Saturday, August 9, 2008

Put a leaf on it

After moving into the city proper for our second two weeks in Hue, we worked at Hue University Hospital, the teaching hospital for Hue Medical College. The work was similar to my daily life as a resident in the states: morning rounds followed by time spent teaching the medical students. I loved my time there - I got to focus on teaching and I learned so much about the similarities and differences between the way medicine is practiced in Vietnam and the US. And the fact that we only worked from 7am until noon, with a 30 minute break for coffee and pho, didn't hurt.

After practicing my Vietnamese over breakfast, we would adjourn upstairs to see the new admissions and the sickest patients. Dr Thuy, Chair of Internal Medicine, heart and soul of the department and my boss for the two weeks, would lead the students on bedside rounds. His breadth of knowledge and sense of humor were unparalleled. I served in a consultative role, weighing in on the differential diagnosis and how we would treat things back home. I also got to do lots of teaching of physical exam skills, much more important in Vietnam given the limited access to diagnostic tests but often less practiced given taboos around touching patients of older age or the opposite gender.

I saw some amazing things, from the medical management of an ST elevation myocardial infarction (that's a really big heart attack, for those of you who don't speak medicalize) to the diagnosis of depression based on a patient's hairstyle. I saw a patient rapidly deteriorate from presumed dengue fever in a matter of hours, followed by a futile attempt to rescuitate him when he went into an unstable cardiac rhythm. Interestingly, the doctors agreed to continue breathing for the patient until the family could transport him home, because otherwise the patient's soul would always be left wandering. One of the most interesting aspects of medical care in the hospital was the side by side use of Western and Eastern medicine. Unlike in the US where patients usually go to a second provider for their accupuncture or herbal remedies, those were prescribed right along side antihypertensives and aspirin. For a patient with an infected diabetic ulcer on his knee, in addition to broad spectrum antibiotics he was told to put a leaf on it. We also learned that patients have to pay by the day for their hospital stays, and that families bring in all their own food as well as do most of the basic nursing care (and hospital laundry).

I got particularly involved in the case of an 18 year old boy left paralyzed by a mysterious illness, most likely a viral encephalitis. I am still working with the Brigham neurologists back home to try to come up with anything to help him. He was actually transferred out of the University Hospital to the Tuberculosis Hospital on the chance that it might be tuberculosis (it wasn't). Because they do not have negative pressure rooms to isolate the tuberculosis patients, they are housed in a beautiful old French colonial building, which has its wide shuttered windows kept open so that a good cross-breeze can keep the tuberculosis at bay.

But my primary responsibility was teaching the medical students. Each day I would prepare a talk on topics such as hypertension or diabetes, which are so familiar to my work in the States and of growing importance in Vietnam. One study found that the rates of these chronic diseases nearly doubled when people in Vietnam switched from bicycles to motorbikes! Doannie was a huge help since he has much more experience in pedagogy as well as much more Vietnamese. It was so much fun for us to work together in our respective careers - here he is explaining surface tension, of course using as his example the head on a freshly poured beer.

No comments: