A veteran returns to care for the poor and help train Vietnamese doctors.
For each of the past six years, I've spent two weeks in Vietnam, teaching critical care to the physicians at Hanoi's Bach Mai Hospital. It's brought me a great deal of satisfaction. But because of the SARS epidemic, which had already reached a nearby hospital, I was rather glad to leave the country when my stint was up last March.
I was also glad to know that the Vietnamese physicians I'd left behind were as prepared as they could be to deal with SARS. Thanks to funds from American foundations and other sources, they had state-of-the-art ventilators designed to function in tropical climates. A number of the physicians had also received training in respiratory therapy in the United States.
When I'd brought over the first modern ventilators to replace the less efficient Russian and Japanese models at Bach Mai, we used one immediately for a young man who'd stopped breathing, paralyzed by a cobra bite. We kept him on the ventilator until the neurotoxin dissipated, and he survived.
When a transcutaneous pacemaker arrived last year, we were able to save a young boy who'd developed third degree heart block after eating 15 toad livers. (There are bufotoxins in the toad skins.) The pacemaker has been used many, many times since.
I came to care about the Vietnamese during my first visit to the country in 1965. I was a member of a US ambulance helicopter unit attached to the Vietnamese Army in the Mekong Delta. Working in a well-equipped military clinic, I cared for wounded soldiers and helicopter pilots. Surrounded as we were by the Viet Cong, we frequently came under mortar fire.
Unexpectedly, I spent much of my year in Vietnam caring for poverty-stricken civilians. First, my staff and I treated the children in a local orphanage run by Roman Catholic nuns. When the village women began bringing their sick children to the orphanage, we set up a Saturday clinic for them. Later, we visited outlying hamlets that desperately needed medical care.
When my tour of duty was up, I returned to the States. I built a successful practice in internal medicine and critical care. But I never forgot Vietnam and its vast medical needs. For more than 30 years, I longed to return and be of help to the war-torn country and its people whom I had earlier befriended.
My opportunity came in the mid-'90s, when Vietnam started opening up to the Western world. I volunteered as a visiting professor in the intensive care medicine departments of the teaching hospitals in Hanoi (Bach Mai Hospital) and Ho Chi Minh City (Cho Ray Hospital). I did rounds in the ICU, gave lectures, and demonstrated critical care procedures. Starting in my second year, I concentrated on Bach Mai Hospital; most Western physicians who visited the country were going to Saigon.
Back in the States, I sought help in obtaining ICU equipment for the hospital. Foundations, medical device manufacturers, pharmaceutical companies, book publishers, and others provided modern equipment, supplies, and an up-to-date medical library. The CHI Colorado Foundation, an arm of the Denver-based Centura hospital system that raises funds to provide healthcare for the poor, donated staff time to make all of this happen.
I realized that much more could be accomplished if we brought young Vietnamese physicians back to the US for intensive training and returned them to the ICU as year-round teachers. With foundation support, half a dozen of these doctors have gone through one-year training programs at the University of Colorado School of Medicine and affiliated hospitals.
My return visits to Bach Mai now focus on bringing supplies and equipment to the ICU. I still lecture and make rounds, but I spend a good deal of time interviewing candidates for stateside training. It's particularly gratifying to see young physicians whom I've trained assuming leadership roles in the teaching program and improving the quality of care in the Bach Mai ICU.
For American physicians looking to recharge their worn-out batteries, I recommend volunteering to help solve the medical problems of developing countries. More than likely, you'll return from that experience more appreciative of your present practice setting and the benefits that you never before recognized.
(Additional information about the Bach Mai Hospital project is available at home.comcast.net/~ckbartecchi/BachMai.)
Carl Bartecchi. Why I go back to Vietnam. Medical Economics Nov. 7, 2003;80:59.