HO CHI MINH CITY, Vietnam — Two-year-old Nguyen My is carried wide-eyed into the operating room before undergoing anesthesia.
He has a blockage in his urinary system and needs a pyeloplasty, in which the blockage is removed and the healthy part of his kidney is reattached to his ureter.
With all eyes on him, Dr. Lars Cisek — with the Utah-based nonprofit group IVUmed — demonstrates how the affected area can be reached with a small incision instead of the larger incision used in the past.
Nguyen's parents wait nervously in a nearby hallway. "I'm a little worried. He's never had surgery before," his mother, Le Truc, said through a translator.
Following the successful operation, Nguyen's father lifts him from his surgical gurney and onto a waiting stretcher. With the help of a nurse, he pushes it to his son's hospital bed a couple of buildings away. Nguyen's mom tucks a blanket around his small body, then strokes his face as he opens and closes his eyes.
"I hope now his pain (caused by his condition) will be gone," she said. "The doctors are very good."
Cisek just returned from the IVUmed medical mission in Vietnam.
Nguyen's case would have been difficult for doctors 17 year ago, said Catherine deVries, IVUmed president and founder. When IVUmed first came to Vietnam in 1994, there were no pediatric urologists.
"These children drop through the cracks," deVries said. "The people who train in adult urology don't necessarily know how to take care of them. Pediatric surgery doesn't train in the specific techniques. There are a lot of very specific things about pediatric urology that require training in just this specialty."
The key is IVUmed's teaching model that empowers local doctors through training and collaboration, which results in a ripple effect. The local doctors have the knowledge and confidence to continue operating and to educate colleagues once IVUmed doctors have gone.
Through years of hard work by IVUmed and its in-country partner, Dr. Le Tan Son, who serves as head of the pediatric surgery department at the Medicine and Pharmacy University in Ho Chi Minh City, today there are 13 trained doctors: 10 in Ho Chi Minh City and three in Hanoi.
The cases the IVUmed team is seeing this trip are complex, ones in which the Vietnamese doctors require second opinions from the Utah physicians or demonstrations of surgical techniques.
"When we see a difficult case I give them an appointment," Son said. "I tell them to come here and see the American team."
One after one, children climb onto the bed as the team analyzes X-rays and discusses each case. Some, it's decided, don't need surgery this trip or at all. Others are scheduled for an operating room slot the very next day.
There's not a lot of breathing room inside the operating room. A crowd of medical students, residents and nurses jockey for position as Dr. Chad Wallis, a volunteer with IVUmed, operates on a 2-year-old boy.
"I'm used to trainees, but not that volume of trainees," he said later. "But when you're working, you're focused on helping the patient, so you try to drown that out from what you're doing."
He seems calm, relaxed and not at all thrown off by the crowd as he inserts a catheter across the significant scar tissue that has been causing the child problems. While the boy will need additional surgery in the future, his bladder can now properly drain, which will allow an infection to heal.
About 45 patients were seen during this trip, and doctors performed 17 operations in Ho Chi Minh City, as well as 14 consultations during a side trip to central Vietnam.
Together, they've helped build a thriving pediatric urology program at one hospital and are now working to develop a high-tech surgical program at Children's Hospital 2. In Vietnam, doctors trained by the group have now operated on more than 7,000 patients independently.
"They've taken everything we've done and amplified it. In fact, they've done many more of some of these cases than we have just because the volume is so high," said deVries. "It's just a great thing to see."
The implicit trust between the Vietnamese parents and the IVUmed team is part of the reward for the doctors. They often don't understand what the other is saying, but they know everything IVUmed does is for the good of the kids.
"They're very generous with their hearts and their children that they open themselves and allow us to help out," deVries said. "I consider it generous because they don't need to be as open as they choose to be."