21 December 2016

Medicine in Vietnam

As mentioned in a previous post, I shattered my right knee in a motorcycle accident in the US on 01 October. To give his permission for me to come back to Vietnam to recuperate, the orthopedic surgeon who rebuilt it made me promise to keep ALL weight off it for a full three months—'til 01 January 2017. Today is my 80th consecutive day on crutches and I'm counting the minutes until I can again walk (okay, limp) again on my own two feet. It is also well into the third week of pretty significant pain in my right shoulder; pain that started, coincidentally, about the time the knee pain became manageable. I'm 99% sure that the shoulder pain is caused by the extra work it's had to do supporting me while I drag my ass around on crutches. The left shoulder hurts a little, but it's not getting nearly the workout.

Last Saturday I met with an exercise therapist who did a comprehensive evaluation and "assigned" me some exercises to help give both my knee and my shoulder a chance at strengthening and healing. Today, when she called to verify our next session this Friday, I told her that the pain in my shoulder is getting worse. It is now very hard to "walk" using the crutches. She suggested I go to a doctor or the local hospital to have a medical professional check it out. She's only been in Vietnam for two months, so she doesn't yet know how abysmal the medical practice is in general, and especially in a small-ish town like Da Lat.

When I told ViLa I wanted to go to the doctor, she was more than a little surprised because of my previous refusal to see a Vietnamese doctor for anything short of a coma. She called a friend who'd had some ortho work done locally and the friend gave her a strong recommendation for a doctor near the local hospital. We called a taxi and headed to the office.

Banks, most offices, and medical practices shut down—literally locking the doors—either between 11 and 1 or 11:30 and 1:30. I have no problem with that and after showing up a few times at locked doors, learned to look at the clock before I set out. We arrived at the doctor's office at 1:45 to find locked doors and no one answering the buzzer. At about 1:55 a woman pulled up on a motorbike and said that the doctor would not be there until 3 p.m. and that I should return then. So we did—after La called to verify that the doctor was actually in.

Upon arriving at the office, the doctor told us (he told La and she translated for me) that he did not treat Westerners.

If you're a Westerner, you're NOT welcome here!

La's friend had told her that this doctor is very good—most "doctors" here wouldn't qualify as valet parkers in the west—so I asked her to push for a further explanation. The doctor then said that the government would "take away my medical license if I treat Westerners."


I am in enough pain that there is no room for any thoughts other than "STOP THE PAIN!" Under any circumstances I would have a hard time believing that even a non-democratic government (coming soon to a super power near you) would mandate such a thing. My initial reaction is that he's lying and there is another reason he wouldn't see me, possibly racism. When I'm in great pain it's very, very difficult for me to see the best in people who are consciously extending the time during which I am in pain.

The doctor suggested that we go to the hospital 100 meters up the road and, even though it's the public hospital I swore I'd never go back to, my pain level was such that I didn't want to endure a 20 minute ride to the only private hospital in town. So we called for the cab and headed up the hill.

Sorry I don't have any more photos; my phone battery died and I was in too much pain to think about taking them. Now I wish I'd borrowed ViLa's phone to do so, especially of the hospital paperwork.
EVERYTHING in Vietnamese medical "care" is pay-as-you-go. Literally. There may be an exception made if you are bleeding out in the emergency room, though I wouldn't bet the farm on it.

Upon our arrival at the hospital, ViLa pointed to a row of hard plastic chairs and said "sit down, please". So I did. She then went to the front desk to get the first piece of paper (cost 8,000 VND, about 32 cents US). This paper allowed her to go upstairs (it's all stairs, I've never seen an elevator in this hospital—if you're in a wheelchair and alone, you're in trouble), pay about US$1 for another slip of paper telling the doctor you've paid and it's okay for him (almost always a him) to talk with you. About five minutes later, she's back downstairs and across the hall we go (no waiting) to see the doctor.

The doctor looks at the paper, and without a word starts poking and grabbing at my shoulder. I point to where the pain is and say "dow", which is my version of the Vietnamese word for pain. I'm sure my pronunciation is wrong, but he gets the idea. He then tries to stick his hands inside the collar of my shirt to grab my shoulder and I barely win the race to unbutton it far enough before he rips it.

He then talks with La for a bit before sitting down at the computer to type out my next piece of paper; permission for an x-ray. While La heads back upstairs to pay 50,000 VND (~US$2) for the x-ray, I get a head-start hobbling down the hall to the X-ray Department. I overshot it because "x-ray" in Vietnamese is "x quang" and I was too stoopid to remember that. I've seen it enough that I certainly should! At a minimum, the "X" in front of another word should've at least given me pause...

By the time ViLa caught up with me, I had overshot the branch hallway I needed by at least 50 feet. That gave me the opportunity to go about 60 crutch-steps round trip extra just for fun, using a shoulder that is injured BECAUSE OF THE F*CKING CRUTCHES.


At this point I still have another 80-90 feet to go to x quang followed by more than 300 feet back to the doctor and my shoulder is on fire! Seeing this, ViLa asks a nurse sitting behind a glass partition if I can use one of their wheelchairs. The nurse says that the wheelchairs are only for emergencies (that's Vietnamese for "NO!"), so I hobble away down the hall past a woman in a wheelchair who is not bleeding out. When we get to the x-ray department, the technician points to the proper door for me and La heads off to find a wheelchair. By the time I get the x-ray film (Da Lat does not yet have digital x-rays), La's back with a wheelchair. I was very happy to ride back to the doctor's office. I didn't see anyone crawling down the hallway, so I'm pretty sure she got an empty one from the ER.

The doctor looks at the x-ray and says that I need an MRI. No problem; write it up and let's go...

This is when we entered the Twilight Zone.

They have an MRI in the hospital, BUT "it's so old that it's no good for shoulders or hips... only knees, elbows, and backs."

I know I'm repeating myself, but WTF???

Refusing to take the first no for an answer, I push back—NOT something done in polite Vietnamese society—causing ViLa embarrassment AND proving myself a barbarian. The doctor says (remember that ViLa's translating for us and, in the case of my words, I'm sure she's also editing) that he will not send me back down the hall for an MRI because it won't be usable.

I ask if we can get one at Hoàn Mỹ, the private hospital 25 minutes away. Of course not! They don't have an MRI machine. He then says that we can get a good MRI in Saigon like it's just down the road instead of a 7-hour drive away. So, for now, I won't be getting the needed MRI.

He (the doctor) then gives me a prescription for three different pills. They are, according to on-line medical resources, an anti-spasmodic (I haven't yet had muscle spasms), a pancreatic enzyme used for cataracts and removal of dead tissue (I have neither), and an anti-inflammatory (okay, this one I can probably use). The good news is that five days' worth of the three only cost 104,000 VND (~US$5). The better news is that I only took two doses before checking to see what they are and throwing 2/3 of them away. What I was thinking when I took prescribed medicine without knowing what it was, I cannot tell you. Maybe the pain is making me stupid(er)?

Before the shoulder started hurting, I wasn't doing very much moving around. Now that it is hurting, I'm doing even less. Only 10 more days until I can limp around on my own and let the shoulder start healing :-D

Today's experience, added to other recent and more personal challenges that I may write about later, has me seriously reconsidering how much longer I'll be in Vietnam.

What happens if I go down hard and can't be immediately transported to where there is competent medical care? Global Rescue is only gonna save me if I can travel—in a medical jet if need-be. If I can't, I'm toast.

Would anyone like to guess as to when I'll next visit a Vietnamese doctor?

1 comment:

  1. Take a medical holiday to Thailand. They have excellent doctors.