Neuroanatomy 101 ~ via translation, a Farewell to IEP, and becoming Vietnamese Chefs (well...not really)

Friday has come and gone and another week has flown by here in Vietnam.  It is quite hard to believe I have been here nearly 2 weeks and that our time is waning.  It's always so interesting how I/we develop such a flow to our lives here while traveling and working and after this amount of time, it feels more relaxed and easy.  A big part of this, especially in Saigon, is our lovely hotel.  It is truly an oasis of quiet and peacefulness and the staff here take such amazing care of us.  The other day, the owner, Natasha, expressed great concern that we have not asked for anything while we have been here (i.e. tea, coffee, or fruit in our rooms) and reminded us these are complimentary.  We the immediately asked for some fruit (as we didn't want to be rude) and within 5 minutes I had a plate of 3 grapefruit sections, a slice of dragon fruit and a large wedge of watermelon.  Truly is lovely.  

I haven't had my cell phone on for 2+ weeks and I can honestly say, I don't miss it at all and I really only check email 2 times each day (morning & night).  Several of the non-medical folks that started our journey with us in Can Tho were very concerned with their connectivity here and most of us medical team folks were so happy to not have our phones at all.  It was interesting.  There is a simplicity of life here which, albeit at times is challenging, is a nice reminder to slow down and take a deep breath.  Although in Saigon, try not to breathe too deeply...the air quality is severely lacking in its cleanliness!!  ;)

Now onto more important things...the cuteness we saw on Friday!!

Here is the sign greeting us in the Rehab department at the Pediatric Hospital #1 in Saigon...

  
They also gave us name tags and our names are now ~ Stacy Lerver and Amy Lervin.  Seems like our work here is being sponsored by the Letter 'R'.  (sorry for the Sesame Street reference...has to do with working with kiddos all day)

Our day continued with many children with hypotonia or floppiness.  There were several different explanations for their floppiness, but the commonality amongst all of the babies/kiddos was that they were so super-cute!!  There, again, were some children with some difficult conditions and we had to have a couple of conversations with the staff and parents about these conditions to help them all better understand the typical trajectory that we would expect for these children.  This is one of the more challenging parts of this adventure for me.

This beautiful girl is Quynh (pronounced 'Quin').  She is 4 1/2 years old and has a diagnosis of Spinal Muscle Atrophy (SMA).  She is very, very weak, but is still able to walk independently although it is difficult.  There are various types of SMA, but they tend to cause progressive weakness.  It is unclear when she began to show symptoms, so this makes it difficult to determine the possible prognosis.  I think she has Type 2. 

Her mother and grandmother came to this appointment and her grandmother thinks the doctor was wrong with her diagnosis.  We encouraged them to seek another opinion and they were given the name of a Pediatric Neurologist to see, but I am fairly certain her diagnosis is correct. She uses her hands on her knees to stabilize her body.

Quynh was very nice and although she was shy, she did all of the exercises I showed her. 

This is a good picture to show the staff observing while I am teaching.  In this picture, the mother and grandmother are located in the center and are speaking with Giao, the director, who serves as our primary translator here in Saigon.

This little lady is Anh.  Wow...was she so adorable!!  She is 8 months old and has Down Syndrome.  She was such a champ, as she was very motivated to move independently and could roll in all directions, pushes up onto her hands when on her tummy and is beginning to crawl on her belly.  She looked so great and was such a delight!

She is so strong and so motivated to engage and to move!!  Her mother was so wonderful with her and they just adored each other, which is always so nice to see!

This is a toy we brought for them in 2010, I think.  It's a great toy and little Anh just wanted to eat it!  In Vietnam they don't like babies to put their hands in their mouths or to eat toys, but we have been doing lots of education as to why this is important for infants, explaining that through their mouths they learn so much and explore their environments.  After a little moment of horror, the Vietnamese staff seemed more comfortable that this little one liked the toy. 

She was such a chub-a-lub, but so darling.  We had a great time together!

She's intent on getting this toy to her mouth!

This little guy is 26 months old.  He has a diagnosis of Agenesis of the Corpus Callosum.  This basically means the middle part of the brain that provides a connection to/from the right and left hemispheres did not develop and so there isn't communication from one side of the brain to the other.

He is working toward sitting independently with his therapist (seated to my right).

We also worked on increasing his tolerance to putting weight through his hands for strengthening of his shoulders, trunk and back muscles.

We also worked on some more independent sitting on a small bench (or in this case, my leg).  He did a nice job keeping his feet on the ground in a weight bearing position. 

His therapist did a great job of practicing these treatment approaches with this little boy.  Our goal is to not only show them what we would do with these children to help them improve, but more importantly, is to teach the therapists how to use their hands and their own bodies to work with the children.

This is another adorable little lady with Down Syndrome.  Her name is Hoang and she is 8 months old.  She is quite floppy and is just working on pushing up onto her hands when on her tummy, as well as increasing her ability to hold her body up in a supported sitting position.

This is her mom on the left and her therapist holding her.  

So sweet!  Amy also worked with this little one, as she does not eat by mouth, only by NG tube through her nose.  So Amy worked with mom on trying some feeding with her, which went well.

This little boy came with his grandmother.  He is 9 months old and is named Khang.  His brain was not formed quite correctly and so he has some eye problems, as well as movement problems.  He is working on pushing up on his hands and sitting with support.  His body is quite complicated and so this prompted the start of a Neuroanatomy lesson for the larger group, as they were struggling with understanding how the brain's development can affect movement. 

Talking with Khang's therapist and grandmother.  







 Our neuroanatomy lesson continued as the final patient of the morning was ill.  Amy acted as my 'white board', writing-out many complicated words about the brain, so that greater understanding could be achieved along with the translation being provided by Giao.  I couldn't have done this talk without Amy's help.  It was a 2-person effort, for sure!  It was a very tiring conversation, as it was complicated and with translation makes things move much slower, but a necessary conversation as previous to now, they weren't understanding that what happens in the brain dictates how the body moves, feels and can be controlled by the infant or child.  It was a very worthwhile conversation and I am hoping they will start to make these connections more readily and easily and what likely will also happen is that they will begin to do more research.  

In Vietnam, 'therapists' are trained basically as a physical therapist via university-training.  They majority of their learning, though, is on-the-job and via more experienced 'therapists.'  They are now, here in Vietnam, doing more specialization of training and there is now a speech therapy training program being administered by the Australian Speech Association.  It has evolved a lot since we first came in 2004, but still is a work-in-progress.  This discussion today though was met with great enthusiasm and great questions, so this was exciting! 

We also had another delicious lunch in the 'Nutrition' department of the hospital...

These are steamed shrimp (paste) on sugar cane sticks.  It was delicious and the sauce (red) was a touch spicy, which was great!

This is an egg-drop soup with mushrooms and corn.  Quite tasty.

This was a beef soup (for the Vietnamese staff dining with us).  Didn't try it, as I don't eat meat, but the colors were fantastic!

 After much-needed showering, our night concluded with a farewell dinner with the IEP medical team, as they were all traveling back to their respective homes (US & Israel) on Saturday morning.  Amy and I are now the only folks left in Vietnam...still working.  :)

We dined at Le Bouchon, a nice French restaurant in the 'fancy' part of Saigon.  It was quite delicious and we had such a nice time seeing everyone for one last time in 2013.  It was a successful mission in 2013 for the surgeons and medical team, so for this we are quite grateful!!

Flecher & Meir, with Chris taking a bite in the foreground.

Jenni (in glasses) and Diane

Lex, Jenni & Bruce's 6 year old, showing an 'upside down smile.'  He and his brother, Logan, (8 years) were such troopers on this trip, but were ready to go home at this point.  Thank goodness for their Uncle Chris (who was fantastic!), as he did such a great job taking care of them in a not-so-kid-friendly locale!!

Flecher in the foreground, Fruma & Chris sitting together.

Bruce (white shirt), some other dude (?)...photo of the restaurant.

The long-view of the table.

Love the Banh Mi...delish!

Green salad with goat cheese croutons.

Lex...taking the biggest bite of pasta that a 6 year old can handle!  He is a ham...just like his dad!

Grilled snapper with vegetable ratatouille...was quite tasty!

It is always a little sad to say goodbye, as many of these people I only see when I travel to Vietnam.  I really think our work together has melded so well and after 4 missions of the surgical team and me being together, with Amy manning the intake system, it is such a great group!!  Last summer, Bruce and Meir and a colleague of Meir's from Israel, did a mini-mission to Namibia in Africa and there is discussion of returning there (and possibly Botswana too) in Summer 2014???  I hope to be a part of that team.  

Meir and Fruma have insisted Amy and I come to Israel to visit them and we are hoping to make this trip happen soon.  I would love to spend more time with them, to meet their family, and to see their wonderful farm.  Maybe very soon???

I always seem to be planning more travel while I am still traveling.  Hmmm...

Saturday morning came along and we made our way to the Ben Thanh Market to attend the Saigon Cooking Class.  This was recommended to me by Michelle M. in Omaha, who was one of David's nurses at the Nebraska Cancer Center.  She and her husband were recently in Saigon and took this class so she recommended we try it while we were here.  If you are ever in Saigon, this is a must-do!!  The website is www.saigoncookingclass.com.  Such a fun experience!!

It began with a market tour/shopping experience, which was so fun, as always.  I love walking through the market ~ especially the food sections.  

Disclaimer ~ There are some photos below that you may or may not want to see.  Use your discretion.

Ca Phe Sua Da (Vietnamese Coffee) (Ca Phe = coffee, Sua = sweet (via condensed milk), Da = ice)

One entrance to the Ben Thanh Market

An eggplant varietal

Pig's feet

Seafood

Soft-shell crabs

Carrots, lettuce, melon (in front)

Eel.  I decided not to post a video of how these are cleaned and prepared.  This picture likely paints enough of a picture.

Something like a turnip

Morning glory (vegetable) that has been shredded.  See below for how this is shredded.

Bamboo.

Not sure how to describe this in English, but the color is fantastically orange!

Say cheese...soft-shell crabs!!  They are stacked one atop another, waiting for sale...and yes, they are still moving a little bit.

Limes in the front are larger and kumquats are in the back and are smaller.  The kumquats are served with Pho (noodle soup) and until now, Amy and I thought these were little limes.  Not so...a kumquat. 

Bull-head fish.  Laying in a flat pan with just a little water, waiting for sale.

This is salmon and tuna from Japan.  It is quite expensive here in Saigon.

Salmon, imported from the north end of Japan.

Blue crabs...love the colors!

Giant squid

Shrimps, as they are called in Vietnam.

Meat.  All of the meat and fish are delivered to the market every morning, as it is caught/slaughtered around 2 or 3 am each day.  Whatever does not get sold in the marked on the day it is prepared, it is taken to a factory and packaged into cans and sold as other foods.  There is no refrigeration or freezing of foods in the market or in Vietnam.

Pork ribs with pork fat waiting for sale.

Pork ribs.

All parts of the animals are for sale.  There are intestines, hearts, kidneys, tongue, and brain shown in this photo.  These are all from cattle.

These are hearts (on the left) and pig intestines with pig ears (on the right).

Always is a beautiful photograph.  It is tripe.

These are boiled silkworms.

This is watercress.

Ben Thanh Market...where anything and everything can be found and bought!

Bing cherries...imported from the US, as they are not grown here in Vietnam.

Noodles...yum!

Dried mushrooms.

All manner of soy products ~ tofu of 2 varieties (firm, soft) and soy milk, etc.

Frogs...being cleaned and prepared.

Bamboo, ginger, and other vegetables.

These are tails.  I am truthfully not sure from what type of animal, but my guess is from water buffalo.

Pig ears and intestines with a little lung located on the left.

We then took a taxi to the Hoa Tuc restaurant, near the Opera House, and the cooking school was located on the top floor.  There were about 12 folks in the class, including me and Amy, and it was a varied cross-section of people.  A couple from New Zealand, a young gent from Scotland, a woman from Japan, parents and their teenage son from Louisville, Kentucky, a couple from Australia, and a couple from England (I think?).  Our teacher was Chef Khang and it was evident he had been trained in Australia, as he had an interesting Australian-Vietnamese accent.  He was great...a good teacher and we had lots of fun!  Now to the good part...the food!!

Our menu was as follows:

• Fresh Spring Rolls with Shrimps and Rice Noodle with Peanut dipping sauce (pork can also be added)
• Water Spinach salad with prawns, fried shallots and garlic with a Kumquat dressing
• Prawns in clay pot with coconut meat, fresh Vietnamese basil and coconut juice
• Passion Fruit custard 

Our cooking stations.

My knife!  Mad me think I need to get my knives at home sharpened again when I return.

Our items needed to make the spring rolls.

(top - bottom) Garlic, pepper (not hot), peanuts

Chef Khang

Peanut dipping sauce

Rice paper, before water was put on top to soften it.  Don't use too much water though.

 Instructions ~ Lay lettuce down, cover with bean sprouts and rice noodles, lay basil and mint on each side (2 leaves of each), and lay cut shrimp in front of the lettuce.  Fold in the sides of the rice paper and begin to roll.  Once you have rolled just past the shrimp, then stop and add the scallion that is shown below.

Ta-da!!  My 1st spring roll...made by Stacy!!

The final product.  Our appetizer.  Was super-delicious!

Rau Muong (morning glory vegetable)

Peppers...not hot.  These will be made into a lily-like flower for garnishing the plate.

Our tools for the 2nd dish.  (l - r) Fancy knife (for cutting carrots with a scalloped edge), Vegetable peeler (with wooden handle), Rau shredder (thin plastic piece with green cylinder at the top), 2 knives

For the 2nd dish...prawns, water spinach (at top), onions (right), basil (left)

My lily, made from a non-spicy pepper.  We then placed them in ice water so they would open up a little more.

Dressing for the salad.  Fish Sauce, Kumquat juice, a little sugar, garlic, peppers (both spicy and not-spicy) and peanuts.

The Rau Shredder.  Rau (green vegetable) is hollow and so we thread it up a long metal spike and then pushed it through these razors to shred it into small pieces.  It was a little tricky at the beginning, but then we became pros in no time!!

The vegetable peeler. 

Carrots...after we used the 'fancy' knife to make them pretty.

This is the Rau, after it was in ice water and then wrapped in cheesecloth and then banged on the towel to get the water out.  After we banged it on the board and then twisted it around, it came out all entangled which was the goal. 

My Water Spinach salad with a pepper lily.  It was so tasty.

Clay pot...and my own personal burner!

Blue prawns with coconut meat.

Garlic & Red Pepper

We're on our way...a little oil, some garlic and then our prawns and coconut meat.

Class, in action!

Our cooking stations.

Long-view of the table.

A better lay-out of our tools.

Peeling carrot with the peeler.

Adding coconut water.

Nearly done!

Final product...served over rice!

 We did not make the passion fruit custard and I realized I forgot to take a photo before I finished it.  Let me just say it was yummy!

We then went for a stroll and started doing a little shopping.  Here's a few sights from Saigon...

Who knew...you can apparently now buy Christian Louboutin shoes in Saigon. 

Pretty archiecture.

A couple of kitties, relaxing in the afternoon.

The Opera House.

Traffic on Le Loi Street.

  Shockingly, it was warm on Saturday, but not too hot!  We walked and shopped until mid-afternoon and then returned to Ma Maison to relax and clean-up before our dinner/party with the hospital staff.  

I will post separately about the hospital dinner + party...it was an adventure!!

xoxo
Stacy