March 31, 2008

Home Visit in Vietnam

I was so exhausted from the travel to the Perfume Pagoda that getting up to go to K2 hospital today was a struggle for the first time since I got here. I think that my biorhythms are resetting so that I now feel sleepy at the right time of day.

The waitresses at the hotel already knows my breakfast order by heart. I feel bad about not leaving a tip for such good service but tipping is not considered appropriate. Then it was off to the K2 by taxi. I know the way now and when he tried to turn down Huong Trih I knew to say “What are you doing!” and he went on straight to 1 and the hospital in record and safe time. Professor Yen had asked me to come to the morning meeting and we got into a good discussion of Colon Cancer staging and treatment.

Afterwards I got to meet Dr. Yen for the first time. She is wonderful to spend time with and her patients are so fond of her and appreciate her obviously good care. I will digress on names here for a moment. There are only about 20 different surnames in Vietnam. So you can not use them for every day. Therefore people go by there first name so Mr., Mrs., Dr. or in this case Professor Yen (pronounced like Ian). However while there are more first names, some are very popular and are frequently not gender specific. Therefore I am working with many Yen’s, Houng’s and Thuey’s. We visited together a hospitalized patient and an outpatient with the residents participating and I think I am making progress with understanding how to be helpful. Afterwards, we ate lunch together in the doctor's work room. Dr. Yen told me that many visitors were surprised to be asked personal questions about family and marriage, children etc. but that I had asked her these questions before she could ask me. I told her that I had read before coming to expect this, so I thought that my new Vietnamese colleagues would expect the same from me. I did not tell her that I was like this at home anyway and that I love the fact I can indulge myself in being inquisitive; my wife might another name for this behavior.

After lunch we were supposed to do home visits. This was starting to rattle me because Eric called and said he could not come, Cuong was gone and now Dr. Yen was not going to be able to go. She did prepare me for the visit and the home nurse, and Houng and Thuey and I went. Of course they had picked a good prospect; delightful women, living with her daughter, who had cancer and the lived together in a nice home. The house was down some very small alleys off a main boulevard in Hai Ba Trong District. We all had to take off our shoes to come in and then talked about her symptoms and I did a brief exam, answered questions and told her that I would report back to Bac Sy Yen. She told the resident doing translation that I had not made her sad like some doctors did. She worries about what will happen if Bac Sy Yen is out of town when she needs her.

Then back to the apartment to work on lecture. This may not seem that busy but with translation and teaching it is a full day. It is like doing 3-4 new consults.

Was able to get groceries, use my ATM successfully and get coffee from my new favorite Vietnamese coffee house that also already knows my order. More on the Pagoda trip when I can process it more.

Perfume Pagoda

March 30, 2008

Perfume Pagoda; and all day trip

Cuong had invited me on the same day we met (Friday) to come with him and his extended family to visit the Perfume Pagoda, which is a Vietnamese site I had read about in the guidebooks. They picked me up on Sunday at 4:30 AM to start the adventure. We drove about 2 hours south and west from Hanoi toward the mountains. These mountains are unusually rounded shapes on a flat plain. The Vietnamese seem to think that they look like elephants.

Cuong was the only one in the group that spoke functional English. We had his frail mother and 90 year old grandmother of a sister-in-law, various aunts and uncles and two teenagers, Cuong’s niece and nephew. The Perfume Pagoda is not a Pagoda but a large number of sites, some with Pagodas separated by mountains and the rivers. A Buddhist Monk founded the first Pagoda’s over 500 years ago. Now, 4-5 million Vietnamese visit the pilgrimage site each year, most arriving during the 3 months after Tet. In fact foreign visitors are not recommended to visit at this time of the year (I realize now). I saw only 2 foreigners during the whole trip, and many times I was the only foreigner there. This was not a tourist trip but a religious pilgrimage I had joined!

We stopped at a small town where there are 1000’s of boats on the small river ready to ferry visitors up the river which is the only way to get there. After a breakfast of Pho and some other things I did not recognize, we all got in a boat and a young woman took us to the first site which was on the river. There was incense and a fire and the temple itself. At each site we would get a lot of different materials out. Food, drinks, rice flowers and some symbols of gold coins and other items the ancestors might need. The platter was carried by the middle aged men into the temple and left on the alters while prayers were said and other sites visited. This was repeated at other sites as well. After awhile they went back for the offerings and carried them back. Some were burned and others, like food were eaten as a connection to the ancestors and since the ancestors had already got the benefit from them.

After getting in the boat again the next ride was up the river 3 kilometers to a new site reached only by boat. We would now hike about an hour up a steep mountain. There were Pagoda’s all around but the final destination was a natural cave that you descend into. Some of the stalagmites apparently look like mounds of rice and mothers milk . We went as deep into the cave as we could to a Buddhist alter and then our gifts were made. There must have been 10,000 people in the cave and the noise, incense and the intensity of the crowd was nearly overwhelming.

Part 2 tomorrow. - I have just got back from the 18 hour trip and all though there is much more to say I will have to wait till another day. Will put up some pictures in AM

Badminton played with your feet, Washers that are dryers too.

March 29, 2008

Catching up and House Keeping

Last night after work it was off to the Vietnamese Folk Opera. Eric and I walked from our apartments, about 20 blocks, to a theatre district that is on a large central park that reminds me of the Central Park in New York. A number of colleagues attended as well, Dr. Thuy, head of Infectious Disease Intensive Care in HaNoi and her husband who is an educator and Cuong who I had only meet today from the 09 center and his girlfriend, his class mate and his wife and child, so a large group.

The theater was new, nice and comfortable and there were 8 musicians, 8 singers (4 women and 4 men). The music was very ethereal with unique instruments, several stringed with only 1 or 2 strings but that were played with bow or slide and seemed to be able to produce harmonics with more than one note even with only one string. I was fascinated by this music that does not have a tonal structure like the west. Also one of the songs seemed to have an 11 beat repeat. Certainly not a simple ¾ or 4/4 kind of structure. Unfortunately about half way through, the jet lag began to set in and I could not keep my head from nodding. It is interesting that you can feel quite awake and then sit down and off you go. I will try to go back when I can fully appreciate this. After this it was off to a juice bar to sit and talk in small groups. Oi ep, or guava juice for me. As is always, you are complimented on knowing any Vietnamese at all. My host is able to speak English, French, Japanese and Russian in addition to his own language. The Russian is from the Soviet time in Vietnam.

Cuong asked what I planned to do on my days off. I said that I thought I would sleep in but did mention visiting Ha Long bay and the Perfume Pagoda. At this he told me that his family was going to the Perfume Pagoda on Sunday and invited me to come. I will be leaving very early in the morning to go and will fill in with more details after I get back.

I slept in late. The apartment comes with a combination washer dryer. I do not mean one on top of the other but that the same machine does both. First washes and then it turns into a dryer. Can only do 6Kg of clothes but did use the washer and dry also using a drying rack. Eric is still at work and I did what I could but then took off on a walk. St. Joseph’s Cathedral is downtown and somewhat worse for wear. I went over a few more blocks north and there were all kinds of markets with foods once again that are kind of unusual for westerners. There were tubs with shrimp and fish still swimming around so that they would be fresh for the customer. I also walked by the Children’s Palace and a monument to a great Confucius scholar. In front of him some young me were doing some impressive break dancing while others play badminton with their feet. They kick the shuttlecock and it is like hacky sac but as badminton. Amazing.

I am going to study some more Vietnamese and go to bed early for my visit to the Perfume Pagoda.

Batter fried boiled Eggs? What to do?

March 28, 2008

This was a day for going solo. Eric, the guy who recruited me, had to go to different hospital so I was off to K2 on my own today. I got there this time all the way in the Taxi although he wanted to charge too much as is always the case.

The day started off cool and I think it must have rained some last night because the city looked washed. Still the road to the hospital is impossibly narrow and pitted and this is the second campus of the National Cancer Center. I got to meet with the Professor today and have coffee and chat before he went to do a colon cancer surgery. He has asked me to come a little early on the days that I am there so that all the doctors can practice their English during their morning report. The Professor has had a very full life and would be interesting to talk with more. He was in the Army as a doctor in the war and also spent some time training in the Soviet Union. Now he is learning English. He is interested in starting a home care program and I told him that that was something that I thought was a great idea since it was good for patient, family and health system. I will be glad to offer our experience at the VA.

Oddly some of the fellows had other duties so today I so saw three follow-ups and one new patient with endometrial cancer. We discussed the other treatments for this.

The fellow paid for my lunch today. It is impolite to refuse but also it is difficult to take something from someone who I know does not have much money. I ate everything except for the deep fried boiled egg in a batter. This seemed a little too strange. She told me that one of her professors told her not to eat too many eggs because of cholesterol. I told her she was so tiny I doubted that would be issue. I gave the fried boiled egg to her and she seemed to enjoy it very much. Maybe I should have tried it? Later one of the doctors was talking and from what he said the government pays them about $7 dollars a day. I felt even worse about getting my lunch paid for after hearing that. The cab driver got paid 5 dollars for taking me to the hospital so I can see why some jobs in this country, while they take much training, do not support a family or pay debts .

In the afternoon we had a very interesting and difficult case for us about HIV and a brain lesion. I doubt that we will know for sure what this is but I am confident that we can help him be better.

Now back at the hotel and I hope to try to get some rest. I am starting to feel a little sluggish. However, tonight I am going to a traditional Vietnamese Folk Opera that Eric has arrange for us to attend. More information to write up on that tomorrow and more pictures to put up.

Giant Turtles. swords and what to say and not say

March 27, 2008

Since last post I have been out and about. Roberto, the Italian that helped me find the hotel saw me on the street and showed me a nice restaurant for supper. He says I will owe him a meal if he helps me out again. I also have been able to get the Blackberry up and going and so that lets me do work emails so that I won't have thousands at home when I get back.

Eric and I went to K2 hospital together today. This time the taxi did take us all the way to the building. I got to round with the fellows to see a new patient with cervical cancer and we reviewed the case and x-rays. It is good to look at the x-rays together so that they can learn to look at the studies themselves. Lots of discussion about the treatment and cause and now what do we do with it coming back. Culturally the discussion of goals of care that I am so used to doing is not appropriate. I don’t know what to say about this. Kubler-Ross when she wrote about death and dying in the US in the 1960’s, was heretical because it was assumed that talking about cancer and prognosis openly was not culturally appropriate. Now we know that many people do want to know about their illness, and with the movement of patient autonomy we tell everyone what is wrong with them.Usually this is for the good, although some people still are overcome by the prognosis and diagnosis.

I think that here it is more of a cultural issue here than it was in the USA ; but it might be overstated here in Vietnam like it was in the USA. It would be interesting to interview patients for their preferences of information and amount of information to see if it is true that they do not want to know the prognosis. I always think people really know most of the time inside that things are not going well. It is hard to plan care though. when you cannot talk openly about how people want to spend the time they have left.

I bought a mobile phone for use here in Vietnam for 600,000 dong; about 30 dollars. Now if I get stuck somewhere I can call locally for help and plan meetings and outings with colleagues here.

After that I went to walk around the Lake of the Redeemed Sword? This sounds a lot like King Arthur and Excalibur but it involves Confusion philosopher and a giant turtle that carrys the sword around. I guess the turtle will keep it until it is needed again. Area is pretty lots of people watching to do and I will want to go back soon.

Now to work on next lectures for tomorrow.

First day on the job

March 26, 2008
First day in Vietnam and I am on my own. Eric has suggested that I come to the hospital for lunch or afternoon if I can rest up some. So that was the plan. I changed some money; $100 is equal too 15,000,000 dung. The calculation of what something is worth is a little tough for me now but a 1,000,000 dong is about 6 bucks.
The hotel used to be called Hanoi Towers before Somerset. The strange thing is that before that it was the notorious “Hanoi Hilton” where prisoners of war were kept. This place had been a prison for over 100 years ago and the French built it originally. The French imprisoned Vietnamese and tortured them until they left about 1960. Of course the Americans have strong feelings about this place too. They have torn down most of the prison to put up this modern hotel/retail complex; but there is a small museum. I have not gone in yet; but did take some pictures of the outside. There was a busload of Americans coming to visit and also many Vietnamese bring gifts of flowers and incense.

I had breakfast here and the waiter tried to help me with my Vietnamese. Everyone is so friendly. I have had trouble with Taxi drivers. This time I was supposed to go to K2 which is one of two campuses of the National Cancer Center. This is located south of Hanoi. The taxi driver called the doctor there for directions. He drove me quite a-ways and then he stopped at what was clearly a hospital. I got out and he left and when I went in they indicated that where I wanted to go was about another kilometer down the road. I walked and found my way to what looked to be the end of the alley and then went in. I found Dr Eric and the doctors doing the fellowship, and they showed me around. See the pictures and you will notice that it is mostly open air. Rooms crowded with beds and 2 people to a bed. Sometimes families were staying in the courtyard.

I had lunch in a little restaurant right there with the other staff and I got a couple of great pictures of that.
People are very impressed that I know any words of Vietnamese and pleased and I can understand a few words of what people say. They had already spent the morning on rounds and in the afternoon there was a lecture and introductions and then a case to present. I had a great time with the discussion and people are very interested. It is interesting and sad about what they have and don’t have. They have a Cobalt machine for radiation and said that they are going to get a linear accelerator. However, the electricity was out from the time I got there till about 4PM. On the other hand they did run out of some TB drugs that they needed for a patient at the other hospital.
I will post some of the pictures on line for you all to check out.

Getting here and arriving

March 24 and 25^th are running into each other. I left today for my flight to Vietnam. Marci took me to the Birmingham airport and after a short flight to Atlanta I flew on Korean Air to Inchon (Seoul). It was a strange experience because we left at 11 AM March 24 and arrived in Korea on March 25^th at 3:30PM but the flight was 13 hours long. We flew over the North Pole, Arctic Ocean and then Siberia. We took a jog to the west to go over China instead of North Korea. The flight was not that full and I could stretch out some but not much sleep. It never got dark. We took off and flew into the Sunset so that it never set. It was hard to sleep when it is so bright. I did a lot of re-reading the HIV/AIDS protocols and reviewing materials.

I am now in Inchon Airport and waiting for my final leg which will get me into Hanoi. I am just going to try to stay awake (I really don’t feel sleepy yet) because it should be after 11 PM local time when I get checked into my hotel in Hanoi and then I can just go to sleep. I hope that will help me get on the right time frame pretty quick.

The Inchon Airport feels very Western to me with the same kind of store fronts and monitors. It just that the news is in Korean and of course I can’t out what they are saying. There are still a lot of Americans here since the Military presence here is strong so I see young looking people clean cut looking like they are reporting for duty.

I will write and send more when I got to Vietnam.

The flight to Ha Noi I finally got some sleep. Getting in to the country was interesting in that there were no inspections or questions. No one opened my bag. Mr. Eric was supposed to pick me up at the airport but apparently he did not get my plane message and he called Marci. I hope that that did not worry her. I could not find Eric so just got a Taxi my self (phrase book) and came on in. The driver wanted me to pay a toll and I said no way that was part of his cost and then he could not find my hotel at all. I showed him in the map and new that I was in the right area so when I saw a very rich looking hotel I told him to stop let me out. i went in to get directions but this Italian older man told me that the hotel was only one block away and showed me from the door. I walked over at Midnight and only one person asked if I needed a massage.

It was my hotel so I am here safe and sound feel pretty good and will start the day.

I have a few pictures from the hotel but no time or battery to post today.

Will write more tomorrow.

By the way the Italian guy got worried about me and a few minutes after I was in the lobby he showed up to make sure I was there. I wish I had got his name.

Preparing to leave

Signed my beeper out for 2 months & changed voicemail greetings to "Please Do Not leave a message"
Packed my bags - tried to take the bare miminum.
Got the garden soil tilled and ready for family to plant after the danger of frost has passed.

First Post

I leave for Vietnam on Monday.