I recently returned to volunteer in Vietnam for the first time in 13 years. On my first mission with One World Pediatric Care, I was still in nursing school, so I had limited clinical expertise, but being a native of Vietnam I was able to provide language skills and cultural knowledge to the team. I have fond memories of our team intro-ducing the Vietnamese doctors to Laparoscopy equipment and training them on its use. When we deprted, we left behind the Laparoscopy equipment. It was gratifying to return to Vietnam and find that Laparoscopy equipment is now readily available and in common use at Vietnamese hospitals and clinics.
This year, I joined a mission trip with Vietnam Health Clinic (VHC) from August 23-September 6. VHC is a student-led organization at the University of Washington dedicated to improving access to healthcare for underprivileged people in Vietnam, and recruits medical professionals to volunteer their services. I joined ten medical physicians, two doctors of dentistry, one ophthalmologist and two optometrists to accompany the approximately 40 student organizers visiting small villages in the Mekong Delta region of Vietnam.
In Vietnam, we traveled 2-3 hours by bus from Can Tho city to remote villages to provide care. Once in the villages, the student volunteers from VHC set up the mobile clinics; our mobile clinic was usually up and functioning an hour after we arrived. We set up different stations such as vital signs area, triage area, vision check, pharmacy, public health area and doctors’ offices.
We often served well over 300 poor and uneducated villagers in some six-plus hours of clinic work. To qualify for care at our clinics, a person’s income had to be below 400.000 dong, or about $18 a month. Many took the day off to access free health care but worried that without pay that day their family would not be able to buy food.
Upon presentation at the mobile clinic, the patient would register their chief complaint, have their vital signs taken, then be directed to triage – often to see me! After reviewing their complaints, I would occasionally send a villager directly to a physician for more immediate evaluation, often due to seriously elevated blood pressure. In general, our village patient populations were there with chronic complaints. After a medical consult and exam with one of our physicians, aided by student translators and recording “scribes”, the patient was directed to see dental and/or optometry for more specialty care. Finally, they would go to the pharmacy for their meds and instructions. For suspected TB concerns, we had a public health specialist available.
Most of our patients’ complaints included blurry vision, back pain, neck pain, wrist pain, hypertension, and diabetes. Other common complaints included sinusitis, cough, headache, and GI reflux. Back, neck, and wrist symptoms were usually caused by working with bad posture on farms year after year. Most patients who presented had a history of previous medical care, but did not fully understand their diagnoses, medications, and treatment plan.
Rather ominously, many patients presented with untreated blood pressure elevations- some systolic blood pressures were noted to be above 200. I asked them if they knew they were hypertensive. Some told me they were aware they had “pressure,” but were not taking anti-hypertensive medications regularly. Villagers reported only taking anti-hypertensive medications when they felt a headache or blurry vision (if they even had the medicine to do that). Some patients ran out of their medications, but did not have money to refill the prescription. A common story was that the local health practitioner would give them “five or six” pills to get started, and expect them to buy the rest. So we aided that situation, refilling their prescriptions when we could, for months instead of days or weeks.
When asked what kind of medications they were taking at home, a majority of the patients did not even know the name of their medications. When these patients had symptoms that needed to be treated, they went to the local pharmacy, the technician gave them medications, but they never know the name of these medications either. Further complicating the problem, many of these patients were illiterate.
Many patients complained of blurry vision. The majority of patients had never seen an eye doctor in their life. After receiving a vision check from a volunteer, each patient got a pair of reading glass for free. For many, this took care of these complaints in dramatic fashion. If their vision was worse than 20/60, or if they had symptoms of illness or injury, they were referred to one of the eye specialists. The villagers were so happy to be able to see well - some kept taking their new glasses on and off to check their vision. They had big smiles on their faces when they were able to see things that were blurry to them before wearing glasses, and I felt overwhelmed to see their smiles.
The tug on my heart to help more people made me want to stay longer. I think anyone who serves on a medical mission cannot help but be touched by the extreme need and gratitude of the people they serve.
Ed. note: a version of this blog post appeared in the Summer 2013 edition of the Mountain to Sound Chapter Newsletter of the American Association of Critical Care Nurses.