Vietnam

It is with a heavy heart that we leave the beautiful people and country of Vietnam. It has been a month that I will always remember in so many ways. Our medical experience was incredible, but that is only a part of what has made this such a memorable trip worth every penny I have spent. This is truly a fascinating place, and I have been enchanted since the day I arrived.
Now it is on to Siem Reap for a couple days and we head for Thailand on March 5th.
-Conrad

So we woke up about 545, well really about 4 when the roosters started cock a doodle dooing, caught a beautiful river sunrise, had a quick, and mercifully light, breakfast then hopped on a small wooden boat to check out the floating market.
There are about 6 of these sactterd throughout the delta. Basically, families with farms in the delta load their harvest onto boats and travel to these markets, living on their boats while on the river. Some markets are wholesale, people come to buy a bunch and seel it on land and others are for individual purchases. Ours was a wholesale one and was fascintaing. They only sell fruits and vegetables, and boats put samples of what they are selling on a tall pole so people can find what they need. Most sold only one or two items but a few sold almost ten. We didn't spend much time there but it was truly a great experience. Not another tourist in sight and no one trying to sell us stuff. We saw local transactions going down and then headed for the land market at Tra On to put our Vietnamese skills to the test trying to buy items we needed for our lunch. The market was amazing, we saw the fruits and veggies first and had as delicious pineapple cut up before our eyes. My favorite section was the meats where I got to play my favorite market game of "guess the animal part" The meat section had every organ you could want (brain to bull's testicles) with beautiful cuts of meat. Each table put the head of the animal (pig or cow) on display as well. Certainly more than ornamental as I am sire this is eaten as well. Quite a sight and I will post pics soon I hope. I would maybe recommend that they clean the animal's head off, but who am I to tell these beautiful and amazing people what to do with their livestock. Chin, by the way, also was on the Vietnamese power walking team, as he sped through the market with us wandering somewhere behind.
We got our groceries and some flowers for our host lady, headed back to make spring rolls (both the guide and the lady of our home commented on how excellent my rolling technique was) and stuffed ourselves with food. The couple would constantly keep pur plates full even if we shook our head no. All delicious and totally stuffed.
We sadly said goodbye to our host family and the German couple who were travelling on the Can Tho, crossed the river and got a car back to Saigon. An amazing trip...

I know Conrad is posting about his view of the trip as we speak, so I won't rehash the details of the trip, but rather tell you what I enjoyed most/least about the trip.

First off, I think it was the perfect way for us to end our time in Vietnam. I really couldn't imagine ending it on a more positive note. We spent two days living life as a Vietnamese person in the heart of the Mekong Delta. We did one of those "off the beaten path" trips to the delta, and we literally saw no other tourists the entire weekend, aside from the German couple who was part of our trip and the few tourists who took the same speedboat to the delta. The boat dropped us off on a handmade bamboo pier for our host family. We opted to do a homestay with a family that has two huge farms full of various delta fruits. We cooked with the family, walked with the family, ate with the family, drank with the family, etc. We slept under mosquito nets and used their same outhouse (although they did have an old wooden one that i think and hope they retired).

What I liked most: seeing no other tourists, having the many village kids run out of their houses to wave to us and say hello, eating the delicious food, learning how to prepare the delicious food (they use sugar in everything, salt minimally), cheers-ing with our host dad, touring the family's farmland and eating the fruits they grow and are so proud of, biking along the canals off the delta, seeing the action of the local floating market (again no other tourists there, no one harassing us to buy random stuff, they just did business as usual), the weather, shopping for goods to make our own lunch with at the land market and speaking in vietnamese with the sellers, buying one of my favorite flowers (stargazer lilies) to our host mom as a thank you gift and giving her a hug before we left.

What I liked least: our tour guide's hurried behavior throughout the entire trip (he was a speed racing biker and walker - and I walk fast so for me to say he walked too fast is a BIG deal), the fact that i was biking so fast to keep up with our tour guide i often didnt get to enjoy the landscape as much as i wanted or wave to as many kids as i wanted, the fact that we couldnt stay and play with all the kids i wanted, the fact that once the family went to bed they locked the doors and turned off the power so when I woke up at 11pm to go pee I couldn't see or even get out of the house to go to the outhouse and pee (It was HORRIBLE! my bladder was going to explode, so I had to get creative and basically peed in a thick plastic bag - lowlight of my entire trip, believe me! Conrad suggested I pee in a water bottle, but I do not have the skill to pee in a tiny opening in the pitch black), the fact that 4 of the family's roosters started non-stop crowing at 3:46am and continued through the whole morning, the 4.5 hr drive back to Ho Chi Minh through rush hour traffic

So here we are in Ho Chi Minh for our last night in Vietnam...I am sad to say good-bye to Vietnam. I really love this country and everything the Vietnamese people represent (hard work, determination for improvement in so many realms, and a developing country that is making strides little by little). I am so glad I got to experience parts of it. We are already planning our next trip in Vietnam, so I am certain I will get back sometime in life.

Now it's on to Angkor Wat in Siem Reap, Cambodia. I have been waiting to see Angkor Wat since 2003, so I couldn't be happier about this trip. Unfortunately we wont get to spend too much time there, since we have so little time left for this vacation.

Before I tell y'all about the wonderful trip we had to the mekong Delta, I wanted to mention something about the hospital in Vinh.

In case anyone was wondering why I never mentioned us diagnosing kids with AOM (middle ear infection, one of the most commonly diagnosed pediatric problems in the States), the reason is clear and simple. Our hospital and most hospitals (per our doctors) do not have otoscopes. They have nothing to look into the ear canal besides a normal handheld flashlight, so they obviously cannot see if the tympanic membrane is red, inflamed, angry or dull. Since they cant see these, likely febrile, kids' ear drums, then it must be the lungs that are infected! Maybe that's why everyone gets diagnosed with pneumonia.

Anyway, I know this is a random post, but this weekend I was thinking about the overdiagnosing of pneumonias in kids in Vinh, and I was comparing it to AOM. In the states or at least the hospitals I have worked in, too many kids are put on antibiotics for AOM.

So apparently Lance Armstrong has a long lost Vietnamese brother named Chin who works as a tour guide for Innoviet tours here in Saigon...Back to this later.

So we have returned from an amazing two days on the Delta. We originally planned to do this bike tour with a company we read about in our travel book. A two day deal for $35. It went to the more touristy places but since we only had two days we figured we would take what we could get. On the way to this place though we were lured into another tour compnay shop by signs of smiling faces riding bikes under banana trees. So we ducked in there and immediately knew we had what we wanted: a two day trip with a visit to a floating market, biking, and a homestay all in a place that saw few tourists.
This trip was considerably more but we quickly booked it. The next morning we met the two other people with us for the trip (a German couple about our age) and we headed to the pier nearby to catch our boat. The boat ride took a little over three hours, but it was great. The first part near Saigon was a massive port about the size of New Orleans (the whole trip was quite similar to the Mississippi) with huge tankers coming and going. In the midst of these massive ships though were many small wooden boats ferrying various goods up and down the river.
As we turned up one of the many fingers of the Mekong as it fans out in the delta, the tankers disappeared and it was our speedboat and hundreds of wooden boats, from tiny cigarette-like boats to large boats and barges carrying dirt and rocks. The river was alive with commerce, from the many piers actively loading or unloading goods and people to the many boats carrying everything from coconuts to sugar cane to dirt to bananas to rocks to pineapple. Everything. It was truly fascinating to see this all in action.
We pulled up to a random dock and hopped off on the land where the family we would be staying with lives. We met them (an older couple with one son who still lives with them). They work a farm right on the river that has been in their family for generations. They have over 2 hectares on which they grow Mangosteens, pomelos, oranges, bananas, pineapples, rhambutans, and coconuts. We settled into the house and began to help make our lunch. It was a vegetarian hotpot with tofu everything, much to my chagrin. I don't understand tofu and never will but most of the tofu we had was the best I have ever had, but that was only because it was cooked in all sorts of yummy spices and herbs. The tofu brought nothing to the table, we even had tofu shaped and colored like shrimp. Gross.
After that we hopped on a boat (our home was on an island in Vinh Long province) and went to the mainland. There we got bikes and this is where the trip got kind of crazy. It definitely felt like we were in the peloton in France. We had one American team and one German team and our fearless leader Chin "Armstrong" who would take off down the road without saying much. We would follow furiously pedalling behind him. Then he would slam his brakes and veer off into the place he wanted to show us without warning, leaving us screeching to a halt or wobbling into oncoming moto traffic.
We did see some cool things. A couple of beautiful Buddhist temples. We also visited a brick factory where they take sand from the river and clay from inland, throw it in a machine that pumps out raw bricks. They then load the bricks about 6000 at a time into huge brick ovens. The fires are fed with rice husks from harvested rice, they bake for 2 weeks, and then cool down for a week. The ashes leftover from burning the husks are then used as fertilizer for their fields. A pretty cool thing, I thought. I was astounded during the whole trip about just how "lived-in" the Delta felt. These people have been here for ages and just have it all down pat work it beautifully. We sped on passing some more farms and then turned down a narrow path along a small branch of the river and the trip got interesting. Kelli was bringing up the rear at this point as we took in the scenery, and I listened to her curse in Chinese as she hit bumps unexpectedly and motos flew by nearly touching our handlebars which would send us either into cacti or down into the river. Then she tells me she thinks her tire is going to fall off, so I tell her to ride past me and sure enough she has a flat tire.
So doing my best impersonation of a support rider in the tour, I quickly caught up with Chin and told him the news. We weren't able to fix the bike so he hired a local dude to drive him the rest of the way on a moto while he carried the bike. This made it even worse since the last thing he said before speeding off was "We go drive slow" and we didn't see him again for a while.
At this point, our German guy friend was bringing up the rear when suddenly we hard a loud crak and looked back to see him pulling his bike back on the road and apologizing to local family whose fence he just knocked down. Apparently, he got knocked from his bike when he took a bamboo pole to his shoulder, medieval joust style. After realizing he wasn't hurt, we commenced laughing hysterically and the locals got a kick out of it too. We made it back to our ferry point and awaited Chin while he got the bike fixed before heading back to the homestay for a shower and to begin helping to cook dinner.

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!