I grew up in Hanoi, the quiet capital of Vietnam, full of milk flowers in the fall and hardworking people all year round. Now I am an orthopaedic resident at the University of Iowa.
When Stuart L. Weinstein, MD, invited me to join him as an interpreter on his annual trip to Vietnam with the AAOS-VOA (Vietnamese Orthopaedic Association) Spinal Deformity program, I realized how much I missed my home. I had been back only three times since I left to study in the United States.
Since May 2009, Dr. Weinstein has been a part of the AAOS-VOA Visiting Faculty and Professional Development Program. The organized instructional course and teach-the-teachers training module led by American experts has provided critical support to Vietnamese orthopaedic surgeons.
The course takes a multifaceted approach to pediatric spinal deformity care. Each day started with surgery that was broadcast live so course attendees could observe it in the conference room. In the afternoons, half the time would be spent in lectures on topics ranging from pediatric spine conditions to surgical techniques and the other half of the time was spent seeing children with a wide range of spinal deformity conditions.
To prepare for the lectures before the trip, I looked through Dr. Weinstein’s translated presentations from the previous year’s course. I appreciated how much work the Vietnamese doctors had put into the translations. Even for someone like me, who grew up speaking Vietnamese but did my medical school training in English in the United States, completing the translation was difficult.
Although the Vietnamese doctors had translated every word in Dr. Weinstein’s lectures into Vietnamese, these literal translations sometimes missed main concepts. Many complex medical terms are not easy to translate. For example, with one simple phrase “positive straight leg raise,” a U.S.-trained physician can convey the physical exam finding as well as express the pathology and diagnosis. Any translation would have to capture the entire meaning.
Patient clinics were busy every day. To accommodate the attendees of the course and the large number of patients, clinics were held in an auditorium. Patients with the most challenging cases of spinal deformity came from all over the country; one patient even traveled from a nearby country. Many patients had advanced spinal deformities, far worse than is normally seen in the United States. This made surgical treatments much more challenging.
Patients also shared with me their psychosocial concerns associated with scoliosis. I remember talking to the mother of a 13-year-old girl with adolescent idiopathic scoliosis. The mother worried that her daughter’s curved back would affect her chances of finding a husband. A father was concerned that his son would not be able to handle the family farm.
The clinic was a grand educational opportunity for all the attending doctors. Patients understood the importance of this educational opportunity and were willing to compromise their privacy by being examined on stage so that everyone could see and learn about each case. The attendees were intently engaged with the discussions of each case and asked many thoughtful questions. It was an ideal learning experience for all.
Surgeries were “hot”
During the 5 days at Viet Duc Hospital (literally Vietnam-Germany Hospital), the largest level I hospital in the North, Dr. Weinstein worked tirelessly in the 90° weather. The operating room wasn’t air conditioned, so we took small breaks to cool off and change our scrubs as needed. Circulating nurses and the anesthesiologist happily wiped our foreheads throughout the surgeries to prevent contamination. People greeted us at the end of each day with fans and cold water.
All the staff were very accommodating and fun to work with. The limited equipment in Vietnam required people to be creative. Intraoperative fluoroscopy was not always available, so surgeons had to rely on their knowledge of spinal anatomy. Equipment that would be single-use and disposable in the United States was sterilized and reused in Vietnam.
Hanoi is much bigger now than it was when I left. Then, I was able to bicycle from one end of the city to the other. Today, people have to use motorcycles and cars to get around. The country’s economy has been growing fast and the medical system is finally catching up with patient demands. As a result, surgeons are seeking opportunities to learn about conditions they did not see a decade ago.
Implementing lessons learned
Over the past several years, Vietnamese surgeons picked up techniques from previous courses, and their surgical skills are rapidly advancing. Complex cases were presented by previous attendees who had treated the patients in the year following their course completion.
The surgeons from Viet Duc Hospital taught surgeons in smaller hospitals the techniques they had learned. Patient safety is being implemented with the “surgical time-out” used in each case. Grateful patients returned for follow-up care. Clearly, the AAOS-VOA program benefits the entire country.
Patients and doctors in Vietnam have a special bond. Patients put all their trust in their doctors without questioning. In fact, a Vietnamese saying compares good doctors to loving mothers: “Luong y nhu tu mau.” As a result, doctors usually take full responsibility for their patients. In addition, doctors in large hospitals seem to take on the responsibility of passing on their knowledge to their colleagues. They taught me much about hard work, perseverance, and overcoming obstacles.
The trip was an amazing opportunity for me to see the practice of medicine that inspired me to become a physician. The experience helped me appreciate the support of the international orthopaedic community. Through the AAOS, American experts have lent Vietnam much-needed support for advancing health care, and the impact is already clear.
Dr. Weinstein taught me to be patient with the language barrier and flexible with the environment and equipment (or lack thereof). The collaboration among the orthopaedic surgeons reminded me of the oath I took on my graduation day—a pledge to advance medicine and remain committed to patients, colleagues, and society.
With only one week in Vietnam, we simply were not able to provide care to everyone. The course, however, built a foundation for a movement of doctors teaching doctors with surgeons in leading centers coaching surgeons throughout the country. Vietnam still has to face many complex challenges in health care, but the hardworking surgeons I met convinced me that they are up to the task. This experience has inspired me, and I plan to continue to help my native country for the rest of my career.
Mai P. Nguyen, MD, is an orthopaedic resident at the University of Iowa Hospitals. She can be reached at email@example.com