The Rotaplast Mission to Can Tho, Vietnam

This trip was the first mission by Rotaplast International to Vietnam. Rotaplast is a Rotary supported plastic surgery project focusing on cleft lips and palates. Rotaplast has done many missions, recently about ten missions per year, over the ten years of existence and most of these have been in south and central America. The mission is surgical repair, education and prevention of these facial deformities. www.rotaplast.org

The Location and Environment

Can Tho is the largest city south of Ho Chi Minh City; the population is estimated at about 400,000 and it is growing rapidly. The only general hospital in Can Tho is also the only large, public surgical facility for all the people living south of Ho Chi Minh City; a low, rough estimate is that there are over 15 million people living south of Ho Chi Minh City, in the Mekong Delta. The population of Vietnam is slightly over 80 million; the Mekong Delta is approximately 1/3 of the geographic area of the country, and it is fairly highly populated, although the population is spread out over many islands and along many waterways without access by road. So this hospital has a huge area and population of responsibility.

Can Tho General Hospital is over 100 years old and has had facilities added one at a time, over many years. The result is a functional and slightly haphazard hospital layout. The hospital can accommodate 650 patients, with a canteen, a pharmacy, 5 operating rooms and many examination and care facilities for a wide range of patient care. A new hospital of 800 beds is being built 2 miles away; it is 4 stories tall and will be completed in April 2004. The new hospital will replace the existing General Hospital, and the existing facility (see photo) will be replaced with new construction.

During our stay the weather was sunny, very warm(95F) and very humid. The team stayed at the Quoc Te (International) hotel, owned by the city authorities who sponsored our visit. The hotel is nice, located along the bank of the river, in the heart of town. The hospital is about 2 kilometers away from the hotel. There are many new and high quality hotels in Can Tho also. There is Coop Mart and much new construction. Coop Mart is a sort of Wal-Mart-like store - large, with food and general items on display, and check out lines we all recognize.

The Rotaplast Team and Mission

The team of surgeons, anesthesiologists, pediatricians, nurses, dentists and other staff counted up to 38 members. We brought 52 boxes of medical equipment and supplies, most of which was used up during the mission. Some equipment, about 24 boxes, was shipped back home for future trips.

Many of the team have worked together on many other Rotaplast missions, but this was the first Rotaplast mission to Vietnam. Many of the medical professionals already know each other in their professional activities. The Rotarians generally knew each other as well.

 Dr. Angelo, Peter, Kathleen and myself had the wonderful chance to meet with Dr. Huan, who is the head of plastic surgery for the district around Can Tho, including all of Can Tho, at his clinic for face and jaw surgery, during the middle of our mission. All our questions were well received by Dr. Huan; there is clearly desire for the professional cross-training provided, and recognition of the need for the large number of high-quality surgeries provided by our mission for people able to reach Can Tho.

The Schedule

The Candidates and Patients

We reviewed about 150 candidates for surgery on our clinic day, our first day of activity in Can Tho. Candidates and families were interviewed and examined, by the surgeons, and pediatricians; each case was prioritized and a surgery time estimate was made to assist in scheduling. We gave each candidate a small amount of money for coming to the clinic (to help with transportation expenses for the very poor) and told those who could not be accepted for surgery during this mission immediately of our evaluation. There were about 100 candidates accepted for surgery and 25 put on the waiting list. Other candidates who showed up in the next few days were evaluated one by one. The final result was 106 patients operated on and about 156 procedures performed. The surgeries were for cleft lips and palates with a range of severity, and in one case a sixth finger (a thumb actually) was  also removed during the cleft surgery. Several dental plates (retainers) and false teeth were prepared by the dental and orthodontic team.

On other Rotaplast missions there are hundreds of candidates, from whom a relatively small number of cases (30%) are selected for surgery. In Can Tho a large portion of the candidates who were presented for evaluation were accepted, but we are not clear how any pre-selection may have been done.

On the day of the final clinic all patients were asked to return for one final evaluation; it is part celebration of success and part final medical instruction. The father of one young patient came to me and quietly asked if he could make a gift to the doctors who helped his baby. We told him was welcome to do so, but nothing is required. He brought out a huge bag of bananas for us, and Dr. Al Goldberg took one and enjoyed it right there to show our appreciation for this gift. They were very good bananas, and they were a variety of banana we might not have know how to buy without this man's gift. It was a very nice moment.

The Experience of being on the Rotaplast Team

With the perhaps glaring exception of me, this was an extra-ordinary team of people. The surgical staff was the best, the anesthesiology team was the best, the nurses were exceptional, and all the support activities were handled in the best and fastest way. The Can Tho hospital staff is very experienced and had glowing praise for the way the Rotaplast team worked together and did an "A to Z" job, as someone described it. There was special praise from the professional staff for the surgeon who slept in the ward with a young patient who had some slight bleeding after palate surgery; this is an occasional occurrence and the surgeon wanted to teach the family of the patient how to apply slight pressure on the palate to stop the bleeding from continuing or worsening.

The surgical teams worked daily (see schedule) beginning about 7A.M., continuing surgery until 8-9P.M.. Recovery nurses and clean up continued after surgery until very late hours at night. This was a regular and grueling schedule for the team, and the only way we could complete the number of cases we did. The dedication of all to getting the maximum benefit for the children involved during our time in Can Tho was clear and consistent. Many team members excelled on a personal and professional level, but of course the entire team is what I believe we will remember.

Living in Can Tho, Viet Nam for 2 weeks

Our primary method of transport was feet (walking) and cyclo. The cyclo ride was about 30 cents to the hospital. There were not many cars on the roads, although we could see a few, including SUV Toyotas and such. Gas was about $1.80 per gallon at the time (but the price was quoted in liters and dong, the Vietnamese money). There were lots of small Honda-type motorcycles that nearly everyone seems to drive around on.

With 38 members on the team we were able to scour the city for shopping and dinner delights when not at the hospital. Although there were some members of the team at the hospital from 7am until nearly midnight nearly every evening, I noticed that in the few free hours available we still found the good places to eat and the best places to shop for clothes and gifts. Our range over the city spread as the days passed. From my poll of the team, we all had a good time, both with the food, the sight-seeing and the shopping. I heard that a couple people got a few games of tennis in during the evenings at one of the local sport clubs, and several people reported surprising experiences while trying to get a massage. Several members also told stories of taking up offers of a ride in a small boat on the river. I went to dinner with Dr. Ba one evening then had the opportunity to meet his parents and chat about all sorts of topics for an hour or so. Dr. Ba and his wonderful family live a very nice and comfortable life now, and his children are very smart.

The first Sunday that we were in Can Tho was a rest day; we spent it together on a river tour in two large boats, going up the river one direction then back in another direction, to a riverside garden and restaurant for a wonderful lunch. Some of the photos show team members enjoying the boat excursion and lunch.

The hotel rooms were fine, but we soon learned that not all had the same level of accommodation. Ted and I were room-mates; we figured out quickly that we not there much anyway, so didn't worry about it. I don't know what others may have decided. Our laundry was done during the day or overnight, and it cost about a dollar total for pants and a couple shirts - washed and ironed. Breakfast was provided, and we had a very nice breakfast buffet every morning. It was great to have an opportunity to compare notes with each other before leaving for the hospital. Alternatively, it was also fun to get going early, skip the buffet and go to the market, for some breakfast at a market counter-restaurant or to get some fruit or other market items. In any case the early morning was cool and comfortable.

Dinner was the other opportunity to get acquainted, and we mixed it up pretty well. Of course, the anesthesiologists tended to go everywhere together, but I learned that is considered normal behavior. smile.

Working at the Can Tho General Hospital for 2 weeks

We miss each other and enjoyed a special time together.

All the staff at the Can Tho General Hospital were wonderful to work with. They accepted us immediately, perhaps because there had been other organizations doing similar work at the hospital in the past couple years. The nurses were helpful and friendly, assisting with all the odd requests we had. The canteen staff got to know a few of us very well; we bought water, sodas and ice from them daily. The canteen ladies were especially friendly to Peter for this reason (I have made sure to include a photo of Peter and his canteen friends.). The pharmacy department assisted regularly with all the drugs and medicines we required. The main contact for all of this was Dr. Ba, who assisted and worked with all of us daily to keep the hospital and us happy with how things progressed, making sure that patients were tracked and available for surgery. He did a great job for us. He also phoned several of us after we left Can Tho, during our trip back to Saigon and afterward to check on our wellbeing.

Ted, our Bioengineer, got all our equipment, surgical and anesthesia, working in a sometimes difficult situation. He then turned to fixing things already at the hospital. Dr. Dao, the Chief of Surgery, seemed to enjoy working with Ted and found several repair jobs for him around the hospital. Ted took care of everything. Ted really got into the surgical oxygen system and made sure that a couple critical washers and gaskets got replaced to stop some of the leaks he located. The final "coup de Ted" was fixing the flush mechanism on the toilet nearest the nurses' station; I'm guessing that they will long remember Ted for that.

Co Tuyen, the head of the nursing staff, was always ready to help get past some obstacle. She also had a sense of humor, like no other. I called her my auntie even though she is actually a year younger than me - that seems to be funny to some of the hospital staff. One day, after seeing how big I was standing next to her she announced to me that Vietnamese people are very small...but, she smiled, "we are also very friendly too." It seemed really funny at the time.

I think we found our friends in Can Tho to be very warm,  hospitable, hard working, resourceful, and open to us in ways we had not imagined. I hope those we worked with think as well of us as we do of them.