Hot, Hot and more Hot

This is apparently the time of the year when the temperatures go up and for 2-3 weeks people will be sleepy, as Bac Sy Thuy from Ha Phong tells me. I was so hot I had to take off my tie and not wear my white coat since it is so thick. I was a little embarrassed the other day to fall asleep laying on one of the tables the using my very thick new Vietnamese dictionary as a pillow. However, today some of my colleagues took a little nap by pushing chairs together and I think I will try that next time since it looks more comfortable. All the families and patients are looking for shade and a little breeze. I think this nap thing would be a good import to Birmingham. We seem to have similar climates and it is pretty restorative.

Another Thuy asked me to vote on line for Ha Long Bay as most beautiful place in world for some contest. I haven’t seen it yet but since I plan to go next weekend and I hear that it is spectacular, I did.

Despite the sleepiness I am getting a lot done and have a few more talks to work on this week and then should be able to be done preparing them. On these long days I spend most of my time at the hospital. At morning report, which is in English, even before I came, to practice their language skill, I am asked to give a little topic discussion. Yesterday and today we have had cases of possible gastric cancer which is very common, second only to lung cancer. I have no doubt that the incidence will reduce as Vietnam continues to invest in its infrastructure, since it is known that both preserved foods and H pylori plays a role. The hospital is just finishing another floor and will expand to 300 beds soon. In the morning I spend the time consulting on patients and discussing medicine and palliative care with the other doctors. Of course air pollution is a problem now but people seem concerned about the environment, and while they want development they want a healthy country too.

Today I gave one of my first official lectures which I shared with Yen to preview. They translated my slides into Vietnamese, and I was pleasantly surprised that I could read the occasional whole sentence. Granted, they were my original sentences, but it is still a thrill to be able to figure them out in a different language. As a bonus, because the hospital had electricity today, they were able to turn on the air conditioner in the conference room. I have a couple of others formal lectures to give tomorrow.

With Skype (a free downloaded computer program) I get to call home every day. For free! I highly recommend it. I can only imagine the loneliness that would exist when letters that might take weeks, and before that it would take months, to be delivered as your only way of staying connected.

What does Yellow mean?

Today I continued to notice that the color yellow has both secular and spiritual connotations. One of the ways that you know where a pagoda or temple is located is that the walls and the gate are painted a yellow color. The trim is usually red; particularly any inscriptions which are in character scripts. Many government building are painted this same hue of yellow although the trim is usually a green or blue. The flag is a red field with a yellow star and the river that Hanoi is on is the Red River. I have been here long enough to know that this can not be some random coincidence but has a meaning; just not yet revealed. If you review some of the photos on line you can check out the color scheme for yourself.

Today continues the important day for ancestors. I thought there was an accident on the way to work; but then it looked like a parade and then I thought it might be a funeral. The taxi driver told me it had to do with honoring the ancestors but with my limited Vietnamese and his limited English he was pretty pleased I had grasped that. Bac Sy Yen had made for us, Cuong and me, a special sweet. It was small balls of dough made from sticky rice with some sugar cane inside and syrup on the outside. It thought it was pretty good but I really can not think of anything that it would be like to help you understand what it tasted like. Cuong said that traditionally that this would be a day when fires are allowed to go out , so food would be prepared beforehand and eaten cold, but that this was not so common nowadays.

I was early and went down to see if I could help and was sent off to see Mr. F. I was halfway there when I realized I did not have a translator and would just have to do with my broken Vietnamese. I was making some progress but I think that about the same time they realized that they had sent me off alone and Huong came to help. This was good since I was trying to figure out how his stomach was doing and trying out my new words that I had not vetted with my teachers yet. Apparently I had a kind of slangy word from the dictionary; once again not very professional but all in all it worked out and he is feeling better.

I have some more writing to do tonight and some slides to produce. This is our half day for me at the hospital since they fellows are supposed to read and work on their projects during this time. I spent some of the afternoon visiting the Temple of Literature which is the over 1000 year old cultural treasure that was the equivalent of the national university. It still is a nice place to read, think and work.

I have appreciated the comments and responses. As someone new to blogging it is nice to know that your message is being received.

Special day for the ancestors

April 7, 2008

This was my first day without Eric, as he is in another city for a week. I got off to a good start with the best cab driver so far for the trip. He was able to go the back way and cut off some time. I spent time with Dr. Hinh and his morning report. I seem to be asked each day to give a short discourse on a different topic. Each day I also get sent a cup of “kafe den”black coffee that you could stand a spoon up in. Coung and I spent time going to see a patient which was very complicated and we reviewed with his doctor. I think that he may have cancer but several attempts to make a diagnosis was not successful and I don’t think that he is well enough to undergo radiation and certainly not surgery. We should be able to get started on treating his infections at least.

I need to review this further but it looks like MS 30mg pain killer is going for about 10 cents. This is a very good deal. This makes it all the more difficult to understand why people are using lots of what looks like Tylenol#3 and which more expensive than the more effective MS. I will look into this further while I try to help them plan for treatment. If MS is so cheap they really need to use more often.

The levity of the day comes from my continuing attempts to learn more Vietnamese. I was trying to figure out how to order an enema only to discover that it is a 6 word phase. As is the case, the same word means 6 different things and then a single word in English becomes a phrase. The day was cut short since this is the 6^th day of the 3^rd lunar month and for reasons unclear to me this is a special day to offer and spend time with the ancestors. Dr. Houng seems to think that I should know that this day is special. I guess I they have high expectations. I will put up when I can a picture of Cuong and a patient and the pain scale when I have a chance tomorrow. Lots of other writing to do today.

Uncle Ho

April 6, 2008

Uncle Ho

Here in Vietnam I can kind of direct what will happen but I don’t apparently have the last word. I have got up to have an American breakfast of bacon and eggs at a hotel nearby. I had thought I would walk by St. Joseph’s Cathedral to see if it would be open on Sunday morning. However, as is often the case you can get turned around on the streets (The cab drivers have the same problems.). I found that I had made my way over to the Citadel; which a walled military fort that was started about 1000 years ago. The area was very pretty, with wide boulevards and trees that are cool to walk under. I realized that I was walking next to what looked like a church and that there were a lot of people going in. There were not signs on the outside but it turned out to be Cua Bak Church; which means North Gate. It is one of the few churches in Hanoi and is the one the foreigners attend if they go to church. There were probably about 1000 people there and 80 percent Vietnamese but the service was in English and Vietnamese and some of the one of acolytes looked like she was European. I talked with some of the people and they were there with the World Bank or a NGO or some business and some had lived here for a few years.

Later I was walking along and a toddler was on the sidewalk with two older women, maybe a Grandmother and Aunt, trying to get the child to eat. I said “em be dep qua” what a pretty baby. They were so pleased and then prompted the toddler to say hello. He was saying hello in English and of course they are proud that he is smart too.

I turned a corner and then I saw something from TV many years ago. This was Ho Chi Minh’s mausoleum. I walked on over and there were many visitors and the guards. I did not get to go in to see him. Apparently he is being refurbished and so his body was not present. In about a month we will have Unification Day and May Day and this is where they have a lot of the parades and activities. This is also where the One Pillar Pagoda is. This was built about 1000 years ago to look like a Lotus blossom and there were several monks and nuns there to greet us.

I have taken some interesting pictures, dragon fruit, flowers and a number of street scenes and will try to put some up for you all to see.

Shrimp Bits versus Bacon Bits

Sleeping in?

Saturday morning here and will be late Friday night back home. I have finished another week and getting in the swing of things. Morning report and review of patients in AM with Professor Hinh continues. I am concerned that I got a younger doctor in trouble for not considering the probable development of second primary tumor in young women with breast cancer rather then a metastatic lesion to the other breast. Things got a little tense and then much discussion that I can only get part of then review with me. Basic issues like the development of chemotherapy resistance and how chemotherapy works are reviewed. People are trying so hard to do things correctly that the science behind is treatment sometimes not clear to them. I have to balance the science behind management with concrete discussions of next steps. Now that they know about Socrates they roll their eyes and groan when I start to teach but much more politely than they would in America.

I just am not very hungry with heat and travel so staying on bottled water. Cholera epidemic has been going on for a month. The government has finally openly spoken about it in the press and my sources tell me that 50 patients being admitted to hospital for dehydration daily. The source is still not clear but may be shrimp sauce. However, very common, almost universal condiment is tiny shrimp about 3-5mm in size whole dried and sprinkled on every thing. They are tasty with salty, shrimp crunch taste, Marci says that they most be like bacon bits in use only shrimp bits. I think that they might catch on in USA. Perhaps this is an investment opportunity.

In the afternoon we have had a lecture about HIV and although in Vietnamese I listen and can catch a few words. When I see on PowerPoint slide—Phat- I asked Cuong what did Buddha have to do with D4T and HIV medicine. He begins to laugh and starts to tell class and there is a row that breaks up the lecture for about 5 minutes. Apparently Phat means both Buddha or rash based on diacritic marks which I do not remember. Part of this is that I think that it never occurs to them that the words seem similar to people outside their language group.

Today I have had a longer sleep after talking with my mother via Skype and home as well. It is amazing that only a few years ago communication so difficult. The world really does seem flat. I am doing laundry shopping and some writing and then out to see some more Hanoi sights this evening. Eric has been called away to Ho Chi Minh City so I will the lonely American here for a few days. More about the Hanoi city later today when I post again. .

Whats in a name

Early Rounds

By going to bed early recovered and able to go on into hospital early enough for morning report. Even a few minutes can make a big difference in travel time. I enjoyed morning report and I am impressed that it is focused and serious but relaxed. Professor Yin expects results but people are not nervous or anxious and tense the way this often is in the USA. We had a discussion of liver tumors. They were rare in the USA before the Hepatitis C epidemic and now on the increase. They are one of the most common and deadliest cancers here. Discussed the relationship to Hepatitis B infection and Dr. Yin tells us that over the last few years a major push to vaccinate all children before they could become infected. This could make this cancer very rare in Vietnam in just a single generation. For the time being they are incredibly skilled at operating on the liver. I think more skilled then USA surgeons who would have had much less experience and practice on such a delicate surgery.

I am continuing my Vietnamese lesions and words like hope (mong) and careful (can than) and fever or hot (nong) I can only manage a few new words every day. Still it is thrilling to hear some one talking and understand one of the words although I can not understand the context.

Also much discussion of if I should have a Vietnamese name. Since the meaning of names are so important and they ask me the meaning of Amos ( a heavy burden) and of course Bailey not much better since it is a jail or jailer. For the time being Mong ( hope) and Phuc (Happiness) are in the running if you would like you can comment and vote.

I am working on presentations today and then supper tonight with director of the Infectious disease hospital and several other dignitaries.

Ma, Ma and Ma the many meanings of Ma

April 1, 2008

Ma, Ma and Ma

Today I tried to get to the hospital a little early but my taxi driver did not turn when I asked so we missed the hospital and had to turn around to go back. Still I made it in time for the end of morning report and to review a few films.

I then had my morning Vietnamese lesson. I am trying to learn 5-10 words or a phrase a day. I did learn "turn left' and "turn right" which will be helpful in the future. Vietnamese is a mono-syllabic language so there is no combining syllables to make new words. Instead by intonation you make one syllable have multiple meanings. Ma with different diacritics marks can mean ghost, mother, morgue and horse. There may be two others they haven’t taught me yet but the difference in the sound is difficult to reproduce. Oh by the way, pho the morning soup and national dish, also means street. That I am even trying to learn is thought to be unusual and nice. We did go check up on several patients and then saw a new patient with naso-pharyngeal cancer which is very common here (saw three cases in 2 days) but uncommon in USA with only 4-5 cases in my 20 year career. I am amazed at the physical strength and endurance of the Vietnamese. I think that most patients with a problem like his would be in so much distress that they could hardly talk. A lot of patients are on radiation but no one complains of a sore mouth for the radiation burn.

In the afternoon I walked over to the Temple of Literature which is 1000 years old and the original national university, a nice respite from the noise of the city. I have pictures and will post soon.

While I was writing this yesterday I was called by Cuong that he had tickets for us to go to a Vietnamese Opera so my writing was cut short. The Opera was long, hard to understand but beautiful and ultimately meaningful. The story is too long for here but this is an ancient culture.

Today I finally made it to morning report on time. Cuong having taught me "re phai" which means turn right!!! I was able to get to the hospital directly. I have worked with some residents, met with medical students and then reviewed more cases for palliative care and managed to work on some of the lectures. I am really tired tonight and we had dinner with the head of the Infectious Disease Center tonight at her house. So off to bed early.