Since returning from Vietnam, I have been unable to see U.S. hospitals in the same way. The halls here are clear, there are rarely more than two people to any room, no one is refused standard care based on their income, and visitors only populate the hospital during certain hours. While there is a noted difference in care, it is only a factor of resources and the system in which physicians are operating. What Vietnam’s healthcare system lacks in resources, it makes up for in ingenuity, resourcefulness, and the cultural importance of family.
In Vietnam, the family is truly a unit, both inside and outside the hospital. I have seen family members function as an IV pole, a fan, a ventilator, and perform all the duties (and more) of a LNA. Family members serve as a strong patient advocate, something which is desperately needed in the crowded and busy hospital.
The daughter of a patient, an American citizen that had flown in that week, sought out our help as to get extra care for her chronically ill and declining mother. The mother of a young man called attention to her coding son, sending physicians and nurses rushing to his side to save his life. The same mother later made the decision to take her son home after his rapid decline, signaling that his final moments were approaching.
One of the interns I spent much of my time with in the pulmonary unit left work early to take care of his mother who had woken up that morning with common cold symptoms. Her tonsils were inflamed, he reported, and he wanted to go home and collect a sample to run tests on. I was pleasantly surprised and told him that he was an extremely caring son. He, in turn, was surprised by my response, telling me that it was very common in Vietnam. “I am the doctor of my family and I must take care of them, so when they are sick, I am there.” In the United States, I explained, everyone usually takes care of themselves, and it would be frowned upon if I called out of work with a mild illness, let alone someone else’s. He looked at me in shock.
One night at dinner, a Saigon resident explained that only 60% (up from 10% in the 1990’s) of the Vietnamese population has health insurance, and bribes impact the quality of care even for those with insurance, including in public hospitals like Cho Ray. If a physician at Cho Ray is performing surgery, the patient must show up at their house the night before with money. While it costs $1.50 USD per day to stay in the hospital, it costs $100 USD per day to stay on the 10th floor, commonly referred to as “heaven,” where rooms are comparable to those in the United States.
I pondered the financial burden most families were enduring. Atop the stress of having an ill family member, they take time off work to care for them, carry heavy belongings up eight flights of stairs in the heat of the day and sleep on the hospital floor at night. All of this on top of the fact that many citizens are unable to afford health insurance. It is no wonder family is so valuable there – you cannot survive without one.