Postscript...

I am now officially back in the US, staying with my sister, Leah, in San Francisco for the night.  It's now 605a in Omaha and I am wide-awake, so thought I would get this final posting done now. 

I am leaving on a flight at 930a to return to Omaha, so, in theory, I should be back in Omaha around 3p or so.  Looking forward to seeing the snow and cooler temperatures.  Ha!

Here's a final few random pictures that I took over the past couple of days:

In the Taipei airport, they have a 'prayer' location, which provides rooms for Christians, those of the Islamic faith, and those of the Hindu faith to pray. 

EVA airlines, which is a Taiwanese airline and the one our team uses for our travels, has a relationship with Hello Kitty.  There is a Hello Kitty gate and there are planes that are all 'dressed' up in Hello Kitty-themed fabrics, decorations and the outsides of the planes are full-on Hello Kitty too.

In Saigon.  Need a cart for your luggage???

One of my favorite things in Vietnam is that things are labeled ironically, but not so much.  This 'cooler' was named "Hot Hot," but offered cold beverages.  As they say in Vietnam, "Same Same."

I wonder what the 'plus' is in Coke Plus???

A mash-up of Marvel and Pokemon.

Hello Kitty!

I love her aviator helmet.

Islamic prayer room.

This is a screen at which you can rate your 'service' in the bathroom at the Taipei airport.  Ha!

This is a new addition to the cyclo-scene in HCMC.  This is a 'seat-belt' for a smaller child and it is worn around the parent's waist and then there is a little lumbar spine pad that wraps around the little child's waist too, linking them together, for when a child is seated behind their parent on the cyclo.  This was new this time around, as we had never seen these before.  There is a helmet law in Vietnam now, but only for adults. 

And, finally...

Peace-out from me and my lovely travel partner and friend, Amy!!  As always, it's a wild ride, but I am so appreciative that she travels with me on this adventure!!

Again, thanks for reading.  Until I return to Vietnam again...hopefully in 2 years.

xoxo
Stacy

Tạm biệt, Saigon...

Goodbye, Saigon!

Our work is now done here in Vietnam.  Sigh.  As always, these 2+ weeks go by so fast.  Tomorrow (Saturday, the 11th), Amy and I will leave HCMC at 355p and will arrive in San Francisco on Saturday, the 11th at 630p.  You do the math...it's a lot of time in airplanes. 

We finished up our time at the Pediatric Hospital #1 today and wow, it was an amazing week!  I saw some great patients today with the Physiotherapy staff and had many interesting conversations with them about these patients.  Here's a little bit about our day together...

Tam Tam, Quyen, Amy and Yen.  Yen is the former director of the Rehabilitation department.  She retired a few years ago from the hospital and she is now working as a Speech Therapist, working with patients with Cochlear Implants.  It was great to see her today. 

 My first patient today, was an 18 year old young man, who is attending University, studying Psychology, and who has a diagnosis of Spastic Diplegia Cerebral Palsy, which means his trunk and lower extremities are impaired in their movement.  He was such a great guy and his mom, Lan, was lovely too.  He is having progressively worse hip pain on the right with walking and the orthopedic doctors here in Vietnam don't have a great plan for his hip.  He is going to have another x-ray to see how his hip has changed (worsened or stayed the same?) soon. 

He was so interesting, thoughtful and enjoyable with which to chat.  He speaks English well and spoke about life as a young adult with cerebral palsy.  He commented when he was young, he didn't think having CP was a problem at all, but now, feels very different than his peers and wants to be able to talk with younger children about having CP and how to grow-up with it and manage life here in Vietnam.  We discussed with Giao, the director of the rehabilitation department, perhaps having this young man and his mom talk with other families who have children with CP and that he could talk with the children too.  He was so insightful and amazing. 

Here he is walking.  You can see how laborious walking is for him, but he's proud that he can walk.  He does have a manual wheelchair that he can push independently, but he said he doesn't like to use it much, as he feels people are looking at him and that they won't think he's smart.  He's very smart.

This is an x-ray of my first patient today.  This was taken 5 years ago and his right hip isn't located where it is supposed to be and he now has pain. 

This kiddo was great.  He had some fantastic facial expressions and worked really hard with me and his PT, trying new exercises.  Because culturally, the PTs don't make the kids work that hard and much of their therapy is more passive (although it is much less passive than it was several years ago), the kids get really, really tired fast when I am working with them.  He is 10 years old and has cerebral palsy, but walks independently. 

These are his AFOs (braces), which were made in the Rehabilitation department.  These are paid-for by the family directly.

Here's another set of braces, worn by a 6 year old boy, who also has cerebral palsy.  These are pretty great for the limited technology they have available to them here.

The final patient I saw was a 9 year old boy, named Viet.  Here he is below.  He recently underwent a surgery, called Selective Dorsal Rhizotomy, which was done by a visiting neurosurgeon in November 2019.  This surgery is done for children with spasticity (muscle stiffness/increased muscle tone) and during the surgery, the nerve roots that run off of the spinal cord are stimulated to see which muscles they activate and then a portion of those nerve roots are snipped to decrease the spasticity in the lower extremity muscles.  This is a surgery that gained popularity in the US around the time I was graduating from PT school in the early 1990s, but now, this is done with less frequency, as there is a very specific patient type that benefits from this surgery, rather than a broad category of kids with cerebral palsy.

Viet was very smart and his father was very dedicated to doing exercises with him at home, so we tweaked their exercises a bit to focus more on strengthening his very weak muscles.  Underneath a child's spasticity, in CP, the muscles are usually profoundly weak, so when the Rhizotomy is done, the child requires intensive Physical Therapy to work on strengthening the muscles.  In Vietnam, this intensive program doesn't exist and falls to parents to execute at home, under direction of a Phyisotherapist at the hospital.  

He was able to take some steps in his walker, but his weakness is significant.  I think he is a boy who, with really hard work and consistency with the exercises, can get stronger and make improvements.  His father is very dedicated and took copious notes as we put together an exercise plan for him that integrated some of his current exercises with some new exercises.  I enjoyed meeting him and his father.

Standing in his walker.  He was very determined to stand and walk.

 
Each day this week, I was asked to do one lecture on a pre-decided topic.  Over the past 2-3 days, during our patient evaluation time, more topics came up, so I spent part of my lunch time writing additional 'short' lectures on several topics.  This is the list of topics I lectured on today.  The final topic, "Fitness Exercises," was the only lecture I was scheduled to complete today.  We got through all of the lectures in 90 minutes, except for #6.  Phew...I need a little break from talking.

Tonight, the hospital staff, including Giao, the director, invited Amy and me to dinner for a party to say thank you for our time.  It was a really great evening and the dinner was filled with all manner of seafood delights and so many other foods there are too many to name.  In Vietnam, the Vietnamese don't often (if ever) go out to dinner, as it's so expensive for them, so they always are a bit 'giddy' and excited to have these dinners.  There were many photos taken with the staff and me and Amy and a selfie stick definitely made an appearance.  (not mine or Amy's, I should say)

It was a wonderful evening and week and it's time to say, 'that's a wrap,' on another successful mission trip to Vietnam.  I feel so fortunate to be a part of this team, to work with Amy and I can honestly say, I always get so much more from this experience than I think I can possibly give to it.  The people of Vietnam are welcoming, kind and so hospitable!  Vietnam and its people are so special to me.

Thanks for reading.

xoxo
Stacy

The time is flying by...

Thursday, January 9th...

Well...we have only 1 more day of working here in Vietnam and then on Saturday, the 11th, Amy and I will travel back to San Francisco.  She will head off to Chicago later that night and I will stay with my sister, Leah, for the night, traveling back to Omaha on Sunday, the 12th. 

The past 2 days have been very busy, but really fun and rewarding ~ watching the Physiotherapists problem-solve with me what to do for treatment for a variety of kiddos with cerebral palsy, seizures/epilepsy, arthogryposis multiplex congenita and other neurological impairments.

The kiddos have been terrific and have done really well tolerating me, as I look very different than anyone they have ever seen.  I've gotten lots of high-fives, some thumbs-up and a little conversation with a few kiddos in English too.  I have been seeing 4-5 patients per day ~ about 60-90 minutes with each patient ~ and then have been presenting various lectures to the Physiotherapists and one Pediatrician each afternoon.  My 'working plan' laid out 1 lecture per day while working with their staff, but yesterday and today, there were topics that came-up during our patient evaluations, so I have been writing an additional 2-3 short lectures each day during our 'rest time' following lunch.  We get about 45 minutes to 'rest,' and the department's staff also rest during this time.  They turn down the lights and everyone rests. 

We have been very deliberate this time asking parents if they mind us photographing and/or videotaping their children and actually, we have had quite a few who have asked us not to take photos.  We want to be respectful of their wishes, so I have less photos than in the past, but here's a few to share with you. 

This patient, Peter, is nearly 21 years old.  He has mild spastic diplegia cerebral palsy, which means his trunk and lower extremities are primarily involved.  He attends University and is studying English.  His therapist, Hung, is terrific and they go to the local Fitness Center to work-out together, for his therapy sessions.  His mom, at the end of our time together, told me that I had initially seen him in 2005, during one of our trips to HCMC and the Pediatric Hospital #1.  She said they have a photo of us together that Peter's dad took.  I was amazed!  He was a quiet guy, but very hardworking and has done very well!

This little charming lady is nearly 2 years old and presents with global developmental delays.  She is working on sitting independently and standing with support.  I talked with the Physiotherapists about trying to build her a gait trainer, which is a supportive walker that has a seat to allow her to be supported, but also to walk, as she has that potential, but will need support.  Her mom was lovely too and it was great meeting them.

This little lady is 2 1/2 years old and has cerebral palsy, as she was born quite prematurely.  She was very spunky and loves her local PT, Huyen.  She is working on standing with support too.

Deep discussion among the Physiotherapists.   They are very engaged and smart.  It's fun to work with them all.  They take everything we discuss seriously and ask terrific questions.

This little guy is 17 months old and he has a diagnosis of arthrogryposis multiplex congenita, a condition in which more than 2 joints of the body are fused or contracted.  This little guys arms were primarily involved, as well as he has some issues with his legs, but as you can see, he can walk.  He was so charming and smart!

If he lived in the US, I would get him a power wheelchair and he would drive himself everywhere he wants, but a power wheelchair here in Vietnam costs about 5,000,000 VND (about $220).  Now, to many of us, this doesn't seem like a lot of money, but here, this is SO much money.  

His father built these wooden platforms and integrated them into this little walker for his son.  he also took this walker, the hospital's, home and built his son a walker that he can use there.  So, we discussed how, between his dad and the hospital staff, they might be able to find a way to give him mobility beyond walking.  He is so smart!

Here's him in action...go kiddo go!!!  He's a champ!  This walker adaptation is brilliant!

This little lady is 5 years old and has cerebral palsy.  She had a lack of oxygen to her brain at birth, causing her impairments.  She is working on walking with her lower extremity braces and forearm crutches and did so well with these with some help from her therapist.  She was very engaging with me and gave great high-fives and lots of thumbs-ups!

The cyclo parking lot + pictures of the plans for the Pediatric Hospital #1's future.

Like at Children's in Omaha, there are pictures drawn by various children up/down the hallway in the Rehabilitation department.  I liked this one a lot.

An important sign to find in all hospitals.

This is an 7 year old boy with diplegia cerebral palsy.  He was social and spoke a little to me in English, as well as could count to 10 in English.  He has difficulty controlling his body in a sitting position, as well as when he walks, he utilizes momentum, rather than good control, so we played a rousing game of "red-light, green-light" to help him be able to stop his body and maintain a static standing position, as well as did a lot of other exercises together.  He was fun with which to work!  And...I loved his glasses...a lot!

Tonight, we met up with our International Extremity Project team for a delicious and fancy dinner at an Italian restaurant in District 1.  It was great seeing everyone again and always is sad to say, "see you later," to these folks.  I feel so lucky to be a small part of this big team and enjoy the friendships ~ both old and new ~ I have from these travels and mission trips!  Here's a smattering of pics of the people.

Flecher and Devon...they are off to Bali now for 10 days of relaxation!  #jealous

Jean, Noah and Jeff

Bobby, Amy and me

Kim, Jenni and Bruce

Jisun and Jenna

Off to sleep now.  Tomorrow will be another good day, I'm sure.  We will work a full day and then the hospital staff will host a party for us, which is a tradition and is always good fun.  Almost time to go home...a sad thought and happy thought...both at the same time.

Inside the front gate of Ma Maison...the light and the flowers caught my eye earlier tonight.

xoxo

Stacy

Bệnh Viện Nhi Khoa #1...

It's Tuesday, the 7th, here in HCMC and we just returned from a great dinner at Te Te (pronounced "Tay Tay")...a craft brew pub here, which has some yummy craft beers. 

The cool staircase at the gastropub.  There is a main level, which has large windows opened to a relatively quiet alley.  

(left) Kloudy Kolsch (in the style of a German kolsch), was my choice.  (right) Amy chose the Mellow Red.  They were both delicious!  They are made here in HCMC.

Amy had their beer ~ their IPA ~ while we were in Can Tho and wanted to buy a couple of their glasses for Robert's and her home, but the guy in Can Tho said he only had about 6-7 glasses and couldn't sell her any.  So, he recommended we come to their HCMC locale and Amy was successful in buying 2 glasses. 

Another mantra to live by, perhaps???

This was my delicious dinner ~ Falafel with red cabbage coleslaw and a matcha sauce.  Amazing!









We began our work at the Pediatric Hospital #1 here in HCMC yesterday and have had 2 great days working in the Rehabilitation Department.  I learned today that there are 3 children's hospitals in HCMC ~ #1, which is where we work, #2 and the City Children's Hospital.  My understanding is they all focus on some different things, but it is not fully clear what those things are. 

We have been working with the staff at the Bệnh Viện Nhi Khoa #1 (children's hospital) since 2003.  In that time, we have really forged some great friendships and working relationships.  Amy and I were discussing today how far the department has come since 2003 in terms of complexity of thought and practice, as well as space and specialization of treatment.   They are still learning how to transition from a more passive approach to treatment to a more active approach, but this too has improved greatly over the many years we have been coming.

This trip Amy and I are not working together, as we typically have done in the past.  I am working directly with the Physiotherapists and one Physician and Amy is working with the Speech Therapists.  So, we see each other in the morning, at lunch and then again at the end of the day.  It's strange not working together, but I think it represents a maturation of the staff and their needs and we both have a more focused 'working plan' than we have in the past.  During past trips, we have held more 'open clinic,' where the staff present a child and their history, etc., and then we demonstrate how we would do treatment for that particular child. 

This year, Amy is providing more clinical supervision + follow-up/debriefing with the Speech Therapists, observing them directly treat their patients, which is very akin to what she does at Northwestern University in Evanston, IL.  I have been seeing 3-4 patients per day with a lecture at the end of the day.  The goal is that the children we see during the day fit the lecture material and so far, it's worked fairly well, but again, I just roll-with-it. 

Again, this change in plan, to us, represents a maturation within the department and it's been good, so far.

They are in the process of building a new hospital, which will be, for here, completely state-of-the-art, which is amazing!  They feel it will be done within the next couple of years.  The existing hospital is likely more that 30 years old and the new hospital is being build amid the old one, so it is a bit dusty and busy ~ more than normal.  We have been told that once the new hospital is completed, the old hospital will be torn down.  

This is the Rehabilitation staff.  We have worked with many of these folks since 2003.  Giao (pronounced "Yow") is the Director (back row, 4th from the left).  Quyen (pronounced "Q-en) is the Assistant Director (back row, 3rd from the left).

This is the 'working plan' for our time at the hospital.  The red indicates who is responsible for our lunch each day.  

The main hallway of the department.  They are in a new location, moving here in the past year or so.  There are some rooms in this new location that are air conditioned.  That is amazing!

A custom-molded seat for a child with footplates (look toward the front of the picture).  They are super-creative with their ideas and make-do very well with what they have.  Over the many years we have been coming, we typically bring along many therapy supplies, but since the internet has opened up here a bit more, they have more access now to things they couldn't access in the past.  

These are ride-on toys that bob back/forth and play music for the children to sit in to pass the time.  They are so cute and were in the previous location on the campus near the Rehabilitation department, so it's good they live on.  Behind the lady sitting is the construction site.

More equipment.  The reddish item is a floor-sitter, a molded support for a child who cannot sit independently.  The blue one is as I showed above.

This room has been my home-base for the past 2 days.  I am working with a group of Physiotherapists (PTs) and one Physician, seeing patients, as well as presenting a lecture each afternoon on 5 different topics.  This room is equipped with 2 fans and an air conditioner that works a tiny bit, but it's been very comfortable overall when compared to our working environment during past mission trips.  No complaints here.

This is the point at which we enter the hospital.  Each morning, Mr. Hung, one of the Physiotherapists, comes, with a driver from the hospital, to our hotel to pick us up.  We, in the past have taken cabs to/from the hospital, but they insist on providing us rides to/from the hospital.  They have communicated their worry that the cab drive might get us there late or get lost.  It is very nice that they pick us up.

This is the cyclo parking lot at the hospital and where people/families enter and leave the hospital.  Many people in HCMC wear masks when traveling via cyclo, as there is pretty significant pollution here.  The women usually wear a face mask, long gloves and a coat when on their cyclos to protect their skin from the sun.

We walk straight down the corridor (in the center of the photo) to get to the Rehabilitation Department, while dodging cyclos coming and going.  We are pretty good at it now.

 This was my first patient on Monday.  A little 3 month old girl, who the staff was concerned wasn't developing properly.  I have taught them a 'test' to do with babies that can help to identify neurological impairments in babies.  Good news is that she was terrific and totally fine.  She does have torticollis ~ a tippy head to the left ~ so, we got to talk about how to fix this with her mother and the staff.  She cannot come to the hospital for therapy, as she and her family live 2 hours from HCMC.  

Quyen (left), Hung (middle) and Amy (right).

 This is a patient I saw on Monday, who is 10 1/2 months old.  She has a diagnosis of Cri du Chat (pronounced "Cree doo Sha"), which is a genetic syndrome.  She was very floppy and has some feeding challenges.  She was very interested in me and the other therapists, which was nice.

She is working on learning to sit-up by herself, by propping on her hands for support.  Her facial features are consistent with her diagnosis and these kids demonstrate a 'cat-like cry,' which is what Cri du Shat means in French.

This 7 year old little guy has cerebral palsy and had recently gotten Botox injections into his muscles behind his knees and ankles, which is done to help relax spastic muscles.  He hasn't had any therapy for the past 2-3 years, but just recently restarted PT at the hospital.  He is very weak in his trunk and lower extremity muscles, but has good potential to make improvements.  His walker is far too tall for him, but it is the only walker the family has, as it was apparently a relatives, so we make due.  He was pretty tired at the end of our session, but did a great job.

These are his AFOs (ankle-foot-orthoses), which were made this hospital.  There are 2-3 gents in the Rehabilitation department that make braces and do a pretty great job.  I have worked with them over the years, bringing them examples of braces that they will re-work to fit other children and working on casting for stretching too.  

These are really good and fit him well. 

This little charmer is nearly 1 year of age and has a birth history of hypoxia, meaning he didn't get enough oxygen to his brain.  As a result, he has cerebral palsy.  He is a very bright and engaging little guy and if I lived here, I would love to treat him, as he has a lot of potential.  His mother's main concern, understandably, was if he would 'walk like all of the other children.'  We discussed his potential for learning to walk (which is high), but that he likely will need support from a walker, and mom said she understood and loved him nonetheless (cue: tears).

He was so smiley and engaging.  Made everyone in the room smile.

This itty-bitty baby is 1 month old.  He came for evaluation, as he had a small brain hemorrhage on the left at birth.  Today, he had a brain ultrasound, which was normal, but the doctor diagnosed him with seizures.  Per his parents, he has never had a seizure and I didn't observe any either.  During our evaluation, he startled to loud noises a few times (totally normal) and I suspect the doctor saw this and thought it was a seizure.  So, the Physician who has been attending my sessions was going to speak with the other doctor to discuss this.  He was terrific and looked great.  No concerns at this point.  He will be seen again by the Physiotherapists at the hospital at 4 months for a re-check of his development. 

This is a walker that the therapists have modified for a child I am scheduled to see tomorrow, who has Arthrogyposis.  It is a complex diagnosis, in which, typically, there are 2 or more joints that are contracted (stiff/tight).  I am curious to see this child on Wednesday. 

Over the many times I have come to Vietnam, I continue to be amazed at the creativity and ingenuity the Physiotherapists, people and families exhibit, making items for their children, loved ones, and themselves.  I think there are lessons we can all learn from this.




Speaking of amazing ingenuity...

I cannot get over how great this is.  Wow.  This photo was taken by a member of our team, who is still in Can Tho.  Love it!!

Last night, after working, we went to a favorite restaurant, which is so uniquely put together, but also kind of funky.  The pictures don't do it full justice, but Amy describes it as though we entered an "Alice in Wonderland" house.  There are stairs that are impressively steep and so narrow to part of the seating areas (this is where we sat) and very small/short doors you have to navigate through, as well as huge steps to climb in other areas.  So interesting, but fun...and delicious!

 

This is a very short door to climb through.  Even Amy had to bend over.  Then, there are 2 huge steps to climb to get to the level at which our table was located.

The underside of the stairs.  There is a railing, but each step is a different height and they are narrow.  Walk slowly, is my advice. 

Another small door to more seating.

Another angle.

Vietnamese Spring Rolls with Prawns and Peanut Sauce.  So yummy!

Another short door to more seating.  In the jar is a snack of puffed rice.

A tall plant growing in the center of the restaurant.

This is an old 4 poster bed, which is actually a table with 2 benches (one on each side).  Have to climb over the bed rails to get into the seating. 

In the past 4 years, Amy and I feel the traffic in HCMC has gotten way worse and so traveling about takes a lot more time now.  There is also a ton of construction, especially in District 1, the shopping and market district, where Ben Thanh Market is located.  We got to this area last night, after dinner, and were totally disoriented, as there is a HUGE construction project going on.  They are building a light-rail system, which will run the length of Le Loi Street, a huge boulevard in HCMC.  Several folks have given us very different time frames for completion ~ 2 to 5 years. 

Digging happening inside the blue walls.

Traffic continues to move around the blue walls.  Lots of cranes.

We have a favorite t-shirt shop here, called Ginkgo.  This is their t-shirt, entitled "Saigon Traffic."  It's pretty accurate.

Time to close for the night, as we have another busy day tomorrow.  So glad to be on this journey and feel lucky to be working here again. 

xoxo
Stacy