- Email: [email protected]
Vietnam: A Medical Mission Diary
INTERNATIONAL NURSING
VIETNAM: A MEDICAL MISSION DIARY Author: Molly B. Delaney, PhD, MBA, MSN, RN, CEN, CPEN, Minneapolis, MN Section Editors: Pat Clutter, MEd, RN, CEN, FAEN, and Nancy Mannion Bonalumi, MS, RN, CEN, FAEN
“G
ood Morning Vietnam!” I sip a chocolate mocha while gazing out French windows at a steamy Saigon street. Honestly? The chocolate mocha is instant, and the French panes are fake. I am one of 30 weary souls who traveled 27 hours with 30 suitcases of cardiac devices, equipment, and medications. Airline food was miso, fish, and dragon fruit (no wonder we saw little obesity in Asia). Three of us secured empty rows and stretched out like cats. No amount of money can buy a good night’s rest. Today we bring feeding tubes to orphans with cleft palates. If a mother in Vietnam delivers a disabled baby, there are no handouts except to orphanages. How sad that mothers are forced to allow strangers to raise their children (Figure 1).
6 hours for interpretation. We hope to teach 12-lead ECG interpretation and set up a cardiology activation process. CPR is not performed here, and they do not have crash carts. Only physicians use stethoscopes. Other concerns are the language barrier and rare follow-up. Although we offer free surgery and devices, lifelong use of blood thinners may be involved, and patients may disappear to avoid their bill. People sell everything to bring a family member to be saved. Many people camp in the hospital courtyard until they get help (Figure 2). We must find a way to make that happen.
Day 5: 20-Year-Old Cardiovascular Accident Patients? Day 2: A 9-Dragon Tour
After a killer breakfast of 6 cuisine stations, we load 60 bags on 2 coaches and drive southwest. Our sister hospital is a 6-hour drive through 15,000 square miles of the Mekong Delta, where most rice grows. The translation for the 2800-mile Song Cu Long is “River of 9 Dragons.” It refers to 9 tributaries where rich soil arrives from the Tibetan plateaus of China, Myanmar, Laos, and Cambodia. During the rainy season, flooding enables a floating economy of markets specific only to this area. Ours is a vacation from a travel book. We will ferry across the Delta and work on the bus surrounded by vistas. Not bad for a day’s work!
I cannot tell you every story, so here is one. A woman with 3 heart defects was advised to have surgery, although she could die either way. She refused—except when she heard the 2013 U.S. team was bringing donated devices and free labor. She agreed to a 3-in-1 repair. Today, she is here for follow-up and is symptom free. The life expectancy here is approximately 50 years because of rare preventive care and compliance. Some Vietnamese have strokes in their 20s and 30s. In the United States, annual physical examinations enable preventive medications to delay strokes until later. One aspirin a day can make all the difference.
Day 6: Break a Leg Day 3: Campus Butterflies
Our team consists of ED, catheterization laboratory, operating room, and ICU physicians and nurses. In this emergency department, 2000 patients are seen daily. The staff get ECGs but fax them elsewhere and wait up to Molly B. Delaney, Member, Twin Cities Chapter 155, is ED Nurse Manager, Emergency Department, East Bank, University of Minnesota Medical Center, Minneapolis, MN. For correspondence, write: Molly B. Delaney, PhD, MBA, MSN, RN, CEN, CPEN, Emergency Department, East Bank, University of Minnesota Medical Center, Fairview, 425 Delaware St SE, Box 710, Minneapolis MN 55455; E-mail: [email protected]. J Emerg Nurs 2016;42:177-80. 0099-1767 Copyright © 2016 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jen.2016.02.005
March 2016
VOLUME 42 • ISSUE 2
Months ago, we planned a cardiac symposium. The interventionalist would discuss heart disease, and I would follow with instruction on basic ECG rhythms. Then would come a discussion of 12-lead ECGs, complex devices, and other topics. My roommate and I skipped dinner the last 2 nights to prepare handouts. While our team dined out on snakes, mice, and small songbirds, we ate banana chips and nuts. It is the restaurant-goers who are getting ill. Double dipping happens here. For meals, each table has one bowl and everyone eats family style. Everyone’s saliva goes into the main food bowl from chopsticks. Ice is double dipped too. Each person gets a fist-sized chunk from a community ice pail. Wait staff swap larger chunks from the pail over time. Conversely, breakfasts involve exotic fruit and Vietnamese coffee. Pour half an inch of sweetened condensed milk in a glass; add thick coffee, then fill up your glass with resort-made ice, and it’s heaven! I need to go make a presentation. I couldn’t do this
WWW.JENONLINE.ORG
177
INTERNATIONAL NURSING/Delaney
FIGURE 1 Vietnam orphan cribs have no personal identifier.
without the love from family and friends. Thanks for your unwavering support!
Day 7: The Mosquito Whisperer
Last night, we dined along the river. Unfortunately, so did the mosquitoes. They transmit dengue fever, malaria, and
whatever their previous victims carried. We all wanted to be bitten by virgin mosquitoes. Meanwhile, our meat was cut into inch by inch blocks rather than disarticulated, which enables whole animals to be used. Therefore, instead of choosing white or dark meat, you choose bones, beaks, or claws. A pregnant dog was underfoot who was not so picky. Week 1 is ending and 5 team members leave tomorrow, as do the NBC videographer and documentary teams. At dinner,
FIGURE 2 Map of a Vietnamese hospital campus.
178
JOURNAL OF EMERGENCY NURSING
VOLUME 42 • ISSUE 2
March 2016
Delaney/INTERNATIONAL NURSING
FIGURE 3 Author Molly Delaney teaches ED nurses how to read ECG rhythm strips.
we celebrated with awards/certificates and in came a FRESH pineapple cake with the lightest, airiest coconut milk frosting ever. It was our Maryland physician’s birthday. Members have come from Illinois, Ohio, Pennsylvania, Washington, South Dakota, Oregon, Minnesota, and Vietnam. Our team is unique and will never be together again. Just when we function as a well-oiled machine, parts come off. Day 8: Everything Falls Apart
A 40-year-old woman was scheduled for a donated valve. Four units of blood were ready. We knew her heart disease was bad, but her atria fell apart like sheets of phyllo. Most of the valves we have are American-sized. We did not have a valve small enough, so we used one of theirs. (They explant valves from corpses, sterilize them, and reuse them.) This hospital bills for valves, so the case was no longer free. With so many broken pieces of plaque circulating, multiple clots formed. Meanwhile, all her units of blood were given away. On Friday night, I heard that bedside dialysis was started. At 10 pm, we got a call asking how to hold a critical incident stress debriefing. This will occur on our bus ride to the island today. It is 6 am, and I know she is gone. I don’t know what this means for our mission, future, our weekend
March 2016
VOLUME 42 • ISSUE 2
trip today, or the team well-being. It is a horrible ending for those who leave today, but we are providers and this is what we do. This weekend will not be about patients, but us taking care of us. Days 9-11: Unplugged
We played hard this weekend. Twenty of us drove 35 miles (which took 3 hours because of primitive roads) to Can Tho. Toshiba financed a cooled coach, ferries, and fishing boats. Two ICU nurses played Farkle for Vietnamese money or dongs. Sharing how one bids for dongs created a string of laughter. Rural Vietnam is like what you see in the movies, with rice paddies, banana plantations, exotic fruit orchards, and lotus fields. Bridges replace boats, but cars are rare. A car costs $60,000 with a 300% government tax—hence the motor scooters. Only elders ride bicycles. Despite money invested in South Vietnam commerce, there is extreme poverty. Although satellite dishes, cell phones, and TV are available, reception is unreliable. Yet the Vietnamese are hardy. They work hard and do not beg. They radiate pride. The Can Tho floating market was organized chaos. Before bridges, farmers would load boats and meet on the
WWW.JENONLINE.ORG
179
INTERNATIONAL NURSING/Delaney
Mekong to exchange items like street vendors. As bridges came, boats were unnecessary, yet elders troll every sunrise. Then we toured an island orchard, sampling coconuts, guava, and green mangoes with dip. The Internet was down all weekend, but we didn’t care. As I journal on our 3-hour drive home, my bladder reminds me of the 90°+ humid heat and how water is a moral imperative. In the dark, karaoke bars pulsate. It is a strong healthy pulse for Vietnam, in so many ways….
Day 14: “We Fix Hearts”
I woke up ill, but because one class was canceled, I could sneak in a nap. Once asleep, my sweet little interpreter crawled up on the hospital cot next to me for protection. I cannot articulate my love for these people. After class, the students brought shaved coconuts. They are starved for education and grateful for the little things. We bring donated bandage scissors, calipers, backpacks, pens, and red plastic bracelets that say “We fix hearts” to encourage coming to class. Yet, THEY make us feel special. God bless the Vietnamese!
Day 12: Why Did I Come?
Our last few working days are here. Friday we pack, and Saturday we fly to Saigon. Everyone plans to shop this weekend. I will visit the War Museum. My cousin Michael, a marine medic, was killed in the “American occupation.” I come to honor him, yet I feel bad for the Vietnamese, whose country has been occupied by so many. Vietnam is exotic, gorgeous, and rich in rare resources. I get it now; no wonder everyone else wants a piece of this heaven.
Day 13: Another Miracle
I toured a 20-bed emergency department and other units. ED staff included 3 nurses and 2 physicians for 12 patients. Families perform all activities of daily living. They had a Doppler, 2 bi-paps, a vent, and 2 defibrillators, with missing pieces. All the machines appeared to be donated because all the dials were in English. Each head wall had oxygen but no gases or monitors. The sink was broken, and there was no hand sanitizer. Next, we delivered toys to the pediatric ICU, where hand sanitizer was wired to every bed! Last night, a baby was born with a heart defect. In the United States, prostaglandin would keep the ductus ovale open until repairs are made. Luckily, we brought 4 vials for another miracle.
180
JOURNAL OF EMERGENCY NURSING
Day 15: The Final Chapter
Closing ceremonies were held. Each of us was called on stage for a gift. It was a plate and stand showing the local triumviral arch, etched with our trip dates. Did we make a difference? • 1 symposium attended by 90 physicians from 19 hospitals
8 valve repair or replacement surgeries 60 interventional stents placed • 400 people educated on hand washing, CPR, heart/lung sounds, rhythms, and head-to-toe assessments • $800,000 worth of instruments, devices, and medications donated with mentoring on their uses This is my last entry, because packing is anticlimactic. Thanks for sharing my journey. It was hard walking out of the hospital today. I am a different person than when I walked in. It will take time to process everything. It is ironic that we came to fix hearts. Now mine is breaking. I am in mourning as I leave a piece of my heart in Vietnam. • •
Submissions to this column are encouraged and may be sent to Pat Clutter, MEd, RN, CEN, FAEN [email protected] or Nancy Mannion Bonalumi, MS, RN, CEN, FAEN [email protected]
VOLUME 42 • ISSUE 2
March 2016
VIETNAM: A MEDICAL MISSION DIARY Author: Molly B. Delaney, PhD, MBA, MSN, RN, CEN, CPEN, Minneapolis, MN Section Editors: Pat Clutter, MEd, RN, CEN, FAEN, and Nancy Mannion Bonalumi, MS, RN, CEN, FAEN
“G
ood Morning Vietnam!” I sip a chocolate mocha while gazing out French windows at a steamy Saigon street. Honestly? The chocolate mocha is instant, and the French panes are fake. I am one of 30 weary souls who traveled 27 hours with 30 suitcases of cardiac devices, equipment, and medications. Airline food was miso, fish, and dragon fruit (no wonder we saw little obesity in Asia). Three of us secured empty rows and stretched out like cats. No amount of money can buy a good night’s rest. Today we bring feeding tubes to orphans with cleft palates. If a mother in Vietnam delivers a disabled baby, there are no handouts except to orphanages. How sad that mothers are forced to allow strangers to raise their children (Figure 1).
6 hours for interpretation. We hope to teach 12-lead ECG interpretation and set up a cardiology activation process. CPR is not performed here, and they do not have crash carts. Only physicians use stethoscopes. Other concerns are the language barrier and rare follow-up. Although we offer free surgery and devices, lifelong use of blood thinners may be involved, and patients may disappear to avoid their bill. People sell everything to bring a family member to be saved. Many people camp in the hospital courtyard until they get help (Figure 2). We must find a way to make that happen.
Day 5: 20-Year-Old Cardiovascular Accident Patients? Day 2: A 9-Dragon Tour
After a killer breakfast of 6 cuisine stations, we load 60 bags on 2 coaches and drive southwest. Our sister hospital is a 6-hour drive through 15,000 square miles of the Mekong Delta, where most rice grows. The translation for the 2800-mile Song Cu Long is “River of 9 Dragons.” It refers to 9 tributaries where rich soil arrives from the Tibetan plateaus of China, Myanmar, Laos, and Cambodia. During the rainy season, flooding enables a floating economy of markets specific only to this area. Ours is a vacation from a travel book. We will ferry across the Delta and work on the bus surrounded by vistas. Not bad for a day’s work!
I cannot tell you every story, so here is one. A woman with 3 heart defects was advised to have surgery, although she could die either way. She refused—except when she heard the 2013 U.S. team was bringing donated devices and free labor. She agreed to a 3-in-1 repair. Today, she is here for follow-up and is symptom free. The life expectancy here is approximately 50 years because of rare preventive care and compliance. Some Vietnamese have strokes in their 20s and 30s. In the United States, annual physical examinations enable preventive medications to delay strokes until later. One aspirin a day can make all the difference.
Day 6: Break a Leg Day 3: Campus Butterflies
Our team consists of ED, catheterization laboratory, operating room, and ICU physicians and nurses. In this emergency department, 2000 patients are seen daily. The staff get ECGs but fax them elsewhere and wait up to Molly B. Delaney, Member, Twin Cities Chapter 155, is ED Nurse Manager, Emergency Department, East Bank, University of Minnesota Medical Center, Minneapolis, MN. For correspondence, write: Molly B. Delaney, PhD, MBA, MSN, RN, CEN, CPEN, Emergency Department, East Bank, University of Minnesota Medical Center, Fairview, 425 Delaware St SE, Box 710, Minneapolis MN 55455; E-mail: [email protected]. J Emerg Nurs 2016;42:177-80. 0099-1767 Copyright © 2016 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jen.2016.02.005
March 2016
VOLUME 42 • ISSUE 2
Months ago, we planned a cardiac symposium. The interventionalist would discuss heart disease, and I would follow with instruction on basic ECG rhythms. Then would come a discussion of 12-lead ECGs, complex devices, and other topics. My roommate and I skipped dinner the last 2 nights to prepare handouts. While our team dined out on snakes, mice, and small songbirds, we ate banana chips and nuts. It is the restaurant-goers who are getting ill. Double dipping happens here. For meals, each table has one bowl and everyone eats family style. Everyone’s saliva goes into the main food bowl from chopsticks. Ice is double dipped too. Each person gets a fist-sized chunk from a community ice pail. Wait staff swap larger chunks from the pail over time. Conversely, breakfasts involve exotic fruit and Vietnamese coffee. Pour half an inch of sweetened condensed milk in a glass; add thick coffee, then fill up your glass with resort-made ice, and it’s heaven! I need to go make a presentation. I couldn’t do this
WWW.JENONLINE.ORG
177
INTERNATIONAL NURSING/Delaney
FIGURE 1 Vietnam orphan cribs have no personal identifier.
without the love from family and friends. Thanks for your unwavering support!
Day 7: The Mosquito Whisperer
Last night, we dined along the river. Unfortunately, so did the mosquitoes. They transmit dengue fever, malaria, and
whatever their previous victims carried. We all wanted to be bitten by virgin mosquitoes. Meanwhile, our meat was cut into inch by inch blocks rather than disarticulated, which enables whole animals to be used. Therefore, instead of choosing white or dark meat, you choose bones, beaks, or claws. A pregnant dog was underfoot who was not so picky. Week 1 is ending and 5 team members leave tomorrow, as do the NBC videographer and documentary teams. At dinner,
FIGURE 2 Map of a Vietnamese hospital campus.
178
JOURNAL OF EMERGENCY NURSING
VOLUME 42 • ISSUE 2
March 2016
Delaney/INTERNATIONAL NURSING
FIGURE 3 Author Molly Delaney teaches ED nurses how to read ECG rhythm strips.
we celebrated with awards/certificates and in came a FRESH pineapple cake with the lightest, airiest coconut milk frosting ever. It was our Maryland physician’s birthday. Members have come from Illinois, Ohio, Pennsylvania, Washington, South Dakota, Oregon, Minnesota, and Vietnam. Our team is unique and will never be together again. Just when we function as a well-oiled machine, parts come off. Day 8: Everything Falls Apart
A 40-year-old woman was scheduled for a donated valve. Four units of blood were ready. We knew her heart disease was bad, but her atria fell apart like sheets of phyllo. Most of the valves we have are American-sized. We did not have a valve small enough, so we used one of theirs. (They explant valves from corpses, sterilize them, and reuse them.) This hospital bills for valves, so the case was no longer free. With so many broken pieces of plaque circulating, multiple clots formed. Meanwhile, all her units of blood were given away. On Friday night, I heard that bedside dialysis was started. At 10 pm, we got a call asking how to hold a critical incident stress debriefing. This will occur on our bus ride to the island today. It is 6 am, and I know she is gone. I don’t know what this means for our mission, future, our weekend
March 2016
VOLUME 42 • ISSUE 2
trip today, or the team well-being. It is a horrible ending for those who leave today, but we are providers and this is what we do. This weekend will not be about patients, but us taking care of us. Days 9-11: Unplugged
We played hard this weekend. Twenty of us drove 35 miles (which took 3 hours because of primitive roads) to Can Tho. Toshiba financed a cooled coach, ferries, and fishing boats. Two ICU nurses played Farkle for Vietnamese money or dongs. Sharing how one bids for dongs created a string of laughter. Rural Vietnam is like what you see in the movies, with rice paddies, banana plantations, exotic fruit orchards, and lotus fields. Bridges replace boats, but cars are rare. A car costs $60,000 with a 300% government tax—hence the motor scooters. Only elders ride bicycles. Despite money invested in South Vietnam commerce, there is extreme poverty. Although satellite dishes, cell phones, and TV are available, reception is unreliable. Yet the Vietnamese are hardy. They work hard and do not beg. They radiate pride. The Can Tho floating market was organized chaos. Before bridges, farmers would load boats and meet on the
WWW.JENONLINE.ORG
179
INTERNATIONAL NURSING/Delaney
Mekong to exchange items like street vendors. As bridges came, boats were unnecessary, yet elders troll every sunrise. Then we toured an island orchard, sampling coconuts, guava, and green mangoes with dip. The Internet was down all weekend, but we didn’t care. As I journal on our 3-hour drive home, my bladder reminds me of the 90°+ humid heat and how water is a moral imperative. In the dark, karaoke bars pulsate. It is a strong healthy pulse for Vietnam, in so many ways….
Day 14: “We Fix Hearts”
I woke up ill, but because one class was canceled, I could sneak in a nap. Once asleep, my sweet little interpreter crawled up on the hospital cot next to me for protection. I cannot articulate my love for these people. After class, the students brought shaved coconuts. They are starved for education and grateful for the little things. We bring donated bandage scissors, calipers, backpacks, pens, and red plastic bracelets that say “We fix hearts” to encourage coming to class. Yet, THEY make us feel special. God bless the Vietnamese!
Day 12: Why Did I Come?
Our last few working days are here. Friday we pack, and Saturday we fly to Saigon. Everyone plans to shop this weekend. I will visit the War Museum. My cousin Michael, a marine medic, was killed in the “American occupation.” I come to honor him, yet I feel bad for the Vietnamese, whose country has been occupied by so many. Vietnam is exotic, gorgeous, and rich in rare resources. I get it now; no wonder everyone else wants a piece of this heaven.
Day 13: Another Miracle
I toured a 20-bed emergency department and other units. ED staff included 3 nurses and 2 physicians for 12 patients. Families perform all activities of daily living. They had a Doppler, 2 bi-paps, a vent, and 2 defibrillators, with missing pieces. All the machines appeared to be donated because all the dials were in English. Each head wall had oxygen but no gases or monitors. The sink was broken, and there was no hand sanitizer. Next, we delivered toys to the pediatric ICU, where hand sanitizer was wired to every bed! Last night, a baby was born with a heart defect. In the United States, prostaglandin would keep the ductus ovale open until repairs are made. Luckily, we brought 4 vials for another miracle.
180
JOURNAL OF EMERGENCY NURSING
Day 15: The Final Chapter
Closing ceremonies were held. Each of us was called on stage for a gift. It was a plate and stand showing the local triumviral arch, etched with our trip dates. Did we make a difference? • 1 symposium attended by 90 physicians from 19 hospitals
8 valve repair or replacement surgeries 60 interventional stents placed • 400 people educated on hand washing, CPR, heart/lung sounds, rhythms, and head-to-toe assessments • $800,000 worth of instruments, devices, and medications donated with mentoring on their uses This is my last entry, because packing is anticlimactic. Thanks for sharing my journey. It was hard walking out of the hospital today. I am a different person than when I walked in. It will take time to process everything. It is ironic that we came to fix hearts. Now mine is breaking. I am in mourning as I leave a piece of my heart in Vietnam. • •
Submissions to this column are encouraged and may be sent to Pat Clutter, MEd, RN, CEN, FAEN [email protected] or Nancy Mannion Bonalumi, MS, RN, CEN, FAEN [email protected]
VOLUME 42 • ISSUE 2
March 2016