And we spent our 2nd to last day at the Pediatric Hospital #1 here in Saigon. It was a more challenging day for both of us, I think, and we both were trying to talk about/teach about topics that are new and a little more challenging for the staff here. I feel like I talked for 8+ hours today and I have been losing my voice a little bit, so am hoping resting it tonight allows me to talk tomorrow.
Amy and I were split-up today, as she spent her day with the 'speech therapists' and I spent my time with the 'physical therapists.' My day was spent seeing patients with Brachial Plexus injuries, which are simply injuries to the cervical spine (neck) that occur during a difficult delivery and/or when a baby is quite large and gets stuck and then the neck or shoulder gets distracted (pulled) and then damage to the nerves coming off of the cervical spine occurs. These little ones then have 1 arm that doesn't work the same as their other arm and this creates a life-long challenge for them and their families. It is a challenging diagnosis for families and children in the US and especially so here in Vietnam, as although there is a fairly progressive approach to surgical management of these problems (I have learned today), the therapist's sophistication with working with these children is at the beginning of understanding.
This is not a population of children I typically see, as they are usually seen by Occupational Therapists in the US, so this creates a challenge for me to discuss these kiddos, recommend treatment approaches and to then tomorrow do a lecture on this topic. Again, I have learned a lot from all of my research and planning, and I have seen a number of these children throughout my career, but it is a challenge for me, which I like.
So here's some pictures of some cute little ladies I saw today...
This is Ngan (pronounced 'Nhahn'). She is 13 months old and was very upset even before I stepped into the room. She cried so much, so I worked with her just a little bit and let her mom comfort her. She has a problem with her left arm and has had a nerve graft done when she was 6 months and has had a little bit of recovery of her function, so far.
Her orthopedic surgeon, Bac Si Minh, came to meet me and we chatted about her progress and his approach to treatment of these injuries. Despite looking like he was about 25 years old, he clearly is knowledgeable about these injuries. He will be attending my lecture tomorrow.
This little cute lady is Hang. She is 10 months old and her left arm is affected. She was a very big baby, weighing nearly 9 pounds, which is HUGE for a Vietnamese baby. I am not quite sure why a C-section wasn't done for this baby...it is a little unclear when they decide to do a C-section during deliveries here.
She had fairly good movement of her shoulder and her elbow, as her main involvement was her hand. She has not had any surgical intervention, but gets therapy at the Children's Hospital.
She could grasp this container with her left hand, but had some difficulty moving her thumb. She was quite a cute little sprite and very friendly with me!
This is called a jiggler and it vibrates. She liked this quite a lot. In this picture you can see it's a little difficult for her to move her left shoulder and her fingers are not quite fully mobile. We had fun together and she had a cute little laugh.
This cute little 3 1/2 year old is Khanh. She weighed nearly 10 pounds when she was born and again, not sure why a C-section wasn't done...her mom was tiny!! In any case, her right arm is involved and she has had a nerve graft done at 13 months and in later February she will have a muscle tendon transfer, which will hopefully improve her ability to extend her wrist and turn her hand palm-down.
She was super-social and engaging. She too liked the vibration of the jiggler. In the background is her PT.
She liked to play with this koosh ball. She frequently tried to use her right arm/hand while playing spontaneously.
You can see her right hand is turned palm-up and this is her resting position.
She was quite fascinated with my camera, so I taught her how to use it and while I was talking with her mother and grandmother and the therapists observing, she took 22 pictures of very random things. She was totally into pushing the button and even tried to use her right hand 2-3 times. Adorable!!
This little 2 month old is Thinh. She was also a nearly 9 pound baby. Her left arm does not move at all, as it is quite impaired. She will, if no recovery occurs in the next month, will have a nerve graft surgery around 3 months of age. Her mother was very sad her arm didn't move (and so was I), as in Vietnam, if you are disabled, you typically cannot go to school, get a job, etc. I tried my best to reassure her that this beautiful baby will learn to do many things. I was sad I could not tell her things would be normal for her baby.
She was just darling. I am hoping she will get some level of recovery of function over time, but her arm is quite limited in its movement at this time.
This spunky little lady brought this huge hammer that squeaked when it was hit against something. She is 1 year old and her name is Nhi. She did not like me, but didn't really cry. She just furrowed her eyebrows at me, every time I either got too close, touched her hand or made eye contact. It was quite funny. Her left arm is affected and she has limited movement of her hand at this time.
She liked the flower toy a lot...as long as I wasn't too close. So many of these kiddos have never seen someone who doesn't look or speak Vietnamese, so they are understandably cautious and timid with us.
This cute girl is Dong. She is 9 months old and is quite a spit-fire. She is standing independently and beginning to take steps...nothing is slowing this little lady down, for sure. Her left arm is affected and she has fairly good function overall. She needs to continue with ongoing PT services and we talked about some ideas to continue her progress.
She is a brave girl!
Her mom is very good about encouraging her to use her left arm. Her hand is the most involved part at this time. It is difficult to say how much recovery she will get over time.
While I was seeing one of the kiddos in the afternoon, Giao (the director) asked me if I could work until 430p, as Amy would be working until 430p. Of course I said yes and so we continued. Wasn't sure what I was going to be doing during the 'extra' time, but I was game.
Basically, they had a couple of chapters from a textbook about Cerebral Palsy and gait (walking), so we talked about that topic. It was a little bit of a challenging conversation as the topics required a little visual, verbal and written demonstration. Today, I didn't have Amy to help me, so it was a bit more of a challenging teaching time. In the end, I think (??) they got clarification on their questions and all was well.
Lunchtime was, of course, delicious...
In the foreground is shrimp wrapped in potato and deep-fried. It was kind of like eating french fries with a shrimp. It was kind of perfect.
In the background (center) is some pasta (what??) with vegetables and squid. Never have had pasta here. Maybe they thought we were missing pasta???
In the very back of the photo are the lovely baby bananas for dessert.
Lunchtime is always good!!!
Amy, too, had a busy day working with the therapists that have primarily self-selected to do speech therapy with the children both in the day care attached to the Rehab department and those who come for outpatient services. They are at the very beginning of understanding development of language and feeding skills, but Amy is a great teacher and therapist, so she is the right lady for the job!
Here's a couple of pictures from her day...
Time for lunch in the day care. There are several therapists and nurses who take care of these children throughout the day. All of these children have some type of special need and diagnosis. This day care is paid for by their parents and is a rare thing here in Vietnam.
The children are getting ready to take their naps. They change into different clothes and then snuggle into their 'sleep sacks', which are little zip-up sleep bags that are stretchy and give them increased sensory input to provide them with organization.
More feeding. There are many more children in this day care than we have seen in the past.
This was a 5 year old boy with Cerebral Palsy, who was seen by Amy and his therapist. He is standing with his mom and grandmother.
Escapee!!! This is a great picture of a little guy trying to escape his sleep sack!!
So, all-in-all a good day, with lots of teaching done. Tomorrow is our last day of work! Wow!!
I took a little video as we were walking back from lunch and it gives a good picture of the grounds of the hospital and all that is going on...and yes, there are kiddie rides throughout the hospital grounds. :)
Will be back in the US in about 4 days...hard to imagine.
xoxo
Stacy
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