POOR PATIENT. I read this label on a patient’s chart, realizing it served as a warning to the providers at Cho Ray Hospital. While I was aware of healthcare settings with limited resources, only here in Vietnam, working at what’s touted as the country’s largest and most advanced hospital, did I gain the unfortunate appreciation of realizing how severe it is: The emergency room is so crowded with patient beds that it’s a fire hazard and families bag intubated relatives day and night because of a lack of ventilators. Treatment is limited to what the family can afford, which is little when the average salary is less than $200 per month. Families must stay with their families during the hospitalization – not so much to provide them support as to care for them by administering certain medicines, bathing the patient, and cleaning the area. The families of patients, too poor to afford housing while traveling from afar, litter the hospital floors at night as they sleep on cardboard. The most unnerving of cases was a 17-year-old boy, previously healthy, who fell off of a motorbike and suffered trauma that compromised 70 percent of his liver. He and his family are farmers and are unfortunately unable to afford plasmapheresis or a $1,500 liver transplant, and he sat idle as his bilirubin and ammonia levels rose. As a result, he was expected to die in the coming days.
While the hospital has its fair share of differences in practice compared to the U.S., what is most remarkable to me is the lack of primary care. While people speculate about the lack of well-trained physicians (doctors in Vietnam can practice alone after six years of post-high school training), and inability to afford the care as barriers, one thing is certain: Preventive medicine is not developed. Even a disease as common as arthritis is never treated under the guidance of a physician. It was commonplace to see middle-aged people obtain the very cheap prednisone-containing drugs from the pharmacy to treat arthritis (without a prescription, of course). The unmonitored use would certainly provide relief for the pain, but it would also bring about Cushing’s syndrome, adrenal failure, and even multiple cases of sepsis. There was also the unfortunate opportunity to see untreated rheumatic valvular disease, tuberculosis, congenital heart disease that should have been repaired during infancy, and other ailments.
As poor as Vietnam’s healthcare system is, they make up for it in their rich culture. The people are extremely generous. In a country that regards its own culture very highly yet admires that of America, I felt like an instant celebrity to the amiable people. Physicians, after meeting me for only a couple of hours, eagerly invited me for lunch or an outing to try their delicious pho soup, sticky rice dessert, or avocado drink. I recall one night when I was returning home from sightseeing when I stopped for street food. After 15 minutes, I was beckoned to join a group of close friends, which turned into hours spent enjoying the differences in our cultures and singing the night away with songs from the American singing duo from the ‘70s, The Carpenters, in broken English.
In the end, I have learned a great deal from my six week-long global health elective in Vietnam. I gained a deep appreciation for the Vietnamese culture and an experience with the healthcare system that was as unfortunate as it was motivating. It has refined my calling to medicine and left me excited to have an impact on others. Lastly, I’ll make a quick plug for experiencing this alone or in a small group. Doing so puts you in an unfamiliar place with an unfamiliar language, which is absolutely scary at first. But the soul searching of assimilating to the local culture and understanding it is something that I feel would be hampered if you were to be able to rely on your American brethrens for support. The act of being uncomfortable and looking into the surrounding community for support is quintessential to make the most of the experience.