Everyone burst of out of bed to our first morning in Vietnam.  Most of the team moved up to Phan Thiet while 3 stayed back in Saigon to collect our equipment and supplies from Tan Son Nhat airport.

Yet another day of delay. The Vietnamese government has continued to hold our medical supplies, medications, and equipment to properly treat the patients awaiting.  Our team members are working around the clock to have the Vietnamese officials sign off on the paper work so we can start our mission, despite the minor set back.

We decided to make use of our ‘bonus’ day to explore what the city had to offer.

About 20 kilometers away is a popular beach Mui Ne which means “hidden cove”. 

It is a upcoming beach resort for local tourists.  The bus dropped us off a few steps away from the beach and beautiful water welcomed us. Local fishermen were working hard pulling in the catch of the day. We bought fresh selling fresh crabs, clams, and snails from a lady on the beach. Everything was cleaned and cooked right in front of us in amazement.

Collecting thoughts:

Tuan - Golden sand dunes surround  Mui Ne which is one of the things it’s is famous for.  Kids wait at the bottom of the dunes with blue plastic sheets used as sleds. We each were quickly surrounded by a gang of children offering their sleds to slide down the dunes.  We felt like we were transported to the middle of the Sahara. 

Hung – This is my second mission with WHA and on this trip there’s a lot of new members from the US. Although it’s been only a couple of days I feel we already have developed a strong bond.

I am eager to begin working on the mission to help the poor villages in Phan Thiet. There’s an interesting dynamic to see the contrast between the beautiful beach resorts and the poor villages.

Helen – Even though the supplies were not released. Everyone on the team went all out with our hearts to do the best we could.

Jessica – It’s disheartening and shocking to see the children not have the opportunity to get an education.

Tam Anh – Although we were delayed with the boxes & supplies we quickly adjusted and found medical supplies and medicine at the local store. During our wait we found activities to keep our spirits high. Even if we didn’t have supplies we worked  together to do our best with what we had.

Though left curve balls were thrown our way, we learned to accept, cope, and adapt to the matter at hand and kept strong as a team. While tying up loose ends we are preparing ourselves for the challenges that lay ahead.  For now, we are taking in the mesmerizing sceneries, savoring the salty air, and mentally preparing ourselves first mission day tomorrow.

 

Dr. Luat, our gastroenterologist, and Dr. Hiep, our cardiothoracic surgeon, were picked up by the school van in Ho Chi Minh city and had arrived in Can Tho last evening. They met up with the school officials from the Can Tho School of Health Sciences today. Both members of our team received a very warm welcome, and were given a detail tour of the facility by the department heads. Dr. Hiep - The school teaches very basic materials, the library needs total renovation as well as medical books written in English. The Curriculum needs work also. From the presentation and after talking to the staff, Dr. Hiep is concerning about the basic knowledge of the student, resident and young attending. Tomorrow, we are heading to the teaching hospital to give lectures.

  

 

Dr. Hiep gave the following lecture topics: 1) Heart surgery: what, why, where and how  2) Cardiopulmonary bypass physiology  3) Coronary artery disease: current trend in treatment.  Dr. Luat gave talks on 1) Upper and lower GI endoscopy  2) Treatment of esophageal varices.  The lecture room was packed with students, residents and attending staff.  Many questions were filled and answers.  Dr. Luat - Overall, it went really well.  Many additional discussions were also taken place in various clinics within the hospital as well.  Dr. Hiep -  The School of Medicine is at a cross road of trying to adapt and utilize the technology available to them.  They need clinical and technical skills and WHA is in a position to help.  I honestly think by working with the Can Tho School of Health Sciences in improving the medical/dental/pharmacy school, the WHA can make a lasting impression in the life of everyone who live in this region.

 

When it time to depart, the team receive an official letter inviting the WHA to coordinate and start a teaching program with the Can Tho University this coming 2011 calendar year.  Our Can Tho team was very grateful for the very warm reception and look forward to working with the University in the near future.

The team was able to extract some of the much needed medical equipment and supplies from customs late yesterday.  The team was joined by 4 local Vietnamese dentists, 2 local Vietnamese dental assistants and is now en route driving pass green rice paddies and sugar cane fields to the village of Dong Giang.  This village is among the 50+ minority groups in Vietnam that has their own language and lifestyle.

Dong Giang is a village belonging to the K’ho ethnic mountain tribe.  This tribe has a unique matriarchic family model. The women are the head of the household and get to keep ownership of the house if there is a divorce.  If the wife dies for any reason, the husband has the option of marrying her sister if there is an available sister.  However, if the husband decides not to marry the sister, he is forced to leave the home and lose his possessions. 

Though part of our team was still back in Saigon, the rest of the team members already in Phan Thiet did not hesitate one second, and jumped right into treating the patients that are in desperate needs of the medical and dental services. The medical team treated 200 patients and the dental team treated 45 patients. 

Although most of the members speak Vietnamese, many of the patients were from the K’ho minority group who speak a completely different dialect causing an additional challenge. At times we needed two translators in order to communicate. One to translate from English to Vietnamese and another from Vietnamese to K’ho.  At the end of the day it doesn’t matter what language is spoken as long as we can help another human being from suffering. The government officials commented that "We were the first large foreign medical team that has been in this village. They were so amazed with our thorough examination and meticulous care."

 

Dr. Minh and chi Mai – it’s feels good to be productive!

I saw all kinds of patients but the most rewarding were the ones with the kids. One of the little girl I saw name was Srong. She is 11 yrs and has a heart condition.  She is clearly frail, underweight and too short for her age.  If we had our cardiac ultrasound equipment available, we would have been able to make a more definitive diagnosis in the field.  For now, her name and information is sent to the open-heart surgery team as potential candidate for further evaluation and treatment in the coming months.

Mai - I’m glad and thankful that anh Minh and I are finally able to go on a medical mission. It’s like a dream come true because this is something I’ve always wanted to do for a long time.

Today was the first time our entire team was all under one roof. The remaining team members from Saigon joined us as well as our Can Tho teaching team and one additional local Vietnamese dentist. We are now at full strength of 26 members and our spirits are flying high. The international team is composed of Vietnamese-American, American, Canadian-Vietnamese and Vietnamese nationals and has physicians, physician assistants, pharmacists, nurses, dentists, dental assistants, and support staff. There are a few first for this mission. This is the first mission which we have Canadian physician and a cardiothoracic surgeon’s participation.

Upon our arrival, patients have already been milling around the village clinic under the hot and steamy sun. The people of this village have a dark complexioned. Their faces worn, their expressions vacant from the struggles of their work, environment, poor nutrition and limited medical attention. Adolescent men and women look like young boys and girls due to delayed development, and adult men and women look far beyond their age due to wear and tear on their bodies.

We saw many children today, a few with signs of malnutrition, but almost all of them, there was no small laughter, chit chat, and no hint of a smile. Even among the children, one can readily see in their eyes the hardships of daily life. Many of these children are already working in the rice paddies helping the family bringing home foods and are not attending school. They can not read or write and are also missing out on the school’s health programs such as the biannual intestinal worm treatment. The clinic doctor informed us that the intestinal worm infection rate in these villages are approaching 100%.

 

This is the first trip we had a mobile dental van to be part of our medical dental mission. With the help of Dr. Tomy V. Luong and Dr. Hoa G. Tran, we were able to coordinate with the Medical University of HCMC, Oral-Maxillo-Facial Department to acquire the mobile dental van.

 

The mobile dental truck helped us provide restorative services, scaling & root planning with Cavitron, root canal treatment with digital X-ray hand unit, and minor oral surgery.

During our examination, we found 2 young girls, age of 11 and 14 with severe congenital heart disease. The family of one child could not afford any medical evaluation while the other could not afford treatment. The 2 girls were clearly underdeveloped for age and one was even cyanotic. Our cardiac ultrasound equipment was still tied up at airport custom and we missed the chance of further evaluating their heart condition. For now, we have forwarded their information to our open heart surgery team to be considered for future evaluation and treatment.

 

This smaller village appeared to be more economically depressed than Dong Huong and it was reflected in the general medical condition of its residents. Signs and symptoms of inadequate nutrition and delayed development were readily recognizable by the team members. Surprisingly an area rich with produce are rarely consumed by the locals who sell these fruits and vegetables for income to larger towns. Intestinal worm infestation appeared to be universal in this small community. Despite government efforts to de-worm the population bi-annually and teach proper cooking techniques it did not appear effective. Most of the villagers continue to ingest raw or inadequately prepared foods. The children often complain of abdominal bloating, distention, diarrhea and occasional stories of worm coming out at night and peeing on their beds. One boy also reported episodes of emesis that is teaming with worms. Our team treated all patients with anti-parasitic medications and emphasized proper food handling techniques.

 

More ominous than intestinal worm infestation is the prevalence of tuberculosis. Many of children reported symptoms of weight lost, persistent fever, and unresolved cough with convention antibiotic treatment. The adults, on the other hand, reported symptom of coughing up blood. We advised government health officials to have them referred to the region’s tuberculosis , set up out of necessity due to the high prevalence of this disease, in Phan Thiet. Our team members were all issued N95 TB rated mask. Despite the hot and humid weather, we kept them on most of the time and issued all coughing patients a mask.

Jessica: The past few days were a whirlwind of emotions. During these days the nursing staff was responsible for the registration and processing of each and every patient. Vital signs were taken on each patient to include temperature, blood pressure, weight, heart rate and respiratory status. The overall flow of the patients throughout all the stations all started and was dependant on the organization we maintained at the ‘frontline’.

This village really needed help and we were glad to be here. Every location is so unique we're not sure what to expect but we are certain the team is up for the challenge!

This village is the smallest of the ones we visited and this is reflected by the size of its medical clinic. Again the team was left to improvise with the limitations of medication, equipment and now space. The first patient was a young girl who came in for a dental examination. She fainted in the dental chair prior to receiving any treatment. Upon gaining consciousness, she gave a history of another fainting spell yesterday. While examining her, our physician found 2 large, deep cuts on the front and back of her scalp that she did not complain about. Our physician and physician assistant took turns cleaning and stitching up her scalp.

All this while the team continues to process and treat our patients who are lining up and snaking around the entire clinic building. Our pharmacy team was clearly the busiest section. They not only were dispensing medications but also nutritional supplements and counseled patients extensively on their disease and the prescribed medications. The multiple patient counseling steps are crucial to the proper treatment of this underserved and poorly educated population. There were more patients waiting for our care than what supplies we have on hand and we closed down the clinic all the while wishing we could do more.

Jennifer: Our final clinic day we saw the worst of the wounds. A young girl had fainted, knocking her head as she fell down. She had a deep forehead and scalp laceration. We had to borrow equipment from the dental team and they numbed her with lidocaine for us. She was so calm and good while they sutured her wounds. Her mom came back to thank us once she was seen by Dr. Do and ruled out for any cardiac condition. While suturing her, a man appeared with fresh facial abrasion and severe lip/facial laceration. He had just fallen off a farm machine and had lost consciousness. Upon further exam he had an extensive laceration on the inside of his lip. Again we sutured him the best we could with our limited supplies and he quietly sat there without complaint. After we have sutured both of these patients’ lacerations, the dental team went to work. They extracted their broken teeth and sutured up the lacerated gum line. This was a true medical and dental team work. We then gave them both antibiotics and detail instructions on following up with the local clinic doctor to guard against infection.

 

The final day of clinic ended with a quick burst of rain which helped cool the muggy air and calmed the remaining crowd. We saw the most severe injuries today and were able to improvise with the supplies on hand and strong team work.

  

The local doctor gathered everyone around and thanked us whole heartedly for our compassion and relentless efforts and traveling to the other side of the world to help complete strangers who would not have had the same opportunity. The bond between the team members came effortlessly and naturally as we spent all of our waking hours together on this medical mission. We also hope we left a positive impression on each patient we treated.

Our time here isn't over just yet. Tomorrow we still have to prepare to meet the Department of Health as well as visit the local hospital in Phan Thiet.

 

 

As stylish as our standard issue blue scrubs are, it's also nice to see everyone dressed up to meet with the Department of Health & Hospital in Phan Thiet. We were given the opportunity to talk about our mission and discuss any improvements that could be made for future missions. Each of the WHA team leaders took turn to share their stories and how this mission has effected them. We also brought up to the health officials about the 2 young girls, age 11 & 14, who we examined and found to have severe heart disease.

These children will have a very short life span without corrective surgery.
We asked what treatment options were available to them and the conclusion we received was "given the limited resource available by the health department and the families' poverty condition, the families here in the area have accepted the faith of their children. They are happy with each passing days that their children are still with them."

Doctor Hoa is one of the key members from the dental team inside of Vietnam.
He is originally from Phan Thiet and has been graciously doubling as our personal tour guide in addition to extracting teeth. He points out on the regional map the route we took to the different villages we helped along the way. Getting a birds eye view of the map where the villages appear only inches apart makes our long and bumpy rides on the dirt road seem like a piece of cake. However, we all know that wasn't the case because the commute was an adventure in itself.

 

It's always interesting to see how a hospital operates in different countries. We were greeted by Dr. Nguyen Huu Quang, the director of Phan Thiet main general hospital. He gave us a tour of the hospital, and introduced us the head of the cardiovascular section, the diagnostic imaging section as well as the gastroenterology suites. He proudly mentioned that the hospital will be receiving a new cardiac ultrasound machine during the next few months. In regard to the gastroenterology section, currently they only have the capability to perform upper and lower GI endoscopy but not biopsy or treating esophageal varices. He is very receptive to the idea of working with the WHA program on a collaborative GI teaching program and has requested for a written proposal.

Tuan, our documentarian and support staff invited the team to his grandmothers house nearby. The bus with the entire team barely squeezed through the narrow unpaved streets as onlookers step out of the way to clear the path. We were treated to home cooked food and personal stories about him and his family. It was a special treat to have this intimate experience in a traditional Vietnamese home.

 

Each of the WHA members are truly 'ambassadors' of health. We not only treat the patients but also educate them about their prescription and healthy practices such as proper oral hygiene. We value the importance of establishing our network with locals in order to set the path for future missions.

 

After spending the afternoon touring a furniture factory belonging to one of our pharmacist’s cousin in Phan Thiet, the team moved to its retreat location in Mui Ke Ga near midnight on November 8th for rest and recovery. 

We spent better part of the 9th cleaning our gears, discussing the mission, writing up reports. It was very peaceful given the hectic pace we have been on this past week.  Just as we were acclimatized to the slower pace, one of our team members received the unexpected news through email that her mother had passed away at home.  This was like an electric jolt and woke everyone on the medical team up.  In matter of hours, we have people comforting each other while other on Skype verifying the news, checking available flight schedule, and helped with packing.  By afternoon the next day, our team member was on her way back to Ho Chi Minh City to catch an earlier flight home.  She was escorted by Dr. Doanh all the way to the airport and was accompanied by Dr. Hiep, one of our Can Tho team member, who is happened to fly back to the US on the same flight.  It was a true team support day.  After returning home safely, our team member wrote “Their heartfelt words , caring , hugs  , and even tears will be forever in my heart”               

 

Though we were physically tire and sleepy from staying up most of the night, the team was managed to celebrate the birthdays of 5 of our team members.  It was a surprise to see how Tuan and Francoise were able to find and order an American style birthday cake out in the middle of nowhere.  The subdue celebration helped to ease our emotions.

 

The team received a request to visit and treat the monks at the very large Buddhist complex named Ta Cu, located high in the mountain in Phan Thiet, about 30 Km from our bivouac location.  On arrival to the base of the mountain, we were lifted up the steep mountain side with our gears and medications via gondolas.  After a lengthily ride, it took another hiked by foot to get to the monastery.

 

This is a very large complex perched high on the side of the mountain. It reported to have the largest, all marble, reclining Buddha statue in the whole of South East Asia.  The statue was indeed large and we had difficult time finding an angle to take a picture of its entire length.  We met our hosts who were delighted to see us.  We examined and treated the monks as well as other temple helpers and workers.

 

 

This was a very peaceful place with only sounds of rushing leaves and bird chirpings.  We were high enough into the cloud that it was misty throughout our visit.  Some of our team members took this opportunity to say a pray for our team mate’s mother who had passed away unexpectedly.

Before departing the temple late in the evening, the team was treated to a vegetarian dinner by our host and given a visit to a small orphanage ran by the temple’s monks at the foot of the mountain.  We left behind medications and a small donation for the orphanage.  This was an emotional visit for all of us.