Screening Day #2...and some random stuff too

(continued from previous post)

We continued to strolling through Can Tho ~ finding a wonderful little place to buy bahn (bread) and then attempted to go out for dinner with some of our folks for Com Chay.  On our way up Hai Ba Trung Street (on which our hotel sits), the music was blaring for the party that would be happening at the Zumba stage.  There were about 30 chairs set-up earlier in front of the stage, but in true Vietnamese fashion, folks just drove their cyclos in behind the chairs, as if at a drive-in.  It was fantastic.  Loads and loads of adorable little children with their families on their cyclos, which is always so great.  Vietnam does have a helmet law now (for adults), so often a family traveling on their cyclo will have 2 helmet-clad adults and a couple of non-helmet-clad children.  Here's a few photos of the kiddos and the whole experience...

It's like a drive-in movie theater...waiting for the show to start!  So fun to see so many families out and about, which is very prevalent in Vietnam.  Very family-oriented culture.

More waiting for the show to start.  Check-out the kiddos on the cyclos.

The stage is ready for some action.  Music was blaring and was an interesting combination...some traditional Vietnamese music, some American music and some Christmas music...all rolled into one!

Look at the family just beyond the gentleman in the front of the photo.  Little kiddo in front, then dad, then another little kiddo, then a 2 year old, and then mom.  Family transportation...not quite a big SUV.

Some kiddos stand on the front end of the scooter/cyclo.  Love this little girl's coat...have to stay warm.  It was about 85 degrees and humid at this time (around 7p).

Folks waiting for the dancing to begin are on the left and then the traffic is moving in both directions along the right side of the street + that's the same side we walked on as well.  For whatever reason, it all seems to work very well.  

Loads of cute kiddos ready to be entertained!!

Families out-and-about together.  :)

Uncle Ho (Chi Minh) watching over the festivities.  He's ever-present.

Almost time...we hope.

Dragons are dancing...red on the right and yellow on the left.

More dancing...it was great!  Celebrating the start of 2013!






This video really captures the whole scene, I think.  The show, once it got, started was fantastic and just a hoot.  We stayed for a short time and then our desire for Com Chay got too great.  Oh...and the singing was horrible, but it was so fantastic at the same time.

Com Chay means 'vegetarian food.'  Vietnam has lots and lots of meats available, but I and several others stick with fish and vegetarian options, for the most part.  This Com Chay place is delicious and so we were sad when they were nearly closed upon our arrival (at 7p).   Again, in true Vietnamese fashion, the owner (an older woman) apologized for closing and as we were walking away, came out to us and asked, 'Are you hungry?'  This is a very traditional Vietnamese greeting, just as we would say, 'How are you?'  She was about 1 minute away from re-opening, but we assured her we would come back.  So nice...

So we went to Nam Bo, which is always fun and yummy.  It was a fun night out!

View from the 2nd floor...the river is just beyond those bright signs.

Another shot of the view.

My beverage choices for the evening.  A pomelo juice to start.  Pomelo is grapefruit, but in Vietnam it is super-sweet and not so tart like the grapefruit that is found in the US.  It is also called pampelmousse in French and Buoi (pronounced 'boo-we') in Vietnamese.  

Tiger beer is the 'gold' standard of beer in Vietnam.  No translation is required...just say Tiger and a beer will appear. 

The smallest round-about ever!

(l-r) Kim, our IT lady/blogger
       Amy, our medical record specialist and awesome speech-language pathologist
       Sahra, one of the surgical residents
       Diane, a former resident...now an 'official' surgeon

All enjoying a rice dessert, which is made of sticky rice and sticky black rice, wrapped in a small waffle/pancake, topped with coconut, sweet sugar paste, and peanuts.


Today ~ January 2nd ~ was the 2nd day of screenings and the great hope was that it would be the final day, so that surgeries could start on Thursday.  On Monday, we screened 42 patients and today we screened an additional 47 patients.  Needless to say, my feet are a little tired and ready to be not standing on them all day long! 

It was a more 'traditional' IEP screening day than Monday ended-up to be.  In this I mean, we saw everything, soup-to-nuts, and everything in-between.  There were several babies and children today as well and several with very odd and perplexing movement patterns.  As usual, the babies and kiddos were so charming and adorable, but there were a few that we struggled with, as we had to tell their families there was nothing we could do, but see them again when we return.  I am planning on having 7-8 of the kiddos we screened today and Monday come to see Amy and me at the Children's Hospital on Monday, the 7th, so we'll be able to give the families some home activities to work on the improve their child's functional skills.  So, a lot of energy was spent by all really trying to sort-out all of the details and make sense of some really complicated situations.  Here's some photos and videos of some selected patients...

Taken during Monday's screening.  I am attempting to explain to the parents of the child sitting to the right with the green shirt how to go to HCMC (aka Saigon) to get AFOs made for their child who has mild to moderate diplegia CP.  The doctor (Bach Si) on the left was acting as my translator.  Communication takes some time here and clearly, based upon my facial expression, some effort to make this all happen so that we are all understanding each other.

Working with a family, explaining how great this little girl looks, despite having CP.  

Bruce (surgeon), Michelle (one of the teenage visitors this trip), Bach Si Em, and Meir (surgeon).

This was our examination room for the 2nd day of screenings which held 2 plinths (tables), but was about 15-20 feet in length and about 8 feet wide.  A little bit crowded...

This gentleman had polio as a young man.  Due to his existing gait pattern (see below), his heel has continued to break-down and so what you are seeing is a skin flap that was surgically placed about 2-3 months ago.  This was his 2nd skin flap.   We recommended an AFO (brace) that would allow him to put less pressure through his heel, as he typically 'slams' it to the ground because he doesn't have control of the muscles needed to slow the motion down.  He was very grateful and happy.






Video of the gentleman above....

Lots of collaboration going on...and lots and lots of people in a very small space!!  Yikes!!

Love that Diane photo-bombed this pic!

This gentleman has either polio or Charcot-Marie Tooth.  It was difficult to discern which...I voted for Charcot-Marie Tooth, as he had bilateral hand weakness as well without truncal weakness.  In the end it doesn't matter what his diagnosis is, but we do try to figure it out as best we can.  The medical history we can suss-out is often very limited and not always so helpful.  Clearly he has a high level of deformity.  He will be having surgery with the IEP docs on his right foot.  

This 12 year old boy has been seen during every mission trip we have done since 2004.  When he was 3 years old he had a significant surgery to reinforce his congenitally-short and poorly developed right lower leg and today, he looks just fantastic.  He is happy and when he is walking with his brace (see below) his deformity is barely noticeable.  It makes everyone smile to see him, as we have been lucky to do on each and every mission.

In the future, he would benefit from a limb-lengthenging procedure, but it will be some time before this will be done, to ensure he has completed growing.

A great success for he and his family and for all!

His current x-ray.  His deformity is on the right.  His tibia, which is the big bone in our lower legs didn't develop fully, so they fused the little bone, the fibula, to the small portion of the tibia and over time (8 years), it has gotten thicker and stronger, supporting his body weight with the assist of the brace below. 

Here he is in standing.  He looks fantastic!!

Here is his amazing brace.  Made in Can Tho, Vietnam!

A front view.

A sweet little girl who was amazed when I blew on her pinwheel.  She will come to see me and Amy at the Children's Hospital in Can Tho on Monday.

She has cerebral palsy and is presently non-ambulatory.  She has great potential to ambulate independently.

Julia and Kim...working the intake station.

 This 18-20 month old little boy broke my heart.  He presented today with no active movement of his trunk or lower extremities below his belly button.  His back was without any obvious signs of a problem and he apparently hasn't been able to move his legs since birth.  So, something clearly happened while he was in utero that affected his spinal cord and he is, in essence, a paraplegic.

In Vietnam this is a very bad thing, as they do not have wheelchairs and the environment does not support that type of mobility.  Most folks who have significant enough impairment that they are not walking, typically become beggars on the street, pulling themselves along on basically what looks like a skateboard or scooter.  There are 'hand carts' which basically are like a bike, but there is a 'steering wheel' that gets pumped back and forth to make it move.  This will likely be this child's fate here.

We will plan on seeing him again when we return in a couple of years and maybe something will have changed.  His story is a sad one though.

This gentleman has a congenital foot deformity and the most striking thing about it is that he has 2 toe extensor tendons (see the 2 'ropey-like' bands on the bottom part of the screen).  They will do surgery to improve his foot structure, which will allow him to then wear shoes, as he current cannot wear a shoe on this foot.

This is the x-ray for the picture above.

 This little girl is about 2 years old and it seems as though she has spina bifida.  She has a dimple in her lumbar spine and the report from her mother is that she has never been able to move her legs below her knees.  Her muscles are severely atrophied on both legs, below the knees.  Like the little boy I wrote about above, this is not good news for her at all.

With some bracing, she could likely walk, but in Vietnam, this is difficult as braces are about $45 each and this is a lot of money for her family, as they live in the country and do not have very much.  She also will not have access to Physical Therapy that would help her so much.

We have asked them to return to see us the next time we are in Vietnam to see how she is doing then.  There is not much we can do for her now, sadly.

These are some AFOs that were made in HCMC for a child with spina bifida.  The difference between the child who has these braces and the child shown above is resources, specifically money.  This is why this child's family was able to travel to HCMC and have these made.  He also has bilateral club feet for which he has had surgery and wears a night brace as well.  I would like to figure out how we, IEP, can provide the funds for children who need braces that cannot afford them.  This is a goal for our next trip.

The night splints a child with spina bifida has been wearing for the past year, following his surgical correction.

 This picture is taken facing a woman in her 30s who was born with a significant knee extension contracture of her right leg.  She is unable to bend her right knee, as it is locked in a hyperextended position and on x-ray it has developed very abnormally and she does not have a patella (knee cap) either.

The plan for her is to fuse her knee joint and then her ankle in a flat/stable position so she can walk more easily.  This will be a big surgery and we are all hoping it greatly benefits this woman.  She had a wonderful personality and spunk, which I always love so much.




Here's a video of her walking.  Due to the severity of her knee hyperextension, watching her walk is a bit difficult, so if you are queasy, you may not want to watch.

This gentleman's deformity is on the left, due to having polio when he was a child.  He will have surgery next week. 






This video below is of a child with untreated club foot deformities bilaterally.  The plan is for him to have surgery next week for correction. 

This little sprite is 20 months old and was so spunky and fun I just had to post her video.  She came to us because of the significant bowing of her legs and her parents and doctors wanted to know if she needed surgery.  Initially, upon seeing her I was a little worried about rickets, but when we looked at her father's leg alignment, it was nearly identical to hers.  We have asked them to return to see us when we next come to Vietnam to make sure her bowing hasn't progressed.  No intervention was recommended during this evaluation.  Other than...for her to stay as spunky and cute as she is today!!

Here's a few photos from our lunch during screening day #2.  Delish!!

Pineapple (with salt/pepper mix) and baby bananas for dessert.

Cauliflower with pork (in the foreground).  Shrimp with bacon (in the background).  Soup with pork and vegetables ~ carrots, potatoes, turnips (on the upper right-hand corner of the picture).

Here's the soup, in all its glory.  The broth and vegetables with rice were perfect!

'Through the lookingglass...'

Taken in examination room, looking through door to door to door to door, etc. of the successive examination rooms.  Can't explain why I liked this photo...only to say it was the end of the day...that's my best excuse!






It was a very hot and sticky day and around 3p it rained for about 20 minutes, which only cranked-up the humidity even more.  Our day ended by successfully having Com Chay, which was delicious and it is very funny when we are there, as the owner continually asks us if we like Com Chay?  Likely this is because they would think we all eat meat and may not understand what Com Chay actually is.  The politeness here is so refreshing.  Finally, while we were sitting and eating a Buddhist monk arrived to dine with the family...made me smile.

Well, time to fall asleep again.  Tomorrow, because we are completed with our screening days and surgeries are starting, Amy and I will have some free-time.  I must complete my lecture and we need to sort-out our supplies, as we begin at the Children's Hospital on Friday morning, the 4th.  Amy did get an email from Dr. Phuong, the medical director of the rehab department at the Children's Hospital, requesting Amy contact another physician, a pediatrician, who has a child with what they believe to be autism.  So, Amy contacted this physician via email and she has requested we come to her house to which she will invite the parents of 10 other children with autism to meet with Amy (and me), as they feel the children would not like to go to the hospital.  We have offered them tomorrow afternoon as a possibility for this 'adventure' and so we'll see what happens.  Will definitely be an interesting experience.

Take good care...

xoxo
Stacy

P.S. ~ We have just arisen for the day ~ it's Thursday ~ and Amy has gotten another email from the local pediatrician.  She now would like us to see 25 patients (it's grown from 4 patients initially to 10 patients before we went to bed and then now to 25 patients overnight) at her home and so we will meet with her this afternoon at 2p to figure out the details.  Wow...wow...wow (as Meir, one of our surgeons would say)!!!

This was taken upon our arrival in Ho Chi Minh City, after about 27 + hours of travel.  It's a bit toasty...clearly!!