A Chance to Make a Difference
By David Campbell, MD, Vascular Surgery
In 1997, a Vietnamese surgeon named Cao Van Thinh visited BIDMC and as the only surgeon who spoke French, he hung out with me. A few months later, I received an invitation to give a lecture at a conference in Ho Chi Minh, Vietnam, to celebrate the 300th anniversary of the founding of the city. There was no financial support but I could not resist the opportunity to visit such an exotic place.
So in November 1998, I made the trip to Vietnam and Dr. Thinh and his wife met me at the airport. They showed me around the city, university and major hospitals. At that time, the people of Ho Chi Minh were very poor; major health issues included malnutrition, infectious diseases, injury from traffic accidents and HIV.
I gave my lecture on the management of diabetic foot problems and my translator, Dr. Khue, invited me to visit her department at Cho Ray Hospital. I was amazed to find a number of patients with Type 2 diabetes and normal circulation who had lost their limbs due to diabetic foot infections. Khue said that nearly all patients admitted with foot infections ended up with a leg amputation. In Boston, I knew it was rare for a patient with good circulation to lose his or her leg.
It was clear to me that patients’ limbs could be saved with some education – both for the physicians and the patients. I asked Khue if she thought it would be helpful for me to visit again with a team consisting of myself, a podiatrist and a diabetologist to put on a seminar for local doctors. She thought it was a good idea, and I returned to the U.S. determined to make it happen.
In July 2000, I returned to Vietnam with Dr. Chan Coopan, a diabetologist from Joslin Diabetes Center and Dr. Hau Pham, a Vietnamese podiatrist on staff at the time at BIDMC. We put on a seminar and toured units in a number of hospitals. We met Dr. Kahn, a physician who had been at our seminar and understood immediately how important early incision and drainage was to treating diabetic foot infections. At Kahn’s request, we treated a few patients to demonstrate the techniques.
When we returned to Vietnam the following year, we were delighted with what we found. Kahn presented a series of patients who avoided amputation because of incision and drainage. We felt we had made an impact on the care of the diabetic in Ho Chi Minh.
In 2003, we returned once more, expecting this to be our last visit. As we greeted staff at the hospital where Kahn worked, we were shocked to find they had reverted to their old ways. Kahn was no longer working here for political reasons and it was a real reminder of the communist dictatorship. It had become clear that free care was indeed not free.
A little saddened by this, we had a conference with Thinh and Khue, who had been so responsive to us in the past. We found out that Thinh had just been made Chief at a different hospital and Dr. Nam, an associate of Khue’s, would run the diabetes department. We decided to bring both of them to Boston for a few months so that they could return fully-trained to set up a diabetic foot center.
This proved to be a great success. I was able to get a lot of vascular equipment for Thinh, and every time we visited Ho Chi Minh after their trip to Boston, we put on educational seminars and would review recent vascular cases.
In 2004, I was honored to appear on the front cover of the Bulletin of the American College of Surgeons with an accompanying article about the work in Vietnam. In 2009, I had the privilege of being appointed a visiting professor to the University of Ho Chi Minh City, an honor they have only bestowed half a dozen times in the past.
We expanded our journeys and started visting Hanoi, Vietnam, discovering the need just as great, though they appeared less receptive to our message. In 2009, Thinh presented the experience at his hospital as part of a seminar at Bach Mai Hospital, and they took this close-to-home story to heart.
Tom Lyons, DPM, Surgery, who had also joined our team, gave a wonderful demonstration to teach endocrinologists how to do debridements, or the removal of dead, damaged or infected tissue, at the patient’s bedside. We were making progress and they were pleased.
In 2011, we returned to put on a daylong seminar at the South East Asian Endocrine Meeting in Saigon, South Vietnam. Local physicians shared success stories of their new diabetic foot treatment techniques, which further encouraged the Hanoi physicians to do something similar. By then, we were very well received in Hanoi at major hospitals, where we also had the opportunity to support and treat some patients.
Shortly after this trip, Dr. Ngoc from Bach Mai Hospital traveled to the U.S. to visit and learn from physicians at BIDMC. He stayed for a couple of months and had a great time. We are looking forward to returning to Bach Mai Hospital this year to see what progress has been made.
So what exactly did we accomplish?
Before our team started visiting the hospitals in Vietnam, the various services and departments never talked to one another. They have gained tremendous strides in the team approach we use so often here at BIDMC.
Additionally, those patients who had diabetic foot problems often suffered amputation. There was no distal bypass surgery to salvage ischemic limbs. We helped Thinh, our friend and colleague, who now has the equipment he needs and has established some credibility. Lack of staff and resources pose ongoing problems, but units such as ones where endocrinologists do debridements, consulting with orthopedics and vascular surgery, have made patient outcomes much more successful.
Politically speaking, this would have been nearly impossible without the continued support of the group from Harvard and the training they received in Boston.