Italian surgeons perform genital surgeries for Vietnamese kids

Italian doctor back in Vietnam to help children with genital loss

Thanh Thien Newspaper: Sunday, November 11, 2012 11:25:00

Dr. Roberto DeCastro is returning to Vietnam to examine patients suffering from genital loss.

An Italian doctor known for successful genital reconstruction surgeries worldwide, including one high-profile case in Vietnam, is returning the country to prepare for more surgeries.
The Da Nang Obstetrics and Children’s Hospital said the Asia Injury Prevention Foundation in Vietnam, which has funded several operations so far, has signed a contract with the hospital to help children in the central region, news website VnExpress reported.
Dr. Roberto DeCastro will visit the hospital on November 15 to examine 11 children suffering from genital loss and will return next year to treat them, as well as examine more children.
He will work for free, as he did before, while his travel and stay is covered by the charity group.
But the patients will have to cover their own hospital bills. Expenses for insurance holders are covered by the state budget and the charity group said it would help poor families with part of the money.
A similar surgery in Italy costs at least $50,000, which can cover the cost of roughly 30 surgeries in Vietnam.
Genital loss is caused by traumatic injury, penile agenesis, sexual development disorders, congenital defects, micropenis, or botched circumcisions due to surgical complications or infection.
Young girls usually suffer from trauma of the perineum involving the vagina and urethra, or congenital effects such as the total absence of a vagina.
They will need two or three phalloplasty sessions every six months.
DeCastro has performed 31 phalloplasties on children around the world over the past eight years using a patient’s lower abdomen to create genitals that continue to develop as the child grows.
He first came to Vietnam in August 2010 to examine some 110 children before performing the first surgeries in November last year with Vietnamese-American doctor Tue Dinh of the Institute for Reconstructive Surgery in Texas, US, and Emilio Merlini—an Italian colleague.

During his most recent visit last June, DeCastro followed up with his former patients, 15 of whom are fine and 11 of whom need further surgeries.
The surgeries were initiated thanks to Tran Mai Anh, the representative of the program in Hanoi, who had convinced doctors and philanthropists to help her adopted son.
Thien Nhan, now six, made national headlines when he was found abandoned three days after his birth in a mountainous region of Quang Nam Province in central Vietnam. Animals had devored his genitals and his right leg.
Anh heard about the boy on TV, decided to adopt him and then brought him to the US, Singapore, Thailand and Europe seeking treatment until meeting Greig Craft, director of Asia Injury Prevention Foundation, and then Dr. Dinh who informed her about DeCastro.
The Italian doctor operated on the boy in Italy in 2010 and 2011, and then again in Hanoi last June.
The surgeries were successful and many parents have called Anh asking if she could help them, she said.
Anh and the group who helped her son have received around 1,000 requests for help from parents.
The Italian doctor wants to teach the phalloplasty procedure to his Vietnamese counterparts so they can treat more children in the country.

Happy Holidays!

We hope that you all had a merry Christmas and wish you all the best in 2012!

A good outcome

Thien Nhan is getting "back on his foot" following his latest round of surgeryin Hanoi. The 5-year-old is healing well and is in good spirits.

All of the 31 other boys who underwent genital surgery at the Hanoi Paediatrics Hospital have also returned home to their families. The all-volunteer surgical team, which included Italian, American and Vietnamese specialists, were pleased with the outcomes of all 32 operations.

Fundraising is now underway to raise money for another 60+ Vietnamese boys to receive surgery to repair or rebuild damaged or malformed genitals.

Thien Nhan Recovering

Thien Nhan's latest surgery at the Hanoi National Pediatric Hospital went well, although he remains in considerable pain and is having trouble sleeping. "He doesn't complain but I hear him crying quietly at night," says his mum, Mai Anh. "The first days are the worst."

Two days ago Thien Nhan, now 5, underwent his third surgery to repair his genitals, which were badly damaged when he was abandoned at birth in the jungle near Danang and mauled by wild animals. His first two surgeries were performed in the US and in Italy.

It is expected that Thien Nhan will require two more surgeries, plus lifelong hormone replacement therapy to help him to mature normally. He is a bright, active and very determined little boy, who loves video games, cake and playing with his brothers.

Thien Nhan's big dream is to get a high-tech, "robot" prosthetic limb that will allow him to walk and run. Due to his very short leg-stump, previous prosthetics have proven unusable. He moves around by hopping on his left leg, which is hard as steel.

Thien Nhan Ready for Surgery

Thien Nhan is in hospital in Hanoi, ready for surgery today. Dr. DeCastro, the Italian surgeon who performed Thien Nhan's genital reconstruction last year, will perform a procedure to enlarge the skin around the boy's groin, so that prosthetic testicles can be put in place during a follow-up surgery next year. Today's procedure is expected to take around four hours.

"Thien Nhan is worried about this surgery," admitted his mom, Mai Anh, yesterday. "He remembers how much the last surgery hurt and is tired. Nobody likes being in hospital. We all feel worried and tired." Thien Nhan turned five last July. He won fans around the world after he miraculously survived being dumped in the jungle in Central Vietnam at birth and horrifically mauled by wild animals.

This November, Dr. DeCastro and a team of Italian and Vietnamese specialists will perform surgeries on 32 little boys with genital deformities in Hanoi. Because everyone involved in this amazing endeavour is volunteering their time, these procedures will cost an average of just US$1,500 per child. These life-changing surgeries were organized by American philanthropist Greig Craft, a longtime resident in Vietnam.

WHERE TO DONATE

At the end of October, three Italian specialists in genital reconstruction will travel to Vietnam to perform genital surgery on 32 little boys. Thanks to these surgeons, who are waiving their fees, and other volunteers, these difficult procedures will cost just $1,500 per child.

While this is an extraordinarily great deal, it still adds up to US$50,000 for the first set of 32 little boys. Another 63 boys are on a waiting list for future surgeries. We are desperate for donations to ensure that as many kids as possible can undergo this life-changing surgery. If you are able to support this worthy cause, funds can be sent to these bank accounts:

Account name: Tran Mai Anh & Greig Craft for Thien Nhan surgery

Account number: 5690849

ANZ Bank - 14 Ly Thai To, Hanoi

Bank name: Citibank N.A, HCMC Branch

Address: 115 Nguyen Hue Blvd, Dist 1, HCMC

A/c name: Asia Injury Prevention Foundation

A/c #: 0-300411-002 (USD)

0-300411-029 (VND)

Please write "DONATION FOR DR.DECASTRO GENITAL SURGERY" in the subject line.

Thank you!

Medical Mission: 95 Kids in Need

Since Thien Nhan's first round of phalloplasty surgery, we've been inundated by requests for help from dozens of other families in Vietnam whose sons are suffering from malformations or traumatic loss of their genitals. In light of all that we have learned and experienced in the past five years, I feel a strong moral obligation to "give back" to others.

Thien Nhan has experienced complications and will require two more genital surgeries. In light of the prohibitive costs, we invited the Italian specialist, Dr. DeCastro, to come to Vietnam - and he generously agreed. In three weeks' time Dr. DeCastro will perform surgeries in Hanoi on 32 young patients - including Thien Nhan, at a cost of $1,500 per sugery. Fantastic!

This was a difficult decision for us, because it involves limiting the funds that could be given to Thien Nhan, who still has many unmet needs, including a working prosthetic limb, physio and educational costs. We hope that Thien Nhan's champions will continue to support him. That said, we also hope to find more donors to help other kids facing similar hardships. There are 95 children in Vietnam awaiting this surgery. Within the next nine months they could ALL receive this life-changing surgery - if we can find funding.

If you can help, please email me at gcraft001@gmail.com


Sincerely yours,

Greig Craft

Progress report

Thien Nhan continues to heal from his operation last February, at which time he underwent major reconstructive surgery on his genitals. His dressings must still be changed three times a day, and he is not back at school yet.

"He is stressed," says the boy's mother, Mai Anh. "He just wants to go back to school and get back to his normal life. A few days ago I heard him crying under the blankets late at night. He said that nothing was wrong. But later he told his big brother that he is scared that something will go wrong with the surgery."

Thien Nhan will turn five in July. All being well, he can go back to school after the summer holidays.

Progress Report

While Thien Nhan is doing well, he's not healing from his genital reconstruction quite as quickly as the doctors in Italy had hoped. "The dressings have to be changed three times a day," reports his mom, Mai Anh. "I take him to the hospital here a few times a week for check-ups, and we also send photos to the Italian doctors regularly to be sure that everything is OK."

Hanoi's humid weather may be to blame for the slow healing process. Or the delay could be caused by wear and tear, since Thien Nhan gets around by jumping on one leg and this puts additional strain on his groin.

"In general he's doing fine," says Mai Anh. "We are very happy that the surgery is behind us."

Thien Nhan Video

Click on the title to see a video of Thien Nhan, taken nine hours after he got out of surgery. He continues to heal well and is looking forward to returning to Hanoi to play with his cousins and his 5-year-old brother, Little Minh.

Good boy

Thien Nhan continues to recover well. "He is being such a good and brave little boy," says his mum, Mai Anh. "But of course he misses home and wants to see his brother, Little Minh, and to be able to get up and play normally."

Today, Thien Nhan is meeting prosthetic experts from a nearby prosthetic center in Bologne. "I hope that they'll be able to find a good solution for him," says Mai Anh. Because the stump of Thien Nhan's right leg is very short, to date, it has proven impossible to attach a prosthetic limb that has enough stability to allow him to walk comfortably.

"After his genitals heal, my next big goal is to help find a way for him to walk," says Mai Anh.

Family Support

"Thien Nhan is able to sit up and is eating well," reports his mum, Mai Anh. Indeed, the 4-year-old is recovering so well that his doctors may allow him to check out early and fly home to Vietnam. "We hope to go home this coming weekend," says Mai Anh. This is good news for Thien Nhan's brother Little Minh, 5, who is back in Hanoi, where he misses his brothers and his mum.

An early return to Asia would also be good news for Thien Nhan's godparents, Greig Craft and Na Huong, who organized this child's life-changing medical mission and accompanied him to Italy. Over the years, Greig and Na Huong have repeatedly taken time off from their demanding jobs in Hanoi to organize and accompany Thien Nhan on trips to see specialists in the USA, Germany, Thailand, and now Italy. All of these journeys have been made at their own expense, and caused considerable disruptions to their busy schedules.

While Thien Nhan had a rough start in life, he is lucky to have found such fantastic godparents!

[Photo shows Greig Craft and Big Minh comforting Thien Nhan.]

Recovering

Thien Nhan spent two days in Intensive Care, but is now recovering well. He is in pain, but his discomfort is being managed with medication. A risk of complications remain, especially pulmonary issues, as fluid can easily accumulate in the lungs of youngsters of Thien Nhan's age post-surgery.

As advised before the surgery, an additional urological surgery will be required in 6 to 9 months. But the goal of this surgery - to rebuild the boy's genitals - seems to be an outstanding success.

"Without going into graphic detail, suffice it to say that he looks 100% normal," says Greig Craft, the American philanthropist who, over the past 4 years, has been instrumental in organizing Thien Nhan's medical care. "Because the revolutionary technique of Dr. De Castro involves creating a penis from the pubic area, where flaps are cut from the side and formed to create a natural-looking, age-appropriate and functioning penis, the end result is stunning. Because this is from his body it will grow with him through puberty, as would his original penis."

The child's scrotum was also rebuilt, and a prosthetic testicle inserted. When he gets bigger, another testicle will be added.

[Photo shows the surgeon who led Thien Nhan's reconstructive surgery, Dr. De Castro, changing the boy's bandages.]

Then and Now

Four years ago, shortly after birth, Thien Nhan was abandoned on the edge of a forest in Central Vietnam. He lay in the open for three days and was badly mauled by wild animals. Found by passerby, the horrifically injured baby was transported 2.5 hours by motorbike to the nearest hospital, where doctors performed life-saving surgery. Unfortunately, the child's right leg was lost and his genitals were badly damaged.

Last week, Thien Nhan, now 4, underwent another life-changing surgery in Bologne, Italy. Surgeons worked for more than 8 hours to rebuild the boy's penis and insert prosthetic testes. "The surgeons say everything went well and he is recovering," reports Thien Nhan's relieved mum, Mai Anh. Full recovery is expected to take three months.

[Top left photo: Thien Nhan recovering from surgery in Bologne, Italy. Top right photo: Thien Nhan in Intensive Care as a newborn in Central Vietnam.]

Best Big Brother

While Thien Nhan's recovery seems to be progressing smoothly, he remains in considerable pain and is on strong medication. Whenever the 4-year-old wakes up, he immediately looks for his beloved brother, Big Minh.

Here, Big Minh is helping Thien Nhan to get a drink of water.

Good news

After about eight hours in surgery, Thien Nhan, 4, is recovering well. The surgeons are confident that the procedure to insert prosthetic testicles, extract the child's penis from beneath a covering of skin, and extend it was a success.

"His penis will be normal size for his age and look normal in about three months," said Thien Nhan's mum, Mai Anh. "It should be able to grow with him and have sensation."

Obviously, it had been a long day for Mai Anh, who was very relieved that the surgery was a success. Speaking at around midnight last night (Vietnam time), she said: "Thien Nhan is still groggy. When he woke up from the surgery his eyes were full of tears. He saw me there and he said: 'I didn't cry, Mummy. It doesn't hurt so don't worry. 'Since then, he's woken up a few more times and told me that he didn't cry."

Thien Nhan must remain in hospital in Bologne Italy for another two to three weeks, to recover from this major procedure.

Off to the OR

Thien Nhan will be wheeled into the operating room in 30 minutes' time. "I couldn't sleep last night," admits Thien Nhan's mum, Mai Anh. "But Thien Nhan is okay.

Last night, before going to bed, Thien Nhan met the doctors. "He asked them if they would cut his body from the neck down and whether or not there would be a lot of blood," reports Mai Anh. "When they told him that the incision would be small, he felt much better. He woke up at 5.45am and the first thing that he did this morning was to reconfirm that the incision would be small."

The surgery to insert prosthetic testicles and reconstruct Thien Nhan's penis is expected to take around eight hours.

[Photo shows Thien Nhan, 4, and his brother, Big Minh, in the hospital waiting room.]

Waiting...

Yesterday, Thien Nhan underwent four hours of medical tests and was declared healthy enough to undergo surgery tomorrow. The operation will start at 2pm Vietnam-time on Saturday January 29th. The surgery is expected to take around eight hours.

"Today we will rest around the hotel," says Thien Nhan's mum, Mai Anh, who admits that waiting is tough.

"Thien Nhan knows that the operation will hurt and be bloody," says Mai Anh. "But he told his brother Big Minh that he isn't scared. He said that everything will be fine and he'll have a penis like his other brother Little Minh's."

Hungry

When Thien Nhan, his mum and brother arrived at their hotel in Bologne in the middle of the night, there was nothing to eat. "Go to sleep now and we'll eat in the morning," said Thien Nhan's mum, Mai Anh.

Unfortunately, in the morning Mai Anh learned that Thien Nhan wasn't allowed to eat until after he'd had some medical tests.

"Mum, I'm so hungry," said Thien Nhan.

"I know love," said Mai Anh. "I'm so sorry but you must wait. I'm hungry too."

"So why don't you have some bread?" said Thien Nhan.

"No," said Mai Anh. "When you can eat, I'll eat too."

"You should have some bread."

"But you're not allowed to eat yet."

"Go on, Mum. Eat something now. I'll eat after I've had my check up," said Thien Nhan.

Mai Anh was so proud of her brave little boy, and so touched by his concern for her.

[Photo shows a tired and hungry Thien Nhan waiting to see specialists.]

At the Hospital

After a long trip, Thien Nhan arrived safely in Bologne, Italy. "He was a good boy on the flight and ate and slept well," says his mum, Mai Anh. "We are all tired but happy to be here."

This morning, Thien Nhan will see doctors for a pre-surgery consultation. The surgeon needs to be sure that he is healthy enough to withstand such a lengthy and difficult operation.