It rained heavily in Can Gio yesterday, and we waited for patients all morning but only one or two showed up. This week has been draining emotionally and physically. But today, Jenny and I both reached a new low. We arrived at clinic in the morning and were once again underwhelmed by patient turnout. According to Dr. Dung, we would be screening at least 40 patients a day, but that has not been the case. Very few patients show up, and when they do, some refuse to partake in the screenings. The group of student nurse interns were also waiting for concrete work, and so Jenny and I decided to spark conversation with the group leader. It was a conversation that came from a place of honesty and shook the reins of reality for Jenny and me.
First, she clarified to me what a "local health commune" or "tram y te" in Vietnam meant. By her description, a local health commune is a place where locals come for very mundane issues such as getting some cold medicine or filling up his/her prescription. She says that very few patients come to the local health commune at all. Vietnamese patients have a tendency to avoid any type of healthcare until their symptoms or conditions worsen to the point of "sap chet" or "near death." And even then, patients prefer to go to the hospitals in Saigon's city center to be treated. Vietnamese patients also have a tendency to "save their medicines." They do not want to waste medicine by drinking it all and would rather let it sit in cabinets. Follow-up, as you can see, often does not exist.
Second, she admits that her biggest difficulties as a student nurse has been voicing her opinions about patient care. "If you study well, you are allowed to work in bigger hospitals. However, in my training, I have seen cases where the patient care was very poor. But you do not have much power to improve it. It is often very discouraging for students like me."
As she poured out all her frustrations, I have remembered one thing: we must adapt. One of the things I value the most this summer has been my ability to communicate with others in Vietnamese. The stories that I hear have been so rewarding and rich in information. I realize that we must first observe, then adapt as things change. Nothing is as we had expected. As Jenny and I are leaving Can Gio for the next two weeks to go on the summer service camp--a medical mission consisting of 100 doctors and volunteers in Ben Tre and Can Gio--I want to list out how and what we can capitalize on in this project.
1. Improve patient turnout to the screenings. Because it is just Jenny and me doing the screenings, it is naturally difficulty for one man--Dr. Dung--to get the word out to all his patients, especially because the local health commune is very far from the main village center and in a place too underpopulated. We need to communicate and publicize our screenings more and set out concrete times and directions for our patients such as fasting for the glucose readings. We also have only been seeing adult patients and want to reach out to younger patients as well for the malnutrition and anemia screenings.
2. Work with Dr. Dung in creating follow-ups. The screenings, for Jenny and me, have been about diagnosis. However, there is a lack of follow-up and treatment. I cringe every time I screen another person for hypertension and communicate this with Dr. Dung, only to find him unresponsive in advising patients or prescribing them treatments. I find myself researching these conditions myself and advising the patients to eat a healthier diet and exercise better. I hope that when we return, we can work with Dr. Dung to create a database of patients positive for hypertension in the community in order to solidify how serious a problem this is. We then have a jumping point to create more educational awareness in the community about it.
3. Work with the local orphanage (nha mo) on English classes and health education classes. Because it is mid-July, the children at the local orphanage have returned home to family or relatives. Jenny and I have not had a chance to meet them, as we were planning on starting English/computer classes. I am excited to meet them after the summer camp.
I am hopeful that these three goals will be met. It has been a whirlwind of an adventure, and as I leave for the medical mission, I must bid adieu to Can Gio for now!
*This journal post was pre-written in June, and I finally had the chance to upload it onto Global Conversation.