Well, it’s been over a year since my last post on the Steady Footsteps blog, though there’s quite a bit of new material on my other blog, A View from Vietnam. We’re still in Da Nang and we’re still busily engaged in trying to make life better for disabled folks in Central Vietnam.
Trang, Huy, and I have been working together at the Traditional Medicine Hospital of Da Nang for more than a year now and hope to continue for the foreseeable future. The majority of our hospital patients have suffered strokes, though many at a younger age than I had been accustomed to seeing in the States. (Our most recent is only 17 years of age!) We’ve also worked with divers from Quang Ngai who sustained spinal cord damage due to decompression sickness (aka: “the bends”) and--of course--victims of traumatic brain injury due to motorbike accidents.
Our work in the community has continued as well. In Dai Hiep, four year old Phuoc, who has cerebral palsy, has started to speak and continues to try valiantly to perfect his head control and gain functional use of his arms. Tiny ten-year-old Nhon, who has what appears to be a pituitary disorder, has transformed himself, with our help, from a weak and listless waif into a dynamo on wheels! Farther afield in Quy Son, Trang has been traveling an hour each way via motorbike to become, in essence, a Guardian Angel for Hoa, a head-injured young woman with coordination problems that I’ve been following intermittently for the past four years. Under Trang’s care, Hoa has started speaking, doing more and more activities of daily living independently in her home, and even getting out into the community for the first time in four years on the back of Trang’s three-wheeled motor bike.
Finally, our efforts to promote the financial success of disabled artists of our acquaintance have led us to formalize a business called The Da Nang Artists Company. (A Vietnamese language version of the site can be seen here.) Through our efforts, paintings by Nguyen Tan Hien, our quadriplegic artist and friend, are now offered for sale not only by us, but also via another on-line gallery based in the UAE: liborius-xu.com Hien’s proudest, however, of two very different accomplishments this year. He and his wife Ly now have a baby son and a little one-bedroom house of their very own!
I’ve been trying, in every way that I can think of, to share my knowledge and love of physical therapy with young Vietnamese therapists since I first started volunteering in Da Nang more than five years ago. Regretfully, neither I nor any of the other American, Canadian, German, Australian, or New Zealander therapists that I’ve encountered have had any significant success in that regard. Even with our best efforts at demonstrating and explaining, with the assistance of the best translators that we can find, we still have not been able to light a fire under these marginally trained so-called physical therapists. What a pity. And what a puzzle, as well.
The question I’ve been wrestling with for the past year or so is: what can I do in the face of this seemingly intractable obstacle to providing decent rehabilitative care for the disabled folks that I encounter here in Central Vietnam? The answer that I finally settled upon is to just provide the care myself, with the help of some intelligent, compassionate, bi-lingual young assistants.
So, for the past six months, Trang (a lovely young disabled woman who initially signed on as our cook) and Huy (my trusty translator) have been working directly with disabled kids out in the countryside, along with me and an occasional foreign volunteer. And it’s been great! What a difference to work alongside young people who are open to new ideas and enthusiastic about helping disabled folks and their families have a better life! Instead of merely talking about rehabilitation, we’re doing it. (Following our lead, the Kianh Foundation hired Trang’s little sister, newly graduated from high school, to work alongside Danielle, their Aussie PT, and found her enthusiasm, diligence and openness to new ideas a breath of fresh air after working for seven years with typical Vietnamese therapists.)
Steady Footsteps has now initiated a new formal relationship with the Traditional Medicine Hospital of Da Nang and an informal one with a brand new school for disabled kids in Da Nang. Trang and Huy are working alongside me with the blessings of the administration of both facilities. What a relief to give up on “Talking the Talk” and finally just focus on “Walking the Walk!”
When Tao showed up at the rehab hospital where I was volunteering last year, he told me that he fell down frequently because of weakness in his legs. From the doctors, I found out that Tao had an inoperable, but slow growing, spinal cord tumor in his neck. Upon examination, I determined that Tao’s legs were actually quite strong. His problem was that he could not feel them. That’s why he often tripped and fell and it was also why Tao was unable to travel by motorbike as nearly all of us do in Vietnam. Not only could Tao not control a standard motorbike, he was even afraid to ride on the back as he feared that his feet would slip off the pegs and get caught in the rear wheel.
With that insight into Tao’s situation, I worked with him on developing a safe and consistent gait pattern while cautioning him that he would always have to pay close attention to his feet, especially when walking on uneven surfaces. I also bought him a pair of shoes with clearly defined heels and had him practice keeping his feet on the pedals of a stationary bicycle. As a result, Tao was finally able to travel on the back of a motorbike with confidence and so was able to travel home on the weekends to be with his wife and three daughters.
Months later, I encountered Tao as he was vigorously pumping a hand-powered cart up a blazing hot, steep stretch of road in the countryside southwest of Da Nang. I cringed to watch him, covered in sweat and with veins bulging on his forehead, struggle up that hill. I knew that the spinal cord tumor in his neck not only blocked sensation to his legs, also caused unremitting pain in Tao’s right arm. Tao’s Herculean effort was surely exacerbating his arm pain. The sort of cart that Tao was using is actually rather brilliantly designed. It needs no fuel and moves as fast as a bicycle on level pavement. In fact, Steady Footsteps has purchased quite a few of them for impoverished disabled folks in the Nui Thanh district of Quang Nam province. Unfortunately, Tao lives in an exceptionally hilly area and was trying to eke out a living by selling newspapers and lottery tickets at various coffee and noodle shops that hilly region. Things were not going well for him—he was racked by pain and he often did not even break even financially on his daily newspaper sales.
We followed Tao to his home that day and listened to him talk about his dream of having a little shop of his own. And we made that happen: Steady Footsteps not only supplied Tao with initial merchandise and start-up funds, we also provided him with a used three-wheel motor bike and lessons in how to drive it. Tao’s life is still no bed of roses—his arm still gives him fits and he’s nowhere close to middle-class—but he’s got the shop of his dreams and he’s able to provide for his family and that’s not bad.
We finally got the phone call we’d been anticipating for more than a year and a half. Dung’s wife Linh has been admitted to the General Hospital of Da Nang, having at last reconciled herself to the idea of having a tube surgically placed through the wall of her abdomen to prepare for a life-long regime of peritoneal dialysis in the hope that she will be able to continue to raise her two young sons and care for her husband Dung.
I met Dung and Linh in 2008 at a rehab facility near my home in Da Nang. There, amidst all the stroke and brain-injured patients, Dung was a rarity. He was entirely coherent and independently ambulatory. He had recently survived electrocution on a construction job and had only one major handicap, but it was a big one.
He had no arms.
We do have a shop in Da Nang that makes artificial limbs. It’s actually pretty darned good when it comes to making practical low-cost artificial legs--in large measure because of the work done here during the Vietnam/American War by the American Friends Service Committee, a Quaker organization. Unfortunately, no one in Da Nang—or in Hanoi, for that matter—had the expertise or the components needed to make a functional arm for Dung.
Dung soon left the rehab hospital, realizing that no one there was in a position to help him, but we stayed in touch. For the next year, I sought an answer to Dung’s dilemma. Finally, the Limb Center of Wellington, New Zealand, came to Dung’s rescue. They not only donated the necessary components to compensate for the restricted range of motion in Dung’s left elbow (his right stump is too short to accommodate a functional prosthetic arm), but they also sent a technician, Malte, to help the local prosthetic technicians fabricate this unusual prosthesis.
During the following year, Steady Footsteps staff and volunteers worked with Dung to help him become as functionally independent as possible with his new arm. We had a three-wheeled trike designed and fabricated for him so that he could become more mobile. His cousin, who is a welder, designed a cup with a swivel grip made from bullet casings so that he could enjoy drinking coffee with the friends and neighbors who came to the little coffee shop that Dung and Linh opened in the front room of his parents’ house. (Dung’s own house had been demolished in an urban renewal project just before his accident and the compensation money they received was eaten up by medical costs after his accident.) As Dung regained the ability to feed, dress, and bathe himself, he began to pull out the deep depression that had enveloped him ever since his accident. Unfortunately, fate dealt this family yet another cruel blow.
While Dung was learning to operate his new arm, Linh finally sought medical treatment for the severe abdominal pain that she had been suffering. Not surprisingly, considering the stress she had been under, tests showed that she had a duodenal ulcer, for which she subsequently received treatment. The surprising news, however, was that tests inadvertently revealed that Linh had only one kidney. The devastating news was that that one kidney was failing.
Linh has been wrestling with that news and its implications for over a year. She’s been hospitalized numerous times since then for palliative treatment and each time the doctors advise her to have surgery and get started on regular dialysis, pointing out that, should she wait until her kidney fails completely, she may very well not survive the surgery. The surgery is more than Linh and Dung can afford, so Steady Footsteps is paying for it. The monthly cost of the dialysis regime is also beyond them and I don’t really see how, in good conscience, we could back away from helping them with that as well.
What do you think? Could you help us out with this project? Of all the adaptive devices that we could ever give Dung, what could we do that would ever replace Linh?
While health care technology has rocketed into the 21st century in Vietnam, with cardiac bypass surgery, total hip replacements and in-vitro fertilization available now to those who can afford it, physical rehabilitation remains mired somewhere in the 1950s. I, myself, studied physical therapy a mere thirty-five years ago in the States, but this observation was offered me by a New Zealander who actually did become a therapist in1950:
“The situation you’re describing sounds just like New Zealand when I first became a therapist. Don’t worry,” she said, “the Vietnamese will gradually figure things out, just as we did over the past fifty years.”
That seems a rather depressing prospect for the 86 million people living in Vietnam today, don’t you think?
In America these days, the American Physical Therapy Association advocates that new entrants to the profession of physical therapy be educated at the doctoral level. Yet USAID-funded programs, such as Health Volunteers Overseas (HVO), routinely send American and Canadian volunteers to Vietnam for two to four weeks at a time to offer clinical instruction to graduates of two-year PT tech schools. Even without looking closely at the results of such a program—which I can assure you are abysmal—could any reasonable person suppose that Vietnam will ever “catch up” to the standards of rehabilitation offered elsewhere in the world?
Vietnam and America’s histories are closely intertwined, in ways that many Americans would prefer to overlook. Even as Vietnam emerges from the grinding poverty and isolation of the bleak decades of US-imposed embargo, parts of that shared history bequeath a twisted legacy to the future.
Most significantly, Vietnam is isolated by language. When you consider that most of the fluent English-speakers in Vietnam were associated with the losing side of a long and bitter civil war, it’s not surprising that they would subsequently be excluded from the educational system and the government of Vietnam. Thus, there are very, very few people in Vietnam today who are truly fluent in English—and those who are most assuredly are not Vietnamese physical therapy technicians! Translators--even those who are graduates of university level programs--may have had little or no previous exposure to foreigners. Even if a foreign volunteer should be lucky enough to be assigned a translator who is actually capable of conversational English, the sorts of things that physical therapists need to talk about are not in the normal English language curriculum. Indeed, there is not even Vietnamese vocabulary for much of what we need to say. How is it reasonable to expect that anything productive will come from this doomed attempt at communication?
Physical therapy in Vietnam is not a high-status occupation, nor is it a highly paid one. Only the top 10% of Vietnamese high school students are admitted to university, and these therapists were NOT in that top 10%! Physical therapy training in Vietnam consists of learning certain well-defined “techniques” and then practicing them under the cursory supervision of similarly trained therapists. Evaluation and treatment planning are NOT part of the curriculum. Neither, for that matter, are transfer and gait training. And yet therapists emerge from this minimal training program convinced that they know absolutely all there is to know about physical therapy. They are invariably polite to visiting foreign volunteer therapists, but foreign therapists who return on subsequent visits to Vietnam are universally disappointed to note that their educational efforts have had no enduring effect whatsoever. It’s important to note that the physical therapy supervisors have had the same minimal training as the rest of the therapists and that they view their role as ensuring that PT continues to be practiced “correctly.” The most promising Vietnamese physical therapy student I ever worked with (the only one who ever “got” the idea of gait training) told me--through a translator--the following:
“You know, I really like what you are trying to teach me. I can see that it is much more effective than what we usually do here. But I have to tell you that if I get a job in a Vietnamese hospital and I attempt to do this, I will be corrected. And, if I continue to use your techniques, I will be fired.”
That statement stunned me, as it is so hard to perceive what is really going on when you stand outside of both the language and the culture of a place. But now, two years later, I know that that physical therapy student was telling me the truth. Even after two years of working continuously at one facility, with one dedicated translator, I cannot honestly say that I have been able to significantly change practice there. On the other hand, I recently had the opportunity to work alongside two volunteer occupational therapists in the rehabilitation department of a different hospital, under the dynamic leadership of two progressive, open-minded physicians and what we were able to accomplish there in a mere two months was simply amazing. Those two physicians had--many years ago--studied about rehabilitation: one in Israel and the other in Philippines. They were ready, willing and able to support and implement new ideas introduced by foreign therapists. Had they actually had full training as therapists, they would have implemented those changes themselves, over ten years ago.
So here’s what those progressive MDs and I want to propose for the future of rehabilitation in Vietnam:
We believe that young, government-employed physicians with a special interest in rehabilitation should be provided the opportunity to study for an entry-level doctorate or masters degree in physical therapy in America. (It goes without saying that they would first need to study English for a year in America to enable them to get the best results from their studies.) Right now, most Vietnamese hospitals are fully staffed with minimally trained PT techs that are going to stay in those positions until they retire, decades from now. It’s actually difficult for new graduates to find a position. Trying to change practice through the existing school system is futile in the short term as new PT technicians would rank below everyone else in seniority and be unable to “buck the system.” Fully trained, Vietnamese physical therapist-physicians, however, would be able to step into any existing physical therapy department in Vietnam with the knowledge, skills and the authority to ensure the delivery of good quality rehabilitation.
There is an idea in America that any Vietnamese person would never return to Vietnam, should they be permitted to enter the US. This is a very simplistic view, which does not begin to take into account how much life has changed for the better in Vietnam recently and how much more comfortable it is to live within the circle formed by one’s own family, culture and language. Government positions in Vietnam are highly sought after, even considering the low salary levels of both Vietnamese PTs and MDs. Employment by the state assures one of job security, health care, four month paid maternity leave, disability pay and a full pension after thirty years (at age 55 for women and at 60 for men). Additionally, therapists and physicians routinely develop private practices to supplement their government salary. I’ve lived in Vietnam for the past three years and I wouldn’t care to live anywhere else. The cost of living is low and the pace of life here is very, very pleasant. It’s simply naïve to assume that any Vietnamese person would willingly abandon such a life.
I believe that America owes a special debt to the Vietnamese people. Moreover, I think that sharing knowledge and skills that can ease the suffering of millions of people is simply the decent thing to do. We don’t need to send specialized, high-tech equipment or vast sums of money overseas to implement such a project. In fact, all the money necessary to fund this project would be spent in educational institutions in the US.
Surely, surely we can find a way to fulfill this dream.
Imagine there's no Heaven
It's easy if you try
No hell below us
Above us only sky
Imagine all the people
Living for today
Imagine there's no countries
It isn't hard to do
Nothing to kill or die for
And no religion too
Imagine all the people
Living life in peace
You may say that I'm a dreamer
But I'm not the only one
I hope someday you'll join us
And the world will be as one
Imagine no possessions
I wonder if you can
No need for greed or hunger
A brotherhood of man
Imagine all the people
Sharing all the world
You may say that I'm a dreamer
But I'm not the only one
I hope someday you'll join us
And the world will live as one
--John Lennon 1940-1980
Here's a link to the on-line version of the New York Times-Special Edition, a brilliant spoof, over a million copies of which were distributed this past Wednesday on the streets of New York City and elsewhere.
Many thanks to all who help us imagine a better world!
I met Trang, a delightful young woman, in the nearby tourist town of Hoi An, while I was visiting a disabled women’s workshop run by Lifestart, an Australian charitable organization. I was struck first by Trang’s glorious smile and, secondly, by her extremely unusual “gait,” or mode of walking. As a little girl, Trang contracted polio, which paralyzed muscles in both of her hips and also those that control her left knee and ankle. Trang struggled to compensate for this extensive paralysis by using one hand to brace her left knee and by throwing her body vigorously from side to side with each step. That's an incredibly energy–intensive way to get about and, understandably, Trang was developing severe back pain. Clearly, her days of being able to ambulate in such an arduous fashion were limited. I thought Trang could benefit from a brace, though I’d never seen one designed to address her specific situation.
With the kind assistance and financial support of the Lifestart organization, we took Trang to a local orthotic workshop. There, with the collaboration of a local orthopedic surgeon who discovered that Trang also lacked the socket portion of her left hip joint and a Swiss orthotist who conceived of the basic brace design, we had Trang fitted out with a special “ischial-weight-bearing orthosis.” Trang took the multiple trial fittings and painful adaptation to wearing such a cumbersome contraption with grace and equanimity. She quickly mastered the technique of walking erect with the brace and her two new crutches, as well as the back exercises I taught her. What a delightful patient and sweet-tempered human being!
Only later did I discover Trang’s talent with embroidery. Here’s Trang’s embroidered version of the famous “Japanese Bridge” in Hoi An:
Having artistic talent and being able to make a living from it are two very different things, however, as my own husband could readily testify. Trang's considerable skill with a needle has not, thus far, enabled her to support herself. So, this year, when the Virginia Beach Friends Meeting inquired as to how they might help Steady Footsteps, I asked Trang to make up some embroidered silk pillow covers that my Quaker buddies could sell at the upcoming Fair Trade Festival in Norfolk, Virginia. The results were just lovely, as you can see here:
Trang was delighted with having received her first artistic “commission” and hopes that she can find other organizations that would be interested in doing similar projects. If you or someone you know might be interested in purchasing custom embroidery by Trang for your fund-raising efforts (or any other reason, for that matter), you can e-mail me at firstname.lastname@example.org and I’d be happy to help you connect with Trang.
Sometimes we can all feel overwhelmed by the effects of the global market place. Small, locally based businesses find it difficult, if not impossible, to compete with gargantuan corporations that utilize sweat shop labor and ship goods by the container load. But we can tilt the balance just a bit when, to the magic of instantaneous electronic communication and rapid air travel, we add a measure of personal connection and compassion. The 29 pillow slips that Trang created for the Virginia Beach Friends Meeting crossed the Pacific in a suitcase carried by a Wheelchairs for Humanity volunteer. All the proceeds from the sales of Trang’s pillowcases will go to Trang and to support the work of Steady Footsteps. Now that’s global trade that we can happily support!
UPDATE: Check out Trang's newest creations on-line at the Da Nang Artists Company website!
One of the unexpected joys of living and working in Vietnam has been in having the opportunity to meet and encourage two young artists: Nguyen Tan Hien and Ho Viet Phuong. Hien and Phuong were both university students-- Hien, studying mathematics in his home town of Buon Ma Thuot, and Phuong, studying architecture in Ho Chi Minh City--until they became quadriparetic (weak in all four limbs) due to spinal cord damage--Hien, having been struck by a bus while riding his bicycle, and Phuong, due to a spinal cord tumor. When our paths crossed on the spinal cord unit of the Da Nang Rehabilitation-Sanatorium Hospital, I noticed that they were spending much of their free time, between their daily physical therapy sessions, drawing. While my husband Dave (who is an artist himself) and I saw real talent in these early drawings, the young men dismissed our compliments, saying that they knew they could only become “real” artists if they were able to get admitted into a university art program and learn to create art “correctly.”
Dave and I decided we needed to convince these guys that they had real talent—even though they lacked art school diplomas. So we commissioned Hien to create some pencil sketches for Steady Footsteps greeting cards and we purchased two of Phuong’s wonderful paper mosaics. As Hien began painting in watercolors and--later--acrylics, we bought some of his paintings as well. And every time we had a foreign visitor at the hospital, we took them by Hien and Phuong’s room, which was gradually evolving into a cross between a hospital ward and an art studio. All of the visitors exclaimed over the art work and some took the opportunity to purchase pieces to hang in their homes in Germany, America and Australia. At our suggestion, the proprietors of three local shops: Reaching Out Handicraft Shop of Hoi An; Tam’s Pub and Surf Shop near China Beach; and the Bach Mai Art Gallery at 12 Trung Nu Vuong Street (just across the street from Da Nang's famous Cham Museum) all agreed to carry and sell Hien and Phuong’s work without charging any mark-up.
A few weeks ago, I saw Hien and Phuong wheeling themselves up the street toward the city bus stop. They said they were “on a business trip”—off to meet with a shopkeeper in the neighboring town of Hoi An. This week, Hien told me, he is working with yet another patient, trying set up his own website.
Our friends Hien and Phuong now consider themselves professional artists—quite a concept in a country like Vietnam, which is just gradually emerging from a bare subsistence level economy and where 95% of the disabled are unemployed! Dave and I are delighted to have been catalysts in their development—and we’re delighted, as well, to have Hien and Phuong’s drawings, paintings and paper mosaics brightening the walls of our home!
UPDATE: Check out Hien's newest paintings on-line at the Da Nang Artists Company website!
Steady Footsteps,Inc. is a charitable organization. Your support is always welcome. More about us and contact information here.