Home at last

The trip back home was long, but pretty uneventful. I did catch-up on some of my sleep on the plane and jet lag has not been too bad here. Marci and Lydia were trilled with the presents and some of the pictures and drawings I had made.

It is interesting that with the advantage of Skype video phone daily that both Marci and me feel that we are pretty well caught up on what has been going on. The yard and home look great with the green grass and all the flowers doing so well with such good weather this year.

Of course it was a sad leave taking from all my new friends in Vietnam and I know that I will be keeping in touch with them by email. I hope that some will get the chance to come visit us in Birmingham at UAB. I don’t know when I will get a chance to return to Vietnam but I am sure a shorter trip could be possible in the future.

This will be my last post for the Vietnam Visitor Blog. You might want to check from time to time over the next few weeks as I will be adding more pictures to the link as I am able to and as the computer will allow. So you should check back to see everyone in the Palliative Care Hat.

Cam on bac si cham soc giam nghe nhieu.!!!!!!!!!!!!!!!

Mong duoc gap lai bac si cham soc giam nghe.!!!!!!!!!!!

Happy Buddha’s Final Day in Viet Nam

Yesterday we listened to the rest of the projects that the fellows are designing. I know that this program that I have been working with will bear fruit. All of the fellows have good plans for projects to apply what they have been learning. The projects are quite sophisticated. It is clear that the MOH (Ministry of Health) sees them as leaders and teachers and is expecting change.

In the afternoon we had the Memorial Ceremony at the 09 Center. I have such mixed feelings about the 09 Center. There is great need for emotional, social support and this is clearly the type of place and patient that I am attracted to work with. However, the needs are great and sometimes even an important medicine would be in short supply. However what those who are so close to the end-of-life need is the human touch. Today, I learned about the charge of Uncle Ho was for the “medical staff must be a gentle mother to the country” and that this is the written over the gate of the hospital. I know from working in West Virginia and Cooper Green and the VA, to a degree, that the needs of palliative care are low tech and the human touch. It is of some reassurance that soon 50,000 Vietnamese could be on anti-retroviral therapy and the rate of infection and numbers of infected are now declining. We had a roll call of remembrance with flowers, and messages that we wrote and then burned to release the messages to the world. This was moving and wonderful and I think that seeing smoke as a spiritual connection must be almost universal.

I have also started to receive gifts. I have, with some cleaver packing, been able to get everything into the suitcase. Eric got a mask decoration of Ong Bac who is the mythical teacher that all turn to at times of testing. I on the other hand got the happy Buddha. With my round, face short hair and by report always smiling this was the most appropriate for me. The happy Buddha is everywhere and he is for good fortune, safety and good times. Both of us could use to loose weight and after this trip I think I must try again.

Then began the dinners; as in the Alabama all occasions are occasions for food. Tonight we had a wonderful feast at a restaurant that trains underprivileged young people to work in the food service.

Today we had the graduation and the high officials from the MOH were here to award the certificates and celebrate. Many speeches were given; but all with the theme of bringing palliative care (Cham Soc Giam Nghe) into all the hospitals. Then it was off for a meal again, this time at Dr. Hung’s restaurant and it was a special meal (including tiny baby birds whole). I can tell that this could be a rowdy, fun hang out and fits his personality so well. It reminds me of the Burley Earl.

Only a few more chores to do; I have managed to sale my cell phone back and I know that I have my assigned seats against the window to both look out and sleep against. I will be looking for home to come into view soon. However, everyone wants to know when I will come back and I know that I can not say for sure but I know that I will think of Viet Nam often and I hope that many of my friends here will visit us in Birmingham.

Starting to Wrap Up

I didn’t feel any tremors after the big earthquake in China but apparently some people in Hanoi did. It is strange to be in this part of the world that has had a major earthquake and typhoon in the last week. The photos are terrifying. Some people here may be going as relief groups to China. Of course the Myanmar junta will not let anyone in to help.

Hanoi is quite busy and I have seen Buddhist monks and nuns all over the city as the International Vesak Day is celebrated. I have hoped to visit some of the Pagoda’s but haven’t had time with a pretty busy work schedule. We are helping the fellows get their research and program development projects written. They each will get some financial support. I am very impressed by the quality of the projects and how much they have been helping each other with instructive reviews and discussions. This is part of the reason I haven’t been out since I have been working a little later with Eric to get all this done.

I am looking forward to getting home. Certainly, coming to Viet Nam has been an amazing experience but I do miss my family and friends. I hope Saturday is an Auspicious Day for the flight. Thuy, who is coming to the USA soon, had been looking at flights in early June. His Mom has discovered that a few days later would be a much more auspicious day to start his travel for his education in Palliative Care. I use to be quite the skeptic about things like this but as you get older you realize there are things that you cannot always explain. It certainly will be an auspicious day when Thuy gets to visit us in Birmingham on one of his trips to San Diego

Tomorrow, we will be having a Memorial Service and dinner marking the end of the official training. I know that I will be keeping in touch by email and I have high hopes a number of my Vietnamese colleagues will get the chance to visit Safe Harbor and UAB and meet all my friends and colleagues back home.

Le Phat Dan

I got up earlier than I really wanted too but the sun in Vietnam was bright this morning. I think they should seriously consider daylight saving time. However, in a mostly rural and agricultural country it is good to start the day off early. It seems most people are up and about by 5:30am and so when I was smugly thinking that I would make to Cau Bac for early church services only to realize I was an hour and half late. I walked on down to a shady square I know and stopped at a bakery and got some coffee; thus fortified I worked on some drawings and doing some people watching.

The traditional pipe for smoking tobacco and I suppose other things, is a long pipe of bamboo about 15 inches long and a less than an inch long platform on the nozzle where the small wad of tobacco sits. This is light and with very powerful puffing (considering the dead space) you get about two puffs. I would guess that although not good for you the amount that you can smoke is somewhat limited and as expensive cigarettes come down in price this will pass away as a shared pipe.

I have been meaning to get my haircut. I am looking shaggy and it is hot. I have looked for a place that cuts hair. There are salons for women and then there are places set up for impromptu barbers. I negotiated the price and tried to explain 5 on top and 3 on side. I even inspected the guards and selected the #7 which I thought would be to long. Obviously the guards are not the same here and I have one of the shorter haircuts I have had in several years! Good thing after 8 weeks I still have my hat. Somewhat beaten up but doing its job under daily use.

Time to go back to Cau Bac for church and it was Pentecost Sunday. 40 days since Easter and my coming to Viet Nam and my time here is coming to a close. Vinglish is what I call the mix of Viet and English and now we had a mix of French too. The Bishop was there for First Communions and Confirmations and there was some pretty enthusiastic flag waving. Pentecost Sunday was when the less educated Galilean and now leaderless apostles suddenly eloquently and elegantly begam speaking in every known language. I could have used this gift the day before when singing Karaoke.

It is Mother’s Day back home and Lydia was our family emissary to Marci. I called on Skype but not the best connection with so many people around the world I suppose calling their mothers.

This week is the beginning of the celebrations of the Buddha’s birthday and enlightenment (another birthday I would guess). It is kind of the combination of Christmas and Easter into one week but more on Phat later.

Karaoke in Viet Nam

Well we finished up the Module 2 of Palliative Care. Mostly this was a brain storming session. It is hard to participate in something like this when you do not speak the language. One of the things that is little hard for me to understand is that in many ways this is a controlled medical system, however, there is the issue of medical resources. The country is growing so quickly and there are private clinics and hospitals all over the place. The medical system here is not as crazy, dysfunctional and mixed up as the USA but they are working on it. I guess I just would hope that they will make a better job of it then we have.

There were some impressive rain storms Friday night, wind and even some lightening. Nothing really compared to the storms back home. I know that this year there seems to be severe storms and tornados back home with damage and death. Every few days there are pictures on the internet of the damage.

Ha Noi was cool and washed clean this morning after the rain. I walked over to see the History of Revolution Museum. Viet Nam as we know has had a pretty turbulent past. In the US we concentrate on our 10 years or so part of the 200 years of their turbulent past. Ho Chi Minh traveled all over the world in the early part of the 20^th century. He spent time in the US and was trying to convince Woodrow Wilson to help Viet Nam get out from under the French. The French were pretty intent on keeping their colonies. However, I wonder what the outcome would have been if someone had listened to Ho earlier on.

I walked over into another new part of town. I also took a taxi to the Ho Tay park and the Sen Restaurant for a group outing. This was kind of like a Vietnamese smorgasbord. The food was great and there was a band. They were channeling the Carpenters’ all evening. There was also a pretty amazing kid who at the age of 4-6 was really belting out some tunes. After this it was time to go to Karaoke. I haven’t been out on the town in Ha Noi and the Karaoke club was not what I expected. Basically there were lots of small rooms and each party could have their private Karaoke machine. Well a few of the songs were in English but most of them were in Vietnamese. I can’t sing that well and I am pretty sure that my pronunciation was not always on target. However, I had a great time with the group and Houng and Thuy have great voices. Lots of songs about love and heart break and being done wrong; it would seem that there is a lot in common with Vietnam and Nashville and Country Music.

The Camel Bites Back

The last two days I have been working with the Palliative Care fellows to help them get Special Projects applications ready. There is so much to do, that very basic interventions could be very productive here. These projects might give them a few hundred dollars to do a project in their institution to change care, such as improving constipation control, pain, nausea. I was hoping that someone would want to try a communications project but I think that this is maybe a little too hard at this point. In addition we have trouble doing this in the USA. So I think that starting with these other projects is a good plan.

Eric has come back and is leading a Module Two, kind of like a second level EPEC training for Vietnamese that have taken a course before. Yesterday, I was helping fellows get ready for a presentation and I gave a lecture on End Stage Liver Failure and End Stage Kidney Disease and Hemorrhage. I think back that about how just 10 years ago we were not doing much with non-cancer diagnosis and it is great to introduce these ideas here early in the process. The problem is that a program of home nursing and home care is not yet developed and I don’t think that the Health Care System has a good idea of what it should look like. I hope that they learn from some of experience and miss some of the pot holes we fell in.

Last night was a large group dinner for the Fellows was required. These can be difficult for me with my hearing impairment and when I am not used to a new accent. I transformed myself from button down professor with bowtie to hip guy with sandals, jeans and un-tucked shirt and I now have enough hair to spike it with gel. This clearly caused some delight for the fellows. As one said I was transforming from Ong to maybe Anh boarding on Em - which is roughly Mister, to young man to teenager in my new style. As usual the meal was served in courses which were numerous and family style. There was one dish that was brown meat and for some reason looked a little different. I inquired about this and was told it was camel. I asked “camel?” you don’t have camels in Vietnam?”, but was assured that they had camel herds. This was one of the few things that I have tried that I just could not get down. I am still a little unsure of the camel issue but the gall bladder farm issue turned out to be true so I have suspended judgment. In any case I have extended my types of food even further.

One of the guests commented that I was doing well with chop sticks. I am not bad, but not great, however apparently I guess so many people just do not try .

The city is really getting spruced up for the 5^th Annual International Buddhist Convention and this is the first time to have it here in Viet Nam. I plan to visit several local pagodas this weekend that have been spruced up so that they are really attractive and ready for the new visitors. They are colorful, cheerful and I will put up some more photos soon.

Communications

Back at work for the last two days with presentations and working on the special projects. The weather has broken some and the heat is not that bad. In fact yesterday it was raining pretty hard in the morning and the cab ride was longer than I would have expected. The fellows have been presenting their special projects and this has been very stimulating and I am very impressed by the quality of the talks.

Yesterday one of the topics led to a very animated discussion of the issue of non-disclosure of diagnosis and prognosis to patients. Although the cultural norm is to not disclose illness severity to patients but to discuss with family there is now some doubt among the group that this is still or is really true. Dr. Thuy from Hia Phong told us that she had been very struck by the way I spoke with one of the patients at 09 Center and how this had been helpful to him and not upsetting. She said she had never talked to a patient like this and that she had asked perhaps 20 people over the weekend if they would want the doctor to talk to them honestly about their illness if they had a severe illness, and everyone had said yes.

Cuong then told us about his experience when he was on call and he had used some of his new communications skill and that this had been very helpful and that nurses and other doctors had noticed the difference and had commented on it. I think that it is clear that both of them will have a change in their practice related to communication.

We also discussed Kubler-Ross and I suggested that they should do some survey work regarding this issue of disclosure of illness because the preferences for discussion may be changing and that I thought it would be important to document this in Viet Nam, since it could effect communications education in medical school and residences.

I have been working on my Vietnamese and I am really enjoying trying to learn more. The more I learn about Vietnamese and the culture the more I think I can understand culture. However, it would take years to truly have a good insight and understanding. I think that there are aspects of the culture that are just not understandable by the Westerner. I think that the Vietnamese have and are doing a much better job of understanding the culture of other places in the world. I think that the USA in general has not done a good job of trying to understand the multiple points of view.

I been looking for festival flags as something to take home as a gift for the unit but I haven’t been able to find any. Cuong said he would help me with this and the told me the character in the middle means unity or solidarity. I think that that is a wonderful sentiment for Palliative Care.

Thit Cho

Today was a chance to explore south. I wandered south to go a park I had not been to before. The streets are still not very crowded and I suspect that many people are away on holiday. I have found a nice park to visit and make my way over to a lake. I have brought a newspaper and find a nice veranda to sit on. It is very hot and others come to enjoy the view and the breeze. Several people are taking naps around the park. Suddenly it starts to rain but the vine is so thick over the veranda that we don’t get wet.

I have decided make my way back towards to movie house but after the rain it is now like a sauna with steam coming off the ground. It doesn’t help when I see a sign saying it is 33 degrees Celsius. I don’t know what that is in Fahrenheit but since a normal body temp is 37 Celsius I know that is hot. I find that I am basically stumbling from one cool spot to another. Although I don’t always look the neatest as a Westerner I can go into a large hotel and hang out in the lobby for a few minutes to cool off.

One of the cool spots is an ice cream parlor and I have some of the best gelato I have had in some time. They send me on my way to the movie house on Ba Treu street. I think that I am close but oddly the numbers on the left and right side of the street are not in sequence. I need to get to 191 but on the left side it is already 280. The location of the cinema is on the 6^th floor of what is by all appearances and American Mall. The theatre looks a lot like the new Rave in Vestavia. The tickets are a lot less but in a new twist the seats are assigned. I go to see Fool’s Gold which is good escapist fare. The audience seems to laugh on cue but there is a lot of physical comedy. I wander about the translation since it was in English. Right as in correct was translated re phai, which I know means the direction but I don’t know if it works the same way in Vietnamese. I will have to check it out with my friends.

I thought I was cool enough to walk home but I found that I was still far from home. However, I notice a shop with the words thit cho on the window. I know that this means dog meat survived here. I decided it was time to pass and get a cab back to Ha Noi towers.

New Orleans in the Orient

This was not an official holiday but still very quite in the city. In fact right now I can not hear the usually beeping and traffic that goes on. Many people are on a five day holiday taking today off with the other two days and then the weekend. I took off today down Hai Ba Trung street to try to make my way towards a building I saw from the bus last weekend. It looked like a public building and in fact turns out to be the Viet Nam National History Museum. The museum was started by a French and Indochine group in the late 19^th century to do archaeological digs and historical research. There has been evidence of ancient man back to the Neolithic period with stone tools in caves 15- 20 thousand years ago. There were some pretty amazing artifact from the long, and I would say violent, history of wars and invasions.

One of the groups I have been interested in is Champa. They had a kingdom during a period similar to Angkor Watt and there are some very fascinating ruins of a kingdom with a Hindu orientation that remind me of the pictures I have seen of the more famous site. Apparently, the ruins have not stood the test of time well. Angkor was lost even to the locals and therefore was not an easy site to quarry for building materials. In addition the wars of the 20^th century were quite violent in the area south of Hue that was the site of this kingdom and there was extensive explosive damage.

I also learned a lot more about the ancient capital we visited the other day and I had always wondered about these wooden poles with different tops that they seem to have at temples. Now I at least know I am not imaging the connection. They had a set of the “8 auspicious objects” but no explanation of what the objects are or why they are auspicious.

After getting a bite to eat I walked on into the old quarter. I first heard the music and then I saw a knot of people and then I realized it was the beginning of a funeral procession. At the front were probably 6 banners with Buddhist figures that apparently some family members were caring. Then there was the band playing traditional music, a very sad lament then some male grandchildren or great grandchildren, 3 in all, carrying a photo portrait of the man they mourned. Then came the hearse, open with flowers and other gifts on the coffin followed by the family, some crying very hard, supported by a large group that followed in support. This is so like the famous New Orleans Jazz funerals and with the city having that French quarter feel. It is sad to think that New Orleans is unlikely to really recover to the pre-Katrina state and just a quarter mile from here is the dike protecting this city from flooding. It could happen here.

I did negotiate some prices for some gifts for family. I cannot buy too much and get it back on the plane. I also found the market which was several stories and many shops to buy material and have clothes made. I did find some time and place to make a few sketches. It is hard since it is hard to find a place to get prospective and also not have too many people come up and watch you, which is unnerving. It seems if I am sketching, I must be an artist?

Tonight the only thing on TV in English is Australian Rules football. This is a strange sport but not as incomprehensible as the Cricket I resorted to watching yesterday. If I hadn’t read Hitch Hiker's Guide to the Universe cricket would have been even more of a mystery to me then it was.

Phat Diem

Today was Re-unification Day. In 1975 this is the day that the Saigon was captured. I have had some concern about how being an American would be received in light of our involvement. Most people around now were young and don’t have much memory of the war. They also don’t hold it against Americans individuals. Cuong has arranged today for a trip to Phat Diem. This is really an amazing place. A person called Father Six about 150 years ago was the driving force behind having this dramatic and beautiful complex of churches, chapels and a seminary. The buildings are so unique with stone masonry. There is the amazing Buddhist temple, Pagoda influence going on with Christian iconography. There was turned up edges of the roof and the decorations that represent the incense and the mythical animals the phoenix and unicorn. The inside of the church had red enameled wooden pillars and gold decorations.

After touring we had lunch and this happened to be a place were a family that Cuong had treated for Typhoid Fever last year, recognized him, and they graciously hosted us. I had goat today as part of my lunch which was unexpected. I wondered why the beef was so tough. I also learned from talking with some of the other travelers that "bo" which I though meant "beef" actually means buffalo. They have a different word for "cow" and the same word, apparently, "bo" is used for meat of either one.

I tried to make some sketches but it is so hard to do because it always attracts a crowd of kids and even adults. There were two little children on the trip and I let them make some drawings with my paper and pencils.

On the way home we suddenly stoped and turned off and went into the mountains. They are strange mountains in that the ground is flat and there are rice paddies and then up out of the earth stick these massive lumps of lime stone. It is like Ha Long bay with rice paddy instead of water. This was the ancient capital of Viet Nam over 1000 years ago before they moved it to Ha Noi. This was a great place for defense but not commerce. There are some temples to the two kings and some areas where you can see the old walls. This is an ancient land. The known history is going back so very far. Of course the Natives American has a history that is truly ancient but the USA is a baby as a culture and country compared to the Viet Nam.

Poor Bear

Tuesday was the day for us to hear some of the new special topics presented by the fellows. Dr. Thung had a great presentation on stigma, discrimination and the need to have physician leadership to combat this. Then Dr. Hung blew me away with a presentation on non-verbal communication and the need to break down the barriers between patient and physician. I was really pleased with the way they are incorporating the teaching. I was supposed to do a role play on communication to help cement this important skill; but we run out of time with so much excellent discussion. I think that if we can help then with teaching communication to others that could have a great impact. I have suggested that they should consider trying to make some communication videos so that they could share skills with students and others.

Well today I had lunch with colleagues. I wish they would let me help pay but they are so gracious that it is hard for me to get them to let me. I didn’t have to ride on the motorbike since one of the doctors had a car. New very nice restaurant in a new nice neighborhood that I hear is quite expensive. The town houses apparently are going for 40-60 thousand dollars. I asked Thuy about if he thought of moving and he said he could not afford it now. I also asked if you pay a mortgage or if it is cash. If I understand correctly, you pay the government a lump sum and if there is a private person you might get a mortgage.

The lunch had several dishes with fish. They made some spring roll like thing with fish and dipping sauces and then a hot pot of a dish fish and vegetables. The most interesting part of the dinner was the bear gall tonic. Dr. Hung was mixing a powder and crushing up the substance in some vodka and then he put it in the whole bottle. This was served around to the men. I had a taste on my tongue but not any more than that. I used my chop sticks to as my way of toasting so I would only have a drop. I can not say that it tasted bad but it just was weird. I told them I was worried about the bears and animals going extinct. They told me there was a process of putting the bear to sleep and using a tube to extract the bile and then doing this over and over again. I wonder if this could be true and it is not so nice for the bear. I do not think that this will catch on in the USA.