Finishing our time in Can Tho (sigh!) and traveling to the big, big city of Saigon (yay!)...

So, let’s see where I left off…a lovely Sunday of floating market and relaxation and then back to work on Monday morning in Can Tho.

We started our Monday with our great breakfast at the Golf Hotel ~ eggs, baguette (bahn mi), fruits of all varieties and topped off with some delicious watermelon juice.  I always forget about this wonderful-ness (? is this even a word?) and know this summer what I will be doing with all of the watermelon that passes my door.  So delicious!

We arrived at Can Tho Pediatric Hospital around 830a and found our therapist friends awaiting our arrival.  We have previously had Hoa ~ one of the new translators for IEP this year ~ helping us with translations but she had class all day, so Dr. Phuong acted as our translator.  Hoa is super-cute, 19 years old, attending university majoring in tourism and this is her first foray in doing any sort of medical translation with our group.  She really did very well from the screening days to helping us at the Children's Hospital and Autism clinic, despite this being tough work in challenging environments.  So to her we are very grateful!!

Hoa is in the green shirt...so sweet!

From the screenings we had done last week with the surgeons, etal., at the General Hospital, there were a handful of pediatric patients that I had recommended come to the pediatric hospital to see Amy and me, as surgical intervention wasn’t necessary for them.  So, I knew I had potentially 4-5 patients coming on Monday morning and then when we arrived the pediatrician, Dr. Phuong, had 3-4 patients for us to see.  Amy and I were quite happy, as we both like to be busy, but it certainly creates a lot of worry for the therapists and Dr. Phuong, as they typically ask us to take a break and rest after seeing 2 patients, as they are worried me might be tired!?  Amy thinks they are worried because our faces are sweaty and glisten-y…likely is the case. 

So, we had a great morning of work ~ 10 patients!!!  A Can Tho world record!  They were so worried about us ~ which is so nice, but I don’t think they understand how busy we are when we are working in the US.  It was so much fun and they patients were all so perfect and wonderful, which always makes it such a great experience.  These children all had wonderful parents, grandparents and aunts as well, which adds so much to the experience and is always such a pleasure for us.

Here’s a few photos from the morning, our last morning, at Can Tho Pediatric Hospital…

We did not see this baby, but I loved how adoringly his grandmother was looking at him and singing to him.  It was beautiful to watch.

We saw a 2 month old baby with a cleft lip and palate, amniotic banding on his left leg and a club foot deformity on the right.  This was the bottle/nipple they were given to use to feed this baby and he was doing great with his eating.  He was growing and getting bigger, which is the most important thing.

This baby is 1 month old and had a cleft lip (no palate involvement).  She looked great and will undergo her 1st stage of repair around 6 months of age.  She is growing and getting bigger.

This 3 year old little boy presented with a new diagnosis of Autism, as he had stopped talking in the last 4 months.  He was incredibly social and playful and engaging.  When Amy asked the right question, she learned 4 months ago he began attending preschool and this corresponded to the change in his talking.  He was very, very shy initially with us, but would engage in play and Amy felt he had selective mutism, not Autism. 

This little boy presented with cognitive impairments.  He was very nice, but exhibited very limited learning skills and limited interest in anything but books.  He is able to walk independently and had wonderful parents.






We then were presented with a lovely gift of a wooden tea set, which so kind of Dr. Phuong and the hospital to do.  We then had another delicious lunch ~ something that is so wonderful in the Mekong Delta…the food! (the folks in the Mekong will tell you their food is the best in Vietnam!!) ~ and ‘took our nap’ and then were collected by Dr. Quyen, the pediatrician from the Autism Clinic.  Again, we apparently require direct supervision…at all times.

Dr. Phuong presenting a gift to Amy.  This is traditional here in Vietnam.  So nice.

(l-r) Amy, Dr. Phuong, 2 of the therapists (unsure of their names), Me

Lunch is served!!!  Always so beautiful to the eye...and delicious too.

Some rearranging of the plates to accommodate the soup, which Amy and I finally figured out always is served last.  

Fish covered with tomato sauce (chopped tomatoes).  It was really tasty.

Small fish (sardines?)...fried...very crispy and quite good.  A little salty too.

This is our favorite fish.  It is a 'river' fish, but has a wonderful flavor, which I think includes tamarind.

Buoi ~ my favorite grapefruit.  This is a slightly sweeter variety than the more pale yellow kind.  Still just perfectly delicious.

Mangosteen ~ just wonderful.  They are in-season from June - January and we were told the uglier the outside shell looks, the more delicious and perfect the inside will be.  They are kind of marshmallow-y in flavor.

This is what the mangosteen looks like when you remove it from the shell.  You can separate these sections and eat them one-at-a-time or pop the whole thing in your mouth (they are small).  The largest section does seem to hold the pit, which is not edible.

The afternoon at the clinic had Amy seeing 4 patients with Autism, ranging in age from 3 ½ - 9 years old.  They definitely represented the ‘spectrum’ of Autism Spectrum Disorder, except for one girl, Minh Ahn, was a little girl with a past history of seizures and who was taken off seizure medications at 1 year of age.  She is now 3 years old and both Amy and I are suspicious that she is continuing to have seizures, rather than presenting with Autism.  Interestingly, each and every time we have come to Vietnam, we have seen at least 1 child who appears to be actively seizing and no one is noticing this.  So, Dr. Quyen was going to refer her to a colleague, a Pediatric Neurologist, for further evaluation and an EEG. 

My role while Amy was discussing joint attention and 2-way communication, was primarily to video and photograph the sessions, but there were certainly instances when we were discussing how to provide sensory information/play and how to integrate motor activities into these children’s lives, so that's where I could best jump-in.  Amy was such a champ with the ‘marathon’ of Saturday and this afternoon (Monday) and all day on Tuesday, as it is difficult enough to evaluate and provide some practical examples for parents to do at home, but to do all of this with translation required for each and every step was doubly challenging.  Also challenging is the view of ‘play’ in Vietnam.  So, the emphasis on having parents join into the play activity their child was doing to foster 2-way communication and the development of joint attention, was made even more challenging and required a lot of examples ~ both practical and written ~ and lots of repetition.  It began to feel a little like ‘groundhog’ day for Amy throughout these experiences, but this is the starting point and Amy and I will continue to communicate with Dr. Quyen via email to help her to continue to help her families.  Amy suggested to Dr. Quyen she start a support group for the families of the children she is caring for, as although these families are all well-connected via email, a support group could provide them all a face-to-face opportunity each month or every couple of months to talk with each other and to perhaps allow them to know they are not alone in these challenges and frustrations.  Their frustrations, questions and challenges are exactly the same as the parents of children in the US, as well as the children here who present with Autism present exactly the same as those children present in the US.  Really makes one think about what is really going on???  

Here's some more photos of the kiddos from the Autism clinic...

This kiddo's name was Tan (pronounced 'Daan').  He was 6 years old and had a wonderful dad with whom he was well connected.  His dad had really nice instincts when given a little bit of guidance for activities to engage his son.  His father also spoke English.  He has a diagnosis of Autism, but also presented with some cognitive impairments as well.  

This 5 year old boy really struggled with the clinic environment and the new people he was seeing.  He calmed when dad gave him is iPhone to play music on while we were talking.  He sang little songs the entire visit and had a lovely singing voice, so Amy worked with his parents to engage with him musically, as that is clearly his strength and what he enjoys the most.  

This is Minh Ahn.  She is nearly 4 years old and had a seizure disorder as an infant.  Her medications were stopped at 1 year of age, but we suspect she is still seizing.  I saw 3 possible seizures in the time we were with her and her mother.  Dr. Quyen will refer her back to a Pediatric Neurologist for further evaluation.  Although she has a diagnosis of Autism, it is difficult to tell if this is the correct diagnosis or if she is still having seizures that these are influencing her behaviors.  She was super-sweet and quite engaging, although at times that I believe she was seizing, she disengaged and then shortly thereafter was able to re-engage again.  

She had these awesome little Croc-like shoes on that were like little caterpillars.  So cute.

She sat herself down in a little tub of balls and kind of camped-out in this little bucket for most of the session.  She was super sweet.

This was the last child on Monday afternoon ~ a 9 year old named Hai Trien who has a diagnosis of Asperger's Syndrome.  He really struggled just being in the room with us and spent most of the time with his face against the wall behind him.  He is non-verbal at this time.  Because of his age, Amy spoke with his parents about establishing his independence with 'life skills', as their primary concern was what would happen to him as they age.  Unfortunately, at this time, he doesn't yet know how to dress himself, take care of himself, etc., as his mother does this all for him.  We are hoping after our meeting with them, that they start working on teaching him these vital skills he will need to survive in the future.  This was a tough way to end the day.  My heart went out to this family. 

Tuesday ~ all-day ~ was more of the same with a wide-variety of kiddos seen.  Because Hoa (our IEP translator) was in class all-day again (dedicated student that she is!!), Dr. Quyen invited 2 other young people to help us with translation.  They were Hanh and Michael.  Michael's real name is Thieu, which is difficult to say in Vietnamese, so he chose the name Michael during his time living in Belgium from 2008 - 2010 getting his master's degree in Chemistry.  Hanh is a junior at University now and these young peoples were great.  Their English was so great, but even better than that was their enthusiasm and interest in what we were doing.  They did a lovely job!!  We also had Fruma Nyska join us on Tuesday morning.  Fruma is from Israel and was formerly a teacher there.  Her husband, Meir, is one of the surgeons on the project, and Fruma always travels along with him on all of his adventures.  We love having her around us, as she is so wonderful and she really enjoyed her morning spent with us at the Autism Clinic.  Meir and Fruma, aside from him being an orthopedic surgeon, have a fully functioning farm in Israel on which they grow dragon fruit, grapefruit and have recently begun making their own gourmet olive oil.  They are a great pair!!

These kiddos ranged in age from 3 - 7 years old.  Many of the children we saw on Tuesday were quite severely impaired and so our work with them began, on several occasions, with providing basic sensory input into their bodies, either by swinging them in a large blanket or rolling then up in the aforementioned blanket, as they needed this external assistance/support to be able to make sense of their environment.  Given the over-stimulation that is Vietnam, it is no wonder these children are struggling with even the most basic of self-regulation abilities.  Needless to say, this was challenging work over the past number of days, but highly worthwhile and is likely a relationship ~ between us and Dr. Quyen ~ that will continue to grow.

This was Trong Nhan, a 7 year old boy with Autism.  He exhibited a lot of weakness throughout his body, so we talked a lot about increasing his physical activity for strengthening, but also to increase his time engaging with his parent(s).  He liked to do a little jumping, but would get quite tired.  He spends a lot of his time right now watching television and playing with an iPad, because he does not easily engage with his parents.

Amy teaching Dr. Quyen (middle) and a parent.  All of the parents expressed gratitude for all of the ideas Amy was able to share with them about their children.

This little guy ~ Thinh ~ was 3 years, 8 months old and has an autism diagnosis.  He has a pretty significant language delay, which is likely a better diagnosis for him rather than autism, as he was fairly engaging and social.  

This little girl (out on the balcony) was Khang.  She was 4 1/2 years old and had great difficulty with self-regulation.  She was very scared and upset ~ which is typical for her if she leaves her house ~ and the only place she would calm down was on the balcony, so this is where Amy worked with her parents.  She also appears to have significant cognitive limitations and exhibits a lot of self-injurious behaviors.  Her parents were very concerned, of course, and were very open to Amy's suggestions and ideas.  She is a very pretty girl and is fortunate to have such wonderful and patient parents.

Such a beautiful little girl.

This is Khang.  He is just a little over 3 years of age.  He has a diagnosis of Autism.  He likes to imitate language and words and like many of the children with autism, knows all of his numbers, colors, letters.  He had a lot of difficulty with joint attention and interaction, so Amy worked with his mom on increasing his ability to engage with another person.

This is another picture of Khang.  He's so handsome.

This is Ngan Phuong (pronounced 'Nyan Fung').  She was nearly 5 1/2 years old.  She also has an autism diagnosis.  Flecher, our team's filmmaker, came by to do some filming and she tolerated this well and worked well with Amy and her mom.  She is a very pleasant child and with some practice on engagement with Amy and then her mom, made some nice changes during this 1 hour session.

I love her little fountain pony-tail atop her head and the turtle on her shirt.

This handsome guy is Khang Ti.  He is 5 years, 3 months of age.  His aunt and cousin came with him, as they are his caregivers.  He had tetanus when he was 18 months old + seizures, so it was unclear if autism was the best diagnosis for him.  He had a lot of difficulty organizing his movements of his body, so we focused on giving him more sensory information into his body, which worked well for him.    He was practically throwing himself down onto the blanket and was trying to roll himself up in the blanket for more sensory information.  He was very silly too and had a great laugh. 

This was Thang, a 35 month old boy.  He came with his father and grandmother initially and his mom came a little later.  His father was so engaging with him and so caring.  He related to his father well.  He is in need of a lot of sensory information and is very disorganized in his movements.  They had seen a doctor in Saigon who diagnosed him with autism and told them to do sensory activities, but never told them what that meant.  So, we were able to give them several sensory activities to do with Thang.  

 This was the last child we saw and his name was Tien Minh.  He was a little over 5 years of age and had the greatest difficulty organizing his body, as he was practically bouncing of the walls.  We finally showed him how to roll up in the blanket and/or to put it over his head and he then spent the next 15 minutes while Amy was talking with his family laying under the blanket while I gave him compression throughout his body.  He was seeking this information and finally was able to maintain a somewhat calm state once this information was provided. 

Both Amy and I suspect by the time we again return to Can Tho ~ likely within the next couple of years ~ there will be more children with Autism diagnoses, as previously in Vietnam's history, as was the same in the US' history many years ago, these children were never taken outside of their homes, etc., and now parents here are sending these children to school and they are engaging in the community, so there cannot help to be some necessary reaction as a result.  It will definitely take time, but Amy and I are already discussing how we can help Dr. Quyen and these parents even more completely the next time we return.  Although this is my 4th mission trip with IEP, I continue to be surprised by and open to all of the new avenues our work here continues to take.  I think that is one of the many things this work has taught and is teaching me ~ to be open to whatever comes your way and to make the greatest impact I can on each and every family and patient I encounter.  This work is such a special gift to me!!!

So, after our marathon day at the Clinic, we joined Dr. Quyen, Hanh, Michael, a parent of one of the children with autism we saw on Saturday (who is also a good friend of Dr. Quyen's, but I cannot remember her name), and also Dr. Phuong, the pediatrician from the Children's Hospital, for dinner.  They were very kind to invite us out.  They took us to a fish restaurant and we sampled a wide variety of delicious foods....(see below!)...

The 'pancake' on the upper right corner of the pictures is a rice pancake, made by basically laying a layer of rice in a hot pan and cooking it 'til it's golden brown.  It is then gently folded in-half and then you break off pieces and dip it into a wonderful compote, located just to the left of the pancake.  It was so delicious...and the 1st time we have ever had this treat!

This is dried fish (kind of like jerky) over thinly-sliced mango.  It was quite tasty too.  First time I've ever had the dried fish.  

This is a blackened river fish covered with greens and peanuts.  It was quite fishy tasting, but was pretty good.  

This is the 'special fish.'  It was deep-fried and served 'standing-up.'  It was really delicious and was eaten over a small bowl of rice with nuoc mam (fish sauce), if you so chose.  

The Can Tho ladies serving us the delicious fish!!  These ladies, and all ladies in Vietnam, are so hospitable and warm. 

(l-r) Hanh (translator), Amy, Michael (translator), Dr. Quyen (physician for children with Autism)

(l-r) Dr. Phuong (pediatrician at Can Tho Pediatric Hospital), Dr. Quyen (pediatrician in private practice, sees many children with Autism), mom of one of the patients with Autism we saw on Saturday (she is an architect and a Can Tho city planner)

These are 3 power-house ladies...lots of education and knowledge.  Very kind and lovely as well.



Someone told me that in the Mekong Delta, historically, people would never ask, 'How are you?' upon meeting a friend and/or a new person.  Rather they would ask, 'Are you hungry?', as because in Vietnam's history, especially in the southern part of Vietnam, there were always hungry people, so this was the initial greeting and concern and it seems as though it still is, as they love to feed everyone!  Thank goodness the food is so delicious!

We said our goodbyes to all of the ladies (and gent) and I know we'll see them all again very soon.  It was a great, yet challenging, experience, but I think the impact that was had on the lives of so many parents and their children over the past few days was such a good start.  A good thing, for sure!

I haven't updated on the surgical side of things since the screening days, so here's a little detail...

• 36 surgeries were scheduled, 87 patients were screened for possible surgeries (done in 2 days)

• Began last Thursday and will end tomorrow (Thursday)

• 2 surgical residents, 5 attendings

• Of the 36 cases scheduled, 5 are for children under the age of 5 years.  In the past this has initially been a little challenge, as the General Hospital has to request a Pediatric Anesthesiologist come over to do the anesthesia for these little patients.  This year we were told they would not do this.  This presented quite a frustration for our team, as many of the patients the General Hospital pre-screened for us were pediatric patients and so we felt it was unfair to the families of those children to allow them to see the team from the US, but not to be helped by them.  So...Dr. Phuong, the pediatrician at the Children's Hospital with which Amy and I work is friends with Dr. Em, the chief surgeon at the General Hospital.  My understanding, as of this morning, is that the surgeons were going to do the pediatric cases (< 5 years old) at the Children's Hospital (for the 1st time), so they would be completed by the IEP team.  Very confusing and took some time, but a good outcome.  Phew...
• I am not going to post surgical pictures here, as it might gross some folks out.  If you are so inclined, you can go to IEP's website at www.internationalextremityproject.blogspot.com or if you are a Facebook folk, then you can look at the page for the International Extremity Project and can find photos there.

So this morning, Amy and I and Ann and Laura, Jeff's (one of the surgeons) wife and daughter, boarded a mini-bus for Saigon (aka Ho Chi Minh City, aka HCMC).  The driver was given 2 specific instructions ~ (1) First stop is the airport, as Ann and Laura were leaving for the US at 330p today, and (2) Second stop is to take Amy and Stacy to District 3 of Saigon (a big neighborhood/area of the city) and call a large taxi for us (as the mini-bus will not fit down the alley through which we access our hotel in Saigon).  Our translator in Can Tho, we think, communicated this information, but alas, when executed by the driver of the mini-bus, the stops were reversed, which wasn't a great thing due to the timing for the traveling ladies.  Good think Amy has been practicing her Vietnamese ~ she was told in Can Tho her 'accent' is nearly perfect, but when we got to Saigon, no one seems to understand her??? ~ and she was able to tell the driver, 'NO!  Airport.'  Crisis averted, as our District 3 neighborhood was only about 15 minutes from the airport, so they arrived in time for their flight.  We then turned around to return to District 3.  We had just crossed into District 3 and the driver passed a taxi (a large sized one ~ we still have 2 boxes of supplies for the hospital here), told him to pull over and then in a random spot on the side of the road, we transferred everything from the mini-bus to the taxi and were on our way to Ma Maison (our hotel).  We think the mini-bus driver was 'over' it and us and just wanted to move along back to Can Tho.  All turned out well, as our taxi driver knew exactly where to go. 

We pulled up to the sign in the alley and unloaded all of our things.  The taxi driver seemed a bit concerned we were going to carry our 2 large suitcases, 2 large totes and our large backpacks, but we tried to assure him we would be fine.  He seemed assured and left.  Amy took her rolling bag through the alley and I waited with the stuff.  Shortly a little Vietnamese lady came running toward me to help.  I wanted her to take my rolling bag, because although it appears to be growing and getting larger, at least it can be rolled, but instead she picked-up one of the totes and started running back down the alley.  Yikes!  Use your legs, madam...that tote is heavy!  Then, as I still waited, a young man came to help and he hoisted the final tote on his shoulder and I managed my bag/backpack to arrive at the lovely hotel ~ Ma Maison.  Ahhh...so nice to be back!

Our home...for the next week.

A little different angle...the entrance is at the bottom right.

My room.  So nice.

My adorable rotary dial telephone.  It's spectacular!

My desk...with a really fast internet connection.

 Amy found this lovely boutique hotel in 2010 and we had a lovely stay here then.  In Saigon, the city center is called District 1 and it is where most of the shopping is located and the Benh Thanh Market is also located there.  Think football field with very narrow aisles and vendors for everything and anything you could ever need and/or want located within that space.  I will post pictures this weekend.  More to come on this...

So, Natasha, the owner of the hotel, again greeted us and when we were making arrangements to return to stay, she so nicely she remembered us from our previous stay.  We were probably memorable in that we brought really large suitcases and loads of extra totes and each day we would return from the hospital looking oh-so-beautiful.  They took great care of us during our last visit.  It is a 5 story building ~ no elevator ~ and each floor has 3 rooms.  Each room is either a single or a double, so Amy and I both have our own room for this leg of the trip.  The room is just beautiful and so well-appointed, making it such a comfortable place to stay.  So happy now...

So, within 15 minutes of our arrival, the skies opened-up and it began to rain...and then the power went out!  This has happened before in Saigon, as when it rains a lot the power lines can sometimes break.  Yep.  So, it got a little roasty in my little room, so while Amy took a nap, I went down to the 1st floor, sat on a lovely window seat with a cushion and read a book.  It kept raining and raining and raining, so I was given a lantern by which to read and had a relaxing afternoon.  Finally, it stopped and after about 3 hours, the power was restored ~ and is still working ~ so all is right with the world.

Amy and I then decided to get a little dinner and so we walked down the alley to the main drag ~ Cach Mang Thang.  We weren't even out of the alley and I already had folks pointing at how tall I am and even got a kiss on the hand from a 'friendly' gentleman.  Welcome to Saigon to me!!  Saigon is definitely a big, big city and so we walked a bit and remembered very quickly that when walking fully attention must be paid, as the motor bikes are going all different directions and you have to be ready to move quickly.  No chatting and walking allowed in District 3!

We did encounter an amazing site as we were walking along.  There was a large bridal boutique (at least we think so) and they had living models lined-up as folks entered the building ~ men in tuxes and women in wedding gowns.  It was such a sight...

There were 6 models on each side, men and women.

Bridal style in Saigon.

 So, a great trip so far and we find it hard to imagine we are done with the first 'phase' of the trip already.  It goes by so fast, because we stay so busy.  We begin working at the Pediatric Hospital #1 in Saigon tomorrow morning.  We will be picked-up at 730a by the assistant director of the rehab department so we will be off-and-running.  Our work here is always very organized and scheduled, so we will be busy, but it will be so great to see all of the therapists we have gotten to know over the past trips.  

xoxo
Stacy