Monica Kieu stood on a four-inch-high wooden box as she assisted the plastic surgeon graft paper-thin pieces of skin onto the four-year-old boy's hand, burned so badly that his fingertips permanently curled into his palm. This wasn't in the pristine conditions of an operating room in an American hospital, it was in Bắc Kạn in a mountainous, semi-rural area of northern Vietnam. She wasn't short; the surgeon just extremely tall.
Kieu had heard from her parents, the founders of Project Vietnam, that conditions at the hospital were poor but imagination had not prepared her for unequipped, antiquated facility.
It was the opportunity to view the experience not only through the eyes of a daughter, but of those of a doctor-to-be. She had heard tales of poverty and those ignored by the governmental health care system.
The fourth-year medical student was on her first medical mission and for the first time she witnessed and understood her parents' objective and purpose.
There was a room full of mothers holding children with an assortment of physical disorders, scarred from prior injuries. Kieu smiled at the adorable children, some disfigured with cleft lips and palates.
Dressed in light blue surgical scrubs, her long jet-black hair pulled back and her stethoscope around her neck, she sat while American surgeons interviewed potential patients. What she'd only heard about in conversation or seen in photographs throughout her life was suddenly reality.
A cleft lip or palate does not fuse properly during embryonic development. Surgical repair corrects the defect, preventing future problems with breathing, speaking and eating, as well as improving the person's physical appearance. In the U.S., the correctional procedure is usually done when during infancy and is covered by health insurance; in Vietnam, the majority does not have insurance, or the income to pay the high out-of-pocket expenses.
Those children couldn't smile back. At least not yet. But the beautiful Vietnamese woman with her long lashes and soft voice offered a diversion from the strange-looking American doctors who spoke in a bizarre language.
The parents were hopeful their child would be selected as a candidate for free corrective surgery. Kieu noticed the families remained stoic, yet their expressions showed desperation and hope.
Kieu grew up in a home with parents whose native language was Vietnamese, so she could understand and speak it, but now she would be expected to explain medical terms for which there was no direct translation.
As she sat with the surgeons in the hospital clinic, selecting those who were appropriate surgical candidates, she thought, "OK, we're going to take care of this.. I'm ready to go."
Kieu knew her parents were proud of her and this mission would open doors.
Bắc Kạn, a small city within the province of the same name, has an urban population of about 54,000. It lies due north of the capital city Hanoi. Its inhabitants include several ethnic minorities including Tày, Nùng and Dao. Those who live in the northern midlands and mountain areas had an average per capita income equivalent to US $400 in 2008, only one-third of the nation’s average level, according to the General Statistics Office of Vietnam. The province has the highest poverty level.
"People here are desperate for care and they are so grateful. No one else will help," Kieu said. "Many have never seen a doctor, especially in the remote provinces."
* * *
Born in 1981, Monica Chau Kieu was second-born to Quynh and Chan Kieu. Monica's parents had escaped from Vietnam in 1975 and settled in Orange County. Chan is an anesthesiologist at Fountain Valley Hospital and Quynh a pediatrician in private practice at the same hospital.
She attended boarding school in Watsonville, Calif., then attended the University of California, Riverside, where she earned her bachelor's degree in anthropology
Medicine wasn't in the cards after college; law was the direction she chose. She scored in the 96th percentile on the LSAT. In the meantime she worked as an extern for a federal judge in Los Angeles.
However, she found she wasn't getting any satisfaction from law and she was frustrated.
"There were no immediate results to show for. I was only doing lots of paperwork," Kieu said. "There was no tangible good. I was impatient. I like to see the fruits of my labor."
The judge saw her frustration. He had a daughter who was an allergist and he talked about how much she enjoyed working in medicine.
She applied to all the medical schools in Southern California, but when Western University of Health Sciences offered her a spot, she took it.
"My parents were supportive of my decision to go to law school," Kieu said, "But when I decided to go to medical school instead, they were very excited.
She added in Asian culture, the medical field is stable, offers job security, but more importantly, provides prestige. The decision delighted her mother.
"She's my number two. My first didn't go into medicine, so I blocked out all my expectations," said Quynh Kieu.
Medical school takes four years, two spent in the classroom, while the rest includes clinical rotations of four to six weeks working in surgery, pediatrics, obstetrics and gynecology and emergency medicine.
"This is the period when a student can pick and choose, exploring different fields," Kieu said.
During the last part of her third year, Kieu chose an elective otolaryngology rotation working in the specialty of ear, nose and throat medicine. She worked in a clinic with patients ranging from infants and toddlers with chronic middle ear infections or hearing problems to adults with facial paralysis and mouth tumors.
"Most of the cases were bread and butter, only requiring antibiotics or steroid treatments," Kieu said. "But, some required surgical correction."
In her fourth year, she tried out the field of her father, anesthesiology.
"I love the lifestyle because of my father," Kieu said. "I could see myself going to work right next to him."
During this time, she took her boards and began seeking a hospital to complete her residency. Knowing both were very competitive fields, Kieu debated between otolaryngology and anesthesiology.
"In the course of four months, I spent about $7,000 traveling all around the country," Kieu said. "Then I heard I was accepted at the Detroit Medical Center (for a residency in ENT)."
Finally able to take a well-deserved break, she seized the chance to play an active role in one of the medical missions which her parents had dedicated so much time and passion.
Founded in 1996, Project Vietnam works in needy provinces providing free, life-altering surgeries for children with birth defects and eye problems, as well as and medical and dental services. It provides ongoing collaborative training to Vietnamese health care personnel in pediatric emergency services, standards for infection control and services for children with special needs.
* * *
The surgical suite had been set up the day before by a staff of volunteers, both novice and well-seasoned with Project Vietnam. Mingled with the doctors and nurses were other friends or spouses who'd come along to lend a hand where needed. Most had brought the supplies needed for a functional operating area, purchased at their own expense or donated from their employers.
The area was clean, yet some of the equipment functional but archaic—a stark contrast from the state-of-the-art medical facilities in the U.S.
Monica Kieu hardly noticed as she was more aware of the personal opportunity. She would be working side by side and under the supervision of two surgeons she considered distinguished in their respective fields, R. Michael Koch, a plastic surgeon from New York City and Edward Kravitz, an otolaryngologist from Orange County, Calif. As a team, the doctors' contrast was striking. Koch, the young, handsome, soft-spoken Scotland native and Kravitz, the outgoing, witty retired advisor, yet their synergy was remarkable.
"Monica is a fourth-year student and matching in ENT for her training. As such, she is more than capable of placing sutures and assisting in the O.R.," Koch said. "At my teaching hospital, I would give a fourth-year med student ample opportunity to scrub, observe and assist. By assist, I mean holding retractors, cutting sutures, placing sutures, etc."
More exceptional was her father would witness her potential, skill and drive. She thought back to her parents' reactions when she announced she was going to medical school and now was the chance to really make them proud.
"I'm working with my mom and dad. This is any parents' dream. They never thought I'd be an ENT surgeon and go this far."
Kieu watched, quietly yet attentively, standing over the sterile area as the surgeons worked on their first patient. After she was safely transferred to the care of the recovery room nurses, the trio moved into the second operating room where 18-month-old Kim Oanu Bui was anesthetized, the scrub nurses ready to go. The baby's face had a large black mole, which somewhat disguised her cleft lip.
Koch and Kravitz took their places on round metal stools. Suddenly, Kravitz stood up, smiling, and gestured to Kieu to take his place. After a moment of hesitation, she sat down, and Koch began to explain the procedure, while demarcating the anatomical and incision areas with a methylene blue pen.
With the metronome-like rhythm of the anesthesiologists' monitor in the background, Koch gently began explaining that first he would make a composite cut to remove the mole and then begin to develop the normal curvature and slope of her top lip.
Intent on the sterile area, Kieu didn't notice her father quietly slip into the room. When he realized it was his daughter, and not Kravitz sitting next to Koch, his eyes lit up with pride above his surgical mask.
Monica Kieu didn't even notice her father since she was hyperfocused on Koch's voice as he guided her through the procedure. He was impressed with his student.
As an associate professor of surgery at New York Medical College, this was not his first time in the role of teacher.
"As you can imagine, teaching surgery to another physician takes a great deal of time and is best compared to an apprenticeship that takes years to complete," Koch said. "Allowing someone to cut skin with a knife is not the same as performing an operation--it would be like me holding onto the rudder of a plane and thinking that I'm a pilot."
The next day, Kieu's confidence level had reached skyrocketed. As she assisted Koch with a cleft palate repair, she asked about healing edges. The banter during surgery was relaxed and casual as the majority-rule female operating room staff agreed Nordstrom's was the best place to buy shoes and all let out a hearty laugh when Koch joked about his wife's passion for Jimmy Choo's.
Chan Kieu slipped in, whispering to the petite anesthesiologist, Loan Le, to take a break, and he stepped in to take her place. He moved in close to his daughter, looking directly over her shoulder.
"When will I ever work one-on-one and receive this caliber of practical experience?" Kieu asked, knowing she would gain what her peers would only get working countless hours in the O.R. "I'm learning so much and getting really good at technique and paying attention to detail."
When the day was over, the last patient out of recovery, safe with caregivers in another part of the hospital, Koch issued high praise for Kieu.
Koch explained Monica assisted with hand surgery, cleft palate surgery and removal of a large facial mole. The hand surgery was to correct the young boy's contracted fingers. This required "z-plasty flaps", or a Z-shaped incision to create flaps to release the contraction. The mole resection involved skin grafting and closure.
"She performed very well and responded to my teaching with interest and attention. She has "good hands" as they say in that she is gentle with the tissue and careful when using instruments," Koch said. "There is a sense of measured control in her hand movements—all good signs for her future skill as a surgeon."
Emotions have set her future into motion as she hopes to someday take on a leadership role with the Project Vietnam Foundation to assure the people of her parents' and ancestor's homeland can assureadly receive proper and affordable health care.
"Seeing medicine done this way, you can practice medicine anywhere," Kieu said.