Trip Report | Ho Chi Minh City, Viet Nam, April 5 -12, 2014

May 3, 2014 at 1:28 am Leave a comment

SurgicalVolunteers_Vietnam_2014_04_01

Surgical Volunteers International (SVI) in partnership with Wonder Works, Americares and Map International has just returned from a week-long mission trip to Ho Chi Minh City, Viet Nam, April 5 -12, 2014. There we worked in Cho Ray Hospital, a large government hospital with an estimated 2800 beds, providing general medical and surgical care with all the usual specialties and sub-specialties. HCM City/Saigon is the largest city in Viet Nam, and the Burn Unit at Cho Ray is the largest and busiest in the country.

We worked in the Department of Burns and Plastic and Reconstructive Surgery. This department is headed by Dr. Doan Dao and has both full-time and volunteer surgeons on the staff. This trip marked the fifth time SVI has been a guest of this department and carried out surgery for the correction of burn scar deformities under the auspices of, and with the assistance of, Dr Dao and his staff.
The SVI team on this mission consisted of 10 people, with the following distribution of labor: anesthesia (2), plastic surgeons (2), operating room/surgical assistant nurses (2), recovery nurse (1), floor nurse/patient coordinator (1) and team director/RN (1). A young surgeon from Cairo, Egypt, in his final phases of plastic surgery training, completed the team and functioned as surgical assistant.
The work began with a screening clinic on Saturday April 5, at which time approximately 55 patients were examined and evaluated for possible surgery. Of those seen, 36 were selected and worked into the operating schedule for the following week.
Burns are literally the scourge of the developing world. They are endemic in many countries visited by teams like ours. Statistics are hard to come by, but anecdotally the incidence is high and the devastation to life and limb tragic. The damage done to the patient, family and community is incalculably overwhelming.
Sources of the burn injuries we encountered included house fires, cooking fires, gasoline fires (accidental), hot water, electrical burns, and perhaps saddest of all, chemical burns by the intentional throwing of acid onto a person’s face and chest. One patient seen in our clinic had intentionally doused himself with gasoline and lighted himself afire. He had nearly total-body burns and yet had survived.
The types of deformities we saw and subsequently operated on included contractures of nearly all joints and movable body parts. One of the most common was the contracture of the chin and neck down onto the upper chest, often with dystopia (pulling downward) of the lower lip and mouth. This often was in the form of a thick collar that prevented almost any kind of movement or lifting of the head. As one might imagine, eating and drinking and control of one’s own saliva were an issue for these patients.
Other problems included deformities of the hands and fingers, in some instances so severe that the fingers were drawn backward onto the dorsum or back of the hand. Often digits were missing or only present as stumps. Similar deformities were found in the feet. Several patients had suffered amputations the hands, arms, feet and legs, either by the mechanics of the fire or burn itself, or by necessary surgical intervention as part of their primary care.
Other problems included absent or deficient eyelids with an eye at risk, microstomia or smallness of the mouth such that one could hardly eat, absent ears and noses, and finally painful scars and open sores from the fragile tissue of the healed burn scar.
In total 36 patients were operated on, some with more than one surgical procedure carried out. Most of the procedures were some type of scar excision and release, and most required skin grafting for coverage. Z-plasties were incorporated into several of the closures. Eyelids were reconstructed and grafted, but on this trip no attempt was made to reconstruct ears or noses, complicated procedures requiring long-term planning and repeat procedures. Also most of the complex hand problems were deferred to a visit some months hence by a team from elsewhere coming to do specifically hand surgery.
We worked closely with the local team, including surgeons, nurses, and anesthesia. They are all excellent in their respective areas of care and expertise. They are just nearly overwhelmed by the sheer numbers of patients and the magnitude of the injuries brought to their front doorstep.
Three additional cases were performed by a talented and clever surgeon who has developed a neat little regional arterialized flap for correcting axillary (armpit) contractures. On another couple of cases, the finesse of the local surgeons with the Humby knife for freelance skin-grafting was ably demonstrated.
This team of SVI volunteers worked competently and compassionately, tirelessly and professionally, laced with good humor and laughter, to carry out the demands of this week. The local team of doctors and nurses gave freely of their time and talents and never once complained about the extra burden of work we brought to them.
The finale of the week was a farewell dinner held at a down-home but elegant small restaurant, where our team was hosted by Dr Dau and his staff of doctors and nurses, and we were given nice memorial gifts as tokens of their thanks for a hard job well done.
The team then bid each other farewell and departed for their various routes to return home and their various daily lives…all touched by the experience of the past week and in particular by the courage and gratitude of the patients for whom we had worked.

mes 13 Apr 2014

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Entry filed under: Uncategorized.

From Tears to Smiles on the Amazon Vietnam Surgical Mission Trip Report

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