Da Nang Orthopedic & Rehabilitation Hospital – Hamad Zafar, DPM

Written by Hamad Zafar, DPM, PGY-2 at Kaiser Permanente Santa Clara Podiatric Surgery Residency Program while on Global Health rotation at Da Nang Orthopedic and Rehabilitation Hospital in Da Nang, Vietnam in June 2017.

Every year the current second year Podiatric surgical residents at the Kaiser South Bay Consortium travel to Da Nang, Vietnam for an one week mission trip at the Orthopedic and Rehabilitation Hospital in Da Nang, Vietnam.

Being a second year resident, this year it was my turn to travel with my co-residents Dr. Aarron Flowers and Dr. Eric Shi to Vietnam. Leading us on the trip was one of our attending from Kaiser San Leandro Dr. Glenn Weinraub, a veteran to this mission trip as this was his seventh trip in eight years. Also joining us on this trip were Catherine La and Cindy Lee, nurse anesthetist for Kaiser Fremont and San Leandro, and Dr. William Slikker, attending Orthopedic Hand Surgeon at Kaiser San Leandro.

We took off from San Francisco late Friday night on June 2nd and after 18 plus hours of travel we arrived at Da Nang International Airport early Sunday morning of June 4th. We lost a day due to the time difference but we were all excited to be in Vietnam.

We quickly settled into our hotel room and began preparations for clinic the following day. It also helped that the views from our hotel room and resort were…

unbelievable.

Monday started early, my trip roommate (Dr. Flowers) and I woke up around am and were unable to fall back asleep. It appeared that our mental clocks had not yet adjusted to the time difference and it did not help that sunrise was around 4:30 a.m. in Da Nang. We arrived at the orthopedic clinic around 9 a.m. and were amazed at the numbers of patients waiting in the waiting room, must have been close to a hundred people.

Clinic was extremely busy, and we probably treated close 50-60 patients that morning from 9 a.m. to 1 p.m. The pathology that we witnessed during clinic was unique and almost unheard of in the U.S. It was very tempting to plan for surgical correction for all patients that we treated in clinic that morning but we realized that our resources and time were limited. We understood, as surgeons, that sometimes we might not improve a patient’s condition or pain with a surgical procedure; rather, with any surgery, we increase the risk of more pain post-operatively even when clinically the correction appears great.

We had one scheduled surgical procedure in the afternoon after the morning clinic. Surprisingly, it was on a patient that we had seen earlier that morning. I was impressed with the staff and surgical team for their ability to organize the procedure so fast; I questioned patient’s NPO status only to realize that it did not matter as almost all patients received spinal anesthesia with no sedation.

The surgical department was small with three operating rooms but I was pleasantly surprised with size of the operating rooms. One of the three operating room had two OR tables and this would serve as the operating room that we would use most of the upcoming week. Unfortunately, for us, the operating room air conditioning was not functioning to the best of its ability and we quickly learned how difficult it is to operate in a warm operating room.

It is safe to say that I was extremely nervous during my first procedure in Vietnam. I cannot explain the reasoning behind my nerves, maybe the temperature, maybe the unfamiliarity with the operating room or maybe just because this was our first case in Vietnam. Regardless, I can say with full confidence that my nerves had the best of me that day. I have heard the saying that “you only obsesses about things that you care about” so I took this experience as a positive and decided to progress through the week.

Tuesday through Thursday progressed similarly; we rounded on our post-operative patients around 8:30 a.m. and then proceeded to the operating room for scheduled surgery. On average, we were able to perform 4-5 foot & ankle surgeries a day. After Wednesday, we developed a routine and we all became much more comfortable, the staff become more comfortable with us and thanks to the Physician-in-charge (PIC) of the hospital the air conditioning was fixed and the operating room temperature became bearable.

The operating room staff and anesthesia providers at the Da Nang Orthopedic Hospital amazed me; and I have to take time to thank and brag about them. The scrub techs were actively involved in the surgery, anticipating every step, assisting any chance they got and being extremely efficient and well organized. The circulating nurses were rotating from room to room because they only had a few circulating nurses on staff; but, it did not matter if they were in the room or not because anesthesiologist were so quick to act and assist.

It was incredible to watch the anesthesiologist help the staff in preparing the room for surgery, walking around the drape and fixing the OR lights, and even dabbing our foreheads when we were sweating during surgery. I had the opportunity to discuss these findings with the orthopedic doctors that were hosting us and they told me that this was very common. According to the local doctors, all members of the staff have to work together and help each other in any way possible because they are understaffed. I was envious of this attitude of teamwork and team approach to work.

We had an opportunity to perform many interesting procedures throughout our week in Vietnam. I do not think I will ever have an opportunity to witness such pathology in such short period.

This male patient around the age of 40 had rigid contractures of all of his digits. This caused him to walk on his contracted Hallux causing him extreme pain. We performed a Hallux amputation and pan-metatarsal head resection on this patient. He did well after his surgery; the pins will remain in his foot for 6 weeks after which he will hopefully have a pain free foot to walk on.