Review of the Week’s Cases and Some Words for Thought – Dr. Van Gompel

Posted by Gabriel VanGompel, DPM  (a third year Podiatric Surgical resident from Kaiser Permanente, Hayward while on a global health elective in Da Nang, Vietnam at  and Da Nang Orthopedic and Rehabilitation Hospital).

Looking back on the cases we were involved with this week, we were able to see a wide variety of pathologies.  There were five pediatric patients with varying degrees of Cerebral Palsy.  Working with the orthopedic surgeons we did a number of releases ranging from adductor muscles in the thigh to hamstring and gastroc lengthening’s.  Thank you Dr. Vu for your instruction in these areas.  These kids are resilient as represented in their pictures.  Although they have bilateral full length cases on, they could not be happier.  (See Picture Below)

We were surprised by the number of arthroscopic cases being performed.  The orthopedic department is performing 2-4 arthroscopic knee procedures per week.  To my knowledge this is one if not the only facilities in Vietnam to be performing this procedure.  They have become proficient at this, but have yet to touch an ankle scope.  We line up 3 ankle scopes for the week and saw some interesting pathology.  The last ankle scope we did was on Friday.  This gentleman turned out to have the largest osteophyte both on the anterior tibia and dorsal talus we have ever seen.  With a history of rheumatoid arthritis let’s just say the joint was difficult to navigate.  Non-the-less Dr. Tanh and Dr. Vu took their turns driving with the arthroscope in the ankle for the first time.  Under the supervision of Dr. Weinraub they had an excellent training experience and hopefully will now have the confidence to perform ankle arthroscopy.

Dr. Tanh’s constant pursuit for knowledge has brought him around the world acquiring valuable knowledge and skills to be used in the orthopedic dept.  As mentioned before knee arthroscopy with arthroscopic ACL repair is now being routinely performed.  More relevant to the foot and ankle is the use of the Ponseti method for treatment of pediatric club foot.  Dr. Tanh had the opportunity to travel to Iowa and work with Dr. Ponseti to learn this technique.  It has made a huge impact on the incidence of neglected club foot.  As compared to years past there was no soft tissue release procedures performed.  One talectomy procedure was done on a young girl (Girl wearing the pink rabbit shirt below).

Despite the lack of equipment and preoperative antibiotics the relative complication of post-operative infection in Da Nang is low.  We reviewed with Dr. Tanh his experience with this problem over the past year and came to the conclusion that their post-operative infection rate was around 2-3%.  This is comparable with the U.S. rate of post-operative infection which has been quoted to be from 2-20%.  This is pretty amazing given the conditions they operate in.  If you think about the amount of prevention used in the U.S. for this complication and the amount of waste it produces and then compare it to the former situation, we are doing something wrong.

The last 24 hours of the trip were some of the best time spent.  As we wrapped up our business at the hospital we planned for our final meals and trips while in Vietnam.  I set out on the Saturday morning to explore the town of Hoi An, south of Da Nang.  It was a wonderful experience.  I was pulled in by a tailor who talked me into having two dress shirts custom made.  Giving them a time frame of 1.5 hours, as I needed to return to Da Nang on a shuttle, they were able to turn pieces of plain material into two amazing shirts.  Exchanging stories, smiles and hugs the experience was great.

Making my way back to Da Nang, Jamie and I rendezvoused at the resort to log some time on the beach.  The most difficult thing was to move our lounge chairs ever hour or so to keep out of the sun.  Awesome!  Later Minh, Dr. Weinraub, Jamie and I met up for a final dinner at a place downtown that Minh had picked out.  The honey chicken was great!  As we went our separate ways after dinner a feeling of accomplishment and happiness came over me.

The relationships I made during the trip are lasting and unforgettable.  Put together by coincidence it is amazing to witness and be a part of such a unique situation.  I have made friends with some of the best people I have ever met and will never forget.  I hope to return soon.