Vietnam

The Story of Lan

Tue, 17 Apr 2007 00:00:00 +0300

Lan is an 11 year old girl, member of the Black H'mong people. The Black
H'mong are a tribe of people that live in the highlands of northern Vietnam
near a town called Sa Pa, which we visited this last weekend.

The weekend was an absolutely fabulous weekend. The mountainous scenery is unique in that the mountainsides are terraced for agricultural purposes -
rice and corn are the main crops. It makes for a spectacular sight,
especially under a blue sky and sun, which we rarely see in polluted Hanoi.
We had the chance to do some hiking at a leisurely pace - about 25 km in
three days - that took us through many villages of the Black H'mong, as well
as the Red Dzao, and Dzay people. For my fellow Juneauites, I imagined this
to be like visiting the villages of southeast Alaska's native tribes. The
houses, however were mostly built from bamboo, and were more like huts with
common sleeping areas, a "kitchen" which was more like space for a campfire
sort of near a door, a common dining room, and some storage area. Often
there is no electricity - in fact one village had only a failed electrical
plant nearby. I'll leave the bathrooms to your imagination.

Again, Lan is an 11 year old Black H'mong. She falls in the middle of 5
other siblings. As most young female Black H'mong who are capable of
walking do, Lan hiked with us from Sa Pa to the Lao Cai village (her home)
while her parents and brothers stayed home to prepare the rice fields for
the upcoming harvest. Everyday, often including school days, these girls
will wake early to make the trek to Sa Pa (about 10km) so that they can then
return to their village with the tourists. These girls have learned English
solely from interactions with tourists (they only learn Vietnamese in
school, which is different than their native language), which is quite
impressive given that they are capable of having full conversations with us.
Their purpose in walking with us, was in the hopes of selling their many
handicrafts along the way. They make everything from pillowcases and hand
bags to jewelry to blankets and more. Their hands are often stained blue
from the indigo they use to dye not only their handicrafts, but their own
native dress (I'll have to send pics).

As a tourist, the battle is to buy enough to show an appreciation for their
culture and their hospitality, but also to be able to say "no!". I've never
met any salespeople as persistent as these girls and women. "You buy from
me," they say. And in response to a "no thank you" they mimic, "no thank
you" in their sweet soft voices. You say, "I've bought enough" and they
say, "Oh! enough! Come on, you buy from me." You say, "No thank you, I
don't need anymore," and they say, "Why not?!" And I could go on for hours.
Literally, hours. Really, a peaceful moment without an offer or demand to
buy something, was valuable and rare time!

Also problematic to us was the fact that those children who bring home lots
of money from their sales often stop going to school because their families
are so poor that their parents would rather send them out to make money than
to school to learn! We also visited some of their schools. Very small
classrooms, made of bamboo, often with two classes in one room. In the
summers the days are very hot and in the winters, very cold, which does not
make for ideal lessons. We did visit a school made of concrete, the funds
for which were donated by a Japanese organization. Our guide said that one
of the best things we could do, should we return, would be to bring
notebooks, pencils, and various school supplies. I wish we had known!

So Lan followed us all the way from Sa Pa to Lao Cai and patiently waited
for us to finish lunch before she asked - no, sweetly stated, "You buy
something from me." Knowing that I had two more days of this to endure,
that I had already bought some pillowcases from a host family the day
before, and not wanting to encourage her dropping out of school, I decided
to hold off until we reached our homestay. As it turns out, we were hosted
by a Dzai family, which is unique among the Black H'mong and Red Dzao in
that that do not have a "uniform" nor do they sell handicrafts. Their
livelihood rests solely on their crop, which in the highlands is only a one
time per year affair (as for Black H'mong and Red Dzao), and the measley
20,000 dong per person (=to roughly $1.25 US) they are paid for allowing us
to stay in their home. We paid $75 for our 4 night/3 day trip, and only
$1.25 went to them (granted the food was provided by the tour company).
Since there was nothing we could buy, most of us gave them a tip. My
measley 50,000 dong really isn't much, but they were so grateful.

For fear this email has already dragged on too long, I won't say much more
about our visit. I am glad we chose this experience over a weekend in
Bangkok as it was truly a once in a lifetime opportunity to visit such an
extraordinary place. Besides, I think Bangkok needs more than 3 days!

Back at the hospital, Jenny and I are continuing our english lessons and our
daily struggle to figure out why people do the things they do. Today we saw
subcutaneous emphysema (air just under the skin that feels and sounds like
squishing rice krispies) in a 2 year old, which in her case was most
concerning for a pneumothorax (collapsed lung) caused by mechanical
ventilation of her lungs. Of course, we still don't know the answer because
when we left 5 hours later, she still didn't have a chest xray! Thankfully,
she was stable, but I'm concerned she may not stay that way if she really
does have a pneumothorax. The physicians may well have a reason for
managing her the way they did, but the frustrating part is we couldn't get
that reason from them.

So this is it from Vietnam. We have to write a "medical report" describing
our experiences, infection control in the ED, inventory, and patient flow,
but I PROMISE I won't bombard your email boxes with that. I just wanted you
to know we actually do have to produce something related to our medical
experiences :) And we're headed back to the states tomorrow night!!!

I hope you are all well.

Love,
Caroline

Happy Easter, Happy Passover!

Sun, 8 Apr 2007 00:00:00 +0300

Hello All!

It wasn't a very traditional Easter for us over here in Vietnam. In fact,
we were in Halong Bay with a healthy sized group of westerners and we all
forgot it was Easter until about lunch time! I was hoping we'd get back to
Hanoi in time for me to walk over to St. Joseph's Cathedral and at least see
a church on Easter, but we got back late and were starving.

We had a great trip to Halong Bay, but are still bitter about the fact that
we got ripped off b/c we paid for things we didn't get - like a "nicer boat"
and more "meal options" and sleeping on the boat. We have to go back to the
travel agency tomorrow and see if we can get money back for the things they
failed to deliver. We'll see how that goes as everybody here seems to go out
of their way to get more money out of Western tourists. It was the topic of
much conversation this weekend that it's impossible to get around being
ripped off b/c everybody has a "western price" and a "Vietnamese price" for
things and even if you bargain, it's nearly impossible to get the locals
price. There's a common attitude that because we're from the west and
because we've traveled here, we have money. As a matter of principle, it's
hard to swallow that everywhere we go - restaurants, stores, tours, or just
buying something off the street - we pay more, even after bargaining. But
often it's just a matter of a dollar or two and so you take a deep breath
and move on....sort of.

We otherwise had a fantastic trip to Halong Bay. The limestone caves were
unlike anything I've seen before. The funny thing was that the caves are
illuminated with bright pink, purple, green, and yellow lights. If they'd
had a strobe light we would have thought we were in a discoteque or rave
party! We had a really fun group from all over - Australia, Germany,
England, New Zealand, Oregon, and Quebec City. We overnighted in a hotel on Cat Ba island, which is a national park. Today we went trekking in the park
and it was probably some of the most technically challenging hiking, at
least within a 2 hr time period, I've ever done. We hiked a couple of peaks
and got some great pics! Some actually did it in flip flops and I can't
imagine how and really consider them quite lucky to have made it back down
from the top!

After our hike and after lunch at the hotel, Jenny and I rented a motorbike
and drove around the island. After Jack and I rented mopeds in Roche Harbor
after our wedding last summer and had to sign our lives away followed by a
20 minute instruction period, it was interesting that some random guy just
handed over the motorbike and keys, showed us the start button, the clutch,
and the breaks and we were off. Oh, there are no helmets, of course. We
fared pretty well after Jenny almost drove us into a ditch and except the
one time the motorbike became possessed and dragged me and two other guys
into a wall and some boxes. But that was entirely the bike's own doing, of
course :)

So after a nice sail back to Halong City from the island with a different
group (most of our original group stayed another night), we arrived to have
the guide tell us that somebody else was going to come pick us up. He says
this as the rest of the group is climbing into the van. When we demanded to
know when and who and a phone number, he of course knew nothing. And after
much debate, and him telling us to just take the city bus, we crammed the
three of us (me, Jenny, and our friend Julia from Germany) into the bus. I
sat more than half the ride sitting on this stupid little blue stool on the
floor of the van. We tried to talk him into a taxi, but decided in the end
that cramming into a bus we knew was going to Hanoi was better than riding
the city bus he'd originally suggested.

In case you were wondering, we really are still working. The ED was
somewhat slow in the mornings last week. For those of you interested in the
medical stuff - we did see a 2 yr old with Tetralogy of Fallot! He even had
the boot shaped heart on chest xray. Poor little guy was waiting for a
cards and surgery consult. We'll hopefully get an update on him when we go
in tomorrow.

That's all for now. I hope all of you had a nice relaxing weekend.

Love, Caroline

More from Vietnam

Thu, 5 Apr 2007 00:00:00 +0300

Hey All!

So the last week in Vietnam has proven to be more fun and lots of
interesting.

So I've learned the generosity of the Vietnamese people is beyond what I
ever could have imagined. Jenny and I went to Haiphong with the Dao's and
met almost the entire family, which includes 8 siblings on Mr. Dao's side
and 4 on Mrs. Dao's side, not to mention friends. It was quite an ordeal as
you might imagine! Everyone was so welcoming, and they all loved to laugh
everytime we'd say "Chow Ba" (a Vietnamese greeting) or "Cam urn" (thank
you), no doubt because our pronunciation was wrong or because we used the
wrong tone with the word "ba". Nonetheless, we ate dinner at the family's
restaurant one night, we were taken cruising on motorbikes out toward the
beach afterward, and were fortunate enough to share in the experience of
going to the Dao's parents' grave with the entire family. More on that in a
minute. The second night we ate dinner at a friend of the Dao's house. It
was probably the best Vietnamese meal we have had thus far and it was a
feast! The owner of this home invited us to his art gallery the next
morning and insisted that we take a painting of our choosing for free! And
if we paid, he said he and Mr Dao would no longer be friends. So you can
see how generous everyone has been with us, not to mention that we were not
allowed to pay for a single thing the entire weekend (and we tried!). The
paying issue is really a cultural thing - it's kind of an insult to one's
manliness to let a woman pay - but even so, the generosity is overwhelming!

Interestingly, as warm and as welcoming the Vietnamese people have been with
us, there is a cold, emotionally distant aspect to their interactions with
one another. For example, while we were in Haiphong, Mr Dao's brother in
law died. We don't know exactly what from because nobody mentioned it
except after we went to visit the widowed sister! And even then it was very
matter of fact, "Her husband died yesterday." And that was it. At the
hospital, we have noticed that the physicians and nurses rarely explain
anything to the parents about their child's condition. They might intubate
with barely a word to the parents. While in the cafeteria eating lunch
yesterday, a worried father approached us, knowing that we were working in
the ED, and asked if we had information on his preemie newborn. He
explained he did not understand what was going on and was very very worried.
SO you can see it is an interesting contrast between their hospitality and
their every day interactions with each other.

I wanted to share about our trip to the cemetary with the family as well.
In Vietnamese culture, it is believed that when the body dies, the spirit
lives on. The spirit has the same need for nutrition and vital goods that
we do here on earth, and so they bring food, "money", a paper-mache (sp?)
like horse for transportation, flowers, and incense to the grave. They
place all of these things on the beautiful marble vault that houses their
bones (the body's are held at a separate place for three years after death,
their bones collected, and moved to the cemetary where all those from
Haiphong are buried). AFter lighting the incense and speaking with and
praying with the parents, all of the material things are burned b/c it is
believed this is the only way the spirits have access to these things they
need.

So that should probably be it for now! Jenny and I are going to Halong Bay
this weekend. It should be lots of fun and will include visiting limestone
caves, kayaking, sleeping on the boat, and trekking in Cat Ba National Park.
Apparently, there is a cave there called hospital cave, which served as a
safe hospital while they were bombed during the war. After work today, we
will go to the Museum of Ethnology. So we are keeping ourselves busy!

Take care everybody. I hope all is well-
Caroline

Blue babies, sweat lodges, and the opera house

Sat, 31 Mar 2007 00:00:00 +0300

Hey everyone!

I wish I could tell you about every second of my life here in Hanoi, but I"m
afraid I might bore you. SO, instead I will share just a few of my
experiences.

On Friday at the hospital, there were lots of sick sick little kids. One in
particular was given a diagnosis of bronchiolitis when we first saw him in
the AM. Over the course of the next few hours as more and more kids were
streaming in with their moms, Jenny and I noticed that the little guy with
bronchiolitis was looking blue. We kept waiting for one of the doctors to
notice or for one of the nurses or even the mom to say something and no one
ever checked up on the baby. Finally I asked Lan, who is the equivalent of
a resident in the U.S. training system, about labs for the baby. This
prompted her to go look at the baby and realize it really was blue. Then
the attending came over and they all decided the baby needed to be
intubated, but not after asking Jenny what she thought. We're really hoping
that he was asking as a teaching point and not b/c he really values our
opinions, but it's hard to tell with the language barrier. Also, we'd like
to think that they were planning on intubating the baby anyway, but there is
a very lax attitude about things in the ED. In the afternoons, when we
teach english, most of the doctors and nurses are in the conference room
with us and we're not really sure who's doing what in the ED! Kind of
scary...

Today we went to perfume pagoda. This time of year, many buddhists
pilgrimage there to essentially "forgive their sins" (in Catholic terms) and
it was not at all what I expected. We took a beautiful ride in a huge
canoe, paddled by the locals, into the mountains. That was very nice. When
we got there, though, the stone path up to the top (about 5km hike) was
jammed packed with tourists and locals, along with stands along both sides
all the way to the top. There were dead animals (yes including dogs) both
skinned and furry, hanging, waiting to be roasted. It smelled funny and
people were really pushy. Three different people wacked me on the arm to
get my attention to demand money from me. Probably the worst was that it
was so hot and humid that I am pretty sure the only other time I've sweat
that much was in the sweat lodge with Piper at Middlebury. It was similar
also in that I'm glad I did it, but pretty sure I won't do it again.

Last thing is, Jenny and I went to the opera house tonight for a benefit
concert for a relief organization for children with disabilities. It was a
Vietnamese-American pianist from Boston playing Chopin. It was great. We
got all done up in our dresses, rode on a motorbike taxi over to the venue,
and had dinner at new restaurant across the street. Funny thing is that our
"fancy" dinner before the show was pizza and cost less than $10! It was
probably the worst restaurant pizza I've ever had, but it still tasted so
good!

Ok, that's it for now.

Caroline

Hello from Vietnam!

Thu, 29 Mar 2007 00:00:00 +0200

Hello to everybody-

I'm just passing on a few fun things about our time in Hanoi so far.

So we've spent one morning "working" (which really means shadowing and
translating) in the ED and in that one morning we saw a whopping four
patients. The interesting thing is that of those four kids, they were all
very sick. We saw one pneumonia, an incarcerated inguinal hernia requiring
surgery, an epidural hematoma, and something else I'm forgetting right now.
Apparently, today was a slow day. We taught english to the nurses and
doctors this afternoon for two hours.

Motorbike traffic here is absolutely insane. It's like running into a swarm
of flies everywhere you go. And interestingly, NO ONE wears helmets. In
fact, the little girl we saw this morning with an epidural hematoma
(bleeding in the brain) is from being "attacked" by a motorbike. She is
doing great, thankfully, and will be fine.

Jenny and I bought tickets (whopping $12) to watch a Vietnamese-American
pianist play at the beautiful Opera House here in town on Saturday night.
Should be fun.

Oh, this is a good one. I payed about 60 cents for 30 days worth of
doxycycline (antibiotic) for malaria prophylaxis. Sixty cents! I feel like
I'm stealing. I'm glad I didn't pay for it back in the states. Of course I
did buy it from a rackety shack on the street - but that's how ALL their
pharmacies are and this one was right outside the hospital. Don't worry
Mom, it'll be fine :)

I think that's about it for now. I have some wine and a shower waiting for
me upstairs before dinner.

Love you all-
Caroline