A Travellerspoint blog

Observations on healthcare in Vietnam

semi-overcast 80 °F

-Not surprisingly, the hospitals here are vastly underfunded and in desperate need of infrastructure improvements. For example, patients in the ER or PICU who are on mechanical ventilation machines that may also need echocardiograms to evaluate for heart disease must wait until they are no longer intubated so that they can be transported to the Echo room.

-Last night we were invited to have coffee with one of the cardiologists at a pretty cafe overlooking a lake. From what we gathered, doctors here are not very well paid in comparison to similar professions (banking, law, engineering) evenm though their training is significantly longer than the others. The doctors work extremely hard here in Vinh. The cardiologist said his family lives about 80km from Vinh and he travels by moto on the weekends to visit them.

- The hospital here in Vinh is quite hold and well worn. There are generally four beds in a room about the size of a hospital room in the US, occasionally there are more than two patients in a bed. Parents here are extremely devoted constantly at the bedside, often sleeping in the beds and doing laundry at the hospital. The parents also are responsible for chaning diapers. A few times on rounds when a doctor saw that a diaper was dirty, he seemed to admonish the parent in a stern tone and the parent quickly moved to clean the baby.

-While I cannot be certain since I do not understand the language, it does not seem that the doctors spend any time talking with the parents about what is going on. Doctors are very well respected here and family seem to accept whatever is told or just sit in silence while their child is being examined.

-The staff here are very desperate fpr any medical books and supplies. We have twice been asked to leave our stethoscopes here in Vinh since they cannot afford to buy even decent ones. The ones they use here are often broken or very cheap. While we caan't leave ours, on our return to the states will be contacting some of the med supply companies to see if they can donate any or give us a reduced price for a solid baseline stethoscope. Also, the cardiologist was showing me websites he uses for information. One site on heart failure was from a veterianarian site. So once I get home I am going to get several books together to send over. It seems that most of the doctors can read English.

-As I have learned from previous medical mission trips to Trinidad and Nicaragua and firurther strengthened here, I try not to get frustrated with the lack of infrastructure in poorer countries. I do not think I have it in me to work to change systems much bigger than me. Some people, like Paul Farmer, try this and the world certainly benefits from these people. I just focus on exploring a new culture, working with other people in the medical field to continue learning to advance my skills (already I have heard several great murmurs and lots of kids with asthma and pneumonia), sharing the knowledge I have and hanging out and smiling at cute kids.

Conrad

Posted by Kellrad 20:34 Archived in Vietnam Comments (0)

Sick kids

A week of cardiology and respiratory illnesses

73 °F

So this week we thought we were going to work on our asthma project, but it seems not too many people in the hospital know much about the asthma project. We are exchanging emails with the Project Vietnam people in the US and in Ho Chi Minh to try and figure out our next phase on this project, but while we figure this out, we have been working, rounding and entertaining the Cardiology and Respiratory doctors and nurses. The cardiologists definitely speak much better English than the respiratory docs, so we get a bit more out of those rounds and patient encounters.

After the last week and a half here at the Vinh Children's Hospital, it is quite clear to us that Vietnam has some sick kids. A LOT of congenital heart disease, so Conrad is in his glory and I am trying to perfect my murmur listening and characterizing. I think I have heard every major type of murmur out there now. Lots of VSDs, some PDAs, an ASD, of course the ToF baby that I love, and yesterday we heard a baby with a bicuspid aortic valve and PDA. The PDA murmur definitely was overhwhelming. Most of these murmurs are grade 4/6 (so pretty dang loud) and we have even been able to palpate a thrill. Yesterday we got to work with the cardiologist doing echos, and both of those kids turned out to have 2 heart defects. Alot of good cardiology practice, that's for sure. I get to reap the benefits of learning from the doctors here and all of the wisdom Conrad has soaked up from all of his beloved Oschner cardiologists.

As for the respiratory standpoint, there isn't as much asthma inpatient as I was excepting. There is a TON of pneumonia though. we have 33 kids on the respiratory floor right now. Of those 26 have pneumonia, 2 admitted for asthma exacerbation, and then a few other random things. Actually there are a good 4-5 patients who have an undetermined central apnea problem, the doctors here suspect from complications of kernicterus.

Project Vietnam has had an ongoing kernicterus project here in Vinh, and so we have helped with that some as well. It's remarkable the amount of progress Vietnam has had as a country over the last few years in terms of hyperbilirubinemia, kernicterus and vitamin K deficiency. For those who don't know, kernicterus is when the brain becomes toxic from too much bilirubin. It can cause devastating effects - cerebral palsy, learning and neurodevelopmental disabilities, and death. In the US, kernicterus isn't a huge problem because we catch the hyperbilirubinemia before it gets too high to go across the blood brain barrier and become neurotoxic. Vietnam is far behind on this, but with the help of Project Vietnam, it is getting much better. In the last year, the neonatal unit in Vinh only had 47 patients with kernicterus (1/3 as much from the year before). In this past year, Project Vietnam has given the hospital 10 sets of bili-lights (6 in the neonatal unit, 4 in the pediatric ICU). There are so so so many hyperbili kids though, so it is very common to see 2 or 3 babies sitting under a set of lights. Exchange transfusion (to remove the bilirubin from the blood) is also a very common thing here. Some babies get it multiple times while in patient. We haven't seen an exchange yet (they seem to always do them overnight), but the doctors say we can watch and learn on their next one.

We have been seeing and learning alot, but I am starting to get a little frustrated. As many of you know, I like my independence. I hate feeling like I am putting other people out, so usually I will do whatever I can on my own. Because of the language barrier, a great deal of my independence has been lost . There are only a few doctors and nurses that speak English, so we have to wait for them to have time to help us with whatever project or clinical experience we are doing that day. I feel bad because maybe they get to do less real work because they are catering to us (they are too nice to tell us they are too busy to help). On the wards, I feel like I am decreasing their efficency, and I can't even do one of my favorite things on the wards - talking to moms and dads. I just smile at them, examine their children, and if the kids are improving I give them a thumbs up or two. The parents seem to love having us examine their kids though. It is not uncommon for a parent to chase us down and show us their kids back while gesturing for us to listen to the child's lungs. I think they feel important and well cared for because these student doctors from the other side of the world have come just to listen to their baby's lungs or heart. But sadly I have no idea what they are thinking...

Posted by Kellrad 20:31 Archived in Vietnam Comments (0)

Tidbits

-So apparently there was some concern over whether we actually had fun in Hanoi after reading my post. Let me assure you that Hanoi was fascinating and I loved the place. Very energetic and charming place...

-Today in Vinh I saw a local drive by on a bike wearing an LSU shirt. After doing a double take I yelled "LSU, Go Tigers" I am pretty sure he had no idea what I was talking about. So maybe it was one of those deals where the send the losing team's shirt to a third world country to use as clothing. Oh wait, what's that you say SPencer??, LSU won BOTH of their championship games. Well there goes that theory...

-Pictures will be coming soon we hope (this weekend) We burned them onto a CD but believe it or not, none of the computers we have found in Vinh have CD drives...

-I am getting more and more comfortable here each day, this place is fascinating and the people so incredibly friendly. Today, after the English lesson on Cardiology that we gavce to the docs, we were invited to a wedding party for some of the nurses who worked in the hospital. Lots of singing, they tried to get us both to sing to no avail, and I had to 100% a Bia Ha Noi with one of the grooms. Very cool cultural experience.

Now it is time for some pho before meeting one of the doctors for coffee (I still hate it but I will choke it down to be polite)

Posted by Kellrad 03:34 Archived in Vietnam Comments (0)

Junk cruise in Halong Bay

80 °F

So on Sunday we left Hanoi early in the morning for a 3 and a half hour bus ride to Ha Long City. After arriving at what is a mayhem of tourists and locals hawking all sorts of goods, we took a small tender out to our Junk (a big wooden sailing boat). Our trip out to the ship was quite interesting and noxious. The Vietnamese drive their boats like they drive their cars: hard, fast, unyielding, honking horns constantly and belching lots of exhaust. But we made it out to our boat, a pretty nice outfit. Threw our stuff in our room (soft beds!!) and headed up top for lunch. Lots of decent food, but the company was what made the whole trip. There were 4 others our age there. 2 dudes from Canada who had been traveling in Cambodia, escaping the frigid winter of their homeland, and two girls, one British who grew up in Hong Kong and the other a fellow American doing a fellowship in Beijing. Great group and we quickly gpot to talking and learning about one another.

After lunch we hung out on the top deck talking as we cruised around the bay. HaLong Bay is a UNESCO world heritage site that is gorgeous. Thousands of limestone islands jutting out of the water covered in dense vegetation. We visited Hang Sung Sot cave and then kayaked through natural tunnel and into a beautiful calm inlet where we saw monkeys scampering amongst the cliffs and trees. There are several locals who live oin tiny house boats and fish and apparently work the caves and different tourist areas. Also ladies paddle around in small boats selling everything from beers to pringles and oreos. We headed back to the junk to clean up and get ready for dinner, again lots of food. We then started drinking beers and hanging out, had great foot massages and much to my dismay broke out the karaoke machine, a national pasttime here. Sorry Spencer, but there are no pics of me singing as I let everyone else embarrass themselves.

Hung out with everyone, drinking beers until about midnight. Our tour guide said the sun would rise at 5 so we got up then only to see it still pitch black. It did not get light uintil 6 but even then it was too smoggy to see the sun. We cruised on back to port and boarded our bus back to Hanoi. Kelli and I stashed our bags at a hotel and headed out on a search for crepes but all we got for our efforts wa s bruised hand for Kelli after a close encounter with a moto. So we wandered the streets of the Old Quarter and I got a delicious poboy like sandwhich with grilled chicken from a street vendor, then we headed to a small place for some cold bia hoi where we meet up with our 4 friends from the cruise. Hung out drinking there for a few hours watching the city whirr by, a round of drinks cost just just $1.
Kelli and I left to find some dinner and wound up having one of our best meals at a local place that was packed with locals. The tables are low and they have tiny stools to sit on, not terribly comfy as my knees were much higher than the table. The food was amazing, sweet and sour shrimp and a chicken and vegetable dish. Our waiter was a very enthusiastic kid about 9 years old. As we left I slipped him 10,000 dong and his eyes lit up with shock and he was speechless. Wandered bac for a couple more drinks and then we headed to the train station for our return night trip to Vinh. Actually quite comfortable and I slept pretty well.

All in all, Hanoi was a fascinating city and the cruise was well worth it for the company and the scenery. We are headed to Hoi An next weekend where we will meet up with the guys from Canada and one of their girlfriends who flew in yesterday...

Posted by Kellrad 03:03 Archived in Vietnam Comments (0)

Midnight Train to Vinh

Happy Birthday Spencerl!!

80 °F

After an awesome weekend, we are heading back home to Vinh tonight. It was a great weekend but we are looking forward to getting back to our friends in Vinh. Will post tomorrow about our trip to Ha Long Bay.
Hope all is well back home.

Posted by Kellrad 02:17 Archived in Vietnam Comments (0)

Lousy Day in Hanoi

overcast 75 °F

I must first apologize if there are lots of typos in this post as I just bought a fresh pineapple on the street for 15 cents and had it sliced right before my eyes. Having no utensils I forced to eat it with my hands so now my sticky fingers are having trouble smoothly navigating the keyboard. Before you feel too bad for me, let me tel you all the other unfortunate things that happened to me today:
-So we arrive in Hanoi at 5 this morning, having taken the overnight train from Vinh (about a 5 hour trip). Our preaaranged ride from the hotel missing, we hopped in a cab (metered, of course) and headed for our hotel.
-Caught a couple hours of sleep, finished off perhaps the best book I have ever read, The River Why, and headed down for free breakfast of Vietnamese tea and a warm, fat thing of French Bread (equally as tasty as that from New Orleans). Then I finished off Kelli's incredibly tasty eggs
-We hit the streets of Old Quarter Hanoi, politely turning down the pleas of street merchants to have a seat and enjoy some fresh baked bread.
-Made our way to the Dong Quan Market, where vendors were rolling out their day's offerings: clothes, irons, rice cookers, shoes, chopstick sets, soft shell turtles, vibrantly colored fruits and vegetables, pigs legs, birds stuffed in cages, kittens, watched a boy whack fish on the head and pack them away in metal cases that sat on the back of motos for delivery to local eateries.
-Wandered over to the Hoa Lo Prison (aka Hanoi Hilton). Incredible place that, unfortunately, only 1/3 of remains after the rest was torn down to build a gaudy skyscraper. Vietnamese were very careful to paint the terrrible conditions that Vietnamese revolutionaries endured under the French, while making sure to show many pictures of American soldiers playing basketball, reading letters from home and even getting souvenirs after their release from prison in 1973. The prison itself was fantastic, I am only being half sarcastic as I really don't know much about the conditions faced by the US soldiers but I think they weren't quite as rosy as depicted today.
-Then we headed up the east bank of Hoa Kiem lake, visited a pagoda on the island and stopped for lunch at Little Hanoi where we enjoyed fresh spring rolls and swapped bites of an avocado and Bacon baguette sandwhich and a Tandoori chicken sandwhich (warm apple tart for dessert)
-After spending 10 minutes commiserating over such a crummy morning, we set off for the Temple of Literature, an ancient (built in 1070), brickwalled complex of lagoons and temples that served as a center for highler learning founded in honor of Confucius
-Leaving there, we dragged our dreary souls past Hanoi Stadium, where a soccer game was fixing to start, to the one pillar pagoda, past Ho Chi Minh museum and walked up to the Ho Chi Minh mausoleum (they really really love Uncle Ho)
-After failing to bargain our way down to 30,000 dong for a cyclo taxi ride back to our hotel, we took the long way. During a walk we decided, in order to save a failing day, that we would find the best massage parlor this side of the Pacific Ocean.
-Lo and behold I think we succeeded, leaving 60 minutes and 12 dollars poorer, feeling slightly better and hoping that all was not lost on the day.
-Decided on a Fremch-Vietnamese fusion restaurant for dinner, bargaine a cyclo dude down to 40,000 dong for the trip. Felt so bad that it was so far away that we gave him 50,000 when he dropped us off
-Stepped into a ridiculously fancy restaurant, with a crowded waiting area. Asked if we had reservations, we said no and were quickly escorted to a table for two and 70 minutes later we hopped in a cab stuffed full of: a four wheel (rum), Wild Rice (more rum), crab and corn soup, fresh duck spring rolls, crushed cashew and prawn fried spring rolls, incredibly fglavorful fish fish curry (with okra in it!), and chicken with a potent seasame sauce, and only $40 USD lighter in the wallet
-Our cab (metered of course) dumped us at our hotel and here I sit making everyone else reading this miserable. Before I head to bed, I will drown my long long day with a cold glass of fresh brewed bia hoi, and it is only 9 o'clock
-I don't think tomorrow's two day trip to Ha Long Bay (google it) (we're doing a tour that offers fishing as an option) will be much better. I guess we will be home soon enough...

Posted by Kellrad 20:58 Archived in Vietnam Comments (1)

Weekend Excursion #1, part 1

Hanoi

77 °F

So last night we took an overnight train to Hanoi. It was supposed to leave Vinh at 11:09, and we got to the train station far too early. We just sat and waited for it to come. We were of course the only non-Vietnamese people in the train waiting room. There were tons of announcements in Vietnamese and a bunch of trains that went through. Conrad and I just waited, looked at each other, and decided to go outside when the masses of Vietnamese people also went outside. Somewhere around 11:45 Conrad went to go look at the train schedule to see if there were supposed to be other scheduled trains stopping Vinh. While outside he ran into a nice Vietnamese man who spoke English and said "Doctor? I met you at hospital yesterday." Conrad smiled. Then the man said the train was coming.

We boarded the train and found our first class (out of 4 level options) sleeper car compartment. This was Conrad's first overnight train experience, and I am not sure what he expected, but he was definitely underwhelmed by the "first class" arrangements. It was basically a 6 bed sleeper car. Each bed fell from the wall and was a hard as rock bed. We got a pillow, sheet and blanket though so I was super excited. The trip was about 5 hrs (of which we probably slept a total of 2.5), so we got here at about 5:30 in the morning. Our hotel was supposed to pick us up at the train station, but we didnt find anyone there for us. We were prepared though ;-) We had the address and a piece of paper asking to bring us to the address in Vietnamese. Our hotel was definitely locked shut when we arrived so early in the morning, but after ringing the doorbell and waking the attendant up, he let us in, gave us a key and we went to a room. We were super excited to learn that indeed soft, cotton beds exist in Vietnam! We caught and hour of shut eye and then prepared for our big day in HAnoi.

We walked and walked and walked and walked. We explored the entire Hoan Kiem Lake district, the Dong Xuan Market, St Joseph's Cathedral (very Notre Dame-esque), the Ambassador Pagoda, the Hoa Lo Prison (where Mccain et al were kept as POWs and the french kept all the revolutionists), walked lake and red bridge, had an excellent lunch (even got a warm apple tart for dessert!), and then continued to walk some more. We walked all the way to the Temple of Literature (sadly no human chess games were going on today), the One Pillar Pagoda and Ho Chi Minh's mausoleum (sadly closed). Then we walked all the way back...we intended to catch a ride with a cyclo but realized we were no longer in a touristy area and couldnt find one.

So here we are tired as can be...and now heading for some body massages!

Posted by Kellrad 01:08 Archived in Vietnam Comments (1)

The language barrier

A Typical Exchange on the streets of Vietnam

sunny

We: Smile, nod, say 'sin jow' (hello)
They: smile, nod say 'allo'
We: Point wildly at what we want, holding fingers for how many we want
They: Ask us a long question in Vietnamese
We: Look at each other and laugh
I: Start staring off into space apparently convinced that Kelli, being half Asian, has miraculously learned how to speak Vietnamese, then I fumble around for the phrasebook while not making eye contact
They: Take out what they think we want
We: nod in approval or disapproval
They: tell us in Vietnamese how much it costs
We: shrug
They: take out calculator
We: go "ohhh" and pay, leaving with dirt cheap, but delicious food

This one lady has a stand that she wheels around town and the last two mornings we have stopped there to buy two mini baguettes for 3,000VND (~15 or 20 cents). She already loves us and got really excited when she saw us, waving two fingers in the air.

Posted by Kellrad 11:57 Archived in Vietnam Comments (0)

The patients in Vinh

The pediatric hospital in Vinh is definitely quite different than the many hospitals we toured on our grand interviewing tour. This hospital, called Benh Vien Nhi, is one of the 12 (?) provincial pediatric hospitals that feed into the major district ones in Hanoi and Ho Chi Minh. This place sees a lot, since people come from the whole general area for surgeries, check ups, and other health needs. There is quite the ancillary staff (pediatric ophthomology, pediatric dentistry, pediatric surgery, etc) and I think we have met every doctor in the place. Or they at least have hunted us down to say hello. Everyone has been very welcoming, and thats been great. This week we have spent our time between the Peds ER/Intensive unit (its one combined place) and the NICU. Both units are locked away (caged doors to admit us) and have about 15 patients in them on a regular basis.

The NICU has a ton of jaundiced babies and other premies with respiratory distress. We haven't seen any kernicterus yet, but apparently it is still a big problem. The Peds ER/ICU has a good assortment of sick kids. 1/3 of them are pneumonias (which was a great word to try and teach the doctors to pronounce) or asthma exacerbations - this wasn't really a surprise to us given the dust & debris in the air from the motorbikes and the fact that we were asked to come work on a respiratory disease project...

Some clinical highpoints so far: we have a 2 yo boy with Tetralogy of Fallot (in non-medical terms - a severe form of congenital heart disease that needs surgical repair for survival) who can't get an OR date until April 2009, a hemophiliac boy who came in with a head contusion, black eye, and hemarthrosis of the L knee (his knee was swollen with blood in it), and a 1 wk old baby with Congenital diaphragmatic hernia (the babies intenstines have moved up where the lungs are) that we helped stumble upon yesterday.

The CDH baby was quite the experience. We did rounds with one of the ER doctors. Each room has 3-6 babies in it. When we were in this room, the baby had oxyegn saturation of about 40% (should be 95-100%). The doctor we were rounding with seemed unphased by the sats, although it was quite alarming to us. Conrad and I took turns irritating the baby so it would cry and take in more oxygen. We got the sats up to 51% at one point, but if we stopped they dropped back down to 40s quickly. Conrad left the room with the doctor to proceed on rounds, and I opted to stay and try and keep the baby's sats up longer. I found one of the chief doctors in the ER and showed him the continual low sats. He agreed that we needed to get this baby some oxygen and got everything set up to intubate the baby. Meanwhile we got an xray that shows likely intestines in the chest. Because conrad is so cool (and male!), they asked him if he wanted to intubate the baby. Of course he was super excited by this and agreed. Unfortunately the baby got worse and the attending had to intubate very quickly, so Conrad didnt get his chance. The baby is doing well on the vent now.

What I have enjoyed most about my time working with healthcare in Vietnam is the variety. We have seen illnesses at stages we would likely never seen in the US (not even in Louisiana!) and we have seen some interesting presentations of more common things.

Posted by Kellrad 18:38 Archived in Vietnam Comments (0)

Lessons learned (so far) in Vietnam

sunny 73 °F

-Mopeds/motorcycles can "comfortably" hold up to 3 adults or 2 kids & 2 adults
-Vietnamese people eat alot or talk about eating alot
-Shoes are not allowed inside most places, including patient rooms
-Vietnam is a very male dominant country (I have yet to meet or see a female doctor, Conrad's opinion matters more than mine in every situation, Conrad gets to play on the hospital soccer team even though he has little to no experience or desire to play - whereas I love to play and am decent, Conrad gets many invitations to drink beer with the doctors and i can come along since they dont want me to be alone, the hospital medical director mainly makes eye contact with Conrad although he is (I think) talking to both of us, etc etc etc)
-They will eat noodles or rice for any meal of the day
-Beverages other than coffee, green tea or beer aren't really consumed much by people
-There appear to be no traffic laws or lines, which is ridiculous cause they have a ton of rotaries in complete disarray
-Crossing the street is a dangerous act
-I can easily pass for Vietnamese, but Conrad cannot
-Conrad is a giant to everyone we have met so far (today one of the nurses asked if it was hotter up where he is)
-There are fewer stray dogs than in Thailand, and these are alot cuter
-There are far more Western toilets everywhere in Vietnam than asian style squat ones, and I am surely not complaining about that!
-Far less people smoke and spit than any other Asian country I have been to
-English isn't commonly known but if anyone knows just one word, they will gladly smile and share that word with you
-Hand sanitizing or washing here is done about once every 6 patients...
-Vietnamese people are oh so friendly (in just two days we have been invited to the head nurse's house for dinner, out to multiple meals, to play soccer with them, to go for beer with them, to exchange phone numbers and emails with them, to visit Ho Chi Minh's birthplace with them, to go to the beach with them)

These are just a few of the lessons I have learned so far. Look for more later
-Kelli

Posted by Kellrad 21:08 Archived in Vietnam Comments (0)

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