Scholarships for Stage 3 medical students
Seung Yeon Lee, Children’s Hospital 2, Ho Chi Minh City
I had the wonderful privilege of spending four weeks at the Children’s Hospital 2 (CH2), the largest paediatric hospital in Ho Chi Minh City, Vietnam. During my time, I was able to observe and learn in the ICU and neurology departments. I had come to Vietnam with the hopes of learning about a different healthcare system, develop my cultural awareness and sensitivity and to embrace the vibrant Vietnamese culture. Thanks to the support of the Hoc Mai Foundation, the fantastic doctors and kind students, I was able to achieve these goals, and so much more.
My placement at CH2 was an interesting and eye-opening experience for me, as I saw firsthand the healthcare issues that overwhelmed the Vietnamese healthcare system and the different ways the system addressed these issues. There are limited resources in a public hospital like CH2, and as such, there were limited numbers of staff and beds. The ICU was a large, single ward with rows of beds and there were neither individual rooms nor any isolation rooms. What struck me at first was the significant proportion of patients in hospital due to injuries sustained in motorbike accidents. Motor accident injuries are a significant issue in Vietnam, and seeing how frequently this occurs was both confronting and saddening. The constant busy state of the ICU was a testament to the unbelievably hard working staff and the sheer number of patients admitted to Vietnamese hospitals.
My two weeks at the neurology department was a nice change in pace, as the children were less critically ill, allowing me to spend time playing games with them. Thanks to the thoughtful staff in the neurology department, I was able to receive a lot of teaching with a huge number of case studies including the opportunity to see rare pathology that would present once a decade in Australia. In addition to the medical knowledge I gained, I was able to develop a better understanding of the hardships some Vietnamese face to receiving appropriate medical care. During my time in the neurology department, I witnessed patients unable to receive treatment due to financial issues and significant miscommunication due to language barriers with ethnic minority groups. Despite reading about these issues prior to my placement, seeing them in action was still challenging and gave me many opportunities to reflect on how similar issues may permeate my practice as a doctor in Australia.
Minh Anh Nguyen, Children’s Hospital 2, Ho Chi Minh City
In January 2016, I was lucky enough to undertake a four-week elective placement at Nhi Dong 2 (Children’s Hospital 2) in Ho Chi Minh City, Vietnam. It was an invaluable learning experience from clinical and cultural standpoints. Children's Hospital 2 is a large regional hospital that serves the local population and also receives referrals from dozens of provinces in southern Vietnam, where two thirds of the Vietnamese population live. Consequently, I was exposed to a diverse range of cases that I was unable to encounter during my paediatric rotation in Australia.
I spent my first two weeks in the Intensive Care Unit, which enabled me to broaden my clinical knowledge base in paediatric general medicine. Although there was little opportunity to take histories and examine patients, the doctors were happy to discuss the patients’ presentation, workup and management. I was able to see a range of rare pathology and clinical signs that I had previously only encountered in textbooks.
I spent the remaining two weeks in the Neurology Department, where there were ample opportunities to gather histories (sometimes challenging with my broken Vietnamese) and hone my neurological examination skills. I saw many interesting cases with the helpful doctors and Vietnamese medical students, who were invaluable translators. My fellow SMP student returned the favour by helping the doctors demonstrate clinical examination skills to the local students.
I was also fortunate enough to spend my final week alongside visiting Swiss neurologists whose mission was similar to that of the Hoc Mai Foundation. I gained a lot from their educational seminars, as well as case conferences, where the local and foreign doctors worked together with patients and families to work out diagnostic dilemmas, and draw up feasible management plans for complex patients. It was truly inspiring to see these foreign doctors give their ongoing support for the Vietnamese doctors and patients, who showed immense gratitude. The visiting doctors were also able to take away a lot from the cases that were rare in their country, including managing these patients using limited resources. This highlighted the value of cross-cultural exchange in the medical community, enabling all involved to continually learn from one another.
A key cultural lesson I took away from this placement was the large inequalities in the Vietnamaese healthcare system. Many patients in both departments unfortunately had histories of late presentations and referrals or illnesses left untreated, so had developed many potentially avoidable complications. It was saddening to see patients, particularly from poor and ethnic backgrounds, struggle with language barriers, costs of travel to hospital, and without insurance unable to afford a hospital bed, diagnostic tests and treatment. It was frustrating to see them discharged from hospital diagnosed with treatable conditions but no treatment. I came to appreciate how difficult the healthcare system is, not only for the patients and families, but also the doctors, who strive to do their best for their patients but become limited by the system.
The challenges with the placement itself were to do with the organization. There were difficulties communicating with the coordinator from the hospital, which created delays in obtaining approval for the placement. We also did not find out our rotations until the first day of placement, which made it hard to prepare for the placement.
Although not applicable to myself, the language barrier would be a big challenge for non-Vietnamese speakers. There would be a rare doctor who was comfortable speaking English, but this was not the case for most hospital staff, patients and families. The hospital notes were also in Vietnamese. Although this meant that I was able to improve my Vietnamese immensely, I can imagine it would be a great challenge for students unfamiliar with the language.
Hugh Carter, The Women and Children's Hospital, Da Nang
I was fortunate enough to spend a fantastic week in Da Nang organized by the Hoc Mai Foundation. During that time I was able to expand my medical knowledge, learn about Vietnam and make lasting friendships with some of the local doctors.
I was placed at the Women’s and Children’s Hospital where in the initial 2 weeks Veronica, another Hoc Mai recipient, and myself were with the obstetrics department.
Because I had not completed my rotation in that department in Australia I could not compare the two countries; and was quite nervous about beginning in a foreign country in a specialty I knew little about! However, we quickly made friends with Dr Viet, one of the obstetricians who was more than helpful showing us the ropes and fielding our questions in English. The entire team was keen to teach and give us experience and in return we attempted to have discussions with the department with the help of online English resources. Some of the interesting cases we observed were patients with polyhydraminos, oligohydraminos and premature rupture of membranes, which were eloquently explained by the treating team.
The following 2 weeks of my elective at the Women’s and Children’s Hospital I was placed in the pediatrics department helping with the anesthetics team. I have a keen interest in anesthetics and quickly befriended one of the young anesthetists Dr Quyen who was also keen to practice his English speaking skills. Dr Quyen and I completed many lists together and throughout he explained to me the many pathologies of the patients and taught me about the required changes to the anesthetics. Under his and some of the other doctors in the department I was also able to help with some of the procedures. Dr Quyen and I also discussed the many differences between Vietnam and Australia and attempted to clarify them for me. I was very impressed with the Vietnamese children’s ability to undergo anesthetic without the help of a parent, a feat I would not have been able to do.
Though there are documented differences between the two countries, I believe that Vietnam holds many similarities to Australia in the form of the dedicated medical professionals having a keenness to learn, a desire to get the best outcome for their patient and a friendly attitude that fosters an excellent teaching environment.
I think I speak for both Simon Walters and Veronica Powys, the two other medical students at Da Nang Women’s and Children’s Hospital, that our time in Vietnam was incredibly enjoyable and were are forever grateful to the Hoc Mai for opportunity to experience such a wonderful country.
Romeo David Torres, Military Hospital 175, Ho Chi Minh City
I was fortunate enough to complete a 4-week elective at Bệnh viện (Military Hospital) 175 in Ho Chi Minh City, Vietnam through the Hoc Mai Foundation. It consisted of two 2-week attachments with the ICU and Anaesthetics Departments, which provided an intimate insight into the practice of critical care in the setting of one of the busiest hospitals in Ho Chi Minh City. As such, my time in Vietnam proved to be an incredibly rich learning opportunity, both medically and culturally. Indeed I found myself learning even before the placement proper began, from the moment I arrived as Dr Duong, the incredibly likeable neurology registrar who insisted on picking me up from the airport (on New Year's Eve no less), allowed me to accompany him on a consult en route from the airport to the guesthouse. (It was a fascinating case of a patient with Marfan's Syndrome developing profound left-sided hemiparesis and numbness as a result of what turned out to be a carotid artery dissection.)
Critical care has always interested and intimidated me, and I began my placements in this area both with excitement in anticipation of the interesting array of cases in the Vietnamese setting, as well as no small measure of trepidation with regards to keeping up knowledge-wise in this intense setting. As it turned out, however, my anxieties were entirely misplaced as the doctors in both ICU and Anaesthetics turned out to be almost superlatively accommodating, collegial, and eager to teach despite the considerable language barrier. All the more impressive was the speed and skill of the doctors with important procedures as spinal and epidural injections, and central line insertions (WITHOUT any ultrasound guidance and often completed in less than 5 minutes) to name a few. I suspect that such proficiency and efficiency were the necessary consequences of medical practice in the setting of a poorly funded public healthcare system with precious little in the way of primary care, and an almost impractically high population density compounded by a dearth of major hospitals outside of the capital cities further drawing patients in from an ever wider rural catchment area. In addition, though comparatively better than the national average wage, the compensation of doctors in Vietnam is often still not enough to cover the costs of living, particularly if there is family in and out of the city to support, and many doctors take on second and third jobs in private clinics catering to affluent locals and tourists.
Despite such challenging conditions, there remained a significant focus on further outreach, and several doctors I met were actively involved in monthly "charity" clinics in rural areas, and my assigned supervisor, Dr Thanh, was busy most of the time organising an upcoming deployment of doctors from Military Hospital 175 to set up a field hospital in South Sudan within the coming year. This further extended beyond the staff as well, and what I observed was how in response to a lack of material and infrastructural resources, social resources were called to flourish, and the wards on the way to the ICU and operating theatres were always saturated with families who stayed 24/7 to tend to their loved ones (a practice apparently encouraged by the doctors as a supplement to the overwhelmed nursing staff and lack of allied health presence).
Overall my experience with this placement was an eye-opening and very valuable opportunity to observe medical and critical care practice in a social and economic context vastly different to my own. The language barrier that I anticipated would be the biggest hindrance turned out to be something of a welcome novelty in many cases, and demonstrated the hospitality of the doctors who took great pains to ensure I knew what was happening at all times. The kindness and resilience of the doctors and nurses I met was really quite inspiring and I am immensely thankful to both the Hoc Mai Foundation and Military Hospital 175 for such an educational and enriching experience.
Simon Walters, The Women and Children's Hospital, Da Nang
Vietnam is an emerging developing country, in that it is quickly developing into a 2nd world country. The Vietnamese people have been through a great deal with the American War of 1969-1975 and many parts of the country are still being rebuilt after the destruction of many cultural landmarks and population centers. Da Nang is one such place, where American Soldiers were based during the war. In spite of this, the Vietnamese people are one of the most generous, kind, and polite groups of people I have encountered over years of international travel. Their resilience and composure has certainly been an inspiration to me and I know that it has made me a better person having had this experience.
As previously mentioned, my entire experience in Vietnam has contributed to me both becoming a better person and a better doctor in the future. The Vietnamese doctors I worked with were very resourceful, hard working, and had a great deal of rapport with their patients. Everyone is treated equally within the hospital regardless of the clothes they wear – wealthy and poor both receive the same care and attention, which is certainly not the case here in Australia.
In terms of culture, I have been able to begin incorporating so many different aspects into my own way of life now back in Australia. As the Vietnamese are a collectivist culture (Vs. Individualistic in most western countries including Australia), my concept of teamwork and community has greatly changed. I no longer see community and family responsibility as something to be shunned, but rather something to be embraced to enrich ones own life and career. Vietnamese people spend a great deal of time with their families, which luckily I can say that I also do. Family is very important, and children often live with and take care of elderly family members (rather than dropping off at the nursing home or hospital when things get tough). Another cultural lesson I enjoyed was gift giving. It is very special to give and receive a gift from a friend newly made in a new country – one of the doctors gave me a Buddhist Sandalwood Beads to protect me from bad spirits and help me find happiness and fortune. Tet holiday (Lunar new year – start of Feb 2016) is the most important holiday of the year and usually when everyone gets time off (however only 8 days a year!). Each department is blessed with a massive banquet of food and fake money is burnt to rid each department of bad spirits and to bring good luck for 2016. The food is then shared amongst all staff after each ceremony.
The major challenges I faced whilst in Vietnam were conversing with doctors that had limited English. My Vietnamese was essentially limited to the bare basics. Fortunately we were teamed up with the doctors that had very good English skills (and part of the English Club!). Conversing with patients was almost non-existent – but it is amazing how much you can understand through observation and non-verbal communication. Another challenge was riding the moped to work each day and not crashing! It was fine after a few days once you get used to the lack of road rules and literally just "go with the flow". Everyone drives very slowly and carefully (albeit with constant horn beeping as a friendly "Hey, lookout! I’m here - don’t run over me").
It was simply a wonderful experience having my placement in Da Nang at The Women and Children's Hospital. We were taken care of every day by supportive staff and often felt like visiting celebrities as the hundreds of Facebook friend requests rolled in! We were taken out to local restaurants and karaoke bars, to cultural landmarks and beautiful natural landscapes.
Thank you to Hoc Mai and all those involved for allowing me to have this truly life changing experience and such a wonderful placement. I could definitely stayed for longer if I didn’t have to get home to my own family.
Danielle Diem Pham, Da Nang Hospital for Women & Children
December 2014, the first 4 weeks of my elective started at Da Nang Hospital for Women & Children. The hospital is fairly new, opened in April 2011, and is the first major specialist paediatric and maternity hospital of the central region of Vietnam. The hospital provides a full range of reproductive health care services including obstetrics, gynaecology, fertility and genetics testing. It is also a designated neonatal training centre of the region. Its NICU admits over 250 newborns per months from inborn patients (60%), referral from other hospitals, and direct admissions from the community.
My coordinator, Dr Hoang Tran is the head of Neonatal Department where I spent my first week. Based on my learning objectives, Dr Hoang also arranged for me a week in PICU, a week in maternity and the last week as my free choice which I ended up spending in HDU (high dependency unit) where premature babies or babies discharged from NICU are looked after with their mothers. Unlike in NICU where babies and mothers must be separated, in HDU the mother or a relative, often the father or the grandmother, stay with the newborn to provide skin to skin kangaroo care. There, they also taught the mother breastfeeding and massaging the baby before discharged them home.
The NICU team was very friendly and helpful. Most NICU doctors can speak English very well and were keen to teach. Every morning we had an English ward round where a junior doctor presented the progression of each patient on the ward and the current management plan. When all the doctors went to their meeting with other departments, the nurses took us for some procedures skills from cannulation, taking blood, inserting NG tube to feeding and bathing the babies.
I found the setting in NICU here is relatively similar to at RNSH NICU where I’d done my OB/GYN rotation. My experience in PICU the following weeks was, in contrast, quite different from expected. I felt more like in an Emergency Department most of the times. It can get quite chaotic in PICU, there was a day when new patients didn’t stop coming in, every single bed was full and they put out extra trolley-beds on the walkway to accommodate more patients. Almost all patients in PICU had pneumonia; either came in with it or developed during admission. There were also numbers of patients with meningitis and encephalitis, and other conditions including many severe congenital heart defects, severe hydrocephalus, Lyell’s syndrome, etc. which are rarely seen in Australia. This provided excellent clinical experience.
A newly graduated nurse - also from University of Sydney- was with me on this placement, and I am grateful that the teams here were happy for us to stick together. It’s always valuable to discuss and share experiences with a fellow student. From her nursing standpoint she stressed to me how poorly infectious control was implemented. Indeed, bed sheets were changed between patients but no cleaning of the surroundings; Isolation of patients with diarrhoea and airborne diseases in PICU were impossible due to bed shortage and overwhelming number of patients. The importance of hand hygiene was well acknowledged but not performed correctly. Hand rub was applied but examination of the patients occurs while the hands were still wet providing perfect moist and warm environments for bacteria to spread and grow; Hand-washing basins were there but hand towels might not be available.
The week in delivery and maternity was even far more different from what I’d seen back in Sydney. As one of the major maternity hospital of the area, there were about 30 normal deliveries a day on average, not including C-section. Spending a morning in delivery, I was able to observe 5 or 6 normal births easily, which is more than I had seen in my entire 8 weeks of O&G at RNSH. There were plenty of chances to assist delivering a baby if you ask for. This was a fantastic opportunity to have some hand-on experience. On the other hand, the practice of obstetric and gynaecological care here is very different and can be quite confronting at times, especially for someone who have seen or known how it is done in Australia. First of all patient’s privacy does not really exist. In antenatal care, pregnant women queuing up for their turn was asked to take off their bottoms in advance whilst in the same room, the doctor was doing an internal ultrasound on another patient.
In delivery, one delivery room would normally accommodates 4-5 patients at once, all in active labour, all were put on their back in the pushing position, and all fully exposed even though it may take another hour till they actually start pushing. Repeated digital vaginal examinations were performed at anytime by midwives, midwifery students, and obstetricians rather than being done by one person, recorded and communicated to the others. Another main difference in practice was that here there is no option for pain relief during labour and normal vaginal birth. A senior midwife explained to me that they were not familiar with nitrous oxide; Opiates were not an option due to the risks of adverse effects on the newborns; And epidural wasn’t practical as the risk of infection was high in a share room like this and also the anaesthetists were flat out in the theatres and often not available. Also, episiotomy rate was almost 100% as contrast to 1% in Australia.
The overall experience in Da Nang was incredible. The people are lovely; the doctors are very friendly and outgoing. Outings are countless and often involve lots of eating and drinking, followed by karaoke session.
Danielle Diem Pham, The National Hospital of Paediatrics Hospital, Hanoi
My 2nd placement is at the National Hospital of Paediatrics (NHP) in Hanoi. The hospital is located 15 minutes’ drive from the CBD, on a very busy street of Hanoi. I spent most of my time in paediatric emergency units.
In emergency department (ED), there is an admission desk where 2 doctors assisted by a nurse would do the triage and decide whether patients will get into emergency room or monitoring room. In the emergency room, there are doctors and nurses available at all time, while in the monitoring room, parents are instructed in how to care for their child and will need to come to the admission desk to ask for a doctor or a nurse for any assistance. ED at NHP also acts as a transit bay where all patients being transferred from different hospital must come first and get their documents ready before being transferred to the appropriate ward.
In Vietnam, people go straight to the hospital when they are sick rather than seeing a GP beforehand like in Australia; GP doesn’t really exists. Thus, to reduce congestion in ED, just outside the hospital there is a clinic areas where all patients who come to the hospital need to be seen firstly by a doctor, who will then decide if the patients need to go to ED or can be sent home with medication. Other patients who are transferred from other hospitals or come in by ambulance may go straight to ED. On a normal day, there are around 3000 patients came to the clinics, of these, 5-10% (around 300 patients) will get to ED.
ED at NHP has a good range of presentations providing excellent opportunity for clinical practice. I spent the first few days in triage learning about assessing, categorising and distributing patients. For the rest of the placement, each week my supervisor assigned a body system to read about, and during the week I could assess and examine patients who present with problems of that system.
The ED team of NHP are welcoming and enthusiastic. Many doctors and nurses are very keen to show me around. Similar to the NICU team in Da Nang, at NHP there are English meetings three times a week when the doctors take turn presenting a case so that everyone can learn medical English. We were asked to present a few cases and topics of our choice as well during our time there.
There are also training sessions and simulation including anaphylaxis shock, cardiac arrest management, setting up medical ventilator, etc. We are welcome to join but some are in English and others are in Vietnamese.
Every Wednesday afternoon, I also got to follow Dr Duy to the paediatric endocrinology clinics where we normally saw 50 or more patients for an afternoon. It was an eye-opening opportunity to see how the doctors manage so many patients. There is a good range of conditions including precocious puberty, Prader-Willi syndrome, Turner Syndrome, growth hormone deficiency, etc. Surprisingly, according to Dr Duy, the most common presentations at the clinics are Rickets, and congenital adrenal hyperplasia, whereas type 1 diabetes is not on the top list.
Social outings in Hanoi were quite similar to the time in Da Nang. There were more outings which involved much more drinking. I could easily refuse alcoholic drinks during lunch-break outings since the doctors were all well aware of the inappropriateness although they still drank; but outing after work was a different story.
Overall, I have gained priceless experience from this elective placement in Vietnam, and I am very grateful for this opportunity, thanks to Hoc Mai Foundation. Not only I got to see and experience a very different healthcare system but also I have learned not to judge but rather justify my own understanding and belief in medical practice. The best evidence-based medical practice does not necessarily work out the best everywhere. In different circumstances like in Vietnam where overpopulation with large health disparity between urban and province are dealt with by already overcrowding hospitals with very limited resources, the best evidence-based practice may not be so effective, nor practical.
Report by Amy Nolan
“Much of Vietnamese society is founded upon the strength of its women”
-Prof Jonathan Morris
She looked like a child, tiny and afraid. Patient T had been labouring for close to 24 hours, and she was clearly exhausted. As another wave of contractions gripped her small body, the midwife climbed up onto the bed beside her, placed her fists on Patient T’s swollen abdomen, and bore down with all her weight. With little more than a silent grimace, Patient T gave one final push and her child slipped quietly into the world. A baby boy, and what should have been a joyous occasion for the young Vietnamese mother. But I watched with confusion as Patient T turned her tired face to the side while midwives quickly swaddled her baby and took him away. The silence in the delivery room echoed what everyone else already knew: her son had died in utero several days earlier, and Patient T would be returning to her home in the countryside only to bury her tiny son.
That day, Patient T was one of approximately 130 women to give birth at TuDu Obstetric and Gynaecological Hospital in Ho Chi Minh City, where I spent my 8 week elective with the Hoc Mai Foundation. Fortunately not all women experience such devastating outcomes, but the sheer volume of patients passing through TuDu means the hospital runs very differently to maternity wards in Australia. With the helpful guidance of the Vietnamese Hoc Mai fellows, I was offered the opportunity to practice obstetrics clinical skills such as assisting with spontaneous deliveries, suturing, and scrubbing in for caesareans and other gynaecological operations. However, I believe my most valuable learning experience came from observing the enormous differences between our two systems.
Report by Cam Hollows
Blood, Bone and Metal:
Report on a Student Hoc Mai Scholarship placement with the Trauma and Orthopaedic Surgery Department at Viet Duc Surgical Teaching hospital Hanoi. (KHOA CHẤN THƯƠNG CHỈNH H'NH - BỆNH VIỆN VIỆT ĐỨC)
The treatment of Motor Vehicle Accident (Road) Trauma in the developing world is an area of need that is expanding in parallel with the horrific toll such trauma takes on societies. MVA’s particularly in developing countries with recent surges in economic development have been labeled the “unsolvable epidemic” of the 21st century. Vietnam is a nation that continues to experience rapid economic growth and a concurrent mechanical mobilization of its populace, along with this mobilization comes the specter of road trauma and polytrauma from MVA’s. Road trauma management is complex and challengeing because each case has unique elements due to the huge variety in the mechanism of injury. Motorcycles play a large and important part in Vietnamese society but there can be no doubt (even following introduction of compulsory helmet legislation) they also impose a terrible cost.
Report by Ji Li
I went to Vietnam with a very open mind. As we were foreign students going to a very big and busy hospital (Bach Mai), I half expected us to fall through the cracks somewhat and be left to fend for ourselves. I am very happy to report that I did not feel like that at all.
As soon as I arrived at Bach Mai Emergency, I was warmly welcomed by and taken under the wings of Dr Tu, who was a previous Hoc Mai scholar. He was very kind and explained interesting medical presentations to me with a lot of patience. I was also introduced to 3 more emergency doctors who were all Hoc Mai scholars; they spoke English well and were all keen for me to see their patients.
Report by Christine Duong
The first four weeks of my elective was spent at the eye hospital in Ho Chi Minh city Vietnam. Ho chi minh city is the largest city in Vietnam and has a population of 10 million. This eye hospital is the largest eye hospital in the south of Vietnam and serves a radius of about 33 million people. It is a very busy hospital in a very busy city. Most nights there would be patients who sleep on hospital grounds because they are from rural Vietnam and there would be no early morning buses to make their 7am appointments, hence they would arrive at night and sleep there to wait for their appointments.
During my time at the eye hospital I went to many different departments such as outpatients (with residents and specialists), trauma, glaucoma, paediatric ophthalmology and the operating suites. Each department was very welcoming and my concern of a language barrier was rarely an issue. I think it helped that I spoke Vietnamese however I speak no medical Vietnamese and most of the time it was easier to communicate in English since I didn’t know the medical words, however the doctors always knew the English words since they learn medical Vietnamese and English. I made many friends at the eye hospital since many people were so friendly and willing to teach. They were also willing to learn conversational English from me, so I felt I could give back a little.
Report by Jane Stuart-Carberry
Arriving at Từ Dũ hospital on the first day I felt like a celebrity! I was welcomed by Dr Hoan, ushered to collect my ID badge and to meet important people. I spent most of my 2 months at Từ Dũ in the delivery ward, where I was encouraged to participate in everything involved in the birthing process from cardiotocography interpretation to vaginal births and C-sections.
One of the highlights of my experiences was night shifts and emergency department shifts with Dr Võ Minh Tuấn. He would either teach us while he consulted in the emergency department, or assign us to a registrar who would take the time to answer our burning questions, and take us into the operating theatre to watch and assist in cesarean sections and gynaecological surgery. I was amazed by the surgeons’ and anaesthetists’ technical skills. Their dexterity, speed and precision was impressive, especially in placement of epidurals, they explained that the sheer number of patients they have treated allows them to fine tune their skills.
Report by Sara Clarke, Tu Du Hospital, Ho chi Minh City, Vietnam
I completed four weeks of my elective term at Tu Du hospital. Tu Du is the largest maternity hospital in Vietnam. It is situated in Ho Chi Minh City and plays a major role in the education of local medical and nursing students as well as midwives from the remote, minority tribe regions. On average 100 newborns are delivered each day at the hospital. In addition to obstetric services the hospital also offers gynaecological, fertility, NICU, genetic testing and pathology services.
The activities that I undertook during my time at Tu Du hospital were based on my learning objectives. As such I spent the majority of my time in the delivery department. This department consisted of a large room separated into six smaller rooms, each containing two lithotomy beds (see photo). The typical process of entry into this room begins when the labouring woman presents to the emergency department at Tu Du. Due to difficulties with transport and the scarcity of ambulance services, she will usually present early in the first stage of labour and remain at the hospital for the entirety of her labour. This ensures that emergency transport to the hospital, due to unexpected complications or fast progression of labour, is not required. The pregnant woman is then admitted to the maternity ward which is a large room containing approximately 40 haphazardly arranged beds, without privacy curtains. When delivery is imminent the woman is moved into the delivery room.
My Học Mãii four week clinical experience in Hanoi promised to be a wonderful opportunity to improve my medical knowledge and skills, as well as to form friendships with Vietnamese health care workers.
The scholarship not only exceeded my expectations in these key areas, but also offered me the opportunity to form relationships with allied health care workers back home and to gain an insight into the Vietnamese culture and way of life.
The four weeks I spent in Bach Mai Hospital - one of the largest in Vietnam - provided me with a chance to complement the last two years of predominantly university based learning with an extended period of clinical exposure. I was able to observe a wide range of medical procedures and clinical care, particularly in the area of surgery. Continued...
As a recipient of a Hoc Mai Foundation scholarship, I was fortunate enough to be able to spend four weeks of my Elective Term at the National Hospital of Paediatrics (NHP) in Hanoi. My time was primarily spent with the surgical department, however I did have the chance to visit other departments around the hospital to gain a deeper insight into medical practice in Viet Nam. This leg of my elective ran from July 20th to August 14th 2009, that is, during the Hanoian summer. Continued...
Hoc Mai Foundation – A Month at Bac Mai Hospital Dec 2009 (Hanoi), by Uma Selvanathan
Between Dec 5-Jan 2, I spent a month in Hanoi, Vietnam with a group of students from Sydney Medical School, 2 Nursing students, 1 speech pathology student and 1 physiotherapy student. Having just completed my second year of medical school as I arrived in Hanoi, my experience with the program was a phenomenal one that permitted me to consolidate my “classroom learning” from the past 2 years and translate it to a clinical, hospital-based context. Additionally, I was able to learn a lot about the Vietnamese culture and the practice of medicine in a developing country.
I spent my 4 weeks at Bac Mai hospital, one of the largest hospitals in Hanoi. The first two weeks were spent in general surgery and ICU, and the last 2 weeks with the Obstetrics and Gynaecology department. Initially, we were unsure as to how much we would be able to see and do as none of us spoke any Vietnamese and most of the patients spoke no English. We soon found out that many aspects of medicine is in fact, universal and we were able to follow surgeries and the ICU rounds and clue in on what was going on. Continued...
Vietnam – a nation of delicious food, amazing people, breathtaking landscapes…and minimal pain relief.
The Học Mãi scholarships provided seven University of Sydney students with the opportunity to experience both the culture and the medical practices of a nation vastly different to Australia. On placements at hospitals in HaNoi, DaNang, and Ho Chi Minh City, we viewed first-hand the horror of motorcycle accidents, the joy of childbirth, and the effects of limited resources.
At Viet Duc Surgical Hospital in HaNoi, we witnessed many families queuing every morning, waiting to visit their loved ones; case after case of mangled hands and severed limbs due to unsafe occupational practices; brain tumors left to grow in patients who cannot afford medical care; and major head and limb injuries due to motorcycle and car accidents.
As one of the Học Mãi scholars described it, “there was a mixture of emotion in the air; a sense of uncertainty in the eyes of family contrasted to one of pragmatic brashness of the doctors trying to help the overwhelming number of patients.”
However, despite their horrific injuries and illnesses, we were constantly amazed at the stoicism and resilience of the Vietnamese people, whose pain appeared to be controlled with the most basic forms of pain relief, such as intra-venous paracetamol ¬– even for major limb injuries, such as amputations.
It was eye-opening to come from a medical system where syringes, sutures, and neck braces are expected as standard care to a country where these are limited.Limited resources notwithstanding, we observed excellent surgical and clinical skills, and felt privileged to be accepted into the Vietnamese medical community. Despite the time constraints, these talented doctors still took the time to share their knowledge – and practice their English!
At Tu Du Hospital in Ho Chi Minh City, we assisted with childbirth, took patient histories, and collected data for public health studies. Everyday we would learn something new, such as the differences in the relationships between patients and doctors, the impact of cultural beliefs on health care, and the difficulties faced in working in a developing country.
Outside of medicine, the Học Mãi scholarship provided us an opportunity to embrace a culture, make new friends, experience the excitement of Tết (Lunar New Year), and refine our palates in relation to the subtleties of regional beers and spring rolls.
We are very grateful to the Học Mãi Foundation for making this opportunity available. It has contributed invaluable experiences and memories, and allowed us to forge bonds with other medical professionals in a country vastly different to our own.
Tamara Rickersey and Paula Conroy
We have just spent four weeks at the Tu Du Maternity Hospital in Ho Chi Minh City. It was an inspiring and eye-opening experience and we are grateful to have been given the opportunity from TuDu Hospital, the Hoc Mai Foundation and the Northern Clinical School to be able work in such an incredible environment.
Tu Du Hospital Delivery Suite staff attends to approximately 200 deliveries per day and over 70,000 each year. It was in the engine room of this amazing machine, the delivery department, that we spent our time for this placement. We were overseen by Madame Trinh, the Head Midwife of the department and midwife extraordinaire and were very fortunate to have such a wonderful tutor teach us about the practice of obstetrics and gynaecology in Vietnam. Ms Trinh was a 2007 Hoc Mai Foundation/AusAID Fellowship recipient.
From day 1, we were made to feel extremely welcome and were encouraged to get involved in all aspects of the delivery process. The numerous midwifes, midwifery student, doctors and medical students were happy to teach us the art of delivery at Tu Du as well as immediate post-natal care for both mother and baby.
The overall experience has made us more confident in the practice of obstetrics and gynaecology and has also taught us much about the Vietnamese culture – we are very grateful to the Hoc Mai Foundation for this opportunity.