COUNTRY: Vietnam
PROGRAM: UniBreak Groups
PROJECT: Community Healthcare: Paramedic & Nursing Students
WRITTEN BY: Laura Bainger, Flinders University
Hello again! We left you on our last night in Hanoi before we embarked on the main part of our trip - to the Mai Chau Valley, about 4 hours west of Hanoi. It is a very poor region of Vietnam, but the town that we are in (Mai Chau) is absolutely stunning. Imagine enormous jungle covered mountains towering over an expansive flat, covered in irrigated rice fields reflecting the mountains perfectly in them. Housing is basic - many wooded houses on stilts with shutters on the windows (and usually a cheeky satellite dish on the roof). It is so peaceful and just gobsmackingly beautiful!
We have had a few additions to our group! We have a couple of Vietnamese med students, an Emergency Doctor from Hanoi and two guides. They are a really great bunch of people who are great translators and are super keen to help us have the best experience possible.
We visited the hospital in Mai Chau. In rural areas it is very hard for them to retain doctors and they get paid a lot less than their urban counterparts. The hospital was even more basic than the one in Hanoi. We got to spend a few hours there and got to see and open appendectomy (the power went out just as they did the last suture), a natural birth, a nursing student who had some seriously old-school traction on a broken leg which included a pin through his foot (only on panadol), many underweight and malnourished anaemic kids and much more. They had a intensive care unit, and very small room with 12 beds crammed into it. Pain relief, oxygen and adequate heart monitoring was very sparse, it's so hard to convey the disparity between Australia and here.
After 2 nights in Mai Chau, we headed up to the small mountain village of Pa Co. This was where our work really began. The small medical clinic there had a doctor and a few nurses, 4 assessment rooms and a couple of admin rooms. They usually get about 300 patients a month...in the three days we were there we saw 250. Our group of 15 nursing and paramedic students split up into an couple of groups. One group was on the trial desk (remember the organised chaos reference?), a couple of groups assessed and another did health promotion. Assessing was a little like being a GP with very very limited resources. At our disposal we had a few blood pressure cuffs, a thermometer, scales and a height chart. Talking to the patients was really hard work, the chain of translation being English to Vietnamese to h'Mong and back again (ie through 2 translators). The common complaints were back pain, neck pain and headaches, due to the fact that the women are the farmers and carry ludicrous weights on their backs; stomach upsets and diarrhoea, worms in kids and a lot of rotten teeth.
We still can't get over the fact that 99% of patients had had their symptoms for over 12-18 months, and even longer, some up to 20 years. On the second afternoon we were faced with a very sick patient. It was a 3 year old girl who had a kidney infection, a chest infection, a fever, and a A LOT of fluid in her belly. We gave the mum money to get her back to the Mai Chau hospital. The next morning we saw an 18 month old baby who had a congenital heart defect and was only 5kg. She was scheduled in to have surgery in 2 months...that was the soonest she could get in. The worst thing was that we could only send her home. The care here is so basic. A few girls got to feel 2 women with abdominal aortic aneurisms (AAA). If a paramedic came across that in Adelaide you would be in an emergency department before they would know what had happened! Knowing that there is so little that can be done for these people who can't afford to get to a hospital is really difficult and totally foreign concept for us. All of the patients that we treated were treated for free, and we donated a lot of medicines including antibiotics. Every patient received a jar of tiger balm, a sheet of panadol and multivitamins. The health promotion consisted of showing kids and adults how to brush their teeth (we gave out free tooth brushes and toothpaste), and also showed kids how to wash their hands properly (and gave them free soap).
We may not have been able to solve everyone's problems but hopefully the people there will be more trusting of western medicine and won't put up with diarrhoea, headaches and stomach pains for so long.
Our homestay was at a local family. The bedding was, well, rough. Imagine a bed sized coffee table, covered with a bamboo mat and a 'mattress' about 1cm thick...safe to say a lot of us had bruised hips after the first night! But the family were very nice. Amenities consisted of a ceramic squat toilet and a shower. Basic but sufficient. One afternoon the house grandmother was chopping wood! The women work very hard, physically their bodies are tried and tested day in and day out. On the final day we got to purchase some homemade crafts, mostly bags from the house mother (I don't want to spoil any surprises that might be in our suitcases!). Over all Pa Co was an incredibly rewarding experience. We got so much hands on experience, saw things we will possibly never see again in our careers, and gained a whole new appreciation for the Australian Health Care System.
After returning to Mai Chau for a night and being taken on an absolutely amazing and forever memorable bike ride around the rice paddies and surrounding villages by our guide Dan, and a trip to the local markets, we set up another clinic at a smaller village an hour towards Hanoi from Mai Chau - Noong Luong. It ran very similarly to the clinic we did in Pa Co, but the biggest difference was the people. In Noong Luong the main tribe is White Thai and they are slightly more westernised, and appeared far more eager to see us and engage with us during consults. At the start of each session Dan would hand out around 30 numbers which meant being mobbed by women all grabbing at him to get one. To us that came across as rude and extremely intrusive to Dan, but obviously it was just a cultural difference that we had to get used to! People here had slightly better health, but we did see A LOT of tonsillitis, so much so that we wondered how some of these kids were breathing...we also (attempted) to assess a woman who was in severe psychosis - speaking in her own language, shouting compliments aggressively at people, bursting out in song and then hiding in the corner of the room. I personally have never seen anyone like that in my life. Even if we had been able to treat her, there is very very little care for mental health patients in Vietnam, which doesn't help the population realise that people who act like that aren't possessed like they did in Noong Luong.
On our final night there we were treated to a traditional dance at a local hall, where lots of mums and kids joined us. A few women dressed up in traditional clothing and did a few dances, and even some of the younger girls got up and had a go! It was gorgeous.
We have formed great friendships within the group, and even the people more inclined to whinge have done so in good spirits! There have been a few moments of homesickness and wishing there was some of mums food on the dinner table instead of rice but everyone has been very supportive of each other. We are already planning pub meals together when we get back!
From here we will head back to Hanoi for a few days to recuperate and then hello Halong Bay - just a cheeky few nights on a junk boat in one of the 7 wonders of the world!
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