When Citibank transferred Bradley LaLonde to Vietnam, the general manager felt a twinge in his stomach: Where would his young son, who has cerebral palsy, get treatment? Within days of his arrival, LaLonde found himself at a rundown children's hospital in Hanoi, where braces were made of bamboo and equipment was broken.
But a dynamic rehabilitation doctor with a vision to improve care for disabled children impressed LaLonde. It struck the American businessman that the hospital was a primitive version of Baltimore's Kennedy Krieger Institute, where his 6-year-old son Phillip is treated.
Ultimately, the encounter set in motion an unusual partnership between the two institutions that has flourished and is now doubling in scope, even as many American business ventures have struggled since the restoration of diplomatic ties.
Kennedy Krieger staff members have trained dozens of Vietnamese therapists and physicians to care for disabled children, particularly those with cerebral palsy. Eventually, their work may make it possible for the children to attend school, and even to track down why so many in this corner of Southeast Asia have cerebral palsy.
"What was the likelihood that a Citibank official in Hanoi would have a Kennedy Krieger-treated child, that would lead to this?" marveled Wendy Batson, director of humanitarian affairs for the Vietnam Veterans of America Foundation, a Washington-based agency that raises money to deal with the causes and consequences of war.
The group got matching grant money from the U.S. Agency for International Development, which, along with Citibank and Kennedy Krieger, has helped fund the $200,000 collaboration.
Now, everyone involved calls it "Phillip's Project."
The LaLondes, who are from Michigan, returned to Kennedy Krieger last week so Phillip could get fitted for a new wheelchair. His lifelong condition causes a variety of motor impairments.
Rocking Phillip and teasing his lips with her finger, his mother, Maribel, coaxed an infectious smile out of her son, who can barely see and has cognitive problems. Later, he fell asleep in his denim shorts and button-down shirt.
"Phillip has no idea how much of an international influence he's been," said Dr. Gary W. Goldstein, president of Kennedy Krieger.
Disability is a strong presence in Vietnam. Of the country's approximately 70 million residents, U.S. experts estimate that 5 percent to 7 percent are disabled.
The fallout of war
In many ways, the Vietnam War of the 1960s and early '70s, and its fallout, are to blame. Land mines still maim. Aid workers say areas that were heavily bombed now have high rates of birth defects, sterility and mental retardation. Trade embargoes, lifted now, prevented children from getting immunizations, and many are left with the scars of polio. Malnutrition and poverty also play a role.
But in Vietnam, disability is still considered a taboo, and without access to technology and textbooks, physicians don't know what the best care is. One book can cost a year's salary. The Hanoi hospital, the Institute for the Protection of Children's Health, is fighting Vietnam's political hierarchy to obtain a link to the Internet.
When they first arrived in Vietnam more than two years ago, Phillip's mother tried futilely to explain to a worker that her son needed to be in a certain position while eating so that he wouldn't choke. But when Kennedy Krieger's team of six specialists -- including a neuropsychologist, physical therapist and social worker -- arrived in November 1995 and explained it, the worker finally believed it.
"I could see the expression on her face changing," said Maribel LaLonde.
During that initial visit, the team found undernourished children whose slumped posture made it difficult for them to eat. They found children forced to stay at home because they had no way to get around.
The Baltimore group used local materials -- plywood and foam rubber -- to show their Vietnamese counterparts how to fashion seats that would hold the children upright, said Dr. James R. Christensen, Kennedy Krieger's director of rehabilitation.
They figured out a way to adapt the seats of the bicycles that families use for transportation. They explained how crucial it is to work on the posture of children with cerebral palsy, to prevent orthopedic deformities and allow organs to develop correctly.
As part of this first phase, which cost about $75,000, two Vietnamese therapists trained at Kennedy Krieger for three months, learning firsthand the institute's comprehensive approach. Instead of focusing solely on obtaining a brace for a child, for example, the Vietnamese now assess overall needs, checking for malnutrition or other health problems that might keep the child from effectively using a brace.
Aid and obstacles