Wednesday, June 30, 2011 - Friday, July 1, 2011
I’ll talk about yesterday first. It seems that I always need to leave my mark in a country by fainting in it. I fainted in both Greece and France when I visited. In the morning, after breakfast and as we were sitting at the table talking to Dr. Man, Thu, and Annie (another PVNF volunteer), I started getting the feeling I get when I want to faint. My vision gets funny, and I have a general ominous feeling. I warned Scott and then fainted into Scott’s lap at the breakfast table in front of everyone! This was also the first time I have ever met Annie, and this was my introduction? Needless to say, I was a bit embarrassed. We went back to the hotel, and I was starting to get some aches and pains in my arms and legs, so I slept all day. I just generally did not feel well. Scott brought a blood pressure monitor with us for the study, and he took my measurements. My blood pressure was 94/50 mmHg, which is low for me!
During this time Scott had to edit his questionnaire, which sounds simple, but is extremely complicated. He uses Microsoft Access to develop a questionnaire in which he has to program each answer to be linked to a database/excel sheet so that he can analyze the data here. It is impressive to see what he has done, to say the least. After talking to my mom on Skype, I started feeling a little better since being sick made me homesick. I ate my protein bars, took my Vitamins, probiotics, Pepto Bismol, and Advil and was ready for dinner with Thu and her family. Just before dinner, we met with Giang, a PVNF volunteer based in Vietnam who is helping us find a translator after Thu leaves. She was extremely warm and welcoming and patient with my Vietnamese. She even offered to take us around Ha Tien on one of the weekends! We all headed over to Hoa Bien Hotel to meet up with Thu and Annie, and four of her family members rode up on motorbikes to take us to the restaurant. Scott, Thu, Annie, and I all hop on the back of someone’s bike, including Giang’s, and we all ride off like a large motorcycle crew. Scott and I have been waiting for this moment—to be riding with the locals and cruising through the city.
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| Everyone at dinner |
At dinner, Thu orders for the whole table. Let me just take a moment to say how wonderful Thu has been to Scott and me. She has really been taking care of us, showing us around, being our translator, and introducing us to her family. We are so thankful that we met Thu, Quoc, Richard, and Han in Saigon. The food comes out and there is dish after dish of pure “yumminess.” We order crunchy tofu, an edible green flower, noodles, clams simmered in tamarind sauce, and of course, lau. After dinner, I start feeling funny again and tell Scott that we need to leave. We get up to walk out, and the world turns black, and I feel as if I am dreaming. I hear people scrambling all around me and voices overhead. “Should we take her to the hospital?” I come to to find myself lying in Thu’s aunt’s lap, and she is stroking my arm and telling people not to worry—that we are both doctors and do not need to go to the hospital. I look around and everyone is staring at me. I just fainted in the middle of a crowded and busy restaurant. The taxi ride home lasts forever, and I just want to lay down.
The next day, I wake up and feel a little better. (Scott makes me drink 3 L of water for the day to combat the dehydration). It’s our first official day on the job with Thu. We eat breakfast at Hoa Bien Hotel and head off to work. Our first patient is a 60-something year old woman who is overweight. We walk into the room, and she immediately starts crying. Something in me wants to reach out to her and comfort her, so I stroke her arm and say in Vietnamese, “Don’t cry, don’t cry.” She stops, and I perform the NIH Stroke Scale on her. The patient is weak on her right side (arm and leg) and has slurred speech. Somehow this makes her sound more like she is 5 years old than 60-something, and I become immediately attached. I want to help her or to comfort her. I want to do something for her. She finds following my finger with her eyes extremely funny and starts laughing. I complete her score, and it is an 8, which means that she has a high chance of having a good outcome. What more can I do? Thu starts the public health interview on her. The patient cries on and off during the whole thing. Her family is poor, and she takes care of them by cooking food and selling it on the streets. She worries about how she can do this now that she has had a stroke. The patient complains that she has had a hard time breating for the past year, so I pull out my stethoscope and take a listen. I don’t really know what I am doing, since I am just a first year medical student, but what better way than just to listen? I think I hear rhonchi, an abnormal breath sound, but I am not sure. Thu does a great job with the interview, and we break for lunch.
Thu takes us to buy some fruit, which we have been dying to try. She haggles the prices, and we eat fruit for lunch back at the hotel. We get all these round and circular fruits, each with ugly shells and spikes and covered in dirt and grime. But we have to work for the treasure inside. We peel the skin away and inside, we find pearlescent, juicy meat. There is one fruit, called
bon bon, where you peel off the skin and there are segments of clear flesh inside. The meat is sweet and extremely fragant. There’s nothing like sharing a bag of fruit with friends.
Back at the hospital, we interview 2 more patients, each with increasingly worse NIH Stroke Scales. I have to get my scores without the patient’s family helping, but they so want to the patient to do well. This was sad to see. A patient who is unable to speak and unable to use her left arm and leg. I can’t imagine what this would be like.
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| In our scrubs and white coats |
How do I explain the hospital here? It feels more like a community center than anything else. Three families are packed into one small room, with each patient on their beds. At first glance, you would think that everyone is related. They talk to each other candidly and help take care of each other’s sick family members as if they had known each other for years. On second glance, these families have just met each other by mere chance—the chance of being put in the same room. I feel like the patients go on holiday here. They come ready with their luggage, their bags of toiletries, and their food for the week. Children are running down the hallways, barefoot and laughing. Families care for other families. People wash their clothes in the hallways downstairs, and you see all the clothes hung out to dry. Coconuts are being chopped. A woman is walking around selling sugar cane juice. People are showering, lounging, eating. People are just everywhere, hanging out. Yet, I would not call it a happy place. Patients are overflowing. Patients in the neurology ward are seriously ill. They are paralyzed on one side, speaking gibberish, crying. Rigorous, productive coughing is heard from two rooms down and a man’s foot is black. This is a place for people to come together and support each other. They all sleep in the some room as other families and on the same beds or on the floor. We are used to seeing nurses’ being the primary care givers of patients in the hospital, but, here, that is what family is for. They bath them, change them, feed them, A little girl helps me assess her grandma. She asks, “Grandma, what is it? What did the doctor draw?” as we point to the shape on the paper. I turn to her and ask, “Do you know what it is?” She shyly nods her head. I ask her, “Tell me. You can whisper it in my ear so we don’t give it away to your grandma.” "A heart," she answers.
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| Audrey and Annie |
Performing my exams is like putting on a show. Patients and their families from all the other rooms gather outside and watch as I examine the patient. They must think I am doing something important. I don’t know if I am, but I am trying my best to assess the stroke severity. They probably have never seen patients assessed as we do in the U.S. I get shy smiles from everyone. Scott and I walk down the hallways, and everyone stares at us in all our pomp and circumstance—scrubs and a medical student white coat. It feels like we are celebrities. Well, that Scott is a celebrity, and I am his groupie. Being a “big, white guy” has weight here in Rach Gia. People stare at him with interest and barely glance my way because I am a woman, and I am Vietnamese. I hear woman whisper at how handsome Scott is, and I hear woman joke that he should marry a woman here in Vietnam. I see men pass by and touch Scott’s arm as if he possesses some sort of power. “Hello, doctor,” they smile, hopeful. I wonder what they are hoping for with our being here.
I was administering the stroke scale to a woman the other day who ended up scoring a zero, but she had other issues including diabetes. She complained that her legs and feet had been getting tingly and numb. I haven’t taken pathology yet, but I suspected she was developing diabetic neuropathy, where patients lose sensation in their feet due to nerve damage and the high blood sugar levels. She asked me if I was going to treat her or give her medicine. All I could say was that I was examining her. I wanted to be able to do more. Give her a long-term solution. I guess we take all the medicines available to us in the U.S. for granted. Diabetes can be well-controlled with the right medications and lifestyle changes. I wonder if the patient knew that.
Children chase after us as we walk down the hallways. Everyone calls us “doctor,” and I feel that I do not deserve the title. I still have 3 more years ‘til I graduate and probably 30 more until I really know my field, yet Scott and I have some sort of presence here.
Our first week on the job at the hospital was a tough one. Adjusting to their work style and dealing with translations make everything so much slower. Scott and I get lost in the hospital because we cannot read the signs. When I speak under pressure, I forget all the Vietnamese words and end up stammering through all my sentences. It is frustrating. I don’t know how my parents learned English when they first moved to the States. Administering the questionnaire also went slower than anticipated because of the health literacy level of the patients and our speaking ability. We also had issues with finding translators to replace Thu once she leaves. We found a break in the clouds when Thu found 3 Vietnamese college students who were willing to volunteer their time to interview patients in exchange for practicing their English. We met Ngan and Tien, two optimistic and intelligent college students majoring in English. Thu trained them, and we are excited to start work on Monday with our new translators.
I have started associating the patients I have administered the NIH Stroke Scale to as my patients. I checked up on 3 of them, and they had all improved! The crying lady was still crying, but she was able to admit that she was much better than the day before. She had regained some of the strength in her arms and legs. Another grandma I saw was more lively and alert, and yet another patient I visited got some of her speech back. It really brightened my day to see this.
The first man we practiced the stroke scale on was a 60-something y/o man. Scott really developed rapport with him through a lot of pantomiming. I was watching Scott as the man talked to him as if Scott understood. Scott threw out all of the words he knew, which were all food.
Old man: “So, how old are you?”
Scott: “Hu tieu.” (Vietnamese noodle soup)
Old man: “What are you doing here?”
Scott: “Banh xeo.” (Vietnamese pancakes)
Old man: “What is your name?”
Scott: “Toi chup hinh duoc hom?" (Can I take your picture?)
It was quite comical to say the least. Day after day in the hospital, the old man would wave and pantomime eating a bowl of rice everytime he saw Scott. On Friday, he told Scott that he should stick around and marry a Vietnamese woman, right in front of me! I jokingly point to myself and say, “She’s right here.” He says, “Marry two.” All the while, our newly translators, Ngan and Tien, are by my side and defending my honor. It was good to end the work week on a humorous note.
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| Do! (cheers in Vietnamese) |
After dinner, we head back to the guesthouse, and all the hospital guesthouse employees and a few guests are enjoying dinner in the front lobby area. We are greeted by drunken cheers and invitations. "More friend!" Only two of the men speak some English, and there is a Korean couple who do not speak Vietnamese. They pour us Saigon beer on ice. (In Vietnam, beer is served with ice in a cup, rather than cold and out of a bottle). The men think that it is funny that I can speak Vietnamese, but they also seem somewhat impressed that I do know how to speak it conversationally. The night is spent talking about random things like: pho (Vietnamese noodle soup that we found out originates in the North), cooking translations, and learning everyone's names. Every few minutes we are interrupted by "1, 2, 3, Do!" (sounds like 1, 2, 3, Yo!), which is "Cheers" in Vietnamese.
-Audrey
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| Sunset and our neighboring lighthouse |
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| Lady enjoys selling us chom chom |
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| Thu and Annie at our favorite lau restaurant |
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| Finally some natural electrolytes! |
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| From shortest to tallest before banh xeo |
