New team members:

1)     Ronda Alexander, Neuro-Laryngologist, University of Texas at Houston (my alma mater!).    Rhonda was raised in Queens, New York and has just recently moved to God’s country!  ) 

2)     Ray Sykola, Anesthesiologist in the suburbs of Charlotte, NC.

3)     John McMahon, former academician in Head & Neck Surgery, now private practice in Chicago.

4)     Augustine Moscatello, academician in ENT at New York Medical College.  Has been with us in Vietnam.  2^nd REI trip.  Hosted one of our last Vietnamese Fellows.

5)     Juan Hernandez, retiring academician at Yale in Head & Neck Surgery.  Was with Augustine and our Vietnam REI team.

Returnees:

6)     Craig Hedges, the senior member of our team.  Craig’s 8^th Cuba trip and more than 20^th REI trip.  Sioux Falls, SD, private practice ENT.  Craig received the American Academy of Otolaryngology’s Distinguished Award for Humanitarian Efforts in 2007.  One heck of a teacher! 

7)     Sam Girgis, private practice ENT in Chicago and recruited John.  Sam has made several trips to Cuba and has been with TIME in Mexico.  Has hosted Vietnamese Fellows.

     Joel Ernster, private practice ENT in Colorado Springs and one of the world’s experts on HPV disease in Head & Neck cancer.  We were residents together in Denver.

9)     Agnes Sax, RN, with the Emergency Transport Team at Children’s Hospit al of Philadelphia.  Agnes and I have been on trips together for 15 years starting with TIME in Mexico.  Her skills are phenomenal in ICU care for children.

10) Julia Roskamp, Audiologist, in Concord, NC.  Julia is the former Exec Director of ComCare International, a hearing aid ministry, and she has done mission work all over the world.  She was recognized in 2002 as the Humanitarian of the Year by the American Academy of Audiology.

11) Don Wallace, REI staff, retired middle school principle and a major leader of our work in Cuba.  Don was a major league baseball player which makes him a hero, of sorts, in Cuba!

12) Lou and Gloria Shomette, REI staff, and the entire reason we are here.  Without Lou & Gloria there would be no REI-Cuba and we wouldn’t have made 14 medical trips.

13) David Parsons comes to eat Cuban food and look at old cars!

14) Benito Lauzurique.  You will read many notes about Benito.  Benito is an extremely proud Cubano, who loves his country and his people.  He has devoted his life to serving them.  Before Fidel, Benito was in Asheville, NC, for undergraduate school, then seminary in Cuba to become a Presbyterian minister.  He is the Cuban equivalent of Lou & Gloria.

15) Tony Paz and Adolfo Hidalgo are our surgeon sponsors as the Cuban Society of OtoRhinoLaryngologia is hosting us.  Tony is the President and Adolfo is the Treasurer.  We have not been able to get visas for two years and these two men are the Cuban reason we are here.  Tony is a Neuro-Otologist and Adolfo is a Rhinologist.  Both did advanced training in Spain.  Craig and Tony have worked together at Hermanos Ameijeiras Hospital (HA) and Adolfo and I have worked each year at Calixto Garcia (CG) Hospital.

Later… ALL the baggage and donations arrived safely.  We are now at the Hotel Habana Libre.  Our first meal was at the El Rocco (an old standby) where the same piano player (who looks like Billy Graham) has been playing for 32 years!  The team is bonding nicely.  Tonight we meet at Benito’s and his wife Deysi’s for dinner and continued team bonding time.  Tomorrow is completely planned, and I will just give you a head’s up that church will be something special!  Make no mistake, the Holy Spirit is alive, well and dynamic in Habana!

A final thought… Through the years I’ve instructed you to “read between the lines.”  I hope we will be able to really be open with you about what is happening, more so than in years past.

Augustine Moscatello, John McMahon, Sam Girgis, me, Agnes Sax standing by many of the donations given by Medtronic-Xomed, hospitals and individuals.  They all arrived safely.

Epilogue:  We are now at home, but we have to ask ourselves, “What did we accomplish?”  “Was it of any meaningful value?”  This team was a group of very successful people who made a commitment to make their goal significance.  Success is often a destination that has never filled the deep longings of one’s life.  The success we’ve known is often insignificant wood, hay and stubble to be consumed by fire, revealing only what is of significance.  Significance can be defined by each individual’s character, values, virtues, faith and the ability to build meaningful relationships.  We all believe that in the end, when we have to give an account of our lives, this significance will be “stored treasures.” 

For many who came on this trip, this has been a crossroads.  This was a group of real “performers,” who have spent a good portion of their lives trying to stay on the cutting edge.  By coming to Vietnam, many were scared of being like a fisherman who might fish all night but, if all didn’t go well, might return exhausted with empty nets.  But in our concern for success, we were told to push into deep water and cast our nets on the other side of the boat.  Pushing into deep water was hazardous and the risk of failure was great.  This might not have seemed like the way to achieve success, but we found our return was so great our boat almost sank!

As we started our trip, we listed our goals: 1) to build friendships, 2) to give the Vietnamese what they wanted most, state of the art medical training, and 3) to share our hearts.  We did all of these in a very wonderful way.  Seeking success was never listed as our goal, but through the emotions of peace and patience, we truly accomplished all of our goals.

Significance.  It is imperishable. It is eternal.  Mission accomplished!  Thank you for your support!

We are in the HCMC airport waiting to board.  All is well!  I was able to interview the team and everyone reports spectacular experiences.  Many were life changing, I believe.  We heard from the Hue team and they also had wonderful experiences.  Many of the team expressed hope that they would be regulars in the future.  What a blessing. 

There were a lot of heartfelt and meaningful goodbyes today and this evening.  Very touching!

Craig and Rebecca Hedges will be staying in Hanoi for the next two weeks.  Pray for their extended one month trip.

I worked all morning teaching a sinus course to 60 province doctors at Cho Ray.  I had a great experience and really enjoyed the morning.  However, this was my goodbye to Cho Ray as I will now be working at the ENT Hospital and Gia Dinh in HCMC.

This afternoon I spent a lot of time with Minh (known as Male Ming to distinguish from our first fellow, Minh!).  We had meaningful discussions about core life issues.  It was a joyous conversation, again, assuring us that we are doing what we are supposed to be doing.

OK… We’ve now landed in Korea, uneventfully, except every step of the way has required more goodbyes.  We are now down to 4 of us.  Sad to say goodbye but wonderful to almost be home!

I will send one final sign off note when I arrive in Charlotte.  It has been one of the best trips ever.  It is very meaningful to have such a group and to serve in such a way.  Joy abounds!  Thank you again for your prayers.  David

Today was the last full day of work and most of us are exhausted.  Some of us will work in the AM tomorrow, then spend the rest of the day sightseeing, shopping, etc.  Some will go to Cu Chi in the AM.  We leave for the airport at 9PM for a midnight flight home.

The ear course ended today with a gala closing ceremony.  The participants were so phenomenally happy with their new skills and knowledge.  They all received certificates, which is a very big deal here.  The ear team was thrilled with the entire two weeks. 

Rod and Connie Lusk had a really good week at the Peds Hospital #1.  Rod was able to arrange live teleconferences with the ENT Hospital and Peds #1 from Boystown so internet live grand rounds from the USA are just around the corner.

Ric Leinbach was with me today and we taught the end of the sinus course for the doctors at Gia Dinh and outlying hospitals.  Of course, the signed graduation certificates were part of this as well!  I met with the Director of the hospital at the beginning and end of the course.  This is a very big deal that REI has made such a huge commitment to this hospital.  I love it!  We did two surgeries and the Vietnamese doctors did a lot of the surgery.  They were thrilled to get to use power for the first time in the nose.  Again, this was a teacher’s heaven!  Bottom line… it couldn’t be any better!!!!

Brian Nicholas has been hanging out with the residents and, both he and Ric have really bonded with them.  Brian met all day with them and they exchanged lectures, books, etc., in a way that has not been done before.  Brian has really been very special to this team in a new way!

Still no word from the Hue team but we will meet early Sat AM in Korea.  

Tonight, I am taking the entire Gia Dinh staff out for dinner.  It should be a fun evening. 

Next year’s schedule is taking shape.  I haven’t discussed this with Begee so changes could still be made but this is what we are thinking:

Craig, Rebecca, Begee and I might be coming for 3 weeks (see… I have to clear this with the boss!) 

Leave the USA on Friday 4 Sep 09 or Sat 5 Sep and head to Hanoi for one week. 

This date is also attractive to our Jewish colleagues because you can stay almost two weeks and still be home for the High Holy Days. 

Sunday, 13 Sep 09, arrive in Hue for one week.  Craig and I plan to work 2 hosp there.

Sunday, 20 Sep 09, arrive in Hochiminh City for one week returning home on 26 Sep.  That gives those wanting to go to the AAO one week to get over their jet lag before heading to San Diego. 

We fixed the HCMC dates but the others are still negotiable based on responses of those wanting to go.  Anyone can come one, two or three weeks!  Just let me know.

Thank you for your prayers.  This has been a trip that will never be forgotten by so many.  Hearts were touched in deep and meaningful ways.  We were greatly encouraged that we are doing what we are supposed to be doing.  We have a great peace.  Good night!  David

The team continues to function at a very high level and everyone is having a great experience (of the HCMC group).  Craig and I have tried to Skype between Hue but no luck.  Once again, I haven’t seen anyone this evening from our group, so I can’t give you specifics for the day except my day.  At breakfast, all were happy, happy, happy!

I continue to be thrilled as I have found a new home in HCMC.  I did two sinus operations today.  Both went great.  The anesthesiologist did perfect, there was no bleeding, the teaching couldn’t have gone better and the patients did well!  I lectured all afternoon to the staff and doctors from many other hospitals who want to learn how to do modern sinus surgery without power.  Power is still a dream to anyone outside the major hospitals.  I am so happy!

Last night was dinner with Phong and her family and it was great.  Tonight I will have dinner with Minh and her family.  She is Begee and my first daughter from Vietnam.  We are very close to her and her family, so tonight is very special.  Tomorrow night, I will have dinner with a small group of the Gia Dinh staff, and that should be very nice.

The ear docs just came in and had a fantastic day.  They are as thrilled as I am.  Scott Estrem leaves to go to Korea to see his son tonight.  John McElveen left two nights ago, so the team is thinning.  Scott, Ric and Brian went to the Cu Chi tunnels today and had a very good experience. 

It sounds all medical.  It is not.  Deep relationships are being established, nurtured, and continued in ways that are vital.  We are where we are supposed to be.  What a blessing!!!!   In His Grace,  David

I operated at the ENT Hospital this morning after the opening ceremonies of the Dissection Workshop.  But for lunch, I was picked up by Dr. Ha from the Nhan Dan Gia Dinh Hospital (pronounced Nan Yan Ya Ding, sort of, or Nan Uan Ua Ding… try to say that 3 times fast!).  I’ve never been to this “people’s hospital” so everything was new.  They have almost no equipment and only one examining chair in the clinic.  But the day was a teacher’s delight.  Everyone wanted to learn, had an amazing thirst for knowledge, could speak pretty good English and listened as well as any audience I’ve ever had!  I have a lot of equipment to give them tomorrow and the Medtronic Xomed rep will be there to loan what I don’t have!

I appeared there a day earlier than expected and we saw patients and used each to really do in depth teaching.  Tomorrow we will do 2 sinus cases, then lecture the rest of the day.  Thursday will be the same as tomorrow.  Friendship 101 is off and running perfectly.  At the lunch, I was amazed how easily deep discussions were initiated and progressed nicely!!!

I believe this will be a new home for me in HCMC.  I feel we may well be becoming obsolete to our doctors at the ENT Hospital.  Translated, that means they are ready to teach most of what we know.  They don’t really need us any more.  It is time to move on.  How great is that!  Kent and I are going over to one of the doctor’s home tonight, which is a perfect team!

Oops!  Just heard that Ric and Brian had a great day and are taking 5 residents out for dinner tonight.  Perfect!

Kent and I reflect the rest of the team.  It continues perfectly.  We are thrilled and joyous!  In His Service,  David

The ear team did surgery by morning and prepared the dissection lab in the afternoon as the course starts in the morning.  75 attended in Hanoi and more than 80 will be at this course.  John McElveen leaves tonight, so he took the afternoon off to visit the Cu Chi tunnels.  These are very special to me because I lived at Cu Chi, above ground, 40 years ago and we were oblivious of the tunnel complex below us.  Returning there in 1996 was part of the cleansing of my soul.

Despite the focus on ears, my schedule was packed seeing very difficult and challenging cases.  We did fun surgery today, presenting new ideas, and tomorrow we will do a very challenging pediatric airway with near total obstruction at three levels.  Oh!  To do this at home!!!! 

We had an unhappy case presentation where a young woman presented with a benign head and neck tumor and her doctors aborted what was her first pregnancy so she could undergo treatment.  We challenged the decision (too late obviously) and said that ethical discussions like this should always be discussed in the department.  We suggested that the young woman probably will have life long depression, a life was taken, and all for a benign tumor that could wait treatment until after delivery.  Well, she does have depression and she still has the tumor.  We suggested that when a tumor is not life threatening, all the facts have to be examined carefully and priorities ethically established.  I believe the entire discussion was well received.  We were able to bring it up again later, to a second group.  Our hope is that by discussing this, such an outcome will never happen again.

The non-medicals came with us for part of the morning and then they disappeared and I’ve not seen them.  That should be good news!  I think an educational opportunity opened that was quite exciting, but I will learn more, later. 

Ric Leinbach and Brian Nichols had their best days, I believe, and the rest of the week promises to be equally exciting for them.  Ric is going to do a difficult oral tumor that he has never seen and the VNese do about 10 of these each year.  Role reversal and Ric is excited to learn!  I them took them to my favorite shopping market and we bought wonderful knock off golf shirts for $3.50 each!!!!  They had a blast.  We then violated all our rules and had Vietnamese Frappacino equivalents!  Mmmmmm!

Kent Dyer, neuro-otology from Oklahoma City, is my room mate and it is allowing me to keep up with ear team.  Tonight we go to our only banquet (I hope) this week.  It should be fun as this is a group we really know well. 

It is so wonderful seeing our “children.”  We’ve helped train so many of the doctors we are working with, and they’ve stayed in our homes and been part of our lives.  The new members of the team are learning how deep and important these friendships are.

Thank you for your prayers.  They are being answered in so many wonderful ways! 

In His Service,  David

So much to tell you!  The team came together Friday night in Hue and I was able to interview everyone to see how their experiences were on Thursday/Friday in Hanoi.  Generally, the experiences were quite good.  The ear dissection course ended Weds eve and the ear surgeons performed many complex ear surgeries Thurs/Fri.  It was an eye opener that equipment, anesthesia and support were completely different!  The challenges were well met and the surgical outcomes and teaching were excellent.  The Family Practice residents, ENT residents and George Sara (anesthesia) all had very good experiences and felt they really contributed to medical teaching.  Everyone was upbeat. 

The two Australians were only with us one week, but their experiences at the Peds Hosp were not good.  The Peds Hosp does not want Peds ENT to be an advanced specialty, but they do want high quality Audiology.  So if any Audiologists want to help us start a hearing program… we have a job for you!  This is the only hospital where we have run into this.  The Peds Hosp in HCMC is the opposite and I expect Dr.Rod Lusk to have a spectacular experience this week.

Saturday was truly a day of rest.  We had no agenda.  People did what they wanted including tours, shopping, reading, swimming, etc.  Craig, Rebecca and I went to Phuoc’s house to be with his family: Nga, his wife, Guitar (really!) his Dr. daughter and their grandchild.  It was wonderful.  I introduced them to this website and encouraged reading about the airplanes!

Today we had a sharing service that was wonderful.  Later, I had the opportunity to do what we come for.  I am thrilled.  Perhaps I know why I am here this year!!!!

We also presented a very large amount of new equipment to a new hospital (for us) in Hue, University Hosp.  Craig will be able to teach sinus surgery on TV with excellent equipment, including a lot from Bryan Medical and Medtronic-Xomed.  Bryan Medical also gave us a huge number of new tracheotomy tubes (the VNese still use the metal ones!), which Craig has distributed widely in both Hanoi and Hue.

Skype FINALLY worked and Begee and I talked unashamedly for a very nice amount of time.  No cost!  When you are on the other side of the world, just hearing…  well… you know!

We are now on the flight to Ho Chi Minh City (HCMC).  Tomorrow begins another very busy week, quite similar to Hanoi but 12 of the team remain in Hue so more ground/more teaching is possible.  We deeply appreciate your prayers.  Know that we are seeing great things happen, most of which will never appear on this web site!  In His Service,  David

I am sorry there are no photos.  I forgot my camera!

Cal did cardiovascular anesthesia and saw a completely different side of VN medicine.  The Hue CV team is an oasis.  They are as good as stateside, have their own huge facility, and practice medicine/surgery at the same level we know.  However, they do not have any ICU Intensivists and Cal said that is where he made his contribution.  Post op complications seem to originate because of lack of adequate ICU care.  This is now a goal for us in recruiting, to get Pediatric and Adult Intensivists.  70% of the surgeries are Pediatric.

The team arrived late Friday night and I will see them for breakfast.  The initial report is that all is well!

Those of you who know my practice know that I do not do cancer.  So the first case presented to me yesterday was a man with an olfactory neuroblastoma of the nose.  No worry… I don’t do this and have no interest in going into unchartered territory.  But I looked at the CT and examined the patient and realized it was capable of resection without entering the brain.  So we did him!  We new it would be potentially bloody as these are very vascular tumors.  But the patient did wonderfully, the huge mass was removed, there was very little blood loss, the diagnosis was confirmed and he is now a good candidate for radiation therapy.  This is the first cancer I’ve done in a very long time, and hopefully, it is the last!  The teaching was excellent and students were able to follow everything very well on TV.  The OR was absolutely filled with ENT staff from 2 hospitals, residents, province doctors, etc.

The anesthesia techniques Cal taught yesterday were extremely effective and allowed this case to be safely done!

Prior to this case we did another sinus case with excellent anatomy, excellent teaching visualizations and an excellent outcome.  I did the first side and the vice director of the ENT Dept did the second side.  This is such a good way to teach.  

Between the surgeries, the huge number of doctors gathered to ask many, many questions.  The teaching opportunity was wonderful.  Their desire to learn was enormous.  They exhibited a huge hunger for knowledge.  Their questions were excellent.  After the surgery, I lectured to the point of exhaustion but it was wonderful.  It is very hot and extremely humid here with little air conditioning!  I was sweating like I had just run a 10K!

We were treated to a banquet with traditional music and great food.  Then the day was done.  Saturday is to be a day of rest and Sunday is a late flight (changed from early) to HCMC.  I am looking forward to the needed rest.  I hope to tell you more about the rest of the team’s experiences in Hanoi on Thursday and Friday, when I learn myself.  Bottom line… it was a great week!  Thank you for your prayers!

In His Service,  David