Bilateral AK / BK amputee

As this patient arrived at clinic, many of the student’s eyes got wide. He basically “maneuvered” himself by placing a sneaker on his right shin for cushioning and two very short crutches to get around on. He lost both limbs during the war from land mines. Post-war, he was fit with 2 prostheses but due to them hurting and causing abrasions and infections he ceased to use them. It has been 20 years since he has not worn a prosthetic. Today our team fitted him with 2 new legs and he even requested how tall he wanted to be. During the check-out process, he said that if the legs were “Made in America”, he promised to wear them everyday proudly!!!

More Pediatrics

Another pediatric patient this year who was carried in by his mother to clinic. This 4-year old fell from his bed 2 years ago, and suffered injury to his spinal cord, basically leaving him with poor nerve innervention to his lower extremities. His muscles atrophied and he has never been able to walk alone, unassisted by his mother. One of the methods to assist this child to regain muscle strength and learn to walk on his own is to wear special braces. Of course our supplies for this type of product is limited, but our prosthetic engineering team is quite ingenious. As you can see they used random materials to make him2 braces that will support his body, with the goal, after he strengthens his muscles, to walk independent. I know we will follow-up with this patient every 6 months to alter the braces as he grows and gets stronger. These are the situations that make working on this mission so rewarding.

Killing Me

After approximately 8 days with the full team, I suppose one misses the delicacies of home. The hotel has been doing a good job at making sure the "newbies" to Vietnam get their share of familiar foods. In all honesty, my stomach can better tolerate local street food, vs, pizza, pasta and burgers offered in Vietnam. Hey, there is always blood clams, chim se, and snake to look forward too!!!!

Disorders of Growth Plates

The majority of our patients are adults with chronic orthopedic pain due to hard labor and malnutrition. Periodically a pediatric case arrives at the clinic, with the parent’s hope of finding a solution to their child’s issue. This 4 year old was brought to clinic by her mother, stating that she has difficulty walking normal, and her legs were curved slightly. First off look at this face, prior to our examination and potential treatment, she brought smiles to our whole medical room. She was pleasant, patient, and playful. After Bac Si Ha initially examined her, we discovered she had a disorder of her growth plates. Before continuing, we sent her to get an x-ray of her lower extremities. Upon confirmation, Bac Si Ha explained that as she gets older, she will grow at a much slower rate than her colleagues, potentially only reaching a very short height. Although she is not in any pain, Bac Si Ha attempted to manipulate her lower extremities and stretch her tendons which have begun to contract. Her smile turned to tears, although our student did an amazing job of trying to keep her calm. Unfortunately, not much can be done with our limited resources for this beautiful young girl. An attempt to fit her with braces to straighten her limbs and increase her growth velocity will take place during our December 2017 trip back to Ben Tre. Until then, keep making the world smile little angel and hopefully we can improve your long-term outcome when we return.

Home cooked "meal"

“Home cooked “Meal” Having been to Vietnam on this mission 7 times over six years, I have gotten to know many of the individuals who are responsible for sending invitations to our patients. Our population is mostly impoverished and are accounted for by “The Association of the Poor”. Getting to know these individuals comes with “perks” periodically, including being invited to one of their homes to meet their wife and eat some home cooked snacks. Of course, many would not call this a “perk” when they brought out the main dish. Lucky for me, I have been fortunate enough to learn the true culture from my Vietnamese partners and have embraced everything, including the cuisine. This “snack” was crickets mixed with peanuts, apparently a good lunch snack for invited guests. I thank the Association for treating me like family, and for sharing a “Home cooked meal”!!!!

Prosthetics component of the mission

There are still approximately 100, 000 patients living in Vietnam that have lost limbs due to silent landmines, trauma, infections, and diabetic complications. The patients are a resourceful group, often times making a crude prosthetic limb out of anything available to them (wood, tree trunks, scrap metal etc…). While these certainly are useful, they are not properly fit causing pain, irritation, infection, and poor gait. They also weigh a great deal more than the prosthetics our team will provide. The Mercer team makes lightweight, universal fitting prosthetics that will be customized to each patient’s situation. The patients also arrive hours before our team does, and once in the prosthetic clinic area, a group of 2-3 students will assess, evaluate and determine the best approach to take to fit each patient. This process could take hours to a full day, however, each patient is so understanding and happy for our hard work, that rarely do you hear a complaint. Many times a patient has never worn a prosthetic and/or walked normal since their accident. This day for them is life changing. We are able to provide most patients with a new and better way of life, and the look of joy and gratitude on their faces is priceless. Fitting prosthetics also gives our team a new appreciation for the way of life patients around the globe live and struggle with each day.

First Official Clinic Day

After our team picked up the Mercer team from the airport, we traveled directly to Ben Tre where we will hold our first of 3 clinic sites. Our mission is comprised of 2 main components: 1. The fitting of prosthetic legs to amputees and 2. An orthopedic disorders clinic. Our entire team this year is the largest to date, which includes 50 members. The team members get divided into stations. Each member has to rotate through each station, including the prosthetics clinic. (Which I will discuss in the next entry). When we arrive at the clinic site at 7:00 am, there are already about 50 patients waiting. Some have traveled for hours just to get treated. The temperature of the first day is expected to reach a “real-feel” of 45 degrees C. (114 degrees F) . As you will notice, our light blue scrubs will not stay dry for long. After a typical chaotic first hour, the workflow is greatly improved. Our students get to use all of the clinical pharmacy skills they have learned through their years of didactic and practical training. The initial station is intake. This station is crucial to the entire clinic flow. We have excellent fluent Vietnamese speaking students to interview each patient to illicit a chief complaint, past medical history, and current medication list. At the same time, another student will perform all physical assessment techniques needed to evaluate them more thoroughly, including blood pressure, pulse, blood glucose, height and weight. The patient then enters the actual clinic room, where a student will evaluate, assess and make a differential diagnosis. This information is relayed to Bac Si Ha, and he confirms with a definitive diagnosis and performs his treatment. Once orthopedic treatment is completed, students assist with the prescribing of medications for longer-term treatment. The patient then enters a physical therapy station, and is taught basic techniques to relieve their condition long-term. Finally, the patient enters the pharmacy area, where proper medication dispensing takes place and accurate counseling is performed by another fluent Vietnamese speaking student. This care in most of our locations, is the only care some of these patients will get. It is our hope that we provide a thorough, complete and successful treatment to each patient. So far we will expect approximately 120 patients per day for the first few days of clinic.