I’ve been back in sleepy Houma, Louisiana for over a week now; looking back through my photos and journal entries from last month makes the adventure seem like a dream. However, I know that the lessons I’ve learned are real and will be carried with me from here onward.

I remember the first patient I tried examining on my own in the internal medicine ward. I was nervous and my Vietnamese was tentative, but I carefully went through all the appropriate steps which I had learned just moments before (look through the patient’s file, observe visual signs, feel the neck and quadrants of the belly area, ask about medical history and lifestyle). Becoming familiar with procedure for new patients and developing my examination skills were top learning priorities for me as I was entering the internship, so I took every chance I could to don the white coat and take a look at patients. In the neurology department, I saw many stroke victims and thus by the end of that week I’d begun to notice the signs and read x-ray charts for stroke of the brain (you can see one below!). Some of my favorite investigations fell under this diagnosis, only because they involved extensive and clever examination. My mentors watched and guided me each day, often with amusement. Although I was sad to leave a department at the end of the week, just when the staff and I were becoming friends, I left my internship having friends all over the hospital. During the last week, I never went to lunch without running into a familiar face. Contrast that with my first lunch at UMC – my mentor was busy so I walked the side streets alone, paranoid that my clothes would label me as a naive foreigner, and still clumsy with Vietnam đồng denominations (which certainly outed me as a naive foreigner).

An x-ray chart for a stroke patient. Names and personal information have been blacked out.

In every department I would find physicians eager to discuss health care politics with me. I spent many lunches, free time in the office, and walks between patient rooms exchanging information with physicians, professors, and students. We talked about the medical school system, method of payment for doctors, health factors, and patient attitudes in both the U.S and Vietnam. Nearly every patient came in with preconceptions about what their diagnosis should be, or was found to have self-prescribed medication after their last visit. The pharmacies in Vietnam require no physician signature on prescriptions, so patients are able to buy any drug at any time. This, of course, leads to complications in diagnosis and treatment. I learned that effective communication was more than half the job.

I suspect this summer is one I will continually come back to, as I make connections between what I have seen and what I will learn in the classroom. I have yet to see much of the terminology and mechanisms I was exposed to during my internship in school, but I know I will eventually come across them. Having hands-on, visceral experiences to link to readings will solidify the knowledge in my mind. For this reason I hope to continue to build more real-world experiences in the medical field by perhaps working as a scribe or volunteering at different hospitals. One day, I would love to travel again with a program to help administer health care. Foremost, I am excited to learn more about everything I have encountered this summer.

For anyone interested in shadowing at UMC or in the industry at all, I highly recommend developing personal connections and reaching out to administrators and physicians directly. Not only is it cheaper than going through a sanctioned program, but it also allows for more control over what you will be learning and accomplishing, and is likely to strengthen and extend your professional network. In such a competitive environment, standing out and maintaining strong networks gives you a special advantage. The more important advice, though, is just to go beyond your borders and do something you love in a new place you might come to love.

For the past two weeks I’ve spent my days in the ER, General Internal Medicine, and Neurology departments at UMC learning how to examine patients, discern pathologies, and execute protocols when a new patient is admitted to the hospital or visiting the office. Although I’ve seen a dense variety of diseases, the majority of cases are of liver cirrohsis, due to prevalent excessive alcohol consumption and Asian people’s increased risk for Hepatitis B. I’ve begun to recognize its tell-tale signs – englarged and hardened belly, reddening of the edges of the palms, “spidery” or star-like red marks on the chest, and sometimes jaundice. My favorite moments are when I can examine the patients myself. My mentors guide me in asking about the patient’s history and lifestyle, looking for visual clues, testing reflexes and pain, feeling for abnormal shapes/growths, and distinguishing between normal and abnormal sounds of the body. Learning the basics of clinical examinations and being able to recognize the most common pathologies in Vietnam were my two top goals when beginning this internship; I look forward to practicing these skills every day. I feel more confident examining a patient now, and although I usually can not make a diagnosis, I can acquire plenty of information on the patient- and this is the first crucial step. To my own surprise, I’ve also been trained to do ultrasounds and take blood for testing. There is, as I expected, a special satisfaction in helping a person improve their welfare, even if I only play the smallest part. It’s this that I am most proud of.

I hope it is not too long before I will be performing these procedures on my own.

I’m still trying to absorb and process everything from my past (and first) week at the hospital. Finally getting to meet my generous supervisor and his staff in person, I was glad to find that they were as excited to host me as I was to begin learning from them. Many doctors take this as an opportunity for them to practice the lingua franca. They teach me medical terms and procedures in exchange. This was my week in the surgery department; fortunately, I was able to see incredible operations and peak inside the astounding human body. My favorites include an operation to treat Parkinson’s in a young woman in which a machine drilled slowly and precisely into her skull and electrodes on her brain were connected to a battery in her chest, a correction of a boy’s malformed ribcage and a knee replacement (both very mechanical procedures), and the many laparoscopic surgeries UMC performs each day. Below you can see a tame picture of the knee replacement.

Besides human anatomy and pathology, I’m also discovering the problems with the Vietnamese hospital system, as told by its staff and patients. Most decent doctors and medical establishments flock to Ho Chi Minh City (HCMC) because, as the cultural and economic hub of the country, it provides greater opportunities for profit. In turn, patients must come to HCMC for reliable treatment – causing hospitals in an already very crowded city to overflow way past capacity. Furthermore, proper and current equipment and sufficient supplies are lacking in many hospitals. UMC is among the most well-funded and supplied in the country, but the surgeons still wish for better instruments.

Next week I’ll be in the internal medicine department, and hopefully will continue to gain new knowledge, perspectives, and friends.

Growing up as a Vietnamese-American child with a precocious affection for science, I was often uncomfortable with the disparities between western modern medicine and my family’s antiquated home remedies.

When I complained of headaches/menstrual cramps/stomach aches/colds/allergies/general lethargy, adult relatives would prescribe that I rub dâu xanh (literally translated as “green oil”; active ingredients: methanol and methyl salicylate – a natural product of wintergreen plants) on the affected area, or swipe some underneath my nose and breath deeply. It has a refreshing minty aroma, but its health effects are otherwise dubious. Even stranger is the practice of cạo gió (literally translated as “scratching the wind,” but can be referred to as coining), which is often used in Vietnamese households to treat colds, respiratory problems, fevers, and fatigue. A person would rub the oil onto the patient’s back, and then vigorously and repeatedly drag a coin from the base of the patient’s neck to the lower back until prominent red abrasions appear on the skin. The tradition stems from a belief that illness resulted from imbalanced winds within the patient, and coining could release these winds and restore a healthy balance. The rubbing draws blood to the skin’s surface and may stimulate circulation, while the oils may have analgesic properties – explaining some of the relief reported by coining proponents. However, none of that is yet confirmed through scientific research.

This summer, I’m honored to be going to the University Medical Center (UMC) in Ho Chi Minh City, Vietnam to get a closer look at Vietnam’s modern medicine. The hospital is associated with one of the top medical schools in the country, and is regularly used as a teaching clinic for students and foreign physicians. I expect it will be nothing like my home remedy stories. There, I will be granted my first experience with physicians’ day-to-day, in a variety of fields. I will spend approximately a week shadowing a physician in general medicine, internal medicine, emergency, and surgery. I’ll also perform duties such as transporting materials and escorting patients throughout the hospital.

I have volunteered at the Children’s Hospital here in New Orleans before, and once shadowed my pediatrician for a day; but I have never shadowed extensively. The opportunity to learn the real stresses and procedures that physicians experience in their career is invaluable to me in my own career pursuits. I am especially thrilled to be studying medicine outside of the United States because it allows me to learn about health care systems different from the one I grew up in. The chance to spend a summer abroad, of course, is a sweet bonus.

Initially, my goal was to find a summer program in which I could gain an intimate look at medicine in practice abroad. I knew that the experience was one I was sorely lacking. After many hours scouring the Internet and asking around, I found several enticing programs – with hefty fees that I was unwilling to pay. I decided to find a position on my own to avoid overhead costs. I began sending out emails to hospitals in Vietnam, and eventually came into contact with a UMC physician who agreed to help me on my journey. I’m glad that I decided to ask the hospitals directly, as it gave me more control over the structure of my internship. Now, I am dying to finish finals week and begin what promises to be a memorable summer.