Written by Hamad Zafar, DPM, PGY-2 at Kaiser Permanente Santa Clara Podiatric Surgery Residency Program while on Global Health rotation…
Posted by Yi-Jen Fong, MD (a third year Internal Medicine Resident from Kaiser Permanente, Oakland while on a global health elective in Da Nang, Vietnam at Da Nang General Hospital and Da Nang Orthopedic and Rehabilitation Hospital).
My wife Sandra and I had the privilege to take part in a Kaiser Permanente sponsored trip to the beautiful city of Da Nang, Vietnam. As a background, Da Nang is a city rich in history as it was ruled by multiple people groups in the past. Going back to the early 1st century it was ruled by the Champas who were deeply involved with the Hindu religion. After around 1000 years it became ruled by the Chinese who were Buddists/Tao/Confucian and then the French who were Christian. This diversity in culture and religion was clearly reflected in the food we ate and the architectures of the buildings we came across during our time there. Another unique historical note is that Da Nang was where the line was drawn between the American and Vietcong forces during the Vietnam War (which the Vietnamese call the American War). Every year many war veterans take trips back there to see the bunkers and the remnants of their time there.
The people in Vietnam were some of the most kind and friendly people we have ever known. Even though we were not able to speak their native tongue, everyone was very patient and communicated through gestures, drawings and of course google translate. During our time there we met people from all walks of life and shared many meals with them. Sharing and serving food is the love language of many Asian Cultures and it certainly is true for the Vietnamese.
The medical aspect of the trip was initially challenging but overall rewarding. When we arrived, we were told the General Hospital of Da Nang, which is the main medicine hub of central Vietnam, had not approved our paper work. There was speculation from the Orthopedic hospital who was our contact there and had submitted our paper work prior to us arriving, that the delay may be due to Tet or what is called the Vietnamese new year. Tet runs for a week officially where people go back home to the countryside to be with family, but this holiday can sometimes run for multiple weeks. We had arrived just at the end of Tet week. So for the initial few days we played tourist and saw the sites.
Meanwhile we had emailed a British woman whom the previous Kaiser residents had met in the General hospital emergency room. She turned out to be an economist and was in charge of the Neonatal Intensive Care Unit (NICU) at the Women’s and Children’s hospital. She was able to get approval for us from the administration of that hospital so we rounded with the NICU physicians and listened in on the didactic sessions. This was exciting from my wife as she is a pediatric nurse and a great opportunity for me to hit the books regarding neonatal care which I haven’t studied since Medical school. Another positive was there was a visiting British neonatologist so everything was done in English.
Through people we met at the international church in Da Nang, we came into contact with foreign based NGO’s that were involved in healthcare. This included a Korean Ophthalmologist who was working to give free care to underserved children and an American who was running orphanages. We also did a home visit for a 39 year old man who was paralyzed from the chest down due to a motorcycle accident. He is an engineer who had a good income but because of his injuries he now does not have much left. In a fee for service health care system, this basically eliminates him from adequate care. We went over his health issues and recorded a video to help him get financial and social support from NGO’s in the future. Given his experience we discussed the lack of social work support for patients like him and his desire to change that for the better.
After a week and a half, the administrator and the orthopedic surgeon of the Orthopedic hospital called and asked us to work in their hospital as there was still no word from the General hospital. For the next two weeks we went to clinic, watched surgeries and even participated in their rehab department. In clinic, patients would have severe complications from untreated rheumatoid arthritis, gout, polymyalgia rheumatica and more. This is where I found myself most useful as I was asked how to treat these medical conditions including acute care, long term care and preventative care. I was also given the opportunity to review some of these topics with the attending physician so often I went home and prepared talks with handouts to be done the next day. We also were invited into the operating room and watched a variety of surgeries including the removal of large gout nodules, repair of torn ACL’s and trigger finger release. The surgeons were very gracious and explained each step of the surgery and answered all of our questions. The third part of our experience at the orthopedic hospital was through the rehabilitation department. We watched and helped with children who had cerebral palsy, developmental delay, torticollis and other conditions such as recovery from a broken femur.
People often ask us what we learned from our experience in Vietnam. Is medicine practiced differently? For me the difference I found was not medical. Of course there is a disparity on resources as there were not enough physicians, equipment or space to take care of the volume of patient in Vietnam. Yes, there is a lack of a primary care system which is similar to other developing nations who are still focused on treating the problem instead of preventing it. But what struck me was the difference in the involvement of the patient’s family in the patients care. In the US often a patient is dropped off to the hospital and the hospital assumes all care for the patient. In Vietnam, the opposite is true. There is always a family member present at the bedside of the patient and they will sleep outside in the hall way so they can be there twenty four hours a day. Because the hospital is short on resources, family is responsible to run out to the store to buy a urinal, a pillow, blanket, food or anything else that would make the patients stay more comfortable. At times this included the medications which were bought from an outside pharmacy. This of course in not feasible in the US but what I took away from this situation was the missing sense of entitlement that we often see in our society in the US.
So the next question is how do we apply these lessons and values we learned during our trip? How can this be translated to our health care system? It will be impossible to ask the families here to assume full care of the patient in the hospital as our society just isn’t set up for that kind of responsibility. Family members here often work full time or even hold two jobs so will never have the capacity. We are fortunate to live in a society in which the government is expected (and capable to a certain extent) to support us when we are sick or poor with programs such as welfare and Medicare. In a society where we value individual rights sometimes the bigger picture of helping each other is lost. This idea of sacrifice for the greater good whether that is a small group like a family or a larger group like a country was more apparent in our experiences in Vietnam.
It is difficult to summarize our wonderful trip to Vietnam in just a few paragraphs. The lessons we learned both medically and personally will stay with us for the rest of lives. Seeing the struggles of those in another country helps us appreciate what we have here in the US. It also prompts us to question ourselves in our comfort what we could do to help our fellow human beings. I would encourage any resident to go and see for themselves what goes on outside of our country and I promise you will be better for it.