Uneasy bedfellows

April 15, 2011 - Ha Noi, Vietnam

Thank you to everyone who's made comments- it's been really heartening to hear from loved ones, even thousands of miles away!

I look back on when I naively described the cramped conditions and lack of resources in the Emergency Department in the hospital, and I laugh. Today is my second day in the Infectious Diseases department, and it has been what the English reservedly refer to as "an experience". Bearing in mind that the diseases in this department are by definition "infectious", you can imagine what my reaction was when I saw the tiny, unventilated rooms, with two patients per (also tiny) bed, top to tail, and in some of the female wards up to 3 patients in a bed. This wasn't including the relatives who were perched atop the bed too. I also use the term "bed" relatively generously, since the beds were metal frames with a board on top of which were spread rattan mats. Some of the patients had pillows, but more often than not it would be a jumper rolled up, or a relative's lap. DVT prophylaxis took the form of relatives massaging legs, not a TED stocking in sight. This department serves as the tertiary centre for ID in the area, so I honestly hadn't expected such basic facilities. Before I'm accused of being overly critical, I should say that the doctors were the first to admit the shortcomings of their own wards. Clearly poor hospital conditions are not a reality reserved solely for places like Africa...

Hospital-acquired infections are rife, and a bid to minimise this was to group diseases together; so the HIV patients sharing a bed, the Hepatitis patients altogether in a ward (rows and rows of bright yellow people in the "Liver Room") etc. Not always the case. Unsurprisingly, the patients (especially the HIV patients, who are particularly susceptible to catching nasties) were a bit nervy, kept as far away from each other as possible, and everyone wore masks.

The nascent immunisation programme in Vietnam has not managed to protect some of the older members of the population, so I have seen my first cases of Rubella in this hospital, something I have yet to see in the UK. Every other patient has TB, and HIV testing is compulsory (nothing like patient autonomy here!) since its incidence is rocketting upwards. It's very common for men to have unprotected extramarital sex with sex workers; they contract the disease then pass it on to their wives. Education about sexual health etc is non-existent, not even in schools, since the subject of sex is "too sensitive". Oh dear.

In the "HIV room", there were 6 patients for 3 beds, one with his face utterly stripped of outer skin, raw and angry-looking- Stephen-Johnson Syndrome, lying alongside another completely covered in brown papules with necrotic cores- Penicilliosis marneffei, an opportunistic fungal infection, looking very sorry for himself. I'd never seen it before, but apparently very common in Vietnam, whereas Kaposi's Sarcoma is almost unheard of. The majority of patients are male in hospital; since patients need to pay for treatment, apparently it is of more benefit for the family to treat their men. I won't say any more about what I think about the glaring inequalities in this country, I'll just be very grateful I am allowed a say at all in the UK...

If you were to ask the doctors what they are most worried about, they would say cholera. With such a huge population, the majority of which has densely packed itself into small urban areas, it spreads like wildfire, and there have been epidemics already. Patients still occasionally come in with Avian and Swine flu, but this isn't nearly as big a concern.

Wow. That was all very serious. It has been an interesting few days, if not horrifying. Last night I had the worst meal I've had since I've been here. It said "chicken" on the menu, however most of it neither looked, nor tasted of chicken. I suspect it may have been dog. If I were to be positive about this, I would say that at least I can cross dogmeat off my list of "funky foods to try before you die". The negative part of me picked out the vegetables to eat and left it at that!


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