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HO CHI MINH CITY, Vietnam — There's not a lot of breathing room inside the operating room at Children's Hospital 2 in Ho Chi Minh City, Vietnam. A crowd of medical students, residents, and nurses are jockeying for position as Dr. Chad Wallis, a volunteer with IVUmed, operates on a 2-year-old boy.
"I'm used to trainees, but not that volume of trainees," he said later. "But when you're working, you're focused on helping the patient so you try to drown that out from what you're doing."
He seems calm, relaxed, and not at all thrown by the crowd as he inserts a catheter across the significant scar tissue that has been causing the child problems. While the boy will need additional surgery in the future, his bladder can now properly drain, which will allow an infection to heal.
This is Dr. Wallis' second trip with IVUmed, a Utah-based nonprofit organization that provides quality urological care to those who may not otherwise have access to it.
"These children drop through the cracks," said Dr. Catherine deVries, founder and president of the program. "The people who train in adult urology don't necessarily know how to take care of them. Pediatric surgery doesn't train in the specific techniques. There are a lot of very specific things about pediatric urology that require training in just this specialty."
- Dr. Catherine deVries first developed the group's teaching and service model in 1992 in Honduras.
- It expanded into Vietnam in 1994.
- Since then it's grown exponentially and is now in 30 countries.
- Vietnam is home to its flagship pediatric urology program.
When IVUmed first came to Vietnam in 1994, there were no pediatric urologists. Today there are 13 - 10 in Ho Chi Minh City and three in Hanoi. That's due to years of hard work by IVUmed and its in- country partner, Dr. Le Tan Son. Together, they've helped build a thriving pediatric urology program at one hospital and are now working to develop a high- tech surgical program at Children's Hospital 2.
The key is IVUmed's teaching model, which empowers local doctors through training and collaboration. It results in a ripple effect - the local doctors have the knowledge and confidence to continue operating and to educate colleagues once IVUmed doctors have gone. In Vietnam, doctors trained by the group have now operated on more than 7,000 patients independently.
"They've taken everything we've done and amplified it. In fact, they've done many more of some of these cases than we have just because the volume is so high," said Dr. deVries. "It's just a great thing to see."
The cases they're seeing this trip are complex, ones in which the Vietnamese doctors require second opinions from the IVUmed physicians or demonstrations of surgical techniques. When all is said and done, they will have consulted on 45 cases and performed 17 operations in Ho Chi Minh City as well as an additional 14 consults during a side trip to central Vietnam. All patients are selected in advance by Dr. Son.
One of the 17 operations is on Nguyen My, a toddler who is carried wide-eyed into the operating room before undergoing anesthesia. He has a blockage in his urinary system and needs a pyeloplasty, in which the blockage is removed and the healthy part of his kidney is reattached to his ureter. With all eyes on him, IVUmed's Dr. Lars Cisek demonstrates how the affected area can be reached with a small incision instead of the larger incision used in the past.
My's parents wait nervously in a nearby hallway.
"I'm a little worried. He's never had surgery before," his mother, Le Truc, said through a translator.
Following the successful operation, My's father lifts him from his surgical gurney and onto a waiting stretcher. With the help of a nurse, he pushes it to his son's hospital bed a couple of buildings away. My's mom tucks a blanket around his small body then strokes his face as he opens and closes his eyes.
"I hope now his pain [caused by his condition] will be gone," she said. "The doctors are very good."
The implicit trust between the Vietnamese parents and the IVUmed team is part of the reward for the doctors. They often don't understand what the other is saying, but they know everything IVUmed does is for the good of the kids.
"They're very generous with their hearts and their children that they open themselves and allow us to help out," she said. "I consider it generous because they don't need to be as open as they choose to be."