By Jean Lieu, DPM
I didn’t know what to expect on this trip, but I was prepared for the worst. Armed with antibiotics, mosquito repellent, anti-diarrhea medicines, anti-itch medicines, cortisone creams, avian flu medicines, sleeping pills to prevent jet lag and a score of medicines to combat anything that I might even have a remote chance of catching, I was prepared to wage and win the war to stay healthy and productive on my trip. No diarrheal bouts or jet lag was going to set me back. I was a woman with a mission, and nothing was going to prevent me from getting it done--be it mud, rain, monsoons or mosquitoes.
The 4 am trip from Saigon to Long Xuyen was pleasant enough. The road was bumpy, making me motion-sick most of the time but it was no match for my anti-nausea and anti-motion sickness medicines. After an hour into the trip, I was out like a light. Much of the trip passed like a blur. The next thing I remembered was that we were in Cao Lanh. It had begun to drizzle a bit, but no major rain. I stepped out of the van a bit groggy, but the sight of the welcoming committee instantly filled me with adrenaline. There was a roomful of people staring at us as we slowly filed into the auditorium. There was a banner proclaiming our arrival as well as a podium with a microphone and a table with six or seven chairs in the front of the room.
We were greeted by the officials in the Committee for Population, Family, and Children of Dong Thap Province and patients who had undergone previous surgeries. It was touching to see parents holding onto their child. These were children, who, a year ago, couldn’t walk or grasp a pencil, couldn’t bend their knees or raise their arms above their heads. There were all kinds of handicaps represented in this small little room. But due to some kind of providence, we were brought together to share this little space. And today, as I stood there, this little room became a testimony to love, charity and kindness. Whatever differences we had were laid aside for the moment. All that mattered were the children.
As I examined each child, I asked them to compare their limitations before and after surgery. Most did well, having regained functions critical for daily life. But for many, the handicap remained. For example, children with neurological diseases tend to have severe contractures in their joints which can only be partially corrected. Even after surgery, many are still confined to and are limited by their wheelchairs because many schools and public places can not accommodate the disabled. So while we’ve solved one problem, we’re faced with another just as difficult to solve, if not more so. Once we’ve sponsored a child for surgery to restore function, where do we go from there? Schools can not accommodate wheel chairs. And even if they did, most families were too poor to send their children to schools, and most schools are too far for children who live in rural villages.
As I talked to the children and their families, I was filled with mixed emotions. My eyes filled with tears for the gratitude they show; these same tears were mixed with sorrow, pity, anger and frustration. Why the children? The sins of the adults are visited upon by the innocents. But they hold no grudge. They only smiled and beamed gratefully.
As I look at them, I was reminded that my family could very well have been amongst them. It was sheer luck that separated them and me. The young mother holding onto her deformed child was about my age. The young man who had lost all function of his lower extremities could have been my younger brothers. The old woman, with her grey hair, sad eyes, and decayed teeth; the old man with hollow cheekbones, and sallow skin hanging loosely from his frame; both could very well have been my mother and father.
For the past nine months, I had been looking at pictures to evaluate the work of the surgeons being paid by SAP-VN to identify and to operate on children with severe deformities. My task was to evaluate outcome as well as to determine whether or not the surgeries were deemed necessary. SAP-VN’S primary goal was to restore function and relieve pain. As I reviewed each case, guided only by poor pre-op and post-op pictures, I adhered to the conservative principles I was taught as a podiatry resident in medicine and surgery. Surgery should only be used as a last resort to relieve pain. It should not be used to improve cosmesis. So no matter how severe a deformity, if surgery can not restore function, then it should not be done. My job was to flag questionable cases, very much like a doctor working for an HMO organization. As hard as it was to determine the outcome of a case with mere polaroids, there were cases that I had no problems flagging, questioning why they were operated on at all. Patients with certain neurological diseases would always be bed-ridden, no matter how many surgeries are performed. Patients with burn scars or keloids (hypertophic scars) should not be operated on because there is no outcome on function. If it had been up to me, there would be a denial stamped across many of these “cases”. But as I stood here, face to face with these children and their families, I held an entirely different perspective. As I look into each child’s eyes, I can read great loss in them, but with the gift of surgery, regardless of the results, there is a ray of hope that now shines in their eyes. Once again, I was barraged with a flood of mixed emotions. The scientist in me told me it’s nothing more than a placebo effect; the sick feel better because they believe in the medicines they’re taking, even if it’s nothing more than a sugar pill. But the humanist in me believes in the miracle of the mind. If you believe you’ve been empowered, if you believe that even a small part of your lost abilities has been restored, a change happens in you, and from that change come great things.
There were many stories of triumph that warmed my heart, but twice as many sad ones for each happy one. A little girl, Myõ Ngoïc,beams as her mother places her on a tricycle that was impossible to ride before her surgery. She places the Winnie the Pooh I gave her in the tricycle basket and rode down the dirt road in front of her house to show off her new-found abilities. Her smile stayed on my mind for days. Even as I sit here, I can still see her smiling as she pedals down that dirt path.
Then there was nine year old Pham Trung Kien with cerebral palsy. His joints and ligaments were so rigid and spastic that his legs could not be bent or uncrossed. His legs remained crossed against each other at the knees like a pair of scissors. His mother had no way of dressing him because she could not uncross and separate his legs. The surgery has improved his condition marginally, but was considered successful because it allowed his mother to uncross his legs to dress him in the morning. As I examined him, his mother’s voice wavered between laughter and tears. We both stopped short and he catches me off guard when he asks if I would fix his arms so he could bend them. I didn’t know what to say. In the end, I told him, “we’ll see.” I didn’t have the heart to tell him that no surgery would ever restore the motion in his arms. It was much easier to scribble or stamp the words “denied” on paper when you never have to look that person in the eyes.
There is also 17 year old Nguyen Thi Tham who was adopted when she was 2 months old. While her adoptive mother was loving, her adoptive father was an abusive drunk. She had a foot deformity that was surgically corrected last year with good outcome. She smiled and ranted on enthusiastically as she told me how happy she was with the results of the surgery. As she was ready to leave, she asked me to examine her bruised wrist. When I asked her what happened, she said she fell, but tears filled her eyes. When I prodded her with more questions, she told me how her stepfather had come home in a drunken stupor and beat her with a wooden beam; she said she was lucky; he hadn’t seen the machete lying on the floor. She had protected her face and head; it was her wrist that received the bulk of the blows. Two weeks after the injury, her “bruise” was still extremely swollen. I could feel the unevenness in her ulnar, the wrist bone near her pinky finger. Fortunately, it was away from the wrist joint itself. She still had normal motion in the joint, no numbness in the fingers and no shortening or visible deformity in the wrist itself. There was nothing I could do for her. To visit the hospital or toget a cast was not an option or a luxury she could afford so I didn’t bother her with those requests. I strongly advised her to rest that wrist so it could heal without further insult, knowing full well that at dawn, she would wake up to heavy loads and a litany of strenuous work that a delicate frame like hers ordinarily would not be able to accomplish. There are thousands of stories like hers, thousands of nameless faces. At the same time that I was faced with the knowledge they exist, I was also fully aware that I was powerless to change their fates.
At times, I am overwhelmed with helplessness and I wonder if any of our efforts make a tangible difference. I am then reassured by the children’s smiles, their gratefulness, and the looks on the faces of those we encounter as we give back to our homeland and share a little of ourselves. Even in my few moments of frustration at my inability to change things, I also see that we are making a difference in the lives of those we’ve touched. Alone, our efforts don’t amount to much. But there is strength in number and I am heartened to see that the poor and the weak are not alone, nor have they been forgotten.
**Dr. Jean Lieu is a podiatrist who specializes in the deformities of the foot and ankle. She currently works for a non-profit community clinic in East Los Angeles.
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