Vietnam - Part 3 - Clinic Day

Prospective patients were first checked off by the wonderful Vietnmese nurses.  They then escorted them to a station where they were registered, weighed, and a blood test was done to determine if they were healthy enough to withstand the surgery.  From there they were photographed and a second photo was taken of the area that needed surgery.  After the photo was attached to their registration form they were escorted again by the Vietnamese nurses to one of two examination rooms where doctors would perform an examination.   The doctors listened to their breathing and heart and checked blood pressure.  They would then examine the person's area needing operation.  If it was within the scope of what we could do and if the person was healthy enough, they were given a green dot.   If they were marginal, perhaps with a cough that might disappear by the time they got to surgery, they were given a blue dot.  If the operation was not possible then they were given a red dot.  Those patients that were given a red dot for cleft pallet or for something that the dentists could remedy then they were moved over to the Dental examination area.  Here the dentists and speech pathologist would examine the person for what could be done to help them out.  Perhaps an appliance could be made to help them out.

After several very busy hours of examination, all those that had shown up had been seen and the doctors settled down to make up an OR schedule and to decide which patients they were going to operate on or recommend the hospital refer them to their own staff for help.  We had cleft pallets, cleft lips, extensive burns that caused gross morphology and even one patient that we could not handle that needed a leg amputation.  It was so hard for all of us to reject a patient because they were beyond our scope of ability.  Some of the patients would need multiple operations to repair their problem and we could be doing the first or subsequent operation this trip.    We were done early this trip because we will be having another registration day later this week so we earned an afternoon off.  For supper we were off on our own to a wonderful floating restaurant (on pilings) but over the river.  Many of us got quite adventurous and ordered unusual dishes⿦frog legs, squid, and eel.  Everyone headed to bed early in preparation for our big day ahead.  
Friday (First day of Surgery) 

We were up and had our regular breakfast of soup⿦yes I said soup.  The Vietnamese are famous for their soups that built the nation.  Some of us chickened out and ate pineapple slices, meat slices or bread.  Pasty rice and rice pancakes also bespeckled plates of some of us. 

The bus took many of us but some walked and others took a taxi to the hospital.  We didn't all need to be there at the same time as the OR had to be setup and the recovery rooms wouldn't be occupied until after the first surgery was done.  We didn't need our scrubs for the recovery or preadmission rooms.  Only surgery required them so some of us wore them while others wore their Rotaplast t-shirts.   It was a bit rocky on the first few patients through as everyone learned their roles.  The patients were never compromised but the volunteers became much more efficient and would anticipate the needs of the nurses as they became more experienced. 

Two volunteers in the presurgery department would retrieve patients as they doctors needed them and then entertain them in the presurgery ward.  The patient, often a small child was given a teddy bear to keep and a beautiful hand made quilt that would be used in surgery to keep them warm in the air conditioned rooms.  The blanket would follow them into recovery and then on to the wards.  They kept the blanket as well as the teddy bear. When Kim, our head nurse, called for another paitent for a waiting OR, there were often tears from the children and only the patient went on into the OR clutching their teddy.

The OR schedule was mounted on the wall at the entranceway to the rooms.  It was interesting to see how things were arranged.  Those same pieces of colour coded paper from the previous day were stuck onto the days schedule in vertical columns under each surgery team.  As the patient was moved into presurgery the paper was given a tick.  When they went into the OR, the tick was changed into an X.  When they left the OR, the paper was moved down off the sheet so that the next patient was at the top.  It was a wonderful system that could probably not be duplicated easily by computer.

When the paitient was stabilized in surgery, they were then transported quickly to the recovery ward.

As time progressed, the volunteers picked up much of the work that overloaded the post surgery nurses.  Watching them work as a new patient was carried or wheeled into the rooms was exciting.  Most of the patients were either awake of awaking as they were brought into surgery.  Some of them, mostly the babies expressed their displeasure in a most vocal way.  Once they were stabilized and given some water (they had been fasting and it was hot) they settled down.  Once they had been drinking and everything was normal, they were moved to the wards.  The wards were manned by only Vietnamese nurses so instructions had to be made clear and interpreters were used often.  We were instructed that we had to be out of the OR's by 7PM so our last patient didn't go to ward until about 9PM making a full day for the recovery room.

Ta Ta For Now,

Ken Beall