Monday, January 26, 2009

Happy New Year, Happy New Year...

If I never hear this song again, I'll be a very happy KT:



I've heard it several times a day since arriving in Vietnam a few weeks ago, and was woken by it far too early this morning (Tết - New Year's Day). It's insane!

Sorry for the dearth of posts - I've actually had plenty of time to post while here, but have lacked motivation. So my first resolution of the lunar new year is to post more regularly on my blog. Most of the hotels here have free broadband in the rooms, so really, I have no excuse.

Hanoi is just as I remembered it - busy, confusing, and LOUD. There are motorbikes everywhere - as well as cars, buses, and cyclos - and they all honk their horns incessantly. Crossing the road is scary! You need a lot of confidence to do it. Some people say you should just walk at a steady pace, without checking for and dodging vehicles, but I think that's crazy. My best method of crossing the road involves a bit of a shuffle, and making sure I'm on my toes in case I need to dodge a speeding motorbike. I've seen the surgical hospital - I DO NOT want to end up there.


Motorcycles everywhere

I'm comfortable getting around the Old Quarter of Hanoi without a map now, which is fantastic. I've done a few touristy things, like visiting Uncle Ho, riding swans (paddle boats) on West Lake, and visiting Tam Cốc (things that I didn't do when I was here two years ago), but it's been fun just settling into life as a resident of this crazy city. The New Hanoian has been very handy, as has the trusty travel bible. We've discovered some really wonderful places to eat, we've been to the opera (La Bohème), and last night (New Year's Eve) we even cooked spag bol for a big group of med students and hotel staff at one of my fellow students' hotels. We bought all the ingredients (except the pasta) from a street market - it was so fresh. The beef was fantastic. And it was so great to be cooking - I love to cook, and was already missing it.


Swans on West Lake

I've gotta say, I'm not loving the local food in Hanoi. I find it a bit bland and greasy, especially when compared with food from southern Vietnam. And I know this is blasphemy, but I don't really like phở bò. There, I said it! I'm just not a noodle gal. That said, I have eaten it and haven't minded it, but I certainly won't go out searching for it (and would never eat it for breakfast like everyone else does). I'm heading south tomorrow (Danang and Hoi An), and I'm really looking forward to eating some of the local specialities, such as white roses (shrimp dumplings) and fried wontons.

I did a good cooking course though. We prepared Hanoi street food - BBQ pork strips and meatballs, noodle and herb salad, spring rolls, and dipping sauce. Unfortunately, I'd woken that morning with a stomach bug, and spent most of the class in the (thankfully clean) bathroom. It was only a 24-hour bug, and I've been otherwise really well.


Spring rolls - deep fried for half an hour!

I'm here with four other students from my uni, and four students from an interstate uni. We all get on well, and have had plenty of fun out and about in Hanoi. Some of the students have been very keen, whereas I've been more inclined to take it easy and have a half-holiday, half-elective experience. On each weekday, I tend to be at the hospital until about lunchtime (sometimes finishing earlier), with afternoons free for sleeping, sightseeing, shopping, etc. Perfect! I do plan to step it up a bit in Danang next week, because there won't be as much to see and do in our spare time there. We've been told to take this week off because of Tết - quel domage!

There are three major hospitals in Hanoi - Viet Duc surgical hospital, Bach Mai medical hospital, and the Paediatrics hospital. I've spent most of my time at Viet Duc. I did a week of neurosurgery, a week of orthopaedic surgery, and a few days of Emergency before heading to Halong Bay last week. I also visited the Paeds hospital one day - my koala bear toys were a big hit with the sick kids (and I still have plenty more to give away, probably in Danang).

Viet Duc hospital has been an eye opener. The thing that's really struck me is the lack of pain relief. I think it's a cultural thing - the Vietnamese people appear to be very stoic, and they don't complain when they're obviously in a lot of pain. The strongest painkiller I've seen on the wards is IV paracetamol. I haven't spotted morphine anywhere yet. Even amputees only get IV paracetamol.


IV paracetamol

The main mechanism of injury at Viet Duc is motorcycle accidents. Vietnam brought in a compulsory helmet law at the beginning of last year, but the poor quality of the helmets and the fact that they're rarely fastened properly mean that serious head injuries are far too common. Limb injuries tend to be catastrophic. Other reasons for visiting the Emergency department are machinery accidents (I've seen many mangled hands) and falls from building sites.

Communication is a big problem for us at the hospital. Some doctors speak English (some better than others), and only a few of the medical students speak English. None of the patients (so far) speak English, which makes it hard for us to perform examinations, and obviously impossible for us to take histories. So unfortunately that means we're reduced to standing around, observing. It doesn't take long for that to get boring. We have been learning some Vietnamese language, but certainly not enough to allow us to converse. (A lot of people at the hospital speak French, so I've been trying to access some HSC French in the deep recesses of my mind, with limited success.)

The operating theatres aren't as sterile as we're used to in Australia. I watched brain surgery while the window to the outside world was open! And I wore open-toed shoes! Although there's a sterile field for operations, the surrounding environment feels decidedly less sterile. We got the sense that people were going through the motions of maintaining a sterile field, without a clear understanding of the theory behind it. We saw some surgical instruments being rinsed after one brain operation and re-used in the next operation. We're trying to remain open-minded - who's to say that Australia and other Western cultures don't go overboard with sterility? We really want to know what the post-surgery infection rates are like, but we don't want to sound arrogant - and we doubt that the statistics will be available.


Open-toed shoes - we have to change into these before going to theatre

The surgeons are excellent, though. Most of them have done some training overseas. For example, one neurosurgeon trained with Charlie Teo in Sydney. They've been friendly, and the surgeons who can speak good English are keen to explain the operations they're doing. However, I'm not interested in being a surgeon, so I'm kind of over the standing around and watching. I'm hoping to get some more hands-on experience in Danang.

The triage area of the Emergency Department is run by medical students. It's been frustrating to watch them faff about with seriously injured patients. For example, we've seen patients with major limb injuries, but no pressure on wounds, no fluids, no pain relief. The students seem to be very good at checking pedal pulses, though - each patient has their pulses checked by at least five students! And they tend not to use supraorbital pressure or sternal rub to test pain response - they do massive nipple cripples instead! We saw one severely comatose patient nipple crippled by several successive students and doctors, until his chest was bright red.

There are a few security guards dotted around the hospital, with megaphones and batons - both of which they love to use to control 'unruly' family members. One patient came into the ED with a severe head injury (actually I think it was the nipple cripple patient), and his daughter came into the room, sobbing while standing by his side with other family members. The security guard came in and stood next to her, then yelled at her through his megaphone, telling her to get out. Guess they don't like public displays of emotion.

I visited the neurosurgery and orthopaedics wards. Both were overcrowded, with beds in the corridors and in spare spaces in each room. I counted at least 15 white coats on the rounds, so there was very little room to move in the crowded rooms. There are also people in yellow coats on the wards - they're family members, who stay in the hospital to help care for their relatives, because there aren't enough nurses to go around.

Wow, this is a long post. That'll teach me to post more often. Congratulations if you've made it this far! Not long to go...

As I mentioned, tomorrow I'm heading to Danang and Hoi An. I haven't booked a return ticket, because I'm going to suss out what it's like down there before deciding how long to stay. Ultimately I have to fly out of Hanoi at the beginning of March.

I just finished listening to the Hottest 100 streaming online (predictable but fab number one) - gotta love the free internet! We were planning to find an Aussie pub for some Australia Day beers, but after a massive NYE we all need afternoon naps and an early night.

Chúc mừng năm mới!* I'll try to stick to my new year's resolution.

* Happy New Year!

4 comments:

*C said...

It sounds like an interesting experience so far, despite the less than thrilling moments. I’m intrigued by the difference in medical culture – the approach to pain relief, emotional expression, etc. It would be interesting to look at aspects of our national character that contribute to that culture. I was reading on the blog Degranulated about the excessive use and abuse of codeine in the Australian population. Reading your observations made me wonder why the difference? Cost and availability surely aren’t the only keys.

Anyway, it’s good to hear you’re including plenty of rest and relaxation into your schedule! It’s nice to escape the real world while you can.

I love Viet Nam and really want to return and explore more. It’s probably very un-PC but I love the French influence in Hanoi’s old quarter. I could wander those streets for days. Hmmm. I’m jealous. I know it’s going to be along time to come before I step on a plane to get the hell outta here…

Dragonfly said...

The food down south is awesome as well, loved sinh to. Was that a KOTO cooking class you did?
Just in case you were thinking of trying it though.....I tried snake wine when I was in Vietnam, and it was AWFUL.

Damjan DeNoble said...

You don't know how timely this post was. I was in the middle of trying to gather information on Hanoi hospitals for the back portion of a Vietnm hospital feasibility study that has so far taken 6 weeks, and here you come along with this brilliantly insightfull post. Thank you.

Did you by chance get a chance to visit the French Hospital of Hanoi and get a look at the situation there?

KT said...

Glad to help! No, I haven't visited the French Hospital. I'm at Bach Mai Hospital for the next two weeks, which is next door to the French Hospital, but I have no plans to visit it.