Da Nang General Hospital and Da Nang Orthopedic and Rehabiliation Hospital – Da Nang Vietnam

Posted by Dhruv Verma, MD  (a third year Internal Medicine resident from Kaiser Permanente, San Francisco while on a global health elective in Da Nang, Vietnam at Da Nang General Hospital and Da Nang Orthopedic and Rehabilitation Hospital).

Da Nang General Hospital in Vietnam

Vietnamese (Tet) New Year

I landed in Da Nang on February 11^th 2013.  It was only days before I left for Vietnam did I find out that February 10^th was the Vietnamese New Year, the most popular holiday and festival in Vietnam. The New Year marks the arrival of spring and is based on the Lunar calendar and celebrated all across Southeast Asia.  I was expecting parades and a rowdy crowd however found the opposite. Most of the city shut down and people spent the whole week with their families drinking and eating at home. Most restaurants, bars, social hot spots were all shut down this week. Surprisingly, some hospitals were also closed. Patients actually preferred to be discharged and spent the week home with their families.  At the end of the week, patients came back and were re-admitted.

Vietnamese People

I was very fortunate to meet some of the nicest, warm, and kind souls out in Da Nang. First off one of the physicians took time away from the New Years celebrations, picked me up from the airport and took me straight to my hotel. The next day he picked me up from the hotel and gave me a tour of the hospital. In my first week I worked in the Emergency Room where I was fortunate to meet at least one person who spoke some English.  The next week I worked in the ICU where almost everyone spoke English. This is where I made some friendships that I know will last a lifetime. Almost every night I was invited to someone’s house for dinner. Almost every day after work someone would want to take me out around town and show me around.  There were countless house parties that I attended and I really felt like “part of the gang” out there with the ICU crew.

February 27^th, which was my last day in Vietnam, coincided with Vietnamese Doctor’s Day. Around 1pm, the hospital shut down and we ate food and had drinks in the main conference room. Nurses and other workers performed dances and sang songs praising doctors for their hard work and dedication to the people. And of course there was karaoke involved.

Medicine in Vietnam

After high school students, attend Medical College, which is 6 years. The first four years are lecture/theory based and are comparable to our first two years. The 5^th year is rotations and the 6^th year is equivalent to internship here. Student can attend medical college in any city they like but the majority of students attend colleges close to their hometown. After graduating from college students apply for jobs. Residency is optional if someone feels that they want additional training. It is mandatory that one only applies for a job in their hometown. For Example, someone from Da Nang, must apply for a job in the city of Da Nang even though they might have gone to a medical college in another city. Everyone works in the Emergency Room for the first 6 months, and it is here where the new physicians are evaluated and it is determined which specialty you will work with. Yes that is correct! The Director of the hospital decides which specialty you are fitted for. For example, one of the physicians in the ICU actually wanted to go into Orthopedic Surgery, however was placed in the ICU instead. If you disagree with the decision, you will have to work the Emergency Room for 6 more months (in addition to the 6 already required) and then “re-apply.” About 50% of the doctors I met, did not “choose” the specialty in which they worked.

Work in the Emergency Room (2/12/13 – 2/16/13)

Da Nang General Hospital, the biggest hospital in the city, is one that is not closed during the week of the Vietnamese New Year. Business is as usual in this hospital and the Emergency Room is quite busy.

The day after I landed I started work in the Emergency Room.  I worked here for the first week and my hours were 9am – 5pm. 6 days a week. Most of the patients I saw were trauma patients. Many Vietnamese people cannot afford cars and thus opt for “motors” (or scooters) instead and these scooter riders get into a lot of accidents. Over half of the patients admitted to the ED had intracranial hemorrhage as result of an accident.

Given the high volume (about 300 patients a day, with 5 doctors covering the ED) the ED works more like a triage unit. There was no time for procedures and initiation of much work up. Patients are quickly diagnosed and then the appropriate specialty is notified for admission.  In a patient with septic shock, Early Goal Directed Therapy will not be initiated and a central line will only be placed once a patient reaches the ICU. This transfer to the ICU could take up to 30 mins. If meningitis is suspected, the Emergency Medicine team will obtain a CT scan to rule out any intracranial pathology and the Neurology team will be notified to perform the Lumbar Puncture and admit the patient. Too many patients and not enough doctors, made it difficult to practice medicine in accordance with the standards that I have been accustomed to, but it was this challenge that made this rotation exhilarating and fun.

The ED also works as an urgent care clinic, especially during the week of Tet New Year, when most clinics are closed. Cases I saw varied drastically from Respiratory Distress to minor cuts and bruises, not unlike the Emergency Rooms here in the States.

Intensive Care Unit (2/17/13 – 2/24/13)

Next week was spent in the ICU which was the most exciting part my trip.  They have a 60 bed ICU/CCU with about 5 physicians on during the day and 2 on at night. The Junior Physicians were fresh out of medical school or were in their 2^nd or 3^rd year of practice and the Senior Physicians had been working in the ICU for 10+ years.  I was very impressed with all of the Junior Physicians. They spoke English well, were on top of the latest guidelines for the various disease processes, and were very comfortable with procedures and protocols (such has central line placement, intubations, and running Codes).

                    

On my first day on the job I performed my first two intubations and my first Ultrasound Free Subclavian Central Line.

The schedule in the ICU was also 9am – 5pm 6 days a week.

Most of the patients in the ICU were admitted for COPD. Because of the high rates of smoking and Tb, Vietnam has one of the highest rates of COPD in the world.  I also saw a lot of non-traumatic intracranial hemorrhage (due to aneurysm and hypertension).  Surprisingly there were lower rates of PE and DVT and higher rates of bleeds.

In my week in the ICU I performed 5 central lines, 3 LPs, and 2 intubations.

Orthopedics and Rehabilitation (2/25/13 – 2/27/13)

The Rehabilitation Hospital was one of the hospitals that was closed the week of Tet New Year, thus I did not work here until my last few days. I spent about 3 days here, mainly in the clinics, rehab facility, and one day in the OR.  I spent most of my time giving joint injections and learning the musculoskeletal exam, which was great because it was definitely something I needed work on. It was also great to see some ortho surgeries, which I had never seen before (mainly because my training is in Internal Medicine, and not surgery).

This hospital does not have a Rheumatology department thus, most arthropathies including Rheumatoid Arthritis and Gout are managed by the Orthopedics Department.

Presentations

I presented 4 power point presentations in my 17 days out there. For the ICU department I presented on septic shock and early goal directed therapy, Acute Respiratory Distress Syndrome, and The American Medical System. For the Orthopedic Department I presented on Rheumatoid Arthritis.

This was a once in a lifetime experience and I am very grateful to have had the opportunity to go out to Da Nang and work as a physician.