International team, the team consisting of dedicated 13 advance medical stuff arrived at Ain Shams University Guest House early Friday morning following their mission to Mansura Pediatric hospital, A detailed discussion of the week’s agenda was held with an agreed upon 7:30 AM daily start time throughout their mission trip, and the anesthesiology team members went to the operative theater to set up the operating rooms for the quick start the next day, On October 1st ,2011, we held a joint clinic where we screened over than 100 cases of 1ry and 2ry cleft lip and palate cases, the clinic was composed of 3 stations one for surgeons, the two others for pediatrician and anesthetists, the clinic went really well and 70 cases were scheduled for surgery for the rest of the week, we started our operative day one on October 2nd, at 7:30 AM, we operated on 18 cases and we finished at 6:30 PM, the workload was pretty the same the next days, by October 5th the total no. of surgeries performed extended to 58, surgical volunteers performed most of the surgical procedures and assisted local doctors in many others, nearly all the medical supplies were provided from the SVI, as well as postoperative medications, we thank all the team members for providing us with the opportunity to work collaboratively with them on this medical mission, and for their extraordinary personal sacrifice of time, effort and money .
The current state of the art in treatment of cleft lip/palate is using presurgical techniques, in order to allow for a more conservative surgery and better clinical outcomes. However there are currently no groups that provide this in the countries we visit, mostly due to financial, logistic and training limitations. Therefore, at SVI we have decided to make an effort to provide these services in order to increase the quality of care to our patients.
The first part of the protocol will be implemented in Cairo this year
We believe that as a result of providing presurgical orthopedics, we will have:
1. Less invasive surgeries
2. Better healing time
3. Decreased amount of revisions required
4. Decreased amount of complications
Additionally, we are making an effort to improve our patient tracking system. Part of this tracking system will include systematic record taking, which will allow us to conduct outcomes assessments on how we can best serve the local population.
Another area of need is teaching the local health care practitioners the newer techniques in cleft care. We are increasing our emphasis on teaching, and hoping to provide visiting scholarships for local doctors to visit some leading Centers in the U.S.
What exactly is presurgical orthopedics?
There are 3 components of presurgical orthopedics, and depending on the severity of the case, each component may or may not be employed
1. Extra-oral taping. This is done for the cleft lip, and:
Gently guides soft tissues and bone into a better position for a cleft
lip repair under less tension.
Allows one to approximate the soft tissues of a cleft lip
Allows for a controlled force to re-position the prolabium and premaxilla to allow for a less invasive surgery
May eliminate need for early lip adhesion surgery.
Relieves tension on sutures when used post-operatively.
2. Alveolar molding. This is done for the cleft palate, and:
Decreases width of palatal cleft
Decreases amount of scar tissue
Decreases likelihood of oro-nasal fistula
May help in feeding by acting as an obturator
3. Nasal stent. This is done for the nose/columnella, and:
Improves nasal tip, nasal symmetry, and columnella length
Decreases deformity of the nasal cartilage
This information was partially taken from the following website, which also has before and after pictures:
You can also become a sponsor
$40 provides extraoral taping and nasal stent for a patient
$30 provides nasoalveolar molding for a patient
If you would like to help in this effort, or if you have any questions or comments you are welcome to contact:
Mairaj Ahmed, DDS MS
Assistant Professor, Mount Sinai School of Medicine
Section Chief, Orthodontics & Dentofacial Orthopedics
Cleft/Craniofacial Team Orthodontist
Mount Sinai Hospital
One Gustave L. Levy Place, Box 1187
New York, NY 10029-6574
We have finished most of the palates, as it is better to do these earlier in the week incase they have any postoperative problems with airways.
The haitian nurses, who have been our scrub nurses on this trip, are doing very well and are improving daily.
Today we completed our second day of operating. On day one, we did 6 lips. Today we did 3 lips and 3 palates. Everything went well. It’s very hot in the ORs, but sometimes we find pockets of air conditioning that feel just fantastic.
The TCH pediatrician who is also here with us, Elizabeth Montgomery, has been spending the days at the “Sean Penn” camp, in their pediatric clinic/hospital and happened to deliver a baby girl today! She is seeing a lot of the illnesses here that we learn about but never really see in the states, like rickets, and also a lot of GI illnesses and scabies.
Out host, Lance, returned home today. He is an American businessman who employs 500 haitians in his factory that makes small electronics. When the earthquake happened, to help these people keep their jobs, he provided full meals for his employees when at work, including one to take home for their families.
We arrived in PAP on Saturday afternoon. After gathering all of our supplies, we piled into our van and headed to the hospital. Upon arrival, there were already 4 or 5 ladies with newborn babies with clefts waiting for us. We unpacked the supplies and headed up the mountain to the home we are staying at. Passing through the main area of PAP was as expected… Tons of tents, rubble in street, and just so many people. Next we passed through petionville, and finally up the mountain to Fermathe. We are staying at the home of a Haitian couple, Nadia and Lance Durban. We had a very homemade dinner.
Today we woke up and realized the beauty of where we are staying. The view is gorgeous and there are avocado trees and wild orchids growing off trees. Very peaceful and quiet.
At 8 am we went down to the hospital for patient screening and prepping the ORs. There are also two inpatient areas, in addition to the ORs and recoveery rooms. About 50 patients were waiting… Mostly with cleft lips. The screening took the entire morning. Patients had traveled from over 5 hours away. One little girl had on a white party dress with white eyelet socks and dress shoes. Adorable. We had to say no to a few patients, mostly patients with vascular malformations, for which we did not have the right treatments. We will definitely bring some sclerosing agents on the next trip. The other patients that we couldn’t offer treatment for were those that were too small- younger than 9 mo or 20 lbs.
Things began to wind down and we were gathering our belongings, when we noticed that a bench we had been sitting on 10 minutes earlier was now occupied by a small body covered in white sheet. It’s one thing to see a picture of it and it’s a completely different thing to see it.
We have 36 on the schedule for this week and will start operating tomorrow AM.