Bubs and the Old Quarter

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

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

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

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

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

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

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!