Dr. S Summer, an emergency room physician, worked at a clinic in the heart of Ho Chi Minh City:

The clinic hours were approximately 7:30-11:30 and 1:30-4:30 Monday – Saturday.  I did not work on Saturdays, and the afternoon clinic often had few patients so that might be optional. Viet Nam is a country where waiting around is part of life.  Bring materials to study and share for the quieter moments.  I practiced Vietnamese and helped my colleagues practice English during slow times.

Expect to be practicing general internal medicine and pediatrics.  Although the level of acute pathology was generally low, the level of chronic pathology was quite high.  Many patients had congenital problems, had suffered from malnutrition, had survived stroke, etc.  It was difficult to get privacy for a patient or to do more than a minimal physical exam.  The patients did not undress.

 I received very little orientation at the clinic. I did not recognize all the medication names, even after looking them up on the internet (some are regionally-used herbals).  But the staff is helpful if you ask.  If I could not find a medicine on their (very short) formulary to treat a particular condition, I could walk to the pharmacy and see what else they had. I could also use the local drug reference book (to the extent I could read it) and had brought a pocket reference of my own.  If I return I’ll bring my laptop (to look things up online from the clinic) or a better drug reference. If a patient’s condition was stable, sometimes the best bet was refilling the previous medications.

Ask the nurses for help using the charts.  It is helpful if you transcribe lab results and past medical history/treatment onto the chart for future doctors to reference.  The labs and imaging reports are kept by the patient and they do not always bring them back to the clinic.  The charts also cover a short time-span, so you often have quite incomplete information.  The nurses also can help you learn to order labs and tests.

Patients are often poorly aware of their prior medical history, medications and allergies.

Cultural aside: Ask if a woman is married before asking if she could be pregnant.  Assume that many of your female patients may be nuns, despite what they may be wearing.

Patients are usually given between a one and four week supply of medicines (two weeks is typical), even if they have stable chronic conditions.  Smaller doses are often used than I was used to, but often a larger number of types of medications were given.  Prescriptions for vitamins are also standard and usually expected.

Despite intensive study of Vietnamese before I came, the language barrier was my biggest problem, especially because some of the English-speaking staff moved on to other jobs.  Although I could ask questions in Vietnamese, I could not understand nuanced answers.  Request help from the other (mostly English-speaking) doctors and the ancillary staff as needed.  Bring lists of yes/no questions in Vietnamese.  Learn to say hello, goodbye, thank you, you’re welcome, take a deep breath, say “aah”, etc.!

The clinic has a few outreach clinics on the weekends.  This is very much like the clinic just at a higher speed with fewer tests.  Again, a limited formulary is available and only a short supply of medication can be provided, even for chronic conditions.  This was fascinating and interesting, so I was glad I went.  It was difficult to get information on whether or not we were going, what to bring, where we would stay, etc. I needed to think more like a Vietnamese person (no worries) and just assume I’d survive it.  But I was glad I packed a lot.  Ask questions, particularly of the clinic director and ELI coordinator before you go as well.

I attended 3 clinic meetings.  I gave lectures at two and sang at two.  Prepare songs in advance! (There is a saying in Viet Nam, it is better to sing often than to sing well.  They do not care if you cannot sing well or do not want to sing.  Just be ready, children’s songs are fine.)  I had my power-point presentations translated into Vietnamese by my friends, but I lectured in English.  This may have been my most important contribution when I was at the clinic.  Be prepared for this, too. 

Get to know your coworkers at the clinic, they will teach you a lot.  I generally found them to be very friendly, and the people I met (both the staff and patients) were the highlight of working there.