Scholarships for Stage 2 medical students
Kim Linh Van, Bach Mai Hospital, Hanoi
From the very first moment that I set foot on the respiratory ward at Bach Mai Hospital I knew that the upcoming month was going to be one of challenge and learning, true to the meaning of “Hoc Mai” – forever learning. The sheer size and crowdedness of the place meant that staff always had something to do or someone to see. It was quite daunting to think about how one would be able to sieve through it all to make sense of how they operated, get to know the staff or see patients – but we did, and my experience at Bach Mai will forever leave a positive impression on my personal and professional development.
I very quickly learnt that in order to appreciate what I was seeing, one must understand two things: first, the Vietnamese health care system is fundamentally privately-funded, and second, that the general Vietnamese population is not that wealthy. A combination of these two factors meant that patients often presented with advanced disease, non-compliance to medications and other costly management recommendations was relatively common, procedures or investigations could be performed with minimal anaesthesia or sometimes not at all, wards were overcrowded (often with three, sometimes four, people per bed), and family provided a large proportion of the nursing care for patients. In addition, patient confidentiality did not appear to be as strictly controlled, with imaging results clipped to the front of the bed in a communal pile for any interested stakeholder.
However, these observations were made more bearable when I came to realise that Vietnamese people are resilient and accommodating and that they are under the care of top-class, hard-working doctors. The consequence of all of the above was that I had the privilege of examining and viewing the imaging of a plethora of patients with expert guidance. These experiences were gained through attending early morning departmental meetings where new or deteriorating patients were discussed, during ward rounds and through seeing patients myself and asking questions or following up with patient notes (if you can find them through the chaos). I found the ability to view imaging and then immediately listen to their chest, or vice versa, to be the most helpful activity.
Given that I was able to adequately speak the language, I also had the opportunity to take many histories and attend seminars, which added to my clinical experience. However, for those who do not speak the language, there are flocks of medical students from Hanoi Medical University keen to practise their English on a foreigner and direct you to all the patients with interesting clinical signs in return. With permission, I was also able to follow some of these medical students through their rotations to other departments (in particular cardiology), where they found lots of interesting heart sounds and other clinical signs for me to listen and see.
My experiences outside Bach Mai Hospital also contributed to making the experience a very memorable one. I was very fortunate to be accompanied on this trip with four fellow medical students who were fun and adventurous and who I had never spoken to prior to the trip. Most weeknights were spent in search of a different delicious Vietnamese dish (deep-fried frog is a must) and the nicest view for a beer/cocktail/smoothie (SkyBar at The Tyrant), while weekends were spent away at beautiful places such as Sapa and Ha Long Bay.
A conversation I had on the last day with one of the medical students sums up my experience in Vietnam quite well. She asked, "What will you remember most from your time in Vietnam?", to which I jokingly replied, "the heart and lung sounds I heard through my stethoscope" (referring to the sheer volume of clinical signs I had seen and heard over the month). But it was evident that the answer was in front of me – the friendships I made whilst overseas is what I will cherish the most. Also important was the realisation of how privileged we are to have the generous public healthcare system we do in Australia and the impact this has on the general health of the overall population.
Mark Grivas, Viet Duc Surgical Hospital, Hanoi
The key medical aspects I took away from our two weeks in orthopaedics were the importance of thorough physical examination and imaging. The obvious language barrier and variability in our supervisors time and willingness to teach and discuss a patients histories meant that we often had to rely on more objective tools to establish a diagnosis and discuss management strategies that would be appropriate.
From our time in neurosurgery we had the opportunity to observe and examine many patients with advanced brain tumours – both benign and malignant. Many of these tumours are rare in Australia and also present much earlier. To witness patients who still have some level of function come in to the neuro outpatient clinic with extremely large space occupying lesions is something I will never forget. However it became clear that the anatomical location of any brain lesion is more indicative of disability and prognosis than size and appearance.
The cultural lessons we took away from our time in Hanoi were perhaps left more of a lasting impression than many of the medical aspects. The robustness of the Vietnamese people was phenomenal. To see patients with severe trauma or post operatively with little pain relief without complaining was intriguing.
The anaesthetic techniques used were both a medical and cultural lesson with total hip replacements done without using a general anaesthetic, again without complaint. Medically it perhaps made me ponder the over use of general anaesthetic and the benefits in recovery times that perhaps this method could offer.
The role family play in patients’ care whilst they are ill does not stop once a patient is admitted to the hospital. Of course family plays an important supportive role in a patients admittance to a hospital here in Australia, however in Vietnam the patients family is central in day to day care, hygiene, feeding and often sleep at the hospital to maintain a 24/7 presence.
There were little challenges in organizing the placement due to the help of the Hoc Mai Foundation and the OGH, as well as the long standing relationship between SMP students and Viet Duc Hospital.The challenges faced whilst on the placement were widely varied with many similar to challenges faced while on clinical attachments here in Australia and others more unique. The language barrier was an expected challenge and the impact it had on my experience was at time frustrating but mostly manageable.
The greatest challenge faced whilst on placement was the disparity in treatment from some of our clinical supervisors towards my female colleague. This is a complex issue involving both cultural and professional aspects. Issues in sexism in the field of surgery within Australia has made headlines over the past 12 months and I believe is now starting to be addressed in Australia – however sexism appears to still be common place in surgery in Vietnam.
It was obvious from our first observations at Viet Duc, a surgical hospital, that the proportion of women working or training as surgeons was negligible – and in fact I did not come across a single female surgeon in 4 weeks. Whilst this is merely an observation, the disrespect shown towards my female colleague and inequality in learning opportunities, due solely to her being a female, was at times frustrating. This may have put a slight negative slant on what was otherwise a thoroughly rewarding and enriching experience, however on reflection was an important lesson and something I hope to learn and make positive change from.
Johnny Chang, Viet Duc Surgical Hospital, Hanoi
A motorbike whizzes past me as I got out of my taxi from the airport. A fitting welcome to Vietnam, a land of people, of ingenuity, and of orderly chaos. Once I arrived at my hotel, David Truong, the hotel manager, quickly gave me a quick guide of the Old Quarter in Hanoi. He has helped and hosted Hoc Mai students for the past 7 years. He reminds me that I will have a meeting with Dr. Duong, the physician who looks after the Hoc Mai students, the next morning.
Dr. Duong organized us to our respective hospitals. Jason and I were paired up and sent to Viet Duc, the tertiary surgical hospital in Hanoi. We were attached to the surgical oncology department ran by Prof. Son. The first day, the resident doctor, Dr. Thau, invited us to join him in the operating room to see a surgery. Little did we know that the surgery was a Frey’s procedure, a complex pancreatic operation that involves cutting it open and re-joining it with the intestine. For my first time in surgery, it was a full on experience seeing such a complicated and long (over 4 hours) procedure.
Our next 2 weeks were just as involved. We scrubbed in to assist in procedures, were taught and given the opportunity to close up patients, hold retractors, help remove 2 uteruses, and a myriad of other procedures. One uterus was the size of a rockmelon! One of the main takeaways from seeing these patients was that many of them did not have access to primary care. They were diagnosed with neoplasms at very late stages and with very severe disease. That was part of the reason why some of the surgeries we performed we very complex. We even assisted in resecting an entire right lobe of the liver. It amazes me to think that such high level of acute care could be delivered in a country that has limited resources. At times, I was in awe of the creativity of Vietnamese people and from a student perspective, I hope I could incorporate some of that creativity to my practice if I were limited by my context.
The placement in Vietnam was very interesting apart from the medical aspect of it. We witness many patients sharing beds, usually 2-3 patients to a bed, yet the patients do not complain. This is something unimaginable in Sydney. Furthermore, the patients were all cared for by their family members. It gave me great insight that Vietnamese society highly values the importance of family and the support they give each other. It echoed that of my Taiwanese upbringing because it was similar in that sense. The other aspect that surprised me about my experience was how friendly everyone was. Doctors and nurses and hotel staff go out of the way to make us feel at home, and treated us very graciously and generously. They were quick to invite us out to luncheons and karaoke and weekend surgeries in distant towns.
The greatest challenge of the whole placement was not the cultural shock, rather it was just the limitations of language. I did not appreciate how difficult it would be to pick up the Vietnamese language. I thought that because I spoke Taiwanese and Mandarin, I would not have trouble with tonal languages but I did. Also, many of the senior staff in the hospital spoke French, a language I learnt in since year 4 until year 11, but I never had an ear for it. I felt that if I could communicate better, I could learn a lot more from the surgeons at Viet Duc as to the reasoning behind each procedure, contraindications, worries, and predicted outcomes.
I feel that the welcoming vignette of whizzing motorbikes in a sea friendly people a microcosm of my experience. It was exhilarating, busy, exhausting, and full of friendly people. The work life and the social life is essentially organized chaos - a babel of noises, sights, and smells.
Jason Qin, Viet Duc & Bach Mai Hospitals, Hanoi
With the support of the Hoc Mai Foundation, I completed a 4-week placement at Viet Duc and Bach Mai Hospitals in Hanoi in December 2015. Viet Duc is the largest surgical hospital in Vietnam and a major trauma referral centre, while Bach Mai is the largest hospital for internal medicine in Vietnam.
I spent the first two weeks in Surgical Oncology at Viet Duc. Here, patients often presented with advanced stage cancers for surgical management. I was able to observe and sometimes assist in surgeries including bowel resections, liver resections, and total hysterectomies. The surgeons were incredibly hardworking – ward rounds started before 7am, then surgeries for the day often finishing late in the afternoon, the registrars sometimes would then do a 12-hour night shift in the ED, followed by another full day of work. On the weekends, the surgeons often headed to provincial hospitals to do more operations. As a visiting student, it was eye-opening not only to see the medicine, but also to observe the hardworking culture the Vietnamese surgeons have.
The second half of my placement was spent at Bach Mai Hospital, dividing between Cardiology and Respiratory. Having spent the first two years of my medical degree at the SAN clinical school, which is a private hospital, Bach Mai presented as a stark and extreme contrast to what I am used to. In the wards, two or three patients would share a bed, and ten or fifteen beds would be put in the same room, without much as a curtain between the beds. A major challenge I faced here was the language barrier. Thankfully, there were plenty of medical students with excellent English who were more than willing to help. They acted as translators between me and the patients for history and examination, and helped explained test results and medical notes. The doctors were also very keen to teach, always happy to explain x-rays, ECGs, and demonstrate procedures. Due to the large number of patients, I was able to become familiar with many of the signs and symptoms, some of which were rare to find in Australia. All in all, it was a fantastic learning experience that prepared me for Stage 3.
Apart from doing lots of medicine, we also had a great culture experience in Vietnam. Being the capital of the country, Hanoi is busy and colourful. The many museums in the city provided insightful knowledge to the country’s history and culture. The food, needless to say, was amazing. On the weekends, we also travelled to Halong Bay, Sapa and Hue, all of which were very affordable. The hotel we stayed at has looked after Hoc Mai students for a number of years, and we could not be looked after any better by the staff there.
My 4-week placement in Vietnam was a valuable and fun experience. The medical cases I saw were eye-opening, and the people there were so kind and helpful that we felt very welcomed and very much indebted to them. It was indeed a privilege to be supported by the Hoc Mai Foundation to undertake this educational and cultural experience which no doubt will benefit the rest of my medical career.
Evelyn Smith Romero, Viet Duc Surgical Hospital, Hanoi
I completed a four-week placement in Hanoi at the Viet Duc Surgical Hospital, a national referral centre for surgery. I was paired up with another second year SMP student, and we spent two weeks each on the orthopaedics and neurosurgery teams. Though these two disciplines are seemingly quite distinct, we found that many cases required the attention of both teams due to the high relative volume of motor vehicle trauma cases. Therefore, we spent some time in the emergency department and emergency ICU. Here we met many junior doctors who were both welcoming and very keen to guide us through the incoming radiology and developing management plans. We were exposed to many acute trauma cases, many of which were complicated by conditions such as sepsis, viral hepatitis, and neurogenic shock.
We spent the mornings in the outpatient clinics, where referrals, as well as pre- and post-operative follow-ups were conducted. An interesting observation is how the clinics themselves were designed. They are usually held in a small room containing a small patient bed for examinations in the corner, and in the centre there is a long table with enough room to fit a few surgeons. Each surgeon has one chair designated for their use, which is kept constantly occupied by the continuous flow of patients. This is an interesting setup in comparison to the single clinical rooms that are expected in Australia: first, it made for easy consultations between colleagues on any particular case. I found that this strengthened the team dynamics, and perhaps also it encouraged better patient care to have many eyes and opinions to help with a complicated case. Secondly, it was interesting to see that absolute privacy is not top priority as patients would be sitting quite close to each other, and sometimes even commented to each other during their respective consults! Finally, most patients would present themselves with many family members, who would gather around their relative's chair. We found that family members play an integral role in the care of the patient throughout their journey in the health system.
Though much time was spent in theatres, which in itself was novel and interesting, I believe the time spent in the outpatient clinics was especially invaluable. The patients were more stable medically than those in the wards, thus allowing for a better assessment of their signs and symptoms. Though we expected (and subsequently discovered) that there would be a language barrier between us and the patients, we didn’t expect that this barrier would make us rely much more on our clinical observation and examination skills. We would then practice correlating our examination findings with the radiology.
During our placement we noticed that many patients with severe acute injuries delayed presenting immediately to hospital, the median delay being a couple of days (according to my purely anecdotal evidence). These delays tended to lead to poorer outcomes due to increased risk of infection and acute kidney injury. We learned that these delays are partly due to issues relating to lack of access to healthcare. One major factor is that many of the accidents occur in geographically isolated areas. Though Viet Duc is in the capital city, approximately 80% of all referrals are from demographically rural patients. This outlines a phenomenon that is a global concern, that of lack of specialists, medical expertise, and advanced technologies in rural areas. This was emphasized for us when we were invited to a conference prepared and delivered by a dedicated team of neurosurgeons from Viet Duc Hospital at the Qang Binh Provincial Hospital. The aims of the conference were to teach the local neurosurgeons, orthopods, and neurologists about emerging indications for investigations and management techniques for head and spine lesions. This conference was in preparation for the MRI machine that is to be installed early this year to alleviate their dependence on the 64-slice CT scanner. The Viet Duc team explained to us how important it is to train the provincial doctors and to advocate for updating their medical equipment to reduce the burden of long distance travel for the rural patients in order to improve their outcomes.
Finally, it cannot be denied that being a female in a male-dominated field such as surgery and in a male-dominated hospital such as Viet Duc can have its challenges, particularly because this is a phenomenon that is pretty much universal. In theatres I was met with differing reactions, from curiosity and neutrality to, in some cases, outright rejection. I believe that anyone undertaking a placement in any part of the world should prepare for circumstances where their own ethnocentric assumptions are at odds with those of the hosts, which can potentially lead to miscommunication. Specifically, one must be prepared to understand holistically why the views and practices in the host country are different from one's own and, crucially, be able to respond diplomatically. I believe this was an important lesson for myself and for the rest of my SMP colleagues. It presented us with the opportunity to discuss the intersecting factors that determine the culture and practice in Vietnamese medical training and, more broadly, the health care system. Ultimately, experiences such as these emphasize how important it is to step out of one's comfort zone and analyze one's thinking from a different perspective. Hopefully this introspection can be a conduit to a deeper understanding of what drives one's own behaviour and practices, a skill that I believe is exceptionally important for doctors to have.
Abigail Fox, Hanoi, December 2014
I completed a 4 week placement with the Hoc Mai Foundation at Viet Duc Hospital in Hanoi in December 2014. Viet Duc Hospital is a national surgical referral centre with 1100 beds and over 40,000 operations conducted each year. The hospital serves the central Hanoi population in addition to the 80% of patients who are referred from provincial areas.
For the first 2 weeks of my placement I was attached to the Maxillo-facial & Plastic Surgery department. The surgeons at the department employ varied techniques including detailed microsurgery to address a very wide range of patient conditions. By far the most common problem addressed by the surgeons is traumatic facial fractures that have occurred as the result of road accidents. In addition to facial trauma we observed innovative surgeries for a nerve injury including a very detailed brachial plexus dissection and a microsurgery to attach an anterolateral thigh flap. The surgeons also address congenital deformities such as polydactyly and conditions such as neurofibromatosis. One very interesting surgery involved the implantation of a custom 3D-modelled metal skull plate for a patient with a congenital skull deformity that had been provided by a charity from the United Kingdom. In addition to observing surgeries we were able to sit with the surgeons during their consultation clinics. This allowed us to get a better idea of the differences between the Australian and Vietnamese clinical approach. Clinics were held openly at a central consulting table instead of the more private facilities we have in Australia. The language barrier made careful observation of the patient to discern what might be their complaint an interesting challenge, before it was later explained to us by the doctor. In addition to our surgical experiences I very much enjoyed being warmly welcomed to the team by the doctors and we were lucky to be treated to some delicious local specialties at lunchtime including the famous bun cha and some excellent Vietnamese seafood. I am very grateful to the head of department Dr Ha and his fantastic team for their kindness and generosity.
For the last 2 weeks of my placement I was attached to the Hepatobiliary department. The department is quite large with approximately 12 senior surgeons and 5 surgeons in training. Each day begins with a formal meeting of all staff at 7.30am to plan the order of surgeries and receive updates on the night shift activities. The meeting is presided over by a portrait of the famous liver surgeon Professor Ton That Tung who was the first Vietnamese Director of Viet Duc and who developed significant innovations in liver surgery in the mid-20th century. The most common surgery performed is bile duct stone removal but we were lucky to see also procedures ranging from partial and hemi-hepatectomies to Whipple procedures. We were interested to learn that the most common stones are pigment stones caused by chronic bacterial infections as opposed to the cholesterol-derived stones that are most common in Western countries. Vietnam has a high prevalence of hepatitis B virus with approximately 15% of the population infected. This virus predisposes to the development of hepatocellular carcinoma and we saw a large number of resections of such cancers with the youngest patient only 19 years old. Many procedures are performed laparoscopically and this allowed us an excellent view of the surgical technique. My sincere thanks to the head of department Dr Hung and the surgical and nursing teams for allowing us such generous access to their surgical theatres.
My 4 weeks in Hanoi were a great opportunity to see a much wider range of surgeries than I would have access to in Sydney and I was also able to learn a great deal about the daily life, culture and history of Vietnam. Time and again we were struck by the hospitality and kindness of our hosts who I hope to keep as friends into the future. I am grateful to the Hoc Mai Foundation for allowing me the opportunity to visit and learn at Viet Duc.
Alex Feeney, Huế, December 2014
I was lucky enough to spend an invaluable month in Huế thanks to the Hoc Mai Foundation. It was a month that broadened my medical knowledge and also created many lasting relationships with local doctors and medical students.
My initial two weeks were in the oncology department at the Huế University of Medicine and Pharmacy Hospital. The medical team in this department were an inspiration. My supervising Doctor, Dr Dung, and his residents Dr Thuy and Dr Huy showed great resourcefulness in the face of overwhelming patient numbers and limited access to some chemotherapies. A culture of learning was fostered among us, with the doctors regularly taking me on ward rounds in English, imparting their knowledge on a wide range of malignancies and allowing me to interview patients by acting as a translator. I was always very thankful for their time. In return, I attempted to assist with questions regarding medical English and pronunciation. Also, when we encountered rarer diseases such as ileal MALT lymphoma and PNET, I would research them and present a one hour presentation to the department.
My second two weeks were split between the internal medicine departments at the larger Huế Central Hospital and Huế University Hospital. My time on the wards at these hospitals was spent collaborating with the many medical students stationed on that ward. We discussed the differences between the Australian and Vietnamese educational and medical systems. We also interviewed and examined patients together and exchanged hints and tips that we had picked up from our respective educations to date. I also spent an evening shift on the ward and was impressed to see the full class of over 40 students stay until 10pm to complete their assigned physical examination tasks. The resident doctors on these wards were also extremely helpful and generous with their time, further enriching my educational experience.
Brian Lesmana and Jim Ge, my fellow Sydney University Hoc Mai students in Huế, participated with me in several education sessions in an effort to give back to the university and community that was being so welcoming and helpful to us. We ran an open session on the Australian healthcare system at the University. We also made several medical presentations to our respective departments. In addition, we were invited to teach English at a charity class run by a University Professor at one of the local temples. We found everyone we met to be extremely friendly and there was barely an evening spent without an invitation to eat with a new found friend. These experiences helped us to form closer relationships with health professionals as well as local community members.
Many well-documented differences exist between the Australian and Vietnamese medical systems and much of this is linked to availability of resources. However, I did witness a very important similarity – the equal dedication, work ethic and desire to achieve the best outcome for patients exhibited by the doctors and nurses day in, day out on all the wards. It is this similarity which has left the greatest impression on me and it is this joint passion for excellence in patient care which will continue to drive the success of the Hoc Mai Foundation. Thank you very much to everyone involved in Hoc Mai and I look forward to further participating in the great work and success of the Foundation in the future.
Brian Lesmana, Huế, December 2014
In December 2014, I was fortunate enough to have the opportunity to be part of the first group of three students from the Sydney Medical Program to be placed in the Huế. Huế is located in central Vienam and was the imperial city of Vietnam during the Nguyen dynasty between 1802 and 1945. Furthermore, it was situated at the border between North and South Vietnam during the Vietnam War, suffering heavy damage. Accordingly, Huế is rich with both cultural and historical nuances, and is far less metropolitan than cities like Hanoi and Ho Chi Minh.
I was placed at the Hue University Hospital in the Trauma Department, which comprised both orthopaedic and plastic surgery. Each day, I was asked to come to a morning meeting starting at 7am, and then to view or assist in morning and afternoon surgeries depending on the day.
To my pleasant surprise, the level of English spoken in the department was of a very high standard, with many of the doctors having overseas experience in countries such as France and Estonia. In particular, the head of department, whom was enormously respected throughout the University Hospital, possessed a vast wealth of experience and knowledge, having trained in France, Germany, China, Australia and the United States. He was particularly interested in the differences in medical education between Vietnam and Australia. He voiced his concerns with the increasingly unmanageable number of medical students coming through the university, concerned that he would not be able to adequately teach and guide individual students to the best of his abilities. I valued such discussions regarding education paradigms, as it allowed me to reflect upon the advantages of the medical program back home, whilst simultaneously helping reinforce his desire to change the medical system at the Hue University Hospital.
In regards to the nature of patients that I saw, there was definitely no shortage of trauma in such a motorbike-centric city. An interesting quirk, however, is that patients seemed to avoid hospital on particularly wet days! Even scheduled surgeries would be cancelled because patients simply did not turn up on such days. Furthermore, it was most intriguing to see how the Vietnamese doctors were able to utilise atypical resources (often due to monetary reasons) to substitute instruments and materials that we would regularly use back in Australia to similar efficacy. It was also fascinating how the doctors were well versed and skilled in such diverse surgical techniques. Unlike at home, doctors in Vietnam are not entirely constrained by their speciality, and are often required to possess a skillset of a broader spectrum.
Moreover, I was not restricted to the trauma department. I was able to make strong connections throughout the hospital; notably, the oncology department took all three of us in and made us feel integrated. We were taken on essentially private ward rounds, part of diagnostic discussion, and were invited to assist in multiple surgeries. Not quite content in these two departments, we were also able to go to the endocrinology/respiratory/neurology department at Huế Central Hospital as well as the endocrinology department in Huế University Hospital. No matter where we were, we were all warmly welcomed and were privileged enough to be exposed to a vast array of cases. The level of support in Huế exceeded my expectations.
Most importantly, however, I believe we were able to make strong connections not only at a professional level, but also at a more personal level. Everyone in Huế was so gracious, obliging and accommodating, and I hope that we can maintain these relationships throughout our medical careers. I would like to give special thanks to Dr Chi Le Van for organising our placements.
Zijun Ge, Huế, December 2014
With the support of the Học Mãi foundation, I was able to spend 1 month at the Huế University Hospital at Huế City in central Vietnam. Huế is home to a population of under half a million and its heritage as the old capital of dynastic Vietnam sets it apart from the much larger cities of Hanoi and Saigon. Despite its small size, the city is also host to one of the few medical schools in Vietnam – Huế University of Medicine and Pharmacy – with over 6000 students at various stages of training. Adding to the bustle is the nearby Huế Central hospital, the largest tertiary hospital in central Vietnam.
3 students from Sydney Medical School undertook an elective at Huế under the invitation of Dr Chi, the Vice Head of internal medicine at the University Hospital who is also a Học Mãi Scholar. As we were the first batch of students to visit, we had little idea of what to expect, especially of the weather. The 3 months of December to February is the rainy season in Huế, a city so famous for its misty rain that numerous poems have been written over the centuries. However, the little surprise at the weather was quickly erased by the friendliness of all the students and medical staff at the hospital. I was attached to the emergency and cardiology departments and the doctors very quickly incorporated me into their team and helped me gain a great appreciation for the differences in healthcare between Vietnam and Australia.
Emergency medicine is a relatively new specialty in Vietnam and many of the doctors practicing in the ED were surgeons and internists. The ED at the University Hospital had 10 beds in triage with 10 more in recovery. The days started at 7am, with a long lunch break and finished at 5pm. The doctors were very keen for me to learn and I was allowed to follow patients as they were admitted – for example to follow to radiology for the CT scan in the case of the patient seizing after a haemorrhagic stroke, assist in the OR for a hand laceration or to attend the cath lab in patients requiring intervention. Minor accidents and complaints were common due to the lack of a well developed primary care system and I was able to perform many minor procedures under supervision. Dr Lai, the head of department, was especially encouraging and even invited me to come back to Huế after finishing medical school. The experience was different to the chaotic and over-crowded ward in the Central Hospital and because of that each doctor had the time teach me one on one, sometimes for a whole day. One down side is that some days – especially when it is rainy – the ED can be very quiet or even empty and on those days I was able to arrange to attend the other departments with my fellow students or take some time off to travel around the city. In particular, Dr Dung from the oncology department was very friendly and gave me the opportunity to give a presentation to the doctors and students, an experience I found very rewarding.
In general, doctors in the cardiology department spoke better English than the ED doctors. This I felt was fortunate as this was a less hands on rotation and more explanation of concepts were required. The interventional unit at the hospital has been in operation for less than 5 years and was much less busy than the ED with roughly 2 to 3 cases per day. Interestingly, the scope of practice was wider than in Australia and cardiologists also performed cerebral angiograms and interventions as well as hepatic ones. One thing that struck me was the difficulties the poor had in accessing care, and often extensive discussions with the family had to take place before an intervention as it may well cost them a few years worth of income.
Outside the hospital, many doctors were very keen to hang out and I was really made to feel at home in my time there. Huế city is renowned for its food and we quickly branched out from the touristy restaurants to more local fare, which is very different from the standard Vietnamese food found in Sydney. On the weekends we found time to travel to Da Nang to meet up with other students of the Học Mãi program, visit UNESCO heritage sites, and even spend some time at the local temple teaching English to children. Some of the doctors wanted help in proof reading their research articles and theses, or to practice speaking English, both of which I found to be good ways to give back to the medical community and also to strengthen personal relationships. Through my conversations, I understood some of the personal challenges faced by Vietnamese doctors – for example, even after graduation, residents do not get paid for their 3 year term of study and must rely on their family for support; research is difficult given the lack of proper training and equipment. In comparison, I feel extremely fortunate here in Australia and it has encouraged me to value the opportunities given to me such as the Học Mãi Scholarship. I definitely feel that me and the other Học Mãi students in Huế really connected with the doctors and students we met and one of them actually plan to come visit us in Sydney in sometime this year. I hope our visit can be a springboard to future visits by more students from Australia and for us to also play hosts to these fantastic students and doctors from Huế.
Overall I am extremely grateful to the Học Mãi foundation for this opportunity to visit Vietnam and it has been an immensely positive experience for me. I look forward to contributing to the program in whatever way I can in the future
Brodie Hookins, Hanoi, December 2014
Arriving in the busy halls of Bach Mai Hospital in Hanoi was an exciting opening to what was to be a very rewarding month in Vietnam. After walking past the curious faces of the family members waiting outside the neurology department, I was introduced to Professor Tinh and the whole neurology team. They were very welcoming and instantly made me feel like I was one of the crew. I was originally sat in the meeting room in the neurological emergency department and quickly had to use my basic knowledge of Vietnamese to communicate who exactly I was. The nurses and doctors were very excited to have their very own English tutor for an entire month, and I was also excited to have an enthusiastic team willing to spend time teaching me what they knew.
It was instantly clear that the hospital system in Vietnam had many differences to what I had become accustomed to in the comparatively silent halls of my clinical school. I soon realized that examining patients would involve me having to arrange the 2 or 3 patients in each bed in order to test their neurological system. Family members also take a much greater role in care of patients in Vietnam, so much so that some family members are permanently camped outside the crowded department in the middle of winter. Communicating almost entirely with the family when discussing the patients’ illness is routine, and was definitely an interesting difference that I had to adjust to quickly.
My limited Vietnamese vocabulary very quickly became full of key words that I would hear again and again, including hypertension, stroke, haemorrhage and diabetes. Because Bach Mai Hospital is the largest hospital in the North of Vietnam, it receives the most difficult cases that the rural medical services are unable to manage. This meant that I was exposed to a very wide variety of illnesses and diseases that are relatively uncommon in Australia. I heard the doctors routinely discussing diseases that had been the footnotes in my readings in Sydney, and the doctors were very excited to be able to present these cases to me. There was never a day that went by when the doctors did not have a very interesting patient that I had examine with them, and it was great that they took the time to explain to me all the details of the cases.
On the occasions that I did ward rounds with the local medical students, I would be asked to show them what I would do differently in Australia. These were great opportunities for me to share my knowledge with them and to really discover the differences and similarities in our methods. I was very happy to be able to help the medical students improve and refine their grasp of medical English, and I am hoping that this will help them when they search through English medical literature.
Overall I would say that the warmness and friendliness of the Neurology department took me by surprise. I have been able to forge friendships and connections that will last a lifetime and I am so appreciative to have had the opportunity to spend a month at Bach Mai Hospital.
Melia Condon, Hanoi, December 2014
We began our first two week placement in the Viet Duc Maxillofacial/Plastics Department and were welcomed warmly by the doctors and nurses before being shown around. Each day, we would be informed as to which doctors were operating, which were in the consulting rooms and which were on call and then be allowed to decide which we would shadow for the day. All of the surgeons seemed to know about the Hoc Mai Program, some even having been on it themselves, and were quite happy to share stories of their own experiences in Australia.
Surgery would begin around 8:30am. We observed the fixation many facial fractures that resulted from traffic accidents. Those who have visited will understand the chaos that is the road system here in Vietnam but surprisingly, or perhaps not, very few accidents occur in the city centres despite the high density of vehicles. It is on the highways and in the provinces that the majority of accidents occur given the speeds at which the drivers move and the lack of helmet use. It is these patients that we saw in the operating theatre to have their orbital, zygomatic, maxillary or mandibular fractures fixed with plates and screws. We also had the opportunity to see some other surgeries in the department such as skull reconstructions, skin grafts, lateral cutaneous flaps and even an attempted brachial plexus grafting.
The consultations were done in a small room in the corner of the department, or on the large communal table where morning meetings are held. Here, patients come for pre- or post-op advice and wound dressing or cleaning. Some of the doctors were very kind and would give us a brief of each patient after they had left the room. The variety of cases was very interesting- a patient would come in for a consultation following their ‘tummy tuck’ a month earlier while the next could have debilitating neurofibromatosis or a jaw fixation that needed releasing.
The second two weeks of out placement were spent in the Hepatobilliary Department of Viet Duc Hospital. The structure of this department was much more formal, but no less friendly than the last. Professor Hung was very glad to have us and welcomed us warmly. He introduced us to Dr Khue who was our direct supervisor for the fortnight.
Each morning, we would arrive for the department meeting at 7:15am then go to the OR for the day. During our time there, we saw the surgical resection of a number of Hepatocellular Carcinomas, the number of which far exceeds our own in Australia given the high incidence of HBV in Vietnam. We also saw both open and laparoscopic cholecystectomies, the resection of hematomas and the removal of gall stones.
We also got to see a number of intrahepatic lithotripsies for intrahepatic bile stones. These are almost endemic to south east Asia due in part to diet and the biliary colonisation of enteric bacteria. This was something we wouldn't see as much back home due to the differences in population demographics. One of the longest procedures we saw was the Whipple procedure, indicated in our patient due to a pancreatic tumor blocking the common bile duct.
One interesting fact was that there is no such thing as an Emergency Physician in Vietnam. Rather, each department will send a Doctor, typically one if more junior rank, to the ED where they will see patients that have been triaged to need assistance from their specialty.
We were fortunate to see various parts of Hanoi and outer regions during our stay. The city itself has some beautiful places to visit, such as the Temple of Literature, but the greater area is similarly beautiful. We spent a day visiting Nha Trang and the Trang An caves by paddle boat and were blown away by the beautiful scenery.
I would like to thank the Hoc Mai Foundation for the opportunity to come to Vietnam and further my medical education in such a diverse environment.
Costa Boyages, Michelle Emerson, and Ashleigh Smith report
We received a warm reception into the Bach Mai hospital Obstetrics and Gynaecology department, perhaps only rivalled by the cosy incubators which met Viet Namese newborns! Our Viet Namese mentors (some of them previous or prospective Hoc Mai fellows) showed great patience and attention to our learning; and generosity with their time.
Our experience on the wards was educational and galvanising. We witnessed our first vaginal and Caesarian deliveries. We quickly began to appreciate the real world elements of good peri-natal care: manual examination to measure dilatation of the cervix, Bishop Scoring to assess whether induction of labour is necessary, Leopold manoeuvres to determine foetal positioning, episiotomy technique and delivery method including active management of the third stage to reduce post-partum haemorrhage.
We also had the privilege of scrubbing in for our first Caesarian deliveries, wielding suction, retractor and surgical instruments under the watchful and helpful eyes of Viet Namese supervisors. We attended outpatient clinics and ward rounds where we saw ante-natal abdominal and transvaginal ultrasound imaging and post-natal follow up with our supervisor helpfully relating history and findings.
There were differences between the Australian and Viet Namese approaches, specifically regarding the role of pain relief, the place of family members in the delivery room and the resourcing available to doctors. In all, the experience was hugely instructive for us from a medical and cultural perspective and we were able to establish very close linkages with Viet Namese counterparts that we will no doubt maintain and further develop throughout the rest of our career.
David Leon report
My four weeks were spent in the plastic and reconstructive surgery department with two of my colleagues (Louise and Elle). However, our learning wasn’t just contained to the hospital. As part of the greater Hoc-Mai delegation of 14 students from medicine and allied health (including nurses, physiotherapists and speech pathologists), we travelled to various parts of northern Viet Nam to discover more of the culture and the people of this country that has such an amazing history.
From the beginning the head of the plastics department, Dr Ha, was friendly and keen to get us involved in learning, assisting and teaching with him and his team. They taught us many valuable skills during our time. One such example was a head to toe screening examination that would help to detect any dangerous conditions that might not be obvious in a post trauma setting. Another was a systematic method to approaching a clinical presentation, in particular for the case of mass lesions and vascular malformations of which we saw quite a number. In this regard we saw various different types of cancerous lesions as well as abscesses and benign lesions as well as seeing arteriovenous malformations, pure venous malformations and haemangiomas.
Lara Monaghan report
Last December I had the privilege of travelling to Hanoi as part of the Hoc Mai scholarship program. I spent the month in the Respiratory department of Bach Mai hospital.
I was initially overwhelmed by the size of the hospital; it seemed more like a town than a hospital. Having got lost as soon as we arrived at the hospital I was anxious about finding my feet in such a huge, unfamiliar environment. I was therefore grateful when a pharmacist called Hai who had met a couple of us at a barbecue in Sydney last year spotted us looking lost and came over to help us. She ended up taking us to meet our supervisor, then on a tour around the hospital. Such friendliness was characteristic of all the Vietnamese people we worked with.
Andrew Murphy report
For the duration of my placement in Vietnam I spent my time in the Viet Duc Emergency Department (ED). This was my first preference for where I wanted to spend my time, and both the hospital and Dr Duong were very helpful in ensuring I was able to be placed there.
When applying for the Hoc Mai scholarship, I had several learning goals that I wanted to fulfil during my time in Vietnam. All of my learning goals were based around how the ED is run in Vietnam. Specifically:
- How patients are triaged, and time management associated with this.
- How major trauma is managed.
- How spinal injuries are managed.
Reflections of Elle Vandervord
The four week placement that I undertook at Viet Duc Hospital over the summer holidays was a greatly enriching experience. I was attached to the Department of Plastic and Reconstructive Surgery along with two other second year students. The placement offered innumerable opportunities for learning, not only about plastic surgery and the Vietnamese hospital system but also about the Vietnamese culture and way of life.
During the placement I gained insight into the scope of plastic surgery practiced in Vietnam. Arriving at 8am each morning, we were able to sit in on daily clinics and observe patient consultations. We were exposed to many different diseases that we had not seen before, including benign symmetric lipomatosis, neurofibromatosis, vascular malformations and advanced tumours of the head and neck region. With the assistance of the surgeons who translated for us, we were able to take histories and examine patients in clinics and on the ward and in doing so gained a good understanding of the presenting signs and symptoms and natural history of these diseases. We also learnt to distinguish between different types of head and neck tumours on examination, for example the features which clinically differentiate benign and malignant tumours and the different types of vascular malformations.
Marianne Dowsett, Mark Er, Arabella Lindsay Walker
On the morning of our first day in Hanoi, Dr Duong and Dr An introduced us to Viet Duc Hospital and our clinical supervisors. Over the next month, we witnessed the working intricacies of Viet Duc Hospital and the ways in which life at the hospital reflected many of the virtuous qualities of Vietnamese culture. For instance, at first glance Viet Duc appeared over-crowded with patients, however, we soon learnt that many of these people were family members there to comfort and support their loved-ones - highlighting for us the strong family values held by many Vietnamese people. Our supervisors introduced us to both the hospital and HaNoi. In theatre and on the wards they showed great diligence, spirit and concern for their patients - qualities that we aspire to match in our future careers. In theatre our supervisors gave us the opportunity to scrub-in, assist and practice skills such as suturing. We were shown interesting diseases and presentations that would be a rarity in Australian hospitals. Outside on the streets of HaNoi, over memorable conversations, we were introduced to Vietnamese food and coffee. Overall, our experiences at the hospital were invaluable and we are so very thankful to be given such an opportunity. Continued
Reflections of Marianne Dowsett
Last summer I was one of the very fortunate students to be selected for the Hoc Mai Scholarship to Vietnam. I worked at Viet Duc Hospital in Hanoi with the Plastic Surgery team under Dr Ha for the four weeks, which I thoroughly enjoyed.
I found the first day of hospital very overwhelming; learning how to communicate with basic English and hand gestures, finding my way around and working out where I fitted into the team, were what I remember most. However I quickly found my place and started enjoying the routine of ward work and surgeries. Dr Ha was a fantastic supervisor and encouraged me to participate in examination on both the ward and in clinic, and whenever he had a spare moment he would teach me an aspect of plastic surgery. The rest of the team was incredibly welcoming and would invite me to assist in surgery and teach me skills such as suturing and drilling.
Report on Học Mãi Scholarship Experience by Lauren Hammer
The Học Mãi scholarship to Viêt Nam was an invaluable learning experience for me. I feel I have gained a wealth of new knowledge and understanding and achieved all of my objectives for the placement and more. As well as fantastic medical teaching, I have had insight to circumstances that challenged my thoughts on health equity, medical ethics and responsibility. These experiences have shed new light on my view of patient care and will make me a better doctor. I was provided with ample opportunity to gain surgical experience in Việt Đức hospital. This experience has opened my eyes to new specialties that I thoroughly enjoyed. At Việt Đức hospital, I also saw the traumatic outcome of Viêt Nam’s primary public health problem; motorbike accidents. This allowed me to have the opportunity to address one of my main objectives of the scholarship; to explore my interest in surgery and public health.
Hoc Mai placement report, December 2009 - Viet Duc Surgical Hospital, Ha Noi. By Edwin Ho
I was fortunate to be a member of the Hoc Mai placement at Viet Duc Surgical Hospital in Ha Noi, Viet Nam, which took place in December 2009. This was a medical and cultural learning experience in the developing world that has left an incredible impression on our budding professional careers. The resilience, passion and generosity of the Vietnamese people are qualities that will inspire my personal journey for lifelong learning and contribution in the global community. So, our placement was true to the meaning of “Hoc Mai” – Forever Learning.
On our first day at Viet Duc Hospital, we realized that this was going to be different to any hospitals in Sydney in most ways. It looked different; crowded, busy, chaotic, and some equipment that would be considered outdated at home. It sounded different; we had to pick up some Vietnamese phrases quickly. It even tasted different; the Vietnamese like their coffee very strong, but the sweet condensed milk took away some of that bite! Our clinical supervisors and enthusiastic medical students from Hanoi Medical University worked hard to welcome and orientate us to their domain, despite their busy schedules.
Five students (Kate Larkins, Renee Burton, Chris Brunsdon, Chloe Wilcox, Susanna Lam) undertook their Học Mãi student scholarship for clinical placement in HaNoi from 29 November to 26 December, 2008.
The students are seen here with Dr Nguyen Huu Tu (a Học Mãi fellow from 2007 and a strong supporter of the Học Mãi Foundation).
Học Mãi second year student report:
"They say you come to Vietnam and you understand a lot in a few minutes, but the rest has got to be lived…."
Five fortunate second year medical students realised this was just as true for the hospitals of HaNoi as it was for Thomas Fowler’s Viêt Nam in the film The Quiet American. We spent four weeks in HaNoi as part of the Học Mãi Scholarship program. This experience introduced us to an incredible culture, a dedicated and committed people and of course offered a unique insight into medicine in a developing world. Continued...
For each of us the Vietnam experience had its different highlights. From becoming budding neurosurgeons, to colorectal surgeons, nephrologists, obstetricians, pediatricians and emergency medicine doctors, each of us were touched by the doctors that took time out of their days to teach and inspire us. Through their eyes we were able to learn about health care in Vietnam; to engage in discussions about diagnosis, management and the intricacies of the Vietnamese health care system. Continued...