A Travellerspoint blog

Healthcare System

semi-overcast 80 °F

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)

Posted by Kellrad 03:38 Archived in Vietnam Comments (5)

Finally...finito!

72 °F

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!

Posted by Kellrad 03:37 Archived in Vietnam Comments (3)

And it continues...

79 °F

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

Posted by Kellrad 23:36 Archived in Vietnam Comments (0)

Food

overcast 80 °F

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...

Posted by Kellrad 12:28 Archived in Vietnam Comments (0)

Utterly exhausted

86 °F

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

Posted by Kellrad 02:16 Archived in Vietnam Comments (0)

Asthma burnout, Hand Hygiene and Infection Control

86 °F

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.

Posted by Kellrad 01:50 Archived in Vietnam Comments (0)

Thank you dinner

sunny 90 °F

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

Posted by Kellrad 16:45 Archived in Vietnam Comments (0)

A nearly disastrous gourmet weekend

sunny 90 °F

So it turns out we could have had it much worse when it came to eating this past weekend. We were a little less than excited to have the hot pot/fondue like smorgasboard of a meal on hot Sunday before our walk.
Determined to slightly expand our options for eating our last week in Vinh, we wrote down many Vietnamese words that were on the signs of various street restaurants. Yesterday we excitedly presented this list to one of the doctors so that he could translate it and open up a wonderful world of delicious food that we were missing out on and so that we could avoid ordering pigeon again.
Well we were quite surprised to learn after getting the translations that we considered eating the following not so tasty list: pig leg, traditional, cheap, common, dog meat, high quality, heart, kidney, restaurant, Hue noodles. Aside from the pig leg (for me not Kelli) the only other palatable, and for that matter edible, word that we wrote down was Hue noodles, a delicious dish from a region in central Vietnam famous for its food.

Vietnamese: 1,232
Conrad and Kelli: 0

Posted by Kellrad 00:28 Archived in Vietnam Comments (0)

Sunday in Vinh

82 °F

We learned today that Sunday is just like every other day in Vinh. People work just as hard on Sundays as every other day, which means the construction guys working across the street from our hotel were up pounding away bright and early.

The only big differences on Sundays:
-There is no school, which means the internet cafes are PACKED with gaming kids (we had to go to 3 internet cafes before finding space)
-Our bread lady runs out of bread fast (don't worry, we still found breakfast, just had to walk further for it)

Today we did yet another random Vinh exploration trip, but this one was less successful. We went into the opposite direction of yesterday (at conrad's suggestion) and saw very little. Walked by the lake which was pretty, but we already knew that ;-) We had fun anyway, but since it was a scorcher today and I have a tiny bladder, our walk was cut short.

Highlight of today was our lunch. We walked and walked and couldn't find anything to eat, and then we stumbled on two lau places (they serve only hot pot/wok). For those who don't know what hot pot/wok is, its basically a big pot brought to your table, with a stove top, and a bunch of fresh veggies and fish. you throw whatever you want into the pot, and a bit later you get to eat it. if you dont like it, then you have yourself to blame.

Anyway, We thought they served other food too, but after our attempts at ordering dishes we knew, and the waitress shaking her head, we gave in and ordered some ca lau (hot pot with fish and veggies). We both love hot pot, but it was a billion degrees so I was really not looking forward to it. It was a fun experience, and the ladies watching us got some good laughs. We ate alot, realized how much we hate the little bones in fish, and were very content by the end. Sure in between Conrad was draining fluids from every orfice of his body (he over did the chilis and wasabi), and I was sweating from sitting right next to the open flame, but we had a great lunch.

Posted by Kellrad 03:49 Archived in Vietnam Comments (1)

Talent show of some sorts

76 °F

As I alluded to in a past post, a lot is loften ost in translation...

So we thought we were going to a city-wide song and dance performance night for several hospitals' health professionals. After seeing it, I still think that's what we saw. However, when we arrived at the place by taxi, we realized it was the same hotel Friday's wedding party was at. Then there was an umbrella dance and all of a sudden the bride and groom from Friday's wedding were in colorful costume dancing in the middle of the umbrella girls. So I asked our hospital's head nurse, Nga, if that was indeed the bride and groom. She said yes, and said this was their wedding party. "Ahhhh. I see." So I told Conrad that we must have misunderstood and this was a continuation of the wedding reception. It was a 3 hr conglomeration of numerous singing and dancing groups (some soloists), all singing, we think for the bride and groom. The vietnamese people LOVE to sing and dance. I feel like in the States people have to beg or bribe others to sing or dance at their wedding, whereas here, people just stand up on a whim and belt out a tune. I think it must be all their karaoke experience.

Anyway, so the night continued with more artistics acts. But then there were 4 or so acts in a row where people were dressed in nurse outfits or waving red cross flags. At that point, I began to wonder yet again if I misundertsood, and if indeed this was a city-wide hospital personnel gathering for talent. So i asked miss Nga who was dancing. She told me "Vinh's malarial prevention group". The next act was another hospital's "neurological devastation group." And another group was another hospital's phlebotomists. We in fact saw the group from our hospital perform twice, and during these performances Conrad and I were chosen (by Miss Nga) to go up on stage and deliver them flowers to thank them for the beautiful performance.

It was a fun night and a great cultural experience. But I still have no idea if it was a wedding reception or a hospital personnel talent show night. If I had to put money on it, I would say hospital personnel talent show.

Posted by Kellrad 19:50 Archived in Vietnam Comments (0)

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