Particularly in comparison to other students' experiences, the orthopedic hospital in Ho Chi Minh City was quite modern and advanced. Joint replacements, even microsurgeries occur on a regular basis, and given that the hospital is a Communist government-run institution, it is incredibly impressive what the staff is able to accomplish with its resources. While rotating through the ER, OR and wards, many of us witnessed cases that were unique and unusual to us: a fairly young man living with the consequences of polio, a teenaged girl with an incredibly advanced bone tumor requiring total amputation, a child with severe and untreated bone malformations. Yet, what seemed to truly resonate with many of us was the cultural aspect of treatment and patient expectations.
Without an ambulance system, patients would find a way to get themselves to the emergency room, often with make-shift splints or bandages holding them together. After arriving at the hospital, they would wait outside. In the heat. Did I mention how hot it is in Vietnam? There is no possible way these people were not in excruciating pain; one may came in holding his four severed fingers, another man sat holding his dislocated shoulder and severely broken clavicle. And yet, no one made a sound. No one complained. Even the admitted patients would share a non-air conditioned room with six other patients and would need to rely on their own family for basic care and food. We could only imagine such a scene in the U.S and the uproar by the patients. It was a difference in expectations of care, a difference in cultural beliefs and behavior. It was not right or wrong, just different. We respected the patients for their stoicism in the face of pain, their families for finding a way to care for them, and the doctors for doing their best to bring relief. We may have even felt a little guilty for complaining about circumstances in the U.S or for times we cried out in pain for something small. Whether it has a religious component in the Buddhist tradition, or a historical one in that many of these people lived through a catastrophic war, we couldn't say for sure. However, appreciating the difference was an important learning experience for us.
The cultural differences extended beyond the reaction to pain. Anesthetic was used quite differently at the hospital, with an emphasis on local blocks rather than general anesthetic. This may not seem like a big deal until you are scrubbed in during the middle of a hip replacement (which is a very, lets say, aggressive surgery) and the patient starts talking to the anesthesiologist. He wasn't in pain and he was somewhat sedated, but he wasn't knocked out either. Again, this is a difference in practice and truly has its merits for patient safety and pain management, but it was none-the-less shocking.
Lastly, exposure to the medical system itself had a cultural component. Our experience in Ho Chi Minh showed a city that was very commercial and appeared quite Capitalistic. Many of its citizens still referred to it as Saigon, and stories were of times pre or post 1975. The Communist influence was obviously still present as the physicians were required to work at the state run hospital for little money, and even a site like Facebook was blocked. The patients still had to purchase health insurance and pay for every component of their treatment. Only one
X-Ray was taken because other views would be too expensive. There was not a central charting system or records, the patients brought their own documents and films. How the chaos was somehow controlled was amazing; the physicians were very efficient and managed to keep track of the patients very well despite the overflowing waiting room.
Yet, despite all the cultural and economic differences, the medicine was the same. The doctors emphasized the patient and educational advancements and despite some limitations, everything possible was done. When congratulated on a successful operation removing the massive tumor from a young girl, the doctor replied sadly that there was nothing good in that situation; the girl's prognosis was poor and there was only so much he could do. Medicine is clearly not an easy profession, but it is inspiring to see that regardless of the location or the people, the drive to help and do no harm is universal. As a group, we too were limited in what we could do and how we could help. Yet, the experience provided us with a perspective and an appreciation. We will be reminded to check our egos, understand that people vary in their expectations, and to respect what we can learn from those with different backgrounds and experiences.
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