This was the fourth time that the NCF in Taiwan has sent a volunteer medical team to Vietnam. The good reputation they have acquired there was obvious from the reception the team members received when they stepped off the plane at Ho Chi Minh City.

The team was welcomed by "semi-official" personnel connected with the city. At the airport, they were not only passed quickly through customs without their bags being inspected, but were also received in the VIP lounge, which is normally reserved for foreign dignitaries on state visits. The reason they were greeted by "semi-official" personnel is that Vietnam and Taiwan do not have formal diplomatic relations. Since the Vietnam War, Vietnam has remained a socialist country, so politically it has to pay a lot of attention to mainland China. But the efforts of Taiwanese medical teams in recent years have benefited around 100 Vietnamese children with oral clefts, and are greatly appreciated by the Vietnamese people. Also, the "non-governmental" status of the Taiwanese medical team allowed the Vietnamese "semi-official" personnel to welcome the team in style, to express their gratitude.

The reception was led by a heavyweight local political figure: former Ho Chi Minh City mayor Nguyen Vinh Nghiep. After retiring as mayor, Nguyen, a Vietnam War hero, went into charity work, setting up the HCM Sponsor Association for Poor Patients, which raises funds both inside and outside Vietnam to assist low-income Vietnamese with medical problems such as oral clefts, blindness, burns and congenital deformities. Over the past years the charity has achieved remarkable results.

Although the NCF surgical teams have only stayed in Vietnam for a week on each of their four visits, they have repaired cleft lips and palates for 30 to 40 children each time. The number of children in Vietnam with oral clefts is astonishingly high. Plastic surgeon Hung Kai-feng of Linkou Chang Gung Memorial Hospital, who has taken part in all four trips to Vietnam, says that the incidence of oral clefts there is as high as one in 500 births, which is significantly higher than the rate of one in 600 found in Taiwan in earlier years.

As well as the high incidence of oral clefts, the number of children born with craniofacial deformities in Vietnam is also very high. Clinicians believe this is related to factors such as environmental pollution caused by the use of chemical agents during the Vietnam War, and the low standard of living which means that most pregnant mothers are poorly nourished.

Seeing A-Fu again

Do you remember Du Duc Duyen-known in Taiwan as A-Fu-who came to Taiwan for plastic surgery four years ago, when he was aged around two? A-Fu had serious multiple deformities of his skull and face, caused by enlargement of his meninges (the membranes that enclose the brain). His eyes were abnormally wide apart and he had no bridge to his nose, giving him a shocking appearance. At that time, Compassion International brought Du Duc Duyen to Taiwan, and after receiving reconstructive surgery free of charge at CGMH's craniofacial center, his appearance was much improved.

Little A-Fu is now almost six years old. Although he no longer appears seriously deformed, he is still blind, deaf and unable to speak. He can only sit up for 30 minutes each day, and for the rest of the time his body is limp.

On hearing that the "Taiwanese doctors" were coming to Vietnam again, A-Fu's mother was filled with hope and brought her child all the way from the countryside of central Vietnam to Ho Chi Minh City in the south, in the hope that they could operate on her son again to correct his cleft lip and palate, so that he would be able to talk.

However, after carefully examining the child, Hung Kai-feng gently shook his head and said that A-Fu's chances of improvement were very slim. His enlarged meninges had compressed his brain tissue, seriously impairing his intellect, so that another operation would not help him. As soon as A-Fu's mother heard the translation of the doctor's words, her hope-filled face fell, though her arms still hugged A-Fu tightly. The worry lines on her dark thin face seemed to have been etched there by the effort of looking after A-Fu. The blow dealt to A-Fu's mother by the news that "A-Fu is very unlikely to improve" was something those present could hardly bear to witness.

What is even more unbearable is that in central Vietnam there are many more children like A-Fu who are suffering the after-effects of war. During the ten years of the Vietnam War, US forces dropped around 7500 tons of the chemical defoliant Agent Orange which seeped deep into Vietnam's soil and finally gave rise to many seriously deformed children, particularly in central Vietnam where Agent Orange was most heavily used. In Quang Tri Province alone, since the war 6000 deformed children have been born. When one adds to this the countless landmines that were laid during the war, which even today still constantly injure Vietnamese children, it is estimated that in Vietnam today there are close to 760,000 disabled children who need surgery and care.

Rough and ready

On the same day as the medical team arrived in Vietnam, to devote as much time as possible to treating patients, in the afternoon they immediately "opened for business." By prior arrangement, the HCM Orthodontic Hospital had spread the news of their impending arrival far and wide, and there were already 50 or 60 children with oral clefts waiting for treatment, having been brought by their anxious but hopeful parents.

The long line of people waiting in the hospital was a remarkable sight. Among the children who appeared there, some had no upper lip at all, so that their two front teeth were exposed; some had "hemifacial microsomia" (underdevelopment of one side of the face)-one was a pretty little girl clutching a doll in her hand, but her face was twisted to one side and she had one eye bigger than the other. Eight-month-old Nguyen Van Hoang, a little boy with big eyes and soft white skin, was born with serious bilateral clefting of both lip and palate. His whole upper lip curled upward and his front teeth stuck out through the gap, so that his parents were too embarrassed to take him out of the house. His father, a trishaw driver, only earns NT$50-80 a day, but in Vietnam an operation to correct oral cleft costs around NT$220,000, which for this family is an astronomical figure.

Twenty-five-year-old Vo Van Phuong had a cleft in the center of his upper lip, with one large incisor sticking out through it. For fear of being made fun of he never went to school, although his six brothers and sisters all did. Due to his severe cleft palate his speech was also indistinct, making it difficult for him to communicate with others. He quietly worked hard as a mason, hoping that one day he could save enough money for reconstructive surgery. But in Vietnam this is a far off dream.

The war not only left Vietnam with countless deformed children, but also greatly hindered its economic development. Today its national income per capita is only US$600, less than one-tenth of that in Taiwan, and the state is unable to provide sufficient medical resources and personnel to treat so many patients.

For example, in Taiwanese hospitals air-conditioning is considered basic equipment, but in Vietnam, where temperatures may rise to 40 oC in the height of summer, hospitals do not have air-conditioning, and a dozen patients may be crowded together in one room. One can often even see two patients having to share the same bed, while patients' relatives can only put down a straw mat and sleep on the floor.

"How can patients get better in wards like that?" Team member Chen Min-hui, an anesthesiology nurse from Kaohsiung CGMH, is distressed at the conditions that patients in Vietnamese hospitals have to endure. The operating theaters there also lack instruments such as electrocardiographs to monitor patients' heartbeat or oximeters to monitor blood oxygen levels. Anesthetist Kao Yi-chuen of Linkou CGMH says that under these conditions, it is impossible to have advance warning of emergencies such as arrhythmia (irregular heartbeat). To ensure the quality of the treatment they give, each time the Taiwanese medical teams have visited Vietnam they have taken their own electrocardiographs and other equipment with them.

Volunteering instigator

The capital of Vietnam is Hanoi in the north, but Ho Chi Minh City (formerly Saigon) in the south of the country is Vietnam's most economically vibrant city. The flow of people and vehicles in the streets is reminiscent of Taipei 30 to 40 years ago. The streets are filled with motorcycles and the dust raised by the traffic, and there are many food stands with low tables and stools selling Vietnamese rice noodles, sandwiches made with French bread, or iced coffee. Vietnam was once colonized by the French, and the architecture and food show signs of a strong French influence. Ho Chi Minh City has many boulevards that run as straight as a ruler and are lined with tall plane trees, earning the city the name of "Little Paris."

If you want to find somebody who knows Ho Chi Minh City like the back of his hand, you need look no further than Dr. Hung Kai-feng of Linkou CGMH. Hung knows his way around the city's streets even better than the local minders, for he was the "instigator" of the volunteer teams' work in Vietnam, and has taken part in every trip.

Ten years ago, during his training in the USA, Hung joined volunteer medical teams going to Central and South America, and after returning to Taiwan he constantly looked for further opportunities to work as a volunteer. Five years ago, with introductions from the Noordhoff Craniofacial Foundation, he went abroad to help the foundation make its first evaluation of the feasibility of providing an overseas medical assistance program, and the first stop was in Vietnam. Since then, Hung Kai-feng has traveled to Vietnam at his own expense with each of the NCF teams, and has even dug deeper into his pockets to pay nurses' travel expenses too. Plastic surgeon Huang Hui-fen of Kaohsiung CGMH has also joined every team that has gone to Vietnam.

If you ask them why they are prepared to give up their hard-earned holidays to come to oppressively hot Vietnam and do nothing but work, they will tell you that the answer is to be found in the body language of and smiling faces of their patients.

On the second day of the team's visit, Huang Hui-fen did her rounds of the wards to see the children who had been operated on the previous day. One mother took out a photograph of her child from before the operation and put it next to her child's face, to show the doctor her joy, excitement and gratitude. Because she could not speak the doctor's language, she used exaggerated gestures to say: "See how pretty my baby is now! Thank you!" At this time, there was no need for words. "That feeling is worth more than any material gain," says Huang with a smile.

Taiwanese medical personnel are full of compassion. The number of CGMH nurses volunteering to go overseas is constantly increasing, so that competition to join the medical teams is intense and participants are chosen by drawing lots.

A businessman's quiet contribution

The Noordhoff Craniofacial Foundation began its international assistance efforts in 1998, and to date has sent teams to four countries, where they have repaired oral clefts for over 600 children from poor families. In all of this, the first person to pull strings behind the scenes was Taiwanese businessman Hsien Wen-chu.

Six years ago Hsien Wen-chu, a long-time resident in Vietnam, saw a report about the NCF in a Vietnamese Chinese-language newspaper. Hsien had long felt great concern for the many children in Vietnam with oral clefts. Most Vietnamese families cannot afford the high cost of treatment, and the quality of reconstructive surgery there is not as good as in Taiwan. So he thought it would be a good idea to invite NCF volunteers to Vietnam to give treatment free of charge.

Full of enthusiasm for this plan, Hsien Wen-chu specially returned to Taiwan to visit NCF executive director Rebecca Wang, but the response he received was a disheartening one. Wang said that because at the time there was an intense public debate going in Taiwan about the need for charities to use funds for the purpose for which they had been donated, and donors to the NCF had not explicitly stated that their donations were to be used for overseas assistance, the foundation had to be cautious in how it used its funds. "Are you kidding?" retorted Hsien Wen-chu, so dumbfounded that he threw courtesy to the winds. "Charity should be applied where it's needed most-why restrict it to a particular geographical area? What's more, sending medical volunteers overseas doesn't just help poor children. Isn't it also an excellent form of people-to-people diplomacy?" But although Wang agreed with this point of view, she could not make any promises at the time, and Hsien went away disappointed.

However, only a few months after Hsien Wen-chu returned to Vietnam, Rebecca Wang contacted him and said that the NCF had decided to send people to check out local conditions and evaluate the possibility of a volunteer assistance program. Hsien was overjoyed, and to let the foundation know how much importance he attached to this matter, he used his contacts to enlist Vietnamese VIPs such as former Ho Chi Minh City mayor Nguyen Vinh Nghiep, who founded the HCM Sponsor Association for Poor Patients, and Mme. Nguyen Van Linh, widow of Nguyen Van Linh, the late secretary-general of the Communist Party of Vietnam, to receive the NCF representatives in person, and arranged for them to visit hospitals. Thus the assistance program finally came into being.

For the past several years, every time an NCF team has gone to Vietnam, Hsien Wen-chu has liased for them and arranged the food, lodging, transport and interpreting, often abandoning his work at his own businesses-a metalworking factory and a restaurant-to accompany the teams wherever they go. But not content with assisting in this way himself, Hsien has also roped in many friends from the Taiwanese business community in Vietnam. For instance, for this fourth visit by the medical team, a shoe manufacturer, the Pou Chen Group, donated VND500,000 (around NT$1100) per patient for pharmaceuticals, while Tung Chia International Co. Ltd. stumped up VND300,000 (around NT$660) per patient for travel expenses. Hsien Wen-chu says that although these donations are not big money for Taiwanese businesses, they bring real benefit to many people, and have the added advantage of enhancing the image of Taiwanese businesses in Vietnam.

Spreading love far and wide

Since the first volunteer team traveled to Vietnam in March 1998, the NCF has sent 19 missions abroad: four to Vietnam, eight to Cambodia, seven to the Philippines and one to mainland China. In total, they have given back smiling faces to well over 600 children.

"But," says NCF executive director Rebecca Wang, "you have to treat the disease as well as the symptoms." The ultimate goal of the medical assistance program is "not only to give them fish, but also to teach them how to catch fish for themselves." The foundation hopes that doctors in the regions it assists can also learn to perform first-rate reconstructive and orthodontic surgery themselves, so that they no longer need to rely on overseas aid. This is why wherever the NCF goes, it seeks out hospitals that are willing to engage in long-term collaboration, and as well as sending doctors and nurses from Taiwan to perform surgery and pass on their medical skills, it also funds medical personnel from the other countries to come to Taiwan for further training.

Over the last few years, 20 surgeons, anesthetists and nurses from Vietnam, Cambodia, the Philippines and mainland China have come to train in Taiwan; and in April last year Filipino doctors who had trained here set up a specialist craniofacial center on Mindanao to treat their own compatriots.

Rebecca Wang says that an even greater vision for this international program is the hope that within the next ten years the NCF can assist partner countries in setting up 50 craniofacial centers, and that this will create a virtuous cycle in which, in ten to 20 years' time, these countries will not only be able to stand on their own two feet, but will have the ability to assist children in yet other countries, passing on the love that began in Taiwan.

(text and photos by Pan Yen-fei/tr. by Robert Taylor)

p.16

"Cleft lip and cleft palate surgery only takes an hour, but it can change someone's entire life." The Noordhoff Craniofacial Foundation uses ads like these to solicit ever-more funding from people in Taiwan in order to provide free cleft lip and palate surgery in developing countries. (courtesy of the NCF)

p.19

Samuel Noordhoff, the founder of the Noordhoff Craniofacial Foundation, hails from the US, but has dedicated his life to Taiwan. With the spirit of a missionary, he has inspired many in Taiwan to bea more concerned with providing medical aid overseas. (courtesy of the NCF)

p.20

This child from Cambodia (first left) was quite shy before undergoing cleft lip and palate surgery thanks to the Noordhoff Craniofacial Foundation, but now happily goes to school each day. He tells neighbors, "The spirits fixed my mouth while I was sleeping." (courtesy of the NCF)