| Vietnam '09 Mission Summary |
HISTORIC CARDIOSTART INTERNATIONAL MISSION TO VIET NAMNOVEMBER 1-14, 2009CardioStart team members embarked on an historic first mission to Asia upon invitation from Humanitarian Services for Children of Viet Nam (HSCV), Minnesota, U.S.A. This charity had recognized a need for improvement in the pediatric heart surgery field. Currently local surgeons are only able to treat 10% of the children with congenital heart disease in Viet Nam. In November 2008 a scout team visited the region and determined the most appropriate facility for this collaboration was Viet Duc University Hospital (VDUH) in Ha Noi, the nation’s capital. In September 2009, following a strong coordinated effort through Mrs. Truong, representing HSCV, a 20-foot container valued at $450,000 worth of supplies and equipment, originating from Florida, Minnesota, Ohio, Oregon and California was shipped from Chico, California by volunteers with Project S.A.V.E (Chico, CA). The cost of sending this container and other supporting financial support was graciously supported by a donation from Variety Children’s LifeLine, (CA, USA). An international team of 23 (CardioStart) and 7 (HSCV, led by Mrs. Tien Truong supported by Mr. Chuck DeVet) volunteers including medical experts and non-medical outreach volunteers and interpreters from around the world, convened on November 1st in Hanoi. The entire mission was coordinated by staff at the CardioStart headquarters in Tampa, Florida and HSCV in Minnesota, working together. Collaborating Universities included: Oregon Health & Sciences University; University of Minnesota; Loma Linda University Medical Center; University of Florida, Children’s Hospital of Orange County, CA, Children’s Memorial Hospital, Chicago, Il, USA, & The King Faisal Specialist Hospital & University Research Centre. A brief description of the mission is on you-tube: http://www.youtube.com/watch?v=gGk4xEvxt80 CARDIOLOGY & CARDIAC SURGERYIn collaborating with existing professionals at VDUH, the goal was to streamline processes and advance techniques in the field of pediatric heart surgery and related specialties. Each day, over 30 children and adults received cardiology evaluations during the mission. In addition to clinical assessment, patients were evaluated using 2-D echocardiography. No facilities on campus exist for angiographic evaluation, although this is available at another hospital in Hanoi. Many were referred for surgery. Two operating rooms were already dedicated to cardiac surgery and four-five cases/day were accomplished. CardioStart volunteers assisted and advised in both rooms and directly influenced the outcome of most cases during the peri-operative period. CardioStart’s portable echo machine assisted with ICU outcome management. Intra-operatively, emphasis was placed on assisting the local team acquire special operative experience and skill enhancement, providing new equipment with direct in-servicing, and teaching advanced perfusion techniques, including modified ultra-filtration, and hemo-concentration. Officially, CardioStart provided major support to 18 cases consecutively, but an additional 5 patients were assisted for essential parts of the operation being conducted by other local surgeons simultaneously. An I-Stat blood gas analyzer on-loan to CardioStart was used to assist with teaching and clinical management scenarios. An anesthetic technician accompanied this mission and gave special assistance to proper anesthetic organization, transfer and safety management during the peri-operative period. A Respiratory Therapist gave specific instruction in various scenarios on intensive care ventilator and general airway management problems. This specialty was a first for the Viet Duc hospital and for Viet Nam. The benefit of having a dedicated intra-department clinical pharmacist was also demonstrated by CardioStart’s pharmacy volunteer who revised the resuscitation cart and advised on appropriate drip management for inotrope and other drug delivery issues. CardioStart’s Intensivist, pediatric and adult ICU nurses gave both formal lecture and clinical bedside instruction sessions to enhance the post-operative recovery of patients passing through the unit.Throughout the two-week mission, patients were interviewed for data collection using the CardioStart database form. This will be the first time Vietnamese children and adults are being tracked as part of the ongoing international follow-up analysis being conducted by CardioStart. The form is a composite which includes all the elements of the STS adult and congenital forms, and also specific examination of developmental, neuro-cognitive and economic issues needing evaluation on patients living under severely deprived or remote/rural conditions. HISTORY MADEThis mission was also marked by a special historic event. CryoLife Inc., (located in Kennesaw, GA, USA) generously donated 2 pulmonary homografts from human donors in the USA. A heart valve (donated by a 31-year-old woman who had died in the USA) was harvested and preserved by CryoLife. By receiving this gift and hand-carrying it to Vietnam, for the first time in the history of Vietnam, a homograft valve was placed in the heart of a 21- year old young man at the Viet Duc hospital by local surgeons led by CardioStart’s surgical team.EDUCATIONAL DEVELOPMENT:Educational materials, protocols, specialized equipment and guidelines were provided in each related subspecialty in addition to the formal lectures. Future recommendations in each department were provided after careful analysis of systems and process.OUTREACH ASSISTANCEReed Franklin, CardioStart Trustee led the orphanage assessment and assistance program. His report is available on the web. As this was a first mission, his role was mainly exploratory, but the visit uncovered very disturbing facts about the plight of children living in orphanages receiving extremely poor local funding. One, located at a Buddhist Temple in Ha Noi cares for 82 abandoned children. These usually begin life at the orphanage after being left at the entrance and found each morning. The children range in age from newborn to eighteen years. The 82 children sleep in 7 bedrooms, the older children providing most of the care for the babies. None are ever made available for adoption but stay at the orphanage at least until they finish high school.Another orphanage in Ha Dong cares for 55 children age ranging from 3 to 20 yrs. This government-funded orphanage receives about 60 cents a day per child to pay for food. These children, who are also not available for adoption, have other serious needs such as soap, personal hygiene items, clothing, and blankets. Both orphanages exhibited good leadership, educational and general structured support but have severe equipment deprivation. HISTORY REVISTEDSENTIMENTS AFTER THE VIETNAM WAR. This mission was a strongly emotional experience for two CardioStart volunteers who were also Viet Nam veterans: a biomedical engineer and non-medical outreach volunteer. Both were highly motivated to participate on this mission, but had concerns about what kind of reception they might receive, and privately, their own personal reactions to this experience. One of these volunteers was walking in the Viet Nam War Museum and met a Vietnamese man who looked to be about the age. He directed the interpreter with him to ask the man if he was a Veteran. The man said “yes” and the CardioStart volunteer introduced himself as a US veteran, uncertain about what the man’s response might be. It was a very pleasant surprise when the man reached out and hugged him, kissing him on the cheek as they both wept. For both men it seemed to be a moment in which an invisible barrier had been lifted and a bridge was built between countries on a personal level. The other veteran reported that while chatting to CardioStart’s 21-year-old cardiac surgery recipient, he was introduced to the patient’s father. On exchanging stores it transpired that both men were at a strategic pass at the same time during the war. Every night the US marine’s job would be to shoot at the Vietnamese transporting supplies through the pass. The patient’s father responded that it was his job to defend the pass! After reflecting on this, both found reassurance in each account, saying to the other “We were both doing what our country told us to do”. Loading the container in Chico, CA in September 09 Acknowledgements: A number of individuals made personal financial donations; CardioStart also gratefully acknowledges the generous support of the following: |