"Toi la bac si si kham benh cho on"... "I am the doctor who is going to be examining you." This is my new phrase and I said it over 20 times on Tuesday in my first full day of seeing patients at the Kim Long Charity Clinic. Doannie's aunt is Dr Nguyen Thi Dien, the medical director of this clinic which provides free services to over 35,000 people in the Thua Thien and Quang Tri provinces. Despite what you might think given that Vietnam is a communist country, medical care is not free and patients must pay a fee-for-service for clinic visits, labs, xrays, medicines, etc. The Charity Clinic was started in 1992 to provide free care for those who cannot afford it otherwise, and has grown every year under the careful stewardship of Dr Nguyen and her colleagues. Patients travel for miles from the rural parts of the province and arrive early in the morning to wait to be seen. Each day starts with an education session, this one geared toward reducing the stigma of HIV/AIDS.
Dr Nguyen, or "Di Dien" (Aunt Dien) to us, is a force of nature. Standing at barely 4'10" (making Doannie appear like a giant), she supervises a staff of over 20 volunteers. Her office is full of medical texts and careful records of donations and health statistics from the province. I was thrown right into the fray on Tuesday morning, occupying exam room 14 with my interpreter, Nguyen. Without him and Di Dien I would have been useless, but with his help and her guidance I saw more patients than I have ever seen in a Brigham clinic session. I saw patients with arthritis, heart disease, diabetes, hypertension - the usual for an American clinic, but I was working with a vastly different toolset. I didn't know the function of about 25% of the medications on the limited list that the clinic carries. My only blood pressure medications were amlodipine and nifedipine. I quickly learned that asking follow-up questions to complaints like "chest pain" was more easier said than done - more than once Doannie had to fill me in on what was really being said in reply. Lab tests, xrays, and referrals, while available, are understandably reserved for the sickest of patients.
After a siesta during the hottest part of the day, we started all over again in the afternoon. I continue to be challenged by the need to treat so empirically on such limited information about each patient. Doannie and I have been brainstorming about simple ways to systematize some of the care here and to bring in some new educational tools for the staff and patients. Friday we will do home visits with some of the sicker HIV patients in the province, which should be yet another invaulable learning experience. In two weeks I will move over to the medical university, where I hope to learn about the medical education system in Vietnam and hear I am expected to do some teaching. Hopefully there will be a radiologist on site!