Note: Thomas Kaschak, DPM, a podiatric surgeon at Kaiser Permanente Fresno (Calif.) Medical Center, is in Da Nang, Vietnam, with several colleagues on a relief mission for the Vietnam Medical Project. Among his colleagues on the mission is Ben Cullen, DPM, a third-year resident at Kaiser Permanente Medical Center in Fremont. Below is Dr. Kaschak’s first dispatch. A dispatch from Dr. Cullen follows, and then a second dispatch from Dr. Kaschak that he sent as he was in transit back to the United States.
July 27, 2012
Hello to all readers:
Tom Kaschak writing here from the Da Nang Orthopedic and Rehabilitation Hospital in beautiful downtown Da Nang, Vietnam. Challenges to internet access led to delay in reporting sooner, but nice to be finally up and going.
Our group arrived in Da Nang Saturday, July 21. We enjoyed 2 days of R&R before starting our busy clinical/surgical schedule which would take us through the end of this year’s tour. Joining me again this year is my wonderful and supportive wife Cissy, Dr. Glenn Weinraub makes his second appearance with his resident Dr. Ben Cullen accompanying him from Kaiser Permanente Hayward Medical Center, along with Dr. Annie Nguyentat from the Kaiser Permanente San Francisco Bay Area Foot and Ankle Residency Program. Dr. Joe Smith makes his first return to Da Nang since his deployment during the “American” War in 1969. He joins us from Kaiser Permanente Fontana Medical Center. Chi Lan Ly, an inpatient pharmacist joins me from my home base in Fresno, along with her lovely daughter Kelsey Mott.
We arrived through the new Da Nang Airport Terminal, opened just a few months ago. Greeting us was a large group of friends and colleagues from the Center. It is always great to see so many familiar smiling faces as we leave the terminal to begin our annual adventure.
Da Nang has gone through so many changes over the 14 years we have been visiting this town. In 1998, Da Nang was truly a “third-world” city with mostly old, weathered buildings, torn up roads, and streets crowded with bicycles and motorbikes. Looking across the Song Han (Han River) from the Central Market was a view of palm trees, jungle and small huts on stilts. Today, that same vantage point looks out to large hotels, condominiums, and brightly lit billboards. Although motos (motorbikes) still rule the road, cars are becoming more popular. Hopefully they’ll remain in the minority, since nothing would move if they completely replaced the bikes.
Only two bridges crossed the water in those early years; one built by the French and the other we Americans built during the war. A third was constructed about 8 years ago and another just last year. Now, those original two are being replaced and three more are under construction. Quite a bit of investment in infrastructure in this emerging economy.
We came again bearing supplies and equipment to help make patient care a little easier. I had hoped to bring two decommissioned tourniquet systems promised to me regularly over the last several years, but, unfortunately, because of restrictive donation policies, this badly needed donation was denied. Oh well, try again next year. Still, we were able to collect some medical supplies as well as “souvenirs” such as crayons, coloring books, sunglasses, lollipops and the like, quite popular with the kids, but moms, dads, and even grandparents line up enthusiastically for the goodies.
Monday was quite a busy day in clinic. We evaluated about 40 patients, enough to keep us busy in surgery for the remainder of our visit. We see mostly congenital deformities such as clubfeet in many and varied forms, old injuries, some still carried from the war, lower extremity effects from cerebral palsy, and fortunately now more rarely, polio.
Surgery began on Tuesday with about seven cases scheduled. Not an overwhelming number of cases, but most were quite long and difficult. The new hospital has three operating rooms, but we mostly use the main OR, which curiously still has two tables side-by-side, a holdover from the days when we worked in the old surgery building – more like a slightly oversized garage outfitted like an operating room. In those earlier days, it was indeed a necessity. One anesthetist, Bac Si Sy, managed the two tables, monitoring the patients with nothing more than a blood pressure cuff and a stethoscope. As he induced spinal anesthesia on one table, the woman who tidied up the room helped “bag” the sedated patient on the adjacent table to keep them breathing – the process had us holding our breath! He now has quite a bit of help, but those side-by-side tables remain.
Each day presented more challenges both in surgery and clinic. Dr. Weinraub shared his expertise with the residents and the surgeons from the Center. The chief orthopedic surgeon is a quiet, unassuming, very bright and talented surgeon, Bac Si Do Van Thanh (Dr. Thanh).
Bac Si Thanh began his career at the hospital in 1999. Then, he spoke no English and was reluctant “accept the knife” in training. Within a year, he spoke English fluently, and was on the road to becoming the exceptional surgeon he is now. Proudly, he now instructs us, but we do still trade surgical “pearls”.
Thanh had several opportunities to study in the USA over the years, and he has really taken the knowledge and skills he learned and ran with it. Here in Vietnam, he has developed the reputation as being the expert in the “Ponseti” method of casting infants born with clubfeet. Thanh studied with Dr. Ponsetti in Iowa in 2006. Dr. Ponseti was even then in his mid-90s, practicing and instructing as enthusiastically as ever. Sadly, he passed away not long after.
Friday, July 27, was an historic day in Da Nang. Under the careful hands and watchful eyes of Dr. Weinraub, Thanh helped perform the first ever ankle arthroscopy in Da Nang with Dr. Cullen assisting. Thanh’s younger protege, Bac Si Vu, also had an opportunity to “take the scope” as well. Dr. Annie Nguyentat, Chi Ly, Kelsey Mott, my wife Cissy and I joined the entire surgical staff as we crowded into the surgical suite to witness this historic event.
We have developed wonderful and enduring friendships here in Da Nang. We feel and are treated more like family rather than just visitors. Each evening, we are invited out to dine with our hosts. The hospital director, Mr. Hoang Van Cuc, gathers us together to share a sumptuous dinner on our arrival and before we depart. The other evenings it is the staff and our coworkers here that invite us out. We reciprocate on the nights they have no plans for us. We’ve become quite fond of Vietnamese food, and cherish the evenings’ fare. We just can’t find food of such flavor and quality (and quantity) in the states.
I invited the residents and Drs. Smith and Weinraub to contribute to this blog and share their thoughts and experiences as well. I’ll try to send off one more before the visit ends next week. Stay tuned.
Dr. Cullen’s dispatch:
July 28, 2012
I have never been to Asia, or on a medical mission, so I didn’t know what to expect on this trip to Vietnam. One of my attending physicians (Dr. Glenn Weinraub) mentioned the trip in passing a few months ago, and from how he described it, it sounded like a once in a lifetime opportunity to experience health care in a completely different environment, with a variety of pathology unlike any I would ever encounter during residency.
This trip has not disappointed.
From the moment our flight arrived in Da Nang, I have been immersed in a completely different world from anything I have ever experienced. Different language, different clothing, different food, etc. But beyond the cultural differences, the pathology we have seen in clinic is almost unreal. Babies with complex congenital deformities, adults with major trauma, degenerated joints, people walking with the top of their feet hitting the ground, and most of these people basically being crippled by their condition and living with it for several years. Stuff that we read about in textbooks, but don’t ever encounter in modern America.
The clinical and surgical side of things has been incredibly rewarding and eye-opening. Patients were lined up out the door, coming from all across the country for evaluations and treatment. We saw patients in rapid-fire succession on Monday, planning out the surgical procedures for the rest of the week. Then Tuesday through Friday it was surgery all day, with a variety of surgeries that I will probably only see a handful of times the rest of residency, from pantalar arthrodeses to macrodactyly and polydactyly, club foot and flatfoot surgery. As the latest technological advances we are accustomed to in the United States are not available here, we have been forced to adapt to not having up-to-date fixation, intraoperative flouroscopy, or high-quality instrumentation. Being able to be flexible here will undoubtedly help me to get out of tough situations in future surgeries in the event things don’t go exactly as planned.
Our hosts were extremely hospitable, taking great care to make us feel welcome and comfortable throughout the trip. We talked about differences in healthcare and cultural styles, and found common ground in our values and hobbies. At the final dinner, we celebrated an incredible week of making a huge difference in the lives of the patients we treated and advancing the ties between our two programs, with a look to the future and how the event can be made even better next year.
This has truly been a life-changing week for me, one that will positively influence the rest of my career. I feel extremely fortunate and humbled to have been a part of this trip, and I cannot thank Dr Kaschak, Dr Weinraub, or the rest of the team enough for enabling me to be involved. This project will undoubtedly continue to be mutually beneficial for all parties involved under the sound guidance of Dr Kaschak, and I already envy the experiences of future residents who are lucky enough to participate in future trips.
Ben Cullen, DPM
Kaiser Permanente Hayward Medical Center
Below is Dr. Kaschak’s final dispatch, sent en route home.
August 1, 2012
Tom Kaschak here again with the Vietnam Medical Project writing from the Hong Kong Airport, where my wife and I get to “time travel” today. We leave for SFO just after midnight, August 1, and arrive in San Francisco one month earlier, at 10 p.m. July 31. Cool!
The trip was quite wonderful this year – and quite busy. Even as I was leaving for Da Nang Airport, I was asked to stop by the hospital to evaluate a few patients. Nothing too complicated, but working right up to the last minute. Just as we like!
Our final unofficial evening was an event to be remembered for sure. As in previous years, the entire surgical staff treated us out to a night of delicious Vietnamese cuisine, generous libations, and the company of new and old friends. It was truly an experience.
Clinic and surgery are quite professional and focused, but after hours, for those not on-call, evenings are to be enjoyed and shared with friends and coworkers. The surgical staff is extremely dedicated to their profession, and care for the patients is exemplary. They take their jobs quite seriously and want to make the physician’s/surgeons’s jobs as easy and uncomplicated as possible. Long hours are not uncommon and no complaints are submitted. In surgery, the assistants strive to learn each surgeon’s manner, technique, and expectations, and their needs are met and exceeded. Instruments are handed to us before we know we need them! It is an honor to work with such dedicated, caring and professional people.
The clinic director, Mr. Haong Van Cuc, Bac Si (Doctors) Thanh, Ky, Tuan, Vu and Sy, were all quite appreciative of our visit. They really don’t need us there anymore – these surgeons have developed skills and have experience far beyond what we can offer, but they do indeed appreciate the helping hand and any supplies and equipment we could bring. As I mentioned in my previous blog though, there are those many clinical and surgical “pearls” we exchange that add up to allow for an easier time in surgery.
An exit poll of all participants this year was overwhelmingly positive. An excellent time and experience was had by all. All declare they will visit again soon – hopefully again next year, and hopefully this will become a regular event for everyone. I want to thank my wife Cissy, Drs. Glenn Weinraub, Annie Nguyentat, Ben Cullen and Joe Smith, Inpatient Pharmacist Chi Lan Ly and her daughter, Kelsey Mott, for making this such a wonderful and memorable year. And thanks to our outstanding hosts and all of the wonderful patients who are so respectful and appreciative of our work.
Stay tuned for VMP 2013!