Vietnam Trip

Overview:

This was my fourth visit with HVO to the Hospital for Traumatology and Orthopaedics, HTO. I keep thinking that I should try some of the other HVO sites for variety but Vietnam has a magic all its own and it's hard to imagine a place that would be more gratifying or more interesting.

Activities and Assessment:

On Monday through Friday I lectured at the 7 AM meeting to the anesthesia staff. The first three days I used my laptop and a projector they were borrowing from B-Braun to give talks on regional anesthesia. On Thursday and Friday I tried running a more interactive session by doing a "Problem-Based" discussion. This worked reasonably well in trying to get everyone talking but because of the translation back and forth slowing things down we didn't cover much territory. We discussed hypotension, the treatment, differential and the management of the airway in a patient with hypotension and a full stomach. The system is more geared towards lectures but I believe interactive discussion is helpful in getting an idea of how much is being absorbed by the staff and students.

After the morning lecture, I spent time in the holding area observing and doing some blocks and also going into the operating rooms to observe. There have been changes since I was there last. They now use a CO2 absorber in circuit in the OR where the scoliosis and other back cases are done with low flows. In one case I was observing the ETCO2 was measured and was quite high (60s and 70s) on a young child and I did not ask but am now wondering whether they change the absorbent often enough. The anesthesiologist also are not mixing the lidocaine and bupivacaine in the same syringe but are giving them in separate syringes at my suggestion the last time I was there. During my last visit I discussed femoral nerve blocks and I was told that the department is regularly doing these blocks now for both intraoperative procedures and postoperative analgesia. On this visit I discussed the use of suprascapular nerve blocks and superficial cervical plexus blocks as rescue blocks for failed interscalene blocks or for analgesia after shoulder surgery. The staff seemed very interested and tried it on several patients while I was there with good results. They have insulated regional needles which they use for select patients. I emphasized the importance of blocking the musculocutaneous nerve separately from the axillary nerve block.

You asked if there was "one person who really touched you during your trip" and the answer is yes. I was attempting to demonstrate an infraclavicular nerve block using a nerve stimulator on a young man scheduled for forearm surgery. The patient seemed very stoic as I kept introducing the needle without any success at finding the brachial plexus. I have to add that this is a technique I have done successfully hundreds of times and feel very comfortable doing. I finally decided to desist ("first do no harm") and do the easier and safer axillary approach to the brachial plexus. I always first block the musculocutaeous nerve separately and then the rest of the brachial plexus. To my embarrassment I had great difficulty finding the musculocutaeous as well- this was in front of about ten eager young trainees. I felt terrible. Finally I found the right spot and as soon as I injected the last drop of local anesthetic the patient was immediately wheeled to the operating room. As the patient entered the OR he looked up at me with tears in his eyes and said "help me" (to my surprise he knew those few words in English). I worried that perhaps the block wasn't working and he was frightened that he would have surgery without anesthesia.

After a successful surgery under a good block (whew!) I went to see the patient in the recovery room and he started crying again when he saw me. I asked one of the anesthesia staff what was wrong and I was told that the patient was so thankful that an "expert" from the US had taken care of him that he was overcome with relief and gratitude. I have to say that this was one of the most pleasant outcomes of a cultural misunderstanding that I have experienced and one that I will probably never see in the US.

Living Conditions and Suggestions:

I stayed in the Spring Hotel. This is the hotel I have stayed in every visit and it is still very comfortable and gives a safe feeling while being close to everything (except the hospital which is a 15 to 25 minute ride away). The most recent addition which I truly appreciated is that if your laptop has wireless access equipment, you can access the internet in your room for free. Otherwise you can still log on to one of the two computers in the lobby for free but there is sometimes a wait. I think there are many new hotels being built in HCMC as more and more tourists come and there are certainly other good hotels to stay in if you wanted to take the time to look. Prices are starting to go up but are still very reasonable compared to the US and Europe. I recommend e-mailing ahead to book a room, especially during peak tourist times.

I recommend taking one of the boats from the city to the Mekong Delta or one of the nearby beaches. If you have time and money there are many wonderful exotic and interesting places to visit. On my way to Hanoi to the Congress, I spent three days seeing Hoi An and Hue, both charming and very interesting historically.

Summary:

Vietnam is a spectacular country. It is beautiful, exotic and friendly. The people I have met are intelligent, interested in education and quick learners. After visiting I feel optimistic about the future of both the medical profession in Vietnam and the country itself. Still, there is much that a volunteer can do to help. It is remains very rewarding to teach in HTO and I certainly plan to return when time permits.