First post from Can Tho- almost 2020!

It's terrific to be back in the southern part of Vietnam, in the Mekong Delta. Our team's flights from San Francisco and Taiwan were easy-breezy. EVA Airlines is always great to fly with, especially when you are planning to sleep through much of the 18-hour flight time!

The city of Can Tho continues to grow. I was last here with the team in 2015, and the city has gained more scooters, more cars, more traffic, and a little more of a tourist orientation. With a growing middle class, more Vietnamese people are traveling around their country. In addition, more foreign tourists are including Can Tho in their Mekong Delta visits. Now there are new tourist attractions, including scenic bridges and light sculptures along the Mekong River.

Sunrise yesterday morning before heading to the hospital

I've already dug in to many of my favorite foods, including rau muong (sauteed morning glory greens with garlic), goi cuon (fresh rice paper spring rolls with mint and rice noodles, dipped in a peanut + vinegar sauce), and a million forms of tofu. A new addition at lunch today was a taro soup that was a gorgeous shade of bright purple with chopped greens in it-- beautiful and delicious!

We got down to business on Monday. As you might know, I fill a few different roles during my time volunteering with this project. During the first few days, I am helping with intake of potential surgery patients at the General Hospital. 

In this role, I am getting brief medical histories of children and adults with lower extremity injuries and deformities and organizing medical records. The podiatric and orthopedic surgeons on the team then assess these potential patients to determine if they would be good candidates for surgeries. 

Intake and screenings are always busy days. People travel 2-3 hours to Can Tho to find out if they could benefit from these potentially-life-changing surgeries. We screened almost 90 people in the last day and a half, with approximately 1/3 of them emerging as good candidates for surgeries. 

Entrance to the general hospital

Nurse Madison, Surgeon Meir Nyska, Interpreter Mai Phan 

Hospital pharmacy- families typically purchase necessary medicines and drugs for their hospitalized family members here. 

Interior view of the 1100-bed hospital

Each collaboration with the general hospital begins with a welcome set of speeches and expressions of gratitude. This year marks 20 years of collaboration between the US-based project and this group of Vietnamese doctors!

Busts of Ho Chi Minh are always featured in the meeting rooms. To the right is Dr. Bruce Lehnert, one of our project directors.

Once the initial greetings were completed, we got to work:

Setting up our intake desk with Mai, Alice, Jenni, and Kim

Reunited with Hoa, a long-time interpreter who started with us 8+ years ago
when she was a wee Can Tho University student!

patient x-rays

Mai consulting with a family

We have the opportunity to help a terrific number of people. Of course, I'm always excited to talk with parents and interact with their children. I have lots of people photos to organize, so more of those to come. Here are a few of the children and families that we have met in the last 2 days.

Not all of the children that come to this hospital screening are good candidates for surgery. Fortunately, my long-time pal, Stacy, is our team's physical therapist. Stacy has the opportunity to consult with those families and make recommendations for what families can work on at home.

Dr. Thuyet was a tremendous help in interpreting and counseling families. 

Terrific to see use of a lightweight wheelchair-esque piece of equipment. Many children with mobility challenges are often carried by family members, rather than having access to equipment. This is a real area of education and resource need. 

Counseling on home exercise and strengthening programs. 

Two genuine surprises and treats at the end of the day! A visit to our hotel from Thuy (in the blue top), who was an interpreter for us in the early years of the project, when she was a university student. She is now a nanotechnology researcher and project director at Can Tho University and the mom of 2 adorable kids. Thuy's mother, Lan (holding Thuy's daughter), is a longtime friend of the project and a local educator. It was beyond heart-warming to see them! 

Lan, Thuy, and Dr. Meir Nyska

Dr. Jeff Spanko, Phuong, Lan

And I'll leave you with a moment of delicious food. A local southern Vietnam treat is xoi do banh. This particular variety contains white and black sticky sweet rice, tons of shredded coconut, a layer of sugar paste, and salty crushed peanuts, all wrapped in two thin toasty rice pancakes. Heaven for 60 cents! My favorite purveyor was in the same place she has been for the last 15 years that I've been coming to Can Tho, surrounded by her drive-up scooter customers:

More project-specific details at https://extremityproject.blogspot.com/ 

Lots more to come from me as I start to do more speech-language pathology things! A happy and healthy New Year to you!

Returning to Vietnam- December 2019. You can help!

I'm excited to tell you that Stacy and I are returning to Vietnam in December 2019 to continue our partnership with the US-based International Extremity Project (IEP), Can Tho General Hospital in Can Tho, Vietnam, and Children’s Hospital 1 in Ho Chi Minh City, Vietnam. As you may know, we’ve been working with these programs since 2004, and we are thrilled to be working with them all again.

This year, we will split our time between the Mekong Delta city of Can Tho and bustling Ho
Chi Minh City. We’ll work at the Can Tho General Hospital with the team of IEP nurses
and surgeons to assess patients for foot and ankle surgeries planned for later that week.
We will also provide direct clinical support and services to the Can Tho Pediatric Hospital and
a local autism clinic. We will then go north to Ho Chi Minh City to Children’s Hospital 1 to
again work with the pediatric physical therapy and speech pathology teams in hands-on open
clinic with patients and to provide training lectures to area therapists and physicians.  

You have been very generous in the past in helping to support our participation in the IEP mission.
If you are able to contribute to the mission again, we would be very grateful. Any donation that you
make is tax-deductible. This year, your donations will be used to defray the shared $5000 in travel
and material costs that we will personally incur to make the trip, with all additional money going
to support the surgery team. 

Here’s how you can contribute:
Online (credit card): https://donatenow.networkforgood.org/1441540.
This site asks: “If you have a special purpose for your donation, please let us know.”
Please select “International Extremity Project” from the drop-down menu AND complete the
“I want my donation to be dedicated…” field with “Amy Levin and Stacy Lerner.” 

By mail (checks only): Make checks out to ICAN (International Children Assistance Network).
Please write “IEP- Amy Levin and Stacy Lerner” in the memo. 

Mail to:
International Extremity Project
1874 Great Highway
San Francisco, CA 94122

LINKS
Check out our blogs about our past work in Vietnam:
Amy: http://amyinvietnam.blogspot.com/
Stacy: http://vietnammissiontrip2013.blogspot.com/ , vietnammissiontrip2015.blogspot.com,
http://vietnammissiontrip2019.blogspot.com

Some other photos of us in action: http://www.donatevietnam2013.org/history-of-our-work-in-vietnam-so-far/

You can also follow the International Extremity Project on Facebook and Twitter (@extremityproj)

On YouTube:
https://www.youtube.com/watch?v=OGuVGb8jzDg&feature=youtu.be
https://www.youtube.com/watch?v=CWOjfSBrTfk

We’d love to talk with you more about our plans—please ask us!
Thank you again for your interest and all your forms of support,

Amy Levin ablevin03@gmail.com
Stacy Lerner stacyllerner123@yahoo.com 

At Pediatric Hospital #1, Ho Chi Minh City

It's hard to believe that a day that starts with this caphe sua da could get any better, 

but I'm happy to report that today was a good one from start to finish. First day back at Pediatric Hospital #1 in Ho Chi Minh City!

This Pediatric Hospital is considered a national leader for pediatric treatment. The therapists are trained at the bachelor's level as "physiotherapists," which includes physical therapy, occupational therapy, and speech therapy. It is very generalized training, and the physiotherapists start to distribute themselves into the different domains once they join the staff of the hospital, and are always looking for additional learning opportunities.

Most of the public space and waiting areas in the hospital are outside.

Stacy in the hospital parking lot

If you look closely at the group of people sitting under the overhang, you might notice that they have sleeping mats on the ground. Families are responsible for much of the care of children in the hospital and often sleep outside the patients' rooms.

Entrance into the hospital

Two of the therapists at the hospital have recently completed a 2-year speech certificate program run by a group of Australian speech-language pathologists in Ho Chi Minh City. The Vietnamese therapists have gone on to provide training to the rest of the speech therapy staff at the hospital. 

The Vietnamese speech therapists have some big challenges in developing as professionals. This trip, we talked a lot about developmental milestones in all the communication domains: there are no Vietnamese speech sound production milestones (what sounds are typically produced by what age), and very limited research about typical and atypical language development in Vietnamese. The therapists are trying to figure out how to evaluate what they see a child doing, write relevant goals for therapy, and gauge progress. 

This year, our collaboration with the department here followed the same pattern as our visit in 2013. The department selects some patients to come in and we are able to consult with the treating therapists and the parents, and demonstrate treatment strategies. This year's focus was on children 3 years and under with global developmental delay diagnoses-- more profound neurological, motor control, cognitive, and communication challenges. 

These case studies were attended by around 30 people; the group included hospital therapists and visiting pediatricians and therapists from other pediatric hospitals. The staff prepared case summaries for us for each child and described the cases in Vietnamese and English:

Stacy and I have been co-treating for a long time, it's great to get a chance to work together again:

15-month old boy who is not yet walking or bearing weight on his feet and is not actively communicating with other people

Working on getting his attention

...while Stacy helps him change positions and bear weight

2;6 year old girl with vision impairment, very limited mobility, and low cognitive levels

We learned a lot by talking with her parents

2;3 year old girl with motor delays and emerging communication

The man in the yellow shirt is her father-- he was a great partner

Talking about and working on joint attention

It starts to get a little bit steamy in the room-- no consistent airflow.... 

Bubbles are always a hit, anywhere you go...

On our second day at the Pediatric Hospital, Stacy and I did 3 hours of lectures to a group of 75 professionals-- the group included many of the folks from the day before as well as other physiotherapists from neighboring provinces. I talked about speech and language assessment and intervention for young children with global developmental delays, and Stacy did the same for physical therapy. 

Hung is a department PT and the default tech guy

Stacy consulting with Giao, the department head

Giao is also our primary translator for lecture day. We can't manage to thank him enough for all the work he does. 

(details that may be interesting only to pediatric therapists to follow...)

After our lectures, we had questions from the participants:

1. What to do with a 30-month old boy who is very active. He was given some kind of medicine that made him sleepy, but then he is just active again. His mother yells at him but that doesn't seem to help him change his behavior. 

2. How do you determine frequency of physical therapy? Who gets to make that decision-- the therapist or the physician?

3. How do work with a child with spastic cerebral palsy to improve his communication? 

I post these questions because, much to the Vietnamese participants' surprise, they are not dramatically different from questions and concerns that we grapple with in the US. The Vietnamese therapists' training and access to resources is not as abundant as in the US, but the issues are largely the same. We work hard to make sure that our responses and recommendations reflect what is accessible to the therapists. 

This is the marquee for our lecture

We had lunch after the morning lectures, and then had a full afternoon of open discussion. Think of oral comp exams, and then take away any air conditioning! We joined the group from the previous day to respond to the following questions:

1. How do you establish head control in a 3 month old? A 2-year old?

2. What are exercises to target the vestibular system?

3. How do you differentiate between Autism and Global Developmental Delay? When? How do you talk with parents? What differential treatment decisions do you make?

4. How to work on motor control with a 5-year old girl with cerebral palsy

5. How do manage hip abduction

6. How do you score the Rossetti Infant-Toddler Language Scale?

7. What is echolalia and how do you treat it?

8. How do you treat in-toeing in a child with diplegia? 

We were able to hear from the Vietnamese therapists about what their current strategies were, in addition to making our own recommendations. This year, we felt like many of their questions were indicative of a higher level of understanding of what was going on with their patients-- great to be a part of!

 

We were treated to a good-bye dinner that night:

This year's trip was a whirlwind, to say the least. We had much less time in each location than in the past, but we made good use of the time we had, thanks to our fantastic and prepared US and Vietnam colleagues. Every time we are here, we think of a million more things that we'd like to do-- our relationships here are strong enough to make me feel confident that each "next time" will be even richer than the one before. 

Thank you for all your interest and support this year, and every year!