Monday, June 20, 2016

Saddest case of the mission so far

During a very busy clinic day, this Father approached our intake station with his daughter in a wheel chair. He provided no invitation letter but just pleaded for his daughter just to be seen by our medical team. As we would never turn down someone in need, we accepted this patient and started the initial work-up. She is a pleasant 14-year old girl, who is very much like any adolescent from the neck up. But thats where the similarities and normalities for this child ends.
She was born normal, however, when she was 3 years old, she had some difficulty walking and her parents brought her to a doctor. The doctor injected something into her lower back and within days, she lost all function of her lower extremities. Over time she has been confined to a wheelchair. With the combination of no motor function and very poor posture in the chair, her body has grown into a dramatic shape.
Her spine is so distorted that while sitting in the wheelchair, one can barely make out the natural direction of her spinal column. She has lost most of her motor function from waist to feet, although she can still wiggle her toes and partially move her arms. Her torso is so compressed that if she continues down this path, dangerous complications such as collapsed lungs and dysfunctional gastrointestinal system will eventually develop.
Our plan is to manipulate her spine to physically attempt to straighten her. We will assist to develop a brace so when she sits in her wheelchair, she can be held up more straight. There is no chance for recovery, but without attempting to fix her posture, she will certainly die an early death.
As everyone filed into the room to watch this girl get treated, taking pictures etc... I looked into her eyes and saw fear and embarrassment. At that point I stopped with the medical assistance and just bent down and held her hand. I hoped that by holding her hand and looking into her eyes with care and compassion, that she would feel less fear, less embarrassed, and more human.
I watched as her tears fell, then dried up, and a slight smile of thank you for just being there to make her feel safe come across her face.
Allowing my tears to flow would have not helped the situation at all, thus I fought hard to hold back my emotions. It wasn't until her treatment was over that I removed myself from clinic and found a quiet alone place to reflect.
Even with our help, she will never live a normal young girls life. All I hope is that she can live knowing that people care about her, no matter what we look like or where we come from.

Sunday, June 19, 2016

Real hands on training

Purposes and objectives for this Vietnam Pharmacy Mission are many. One of which is to provide our students an opportunity to provide clinical pharmacy services and many other medical/physical therapy/ and prosthetic fitting assistance. The best way to remove fears/obstacles about practicing pharmacy after graduation is to get real hands on experience doing what the profession will expect them to be proficient at: Giving injections of vaccines etc...
After much proper pre-mission training, during which most of the students had needle phobia, either to give or receive, they were ready to provide injections in the medical clinic.
After dozens of injections, hopefully the team will be well prepared to practice at the expected level post-graduation!!!

Wednesday, June 15, 2016

Fix what was "broken"

This boy's mother brought him to clinic with little to no use of his left arm. He is 11 years old and broke his arm a few months ago playing with his friends. The local physician and hospital provided care for him, resetting his bones and casting him. The follow-up x-ray, in the cast, shows the quality of the resetting. The bones reset crooked, causing the nerves to be damaged, pain, and little to no movement. What occurred next would seem barbaric to some, but life changing to others. Bac Si Ha decided he would have to re-break the arm at the place where it healed inappropriately. After he would reset it straight, make a splint to stabilize it and confirm with another x-ray.
I was expecting loud yelling, crying pain, and screaming during this procedure.
After injecting about 20 ml of lidocaine 1% into the surrounding tissue and muscles, Bac Si Ha starting to manipulate the boys arm. A few winces, but not a single tear fell from his eyes as the manipulation became more rigorous. Finally, and suddenly, I heard a pop. Bone re-broken. I assisted in the splinting of the newly reset arm with four random bars of metal from our prosthetics supply and tightly wrapped medical gauze and bandages. All the while, the team watching the procedure looked more uncomfortable that our brave young man!!!
A reconfirmation x-ray showed a better reset. We provided the local clinic instructions for follow-up in the next few days. Our hope is that this will set normally, providing the patient with better range of motion, less pain, and proper use of his arm.
Your stronger than most ban toi!! (my friend).

Monday, June 13, 2016

Did it for grandchildren

This so far is the most emotional patient we have treated during this mission. We are now treating patients in Phong Dien, a small suburb 40 minutes from our hotel in Can Tho. About half way through the day, this patient arrived at our intake station being carried by her daughter and accompanied by a young boy. When they placed her carefully in a seat, she was missing both arms below the elbow and both legs below the near. A quad amputee. Here is her story:

A few years ago while baby sitting her grandchildren, she developed chest pain. Her family took her to a local hospital where it was discovered she was having a heart attack. Her hear rate slowed dramatically, which caused acute kidney damage. Her heart stopped beating and a code was called. The medical team tried to revive her heart with two different medications which failed to bring her back to life. The doctors told her family that they have one other medication they can use to attempt to revive her, and there is a good chance it will work. They also discussed the dangers if the medication saying there is also a strong possibility that it will cause her to develop multiple clots in her body. The family decided to accept the treatment in order for her to watch her grandchildren grow up.
The treatment worked and her heart started beating. Within 2 days, she developed clots in all 4 extremities. The doctors said that, now the best way to keep her alive is to perform quad amputation.
After the surgery, they attempted to fit her for prosthetic limbs, however, she told them it was too painful to walk and she stopped trying to use them. For years she has to have family take care of her for everything.
Today, our team was able to fit her with two properly fitting prosthetic legs and cast her to make 2 prosthetic arms that will be sent to her in December.

As they were interviewing her, she said that "she is so happy to now be able to start to walk again. She can now start to do things on her own. She can not wait to get home and set up a pratice area where she can get stronger and more independent. She is overwhelmed with joy, love and affection for our team for helping to give her her life back!!!"

Our teammate Molly, who assisted with the fitting told her that today was her birthday and that seeing her happy and able to walk is the best gift she could ever receive. With no prompting the woman teared, hugged Molly, and sang Happy Birthday in English.

At this point, all team members present broke into tears!!!

This is what selfless charity work is all about. Seeing the work we do, change lives forever!!!!

Thursday, June 9, 2016

PAIN: Relieved

All day during clinic we attempt to provide treatment for orthopedic conditions and pain relief. Sometimes the outcome seems subtle, but other times it is visibly dramatic. No pain, no gain they say and the physical reaction by this patient says it all!!
Status-post motor vehicle accident months ago, this patient has not been able to move his shoulder. His range of motion was very much decreased and he has suffered in pain, not being able to work to support his family. Upon physical examination, it was discovered that his shoulder was dislocated. After multiple injections and painful manipulation, we were able to pop the shoulder back in place allowing for almost full range of motion. He walked into the clinic with a painful grimace, but walked out of the clinic with a joyful, grateful smile!!!

Patients of all ages

The majority of the patients we see and treat are adults with chronic pain and orthopedic illnesses. They develop These conditions due to poor nutrition and extremely hard labor. They presents with severe sciatica, lumbar bone spurs, cervical compression, disabling osteoarthritis etc..
But every now again we treat children with childhood disease such as post-polio syndrome, neurologic complications from fevers etc...
This child presented with severe contractions of the lower extremities, particularly his achilles tendons which prohibited him from walking normal. The thought of this child not being able to walk and play with friends brought tears to my eyes. After physical examination by Bac Si Ha, we injected the affected area, which brought crying from him, and broke my heart. However, We were able manually manipulate his lower extremities relieving the tension and pressure in his legs. His ears stopped, and he was a very brave and strong boy. In the end he endured the pain which led to him being able to flex and extend about 50% better then pre treatment. The plan is now to build a brace that will help strengthen and decrease the tension so he can grow up with a normal quality of life!!!

Life changing prosthetic fitting

Our mission is composed of 2 major components. First is the orthopedic medical clinic and second is is the prosthetics clinic. Our partnering team from Mercer University is trained well and supplies all the materials needed to successfully fit prosthetic legs. Patients in Vietnam have lower extremity amputations for a variety of reasons including silent land mines, trauma, diabetic complications etc...
Many of them go years without having the ability to walk on 2 legs, while others get very creative with their home made prosthetics. We see patients who make limbs out of wood, tree stumps, and even sheet metal. These legs typically are heavy and do not properly fit for a correct walking gait leading to pain, sores and infections. Our team develops and makes universally fitting prosthetic legs that are able to be custom made to fit each and every amputee. They are strong, durable, lightweight and most importantly properly fit.
This fitting process can take up to 8-10 hours of hard labor, which the patients gladly endure for the chance to have a normal life once more. From the intake process you can hear the stories of the cause of the amputation which is always emotional. Once taken into the fitting area, their stumps are tested for strength, range of motion, and measured. After hours of very detailed and accurate variations, the patient is finally ft to a custom made new leg.
When they arrive back at checkout, the overwhelming joy, smiles, and sometimes tears barely can describe the way they feel. There is something very rewarding, gratifying and life altering for our team members, that help to improve a life one leg at a time!!!