Today we went with the PVNF group to do a medical mission in a small village in the countryside. We had to meet at 5 am to depart on the buses. Yawning and sluggish, Scott and I made our way over. The buses had been assigned to all the volunteers, so Scott and I got onto one of the buses that had extra room in the back. In the States, the back of the bus is always bumpier, and in Vietnam, it is much worse. We could feel every little rough patch in the road. We fell asleep, our heads jostling to and fro. Every time we crossed a bridge, the back of the bus would jump up because the ramp up and down was not very smooth. My bottom was literally lifted off the seat. We got to the river, where buses and people alike boarded a ferry. Scott and I climbed out of the buses and walked to the front of the ferry, where we could see it slowly making its way towards the jungle. To the right and left of us, we could see little speedboats passing by and men in their fishing boats. We also watched the sunrise. I don’t know if I have ever been up early enough to actually watch the sun come up over the horizon, but this time I did. A sunrise is much softer than a sunset. The colors are lighter and less vibrant, as if the sun itself is waking up too.
 |
| Sleepy volunteers on the ferry |
 |
| Capturing the moon |
 |
The troops disembark
We had arrived at 8 am, and already, hundreds of patients were lined up outside of the exam rooms. PVNF volunteers immediately went to their stations to do crowd control and take vitals. All of the providers, medical students and doctors, were called into a room to be assigned tasks and to be briefed for the day. Scott and I chose to be in the same room as Richard, an MS4 from UCSD, and Dr. Ed, an internist who works in Huntington Beach, CA. All of us piled into a small, poorly ventilated room with one fan, two translators to the each of us. Richard gave me a run down of all the medications that PVNF hands out. The most important for me would be: ibuprofen, vitamins, calcium, and Mebendazole (anti-parasite).
 | | Many anxious patients |
 | Nervous about his appointment
|
Slowly, the patients began filing in, ticket and papers in hand. I saw one patient with Richard and was ready to go off on my own with Scott shadowing me. My first patient was an elderly man with a cough and itching with no visible rash. The man was tan and his skin was leathery. His right eye was cloudy and nearly white. I began interviewing him. With so little time and in another language, I basically forgot how to take a history. I forgot my OLD CARTS, and I was asking questions in a very disorganized manner. I mostly was speaking Vietnamese with the patient, but every once in awhile, I needed the help of the translator, Kim, a recent high school graduate. I took a listen to his lungs and heard some soft wheezing, so I asked him to force air out as he exhaled, and I was able to illicit a stronger wheeze. He said he has had his cough, on and off for a few years. I couldn’t discover the cause of his somewhat arbitrary itching, and neither could Dr. Ed and Richard. I also listened to his heart, which was normal. After taking his social history, I discovered that he had been smoking for 30+ years, which led me to believe he probably had chronic obstructive pulmonary disease (COPD) or a chronic bronchitis of sorts. I prescribed him some anti-cough and anti-histamine medications. I counseled him on trying his best to quit smoking or to smoke less or else his cough and breathing problems would continue to worsen. As he walked out, I wondered what I had really done for him. The anti-cough medicine would not cure his cough, and what would happen once he ran out of anti-histamine? Would he just continue itching for the rest of his life? Yet, he woke up early and sat in line all morning just to see an American “doctor”, or rather, medical student. I can only hope that he does try his best to quit smoking. Scott sat patiently by my side, observing and watching. |
 |
| Audrey gears up |
 |
| Richard's seeing patients |
That morning, I got two other elderly patients who also were experiencing itching. One of the men I thought had scabies, itching caused by a small insect that burrows in your skin and lays eggs in clothing and sheets, but I could see no visible rashes. Finally, I started seeing some pediatric patients. One young girl came in who was 11 years-old, but she looked like she was seven or eight. She was very cute; her hair was in pigtails, and she spoke softly. She was by herself, so I guessed that her mother was being examined in another room. Her chief complaint was that she has had loss of appetite and difficultly sleeping. One look at her, and I could tell that she was malnourished. She had bags under her eyes, her skin was pale, and she looked tired. She answered my questions as best she could. After the history-taking, I listened to her heart and lungs which were both normal. I examined her abdomen while she was sitting on a chair. It was difficult to assess her. There were no exam tables and no where for her to lie down. I consulted with Richard, and we both agreed that she probably had some parasite which was causing her loss of appetite and malnutrition. I prescribed her Mebendazole, an anti-parasite medication, a multivitamin, and Calcium + Vitamin D. All of the children I saw that day had the same look: bags under their eyes, pale, underweight, and tired. What a contrast to the obese and overfed children of America. Couldn’t we just find some sort of balance and equalization of these extremes?
During my examinations, Scott and I saw and heard a lot of firsts. We saw our first perforated eardrum, which was a black hole in the pale grey membrane. We heard our first Grade 1 systolic murmur of a 14-year-old boy. It was a soft whoosh-dub, whoosh-dub, for every beat in contrast to the strong lub-dub, lub-dub of a heartbeat. The boy had been experiencing fatigue, especially after running around, for some time. His mom told us that he had been diagnosed with some sort of valve issue by the Vietnamese doctors here. I asked her if she had ever noticed her son’s lips turn blue from strenuous exercise, and she said no. I told her that there was no medicine that we could give her to make the valve problem go away, but I told her that if the fatigue worsens, she must see a doctor again. We also saw our first “cerumen impaction.” This may sound impressive, but don’t be fooled, it just means a lot of earwax in the ear. I looked into a young girl’s ear and could not see her eardrum, just a lot of dark substance. I was so worried because I had no idea what all the strange substance. Richard comes by and says, “Yeah, that’s just a lot of earwax.” Scott and I saw more patients, and he did many of the lung and heart exams after I showed him how.
Many of the patients wanted medication that would cure them and make their problems disappear. I would ask a patient a question about her symptoms, and she would respond, “You are the doctor. You tell me what problem I have. You tell me what I am supposed to feel.” I think they put a lot of weight on what we had to say or, at least, expected some sort of miracle from us. I did the best I could, and mostly prescribed ibuprofen for pain, vitamins, and occasionally, high blood pressure medications. Even so, what would happen when their high blood pressure meds ran out in two months? Would their blood pressure spike again and cause a hemorrhagic stroke (bleeding in the brain) like so many patients that I saw at Kien Giang General Hospital? I could only hope that we were doing some good for them, if only to offer them the comfort of seeing a “doctor”.
We broke for lunch and all the volunteers crowded outside where there were large bowls of rice, stir-fried noodles, and vegetables. We rested for one hour and ate bananas for dessert. Afterwards, we got back into the grind of things. I don’t know how doctors do back this at home. They have to examine so many patients in so little time. On top of all that, you have stay alert, attentive, and in a good mood. Our last patient of the day was a young 2 year-old boy who has had loose stools for 2 months. He complained of stomach aches and just seemed a bit tired. Scott and I guessed that he probably had an intestinal parasite as well, so we prescribed him Mebendazole. It was finally time to pack up and leave. We all got on the bus and immediately fell asleep, regardless of the bumpiness. We ate dinner with the volunteers again at the same restaurant, Nha Hang Nam Nho, and everyone went back to their respective hotels to immediately fall asleep after the events of the day.
-Audrey
No comments:
Post a Comment