Medical Students Visit Vietnam to Explore Physiatry

Vietnam 2005
by Nhat H. Tran, M.D.

It began as a dream inspired by Albert Schweitzer and his humanitarian work in Gabon . As a 2000-2001 New York City Albert Schweitzer Fellow, I was introduced to the legacy of Albert Schweitzer and how his efforts helped build a hospital in Gabon . My Schweitzer Fellowship Project involved helping the disabled community in New York City to live their lives to the fullest. Working in conjunction with H.A.I. (Hospital Audiences Inc.) and experimenting with some of my own ideas, we were able to make a small contribution to the livelihood of individuals with disabilities. My involvement with the Schweitzer Fellowship served as a great learning experience as I realized that not all ideas and dreams manifest smoothly in reality. It actually takes perseverance and a solid foundation in order to build upon one's hope and desire. With that lesson learned, I began to set my sights on doing something that involves helping the disabled in developing countries.

As my medical training progressed, my desire to help the disabled intensified. This resulted in Physical Medicine and Rehabilitation (PM&R) as my career choice. For me, this decision was also very personal since I also experienced adversity as a result of having Guillain-Barre Syndrome at the age of 17. This illness still leaves me partially paralyzed from my right knee down. But my motto has always been "Just because I am disabled does NOT mean that I am unable." With this motivation serving as my driving force, I set out to try to make all of my dreams come true. One of those dreams involved helping disabled individuals in developing countries. After several years of hopeful thinking, my wish came true as I was given the opportunity to go to Vietnam to do a volunteer/clerkship experience at Bach Mai Rehabilitation Center.

I owe much gratitude to Dr. Mark Young, whose guidance and support enabled me to fulfill my dream of doing international rehabilitation. Dr. Young is the chairman of the ISPRM International Exchange Committee, whose objective is to facilitate international educational opportunities for physiatrists. Dr. Young's work in ISPRM allows him to network with other doctors worldwide who share the same passion in helping the disabled. Fortunately for me, Dr. Young knew Dr. Robert Weller from Australia who in turn knew Dr. Nguyen Xuan Nghien at Bach Mai Rehabilitation Center in Hanoi, Vietnam. Dr. Nguyen is chairman of the Bach Mai Rehabilitation Center and also serves as President of the Vietnam Rehabilitation Association. Thanks to Dr. Young's letter of introduction on my behalf, Dr. Nguyen accepted me for a one month clerkship at Bach Mai Rehabilitation Center.

My journey back to Vietnam also had personal significance to me. My parents and I left Vietnam in 1979 in order to search for a better way of life and to give me the opportunities to thrive and prosper. They felt that these opportunities were plentiful in America and so we emigrated to the United States, in search of our American Dream.

Decades after we left Vietnam , my journey back to Vietnam not only allowed me to learn about medicine in Vietnam , but also to re-introduce me to my Vietnamese roots and the land of my ancestors. This trip also allowed me to brush up on my Vietnamese language and to learn about Vietnamese cultures and customs. But most importantly, this return to Vietnam helped me reconnect with my relatives, especially with my aging Grandmother who had "cherished me worth my weight in gold" when I was then her first and only grandchild over 25 years ago. Seeing her reminded me the importance of family and the strong bond that exists between a mother and child and that of a grandmother and grandchild. Although my Grandmother is a little weaker and not as sharp as in years past, I am ecstatic to know that she is proud of how her little "Cu Nhat" has turned out to be. I hope that my life efforts will be worthy of her love and admiration.

During my medical experience in Vietnam, there were several objectives I wanted to accomplish. First, I wanted to observe and learn how medicine is practiced in Vietnam , and in particularly the field of PM&R. Because financial means are limited and that the majority of the Vietnamese population does not have medical insurance, many individuals do not see a physician until they experience a major health crisis. Based on my observation, preventive medicine is not widely practiced in Vietnam. Similar to America, not many people in Vietnam are familiar with PM&R as a medical specialty. When patients finally see a physiatrist in Vietnam, most of their resources have been depleted after seeing other doctors from other specialties. As a result, PM&R does not and is unable to generate very much revenue for the hospitals. In addition, there is some overlap in the patient population between PM&R, neurology and rheumatology which results in a competitive atmosphere amongst the different specialties. When patients are fortunate enough to afford to stay in a hospital, they face over-crowding and limited hospital resources, some of which we take for granted here in the United States. For example, ICU patients are often clustered together in a single room which makes the patients susceptible for cross infections. Most hospitals do not provide food or assist patients with their daily care, in which case, such activities are provided by friends or family members. Sometimes, it is not uncommon to see patients sleeping on a cot outside the hospital room because there are not enough beds inside the room. In regards to outpatient clinics, some patients arrive at the hospital extremely early in the morning and would still have to wait for several hours before being seen by a doctor. Private medical offices are generally reserved for the more affluent who can afford to pay the higher costs of such visits. When seeing patients and visiting several medical facilities, I took notes and considerable amount of pictures so that I can share my experiences with others who might have a desire to go to Vietnam for a medical clerkship/volunteer work. I hope that my observations can shed small insights into the practice of medicine in Vietnam. It is also my desire that further exploration, networking and collaboration develop between international medical professionals and Vietnamese doctors so that the people of Vietnam can benefit from better medical care.

While in Vietnam, I spent 2 weeks in Saigon (Ho Chi Minh City) where I visited relatives and several rehabilitation facilities and surgical hospitals. One of which is ChoRay Hospital. This hospital was founded in 1900 and went through several name changes until the official name of ChoRay Hospital was adopted in the 1950's. This is a teaching hospital affiliated with Saigon Medical School. Rehabilitation services here consist of primarily outpatient clinics and outpatient physical therapy/treatments along with some inpatient consults. The chairman of ChoRay Rehabilitation Center is Dr. Bui (a former student of Dr. Nguyen). I also visited the Orthopedic and Special Surgery Hospital of Saigon. This hospital has a small physical therapy facility where post-surgical patients come for rehabilitation.

During my stay in Hanoi, I spent the majority of my time at Bach Mai Rehabilitation Center, situated within the Bach Mai Medical Center Complex. Bach Mai Rehabilitation Center serves as the training ground for all Vietnamese physiatrists within the last 30 years. Inpatient and outpatient facilities are housed in the "Round Building." About 60% of the patients occupying the 40 inpatient beds in the Round Building can actually be treated as outpatients. But because the majority of these patients live from far away provinces, they are allowed to occupy these inpatient beds. For example, patients experiencing neuromuscular pain such as those resulting from herniated discs are allowed to stay in the hospital so that they can have daily physical modality treatments (ie. Traction and Electrotherapy.) Other rehabilitation services at Bach Mai are similar to those from American hospitals. For a more detailed description of these services, please click on "Bach Mai Daily Routine" from our homepage.

While in Hanoi , I also spent some time at Viet Duc Hospital, which is the premier surgical hospital in Vietnam. Besides performing gastrointestinal, neurosurgical and orthopedic cases, Viet Duc also conducts research and hosts symposiums where doctors from other Vietnamese provinces and international lecturers congregate to discuss relevant topics in their field of specialty. At Viet Duc, I was allowed to observe several neurosurgical cases, conducted by an Australian neurosurgeon who volunteered his time and efforts while also giving Grand Rounds pertaining to his expertise.

Several rehabilitation facilities existed in the rural areas of Vietnam as well. One of which is located in Quoc Lum, a small beachside resort community several hundred miles southeast of Hanoi . This rehabilitation center serves primarily industrial workers needing time off to de-stress from their daily manual labor jobs. Several patients suffer from silicosis and asbestosis due to their work in factories. However, the main reason why many patients come here is still rest and relaxation. Another rehabilitation center is located at AGAPE Hospital in the province of Nam Dinh. AGAPE Hospital receives considerable amount of international aide and charities, one of which is from VVAF (Vietnam Veterans of America Foundation) who funded the opening of a prosthetic and orthotic workshop at AGAPE. To learn more about VVAF and their work in Vietnam, click on "VVAF Ortho Workshop" from our homepage. Another international organization involved in prosthetics and orthoses in Vietnam is Vietcot. To learn more about Vietcot, click on "Vietcot" from our homepage. I visited the main facilities of VVAF and Vietcot since they both are located in Hanoi. These two organizations have been instrumental in providing knowledge and resources necessary for the construction of prosthesis and orthoses for the disabled people in Vietnam.

When I was at Bach Mai Rehabilitation Center, I rounded with the attendings and residents during my clerkship there. Although I could speak Vietnamese, the medical translation gets lost as I am not familiar with the medical terminology in Vietnamese. Fortunately for me, Dr. Dong Nguyen (son of Dr. Nguyen Xuan Nghien) who is also a physiatrist, spoke fluent English and was able to translate for me the medical terms from Vietnamese to English and vice versa. Many patients knew that I am a doctor from the United States and so they wanted to ask me about their medical conditions and prognosis. Several of these patients stand out in my mind in which I have included them in the "Bach Mai Patients" section of our homepage. Some of these patient's medical conditions could have been avoided if better sanitation existed in Vietnam whereas other patient's co-morbities could have been less traumatic if basic therapeutic devices were available at the hospitals. Having trained and worked in American hospitals in the United States , I took for granted the resources we have at our disposal as doctors in America . It is my desire that these resources be available worldwide to other medical professionals so they can better help their patients. Thanks to my medical journey in Vietnam , I'm even more committed to the field of Physical Medicine and Rehabilitation and I hope to broaden the reach of PM&R internationally, so that people with disabilities can be empowered to live their lives to the fullest.
 

For More Information on Dr. Tran's Visit to Vietnam please visit www.internationalrehab.com