Daily Titan Special Section: Project Vietnam 2011

special report Student journalists traveled to Vietnam to embark on a humanitarian mission, documenting the trip through stories

Table of

Contents Writers Keith Cousins Melissa Hoon Sophia Islas MarryAnne Shults Don C. Stefanovich Photographers Larissa Bahr Johnny Le Mark Samala Lucio Villa Broadcasters Philip Cabrera Mario Davis Katie Widner Designers Jonathan Gibby Steve Sly Patrick Schwarz

Western quality in the jungle The Project Vietnam dental team performs minor surgeries, such as extractions and fillings, to Vietnamese children

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Through the eyes of a daughter A Vietnamese American fourth-year medical student assists Project Vietnam doctors in performing surgeries

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The opinions expressed within are the responsibility of the writers and don’t necessarily reflect those of the university, faculty or student body.

Twenty-nine remain An elderly woman nearing death travels through mountain passes with the help of her family to receive medical treatment from Project Vietnam doctors

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New hand, new life A New York surgeon performs a skin graft surgery on a 5-year-old burn patient to attempt to give his hand full range of motion

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Elderly seeks medical aid In rural areas in Vietnam, elderly and ill people receive primary care treatment and medicine from American doctors

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A Letter

From Professor Brody Students in Professor Jeffrey Brody’s Communications 438T, Reporting on Minorities, class spent 10 days on a medical mission to Vietnam in early March. Upon their return, Brody wrote the following to Comm. faculty: The class made it back from Vietnam after a nine-hour layover in Tokyo. We had planned to tour the city but spent the whole time in Narita Airport wondering if the reactor would blow and if we would be able to take off.

Some of you ask what the trip was like.

Here is my note to the students: Up at 5:30 a.m. Don’t know how I’m going to teach from 7-9:45 p.m. tonight.

Let me say you were a great group and it has been a pleasure traveling with you. You endured some of the toughest living conditions in musty mold-ridden rooms, you did the heavy lifting of medical equipment for the volunteers on the trip, you never complained about the stringy meat and oil-soaked fried food, you worked in humid conditions for 10 days without sun, you wore clothes over and over again because we moved so much you couldn’t do laundry, you walked on muddy roads and through the rice paddies, you met villagers whose wrinkled skin and weathered faces made them look much older than their years, you saw that happiness can burst through poverty, you learned how good you have it, you shared the experience with doctors, surgeons and nurses who endured the same hardships as you, you witnessed make-shift surgery in a hotel lobby, you saw hospital wards with patients, and their families, stuffed into a room, sleeping on soiled beds, you woke up to loudspeakers broadcasting propaganda, you side-stepped the guards, you wandered through outdoor markets and watched butchers hacking chickens and pigs, you observed the merchants with bloodied fingers cut up live fish, you saw noodles being made, you spoke with monks in Buddhist temples, you dodged the motor scooter traffic in Hanoi, you climbed more than 100 steps to enter a secret cave in Ha Long Bay, you partied and woke at dawn each day, and through all this you accomplished your mission of capturing the stories of people in Vietnam and the medical group that came to help them. One last thing - you put up with me prodding and pushing you to become the best student journalists in the world.

Western Quality in the Jungle

We have a chance to come into rural areas and eliminate that pain for these poor children.

That makes us and the children feel good.

-Tom Tran PVNF Dental Team

The Project Vietnam Foundation’s dental team is committed to providing quality care in order to eliminate oral pain for the children in remote regions of Vietnam – one tooth at a time.

Reporting by Keith Cousins Photographs by Lucio Villa As the haze settles in for the day, a truck drives through winding dirt roads and arrives at the village of TT Na Phac in the province of Bac Kan. Tom Tran, a retired aerospace engineer, gives the order to unload. An assembly line unpacks dental instruments, sterilization equipment and additional medical supplies. Two volunteers remove a generator. In less than an hour, the Project Vietnam Foundation sets up a Westernized dental clinic six hours north of Hanoi.

Founded by Dr. Quynh and Chan Kieu in 1996, PVNF is a nonprofit organization that provides medical assistance in Vietnam.

Tran and his wife Cateherine Pham, a dentist, heard about Orange County Calif. based PVNF and in 2005 joined the organization to provide dental care. Pham’s sister Bich Le, also a dentist, and her husband Thanh Tran, an electric engineer and Tom’s brother, also accompany team along with other volunteers.

“I started from nothing to the point that I was able to support my family and a little more than that - so I decided to give back some,” Tran said. “To me, the most important way to give back is to give back to the poor people back in Vietnam.”

Tran fled Vietnam at the end of the war and settled in America in 1975. He started out mopping bathrooms at Burger King, and worked his way up to become a successful engineer. The chance to remake his life after the war is one Tran is forever thankful for.

Unaware of the expectations for their first mission with PVNF, the then small dental team went to Vietnam expecting to treat 250 children

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in a week. Upon arrival however, the team saw just how much their services were needed.

“The need was so, so, so big here that we hunkered down and on the first mission we worked (on) around 600 to 700 kids,” Tran said.

After the first mission, the team’s primary focus was on organization and improving the number of patients they could see. For six consecutive years, the team has served around 2,000 children each mission.

“We are all professionals in America,” Tran said, while moving dental instruments from a chlorine dioxide bath into a pressure cooker where the instruments will steam at 125 degrees Celsius. “Instead of having to think a lot about it, we make plans as if we are making plans at work. We follow the plan and improve the plan every year. “ The dental team’s mission in 2011 was no exception. Working with no power or running water, Tran proudly said they were able to provide “American quality in the jungle.”

The Assembly Line Thanh Mia, in the Bac Kan province is a remote village seemingly cut out of mountainous jungle. On March 8, the PVNF team sets up at a middle school surrounded by jungle on the edge of town. A power generator rumbles as hundreds of children wait anxiously in line to see the PVNF dental team.

Roger Lutz, an engineer who serves as technical support for the team, gives the go ahead to the dentists after double-checking the power supply.

“We’re cooking,” Lutz said. “The kids are smiling, at least when they

come in.”

The process is quick. Pre-screening takes no more than a minute using a small LED flashlight. A stamp is used to mark extraction or filling.

If the teeth are fine, the patient gets a “Dental OK” stamp, and proceeds directly to the gift area – where they are given a bag with a toothbrush, toothpaste, notebooks and some candy.

It is always a race against the clock. Too many patients, not enough time.

First time volunteer, Robert Dinh, a practicing dentist of 12 years in West Covina, said, “ it’s not like we can schedule these patients tomorrow.”

With that in mind, the dentists focus on both the top and bottom first molar. These teeth usually come in when a child is around six and are

critical to eating.

“The teeth we do focus on, if we don’t save those teeth and they get rotten and come out – there is not another tooth that comes out to replace that,” Dinh said. “We usually focus on teeth that are going to last them a lifetime.”

Children hold onto slips of paper throughout the procedure. This slip lets the team know how many fillings and extractions were done. It is also the only visible sign the children display of discomfort throughout the process. There is no kicking and screaming. No crying. The only indications of pain are the crumbled patient slips that are handed to Lutz.

The generator rumbles on as the team works through the day, only taking an hour break for lunch. In the course of their time in Thanh Mia the team sees 292 patients.

Some 492 fillings and 82 extractions were preformed.

While working as a dental assistant in Orange County with Doctor Catherine Pham, Brian Loc Nguyen, 26, was compelled to join work side by side with his dentist and the rest of the PVNF team. The result was also a homecoming 19 years in the making.

Brian’s Story Prior to 2010, Vietnam was simply flashes of childhood memories for Nguyen. He did not remember anything concrete. Sometimes it was images of a cyclo driver pedaling passengers to their destinations on run-down roads in Ho Chi Minh City. He was only seven when his immediate family immigrated to America as a result of the UN Orderly Departure Program. But

A shot of anesthetic is administered prior to extracting a tooth (above). PVNF dentists fill the teeth of a child at a middle school in the Vinh Phuc province.

Over the course of the week 1371 teeth received fillings (left).

2010 changed things for the dental assistant. Urged by the example of Dr. Pham’s work with the dental team, Nguyen made the decision to return to Vietnam and participate in the medical mission.

“I figured, lets just go for it and see what the project is like,” Nguyen said. “I would get to explore my country, but I was there to help my dentist – that was my goal.”

Nguyen has worked as a dental assistant for Dr. Pham for close to three years. In April, he will take two months off the full time job to study before he takes the first step in reaching his goal of becoming a dentist – completing the Dental Admission Test and applying to dental school.

“At first I didn’t want to be a dentist ... (then) I worked at her office and being a dentist is very stressful – but it gives you the opportunity to socialize with your patients on a very personal level,” Nguyen said. “I really liked that, I feel like going to work everyday is having a party.”

Working in remote regions of Vietnam is similar to the work Nguyen performs in Orange County, but with the unexpected thrown in. A constant stream of patients waiting for what is likely their first time seeing a dentist increases the pace of his work. Sacrifices are made.

“You make your consultation very fast and then you just treat the most severe of the areas,” Nguyen said.

“You can’t treat all of them, so you

have to pick and choose a certain area and go with that.”

In place of the patient interaction found in the United States there is focus. Nguyen said that in order to be successful on the mission, each member had to focus on one thing and do that thing well.

In 2011, the one thing Nguyen focused on was amalgam – the mercury solution that is shaken rapidly in a machine to make material for fillings. The task is essential to maintaining the fast pace of the dental team.

“Last year, I was assisting and sometimes we had to wait a long time because people weren’t paying attention,” Nguyen said. “The efficiency dropped because the amalgam wasn’t being mixed fast enough.

But this year, when the dentist say ‘mix’ or ‘more’, I run to it right away.”

Nguyen compared the labor-intensive work the dentist’s perform in Vietnam to running laps on a track.

There is always the one lap after many where fatigue sets in. The lap that makes the runner want to give up. But for Nguyen, that is the time to push. To overcome the tired feelings and move forward, until all of the patients are seen.

Often, it is the thought of PVNF’s unique opportunity to serve in the rural areas of Vietnam that keeps him moving. The thought that children come to them for what will likely be the first and last dental ex-

amination of their lives.

“No one is going to try to go up to these locations,” Nguyen said.

“To have the opportunity to go to parts of Vietnam and go to these areas – it’s pretty special, you are helping kids who are completely isolated.”

When the mission concludes, Nguyen will once again spend an extra week in Vietnam, visiting his large extended family that still resides in Ho Chi Minh City and surrounding areas. It isn’t the Ho Chi Minh of his limited childhood memories. Motorbikes have replaced rickshaws and the streets are more crowded. But for Nguyen it’s not about seeing the city of his childhood, it’s about reconnecting with his bloodline.

“To see them again and talk to them, to see their personalities – it really connected me to my heritage,” Nguyen said.

Nguyen is not only discovering his heritage as a result of his participation with PVNF, he is building much needed experience in the field to succeed in his ultimate goal of becoming a dentist – but his number one priority is aiding his dentist.

“For now, my main goal and function is to help my dentist,” Nguyen said. “That’s my main goal.”

Achieving his goal also enables the dental team to achieve their ultimate goal of providing care to the countless children in remote areas who have all but been forgotten.

A Numbers Game Each morning after setting up their workstations, a line of children awaits Project Vietnam dentists. They laugh and giggle, while they squeeze as close to the entrance as possible. The scene repeats after lunch, and then daily for the course of the week. When facing a need of this magnitude, efficiency and speed are key.

In order to see as many patients as possible, the dental team makes plans to ensure success for each day in the field.

“It’s always very dynamic situations when we go to places where we don’t have 100 percent control,” Tran said. “As an engineer, when we setup the plan we always go for the worst case. We always have plan A, plan B, and maybe plan C in there too.”

As early as January, Tran begins to plan in order to ensure everything will be in place for the March trip.

Although, according to Nguyen, all the planning causes a great deal of stress to Tran – the end result is being able to respond to the unexpected.

“It’s always smooth,” Nguyen said.

Over the course of five days, 1100 children lined up to be seen and received care from the Dental Team.

Every single child got at least a dental examination.

Cavities were drilled away and teeth were filled in 1,371 mouths

– 255 teeth were removed. Due to time restrictions, 275 dental packets were given to children who were unable to be seen by the team.

Although speed and efficiency enables the dental team to see the maximum number of patients, the team is only at a given location for one day during the mission.

“You spend one day here, we treat as many patients as we can and then it’s off to another city,” Dinh said.

“Some of the people that aren’t seen will probably never see another dentist or physician for a while, unless another project comes along. It’s pretty sad to see that.”

The Pay-Off At the end of each day a hole, two feet deep and four feet across, is dug in the tan jungle floor. Sometimes a local volunteer does the digging, other times it’s a group of PVNF volunteers. Water bottles partially filled with gasoline from the generator are placed in the hole with used needles, medical garbage and other debris from the days work.

The pile is then lit on fire. Burned in order to prevent locals from trying to reuse the potentially harmful waste. As acrid black smoke trails off into the evening sky, the dental team loads the truck and leaves nothing behind.

“It’s an adventure,” Nguyen said.

“You work your butt off, but at the end of the day you are going to feel like you didn’t waste your time.”

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Through the eyes of a

Daughter Reporting by MaryAnne Shults Photographs by Johnny Le Monica Kieu stood on a four-inch high wooden box as she assisted the plastic surgeon graft paper-thin pieces of skin onto the four-year-old boy’s hand, burned so badly that his fingertips permanently curled into his palm.

This wasn’t in the pristine conditions of an operating room in an American hospital; it was in Bac Kan in a mountainous, semi-rural area of Northern Vietnam. She wasn’t short; the surgeon just extremely tall.

Kieu had heard from her parents, the founders of Project Vietnam, that conditions at the hospital were poor but imagination had not prepared her for unequipped, antiquated facility.

It was the opportunity to view the experience not only through the eyes of a daughter, but of those of a doctorto-be. She had heard tales of poverty and those ignored by the governmental health care system.

The fourth-year medical student was on her first medical mission and for the first time she witnessed and understood her parents’ objective and purpose.

There was a room full of mothers holding children with an assortment of physical disorders, scarred from prior injuries. Kieu smiled at the adorable children, some disfigured with cleft lips and palates.

Dressed in light blue surgical scrubs, her long jet-black hair pulled back and her stethoscope around her neck, she sat while American surgeons interviewed potential patients. What she’d only heard about in conversation or seen in photographs throughout her life was suddenly reality.

A cleft lip or palate does not fuse properly during embryonic development. Surgical repair corrects the defect, preventing future problems with breathing, speaking and eating, and improving the person’s physical appearance. In the U.S., the correctional procedure is usually done during infancy and is covered by health insur-

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Fourth year medical student, Monica Kieu assists Dr. Michael Koch in a cleft lip surgery.

Using forceps, she holds the sutures taut as Dr. Koch sews incisions closed.

ance. In Vietnam, the majority does not have insurance, or the income to pay the high out-of-pocket expenses.

Those children couldn’t smile back.

At least not yet. But the beautiful Vietnamese-American woman with her long lashes and soft voice offered a diversion from the strange-looking American doctors who spoke in a bizarre language.

The parents were hopeful their child would be selected as a candidate for free corrective surgery. Kieu noticed the families remained stoic, yet their expressions showed desperation with a glimmer of hope.

Kieu grew up in a home with parents whose native language was Vietnamese, so she could understand and speak it, but now she would be expected to explain medical terms for which there was no direct translation.

As she sat with the surgeons in the hospital clinic, selecting those who were appropriate surgical candidates, she thought, “OK, we’re going to take care of this. I’m ready to go.”

Kieu knew her parents were proud of her and this mission would open doors.

Bac Kan, a small city within the province of the same name, has an urban population of about 54,000. It lies due north of the capital city Hanoi.

Its inhabitants include several ethnic minorities including Tày, Nùng and Dao. Those who live in the northern midlands and mountain areas had an average per capita income equivalent

to US $400 in 2008, only one-third of the nation’s average level, according to the General Statistics Office of Vietnam. The province has the highest poverty level.

“People here are desperate for care and they are so grateful. No one else will help,” Kieu said. “Many have never seen a doctor, especially in the remote provinces.”

Born in 1981, Monica Chau Kieu was second-born to Quynh and Chan Kieu. Monica’s parents had escaped from Vietnam in 1975 and settled in Orange County. Chan is an anesthesiologist at Fountain Valley Hospital and Quynh a pediatrician in private practice at the same hospital.

Kieu attended boarding school in Watsonville, Calif. then attended the University of California, Riverside where she earned her bachelor’s degree in anthropology.

Medicine wasn’t in the cards after college; law was the direction she chose. She scored in the 96th percentile on the LSAT. In the meantime she worked as an extern for a federal judge in Los Angeles.

However, she found she wasn’t getting any satisfaction from law and she was frustrated.

“There were no immediate results to show for. I was only doing lots of paperwork,” Kieu said. “There was no tangible good. I was impatient. I like to see the fruits of my labor.”

The judge saw her frustration. He had a daughter who was an allergist

and he talked about how much she enjoyed working in medicine.

Kieu applied to all the medical schools in Southern California, but when Western University of Health Sciences offered her a spot, she took it.

“My parents were supportive of my decision to go to law school,” Kieu said, “But when I decided to go to medical school instead, they were very excited.”

She added in Asian culture, the medical field is stable, offers job security, but more importantly, provides prestige. The decision delighted her mother.

“She’s my number two. My first didn’t go into medicine, so I blocked out all my expectations,” said Quynh Kieu.

Medical school takes four years,

two spent in the classroom, while the rest include clinical rotations of four to six weeks working in surgery, pediatrics, obstetrics and gynecology and emergency medicine.

“This is the period when a student can pick and choose, exploring different fields,” Kieu said.

During the last part of her third year, Kieu chose an elective otolaryngology rotation working in the specialty of ear, nose and throat medicine.

She worked in a clinic with patients ranging from infants and toddlers with chronic middle ear infections or hearing problems to adults with facial paralysis and mouth tumors.

“Most of the cases were bread and butter, only requiring antibiotics or steroid treatments,” Kieu said. “But some required surgical correction.”

Left: Monica uses a Frazier suction tip to remove excess fluids during surgery. Above: A quiet moment, Monica regains her focus in the recovery room in between surgeries. Right: Dr. Chan Kieu, Monica’s father and PVNF co-founder, looks on as his daughter observes and assists with surgical procedures.

In her fourth year, she tried out the field of her father – anesthesiology.

“I love the lifestyle because of my father,” Kieu said. “I could see myself going to work right next to him.”

During this time, she took her board exams and began seeking a hospital to complete her residency. Knowing both were very competitive fields, Kieu debated between otolaryngology and anesthesiology.

“In the course of four months, I spent about $7,000 traveling all around the country,” Kieu said. “Then I heard I was accepted at the Detroit Medical Center (for a residency in ENT).”

Finally able to take a well-deserved break, she seized the chance to play an active role in one of the medical missions that her parents had dedicated so much time and passion.

Founded in 1996, Project Vietnam Foundation (PVNF) works in needy provinces providing free, life-altering surgeries for children with birth defects and eye problems, as well as medical and dental services. It provides ongoing collaborative training to Vietnamese health care personnel in pediatric emergency services, standards for infection control, and services for children with special needs.

The surgical suite had been set up the day before by a staff of volunteers, both novice and well seasoned with PVNF. Mingled with the doctors and nurses were other friends or spouses

who’d come along to lend a hand where needed. Most had brought the supplies needed for a functional operating area, purchased at their own expense or donated from their employers.

The area was clean, yet some of the equipment functional but archaic—a stark contrast from the state-of-the-art medical facilities in the U.S. Monica Kieu hardly noticed as she was more aware of the personal opportunity. She would be working side by side and under the supervision of two surgeons she considered distinguished in their respective fields, R. Michael Koch, M.D., a plastic surgeon from New York City and Edward Kravitz, an otolaryngologist from Orange County, Calif. As a team, the doctors’ contrast was striking. Koch, the young, handsome, soft-spoken Scotland native and Kravitz, the outgoing, witty retired advisor, yet their synergy was remarkable.

“Monica is a fourth-year student and matching in ENT for her training. As such, she is more than capable of placing sutures and assisting in the O.R.,” Koch said. “At my teaching hospital, I would give a fourth-year med student ample opportunity to scrub, observe and assist. By assist, I mean holding retractors, cutting sutures, placing sutures, etcetera.”

More exceptional was that her father would witness her potential, skill and drive. She thought back to her parents’ reactions when she an-

nounced she was going to medical school, and now was the chance to really make them proud.

“I’m working with my mom and dad. This is any parents’ dream. They never thought I’d be an ENT surgeon and go this far,” Kieu said.

Kieu watched, quietly yet attentively, standing over the sterile area as the surgeons worked on their first patient.

After she was safely transferred to the care of the recovery room nurses, the trio moved into the second operating room where 18-month-old Kim Oanu Bui was anesthetized, the scrub nurses ready to go. The baby’s face had a large black mole, which somewhat disguised her cleft lip.

Koch and Kravitz took their places on round metal stools. Suddenly, Kravitz stood up, smiling, and gestured to Kieu to take his place. After a moment of hesitation, she sat down, and Koch began to explain the procedure, while demarcating the anatomical and incision areas with a methylene blue pen.

With the metronome-like rhythm of the anesthesiologists’ monitor in the background, Koch gently began explaining that first he would make a composite cut to remove the mole and then begin to develop the normal curvature and slope of her top lip.

Intent on the sterile area, Kieu didn’t notice her father quietly slip into the room. When he realized it was his daughter, and not Kravitz sit-

ting next to Koch, his eyes lit up with pride above his surgical mask.

Monica Kieu didn’t notice her father since she was hyper-focused on Koch’s voice as he guided her through the procedure. He was impressed with his student.

As an associate professor of surgery at New York Medical College, this was not his first time in the role of teacher.

“As you can imagine, teaching surgery to another physician takes a great deal of time and is best compared to an apprenticeship that takes years to complete,” Koch said. “Allowing someone to cut skin with a knife is not the same as performing an operation.

It would be like me holding onto the rudder of a plane and thinking that I’m a pilot.”

The next day, Kieu’s confidence level had skyrocketed. As she assisted Koch with a cleft palate repair, she asked about healing edges. The banter during surgery was relaxed and casual as the majority-rule female operating room staff agreed Nordstrom’s was the best place to buy shoes, and all let out a hearty laugh when Koch joked about his wife’s passion for Jimmy Choo shoes.

Chan Kieu slipped in, whispering to the petite anesthesiologist, Loan Le, to take a break, and he stepped in to take her place. He moved in close to his daughter, looking directly over her shoulder.

“When will I ever work one-onone and receive this caliber of practi-

cal experience?” Kieu asked, knowing she would gain what her peers would only get working countless hours in the O.R. “I’m learning so much and getting really good at technique and paying attention to detail.”

When the day was over, the last patient out of recovery, safe with caregivers in another part of the hospital, Koch issued high praise for Kieu.

Koch explained that Monica assisted with hand surgery, cleft palate surgery and removal of a large facial mole. The hand surgery was to correct the young boy’s contracted fingers. This required “z-plasty flaps,” or a Z-shaped incision to create flaps to release the contraction. The mole resection involved skin grafting and closure.

“She performed very well and responded to my teaching with interest and attention. She has ‘good hands’ as they say in that she is gentle with the tissue and careful when using instruments,” Koch said. “There is a sense of measured control in her hand movements; all good signs for her future skill as a surgeon.”

Emotions have set her future into motion as she hopes to someday take on a leadership role with the PVNF to assure the people of her parents’ and ancestors’ homeland can assuredly receive proper and affordable health care.

“Seeing medicine done this way,” Kieu said, “you can practice medicine anywhere.”

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A child cries while waiting to be seen

by Project Vietnam doctors in Southern Vietnam. Photo by Mark Samala

Taken from inside a moving bus on the way to Hanoi, a man plows his rice fields.

Photo by Lucio Villa

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Two boys wait outside a recycling center where they also reside in Bac Kan, Vietnam. Photo

by Mark Samala

A woman performs daily cleaning duties on a crowded street in the province of Bac Kan, Vietnam.

Photo by Johnny Le

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Twenty Nine

Remain One family’s journey for hope and healing Reporting by Don C. Stefanovich Photographs by Mark Samala

Khe Phung Thi vomits into a pink, plastic shopping bag.

A fit of coughing and wheezing shakes the 78-year-old’s frail frame. Lai, her daughter, closes the bag when the spell has passed. Dr. Eugene Etzkorn delicately peels the bright red, black and yellow plaid scarf from her head exposing her steel-wool hair. His fingers trace her leathery jaw line down to her neck and examine her glands. His hand brushes aside a bright orange coat and his stethoscope pauses in several places on her chest. Between a brow furrowed with concern and thin lips offering a comforting smile, Dr. Gene’s blue eyes remain focused. The prognosis looks grim.

Edema bloats her feet. Osteoporosis erodes her bones. Hypertension assaults her arterial walls. Atrial fribulation denies her body oxygenated blood. Malfunctioning heart valves strain to keep pace with the spasmodic beat.

Congestive heart failure is killing Khe. It’s the kind of case that Dr. Gene treats by the hundreds as a part of the Project Vietnam Foundation (PVNF), a medical non-profit that has been treating patients and training local providers in rural Vietnam since 1996. The 63 year-old infectious disease specialist, a former military doctor, joined the mission to provide medical care to poor minorities in the remote and destitute villages and provinces of Vietnam. It’s an effort that he says is all too often only a temporary bandage in cases like Khe’s.

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Khe only weighs about 60 pounds, but it takes three people to carry her and an entire family to support her.

In May 2010 weakness began to eat away at Khe’s ability to contribute on the farm high in the mountains above Dong Dan village near the Chinese border. Her breaths grew shorter and took greater effort. Sleep eluded her as the constant battle for oxygen required conscious effort throughout the night. Thirteen family members – four generations – began to take turns sleeping next to her each night in the dirt-floor hut.

Her room – the only one partitioned from the rest of the living space, a sign of respect – contains her bed, adorned with brightly colored blankets and pillows. The rest of the hut wraps in an L shape around Khe’s room. On one end are the only two other beds. Lai’s is closest to her mother’s room. Her granddaughters share the next bed. On the opposite end of the hut is an old, wooden chair next to a small fire pit. Smoke and embers rise toward the thatched roof making the sunlight visible as it sifts through the holes in the log walls. In the dappled light, three conical hats rest on one of the wooden supports running overhead, parallel to the ground. A loft overhead stores their harvested corn and straw mats where Khe’s great-grandchildren sleep.

In the middle of the L is a faded green set of child-size table and chairs.

A tea set rests on top. Just in front of the dining set against the outer wall of Khe’s room is a fading cherry-oak credenza containing the family’s few dishes, utensils and possessions. On

Above: Khe Phung Thi, 78, is carried up a mountain by her family members to their home. Photo by Mark Samala. Right: Dr. Eugene Etzkorn examines Project Vietnam patient Khe Phung Thi in Tt Na Phac. Photo by Johnny Le

top sits a large, rectangle picture frame. Behind the cloudy glass are old, faded, family photos taken long before Khe was sick. A shovel leans by the door next to a broom used to sweep the dirt floors. Everything is in immaculate order.

Outside the wooden walls, peeps scurry about in the dust, scattering at the sight of dogs roaming the grounds. Hens protect their eggs in wicker baskets set off the ground and covered by straw overhangs. Hogs grunt and root in bamboo cages.

Down a path enclosed by bamboo fence approximately forty yards, in the shade of a small stand of palms, cows mill about in a small barn constructed of wooden planks. A blue tarp partially protects the western side from sun. Beyond, the narrow path leading from their home snakes through the fields before descending through corn fields, terraced rice paddies and into the dense forest.

It is a long way down to the dirt roads and villages below; over three miles of a narrow, steep, muddy trail.

There are switchbacks and streams; rocks and logs.

Khe’s only way down is on the backs of her granddaughters.

From there, it is over three hours by motorbike to the closest hospital in Bac Kan, six hours north of Hanoi, the capital. Khe stayed there at the hospital in Bac Kan for a week recently after taking a turn for the worst. Her condition stabilized. They released her and prescribed medications.

The prescriptions were never filled.

They were too expensive, and after paying for a week in the hospital, the family’s resources had been exhausted. Khe can no longer work and with one person having to be by her side 24 hours a day, their productivity has dropped dramatically. Most of

their profits go to the owners of the land where the small farm sits. They barely survive on what is left, most of which goes to Khe’s care.

When they heard about Project Vietnam – heard about the promise of western doctors and medicine so close, closer than the hospital in BacKan – they knew they had to find a way.

But only 10 vouchers would be hand delivered to each village. Only 10 vouchers would be distributed among the hundreds. The veritable golden tickets would have to find their way through the grasp of greedy officials, their passage propelled by “donations” in the form of scholarships and televisions, to those in most critical need; those young and old in need of care; those who couldn’t afford it otherwise; those like Khe. Somehow one of those vouchers found its way to into Khe’s gnarled, leathery hands.

Left: Thi sits by the fire in the dirt floor hut she shares with 13 family members.

Photo by Mark Samala. Above: Thi’s great- grandaughter leans in the doorway of their hut, high in the mountains above Dong Dan VIllage.

Photo by Don C. Stefanovich

As she sits in the back of the crowd of impoverished children and decrepit elderly waiting to be seen, hunched over listlessly on a plastic child’s seat, a fly crawls on one of the filth encrusted, overgrown fingernails of those gnarled hands.

Khe doesn’t notice.

The medical team has worked all morning treating hundreds. The first batch of patients is nearly finished.

The once crowded compound standing between Khe and the doctors is now mostly a sea of empty, red, plastic children’s chairs.

Khe doesn’t move.

Pain contorts her wrinkled face.

Several volunteers notice. With the help of a translator and the permission of a doctor, she is given permission to skip the remaining wait and intake process.

Two volunteers lift her to her feet.

Khe can’t walk.

She is placed in another tiny, red, plastic child’s seat and is carried through the crowd and into the dingy, crowded, makeshift examination room.

Dr. Gene’s blue eyes remain focused.

Congestive heart failure is killing Khe. Dr. Gene would normally prescribe Furosemide, a diuretic, to relieve her edema, relax her hypertensive state and allow her swollen heart to return to normal size, hopefully regaining its regular rhythm.

The team’s pharmacy has never actually stocked Furosemide – until now.

But the diuretic carries the risk

of dehydrating Khe. The standard 40-milligram dose could easily be too much for her, but half that may be ineffective.

If it’s too much, Khe’s electrolyte and pH levels could spiral dangerously low.

She could lose what few precious nutrients she does take in as part of her impoverished diet.

Her kidneys could fail.

Khe could die.

Dr. Gene could try Atenolol, a drug used to treat hypertension by slowing the heart and reducing its workload.

It doesn’t carry the risk of dehydration, but won’t do anything to relieve her edema or reduce the size of her swollen heart, only slow it down.

It could slow it down too much.

It could stop her heart.

Khe could die.

Dr. Gene’s prescriptions would normally include follow-up visits and careful monitoring of dosages and reactions.

The PVNF team has received unexpected word from officials that this is to be their last day at this location.

They are here to help, but there is concern that the team is creating a threat to security. Follow-ups are not an option.

If left untreated, Khe’s condition will only deteriorate.

Dr. Gene knows that she has a 90 percent chance of dying within a year.

If her heart doesn’t give out or she doesn’t suffer a massive stroke, her shortness of breath will only worsen as her lungs fill with fluid.

Her respiratory system will fail.

Khe will drown.

Between a brow furrowed with indecision and thin lips offering a comforting smile, Dr. Gene’s blue eyes struggle for an answer. The risk weighs Volunteers carry Khe back out to the waiting area of the compound and sit her on a plastic child’s seat.

This time it’s blue.

She rests momentarily before beginning the journey home. Her shaking hand raises a small, round, white pill to her cracked lips.

Sandwiched between the driver and her granddaughter on the back of a tiny motorbike, Khe winces as they bounce down the dirt road past a blur of ramshackle huts, lakes and rice paddies fertilized with human excrement.

The rest of the family walks.

Nearly half an hour later the bike reaches the base of the trail leading to their mountain home. Khe hunches on a log next the dirt road as the bike whirs away in a cloud of dust to pick up more passengers.

Her great-grandchildren laugh and play as another fit overtakes her.

She leans over, hacking, and vomits behind the log. A withered hand grasps that of her granddaughter, Nhat, the only one wearing blue jeans. She stands and straightens up the best she can.

Lai’s gold teeth glint as she smiles.

Together, she and Nhat help Khe onto the back of another granddaughter wearing pink sweats. Pink laughs. Straddling piggyback, two generations apart, they are bound to-

gether by long strands of blue cloth.

The cloth wraps under Khe’s shoulders and criss-crosses around her waist and under her legs.

Pink puts one foot in front of the other on the narrow path that meanders up into the trees, cutting back and forth through weeds and ferns.

Wearing only flip-flops, she carefully places her feet on stones and logs as she crosses streams carrying the weight of her mother’s mother. Khe’s bare, swollen feet dangle no more than a foot and a half over the obstacles her granddaughter traverses.

Khe’s great-grandchildren run ahead, laughing. They often swim here in the pools below cascading waterfalls. They hardly notice the steadily increasing grade.

The dense, green canopy provides shade from the sun but traps moisture.

Humidity pools with sweat on Pink’s brow and rolls off her nose.

Her straight, black hair sticks to her forehead. Out of breath, she squats as Lai, gold teeth glinting, undoes the cloth.

It’s Nhat’s turn. As she stands, Khe cries out.

The straps between her legs are too tight and are hurting her.

They try again.

Nhat rounds a tight, steep, rocky switchback and with lunging steps drags her sandled feet up the leafcovered slope. Vines hang here where the children swing and climb.

Nhat tires quickly.

Khe’s third granddaughter, wearing a red button-up, sleeves rolled, with blue, plaid pajama pants kneels.

The mud turns the plaid of one knee brown as she is bound to her grandmother.

Her pink sandals scrape along the dirt path. Twigs and shrubs rip and scrape at the plaid pants.

Dense foliage gives way to fields and soon the path winds along terraced rice paddies.

They switch again. Nhat once again hoists her grandmother up and plods on.

The blue tarp of the cattle pen is visible among a refuge of palm trees in the distance. Dogs bark.

Soon the dirt path is littered with chips of wood, dead bamboo shoots and scraps of trash and paper.

Bamboo fences guide the way home.

Khe hunches on an old, wooden chair beside a crackling fire. She attempts to drink from an old, oxidized mug, but sputters and coughs.

Water and spittle splatter the dirt floor between her bare, swollen, cracked feet.

Beneath a blue and white bandana with red flowers wrapped tightly around her head, Lai grins, gold teeth glinting. She examines the contents of a tiny brown paper bag.

Inside are tiny, foil packs of precious medicine. It will keep her mother’s sickness at bay as long as she takes it, the doctors said.

Khe is supposed to take one of each every day.

There are 30 multivitamins in a plastic baggie.

The other foil pack reads, “Furosemide 40mg.”

Twenty-nine remain.

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Burn victim Húng Ðung, 5, has his hand evaluated by a nurse from Project Vietnam Foundation (PVNF), a medical mission organized in Orange County, Calif.

New Hand New Life Reporting by Melissa Hoon Photography by Larissa Bahr Ðăng Thi Ðung gazes at her 5-year-old son’s burned and deformed hand, wishing he could be able to write his name. She cradled him on the back of a speeding red motorbike as her husband, Son Văn Triêu, drove for four hours through narrow winding roads and muddy mountain passes to meet with a New York surgeon in the province of Bac Kan, Vietnam.

Four years ago, as he was learning to walk, Húng Qúy Triêu trampled across the dirt floor of his family’s one room hut and fell into a pile of burning coals. He used his hands to break his fall and burned his right hand, causing it to morph into a deformity that resembled a

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claw.

“Húng cannot write and is not as normal as other kids,” Ðăng says through a translator. “I would be very happy if he could have a normal hand and a good future.”

After driving four hours, Son, 27, and Ðăng, 24, wait in a tiny hospital hallway packed with dozens of patients for Húng to be prescreened before his surgery the next day. Son and Ðăng, who spend their days with their back hunched with beads of sweat dotting their foreheads as they cultivate rice for $3.75 per month, dressed Húng in his finest clothes to see the American specialist. Húng sat quietly in his mother’s lap, wearing a red

silk suit lined with camel-colored faux fur and a striped coffee-toned beanie that kept him warm under the moist gray skies of Northern Vietnam.

Húng’s wide brown eyes carefully scan his surroundings. He smiles docilely as his blood pressure and temperature are taken.

Dr. Michael Koch, the New York plastic surgeon, evaluates Húng’s claw-like scar tissue. Húng is playful and laughs when the nurses and Dr. Koch tickle him.

A communist party official told Son and Ðăng that Húng might be able to have his hand repaired by an American doctor. They walk their son up two flights of dusty

hospital stairs to a 10-by-6-foot room. Húng is energetic, racing across the room and tugging at Son’s pant leg, as Ðăng rolls a thin bamboo mattress across a twin metal bed frame. They will stay the night in this ward that is crowded with other patients and their families. In Vietnam, family members take on traditional nursing tasks, such as feeding patients, changing bed pans and administering medicine.

It’s 7 o’clock the morning of the surgery. Wearing clothes from the previous day, Ðăng clutches Húng to her breast and lightly pushes his dark hair back from his forehead

A skin graft surgery was performed in attempt to give Húng’s hand full range of motion. Skin from his groin replaced inelastic scar tissue on his hand.

Dr. Koch uses both hands to stitch the skin graft during the three hour surgery.

Húng’s joints and tendons function normally, but his skin is limited.

as they wait on a rickety bench near the hallway of the operating room (O.R.). Dr. Koch, part of a medical mission organized in Orange County, and his nursing team prepare the O.R. just 30 feet from where Húng and his mother wait.

They unload neatly packed boxes from the United States, pulling out shiny syringes, scalpels and medical tape. Outside, Húng kicks and screams as Ðăng tries to soothe him. The anesthesiologist, points a syringe upward, shooting a clear strand of liquid into the air. He gently gives Húng a shot. Within minutes, the boy’s wide eyes flutter and his motion grows slower until he is asleep.

Nurses sterilize utensils for the three-hour surgery. The anesthesiologist carries a limp Húng and lies him on the operating table. At 8:15 a.m., Dr. Koch uses a black felt pen to carefully draw a halfmoon shape just above Húng’s groin area where skin will be removed for a graft. A thin scapula makes an incision along the halfmoon. He peels Húng’s skin away slowly from his muscles, then carefully rolls the skin like a cigarette and puts it aside to be grafted.

Just after 9 a.m., Dr. Koch be-

gins removing scar tissue from Húng’s hand. Skin crackles and sizzles as he cauterizes areas where blood leaks. Húng’s joints and tendons function normally, but his skin is limited, scarred and inelastic. After Dr. Koch removes the scar tissue, he unrolls the removed groin skin and cuts precisely. The small shapes he makes of the skin fit the gaping blood red holes on Húng’s hand like pieces to a puzzle. Dr. Koch sews the skin puzzle pieces together, using both hands to stitch with ease. Ðăng sits in the hallway looking like she might cry. She occasionally paces back and forth on the damp concrete pavement, as her frequent stares penetrate the hospital’s double glass doors. She expects Dr. Koch to walk through the door with Húng and his newly functioning hand at any moment.

Dr. Koch carefully stitches the last bloody hole on Húng’s hand at 10:58 a.m. This is the first of many surgeries Húng will need for his hand to function normally.

His parents’ farming income will not be enough for him to receive another surgery. By practicing physical therapy at home with his

parents, however, Húng is likely to gain almost full range of motion in his hand after his free first surgery.

Dr. Koch paints a thick gray paste across Húng’s hand and arm to set a cast. He wraps Húng’s hand slowly in layers of white fluffy gauze. A nurse carries Húng across the hall to a cramped recovery room with metal frame beds only four feet from one another.

Nurses check Húng’s temperature and take his blood pressure. They prop a stuffed animal underneath him so that his arm is raised so the skin graft will fuse successfully. Ðăng sits by Húng’s side at the edge of the bed and brushes his hair away from his closed eyes.

Through a soft smile, she talks to him soothingly, hoping he’ll wake up to her familiar voice. She stares at his bandaged hand. Nervous but joyous tears rush down her smooth tan cheekbones. It’s as if she sees through the thick layers of gauze, seeing Húng’s hand looking and functioning almost normally.

“I’m worried because I don’t know yet how Húng will be when he wakes up,” she says. She speaks softly but innate concern lingers in each word.

Húng’s eyelids fly open at 11:35

a.m. His deep chestnut eyes are wide and worried. He screams and cries in confusion and pain. Ðăng rocks Húng as she drapes him with a small pink blanket.

A nurse smiles and gives Húng a coloring book and crayons, which Ðăng politely sets aside. The nurse folds a blue towel into a triangle and safety pins it into a makeshift sling to hold Húng’s arm above his chest, over his heart. He stops crying and is carried to the room where he stayed the night before.

He and his family will stay there for the next two nights.

Just after 8 o’clock the following morning, Dr. Koch visits Húng for

a post-operation evaluation. He gives the family antibiotics and pain medication to administer to Húng. As Dr. Koch approaches Húng, the boy remains in pain, but is silent and docile. Suddenly, Húng’s eyes pop and a smile shoots across his face as Dr. Koch hands him a yellow remote control car.

As a nurse speaks to Húng’s parents, Húng drives his new car around the crowded recovery room, weaving it through nurses’ feet. He is back to his playful self.

He seems to forget he’s in a hospital as he steers his new toy with his free hand. Soon, the nurses say, he’ll drive the toy car with both hands.

Húng’s mother’s frequent states penetrate the hospitals’s double glass doors. She expects Dr. Koch to walk through the doors with Húng and his newly functioning hand at any moment.

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Elderly Seeks Medical Aid An 86-year-old woman visits doctors for the first time in 30 years. Traveling by foot she makes her way to a makeshift Westernized clinic nearby her home in the Bac Kan province.

Weighing in at 42 kilograms with a height of 146 centimeters, Tham’s frail body barely allows her to make the three kilometer journey to the school.

Reporting by Sophia Islas Photographs by Lucio Villa

The villagers sit in small plastic chairs as they watch Project Vietnam volunteers set up a medical clinic at the Truong Th - Thcs Thanh Mai school in Northern rural Vietnam.

Adults and children fill in the chairs and clutch their medical record forms as they wait their turn for treatment.

Among them is Ng Thi Tham, an 86-year-old resident of Bac Kan, who lives three kilometers from the school.

She is one of the many who hiked and rode motorbikes through Bac Kan’s mountainous terrain, making long treks in order to see the American doctors, optometrists, dentists and pharmacists of Project Vietnam. The non-profit organization assembles medical missions throughout the year to visit impoverished villages in Vietnam where medical aid is not readily available. To visit doctors, villagers are directed to nearby schools and sub par medical centers that have been fashioned into Westernized clinics where they will make their way through four stations: vitals, physical assessment, pharmacy and optometry.

With her frail, calloused hand resting on her chin, Tham stares off into the distance, her pale brown eyes peek out of a face filled with wrinkles so deep that they resemble the crevices prevalent throughout the mountainous areas of Bac Kan. Surrounded by a courtyard composed of four crème colored buildings, she sits with a permanently arched back that is concealed by a heavy, deep purple sweater, one that fits one size too large and further exaggerates her tiny frame. Her hair is stylized into a bun and is secured with a black headband; though wisps of her salt and pepper grey hair escape to create subtle bangs that surround her face.

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She snaps out of her contemplative state momentarily to pick off crusts of dirt sandwiched between her fingernails. Her skin is as rough as sandpaper and etched with fine lines that reveal a body that looks closer to the age of 100 rather than 86. She is dressed in her best outfit and aims to present herself to the doctors by looking as clean as possible.

“I have not seen a doctor for 30 years,” said Tham, who has lived in Bac Kan her whole life. “I have many problems: I can’t sleep, I can’t eat and I can’t see well… I want to get help.”

Tham’s situation is characteristic to those who live in Northern and Southern rural areas of Vietnam.

Since many individuals wait so long to seek immediate medical treatment, conditions that aren’t treated immediately can lead to extreme long-term health problems. This, paired with the bureaucratic health process regulated by the government, leaves many individuals to make what seem like pilgrimages to visit medical centers or, like Tham, forego seeing a doctor at all.

When a volunteer calls Tham’s name, she rises slowly from her seat and takes small steps to reach the vitals station, which is housed in one of the two abandoned classrooms that inhabits each building. Making her way passed remnants of the previous days’ math and writing lessons inscribed neatly on green chalkboards heading the classroom, Tham sits with a nurse. Weighing in at 42 kilograms with a height of 146 centimeters, the nurse taking her vitals immediately says that Tham is underfed and malnourished. Her body is so rail thin and weak that she needs a helping hand in order to move from vitals to

the physical assessment station.

She sits across from Dr. Douglas Nguyen, who begins checking her blood pressure. While getting her assessment from Nguyen, Tham begins talking about her family.

Tham’s husband died when she was 40 years old, leaving her to take care of herself as well as her children.

She tended her own farm and earned enough money to take care of her family. When her son became an adult, he moved in with his wife and cut off communication with her. Tham now lives alone and receives money from the government in exchange for harvesting crops.

While the government provides some assistance, it’s still hard for Tham to actually obtain her allotted money because it is treated as an all day affair. It takes time for her to travel by foot back and forth to government locations to collect her allowance; she travels alone and finds the task difficult because she cannot walk far distances without taking multiple breaks. The little money that Tham receives is used to purchase medicine unofficially, from people who sell herbs and drugs off the market at reduced rates.

“It’s much cheaper than going to a doctor,” Tham said, with tears welling up in her eyes. “It’s hard to get help when you’re old and living by yourself.”

Nguyen finishes off Tham’s physical by checking her stomach and her heartbeat with his stethoscope.

He reaches the diagnosis that she is anemic and requires more vitamins and minerals in her diet. Though, his assessment is partly inconclusive.

“Since most people who live here live off the land, it’s hard to figure out what they use to cure their afflictions,”

said Nguyen. “She’s been using unknown herbal medication, mostly roots, so I don’t know what her diet is and whether it’s causing her lack of sleep and body pain.”

After getting two bags from the pharmacy, one containing 30 pills of ibuprofen for her pain and the other containing 30 multivitamin pills, Tham goes to the gift station and receives a small plastic orange bag filled with an assortment of dry and canned food products.

Tham smiles, showing her toothy, yellow teeth as she rounds up her treatment at the optometry room.

Aside from her hope of getting treated for her constant pain and insomnia, Tham was most excited about getting a prescription for glasses. Optometrist, Dr. Ky Nguyen, had Tham take a vision test that required her to read directional queues from about 20 feet away.

Placing a black plastic left eye occluder over her eyes, Tham begins to read from a vision chart with 12 rows of circular shapes, ranging from a font size of about 72 at the top and 14 at the bottom.

“Left, right, right, down, left…”

Tham stops at the third row and is unable to read further.

“Her vision is extremely poor,” said Nguyen. “At 86 years old, she has severe cataracts in both eyes that can only be corrected through surgery.

She cannot have glasses, they won’t do anything for her.”

According to Nguyen, many of the older villagers are not eligible to receive glasses because of the lack of lighting in their homes. The classrooms, which are illuminated by a combination of low lighting and natural light that peers through doors and windows, are

an example of a common contributor to poor vision.

As Nguyen advises Tham to get in contact with a doctor to perform the surgery, she shrugs off his suggestion. Since Tham lives alone, she believes that getting surgery would be problematic because she would need help during the recuperation stage post-operation. All she wanted was a pair of glasses that would help improve her vision, even if they did so marginally.

“Surgery and operations are something that I don’t want to worry about,” said Tham, who then brought up how she misses her family.

It’s been five to six years since Tham has seen her son or daughterin-law. She wishes everyday that they could visit, but they are poor and they are incapable of setting aside time and money to visit her. As Tham reminisces about her last encounters with her son, she begins to cry. With tears filling and flowing down the cracks of her cheeks, she says that she wants to see her son and mumbles incoherently about her life and how alone she feels.

“I feel pity for myself,” Tham said as she clutches her chest. “I have to beg just to get clothes. I am poor and old and I have to beg for everything. I am sick and cannot even receive a pair of glasses to see.”

After wiping her eyes, Tham thanks Nguyen and slowly exits the building.

“I’m thankful that the government cares about my well-being and that I’m able to visit doctors close by,” Tham said while walking toward the school entrance. “I thank God that I’m fortunate enough to be alive even when I’m so poor and alone.”

Tham has severe cataracts in both eyes that can only be corrected through surgery.

The doctor said she cannot have glasses.

I have not seen a doctor in 30 years, I have many problems: I can’t sleep, I can’t eat and I can’t sleep well... I want to get help -Ng Thi Tham PVNF Patient

Ng Thi Tham gets her vitals are checked, the nurse immediately says that Tham is underfed and malnourished.

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