Naomi Shields, MD, (left) and Robert Mihalich, MD, evaluate patients at Lao Cai Hospital in Lao Cai, Vietnam, as local surgeons look on.
Courtesy of Zan Lofgren

AAOS Now

Published 10/1/2016

AOFAS Celebrates 15 Years of Vietnam Outreach

Volunteers from the American Orthopaedic Foot & Ankle Society (AOFAS) recently completed the organization's 15th Overseas Outreach Project to Vietnam. Since 2002, members of AOFAS have participated in more than 1,300 surgical procedures and have seen more than 3,000 patients in clinic in Vietnam. The ongoing program has its roots in a 2001 fact-finding mission, in which AOFAS members explored the feasibility of traveling to that country to train local physicians while treating land mine victims and disabled children. The initiative provides free corrective surgery for children and adults with lower extremity deformities caused by club foot, polio, cerebral palsy, trauma, and other conditions.

Participants in the 2016 program included A. Holly Johnson, MD; Robert M. Mihalich, MD; Naomi N. Shields, MD; and Raymond J. Sullivan, MD.

Vietnam is a nation of more than 94 million people, with about 11 percent living below the poverty line (based on 2012 data). Under such conditions, many patients lack access to care or are unable to afford advanced medical services. An ongoing challenge faced by the visiting surgeons included a lack of equipment. Many tests that are common in the United States are rare in Vietnam.

"I would see some unusual cases," said Dr. Mihalich. "I was still surprised by the level of deformity and the children's will to overcome their disabilities. Most of the patients we saw were just looking for help and grateful for whatever we could do."

During the 3-week project, members of the AOFAS teams traveled to hospitals and rehab centers across several cities in the northern provinces. They evaluated 218 patients and performed surgery on 66. Many of the cases involved untreated congenital deformities.

"Most of the surgeries we performed involved complications of clubfoot and cerebral palsy," said Dr. Johnson.

Education goes both ways
In addition to treating patients, education is an important feature of the initiative. The volunteers, along with Vietnamese orthopaedic surgeons, gave presentations at an annual conference cosponsored by AOFAS on lower extremity surgery, which was attended by 120 Vietnamese surgeons.

Naomi Shields, MD, (left) and Robert Mihalich, MD, evaluate patients at Lao Cai Hospital in Lao Cai, Vietnam, as local surgeons look on.
Courtesy of Zan Lofgren
A. Holly Johnson, MD, (left) and Raymond J. Sullivan, MD, (right) perform surgery with local surgeons at the Orthopaedic Rehabilitation Center in Ba Vi, Vietnam.
Courtesy of Zan Lofgren

For many visiting surgeons, such educational opportunities extend to the trainers as well as the trainees.

Volunteering in Vietnam "allowed me to grow as a surgeon," said Aaron J. Guyer, MD, who participated in the program in 2012, 2013, and 2014. "Having to think 'outside the box' on how to accomplish a specific surgical goal with the limited resources available was a daily occurrence. This forced me to think back about basic orthopaedic principles and rely less on the many modern implants, instruments, and imaging modalities we have available in the United States for diagnosing and treating orthopaedic foot and ankle problems."

"The patients were amazingly resilient and brave," said Dr. Johnson, "and we felt lucky to have the opportunity to offer them our care. We also enjoyed teaching the local surgeons diagnosis and treatment algorithms for different foot and ankle problems."

"I returned home with a renewed sense of purpose and improved perspective on what it means to take care of patients," agreed Dr. Mihalich. 

"My life is much richer because of the humanitarian service work that I do," said Dr. Shields, who has been a volunteer on this project for the past 15 years.

The Overseas Outreach Project to Vietnam is cosponsored by AOFAS and Mobility Outreach International. Under the program, surgical volunteers pay their own travel expenses, with in-country expenses supported by the AOFAS Orthopaedic Foot & Ankle Foundation with charitable donations from individuals and industry.

The project is open to active members, candidate members, and international members of AOFAS. For more information, or to volunteer please visit here.