Paediatric surgery in Hanoi – Hoc Mai Foundation scholarship
Catherine Pham – 200307701
As a recipient of a Hoc Mai Foundation scholarship, I was fortunate enough to be able to
spend four weeks of my Elective Term at the National Hospital of Paediatrics (NHP) in Hanoi.
My time was primarily spent with the surgical department, however I did have the chance to
visit other departments around the hospital to gain a deeper insight into medical practice in
Viet Nam. This leg of my elective ran from July 20th to August 14th 2009, that is, during the
Hanoian summer.
The first day of my elective almost didn’t happen, as I had woken up to the breath-taking
sight of Hanoi’s streets under water, transformed overnight into canals. I was so exhausted
from the flights the previous day that I had slept through the entire torrential downpour, so
you can imagine my surprise when I peered out the window! For the next few weeks, I
would come to remember that morning with a sense of serenity, as the streets of Hanoi had
never been quieter. Determined to make it on time for my first day at the hospital, I waited
restlessly for the water to subside a little before summoning a taxi to take me over to the
hospital, which is located about twenty-five minutes west of the Old Quarter. After wading
knee-high through the murky brown water to two successive taxis that both turned me
away, I decided to call the hospital’s director and my supervisor, Professor Nguyen Thanh
Liem. This first encounter with Professor Liem gave me some insight into the great
determination that he, and many other Vietnamese people, have. While I was ready to
throw in the towel and sit out the flood in my hotel room, Professor Liem brushed aside that
notion and suggested that I take a motorbike (xe om), or catch a bus (xe buyt), or wait an
hour and try a taxi again. Long story (sort of) short(er), I eventually got to the hospital after
lunch only to be denied entry by the guards who take visiting hours very seriously. As I had
just battled my first flood to get there, I wasn’t going to be turned away, so I stubbornly
stood my ground and weakened the phalanx. Well, maybe it wasn’t as dramatic as that, but
the guards let me through and we became friends thereafter.
The National Hospital of Paediatrics was established in 1969 and is the leading centre of
paediatric care in Viet Nam. Each year approximately 40 000 inpatients and 350 000
outpatients come through the gates of the hospital, which comprises a large number of
treating departments. These include neurology, respiratory diseases, malnutrition,
oncology, nephrology, cardiology, gastroenterology, surgery, neonatology, intensive care,
emergency, infectious diseases, psychiatry, traditional East Asian medicine and
physiotherapy rehabilitation. The surgical department is the pride of the hospital,
performing about 6000 major surgical operations each year and boasting a number of
world-first laparoscopic techniques.
The surgical department surprised me in terms of its standards, practices and equipment.
While I was expecting cramped operating rooms with no air-conditioning and open
windows, a scarcity of staff and resources, and an inability to effectively practice aseptic
techniques, I was greeted instead by plasma televisions, laparoscopic gadgets, stringent
scrubbing techniques and a team of doctors and nurses who took their craft very seriously.
While it was not possible to maintain the desired standards at all times, for instance when
there was a fly freely landing on the greens during one open heart surgery, I could feel the
sense of pride in the team of their pursuit for world-class surgical practice. This was
particularly highlighted on one occasion when Professor Liem was at the helm performing a
world-first laparoscopic repair of a patent ductus arteriosus in a neonate under high
frequency oscillating ventilation. The tiny room was packed with doctors, nurses, a
television crew and journalist, all full of nervous excitement and suspense until the
procedure was completed to cheers of elation and congratulations. Professor Liem was
emphatically telling the media, “This is a world first! Not just the first in Viet Nam, but the
first in the world!” Within minutes the room cleared and everyone went back to business.
The French medical student, an anaesthetist and I were the only ones left in the room,
watching the delicate baby girl struggling to breathe with her oxygen saturation falling to
the seventies. She stabilised over the next few days, and was battling on to live a life that
she might not otherwise have had if Professor Liem had not been such a determined and
pioneering man.
The corridor outside the surgical department was always lined on both sides with patients
and their parents, sitting or lying on the floor nervously awaiting their turn to enter the
mysterious abyss. It was no wonder that I saw so many operations during my time there,
many of which I may never see again in my life. Conditions included congenital
diaphragmatic hernias, hirshsprung’s disease, enormous teratomas, gastrochisis,
choledochal cysts, undescended testes, hyperhidrosis, hypospadius, pectus excavatum,
oesophageal atresia, and a never-ending stream of congenital heart defects. I savoured the
opportunities to scrub in and assist with doctors like Drs Hien and Hau who were very
encouraging and eager to teach. However, the surgical department did seem to
accommodate an excess of keen young doctors, local and visiting, and so these chances
really were rather few. Nonetheless, most of the procedures were explained to me either in
Vietnamese or English. As many of the procedures were performed laparoscopically, it was
often best to just watch the screen anyway.
Many of the doctors at the NHP could speak English very well and they were often
encouraged to communicate with each other in English during surgery (but only when
Professor Liem was around). This was a great point, because while I can speak a feeble form
of Vietnamese, my grasp on the language is not so steady as to solidly understand all
medical explanations. However, I was aware that I looked like everyone else (identifiable
mainly by my bright green crocs) but my use of English in theatres isolated half of the room
from the conversation. I became more reluctant to speak in English and just left some
questions unanswered. My persistent attempts to speak Vietnamese did seem to win the
favour of the staff there though and many of them used the opportunity to practice their
English with me, to get translations or just to have a chat and ask me about my life in
Australia. They took me under their wings and made me feel very much a part of the group,
even trying to marry me off to all of the single doctors there.
I must say that in the operating rooms I felt somewhat sheltered from the real struggles of
the Vietnamese people with the lack of health care services available. In theatre the patient
is carried in, swiftly sedated, operated on and set in the corner of the room to recover while
the next patient is brought in. I didn’t see many of the day-to-day hardships that they and
their parents have to endure to even get to the hospital, let alone stay there. For this
reason I spent one week visiting different departments in the hospital and caught a glimpse
of the hospital experiences of numerous children. I spent a few days in intensive care,
which was fantastic, as I got to see many of the patients that had been operated on a few
days after their surgery. While it is heartening to see some children recovering well, it will
always be hard to look over a baby who is limp and lifeless, or as they struggle for every
breath. It is unimaginable how it must feel for the parents, some of whom are not allowed
to see their children for the duration of their stay, for fear of infections.
It seemed that the further you walked away from the operating rooms, the more the
developing world caught up with you in the hospital. The neonatology unit was
indescribably overflowing. Premature babies lay in plastic cribs lining every wall of the
building. There were two or three babies in each crib, with ten or so cribs in each room.
Each room was monitored by one doctor and a couple of nurses. It was interesting to me to
see that the babies were all labelled with just a strip of tape on their foreheads with their
names written on it. Considering that some of the babies were almost scratching their
neighbour’s face off, it made me question if babies were ever sent home to the wrong
parents. For shorter visits I went and saw some interventional radiology where doctors
were smoking in the rooms, the respiratory department and the cardiology department.
The respiratory and cardiology departments were a real eye-opener. They were more like
what I expected to see before coming to Viet Nam. Patients here were being nursed by
their mothers or fathers or grandparents, with almost no staff in sight. They lay in humid
rooms with barely any space between the rusty-framed beds lined only with a bamboo mat.
There appeared to be just three squat toilets available to the entire ward of several dozen
patients. Even so, not a single person was complaining. I guess they know that there are so
many sick children out there who can never be offered a bed, as meagre as it is. Oh, and
there is no such thing as privacy or confidentiality anywhere in the hospital.
Now for some practical points that might be of value. Take photos early on! Don’t leave it
until the last few days as you never know when you might get really sick from a suspicious
meal of brain, intestines, heart, liver, kidneys, testes and other unidentifiable parts of
unknown animals (which may or may not have left me in bed for two days feeling like I was
going to die). Try to find a supervisor on the ground as soon as you can. You don’t have to
stay with them the whole time, but it helps to get you started and settled. Attend morning
meetings at the hospital on Tuesdays, Wednesdays and Thursdays at 8 am. They’re usually
short medical case presentations in English, unless Professor Liem isn’t there, in which case
they will revert back to Vietnamese. Try not to get a hotel within metres of the train tracks,
it will drive you to the edge of sanity. However, the hotel did belong to my second-cousin’s
wife’s parents who welcomed me like family, so I am eternally grateful to them for that. It’s
best to stay near the Old Quarter of Hanoi and take a taxi, motorbike or bus to the hospital,
as there is a lot more to do, see and eat over there. I was driven on the back of my secondcousin’s wife’s brother’s bike every morning and it was awesome. I don’t recommend long
bike rides in the afternoon though, particularly if you enjoy breathing. A travelling buddy
would also have been useful.
All in all, this was an incredible opportunity for me to experience medicine in the country
where my parents come from. The hospitality of the doctors, nurses, cleaners, guards and
everyone else in between was unforgettable. I would particularly like to thank Professor
Liem, Drs Duong, Thuan, Hau, Hien, Lieu, Huong, Hang, and nurses Thao, Lan, Sang, Hong
and Dung for taking care of me. Finally, I must thank the Hoc Mai Foundation for generously
offering me this chance to see medicine in a whole new light.