Week 32 - Down to business under grey skies!

Hello everybody,

This week I'd like to focus a little bit on some of the professional challenges I face working in Vietnam, where ready-made equipment (which can be a large part of me work in a hospital setting) - is not available. My American physiotherapy colleague (Virginia Lockett) has been a real inspiration for me when it comes to thinking about using local resources to make equipment. So I'd like to share a little of my work experience with you. Of course no weekly report is complete without the mention of a few social excursions, which I'll get to a little later!

The major event of the week has been my clumsiness as I dropped my lap top on Friday night and have broken my screen, which I just about continue to use, and hope it doesn't completely break before I get home to repair it!

So to work, and here is a picture of my really fantastic translator Nga, who is my life line here in this job.... Even with some of the staff speaking very good English, my trainee does not speak enough English to allow for in depth communication. But I must praise Nga here because it's her ability to make the patients feel at ease that really allows me to get the information I need. So thank you Nga! She also looks after her young baby, and has been taking exams after studying! So to some of the little bits and pieces that I have been working on. Firstly we have many patients who have suffered from strokes (CVA), so they have problems with one side of their body, including weakness, paralysis, or other complex difficulties. We also have patients who have had serious road traffic accidents on their motorbikes and have badly damaged arms and hands. You can imagine some of the difficulties people have if you can only use one hand or arm, and especially for some women here who are trying to prepare food, or dress (bra's!), it's a real problem. In England there is ready made equipment to help with these kind of problems, but in Vietnam these things don't exist, the materials are not readily available and to have equipment copied or made is an expense that neither the hospitals or patients can afford. So it's a case of sitting down and trying to think of ways in which you can use everyday objects to create the kind of equipment you need. I have used 3 chopsticks taped together as a temporary 'dressing stick' but how to help two women that said they could not cut or peel food when preparing a meal, provided a tough challenge. As my planned trip to Hue got rained off, I took off round the markets with my friend Thao, who ensured I didn't get ripped off too much, and we found some useful stuff to experiment with. The barbecue tongues are replacement dressing aids, as instead of using a helping hand ( grabber / pick up stick ), the patient can now reach down to dress their lower half, and the edges of the tongues are rounded to ensure materials don't get ripped... To be honest, most people can squat and have such flexible hips that they can always bend down to dress, but if their balance or strength is affected then they need extra reach on occasion.

The self made peeler was an idea that we concocted yesterday. The clamp design (clamp a peeler blade to a table top) you see in the UK and US was no good because people mostly prepare their food on the floor here, even thought they may cook it on a stove on a higher surface. This explains why people who have the use of only one arm, open jars by holding the jars with their feet or legs, and turn the top with their one good hand! So fixing a peeler to a plastic bowl, was not only cheap and cheerful (30,000 dong - £1/$2), but culturally adaptable... I must say though, that this is just test model and we'll see the results of the tests later this week. Attaching the peeler to the bowls (different shaped bowls with different depths will help us determine what shape & strength bowl is best for this activity), was fun as we used the as stove in my friends kitchen to heat a screw driver to burn into the plastic!! Awesome... I must admit I like to think of ideas for this kind of stuff, but people here really have the ability to just have a go at the actual making of this kind of thing!

To one more story of sheer brilliant invention by a Vietnamese physiotherapist working at a different hospital. A patient suffered a horrific work accident where an industrial saw cut off one of her arms, and badly damaged the other, leaving her with movement only at the shoulder joint. Staff were keen for her to be able to at least try and use the full arm, but with almost no movement below the shoulder this would be difficult. A few different ideas were tried, including making a plaster cast splint with an attached spoon, see below...

It was this second idea that was just brilliant! The straps are just normal Velcro type material, which straps to the arm, and the gray material is just ordinary plastic piping, that has been burned, cut and reshapes, with one solitary screw and bolt to hold it. The spoon is held in place by a standard universal cuff... (Velcro strap) which sits on the fingers.... simple genius!!!! The elastic band was designed to give some element of control via weight of the arm, to stop the patient hitting flinging the spoon around... and the end result was... see below...

I hope this gives you a brief taste of the kind of challenges we (therapy workers & patients) face here in this kind of setting!

To more social matters, the beginning part of my week began with a bang.. or should I say song as both Monday and Tuesday night I found myself at a Karaoke club, firstly with my neighbour from Hoi An, (Yen) and her student room mates from the University of Da Nang, female hall of residents. No pictures available thankfully, as though I assure you all the girls were between 19-21 they look younger and nobody wants Interpol chasing them eh!

Tuesday night was with my new colleagues from the hospital - karaoke is really the only way to get to know your colleagues here!!! So after more renditions of the usual numbers, and the Beatles 'Hard Days Night' the night ended, here are some snaps...

One more thing to mention, on Wednesday lunchtime I got invited to a wedding.. yeah at lunch time.. I know.. so 4 of us left work at lunch well 11:15, and were soon stood outside a very posh restaurant indeed, the groom was clearly a rich man (doctor from the hospital), everyone was wearing suits.. I had sandals and jeans on! Very different form the weddings I saw in Hoi an, where people were sat around on plastic chairs drinking and having fun, loud fun!!! Here everyone was seated at fancy decorated tables, there was music, lights, dancers, and even indoor fireworks! it was like watching a West-end show, not being at a wedding! really unreal! Several courses of food were served as the wedding party moved around the hall, before people paid tribute to the wedded couple by singing on stage.. honestly... It was quite surreal. People had already handed their money envelopes in on the way in as is customary here! enjoy a couple of pics below...

Ok, I promise this is the last thing I will say! Yesterday when I was coming back from the markets to my friend's place I was driving my motorbike with my friend on the back. When we got back to my friend's house and I went to turn off my motorbike engine, the keys were not in the engine, I know I know... I didn't realise the bike could still run with no keys, but here it was, and after retracing the short journey from the market I couldn't see the keys anywhere!!! Oh crap I thought!! what could I do??? The answer was surprisingly easy and worrying, at the same time. Just a few houses down the road was a shop that simply made me a new set of keys for the bike. They didn't have a key to copy to make a new key, they just looked at my bike, and within 5 minutes I has new keys! Phew I thought, but then I though if it was so easy to go and get keys made for a motorbike, then surely it's a bit easy to steal stuff... I jokingly asked if they could make keys for the passing Ferrari! (just kidding!).

Ok that's it I promise!

Regards from Vietnam