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Facing the World: Da Nang, Vietanam

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Facing the World: Da Nang, Vietnam 2012

Mr Richard Young MA BM BCh FRCS FRCS(Plast) is a craniofacial surgeon at Bupa Cromwell Hospital and Chelsea & Westminster Hospital.

There's anticipation in the air. It's late November 2011 in a cold, grey London as the first planning meeting for the 2012 Da Nang charity mission gathers at the headquarters of Facing the World. The weather is in stark contrast to the hot, humid and occasionally wet days that the team will experience in Da Nang, central Vietnam on this, their fourth medical mission. Retiring to a local Vietnamese restaurant at the close of the meeting brings some familiar smells and sounds.

Facing The World is a charity founded just over 10 years ago by two craniofacial surgeons based at Chelsea and Westminster Hospital here in London – Norman Waterhouse and Martin Kelly. It was set up to provide life-changing surgery for children with severe facial disfigurement. Very few other charities in the world cater for this group of children. Initially children were brought to London with a family member to undergo surgery. Then five years ago FTW was awarded a major grant from the Vocational Training Charitable Trust (VTCT) to partner with Da Nang General Hospital in central Vietnam. The aim was to set up Vietnam’s first craniofacial surgery unit. The hospital already had the core surgical specialties of plastic surgery, maxillo-facial surgery and neurosurgery, but the one thing it lacked was joint or multi-disciplinary working. We have not only taught, trained and operated in Da Nang, but the three senior members of each of these sub-specialties have spent time with us here in London learning new techniques and new approaches to a wide spectrum of craniofacial conditions. In addition to this our anaesthetist teaches during the cases and our nursing team help the local theatre team familiarise themselves with the new equipment that we have donated to the hospital with the help of Stryker. The 2012 trip will be our fourth clinical mission to hospital. The aim of the mission will be to teach on complex facial trauma and to introduce fat transfer to their reconstructive repertoire to help patients with facial deformities such as hemifacial microsomia.

Viet before and after photos

Since 2009 we have travelled with members of our own craniofacial unit based at Chelsea and Westminster Hospital. Each year the trip has a theme. To date we have covered hemifacial microsomia, nerve sparing parotid surgery, neurofibromatosis, giant congenital melanocytic naevi, facial trauma, vascular anomalies and have set up a prosthetic eye unit in conjunction with Mr Colin Haylock, prosthetician. The children with conditions that cannot safely be treated in Da Nang are still brought to London. This year we have cared for a toddler with bilateral facial clefts, Viet, and a 4-year-old with an extensive lymphatic malformation of the cheek and lips, Le Huy. These cases have been operated on and looked after at Bupa Cromwell Hospital. Facing the World would like to thank Michelle Lahey, CEO, and all those involved for their support of our work. One thing that's been truly wonderful is that cases we have started in London can now be finished in Da Nang, either in conjunction with us when we go or by the local surgeons. This is a step change in their practice and one that they are rightly proud of. FTW has not only been able to develop practice by being directly involved but last year we opened the Martin Kelly Library at Da Nang General Hospital in honour of Martin who tragically passed away in 2008. The books were kindly donated by his wife, Natasha McElhone, Trustee of FTW.

Fast forward to April 2012 and the planning is over, the flights are booked with some help from Cathay Pacific on the excess baggage! The tasks have been divided up amongst the team and the equipment is piling up at the FTW office. Eimear Murphy, charity volunteer and clinical nurse specialist for plastic surgery at Chelsea and Westminster Hospital, has it all under control. Every one of our previous patients have been contacted and transport arranged in conjunction with Children of Vietnam so that they can be reviewed in clinic. The local team have lined up an ample number of new patients who they would like help with operating on when we are there and several who they think may need to come to London. Our mission will last two and a half weeks in all with one surgical team covering the first week and a second team flying out to replace them for the second week. Each team consists of two consultants, two registrars, two nurses, a Vietnamese speaking anaesthetist, a general physician, and a team co-ordinator. In Da Nang we also hire a professional translator, Nhi, who has been with us now since the first mission. Nhi is a key player in delivering care to the patients with a fantastic grasp of English and a great sense of humour. She caters for all our strange requests; most recently for a glass fronted, lockable bookcase for the Martin Kelly Library. Nhi is helped by a troop of local IT university students who study English under Hung, a jovial ex-Vietnamese boat person who has recently returned to Da Nang from the USA to set up and run his own IT business, Enclave. He also teaches at the university in Da Nang and he sends his students to us as a placement. One of our jobs is to mark them at the end of the week!

Twins before and after

Monday is our out-patient clinic with both old and new patients. This usually lasts all day, but this year Dr Anh, Head of Plastic Surgery, has other ideas and he's already lined up two cases for the afternoon. However, in the morning we have a chance to see some old patients. "The Twins" arrive. Now two young men, but when we first met them three years ago their appearance, and therefore their lives, were blighted by neurofibromatosis. They travelled over 1,000 miles from the highlands to visit, and since resection of their facial and trunk tumours have gone back to school and will graduate this year. In the morning we also see a young boy with CMN on his nose and forehead. We undertook his first stage last year by resecting the congenital melanocytic naevus covering his nose and replacing it with a forehead flap. The forehead flap then needed to be divided from its blood supply a few weeks later. We left this for Dr Anh and his team to do after we departed. This year the aim is to remove the rest of the naevus.

The week passes in a flash with the days spent in the operating theatre and occasionally reviewing additional patients who turn up on an ad hoc basis. This year there is a very special day when Viet, who has returned with the team to Da Nang after his surgery for bilateral facial clefts is offered a place at the local blind school. This should secure his future and teach him a trade to support himself and his family. In the evening we hold a planning meeting for the following day’s theatre list and have a chance to visit Hoi An, a nearby UNESCO World Heritage site for a stroll around lantern lit lanes and dinner overlooking the river.

The aim of each mission is mainly medical but we also collaborate on research and audit projects to detail the work and the outcomes that we achieve. This year we are looking into the feasibility of organising the first Vietnamese Craniofacial Conference which will hopefully take place in 2013 as well as trying to set up an online patient database combined with telemedicine.

For more information and to make a donation please visit Facing the World.

For further information about our services please contact our GP Liaison Team on +44 (0)20 7460 5973.