Day 1
I thought it would be fun to drop a few field notes and tasteful photos during our visit here in Ha Noi. For 23 years now, our surgical team has offered free cleft-lip and cleft-palate surgeries. This mission finds us in new territory as part of a burn team partnering with Surgical Volunteers International headed by Tom Flood out of Tucson, Arizona. Strengthened by this new partnership, Operation of Hope is now part of a pool of volunteers from all corners of the world. Especially noteworthy are our key medical volunteers born in Ha Noi and Ho Chi Minh City.
In all, there are 15 members on our team for this surgical mission. We are all shacked up in a simple and oddly decorated tower of a hotel located in the gritty industrial section of town, close to the hospital where we are stationed this week. As we wake up halfway around the world from our homes, Ha Noi seems like a massive concrete beehive, but one with many wonderful layers to explore.
March is winter-like in Northern Vietnam. Grey and wet. Typically by noon, the moist morning chill takes a rest and the warm hands of the sun visit to remind our shivers that warmer months lie ahead for this amazing country. In the few days leading up to this surgical mission, we have a short time to get acclimated. We take in our share of walking about town along broken and intensely cluttered sidewalks. The hobble of streets are packed with silk and coffee vendors, rows of cheap clothing and knock-off shoes. Heavy wafts of green, black and Jasmine tea and Cha Ca pots snapping fish in spicy oil fill the air. More than 85 million people call Vietnam home. Often, a sultry street walk will also deliver an acidic tapestry of garbage, gray waste water and sewage reminding you of a beyond-cramped urban lifestyle. Toss in thousands upon thousands of buzzing mopeds scrambling in every direction, and you have a swatch of everyday life in this busy little corner of the world.
Saturday we screened patients at the Hospital. Hundreds of people showed up looking for one of the 40 spaces we have available on our surgery schedule. It did not take long to fill the list. Families, kids, moms and dads packed the halls. Minor burns here. Major burns there. I was taking pictures, and kids in my lens waved back without hands or fingers. The 220 amp wiring in this country needs a little taking-a-look-at. Everywhere, heavy black wires are strewn in hairballs along telephone poles. The wires often hang near balconies or drop to the ground where people walk, drive and ride mopeds over without hesitation. Low soup pots burn intensely as toddlers learn to walk on uneven floors. Old propane stoves are wed to leaky knobs. Injured mopeds are repaired in tightly cramped quarters. Often, fuel leaks along the shop floor. Cheap cigarettes are hugely popular. You all know where this is going for a burn team ready to get to work.
As I write this email, it is Monday, the first day of our surgery schedule. With a late start we managed to finish three cases and will look to complete five or six more after a lunch. The first two cases were three-year old adorable little Vietnamese boys. Each boy’s hand curled up into little permanent fists as a result of falling into steaming hot soup pots on open fires. In Operating Room one, I watched Dr. Bauer Horton from Texas and Dr. Anthony Tran from Saigon use a fine blade to release the seared webbing in this little boy’s hand. Graceful latex gloves and sterilized blades gently unfolded tiny fingers. Skin from the child’s waist was harvested to replace the skin between fingers that had once seared together. This boy’s hand will never be perfect, but the little guy will have a basic range of motion and will discover some long-lost abilities. Maybe he will one day wave back to friends when they take a picture of him, all fingers open and dancing.
Day 2
It’s been an interesting cadence of the senses as we wander through our day. See, touch, taste, smell, and hear. Rinse, lather, repeat. This is day two at the burn hospital in Ha Noi, Vietnam. Our volunteer surgical team stayed late last night and managed 7 cases without incident. No hiccups are a good sign, given all the variables. Yesterday we became rapidly familiar with our own team and also the Vietnamese hospital staff we are partnering with. In this fashion, the language is a huge barrier, especially with the patients. I wish it were as simple as asking a question each time we want to understand something. Instead, we rely on the few bilingual translators we have on hand. Otherwise, it’s body language and fluctuations in tone. Eyes become key. To cope, we find ourselves drawing pictures of items on our “needs list” or making chicken noises when we ask directions to a restaurant. I do hope it’s as amusing to them as it is for us. In the end, smiles are usually exchanged as a common denominator.
We are guests in this military hospital stationed with 300 beds. 100% occupancy. 100% of the time. The waiting list is long, which can be excruciating when faced with a severe burn. If a patient doesn’t have money, the wait can get very long, as in eternal. We are here to help those who can’t afford to wait forever. As we walk the halls, the daily sights can be warm such as when a mom or dad throws you a gentle wave. The sights also cut your wind short as in the oozy beds sourcing newly arrived patients. I love that our volunteers have given up time with their families and loved ones. Revenue streams will slow. Some volunteers will probably get sideways with a nasty stomach bug. I love that our donors have given us the opportunity to help these families. I wish I could take every person that has ever given us a dime and introduce them to a Vietnamese mother after we have helped her son or daughter.
It’s noon now. The hospital lunch room is the size of a small hallway. The kitchen staff is throwing down some mean chicken curry Pho soup and rice noodles along with bananas, watermelon, an oddly square loaf of sandwich bread, vacuum fried lotus seeds (vacuum fried?) and green tea that has the words “functional food” on the packaging. The team takes breaks between cases where they can. I’m grabbing a short sit and then I will walk over to Operating Room two. A 7-year-old girl named Nguyn (pronounced “Win”) is undergoing an abdominal keloid excision. This adorable little girl was accidentally nudged into a pot of raging hot water that was being boiled for drinking water. Now her stomach is a storm of scar and tissue mass. It could be different as this case is so preventable on the surface. But maybe those are our standards. Reality is…this is a very poor country. To survive, you burn a fire on the floor and throw a pot on it if you want to drink water. Stoves and sturdy tables are a luxury. Surgery for your child is beyond luxury goods. I’m glad we’re here to help a girl with a genuine little smile.
Day 3
Day three. Last night after surgeries wrapped up, I realized some of our staff may have been a little homesick. Soon after we made sure all our patients had a bed on the ward, we found ourselves in one of Ha Noi’s few Kentucky Fried Chicken locations. Imagine traveling this far to eat American fast food? My sense is everyone was trudging through a massive case load of patients, and combined with severe jet lag, the idea of bringing local 333 beer, sugar-cane cokes and fried chicken back the hotel and crashing was just what this team needed.
We paid over a million Dong to buy two buckets of the Colonel’s finest; however our street smarts told us to skip the cole slaw. The gamble paid off as the locals hit the secret-recipe out of the park. Odd thing was, as the team gave the buckets a good pickover, people admitted it had been years since anyone had actually had KFC in America. Part of this may be the mental exercise one gets over here when deciding what to eat. Some things look like bread and taste like beans. One particularly tough skinned green fruit opens up and reveals a batch of what I swear are frog eggs. Salami often tastes like a camping mattress. That said, the majority of the food here is sensational. There is also a thick hangover of French-influenced cuisine so the fact is we have been flat out spoiled. The range of flavors and textures fill our tanks and adoringly support the reason why we are here.
Today’s schedule is filled with many finger, toe, elbow and neck releases. One interesting case is a 20-year-old man undergoing a neck advancement with an axilla release and a FTSG (full thickness skin graft). The poor guy had his entire throat and face seared when a propane kitchen stove leaked and ignited. When we asked him about the accident, we discovered while on fire, he tried to turn the stove knob off so his family would not catch fire.
Point is, we’ll do what we can today. We’ll take his chin, which is pushed down permanently into his chest and release the tissue. In a week or so he’ll be able to hold his chin up. He will look left and right without swinging his entire upper body around. He’ll walk away with some normalcy. It’s a good day this thing called Wednesday.
Day 4
Four days down. One to go. Tomorrow is Friday. We will look to push through 8 or 9 more patients and then start packing for home. I sense the horse must be smelling the barn because the team ran at an amazingly fast clip today. Between cases 3 and 4, volunteer Dr. Bauer Horton from Baylor College of Medicine also managed to squeeze in an educational seminar on post-trauma, free-flap reconstructive surgery for about 45 Vietnamese plastic surgeons and medical students. The fisherman from Texas taught a few locals how to fish today.
The first case today in OR 1 was simple. Clean and basic. I looked at the operating table and gave a long sigh, especially after seeing some of the head-to-toe, 4+ hour insane surgeries we had yesterday. Draped on the table was a Vietnamese woman’s right foot that had been burned across the top 10 years ago by a wayward pot of hot water. Since the accident, her foot constricted, forcing her to walk on her heel. Most of her toes fought to point straight up with the little piggy winning the battle.
Indian-born Kriti Mohan, volunteering as a medical student/soon-to-be doctor from Baylor College of Medicine in Houston, Texas, explained they would be using a technique on this woman’s foot known as the jumping man flap. I pulled out a small tablet, and Kriti drew a diagram showing where the cuts would land and what they would do once the skin was freed up. Our exchange felt like a game of street football where the quarterback draws out a play on the dirt.
I looked down in my notebook and saw a zig zag of triangle shapes which Dr. Mohan called flaps. No surprise, the diagram looked like a stick man jumping in the air with his arms waving around. The goal was to take the tips of these triangles, twist them left or right and thereby release the tightened skin on this poor woman’s foot. Some days from now, a few rounds of bandages removed, this woman gets to walk around like most in this town. Her toes will be treated with a similar procedure. As I watched Dr. Mohan cut and sew, I wondered what kind of shoes this woman would one day pick out. How nicely her foot would slide into them. I wondered how much self-esteem she would gain from looking down at a nice pair of shoes gracing her own feet.
A mission like this genuinely allows a wonderful a country like Vietnam to unfold in front of you with every step. The town is gritty and hard. The people are gracious and kind. The challenges are extreme as you hope to make your way in this neck of the woods. I just hope we can shed a little light here in the dim of this burn hospital. With four days behind us, I know we are doing all right. What I love is how our passionate donors have empowered us. Simply put, they have given us the nod to draw little jumping men all over people.
Day 5
This entire week was a steady and well-trained-for performance. Today is Friday, our last day of surgeries. Today we fly mid-air in a blur of twists and turns and stick our landing. Today we will soak in the remaining hours as guests in this beautifully layered, tough but graceful country. Having been witness all week to helping Vietnamese men, women and children who have suffered burns, we leave with awe stuffed in our pockets.
I promise I won’t go heavy on you today. The mission has been thick with cases where written description and photographs would simply be too much. I’ll just leave it at this. If you have ever given a dime to our foundation or would ever do so in the future, it’s a bell-ringer of a time to reflect on that thought. Five days straight. Eight to ten cases a day. We took donor passion and turned it into surgical solutions for people loaded with excruciating problems. Keep it coming, friends.
They always say the character of a team is a reflection of their coach. Coach here being Tom Flood, a Vietnam-era veteran with the U.S. Army and Air Force and retired R.N. who ticked 25 years at the Methodist Medical Center in Houston. Tom is easy to track down in these halls as he’s as tall as a starting forward and bald as a sand dune. A steady dose of smiles always swirl in his wake. Tom’s been running medical missions for 12 years now and knows how to navigate the nuts and bolts of this dance. Hands, burns, urology, cleft-lips and palates. If you’re clay-dirt poor and live in a developing country and need surgery, Tom Flood is a welcomed friend.
Our volunteer surgical team has bonded. Laughed together. Strange food has been shared. We are all staying at the Perfect Hotel, which is a $1 taxi ride from the hospital. Ironically, the hotel isn’t perfect. It’s just the name of the place. In the lobby there is a giant mural painting of a tiger, an eagle and a shark all trying to eat each other in a mad battle. The downstairs restaurant smells like old hot-dog water. “No Smoking” signs are on every wall, usually with an ashtray positioned directly below. That said, it’s basic and cheap and by all accounts, for us it really is the perfect hotel. Our long days render us hound-dog tired, and a bed is all we need.
Tomorrow we’ll all say goodbye to Vietnam. An old friend for some. A new friend for others. It will be like letting go of a comforting hand. We hope to take with us the kindness and sincerity of a Vietnamese mom and dad, and the charm of a Vietnamese child, with eyes dark and wet as strong black coffee. This friend we all call Vietnam. Hope to see you soon.
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