Vietnam: A 20-Year Commitment

Bryant A. Toth, MD

Physicians have traditionally been extremely generous with their time, volunteering not only to help the poor and underprivileged in their own country but also taking their skills to patients internationally in the spirit of good will and friendship. Plastic and reconstructive surgeons in particular have traveled the world to help children born with severe facial deformity. What makes plastic surgery uniquely exportable is that, in general, children born with cleft lip and cleft palate are healthy and all that is necessary is the skill to repair their particular problem. This, therefore, allows a plastic surgeon to travel and address these problems without the need of a complex support group, such as a cardiac surgery support team. I represent one of those plastic surgeons who for the past 20 years has been involved with a medical project in Vietnam.

As I was completing my residency in general surgery and plastic surgery at the Massachusetts General Hospital in Boston, my good friend, teacher and mentor, Dr. John D. Constable, asked if I would be willing to join him in a project to help restore reconstructive surgery to what was then one of the poorest countries in the world, Vietnam. John had been a civilian-consultant during the Vietnam war and had the political contacts to gain entry into the country. I represented a new generation of plastic surgeon who had all of the newly acquired skills, coming fresh from an outstanding residency training program. So in that year, 1986, I began participating in what would become an annual mission to Vietnam.

You must remember at that time the United States had no diplomatic relations with Vietnam. It was an extremely poor country and even telephones were few and far between. John and I would fly to Bangkok and wait. Daily we would make our way to the Vietnamese embassy on Wireless Road and inquire as to whether our request for a visa had arrived. All of the paperwork was handwritten and the visas were hand-delivered from Hanoi and would take up to seven days to arrive. There was never any guarantee that we would actually get one. When the visa finally did arrive we routinely headed off the next day on Vietnam Airways, flying on a Russian Tupelov or Ilyushin jet along with the few fortunate Vietnamese who were allowed to return home, in addition to the variety of animals (dogs, chickens, geese) that were packed onto the airplane. This in itself was an extraordinary cultural experience. The Russian plane would expel what appeared to be smoke through the ventilation system, not because the engine was on fire as we imagined, but because the air-conditioning unit was being activated. More than once a prayer was said at takeoff and landing in these old and, I am sure, undermaintained Russian aircraft.

In the early years our attention was directed to the major cities in Vietnam, Hanoi and Saigon. It was extremely important to the Vietnamese that the majority of our time was spent in Hanoi, now the new capital of the country. The U.S. forces left the south in 1974 and it eventually fell to the Vietnamese troops in 1975, so at this point reunification was only ten years old. In Saigon we worked at the Barsky Unit, a hospital built in the 1960s by Americans to showcase American plastic surgery in South Vietnam. It was named in honor of the New York plastic surgeon who spearheaded the fund-raising for it and convinced his American colleagues to volunteer in the unit.

A typical trip consisted of operating from dawn until dusk for 10 days in the south and then moving on to Hanoi, where we would do much the same. In Hanoi our home base was Viet Duc hospital, the primary teaching hospital for Hanoi University. Hanoi was much more primitive than Saigon, albeit much more beautiful, having retained much of the elegance and grandeur of the French colonial city and capital of Indochina, which it formerly was. The Vietnamese surgeons with whom we worked were extremely dedicated and talented individuals. Never once did we feel any resentment because we were Americans. They were extremely proud people and had excellent surgical skills, but lacked the information sources for new developments and technology from the West, which we were happy to provide. I am proud of the small difference we have made in dealing with congenital problems there.

After several years we realized that we wanted to leave a sustained legacy in Vietnam, and that arriving once a year and operating on a small percentage of children was not going to be the answer. John Constable, Michael Moses (a plastic surgeon from New Orleans) and I created a foundation: ISEE (Indochina Surgical Educational Exchange). We had grateful patients from the U.S. donate to this foundation as well as the funding we provided ourselves. We quickly found that if we wanted to leave a true legacy we would need to train the existing physicians in Vietnam to deal with the problems the way we were taught to deal with them. This meant providing a vehicle such that they would be able to come to America, spend a lengthy period of time with us to see how we address the same surgical problems they faced, and then allow them to reintegrate these into their own systems, using the skills that they acquired while training in America with us. The Chinese have a great saying for this, "Give a man a fish and you feed him for a day. Teach him how to fish and you feed him for a lifetime."

Over the past 20 years we have trained some 50 Vietnamese doctors, who have come and lived with me and my family here in San Francisco as well as in cities such as Boston and New Orleans. These physicians sacrifice enormously as individuals, leaving their families for up to a year. They accompany us in the operating room to watch how we deal with problems as well as listen carefully to how we interact with our patients, feeling free to ask questions both of the patients and of the surgeon. It is now extremely gratifying to return to Vietnam where, upon our landing, there are often many families waiting at the airport to greet us. There is an enormous sense of warmth and appreciation that extends to both sides of the aisle. As progress has been made in Vietnam, the project has expanded to many of the other poor countries in Southeast Asia including Burma, Cambodia and Nepal.

As I reflect back upon this project it gives me a great deal of satisfaction to know that we have made some degree of difference. We have received the Medal of Freedom from the Vietnamese government, the highest award that can be given to a civilian agency. There is no question in my mind that whatever we have given to them we have received back from them much more in terms of friendship, collegiality and an understanding of what it takes to be happy. Our trips to Vietnam enabled us to see firsthand the importance of the family unit, and the fact that friendship can be extended across all borders.

Dr. Toth lives and practices plastic and reconstructive surgery in San Francisco. Previously, he was a resident in plastic surgery and general surgery at Massachusetts General Hospital in Boston. As the 1983 Kazanjian Fellow in Surgery, he studied and worked in Paris. His practice today consists primarily of cosmetic surgery in addition to dealing with craniofacial deformity.