I have finally begun the summer service camp, an annual medical mission run by Project Vietnam Foundation. In these two weeks, 100 doctors and student volunteers from across the world will be coming together and opening clinics in different rural districts in Ben Tre and Can Gio. We hope to provide check-ups from pediatrics, to primary care, to dentistry, and to gynecology to over 4,000 people.
We started the official clinic in Ben Tre today. Ben Tre is my parents’ hometown and the place I was born. So truly this means all the more to me. Ben Tre is beautiful in its ways—I love how honest and sweet the people are, the rows of coconuts neatly stacked up along the roads, the motorbikes replaced by bicycles with basket handles, and the kids playing along the streets. And especially the calm river, when its bridges are lit up at night and reflected like tiny diamonds in the water: it is a place that I can imagine myself growing up in, and would have had to—if I did not come to the states.
The Ben Tre bridge at nighttime
We set up the clinic in an empty elementary school in Ba Tri, a rural district about an hour ride from the center of Ben Tre. We woke up early and arrived at 8am, and there were about 100-200 adults and children already sitting on plastic chairs waiting for us in the morning heat. There were so many people there the age of my grandparents. My ong ngoai or grandfather, probably much younger than some of the folks there, would definitely not have been able to wait an entire day in the heat to be checked. The older patients here all remind me of him--their skin charred to a deep golden brown, back bent, and and eyes squint as they waited in the burning sun. It takes a tremendous amount of patience and effort. Tenacity held us; the sight of our patients' tenacity gave our team a huge sense of morale and responsibility, to do our jobs efficiently and accurately so we can be sure that each patient receives the check-up they so rightfully deserve.
The long line of patients waiting to be seen. (photo by Vincent Nguyen).
The school where we set up the clinic.
Setting up our station in vitals to take blood pressure, glucose levels, and do our hematocrit lab test.
But the sun was kind today, keeping us all cooler than we thought we would be. Our clinic team was responsible for vitals and lab. I have done these things before at the clinic in Can Gio with Jenny, but the amount of people trickling in today was beyond imaginable, and I have begun to appreciate everyone in the team making it work: our crowd control friends calming the kids, Kaleem working the hematocrit machine, Emmeline chatting with the older patients getting their blood glucose levels checked. In those first four hours, we set up and I worked on the hematocrit station—which is a test for anemia in children or those under the age of 16 years old. This is the first year that Dr. Ho has introduced the hematocrit test. Is is an easy and affordable alternative to a test done in the lab. You use a capillary tube to take in the blood and send it through a centrifuge to separate the blood and plasma. I knew this would be the most frustrating part of the vitals station, because it is difficult to extract enough blood and often you have to prick more than once. On top of that, we were performing it on children, and the sight of anything slightly sharp usually sends a child running away.
How do you begin to tell this young girl and boy that we need to prick their fingers again and again? These two are the sweetest pair of siblings you will ever meet. The older boy is extremely protective of his younger sister, and they are going through check-ups by themselves.
Well, I have never seen such brave children. All of the children who came in had already waited for several hours outside. I sat one child down about the age of nine and asked him if he was afraid. He bravely said no and only smiled at me the entire time—even though I ended up pricking him three times. We not only had to prick his fingers with a long needle (which was actually too dangerous to use and we soon switched to lancets), but had to extract enough blood for 2/3 of the hematocrit capillary tube. The tubes often became clotted and we would have to re-prick the child’s finger to get enough blood. On top of that, the centrifuge machines were not working properly and we did not receive accurate lab results. And so the first few kids who came in had to be re-pricked while waiting for their lab results. They all came into the vitals station without their parents. Only one or two kids cried, but this was only after they found out they had to be pricked for a third time. We were super proud of them. Safe to say, most of the kids tested negative, although there were about two positive cases. We finally ran out of lancets and had to shut down the hematocrit station for the day. I love working with children. The strength they possess bewilders me every time, and I will never forget the sad (but brave) look on their faces when we told them they had to get pricked again.
Anxiously waiting for their turn in lab.
A boy who came along with his grandma. He sang and dance for us and then demanded to take a picture with the "ladies..."
After grabbing some lunch, we headed back to vitals and began working with older patients before sending them to primary care: measuring blood pressure and taking pulse/respiratory rates. The best part about this is getting to hear people’s stories. If ever, it was in that moment that I appreciated being able to speak and understand Vietnamese. Communication and language has been so crucial in our work. I screened the last few patients of the day, who were mostly women, and asked them about their health. Many said that the joints in their knees hurt, they often had bad migraines, and they were often very “tuc nguc” (had chest pains). The conversation involving health never stops there.
You ask about their lifestyle… and you ask about their family, their jobs, their children, their diet, and you see that these issues are all interrelated. A lot of these older women have labored and are still laboring too hard. For example, a woman who receives nutritional ration such as milk or food for her pregnancy often sacrifices those things for her children and her family. The mother never places herself first in the household, and this paradigm manifests itself in health. This leads to more chronic issues such as chest pains, back pains, hypertension, and arthritis. I asked these women why they were willing to wait so long in the heat to be pushed around from station to station. Many said that the doctors at the tram y te or local health commune centers near their homes are not helpful. One woman said that they only prescribed to her medicine and did not do a diagnosis and only prescribed medicine. She had also been misdiagnosed at different locations. Since it is our first day, patients were constantly being shoved around and the clinic had little fluidity. Can you imagine, then, how bad their experiences must have been at other places for this ‘waiting in line for eight hours at our clinic’ to seem worth the wait?
Dr. Quach doing a check-up for a woman in primary care (photo by Vincent Nguyen).
I remember telling one woman, “Bac oi (Auntie), you have to remember to exercise daily. Even if it’s just walking.” In reply, she says: “Well, all I can do and have been doing is walking! We don’t have motorbikes!” The concept of health is oftentimes so secondary to people who are working to support their family’s livelihood. It does not apply to just Vietnam. When you are busy making a living, things like remembering to eat your fruits and vegetables sound silly. Talking to these patients reminds me of my ba noi and my parents, who have worked and given up their entire lives for their children. And are continuously doing. These struggles brings me a little closer to these women. It is a short time frame where I am able to see a part of these people’s lives and help them see that they need to be taken care of.
A woman getting her vitals checked.
I have to say, one of the most eye-opening parts of today was a man who walked into the vitals station with his wife. He had a smile and a light that makes all the hard work, worth it. He walks on one leg and cannot to stand up straight nor walk well.
I ended clinic to find out that his wife carried him on his back and walked two hours to be seen at our clinic today. And he was one of the last few people to be seen. After we knew this, we arranged a motorbike to give him a ride home. As they told me, they “crawled” here. And with that, everything that I have been feeling today boils down to this. Seeing patients being shoved into our chaotic clinic after waiting in line for over eight hours just to be seen because they trust us, because this is their only means of access, is utterly frustrating. What happens when the 30 pills we give them for diabetes or hypertension runs out? Will they stop the treatment? Probably.
And all you’re left with is standing, looking out into the sunset at an empty clinic at the end of the day, and frustrated that there was not more for these patients.
A bittersweet and beautiful sunset at the end of clinic day.
Vietnam teaches me so many things. I often forget why I always get pulled back to working here. Because it teaches you that although issues like structural inequality, poverty, classism, racism, and sexism all exist in the states, these issues are so salient and in your face here in Vietnam—your soul has to be blind to not see it. But it also teaches me to recognize that although our world is not and can never be perfect, simple things like making a friend can make life a little fuller. And not through a give-take dichotomy, because I am being given so much.
