Feb 2009

Our month in Vinh truly was worthwhile. It was great to be immersed in a health care system tootally different from the one in which I have trained so far. Everything was such a memorable experience: from talking with the doctors in broken medical English to examining so many kids with pathologies that we rarely see in the U.S. because of the access to so much care back home. I also fell that the asthma survey will wind up doing much good. We had a final day meeting with the hospital director and we gave him suggestions as to how to implement a program to educate both children and parents about asthma. It was an incredible learning experience and I hope to return one day when my medical knowledge is so much better than it is now, and maybe my Vietnamese will be slightly better also.
An awesome experience and Kelli and I hope to set up a pipeline to Vinh for Tulane students to come every year or so. We would highly recommend it.
The country is amazing and the kindness, hospitality and generosity of the Vietnamese people is truly humbling. This has so far been a trip that will forever be on my mind and as soon as I return home, I will be trying to figure out when I can come back.

I know we have been MIA for the last two days, but it's only because our days have been jammed packed with fun. Our last day in Vinh went by so quickly. We went to the hospital, said bye to many cute kids and to most of the staff. Although many of them said "see you again soon" so I am not sure if they understood that we were leaving for good, or if they were just being optimistic for our return soon. Either way, it made the good bye easier. Conrad and I definitely would love to return to Vinh sometime in the future, whether it is to work in the hospital again (which we both would definitely do) or just stop bye and say hello to our friends. We had an excellent visit here and made so many memories. It was very sad to leave them all, especially when they said how much they would miss us. They stuffed us full of yummy food over the last few days, gave us some delicious candy from the region as a thank you, and gave me some (regifted and moldy...) flowers to say thanks. It's the thought that counts!

On our last day we sadly did not give English lecture. Everyone was too busy, since it was also national health professionals day (thanks to Uncle Ho who started the holiday in the 50s). Instead, we met with the medical director and vice medical director to talk about our month at the hospital. It was an excellent meeting. I thought it would be a few mins long since they dont speak English and our french is basic, but we had two of hospital friends as translators, and it was a really productive and optimistic meeting. They wanted to know how we enjoyed the hospital, Vinh and the doctors. They asked for our advice on improving health care at the hospital and within the local communities. They asked about asthma and future directions they can go to fight it in the community (of course I went on to several tangents about the role of public health, education and preventative medicine...). They asked about other possible projects medical students could do in the future. They asked about ways they can improve English skills among doctors. They truly just want to be better at everything, and their dedication will prove them far into the future, I hope. At the end of the meeting the medical director wanted to take us out to dinner, but it turned out we all already had fun plans, so we had to decline.

We went to an awesome dinner part with the entire Emergency department. It was an assortment of chicken with lots of beer. The table was segregated for "tradition." All the doctors (men) at one end, nurses at the other, and me at the cusp. It was great because they wanted me to drink beer with the men and cheers with them too, but since I was also a girl and on the cusp, I didnt have to do it all the time. Conrad had to drink with the big boys. The only bad thing was that all the nurses were talking about me, my weight and height. No idea why but they wanted to know. They were making guesses. One lady guessed I weighed 80 kilos!! I almost died. I know I am much fatter than I have ever been, but geez, 80 kilos (176 lbs!) no way. One of the nurses was right on with my weight and height, so we cheers-ed together.

Other highlights from our last day: we stopped for bia hoi at this place we always walk by en route home. it was alot of fun. One guy who worked there came up and wanted to take our order. He didnt speak any English but started off with "Sprechen sie Deutsch?" It was amazing (for me)! I got all excited! As we were leaving, some locals wanted to 100% with us, and we obliged. Also alot of fun. I think we have more than 10 pictures of us 100%-ing with people.
Also, we went down to Ho Chi Minh Square last night to celebrate national doctor day with many hospitals. More singing and dancing, and luckily we did not have to sing! Afterward, we went for coffee and this delicious frozen yogurt (it was literally a thing of breakfast yogurt that was put in a freezer). Then back to the house to crash.

Today, it was pouring and storming for a few hours. The first real rain of our whole trip. We couldnt believe it. Conrad and I were afraid the one and only flight out of Vinh (ours) would be cancelled, but luckily it stopped. One doctor and the head nurse took us to visit a war memorial 30 km outside of town today. It was in honor of 10 single women, who volunteered to rebuild the roads that were destroyed when the US bombed in the war. They were all killed with one bomb, which left a huge whole in the ground (still there today). We had an awesome lunch with our doctor friends and then were escorted in our hospital's ambulance to the airport.

Now it's on to the Mekong delta...

So we arrived back in Saigon today after our send off from Vinh. We were brought to the airport via ambulance with 3 of the doctors we worked the most with as well as Nga and her two daughters. After spending much of the week eager to get our vacation started, it was certainly with a heavy heart that we said goodbye to the people we worked with and the few people in the community we came to know (even if not linguistically) during our time in Vinh. It truly was a memorable experience, culturally and medically.
We made it to Ho Chi Minh city safely, booked our flights to Siem Reap on Tuesday, got a METERED cab (this ride cost us less than 6bucks compared to the $16 or so we spent the first day) and made it to our hotel.
Coming from the quieter much less crowded city of Vinh back to the craziness of Saigon was a small shock. But I already have a much better feel for the life of Saigon. I think our first stop a month ago was so quick and I was in shock at how much different Vietnam was from the US. While I still think Hanoi is much better, Saigon is a vibrant place that really never sleeps.
Also, THEY HAVE PEOPLE WHO LOOK LIKE ME!!! Now I don't stick out like a sore thumb, but it is kind of weird to not have people staring at you and to come across so many natives who speak English.
We then set out and booked a two day Mekong Delta Tour. We will be leaving by boat tomorrow morning and will be exploring the area around Vinh Long by bike and boat with a couple of cooking classes and a stay overnight with a local family, then an early morning visit to a floating market, which I am most excited about. It seems that it will be similar to our one day trip in Hoi An, but not quite as rustic and certainly with not as much fun company as we had with the Canadian trio. But we are excited since Vinh Long sees much fewer tourists than other towns in the delta.
Excited about our two weeks of vacation and will keep updating although we won't lilely be back online until we return from the delta on March 2.

I will try to stay as apolitical as possible here.
One of my college professors would be able to speak much more intelligently on this topic but I will do my best.
First, I must say that Vietnam's health care system is certainly not nearly an adequate model to use in comparing various systems, but as I have been working intensely within this model for the last month, it is what is most fresh in my mind.
It is also an issue that is certain to be in the news back home much more frequently as President Barack "I can do or say no wrong as long as I end my speech with 'Yes We Can'" Obama has just said he wants to spend over 700 billion on overhauling the healthcare system. Where exactly all this money he wants to spend is coming from is another story. I will say I am certainly intrigued to see the ideas that will be tossed about to improve the system we have now.
I think it is terrible that there are so many Americans with no insurance and are just an accident away from financial ruin. We certainly need to find some way to provide every citizen with affordable health care coverage, at the very least every one of our children.
So back to Vietnam health care system... After working here for the month (again keeping in mind that this is not the best model to make the conclsion I wanrt to make), I have realized some things:

1. Nothing too groundbreaking, but the quality and quantity of medical care in the U.S. is unrivalled. The superiority of the doctors, hospitals, medical education, and treatment options is the best in the world. It has really been an eye opening experience to see that, for example, in Cardiology here in Vietnam it seems that heart rhythm problems in children are for the most part ignored or not well addressed. The ECG machine here is broken and has been for four months. I have been surprised that even issues more basic than an ECG machine, such as hand washing, are not at all emphasized.

2. Governments should not be responsible for providing and paying for healthcare for everyone. I don't care if you are as rich as the US or as poor as Vietnam, politicians should not be allowed to have 100% control healthcare. I really am not sure how best to improve access to healthcare system in the US, but I will leave here with a stronger belief that a completely nationalized, government-run system is not the way to go.

3. After getting another onslaught of completed asthma surveys this morning, we finished them all off! Huge relief would be even bigger if we didn't have to do preliminary data analysis on over 1200 kids. We should definitely have some interesting and useful results, but this week has confirmed why I hate research stuff. It just bores me (unless of course it's Cardiology related)

I am happy to report that we have finally finished logging all of our school survey data into excel. We thought we would be done very early this morning, but of course we got another 100 or so to do. A total of 1200 students' information! And now the fun part...tallying and doing some basic statistical analysis. That's what we are going to try and tackle tonight, so that we don't have to spend our last day in the hospital doing statistics. We would much rather see some adorable kids ;-) Who wouldn't, right?!

Today we did mostly data entry, but got to work clinic for an hour or so. A lot of rashes among other things. It amazes me still how different our countries practice basic pediatric care. The whole "common things are common" is the guideline they use here. Anyone who has cruddy sounding lungs MUST have pneumonia and MUST need a cephalosporin. Every kid with a rash for longer than a month must be allergic (so we observed today). That's just the way it goes. They order the tests they can, and they don't order the tests that are out of the realm of the possibility. In saying this, I mean, they really will order every test they can for something, even if it has NO BEARING on their management. They love their CRP and ESR, which I know alot of people in the States do too, but I am not one of these people. I just find such little use in them. Sure they can notify you of inflammation, but more times than not, they are just some moderate number and it doesnt help me or hurt me to know this. Here, they do it all the time. For example, a kid with pneumonia today (this girl really did have pneumonia, I think). Get a chest x-ray and CBC, but why a CRP or ESR? If the chest x-ray looks bad you are going to treat. If the CBC shows high WBC, you are going to treat. If these are fine, but a CRP or ESR are mildly elevated, then what? I know, I know, I know, I am not a doctor yet. But after my Finger-upbringing where you better have a reason for doing everything you do, working in the clinic here is a challenge at times. Especially when the doctors look to us for alot of guidance it seems (often times on rounds they ask us - so what is your diagnosis? what should we do?). It's scary at times. Especially when they want us to change the vent settings or read the CT scans because they have little to know experience in doing so. I think they forget that we are still students...

Today we also had a ~13 yo male patient that experiences chest tightness towards the end of swimming and for 5-10 minutes afterward. I was thinking exercise-induced asthma, since I had many swimmer patients on my away rotation at Pittsburgh with the exact same complaint. I suggested to the doctor that maybe it was asthma, and he first said "I don't think." I asked him why not, and he told me to listen to the lungs. I did and of course they were clear (he wasn't exerting himself at all, just sitting on the bed). I think the doctor thought the kid should wheeze if he had asthma. I explained to him that often times kids with exercise induced asthma will only sound bad during and after exercise. Then he asked me if they should get a chest x-ray. The kid also had a HR of about 96, so in the end he decided to order only an EKG, which has to be done at another hospital since our hospital's EKG machine is broken.

One thing I have observed and really find value in is that the doctors very common prescribe vitamins or other supplementation to their kids. So every kids with pneumonia also gets a multivitamin (which by the way also include Taurine! yes the same taurine that is a big ingredient in red bull), every abdominal pain kid gets lactobacillus, every dermatitis kid gets vitamin C and E. I was thinking this may have to do with the fact that Vietnamese people really only seek medical attention when they are really ill, so maybe the doctors are grasping every opportunity they can to boost up these kids. Whatever the reason, I am okay with it. Especially since this country doesn't acknowledge the concept of preventative medicine to any significant degree.

On a happy note, the last kid we saw in clinic today was the most adorable thing ever. Maybe 15 months, and he was just smiling and giggling with his big cheeks. It was great!

After borrowing a doctor's laptop to do more data entry from our hotel last night, we thought we would finish all the surveys today. But then we got a reqest to work with one of the PM&R doctors in clinic this morning, and while in clinic the head respiratory docto delivered us another 250ish surveys. MORE! So we didn't go back to our hotel at lunch and instead did more data entry. Looks like it will continue all night, tomorrow (since we already committed a halfday to working with the cardiologist in his clinic tomorrow), and maybe Friday.

Fortunately/unfortunately for me I finished my last book last night (which had a lame ending by the way). Now I have nothing to distract me from more data entry...

Unfortunately I also have nothing to read on the 3 hr flight back to Ho Chi Minh City on Saturday either. Bummer.
-Kelli

The russian roulette game that is eating in Vietnam without knowing the language continues. Last night we decided to try a place that had Bun Hue, a noodle dish that we thought just had pork in it. So as Kelli is watching the lady make our meal, she sees her pour some unidentifiable meats into the stew. When we get our bowls there is much more than noodles and beef in them. Kelli quickly throws some sort of pate looking thing from her bowl into mine. After looking at the off white slices with unidentifiable clear chinks in them I decided it reminded me of geology, as they closely resembled sandstone. I took a bite, not gross but not terribly tasty. I have no idea what it is. The next meat object was a pork rib. Not too tasty, very tough. Then I picked up what looked like liver. I gave it a bite, not as bad as I was expecting but a weird smooth, greasy texture. So I left the rest of the "liver" and ate all the noodles and the broth.
This morning on the way to work, for some reason, I remebered reading in a book that Bun Hue is a popular dish that usually has beef and coagulated blood cubes. So yes, I am pretty sure what I ate was not liver...

Some of you may know how much I dislike people telling me I look tired. I know they really don't mean anything by it, but I always feel like it means 1) I look like crap 2) I should take better care of myself 3) maybe I look bored or disinterested. Maybe they just say that because normally I am a bubbly, energetic person who smiles alot, and to stray from this norm must mean I am tired.

Maybe it's none of those things, but they always cross my mind. Anyway, it has been a trend since maybe last Thursday for one or two doctors or nurses to tell me I look tired. I have been getting considerably less sleep lately (due to a variety of loud noises-domestic disputes, heavy construction, and maybe a kid seizing or shouting in pain-inside our hotel). Additionally, we have just been working a lot. Last week we had to help the cardiologist translate a 52-slide powerpoint into English for his uncle who was going to Ha Noi to present it. We ended up staying at the hospital until 9pm or so that night. This past weekend I got alot of sleep and felt well rested, and the last two days we have been working non-stop with data entry (even skipping our afternoon lunch/reading/internet-ing break to do more data entry).

Anyway, I do feel completely exhausted. Today I didnt even want to make the 10 minute walk back from the hospital to the hotel. I think I am just ready to be on a real vacation. Lucky for us, it starts this Saturday! I just hope I can muster the energy to get me there without too many people making me feel bad for "looking tired."
-Kelli

Monday we got about 500 asthma surveys back from one of the schools. I was very impressed with the response rate of the survey. I figured more kids would "forget" to give it to their parents or just forget to bring it back in. With so many surveys, Conrad and I started furiously entering all the data into excel. Each survey has about 15-20 things for us to report (name, age, wt, ht, asthma sx in the last year and last month, ER visits, other allergic reactions, symptomatic triggers, etc etc etc), and with all those surveys we have ALOT of work to do. Oh and mind you, the surveys are all in vietnamese, and sometimes people don't check the boxes but just write whatever they want in the margin. So it's very time consuming and will continue to be this whole week. Especially since today we got another 250 from the same school.

In addition to the asthma data entry, we are also finishing up the infection control and hand hygiene part of our project. Yesterday we went to 7 of the wards to find out how many patients, parents and beds were in each room. Also to see if there was hand sanitizer or a sink w/soap (which there is not in any of the patient rooms, just one sink area for the entire floor) and more importantly if anyone (patients, parents or hospital personnel) were using them before/after contact with patients. The general consensus throughout the hospital is no one really washes their hands before or after touching patients, and out of the 7 wards, I think 2 or 3 of them actually had hand sanitizer bottles in the rooms. Also, the hospital is VERY overcrowded. Way more patients than beds (this was the case in every department, except surgery). The respiratory floor was insane. 57 patients scattered among the 28 beds on the floor. Two beds had 3 patients in them, and these beds are about 50-60% the size of an American pediatric hospital bed.

Today we went around the hospital with one of the infection control administrators, who we have been spending much more time with lately (since the Uncle Ho day). She comes to our English lectures, so her English is decent which was very helpful. We started by touring the laboratory facilities, which are meager at best. They process about 400-500 blood chemistries a day, 300 CBCs, and 10 cultures a day. They have a room with ladies who physically clean a ton of test tubes and one lady who types and cross blood by smears and slides. They have a fridge for their stored packed red blood cells for transfusions (probably had about 10-15 250cc packs in it). They have a shortage of blood right now, pay people USD $10 for a donation, and encourage family donation. Then we toured the sanitation area, which has only one autoclave in it for the whole hospital. One washer, one dryer (all donated). One room with 3 ladies, who physically cut big sheets of cotton into balls, which are then used throughout the hospital to sterilize the skin before labs. Crazy.

We also toured the surgical floors, saw a child get debrided after some serious burns, and visited the ID floor. The surgical floors had NO hand sanitizer in site, at which point we asked the infection control lady about it, and she got on the head nurse about it. We felt bad...We were told that sometimes patients' parents just steal the bottles for themselves. The ID floor was much different. Hand sanitizer all over the place. One room even had 2 large bottles! Also the parents of ID ill children are distinguished from other inpatients' parents because they must wear a bright yellow shirt instead of the typical blue shirt. Kinda like a scarlett letter - now other parents know you may be carrying worse germs.

It's been an exhausting last few days, but all productive on the learning front. I am really anxious to see preliminary results from our asthma study. I know, I am weird because I think asthma and allergy are cool...but I hope my enthusiasm for the topic is enough to carry both me and Conrad through the 500 more surveys we have to log.

So Kelli and i wanted to invite Nga, the head nurse, and about 4-5 doctors that we worked closely with to a dinner to say thanks for everything they have done for us during our month here. So we invited Nga yesterday (Monday) and someof the other doctors and said maybe we could do it on Wednesday. So we had tentatively set it for that date. Then at our English lesson that afternoon, Nga told us that we would go to dinner tonight and then she told us she would ask one of the neonatal doctors to come along as well. Kelli and I left the hospital with a vague idea of how many people were coming, and we were slightly worried that there would be quite a crowd so we decided to take about 1 million dong (~$60 US) and we were picked up to go to a fried chicken place.
The restaurant was pretty much built for big parties like ours and it was already pretty rowdy in there. The number of people actually turned out to be quite manageable, but there were a couple of doctors who we hardly ever worked with and anohter guy who used to work at the hospital but now works on the country's HIV program.
It wasn't as small as we were hoping for so that we could really show our appreciation to the people with worked with the most, but it was still a fun night.
So this restaurant has only three things on the menu: chicken cooked all sorts of ways, beer and cigarettes. Kelli sat next to one guy who had apparently had a couple of shots of Vietnamese wine before coming and when the chicken came to the table he began peeling off bits of meat and placing them in her bowl to eat. Fortunately for her this did not last too long. But we started out with fried corn kernels and fried coconut rice cake thingy that I thought was excellent. Then the chicken came, two plates full of various boiled chicken parts which we dipped in a salt, pepper and lime juice slurry, a tasty plate of grilled Bok Choy, 2 more plates of boiled rooster (complete with head) topped with strongly bitter vegetable that is often eaten as a traditional medicine to help the blood, and 2 plates of noodles with young bamboo. So combining all this food with the obligatory 100% toasts of Bia Ha Noi, we became full quickly. Slightly worried that we may not have enough money to pay the bill, we were relieved that the damage was a modest 855,000 dong,just a shade under $50. Not bad at all but considerablymore than we had budgeted for but it was a fun dinner.
And of course as I have learned here, much to my dismay, no night on the town is complete in Vietnam without a trip to the karaoke bar. So away we went to listen to them belt out songs. Kelli and I sang one song and then left with Nga to catch a cab back since we were exhausted froma day of data entry for our asthma project.
All in all a fun night