Carolyn Hope Smeltzer, RN, EdD, FAAN, FACHE
Recently I had the opportunity to visit Vietnam with a Loyola University-Chicago group. The purpose of the trip, organized for Loyola faculty and supporters, was to immerse ourselves in the culture, the values, the life, and the healthcare system of the Vietnamese people.
We observed and learned much on this international immersion through activities that touched on every aspect of Vietnamese life, including government, business, culture, their Catholic communities, educational values, and their healthcare system. We were very fortunate to have a Vietnamese history professor with us, as well as two theology professors, the Associate Provost for International Study, a teacher of English as a Second Language (ESL), and some political science professors. The President of Loyola University-Chicago was particularly instrumental in helping us understand how the University could help the Vietnamese government to develop medical school education, train nursing education leaders, and develop ESL programs. In addition, we were able to enjoy some of the lighter aspects of Vietnamese culture, also attending a private fashion show, shopping at the local markets, and viewing a water puppet show that explored Hanoi’s historical cultural folklore.
The setting of the hospital we visited was striking and will forever be in my memory. It was the orthopedic and trauma hospital in Ho Chi Min City. The hospital bed capacity was five hundred, but the average daily census well exceeded this capacity, sometimes reaching 700 occupants in a single day. The beds did not expand into the hallway as they do in the United States, but instead two or three patients shared the same bed in a small room that housed from six to eight beds.
This hospital was a five-story building surrounding a courtyard, with each level opening onto a large balcony. The hospital was accessible only by stairs and lacked a kitchen, which explained the numerous food stands that surrounded the area. Because the basic infrastructure of the hospital was to provide treatment, the families were responsible for the patient care. The families used the balcony as their waiting room in order to assist with care, comfort, nourishment, and basic hygiene of their inpatient relative. Like the patients and family, we climbed stairs to view all five levels of the hospital since there was only one tiny elevator, which I never saw, in the entire hospital.
Other aspects of the hospital surprised me. As American visitors, we were shown one of their most recent pieces of equipment, a bone density scanner. We were told it would be used for any female over the age of 68.5 years old (average life span for women in their country is only 72). When asked about the motivation behind this acquisition, one of the Vietnamese physicians conceded that Vietnamese women do not have a high incidence of low bone density and that the hospital did not have any treatment they could offer these women if the test results were negative. I wondered why they had this scanner, rather than other, more useful, medical equipment. How did they acquire it? Was it a gift, or did a salesman sell it to them? On the other hand, I was amazed on how inexpensive this procedure was in Vietnam. As opposed to our United States average cost of 365 dollars per test, this procedure costs the Vietnamese patient eight dollars in cash.
Teaching and research from other Asian countries is very important to the medical practitioners in Vietnam. That morning, we attended rounds, where x-rays of pre- and post-surgery were displayed on screens, along with a discussion of the patients’ prognoses. In addition, there were over eight visiting physicians from other Asian countries presenting their research findings on orthopedic conditions. They were on a journey to visit different medical centers and hospitals in Asia in order to share knowledge and new treatment discoveries. All types of healthcare disciplines attended the rounds, including doctors, nurses, dieticians, lab technicians and administrators. Although many of the sample studies were small, it was clear that there was roundness for sharing research findings and reviewing new methods of providing care.
When we exited medical rounds, I noticed almost all floors of the balcony had cloths lined with patients' laundry hanging from them. The laundry was done by the patient's family members and the hospital laundry was done by its staff. This was a visible display of keeping the environment clean by both the staff and family members. At times, it appeared chaotic to witness patients’ waiting for or receiving care/surgery, their families patiently supporting them, while healthcare staff conducted their routines. However, what appeared, at first glance, to be chaos was a very organized way of providing care that both the patients and the families understood and participated in together.
As we moved throughout the day from the tour to the government and business meetings, I was also struck by how larger issues of poverty contributed to the overall chaos at the hospital. We learned that day, and again in government and business meetings, that approximately 80% of all the orthopedic patients’ visits and surgeries were due to motorcycle (or scooter) accidents. These accidents overtax the healthcare system. Three or four individuals, usually a family, could be riding on a scooter. The roadway and infrastructure for the traffic in Vietnam has not been developed. The relationships between government, economics, roadway infrastructure, and healthcare became vividly clear. The quality and safety of the roads and roadway infrastructure have a direct effect on the overcrowding of the hospital.
Despite the many differences I noted, the challenges that the Vietnamese face in government, business, and healthcare are not that different from ours. They are equally concerned about quality of care, access to care, and the safety of the care provided. The government and business communities are searching for new partners and methodologies in order to become more internationally recognized for their medical science, curriculum, and education. They are looking for international partners that can jumpstart designing medical curriculums that will help to elevate the status of the physician within the country, as well as to increase the number of experienced and skilled nursing faculty so that they can export nurses both abroad and to the rural settings.
It is always easy to look at gaps or differences when in a foreign culture. Perhaps the most lasting memory of the trip was not reflective of the differences in the culture or the healthcare system, but rather the sameness of the caring. When touring the orthopedic hospital, one of the Loyola physicians participating in our tour was stopped by the distraught relative of a patient. She quickly identified herself as the mother of a two-year-old girl who was in surgery having her three fingers amputated. It was unclear what caused the little girl's injury, but the feelings of the mother's despair, the not wanting to be alone, and the need to have someone to talk to were clear.
Dr. Myles Sheen, a Jesuit Priest and physician in our group asked if she was Catholic. She said yes, (only 6% of the Vietnamese are Catholic). Dr. Sheen gave her a blessing, for which she wept and thanked him, as if her prayers had been answered. God was caring for her and her child. Dr. Sheen looked at me and said, "Mothers are the same in every country." Indeed, this trip revealed to me that despite differences in organization and resources, the desire to care for our loved ones is universal. Hopefully this collaboration will help bring the Vietnamese people one step closer towards making this a reality.
, RN, EdD, FAAN, FACHE, is a partner at Pricewaterhouse Coopers and on the Board of Regents of Loyola University Chicago and the Advocate Healthcare System. She is a national speaker and writer. Carolyn has co-authored three books, Ordinary People, Extraordinary Lives: The Stories of Nurses, Chicago Nurse Parade and Lake Geneva in Vintage Postcards. She also serves on the Advisory Committee of Hektoen's Nurses & the Humanities.