AAOS Bulletin - August, 2006

AOFAS turns one man’s vision into reality

Overseas Outreach Project to Vietnam celebrates fifth anniversary

By Judy Datz

What started as a dream of helping people disfigured by war and poverty has grown into an ongoing, annual expedition for members of the American Orthopaedic Foot & Ankle Society (AOFAS) Overseas Outreach Project to Vietnam. AOFAS members just recently returned from their fifth mission to aid Vietnamese children and adults.

Members of the fifth AOFAS Overseas Outreach Project to Vietnam pose with hospital staff in Vihn City. Pictured are (back row, third from left) Nimrod Ron, MD, and (front row, seated from left) Naomi Shields, MD, and Ruth Thomas, MD

According to the late Ernest M. Burgess, MD, “The principle of self-reliance is key to restoring stability to war-torn nations and confidence to their people. Let us look forward to peace and stand ready to share our skills and knowledge, recognizing that there is no greater act than giving to people the tools to improve their own lives.”

The Prosthetics Outreach Foundation

Dr. Burgess, an AAOS member, began planning what would become the Prosthetics Outreach Foundation (POF), a Seattle-based nonprofit geared to “bring modern rehabilitation to amputees living in areas of great need.” One goal was to offer free medical care to Vietnamese civilians who had lost limbs to land mines left behind after the Vietnam War ended.

Since 1991, the POF has operated a prosthetics clinic in Hanoi that uses automated manufacturing technology to fabricate artificial limbs for land-mine survivors and other amputees. This technology allows for quick and economic fabrication of comfortable, custom-fit prostheses. The clinic is operated by a small staff of local people who regularly visit rural areas to bring prosthetic care to amputees living in remote, mountainous communities.

Scrubbing for surgery, Vietnam-style.

Dr. Burgess, who was honored posthumously in 2001 with the AAOS Humanitarian Award, understood that self-reliance and independence were keys to success for patients and their countries. Since Dr. Burgess’s death, Pierce E. Scranton Jr., MD, a protégé of Dr. Burgess, has continued his work. Dr. Scranton reached out to fellow members of the AOFAS surgeons to begin an annual mission to the hillsides of Vietnam.

“It is a very emotional experience to see children walking when they couldn’t before; to see their legs and feet straight when before they were crooked; and to see amputees, who could only hop on painful stumps, walk effortlessly on a new prosthesis,” said Dr. Scranton.

In 2002, the AOFAS partnered with the POF and established links with the Vietnamese government to provide life-changing orthopaedic surgery for disabled children and adults. The result is the AOFAS Overseas Outreach Project, which is funded through corporate and member contributions to the Outreach and Education Fund (OEF) of the AOFAS, and which provides corrective surgery to patients with lower-limb deformities because of polio, cerebral palsy, club foot, injury and amputation.

An “immensely satisfying” project

This year’s contingent included surgeons returning for the fifth time, as well as some on their first visit to Vietnam. Working with both Vietnamese and AOFAS surgeons on the team, Robert B. Veith, MD, performed surgeries in Vinh City and Ba Vi, and worked with Vietnamese orthopaedic residents at Viet Duc Hospital, the major teaching hospital in Hanoi.

“This is my third trip and it is more satisfying each time to know that we are bringing care to people, many young children, who otherwise would never be able to receive these life-changing surgeries,” said Dr. Veith. “Situations such as club foot, which are so easily treatable among the very young in this country, go neglected in Vietnam due to the distance village people must travel for good medical care. Our surgeries enable these children to have a normal life. Another immensely satisfying aspect to the project was the opportunity to work with the medical staff and faculty at the Viet Duc Hospital and teach them new surgical techniques, knowing that you are making a difference.”

Thomas H. Lee, MD, joined the group for the first time. The two weeks he spent operating on Vietnamese children and adults left an indelible impression. “During this visit, I have performed some of the most challenging surgeries of my career,” said Dr. Lee. “It pushes you to the edge of your comfort zone. Here we have the necessary technological environment, but in Vietnam we are forced to grow within ourselves to meet the different patient needs.”

Expanding knowledge

Both surgeons also presented at this year’s Fourth Annual American Vietnamese Seminar on Surgery of the Lower Extremity in Hanoi. Cosponsored by the AOFAS, the POF and the Vietnamese Ministry of Health, the conference was attended by approximately 180 Vietnamese orthopaedic surgeons and representatives of the AOFAS. Simultaneous translations enabled everyone to understand the presentations.

At the prosthetic manufacturing clinic in Hanoi operated by the Prosthetics Outreach Foundation, Dr. Shields examines the artificial limbs developed for land-mine survivors and other amputees.

As Dr. Lee expressed, “One of the main reasons for being here is not only an educational exchange with the Vietnamese surgeons, but the value of what they give us. It is a thrill to tackle adverse and difficult conditions with our Vietnamese counterparts!”

All the surgeons enjoyed the satisfaction that came with expanding the knowledge of the Vietnamese orthopaedists. First-time participant Nimrod Ron, MD, said, “For me, the most important thing during my time in Vietnam was the opportunity to help local surgeons learn and think about modern techniques. The patients came with deformities that challenged our problem-solving abilities. We performed surgery on deformities and conditions that we just don’t see in Israel, with limited equipment. There is a lot of catch-up to do here.”

Reflecting on the differences in practice between his home in Israel and Vietnam, he noted, “My practice in Israel includes trauma, most often from traffic accidents. In Vietnam, the principal means of transportation there is the motorbike, and accidents result in a great deal of lower-limb trauma. Also, the treatment of these injuries is more conservative. I believe we performed a very valuable service for the Vietnamese patients, who would not have been able to get this care due to their personal circumstances.”

Dr. Ron examines the lower limb of a young Vietnamese woman. Many patients have deformities from polio, rickets, cerebral palsy, and tuberculosis.

The people of Vietnam are so grateful for these surgeries that they come down from mountain villages and wait in long lines outside small hospitals and clinics. There are no complaints of painful surgeries or long recuperative periods. They are simply thankful for the care.

Loretta Chou, MD, felt very strongly about her participation, particularly the life changing surgery she performed on a toddler. “I operated on a 19-month-old child with bilateral club-foot deformities,” she recalled. “The mother and child traveled from the mountain region and needed to stay in Hanoi for the full six weeks of postoperative care, which involves serial casting every two weeks until the feet heal. The prognosis for improvement of the deformity is very good. This may be the only opportunity this toddler has for treatment of his congenital deformities.

“I realized how little opportunity some of these patients have for adequate medical care. The hospitals are filled with trauma patients who require immediate operations, so elective cases go untreated. I saw many young adults and teenagers with foot deformities—not because there is no treatment, but because they had no access to it. They walked on the sides of their feet and the feet looked ‘backward.’ What made it more strange was they wore plastic sandals, but the sides of the sandals touched the ground, not the bottom.”

Dr. Thomas examines a young patient at a rural clinic north of Hanoi.

The week Dr. Chou arrived, there were 82 new orthopaedic trauma patients. Patients had to double up and share hospital beds. “I helped care for 15 patients who otherwise would not have the opportunity for treatment,” she said. “It made a difference in my life, too.”

A legacy of learning

One important aspect of the program is education. Each year, a seminar is held with about 200 out of the 500 orthopaedic surgeons from Vietnam in attendance. Through OEF funding, the AOFAS gave one Vietnamese orthopaedic surgeon the opportunity to attend the AAOS meeting in Washington, D.C., and to visit U.S. surgeons. Teaching local surgeons and residents is ongoing.

“In 2004 AOFAS members brought new technology to Viet Duc Hospital,” said team leader Naomi N. Shields, MD. “There were 20 to 30 surgeons observing each case! In 2005, Dr. Ngo Toan, chief of orthopaedic surgery at Viet Duc, presented outcomes on 18 anterior cruciate ligament surgeries; a year later, they reported outcomes on more than 40 patients. Each year their techniques are evolving. The Vietnamese surgeons are very good and are eager to learn more modern techniques. It is gratifying to see patients who were operated on one side return to have surgery on the remaining side.”

Ruth L. Thomas, MD, was participating in her third mission. Previously, she had operated on youngsters with bilateral club feet, spina bifida, residual effects of cerebral palsy and polio, femoral malunion and calcaneovalgus foot.

“The patients and their families are extremely appreciative. The children tug at your heartstrings and their stoicism will make you cry,” she said. “I encountered pathology I had only seen in textbooks. The challenges were exciting and the immediate results rewarding. I felt accepted and welcomed by all the Vietnamese surgeons involved with this project.”

To date, more than 300 Vietnamese patients have benefited from the surgeries performed during these visits. The POF provides free prostheses, enabling many young children, women and men to care for themselves and their families. The surgical skills donated by the AOFAS surgeons complete the circle of care and education offered to the people of Vietnam.

Perhaps Dr. Shields best summarized the surgeons’ feelings about their mission to Vietnam. “AOFAS surgeons have made many good friends and built numerous quality professional relationships during our trips. We want to continue to strengthen our relationships with the local doctors and nurses. We thank the Vietnamese staff for all that they teach us; we learn much—perhaps more than we give. The AOFAS is happy and proud to be invited to Vietnam.”

Judy Datz is communications manager for the American Orthopaedic Foot & Ankle Society. She can be reached at jdatz@aofas.org

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