Viet Nam Experience
David Cooke
Five am. The loudspeakers on telegraph poles blare out scratchy music to wake the populace and induce them to start their day's work. I wonder why they couldn't wait another hour or so to let me sleep till a reasonable time. Later in the day the tourists will be entertained with Vivaldi broadcast from those same speakers.
Already the day is heating to its 35 degree and 98% humidity, and the hazy sun beats down on the ever busy roads. Motorbikes and pushbikes stream in a procession past the hotel in a seemingly chaotic traffic system that strangely appears to work. It is not unusual for a bike to accommodate four people weaving like fighter pilots with incessant tooting of horns.
At 7.30am my nurse Judy Avenell and I are picked up by two young interpreters, An and Nguyet, and, hanging on we enter the traffic for a clinic out of the town of Hoi An. After twenty minutes we are still alive and Judy has managed to open her eyes for the last two kilometres.
We enter the clinic building which is proudly shown to us by the local “EC”, a man trained somewhere between a nurse and a doctor.
A fan is fetched and Judy begins to screen the patients for diabetes and blood pressure before handing them on to myself and Mai, an Australian nurse who manages the Hoi An Foundation and has been here for many years. American doctor, Joshua Solomon started the organisation some years ago and spends many months of each year in Viet Nam.
The people are gentle and appreciative but suffer from these two diseases due to the high salt and sugar content of their diet.
“Are you taking the tablets?” the interpreter asks on my behalf.
“No, I felt better,” is a common answer and indicative of the amount of education these patients need about their treatment.
I sigh and the interpreter explains that the blood pressure is 200/100 and that this fifty year old is at risk of stroke. We give advice and prescribe the available medications some of which we stopped using in Australia twenty years ago. One such is Cozaar I note, stopped in a hurry in the western world because of serious side effects, and so I take people off this treatment. I wonder why we are doing this work when there are locally trained doctors until I learn that they have no continuing medical education, never meet for discussions and are reluctant to share any medical information.
With vast amounts of bottled water to counteract the enervating heat, we wade through the day seeing more heart murmurs in my three weeks in Viet Nam that I have seen in forty years of Australian practice. It is largely rheumatic disease with a smattering of Fallot's tetralogy and septal defects. These go unrepaired in the majority of cases due to the cost ($US5000) of surgery for people whose annual income may be around $US600. These people would be lucky to reach twenty years of age.
I see wounds from the “American War” and there seems no resentment by these ex Viet Cong men and women. “That was then,” they say, “this is now.”
The pathology is gross and plentiful - hydrocephalus, Marfan's syndrome, cerebral palsy, marked clubbing and of course the horrific effects of Agent Orange.
The people seem happy and accepting of their situation, and, as doctor is spelt “GOD”, I seem to have more success in getting patients to stop smoking than in Australia.
Today we see about seventy patients although each day is totally different. Some days we travel far out into the countryside while others involve loading the bike on a ferry and working across the river on one of the many islands.
What a momentous experience. What a learning curve! My wife and I live in a comfortable hotel for $US25 a day including breakfast and it is possible to eat for $US7 - 8 per day.
Would I go again? Ask me in a year's time when I've got over the exhaustion, but probably Yes.
The two Vietnamese girls, Nguyet and An are stimulating, energetic and full of knowledge, (as well as being clever on a bike) and Mai and Carol, two Aussie nurses who run the Hoi An foundation are truly inspirational, dedicated and selfless.
Three weeks of this experience and I return to my Lighthouse Beach Surgery. The rooms are airconditioned, there are no frogs jumping across the floor and the computer generated scripts for modern medicines are paid for by the government. A man needs heart surgery and is taken by air ambulance to Sydney where a surgeon will perform the operation at no cost to the patient.
I muse on the difference and I shall never be the same again.
