Doannie and Holly in Vietnam

The Obligatory Top 10

2008-08-21T12:47:00.000-07:00

What end-of-the-summer, end-of-the-trip blog would be complete without a top 10 list?

10. Pagodas, pagodas...and more pagodas.

9. Tailor-made clothes: cutting out the Western middle man and going straight to the source.

8. Multiple karaoke sessions - who knew Lionel Ritchie was so big in SE Asia?

7. Nuns.

6. Being some of the tallest people in an entire country of 90 million souls.

5. Watching East meets West-ern medicine...while only working 6 hours per day.

4. Finding beach bungalows - all along the South China Sea coastline.

3. Cheap eats on a red stool as good as any $30 entree at an Asian fusion hot spot in the states.

2. Having our first conversation over dinner...entirely in Vietnamese.

1. Seeing the Que Huong (the homeland).

Sliding the Red Sand Dunes

2008-08-16T07:33:00.000-07:00

Vietnam has a lot of stuff going on in a small country. We've seen quite a bit of it in our travels, from the limestone teeth of Ha Long Bay to the flooded plains of the Mekong Delta. As our time in Vietnam is coming to an end, we decided to travel with our friend Christiaan to Mui Ne, a town in Vietnam that is home to a geological feature we haven't seen yet, the red sand dunes.

After the lushness tropical goodness of the rest of Vietnam, we were surprised to come upon the otherworldly desert austerity of the red dunes at dawn. The only thing piercing the Mars-like quality of situation was the hordes of wealthy Saigon tourists being disgorged by the fleet of tour-buses arriving every 15 minutes. And the wedding pictures being taken at the top of one of the dunes. And the swarms of poor children renting pieces of plastic used to slide down the dunes. So, it wasn't so much Laurence-of-Arabia-solitude, but the pictures are really convincing, aren't they?

We did manage to hike away from the bulk of people, led by a group of great little kids who helped us find a great vista point for the sunrise and instructed us in the finer points of sliding down the dunes.

We were also fortunate enough to find an amazing resort in Mui Ne to round out our time in Vietnam. We had a beach front bungalow with a couch, and two beach chairs with a wide umbrella. What more can you really ask for? This place definitely ranks in our top 10 of most beautiful places ever. And No, Christiaan did not stay with us.

The real clincher: 8 dollars for a 1 hour massage on the beach. 'Nuf said.

Since Christiaan just finished his Massachusetts Bar exam, we decided to treat him to a beach massage. And so began the following dialogue, conducted in Vietnamese, translated by me for my American companions. I may have taken some dramatic liberties.

It is clear that everyone now assumes that Holly and Christiaan are married. My masseuse is a funny, good natured young lady.

Doannie's Masseuse: [to Doannie] So, are you married?

Doannie: Yes, that's my wife right over there.

DM: [incredulous] Really?

Doannie: [gesturing towards Christiaan] But that tall white guy over there? He's single.

DM: [coyly] I have been waiting for a tall, handsome American to come and sweep me away. What kind of women does he like?

Doannie: Hey Bubs, what kind of women do you like?

Christiaan: I like talkative, fun girls.

Doannie translates.

DM: [Excitedly] Oh, I am very talkative and fun.

Christiaan: But I live in Boston, and it is very cold.

DM: [as if speaking to a dense child] But if two people love each other, it doesn't matter. If you come back in two weeks, I will learn to speak English for you. If you say that you will accept me, I will spend a sleepless night, restless with excitement. If you say no, I will come to this beach and drown myself in the ocean. [thank goodness, she was laughing through this]

Christiaan: [with the fervor that comes when you only know one Vietnamese word that happens to come in very handy at this moment] Khong! Khong! (translation: No! No!)

But it all turned out well in the end, with no broken hearts, but rather, with an unfinished bridge between two ships passing quietly in the night. I might also add that I think that Christiaan owes me for a translators fee and because my massage suffered as my masseuse's attentions were decidedly elsewhere.

Plus a couple of random pictures: Here's the highly illogical Vietnamese fishing boat. Basically a floating donut.

Here's me learning how to kite-surf.

Bubs and the Old Quarter

2008-08-15T08:43:00.000-07:00

From Hai Phong we moved on to Vietnam’s capital, Ha Noi. In addition to visiting hospitals with the VCHAP group there, we welcomed our friend Christiaan to the homeland. Better known to many of our readers as Bubs (and frankly, much easier to pronounce by the Vietnamese), Bubs started his 6 week post-bar trip just as we wrapped up our 6 weeks in Vietnam. Not that we blended in well before, but having a 6’4” red-head in our midst certainly increased our profile. To keep everyone from thinking Doannie was our tour guide and to reduce confusion when checking into hotels, Bubs became my baby brother for the week, or as he preferred given our shared birthday - my twin brother (just born 2 years later than me).

Our first goal was to introduce Bubs to the little red stool, an eating venue he took to easily given its minor impact on the budget travelers’ wallet. We also started the search for Vietnam’s cheapest beer, found in one of the many bia hoi houses - 18 cent draft served on lively street corners. Bubs and Doannie certainly deserved a bia hoi after putting up with my marathon shopping sprees. I had saved all souvenir purchasing for the end, and Ha Noi’s Old Quarter lived up to the task at hand. A series of tiny winding streets still full of old French colonial charm, each street was initially home to one type of merchant - silk, wood, paper, etc. The streets retain the names of the original goods on sale but the products are now for a modern clientele - imagine entire street blocks selling only high heels, or knock-off Lacoste and Polo shirts, or sunglasses, or bathroom fixtures. A shopper’s paradise.

In between the working and the shopping, we managed to take in some historical sites as well. We visited the famous Huc bridge and Den Ngoc Son pagoda, the Tortoise tower and the Opera house. A trip to the Temple of Literature, Vietnam’s first University and center of Confuscian culture, was a highlight, as was a tour of the infamous Ha Noi “Hilton” where John McCain spent 5 years as a POW. And while Bubs was in Ha Long Bay for the evening Doannie and I attended a dinner party at the home of Dr Kim Ninh, country director of the Asia Foundation in Vietnam. Good thing she happens to be the sister of Doannie’s aunt, because otherwise I don’t think we would have found ourselves at the same dinner table as the SE Asia Correspondent for the New York Times, a freelance writer for the BBC, an up-and-coming reporter for Vietnam’s premier newspaper, and a linguist contributing to the current genocide trials of the Khemer Rouge in Cambodia. Needless to say we were a bit out of our league.

An encouraging model

2008-08-14T20:04:00.000-07:00

After our weekend in Ha Long Bay, Doannie and I joined up with the VCHAP group (Vietnam CDC Harvard AIDS Partnership) in Hai Phong. This is the third largest city in Vietnam and a large port city. Unfortunately, it has Vietnam's fastest growing HIV population due to a high rate of IV drug use and opium trafficking. The Ha Noi group comes out once a month for a week to do hands on training with the new HIV doctors in the province and to offer consultative services on difficult cases in the afternoon. This is done by the dynamic duo of Dr Huong, an MD/PhD from Hai Phong and a total firecracker, and Dr Marcelo, an HIV specialist from Argentina and a total wisecracker. Together they are a total riot.

We saw a very encouraging model in Hai Phong, something we had yet to encounter in our 5 prior weeks of working in Vietnam. The new doctors practiced taking a history and performing a physical exam in front of Drs Huong and Marcelo, who then provided direct feedback and filled in the gaps by asking additional questions and doing additional exam maneuvers. In the US medical education system this is known as precepting and in the European system as mentoring. It was wonderful to see in contrast to either the complete lack of supervision of junior doctors or the omnipotent decree of senior doctors with the junior doctors expected to learn by observation alone. This of course requires buy-in from the doctors-in-training, who have to be open to criticism and critique, and we learned that the enthusiasm of the Hai Phong trainees is as of yet unmatched in other provinces where VCHAP works.

We also got to spend some time in a thoroughly un-touristy town, which was a unique experience in its own right. We visited one of Vietnam's only microbreweries, where the choices were either "black beer" or "yellow beer" and ngo-ing was in full force. We encountered a Vietnamese break dancing group and a park full of people doing what can only be described as calisthenics. Check out this particular routine for a good laugh:

The Dragon Bay...AKA a bunch of real pretty rocks

2008-08-13T05:16:00.000-07:00

For our next-to-last weekend adventure, Doannie and I left Hue and headed for Ha Noi via Ha Long Bay. Hue had really started to feel like home and we were sad to say goodbye to our Vietnamese teacher, to the medical students, and most of all to his family. After three nights in a row of big sendoff dinners, we reached our first snag of the whole trip...our flight to Ha Noi was canceled. Which was not a big deal, but a big inconvenience as we missed our Saturday morning departure to Ha Long Bay, Vietnam's candidate for the new 7 Wonders of the Natural World (http://www.new7wonders.com/nature/en/nominees/asia/c/HaLongBayBay/). We eventually made it there Saturday night, but not before spending a hairy evening in an old Soviet style hotel that Vietnam Airlines put us up in and braving 3 buses and 1 boat on public transportation to meet up with our tour group.

We were rewarded with hundreds of limestone karsts - really large and beautiful rocks jutting up out of the sea. Vietnamese legend holds that dragons sent by the gods spit out these jewels of jade to create a wall of resistance against the Chinese. They certainly were mythical, shrouded in mist and rain and hiding secret caves. After a tour of the bay on an old junk and a kayak around the karsts, we retired to our beachfront bungalow on a private island. Why can't we have weekend getaways like this when working in Boston?

Little Red Stool

2008-08-12T00:12:00.001-07:00

I think most people consider the non la, the conical hat worn by everyone from rice farmers to trash collectors, the most easily recognized image associated with Vietnam. I disagree. If any object in Vietnam is iconic, by which I mean ubiquitous, irreplaceable and emblematic of the daily life of the vast majority of Vietnamese, it is the Little Red Stool. Oh how I love thee, let me count the ways.

Oh red stool, you are always an indicator of the best, and cheapest, food Vietnam has to offer. Any chair with a back and four walls to surround it is sure to increase the price and decrease the quality by a factor of four. It is you that shines like a crimson beacon on sidewalks across the length and breadth of Vietnam, pointing the way to delicious cauldrons of steaming pho or bun bo hue or bun thit nuong like a lighthouse to a wayward and starving sailor. Easily stacked and strapped to the back of moto, bike, or cart, you are whisked away at the end of every long day, free from the binds of taxation or permanant address or sanitation standards, only to return reassuringly with the dawn. Harbinger of streetfood, I salute you.

Oh red stool, you provide seating where there once was none, where many thought seating was never meant to be. In aisles and hallways of theaters, hospitals, nay! even "private" buses, you democratically and generously allow all the wretched comers to rest their weary haunches in numbers far exceeding pedestrian concerns of "safety." Some might consider the intrusion of an elbow into their back or a knee into their thigh for a 3 hr bus ride a burden too heavy to bear, but not I, red stool. Let the prols come, let them sit on your four flimsy pillars of communism, for they have been making French Fries all day for the gringos, and must dream fitfully of revolution.

Oh red stool, you are tool and toy, father, mother, secret lover. You allow us to reach objects five inches from our grasp and let us sit with our knees six inches away from our faces. You make tall white people look ridiculous. But soon the rains will come, and your sidewalk habitat will be made untenable by the vagaries of weather. But you will retreat, into the covered places, and you will bide your time. And in the spring, when the showers end and people emerge hungry and stiff from months of sitting in proper chairs, you will have your day in the sun.

Red stool, I [heart] you.

Put a leaf on it

2008-08-09T10:50:00.000-07:00

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.

A Trip down the Perfume River

2008-08-06T15:13:00.000-07:00

First, an apology to those of you following the blog. Our last 2 weeks in Hue were spent living in the city, carrying out a daily routine of work at the hospital in the morning, lounging by the pool after lunch, Vietnamese classes at the local University in the afternoon, and discovering a delicious new spot to eat each night. We thoroughly enjoyed our little attempt at becoming part of the fabric of everyday life in Hue, but it didn't make for dramatic blogging.

We finally hit up the main tourist attraction in Hue during our last week. The beautiful Perfume River runs through the center of Hue then meanders on past the royal tombs built by the emperors of the Nguyen dynasty in the 1800s. It is a relaxing and efficient way to the city sights, and despite its clearly touristy nature Doannie managed to have a good time. Here are a few of the highlights...

The Tomb of Khai Dinh: Known for his extreme vanity, his tomb is famous for its small army of mandarins. Can you pick Doannie out of the crowd?

The Tomb of Tu Duc: Known for his love of poetry and his dedication to building beautiful grounds, his complex also housed over 100 wives and thousands of concubines. Doannie hangs out in the ruins of the concubine palace.

The Monastary where Doannie's mother's cousin Cau Han waited out the American War:

Trying my hand at making incense at a shop alongside the river: This area is also famous for the construction of the most well-photographed symbol of Vietnam - the conical hat, or non la.

Pig of the Forest

2008-08-02T23:51:00.000-07:00

There is no doubt that you can eat some really strange stuff in Vietnam. Congealed duck blood is served with ground beef, still-beating snake hearts can be procured in a shot glass filled with the blood of the unfortunate reptile, all with a vodka chaser. This doesn't even mention the oft-cited prime example of the unusual Vietnamese culinary tradition: the roasted dog, bane of every mercilessly teased Vietnamese immigrant child everywhere.

But it turns out that this list is far from exhaustive. Despite the lush productivity of their lands, the effortless fertility of their soil, the Vietnamese seem to have left literally nothing off the table in their quest for a good meal. Holly and I got to experience the smaller, furrier side of Vietnamese cuisine at a place called Huong Lua, far outside of Hue.

Of course, it would be uncle Han who took us to this place. For those of you who don't know, Vietnamese men's favorite past time is an activity known by a single word in Vietnamese with no precise translation in English. To ngo translates roughly as "drinking and eating prodigious amounts at a sub-glacial pace, typically while women form a human conveyor belt of food and alcohol and simultaneously mind the children, houses and businesses." I blame the particular talent and energy that Vietnamese men devote to ngo-ing for why Vietnam hasn't won an Olympic medal in.....well, forever. Uncle Han is a practitioner of the mildest form of ngo, a pleasant collection of overworked older men, gathering for some good natured toasts and friendly ribbing. At the ngo's worst however, spirits can be broken, pride obliterated beyond recognition, vast sums of money exchanged without thought or consideration of consequence. Insiders know that a prolonged ngo session between Ho Chi Minh and President Diem started the whole mess that the country has never really recovered from since, the ultimate day-after hangover.

So our particular ngo began with sight of this little fella. On the ride over to Huong Lua, Uncle Han was explaining to me what sort of foods were available at our destination. As I've described, some foods in Vietnam are odd because of composition, others are weird in translation, still others strange in circumstance. What Uncle Han described to me was sort of all three. I know the word for pork, which is heo. Okay then, something with pork. But he followed it with other words which were lost on me. We stumbled through a few more sentences of missed meanings when he was finally able to break out with a phrase in English: Pig of the Forest. As yes, the elusive Pig of the Forest, terror of woodland denizens everywhere, otherwise known as a wild boar. Arriving at the restaurant/petting zoo/slaughterhouse, we saw this decidedly un-fearsome looking little guy sitting in a cage next to a civit, a hedgehog, and several lizards. Luckily we were spared from having to choose which animal(s) would be served up to us, but we went inside to see what other surprises were to follow.

The remainder of the evening was filled with delights less grisly and more PETA-friendly. It turned out that we were there at the same time as huge group of driving instructors, all of whom were, bizarrely, drinking copiously without a designated driver in sight. Holly and I already know how to parallel park, so they became intent on teaching us other essential Vietnamese skills.

Vietnamese toast in the following ways, nearly all of which involve standing:

"Tram phan Tram" -This essentially means, 100 parts of 100, or 100%. We would call this, Down in One, or Bottoms Up. In other words, drink your whole glass, or you suck.
"Nam muoi phan Tram" - 50%, or drink half.
"Di Saigon" - Literally, Go to Saigon. For people anywhere north of Saigon, the city Saigon represents the the bottom of the country, a proxy for the bottom of the glass, the view of which should be unobstructed by beer by the end of this drinking session.
"Di Da Nang" - Da Nang is roughly in the middle between Hue and Saigon. Get the picture? People in Ha Noi will substitute this with Hue, which is the exact geographical center of Vietnam. No wonder the Vietnamese are so good with their geography.

So that's how we spent the better part of the evening, analyzing our spatial relationships in relation to other cities in Vietnam and practicing fractions through the soft, light amber haze of our favorite fermented beverage.

To all of those friendly gentlemen, may they always drive straight and use their horns liberally.

Di Saigon!

Like Costa Rica - without the crowds or the harness

2008-07-28T22:24:00.000-07:00

Costa Rica has the canopy tour through the Cloud Forest of Monteverde. Switzerland has the sport of canyoning through the gorges of Interlaken. Both of them appeal to tourists seeking adventure-eco-travel, and both are wildly popular (and fun). You can do all of this and more for a fraction of the cost atop Vietnam's Bach Ma mountain without running into a single other tourist - if you are willing to go without the helmet and the harness.

We spent the past weekend at Bach Ma National Park, which rises 1450m above sea level but lies only 18km away from the sea itself. The number of tourists is limited by the few places to stay on the mountain - only a handful of charming old villas leftover from the French Colonial days. In fact, we were told there was only one room left on the whole mountain and we would have to share a triple with our friend Phuoc from Boston. Which was fine, but odd considering we saw only about 30 other tourists during our entire weekend there. The Vietnam tourism industry is totally missing out by not promoting Bach Ma as the eco-adventure experience it proved to be, but it sure was nice to have it all to ourselves.

We arrived at our villa after a harrowing half hour of careening up switchbacks on a single lane road - reminiscent of our friends Jesse and Theresa's recent post from their trek in India. We had left Hue in 90 degree heat but we emerged into 60 degree bliss. For much of the day the mountain was shrouded in a cool mist, making it one of the few true clout forests in the world (http://en.wikipedia.org/wiki/Cloud_forest). When the fog dissipated, the view was spectacular: ribbons of river winding through shimmering rice fields and spilling into the South China Sea.

After taking in the views and enjoying a light lunch, we set out for Bach Ma's most ambitious hike, which would take us by 5 lagoons before we reached a spectacular waterfall. The two people who ran our villa said it would take the whole afternoon, and they were right. But they somehow failed to mention the part about pulling yourself along wires wrapped around trees as your traversed through the gorge, or the 700 steps you had to go down to get to the base of the waterfall...and then the same 700 steps you had to go back up.

Doannie was made for this sort of thing, with his low center of gravity, freakishy long toes capable of grasping slick surfaces, and his general lack of fear. I on the other hand am pretty risk adverse. I may have bungee jumped 400 feet from a cable car in Switzerland and rappelled down waterfalls in Costa Rica, but both of those were before I turned 30 and both of those were with quality carabiners and ropes. It was all Phuoc and Doannie could do to keep me from turning back, and if the views were not as magnificent I probably would have! For the final test of the 1400 steps, I was huffing and puffing and seriously concerned that I might have a small troponin leak. We made it back just in time for dinner at the villa. I'm still recovering.

The Sound of Music

2008-07-27T05:33:00.000-07:00

Odd things can happen to you at any time. You can find 20 dollars on the street, or you can get hit by pigeon poop walking across a public square. In this particular case, we got accosted and serenaded by a gaggle of nuns after running into a group of Microsoft employees from Seattle bringing 20 computers for the convent.

Those of you who are following this blog know that we have been staying at the clinic attached to my aunt's convent for the past two weeks. Still, the number of actual nuns that we have run into has been pretty small, and for the most part, they have been short interactions, full of deference, soft voices, soulful eyes.

Not this time. This time, we met up with about 10-15 Aspirants, or young women who are just beginning the 13-14 year long journey to full nun status. We proceeded to go through long meandering conversations in English/Vietnamese hodge podge with some of the most spirited and boisterous people I have ever met. It was as if every single one of them was like Maria from the Sound of Music. It wasn't clear to me how the metamorphosis from chatterbox to serene vessel of God's grace was supposed to occur, but I suspect that it has something to do with the two year VOW OF SILENCE that each of these Aspirants was about to undertake. If I was about to not talk for two years, I would probably be yakking my head off, too.

But clearly, the most surreal, Sound-of-Music-like moment was about to come. For what would be more Rodgers and Hammersteinesque than a full-on musical moment? One nun would start, and then all the rest would join in with perfectly blended, multi-part harmonies. Somehow, we got shamed into our own choked version of America the Beautiful, only to later learn that these nuns have choir practice three times a week. Basically, we got vocally hustled.

They invited us to join them for a ride on the famous Dragon Boat tour of Hue's Perfume River, but we declined. I won't say that we didn't feel like getting schooled again as they sang up a storm while floating down the river, but I'm sure if factored into our decision.

Here's your moment of Zen: We were there with our friend Phuoc, who also has a caucasian wife and he was showing them a picture of her. She is also blond and fair skinned, and one of the nuns asked if she and Holly were related. To see her response when we said no, you'll have to watch the video of the singing shown below:

Oh how, the tables have turned. Please see www.alllooksame.com

HIV Home Visits

2008-07-23T02:04:00.000-07:00

Today we set out early in the morning for the countryside of Quang Tri province to call upon 3 of the HIV patients under Di Dien's watch. On the way there we learned that she has 95 HIV/AIDS patients assigned to her and that about 1/3 are on anti-retroviral treatment (ARVs). As a primary care provider of sorts she does not dispense ARVs; the patients must make the trek into Hue once a month to the dispensary at the main hospital. Rather she serves more as a case manager for the patients and their families, periodically checking in on them to ensure that they have the food and water and shelter necessary to comply with their ARV regimen. The standard ARV regimen in Vietnam consists of three medications which must be taken twice a day with food and water; if a patient misses doses the virus can rapidly develop resistance to the medications, rendering them useless. The same is true of anti-tuberculosis regimens (a four drug combination), and about 10% of patients with tuberculosis in Vietnam also have HIV.

Patients are referred to her from the Infectious Disease Unit of Hue Central Hospital after they have been diagnosed with HIV. She and her staff of volunteers conduct an initial home visit to assess the living situation upon discharge. They look for things such as whether there is running water, a clean cooking area, and a separate latrine from the house, or whether the patient even has a house at all. If the living situation is deemed unsafe or unsanitary they argue the case before their board of donors and try to relocate the patient. They also assess the health of the family members, who may or may not have contracted HIV themselves, but are disadvantaged by having a relative with this still stigmitized and often debilitating disease. They check to see whether the children of the family are in school. They provide financial and emotional support for the family, even after the person with HIV dies. All in a day's work for Di Dien.

Of course if she finds a person too sick to stay out in the province, she brings them back with her and admits them to the hospital. Fortunately this did not happen today, although we did visit one young one man with HIV and TB who was recently discharged after she had found him very sick on her last visit. We met him on the side of the road, because his father is currently not allowing him in the house. He showed us his ARV and TB medications, kept in a small baggy in his pocket. Di Dien was very concerned about his situtation and will be working to secure stable housing for him. We also visited a woman widowed after her husband died of AIDS. She and their 3 children (thankfully uninfected) and the grandmother all sleep together on one bed in the simple 2 room structure, although they do have a mosquito net. The cook over an open fire but they do have running water and a proper latrine 20 feet from the house. Much better off than many I met in Tanzania all those years ago. They even have their own local drugstore of sorts - check out this guy on his bike selling an aray of sundries to the tunes of his boombox. He just rolled right on by while we were standing on the path in the middle of the rice fields!

In addition to getting to see the patients in their homes (or lack thereof), today was also an amazing opportunity to see more of the rural countryside. The guidebooks talk about how difficult it can be to get away from the coastline and visit the rural villages nestled in the mountains and foothills of Vietnam. In some cases tourists simply are not allowed by the government. The lack of good roads or anything in the way of a restaurant or hotel is also prohibitive. Standing in the shadows of the rolling green hills which separate Vietnam from Laos today was yet another privledge we were afforded in our roles as part tourist, part family.

Lost In Translation

2008-07-23T01:44:00.000-07:00

I've only seen "Lost In Translation" once, the film by Sophia Coppola starring Bill Murray and Scarlett Johansen. I remember it as a story of two people at very different stages in their lives, each feeling lost but finding themselves through finding each other. I remember it being beautiful and moving, but the only scene which I specifically remember is the one where they end up in a karaoke room in Tokyo. Something about the simultaneous strangeness and familiarity of the karaoke was particularly striking, both for the characters and for me.

Doannie and I had our own "Lost in Translation" moment last night when we too ended up in a karaoke room. We went with a group of Vietnamese medical students after conducting a conversation class with them down by the river (one of the responsibilities of my rotation at the hospital here). From the outside the place looked like a small hotel, at least 8 floors high but no more than 2 rooms wide. Then just like in the movie we were ushered up a narrow staircase and into a small room equipped with its own karaoke machine and a serious sound system. Instead of an American style karaoke bar where you write down your song requests and sing to a room full of strangers, this place was full of tiny rooms of solo performances, which turns out to be a slightly different beast.

We quickly learned that crowd pleasers back home like "Sweet Caroline" and "I Love Rock 'n' Roll" don't go over very well here, because there is no crowd to play to. Actual singing on key and on time is the goal, usually as a solo. The karaoke machine actually rates both your timing and your ability to stay in key and gives you a score (Doannie and I both managed to get in the 80% range). Thankfully we had bottle service from the bar downstairs (i.e., a guy brought a bucket of warm beers and a bucket of ice) to loosen us up. A duet of Boyz to Men's "End of the Road" won us some fans amongst the medical students.

For them karaoke is serious business, and a few of them scored 100%. As I listened to them sing tender love songs in Vietnamese (as well as a few by the Carpenters and Celion Dion), I had my own "Lost in Translation" moment. I don't understand most of what is said around me most hours of most days, and I have come to rely heavily on Doannie to fill me in as best he can. But I have also found my acuity for emotional subtext has sharpened as I watch the world go by in this strange and lyrical tongue. It is a beautiful thing to bear witness to someone else's pilgramage to their homeland, especially when that someone is your newlywed husband. As I sit on the sidelines in unusual-for-me silence, I see what a special gift we have both been given to experience this together.

Hoi An: Better than Filene's Basement

2008-07-21T08:00:00.000-07:00

For this weekend's adventure Doannie and I traveled to Hoi An, an ancient shipping village which was part of the famous Silk Road. A bustling port which once connected silks from Japan to spices from China, it is known for its unique blend of Japanese, Chinese, Vietnamese, and French architecture. During its heyday merchants from each of these countries maintained their own local governments in town while they went about their trades. The port ultimately filled in with silt but Hoi An was left with the regal buildings of these four communities and a legacy of fine craftsmanship. Otherwise known as...the place to do some serious shopping.

The adventure began when we boarded our bus Friday afternoon to find out that it was no ordinary bus, but rather a sleeping bus! Strapped in on the top level of the double decker like babies in bassinets, we traveled the four hours from Hue to Hoi An in style. The trip took us into the fog of the mountains and over the incredible Hai Van pass, after which we descended upon beautiful blue bays and white sandy beaches. After a week of saving money at the convent, we decided to splurge on a 5-star beach resort, a complete bargain at the current Dollar to Dong ratio.

But the bargins didn't end there. We had come to Hoi An on a mission: to purchase 8 tuxedos for Doannie's best friend Daniel's wedding (see related post: Buu Doan in the Buu Dien). Hoi An is full of tailors who will make anything you want in any material you want in a matter of hours. The shear number of choices was overwhelming. Wool coats for $50 (try trying one of those on in 100 degree heat), complete suits for under $100, shoes made to fit your feet...I could go on an on. And on it on it went, with the shopping and then the relentless haggling for prices consuming over 8 hours of our first day in town.

I realized things were a bit out of hand when on day two I said to Doannie over breakfast, "We really should see some of these ancient houses today" and he replied "Don't you remember walking past them all day yesterday?" (I did not). We had come to Hoi An for some R&R and to experience the famed Silk Road of old, and yet we were frantically consumed with modern consumerism. We did carve out time on Day Two to visit many of the old meeting houses, as well as several historic homes which had been in the same families for hundreds of years. We watched men and women executing the time honored tradition of lantern building, a special treat since the lanterns hanging from the rafters at our wedding were ordered directly from Hoi An. A trip to the Tran family chapel to hear a fellow Tran tell us about the 10 generations of Trans whose placentas were buried in the back yard (that way their souls are never far from home) was another highlight. Although she did eye me strangely when I said "I am a Tran too!"

Visiting the Homestead

2008-07-17T07:49:00.000-07:00

My parents say that they are from Hue in the same way that I say that I am from Atlanta. They are both catchall geographical terms that allow people not familiar with the area to attach location and meaning to your origins. But just as Atlanta area people have a sense of the subtle variations between Alpharetta and Doraville, the people of Hue draw distinctions between different villages. People around here can even pick up on what village or province you are from just by dialect. On Wednesday, we got an opportunity to visit the villages that make up my parent's past. In honor of the release of The Dark Knight, I will tell the tale of the uncovering of my parent's own origin stories using analogies from the Batman franchise.

Gotham City: My Mom was born in a small village called Vinh Hoa about 30 km away from Hue. It's a small, quiet beach town where my mother's family goes back at least two generations. My father was also born on the coast, but further to the south, not far from Nha Trang, but his mother's family is also from a village near Vinh Hoa. The entire region is dominated by rice farms. For those of you who have never seen one, a rice farm looks like an absolutely perfect emerald green lawn, except that the grass is about a foot high and submerged in six or so inches of water. The wind ripples its surface, making it look like the east Asian version of the American prairie. Rice in place of wheat, water in lieu of dust. At the right angles, at the right time of day, you can see the sparkle of silver water between the blades as farmers wade through their fields maintaining their livelihoods. Rice cultivation is one of the few major modern subsistence crops that resists industrialization, so everything is done by hand and oxen. There is no diesel-powered behemoth combine, the only motorized vehicles are the ubiquitous motos, buzzing like overgrown cicadas. Being a coastal village, the other industry of the area is fishing, a trade plied on long skinny wooden boats propelled by a thin paddle like the one used by a gondolier. My mother's family was actually involved in construction, but I guess it turns out that both my Mom and Dad were really kind of beach kids. Which is weird.

Wayne Manor: My Aunt Dien and Uncle Han took us to the house where my mother was born. I don't think it takes a rocket scientist to understand how powerful of an experience this was, to see the house that my grandfather built, where my uncles lived, where my mother cried because my uncle Han (her cousin) wouldn't give her some of the fruit he had picked from a tree in their yard. Inside the house was the same shrine to the ancestors that you'll find in every home and business in Vietnam, but this one was unique to me and my family, tracing a line from me to someone who lived so long ago their portraits were sketches on paper. Generations of my family are buried there.

It was my experience as a child of immigrants to have a loose connection to my parent's homeland. It was not see-able, or really know-able, even though it was an ever present spectre in our daily lives. I think that's why I have such a strong feeling of connectedness to my places, the Athens's, the Oakland's and Boston's that have made up the fabric of my life. To understate what has clearly been a theme for this whole trip: it has been nice to see where my parents grew up.

The Batcave: Anyone who knows my parents knows that the only place where they would seek refuge and rest, to rearm and prepare for any upcoming challenges is a church. And lo and behold, my Mom grew up about 10 feet from the Catholic church in town. My grandfather was a lay deacon, and my family has given money over the years to build up new additions and upgrades to the facility.

Cast of Characters...a Female lead and a bunch of really really old people like Alfred: We visited a lot of distant family. For my family's sake and the fact that it is extremely unlikely I will remember them later, I will briefly outline their relationship to me under each picture.
Here's the classic multi-generational Vietnamese household.

Believe it or not, these two very elderly women in the background are my father's cousins. My grandmother was one of the youngest of her large family and these women are the children of the oldest. They are still kickin' well into their eighties. Bodes well for me.

She is the younger sister of my father's mother. Also amazingly robust. Go Asians.

What a cutie. The Byzantine maze that describes her relationship to me is not important, but she was an enchanting little lady. They were all amazed that I would come to visit them and were patient through my limited Vietnamese as we outlined their relationships to me and mine.

As we drove away, I wondered if I could ever have much of an idea what it's like to live their lives, to see what they've seen, to do what they must do everyday. Did they see the vast asymmetry, that what divides our stations in life isn't genetics or race or any other scapegoat for poverty, but zip code? A daring parental act 35 years ago created a rift between us, with tile and porcelain and limitless opportunity on the one hand and concrete and bamboo and mildewed squalor on the other. It's hard not to think that my parents slipped through an ever narrowing door, that the world will not receive these sons and daughters with the same sort of jaw dropping generosity it gave me and my sisters.

Raiding the Imperial City

2008-07-17T07:46:00.000-07:00

Hue was the Imperial capitol of the Nguyen dynasty from the early 1800's to the mid-20th century. As such, it is home to a massive citadel, a city within in city on the north bank of the Perfume River. Modern Hue surrounds this old walled compound. The north bank is called the Imperial City or the Citadel, and the part of the city on the south bank of the river is sometimes called the European city, a reflection of its more recent origins. Ancient-looking walls surround ancient-looking buildings with ancient-looking woodwork. By and large, however, most of the feeling of ancient-ness in the Citadel exists at the intersection of illusion, artifice and really clever marketing.

This is not to say that Vietnamese culture is not very very old, because traceable elements of it do extend back thousands of years. But as ancient-looking as this amazing structure was, we just kept thinking that there were things older than this in Boston. The oldest things we were seeing dated from the mid-nineteenth century, and on top of that, most of the buildings of the Citadel were destroyed by the particularly intense fighting and bombing campaigns around Hue during the American War. The scenic gardens, the houses of meditation and worship were mostly reconstructions of a remembered past.

Still, it was a sight to behold, with its high and forbidding walls surrounded on the exterior by a moat filled with beautiful purple water lilies. An interestingly delightful choice for a defensive mechanism usually filled with stakes, burning oil and/or crocodiles. Maybe all of these things were in there. If so, it's a little like putting a candy coating on a wrecking ball.

Holly and I were not alone on this little tourist jaunt. No, the young girl pictured here is not some wayward street urchin, nor a girl that Holly and I are adopting to bring back to the US (surprise!). Interestingly, these are not too far from the truth. Unfortunately, these sad, made-up scenarios are not even fully reflective of the real tragedy of her story. Her name is Tam, and she and her sister are orphans. They lost their parents years ago and now live with my aunt in the clinic. She is, frankly, more cheerful that I would be if that were my life, and she had a great time exploring the temples and gardens of the Hue Imperial City and the Thien Mu Pagoda we visited that day.

The Thien Mu pagoda is more expansive than one expects and houses a Buddhist monastery on its grounds. Above, you can see some new recruits getting their first taste of the ascetic life. We started talking to one of the older monks there and he told us that these young men were former pickpockets and street thieves turning over a new, and more cleanly shaven, leaf. As I'm used to saying as a teacher, every day is a new day, right?

Every day is an opportunity to do right by the world, too. The Thien Mu pagoda is mostly a testament to a distant past, but it holds one semi-modern relic shown above. An old beat-up car is a standing monument to the Buddhist monk who immolated himself in Saigon to protest the lack of religious freedom experienced by the Buddhists of Vietnam. At first sight, seeing a car on these natural surroundings seems dissonant, but ultimately the mind brings into focus what they eye can't see: that sometimes creating a peaceful nirvana on earth requires acts of personal and grotesque sacrifice.

Funeral in Hue

2008-07-16T05:36:00.000-07:00

For a blog about a summer travel excursion, this probably seems like an odd posting, a dour sidetrack to an otherwise sunny and exciting adventure. Actually going to the funeral of a very distant relative here in Hue, however, made me remember one of the reasons I decided to come to Vietnam instead of some other country in Central America, or Europe or Africa. It's a reason so cliched that only Jhumpa Lahiri can write about it anymore without irony: I came, in part, to find my roots.

The language, the food, the very geography highlight the connections ripe for the making. Walking around Hue, certain characteristics about my family become clear. Hue is a city known for education. People love school here. Every slightly decaying French colonial building is a shrine to higher learning. Is it any wonder that my parent's highest aspiration for me and my sisters was to go on to graduate school of some kind? The food is elaborate, the people kind, formal and aloof. The landscape serenely beautiful, the kind that is easy to miss and long for in the deepest recesses of your heart. The longer we're here, the more details about my parents and my upbringing seem to snap into clearer focus.

Oh the language. This one thing is probably, and inevitably, what makes this root-finding business so difficult. The accent of Hue distinguishes it from every other region of Vietnam, and it has done an excellent job of distinguishing me to exclusion. I'm regarded as an oddity on a par with Holly and her big blue hat. I've lost the one thing that could make me feel at home in this city. Every word that I successfully scrabble for in the dark places of my brain, each phrase that I correctly piece together is greeted with moderated indifference. It's expected. Anything less and the questions begin to fly about why I haven't been studying my Vietnamese more back in America.

Any-hue....(sorry I couldn't resist) back to the title of this posting. This morning, we went to the funeral of my mother's cousins mother-in-law. This is roughly equivalent to our future children attending the funeral of Holly's cousin Macie's husband Kent's mother's funeral in Zimbabwe. But it's what my people do. We attend Mass, we sing, we cry, we chant and we remember. And we eat. I've seen this ritual carries out many times, but this time I got to see them where they were meant to be carried out, not 10000 miles away in a country where snow falls from the sky. The transplant is because of other things that my people do: we survive, adapt, and carry what we can. You lose some things, gain others. But you can find lost things sometimes, and maybe be better for the looking.

Kim Long Charity Clinic

2008-07-16T04:47:00.000-07:00

"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!

It's "Hue" better here

2008-07-16T02:07:00.000-07:00

For those of you who might not know, and to put the title of this post in context, Hue is pronounced like "Way." It is also the home of Doannie's parents and where we will be spending the next month working. We arrived Sunday night, and in the couple of days that we have been here in Hue, we have really come to appreciate how different it is from Saigon. First of all there are many fewer motos, which has lowered my heart rate considerably.
There is a lot less in-your-face poverty, and there are is a certain air of refinement in the way that life is conducted here. The banks of the Perfume River have been spared overdevelopment, and instead of crumbling houses and storefronts they boast a 2mile long promenade lined with trees and gardens and filled with sculptures. There are over 5 universities here, and an early highlight was a trip to the Quoc Hoc High School, built in French colonial times and attended by Ho Chi Minh. The pristine grounds boast the words "Day Tot, Hot Tot" or "Teach Well, Learn Well." It should be noted that while Hue people consider themselves the enlightened academics of Vietnam, the rest of the country considers them a bit snooty and highbrow. Coming from Boston, we fit right in.

We spent Monday getting oriented to the city and to our new digs - a room over the clinic adjacent to the Convent of the Daughters of Mary Immaculate. Complete with nuns running around in blue habits (including Doannie's aunt, the physician-nun for whom I am working), it is very Sound of Music. Our room is spotless but a bit sparse - we sleep on a simple mat and blanket. But the views overlooking the Perfume River and the deliciously prepared Hue cuisine are well worth it, plus it is forcing me to speak Vietnamese. So far I can say "Toi khong biet noi tieng Viet" which means "I don't speak Vietnamese."

After walking around in 100 degree heat and 100 degree humidity for 6 hours on Monday, the purchase of a sun shade of sorts became our singular quest. Finding the hat store was like finding an oasis in the desert - except that only one hat fit my huge noggin (turns out Doannie's equally large cranium is unusual for the Vietnamese). This unfotunately left us with little room to bargain - they had me cornered, and they knew it. So I am now the proud owner of a ridiculous looking big blue hat which I am sure will feature prominantly in all future blog pictures. Who knows, it might even earn me a reputation about town as the Blue Hat Lady - fitting for slightly eccentric Hue.

War Remnants Museum and Cu Chi Tunnels

2008-07-13T01:46:00.000-07:00

I am a small guy. I'm not afraid to admit it and anyone who has seen our wedding pictures would certainly agree. And in addition to all those great games of hide and go seek I used to win as a kid, it finally came in handy today. Holly and I visited the Cu Chi Tunnels, an area 70 km north of Saigon that was a major staging ground for attacks into South Vietnam. It is a 200 km network of tunnels that served as homes, factories and fighting grounds for the Vietnamese through their wars with the French and the Americans. There was even a nursery where babies were born, all 10 to 30 meters underground. I used to think that most Vietnamese were just small. But now I know that we are small AND crazy.

I was the first to volunteer in the one authentic tunnel that tourists are allowed to use. Let's just say that there wasn't a lot of room between me and the bats. To give you a sense, I'm 5 foot 4, and I was on my hands and knees with not much room to spare. Reminded me of my first apartment in Athens. In contrast, Holly had to bail after 15 meters in the tunnel that was widened and lit for tourists.

We also saw exactly what a B-52 shell can do the ground that it hits. Big....damn....crater. Our tour guide also showed us the ingeniously devilish booby traps made by the Viet Cong. Very sharp objects. I also got to shoot an AK-47 for 1 US dollar a round. Let's just say that we left the tunnels with the knowledge that humans can be especially inventive when thinking about ways to kill one another.

Exhibit Two in this case: War Remnants Museum. Blatant Anti-American propaganda mixed in with genuine, sincere, and grotesque demonstrations of how bad war really is for everyone involved. Through a partnership with the Commonwealth of Kentucky (not kidding), pictures of Agent Orange and napalm victims were juxtaposed with images of dying and wounded American and Vietnamese GI's, to be gazed on by silent witnesses 40 years removed.

Take away message: War is bad. Fried chicken is good.

The Seventeen Saloon

2008-07-12T01:58:00.000-07:00

After a hard day of riding a hot bus and hot ferry boats back from the Mekong Delta, Doannie and I needed a cold beer and a comfortable place to hang our hats. What better place than the Seventeen Saloon, a western-themed bar complete with Vietnamese dressed in cowboy outfits and walls adorned with the headdresses of American Indians and some oddly misplaced paintings of Mardi Gras. After getting used to paying only 75 cents for a beer, the asking price of $5 for the local brew on draft was a bit shocking. But when the entertainment came on stage, it quickly became evident that it was worth every penny.

For anyone with me in Thailand in the spring of 1999, let's just say that this place gave the Thai Cowboy in Chaing Mai and the performers in Assless chaps singing "Country roads take me home" in Bangkok a run for their money. What we got was not rockabilly or sounds from the heartland, but rather a metal band with a bit of Bon Jovi thrown in. This was made all the more surreal by the fact that the band was wearing "40 Watt" T-shirts from Athens, Georgia and the debut of coordinated thrashing hair routines. During the instrumental portions of each song, the 3 scantily clad backup singers AND the male lead would launch into highly syncronized gyrations of their long locks. Please see attached video - words do not do it justice.

Mekong Delta

2008-07-11T01:28:00.000-07:00

From Saigon, it's pretty easy to access the entire southern part of the country, and one of the most notable features is the famous Mekong River Delta. Both the rice basket of the country and the site of swampy battles during the American War (read: Vietnam War), it offered many sites and experiences. We got to do a home stay with a fabulous family that taught us how to cook some delta dishes and were exceptionally patient with Holly's Vietnamese.

Over two days, we took small boats throughout the many tributaries of the Mekong, visiting floating markets and islands throughout the delta. Even though we recognized that this was a big tourist event, it was still interesting to get a glimpse of life in this really rural part of Vietnam, and it was a nice contrast to the hustle and bustle of Ho Chi Minh City. Life in the delta revolves around things you can do on, with, and in your boat. People sell fruit, vegetables and snacksfrom their boats. People shuttle things to and fro on their boats. Lot's of people sleep in their boat. And judging from the large numbers of children scampering around on the boats, people do a lot of not sleeping on their boats, too.

The people of the delta are extraordinarily industrious and do things with rice, coconuts and bamboo that most people would never imagined possible. We saw people making rice paper and noodles, and learned that three or four people can churn out 500 kg of noodles per day using tools made only from bamboo. People there make coconut candy and also make a curious concoction: cobras and scorpions steeped in rice wine. Did Doannie have a sample? Did he have two? Yes. Did Holly? No. Did she grimace and make the yucky face? Also yes.

Arrived safely in Vietnam! + First Day

2008-07-09T20:42:00.000-07:00

Welcome to our Vietnam trip blog! We arrived in Ho Chi Minh City safely on Tuesday evening and were quickly welcomed by the hustle and bustle of this crazy town.

We spent yesterday getting our bearings and visiting the VCHAP (Vietnam-CDC-Harvard Medical School AIDS Partnership) Clinic in District 5 of Saigon. We meet with their staff and saw three HIV case presentations, and in doing so, discovered a gap in our respective strengths. I know more Vietnamese than Holly, and she likewise knows more medicine, but my already tenuous ability to piece together meaning starts to break down when words like "Zidovudine" are thrown in there. The situation was made all the more difficult by the presence of Dr. Donn Colby, Medical Director of VCHAP-HCMC, who speaks Vietnamese as fluently as the guy that sold you pho at the street corner. Only he also knows the medicine.

From the Infectious Disease Hospital, we went to the Jade Emperor Pagoda, expecting to see a tourist-oriented, grand and ancient spectacle of a temple. Unexpectedly, but not unpleasantly, we instead found ourselves visiting a quiet, somewhat-shabby, but serene place of worship for the Buddhists of Ho Chi Minh City. We were some of the few tourists tip-toeing around people prostrating themselves before altars, suffused with the smell of the incense placed by worshippers going about their daily prayers and meditations. Turtles big and small splashed obliviously around the moat that surrounded the pagoda, symbols of good luck and fortune. Then the torrential rains came, reminding us that for all of the urbanity of HCMC, we were still essentially in the middle of a coastal jungle.

We decided to make the long walk that transects three of Saigon's 10 Districts back to our hotel. We saw huge differences in wealth, cleanliness and western influence, moving between streets with classic Vietnamese sidewalk food for sale from carts, to high-end shopping streets with young professionals and French pastry shops. We saw the pagodas and rickety shanty huts of Saigon's massive underclass and the huge French colonial buildings that still held the seats of the city's power. But most of all, we saw the scooters of Ho Chi Minh City.

Honda must do brisk scooter business here in Saigon, because you cannot turn a corner without seeing about 800 of the loud two-wheelers buzzing around you like a school of fish. Nor should you turn a corner without looking both ways ten times with three Hail Mary's thrown in for good measure. Only through the powers of divine intervention and Matrix-like bullet dodging do the people of this city survive unscathed. Scooters dip and dive between taxis, zip around pedestrians, plow up onto sidewalks in droves during rush hour. Seriously, the margins of clearance between people, cars, and scooters cannot be more than a few centimeters, and although I'm glad that all scooterers wear helmets, walking in this city makes me want to have a riot shield and a baseball bat.

Holly holds my hand like a small child and is afraid.