Our strabismus surgical mission to Vietnam was a wonderful success! Through the non-profit organization, “Project Vietnam Foundation,” Drs. Mark Steele and Julie Nam were the selected pediatric ophthalmic surgeons for the winter 2010 ten day trip.
Strabismus is a culturally significant disorder in Vietnam as these children are generally “hidden.” An obvious physical defect in a child is an embarrassing stigma deemed to be caused by evil ancestry which is obviously something families prefer to not advertise.
Black mold covered adjoining room walls, no effective air conditioning and open air wards with 10-12 patients (and families) per room.
Our first several days were spent enduring repetitive but apparently important meetings with the local communist party government leaders and hospital brass at two separate locations. Abbreviated translated portions of what was said (including a lot of seemingly angry repetitive dialogue) was translated to us in what appeared to be a sugar coated version. The bottom line is that the government representatives were ultimately grateful for what we did for their constituents but all along were very concerned that we deliver only the best and safest care – they did not want to have any “problems.”
Over the course of 4 O.R. days, we operated upon 61 children with strabismus conditions ranging from large angle horizontal deviations to more complex paretic and restrictive misalignments.
We started in the Ben Tre province of the Mekong Delta region in southern Vietnam. In this province, there were no eye surgeons performing strabismus. Patients with financial means would have access to ophthalmologists in the big city of Saigon (approximately 2 hours away). There, strabismus surgery would cost $125 USD but the indigent patients we treated were mostly from rice farm worker and fishermen families that earn up to $2 per day. Many of them arrived in our makeshift clinic in bare feet.
We performed cycloplegic refractions and dilated fundus exams on all of the children and deemed many as good surgical candidates.
We saw some patients with congenital anomalies like persistent hyperplastic primary vitreous (PHPV) and retinitis pigmentosa who we were able to counsel but not treat.
The most difficult day was our last pre-op clinic in Ben Tre the evening before our last OR day there. Word apparently spread in the neighboring provinces as to what we were doing and without invitation, many children traveled great distances and just showed up at our hotel. As we disembarked the bus after a busy OR day, there was a sea of cross-eyed kids sitting on the driveway, many severe, who we simply had to turn away as there was no time left to accommodate the demand. We will always be disturbed by this memory.
The American surgical team was composed of amazing people – many of whom regularly choose to spend their vacation time to work extremely hard in very harsh conditions. No complaints from anyone though. An immediate bond among the team was forged and it was exhilarating. 4 seasoned O.R. nurses, a young Vietnamese American RN who served as translator and surgical assistant, 3 excellent Vietnamese American anesthesiologists, 3 recovery room nurses and 3–4 (depending upon the day) translators/assistants to keep it all running smoothly. The pre-op physical exams were performed by a team of primary care physicians.
Operating in the Ben Tre hospital was truly a third world experience.
Our sterile cotton tip applicators that we use during surgery to dehydrate an extraocular muscle prior to suturing were quite handy in squashing ants that frequently made it onto our sterile surgical field.
Lots of mosquitoes in each OR succumbed to one of the volunteers expert swatting.
As there were no surgical stools to sit on, we stood while operating and sweated profusely in the 100+ degree humid heat. The circulating nurse would wipe our brow sweat from time to time as our surgical caps quickly became saturated. Every hour or so, we would drink 250 cc of water with added electrolyte powder. At the end of each O.R. day, the sweat came off pretty easily with a cold shower (no hot water in the hotel). On the first O.R. day in Ben Tre we operated 10 children, the second day 14 and the last day 16. We then moved on to Saigon where we operated 21 patients in one day.
Incredible good behavior and stoicism in these children. Not one child we encountered was manipulative or ornery. We suspect the parents instilled the fear of God in these children to be on their best behavior so they don’t ruin this rare opportunity to have their strabismus corrected by the American team.
The most fun was conducting rounds in the post-op ward the morning after surgery. A room full of straight-eyed kids and smiling, grateful parents. The fruits of the team’s hard work were quite apparent and dramatic.
One of our roles was to instruct local eye MDs in contemporary strabismus diagnosis and management – one of the ophthalmologists in Saigon did express her gratitude for our operating via the “invisible incision” technique as she had read a lot about it but had been forbidden to use this approach by the hospital administrators. As the admins have now seen the excellent results we obtained, she explained that she will now be approved to employ this cutting-edge technique. The local ophthalmologists were particularly receptive to learning from our extensive experience performing eye muscle surgery on patients with nystagmus.
This was an incredible experience for us on many levels. We were absolutely inspired by the selfless dedication to humanity of the people with whom we worked. These folks traveled half way around the world volunteering to work extremely hard under poor conditions. We were honored to be a part of this fantastic surgical team. Obviously not travelling as tourists, we become privy to real life conditions for the people in Vietnam. We can never be complacent about our wonderful modern conveniences from which we all benefit within and apart from our hospitals and clinics.
Photos courtesy Jeffrey Brody
The pre-op patients all sat together in the OR hallway watching the “on-deck” patient be rendered unconscious from an IM Ketamine injection (different pre-op protocol here in the U.S.), observing the whole process before having the surgery themselves.
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