Discussion to the Article: Teaching Pediatric Hand Surgery in Vietnam

The admirable efforts of the surgeons, anesthesiologists, nurses, paramedical staff, and other volunteers offer a tremendous service to unfortunate individuals in underdeveloped countries. The authors have eloquently described their experience abroad, treating patients afflicted with a variety of ailments. Many patients in underdeveloped countries must bear the burden of living throughout their lives with various deformities. These deformities may result in functional loss that significantly impairs their activities of daily living. In fact, afflicted patients may be ostracized from their own community because of their deformity. There are many implications and ramifications of these medical problems not only for the patient, but also for their families and the local society. I too have traveled overseas for volunteer work, performing surgery on patients with burn contractures, nomas, congenital deformities, and other acquired disorders that impair function. The experience offers a multitude of benefits to these patients, their families, and the local community. These patients are extremely grateful and return to productive lives. Such trips require significant commitment and can actually be quite tiring. Depending on the location, the travel can be long and grueling, often involving various flights, bus rides, or other modes of transportation. Jet lag and fatigue are not uncommon during these trips. As the surgical team arrives, the equipment must be checked, calibrated, and/or repaired prior to performing any surgery. The instruments and supplies are removed from boxes and the operating rooms are set up to permit safe, reliable, and efficient surgery. The patients often arrive from miles around with the hope that they might be lucky enough to be operated upon by experienced, knowledgeable surgeons. The patients are usually screened by the surgeons, anesthesiologists, and staff to prioritize those who would be candidates for surgery. The short amount of time that the surgical team has at any given destination unfortunately limits the number of procedures that can be performed during each visit. The surgical team must therefore look to perform procedures that would have the greatest impact on patients, focusing primarily on restoring function. Following the surgical screening, the patients are assessed for operative risk factors, as safety is foremost in the minds of the entire team. In fact, the partnership and communication between the surgeons, anesthesiologists, and nurses are often more intense and constructive than at our own surgical theatres. The many surgeries can include cleft lip and palate repair, contracture release, free tissue transfer, skin grafting, and flap reconstruction. The patients therefore require surgeons with expertise in reconstruction of the head and neck, hand, lower extremity, and trunk. Postoperatively, nurses and paramedical staff care for the patients to aid in safe recovery. It is amazing to witness the care that the families provide in the recovery process of these patients. The surgical team uses the resources it has brought with them, as well is what is locally available, to provide adequate rehabilitation. The daily rounds on the patients after surgery are for caring and education. It is often astonishing to witness the makeshift dressings, splints, and wound care that are available from the local surgeons and HAND (2007) 2:25–26 DOI 10.1007/s11552-006-9020-4