Day 1, or token white girl goes to cinic

I show up to clinic at 8 am like I was told last week. I climb five flights of a staircase lined with bodies in various degrees of wakefulness. The clinic waiting room is already super crowded. I walk past the reception into the clinic area; it already smells like products of conception. I walk up to the nurse sitting in the hallway, and ask for her boss. The nurse scurries away, then returns and drags me to a different doctor-looking person, presumably understanding English. Now, this is my fault because I entirely should have anticipated what followed.
I am asked who I am. I am a doctor, from America, I spoke with your boss…..of course I don’t remember her name, and she told me to come here today…and it is today. Another (male) doctor is summoned, they take out cell phones, start calling people, then I am dragged into the back of the clinic, where another doctor is summoned. The three of them proceed to have a conversation, the third doctor does not seem pleased. I am escorted back to room one. What is the purpose of your trip? I am here to work and to observe. More conversation; the entire staff is now out, staring at this spectacle, ie me. eventually, I am escorted back into a locker room. You can change your clothes. Do you mean into surgery clothes? No just white coat. Oh, I certainly don’t need a locker room for that. I put on my white coat and we walk back into the clinic room. You will observe me examine patients? Sure, that’s all I ask.
The clinic room is about 8x20, separated in the middle by a large column, with US and blood draw area in the back, separated by a plastic half-wall. There is a desk on one side, another on the other, plastic fold out chairs behind the desk. The two doctors sit behind the desk, they pull a chair for me and make me sit in it. The patients come in randomly. There are plastic stools (about 5) lining the wall, which is where they wait. Each patient carries her own chart—paper with handwritten notes on history, payment stubs, number in line (DMV style)—all handwritten and stapled together. There is a nurse who sits at the side of the desk and takes the charts from women's hands and places them in the corner of the desk, from which they are taken. This whole clinic operation, the clinic itself, functions like triage: women are seen for terminations, for consultations with questions of weirdo bleeding, for procedure follow up. They enter the room, whenever, and line the walls sitting or standing until their chart is pulled from the pile. There is no privacy, there is no HIPAA. Conversations, counseling, discussions of medical histories happen outloud, with everyone listening.
Doctors take the chart, calls the name of the patient, who then moves to the chair across the desk. Ultrasounds are reviewed, notes are scribbled and labs are recommended, after which the doctor pulls some sheet of paper, writes her orders and passes it along to the nurse, who fills the rest (patient’s name, birth year) and explains to patient where to go. Cross-conversations happen all the time: doctors are talking this way, while the nurse is talking about something with a different person sitting at the desk that way. Everyone's paper is stamped—tehre are about 5 different stamps on the desk--blue and red—and the nurse staples all of it together.
I feel like I’m on display, sitting at this desk with everyone walking in (or passing by, for that matter) staring confusingly at me. yes I stand out, I am aware. The room is crowded. At one point I counted 12 patients just hanging out along the wall, waiting to be called. This is including 2 doctors, 1 nurse, big ole’ me, and about 7 different nurses and ultrasound techs hanging out behind the desk waiting on patients. Everything is in Vietnamese. The young doctor, who is a resident (confirmed later, she has 6 more months left of residency) intermittently explains things about patients, but they are too busy and I feel bad taking their time. I piece information together largely by ultrasounds, figure out what patient are here based on grainy and poorly taken pictures (I would have made my residents redo the ultrasound). Super tiny early pregnancy, tiny slightly older pregnancy, thin uterine stripes of follow up. A 68 year old diabetic woman shows up because she has had an IUD for the last 20 years and wants it out. (This is way big to do about nothing, if you ask me), but she is sent to the lab for blood sugar check and then likely hospital…because she is 68. Another woman walks out of ultrasound crying: she has an embryonic demise--fetus with no heart beat. Another woman has thyroid cancer and is undergoing chemotherapy—freshly keloid scar across her neck, shut voice—her 18 week fetus has no heartbeat. One woman is turned away: she is 23 weeks, Vietnam allows termination up to 22. Patients who are admitted to the hospital get a blue chart; procedure charts are green, both are started at the desk. It is hard to tell if patients are being counseled—medical versus surgical termination—or just told what is happening. It is all in Vietnamese.
By 11a my doctor friend gets up and disappear, two more patients to see. Then, she comes back to tell me that she is working the night shift and because of that gets to go home half day to rest. If I’d like, she’ll take me to lunch. We walk outside. Do you eat Vietnamese food. Yes, but no meat, no fish, no street food. Oh, you’re vegetarian---dumbfounded look. Do you eat bread? Yes, but I’d prefer not to. She takes me to a ‘nicer’ looking café. After scrolling through the menu, together, nothing is vegetable friendly other than a pot of vegetables, so a waitress is summoned. She suggest french fries… umm, maybe I’ll just have thing yogurt thing. My companion orders the same, I think, because she feels bad. As it turns out I basically order dessert: soupy yogurt with crushed ice, whipped cream, pieces of strawberry on the bottom. My companion fears I will be hungry; I fear SHE will be hungry. We talk shop, medical practice while eating. Then head out, I thank her for her help and company, and then realize—I’ve just eaten ice. Shit!
So one redeeming doctor things I did today was help talk to this young Spanish girl who is traveling through southeast asia and just found out she was pregnant. she is too early in the pregnancy, and the ultrasound could not see the pregnancy. So I have to explain to her that we cannot do her abortion until we see the pregnancy in the uterus, until we make sure it is normal, otherwise, it can be somewhere else and not normal, and that would require a whole different set of meds. She is on a visa which expires, she has plans to travel the country before she leaves, she is now sobbing. I try to tell her not to worry. That if she can change her plans, she should come back in one week and we’ll take care of her then. Then, I ask her where she is going. It’s ok, if something happens, we’ll take care of you in Thailand. I hand her my email address and tell her to email me with questions. I tell her not to worry. I hope she feels better. I mainly feel bad because I can see myself, ten years ago in my travel days, suddenly being pregnant in a foreign country. I would have flown directly home, and I admire her for the courage to walk into a mess of a clinic, in a foreign country to take care of a very unintended mistimed pregnancy.

the war remnant museum

which is where i went today. everyone told me to go, and it was interesting in that it portrayed the war from the local perspective. and it was good and introspective in that regard. but here are a few things which i found uncomfortable...not like upsetting because it is disturbing (the only really disturbing part i actually had to walk out of was the prisoner/torture part), but more like eh this is not how i would do this museum part.
so there is a lot of stuff on international anti-war support which was cool, and some historical facts and strategical involvement part. but the issue is vietnam remains a socialist country. there are party flags all around the city (at first, i was confused why there are all these almost soviet flags, with hammer and sickle, around the city, but i think it's just the party flag). children wear young pioneer neck ties, red like in the soviet union, not blue like in GDR. so some of the information read a bit propaganda-esque, and i think there is an actual reason for that.
the other thing is that some of the information/commentary seemed to forget that this was a political conflict. not to downplay the US involvement: i fully believe that this was not our conflict, and we had a lot of political AND economic interest, and we did a lot of shitty shitty things to many civilians, but there was a greater political context to this. other parties were involved, and while the museum did mention, casually at some point, the number of guns supplied by china and the soviet union to the north, and while i doubt the chinese or the russians were committing atrocities, still this was a bigger thing. and because i am generally obsessed with 20th century history, and specifically, with the politics of the 60s, this to me seemed odd. and war is war, terrible and unnecessary, but any war is war. and showing pictures of bombed out factories just to show 'look how bad things got' seemed redundant. i mean, of course, factories will be bombed, in any armed conflict, right?
the other thing that was less palatable was the excess of pathos when discussing war 'casualties'. again, i think the amount of civilian badness that the US committed is inexcusable and absolutely terrible. but it was portrayed in, maybe, a slightly over-dramatic way. there was a room dedicated to victims of chemical orange, and it was literally a wall of pictures of people with handicaps and deformities with inscriptions like "this newborn is deformed because it was born to parents exposed to agent orange, how will it start its life??" "this girl is mentally retarded because her parents were exposed to agent orange, she spends her day in a cage where her parents put her." (wait, what??) "this newborn has anencephaly and it died a few hours after it was born because its parents were exposed to agent orange" (anencephaly is not so uncommon chromosomal abnormality, and can be caused, among other things, things like lack of folic acid or advanced maternal age, so causality here is less clear to me, from a professional stand point). yes, dioxin is terrible, yes we poured tons of bad shit on a lot of people, yes the pictures are powerful and profound, but maybe overly so?
and of course, as any museum, it was full of tourists, with complete and total lack of personal space manners, who would eagerly try to read the inscriptions even though i am already standing perfectly right in front of it. and then being super obnoxious and taking pictures next to museum exhibits and posing, smilingly, with the war aircraft outside. yeah, that's tacky.

conferencing

day 2. i attend a CME (that's continued medical education) conference. it is on HPV and update on CIN guidelines, is meant for physicians from other hospitals/regions, and is entirely in Vietnamese.
One of the FP doctors picks me up in the morning to take me to the university, which is further away then the hospital. he is 15 minutes late. he is supposed to be taking me on his bike (dont tell my boss), but my landlord who was keeping me company while waiting, strategically talks him out of it and suggests we better take a cab (cassing should thank him). we arrive at the conference already in progress, and since no one wants to sit upfront, we park in the second row.
the conference is in the medical university. the conference room itself seems oddly familiar, like i've seen it somewhere before, maybe at a conference in russia, maybe somewhere in east berlin. the conference room is old, built likely right after the war, maybe even before. the walls used to be beige with pink splatter; they are now gray with some pink peeking through. concrete floor, linoleum stage, red velvet curtain behind the screen. giant bust of ho chi minh sitting at upstage right. there are red banners with ho chi minh quotes (i assume they are his because the quotes are signed with his name); no a/c whirring fans over rows of wooden conference chairs.
i am learning all about pap smears, and how the ThinPrep has a higher sensitivity. the slides and the lecture, of course, is all in vietnamese. i understand vietnamese! wait, no, i can just piece together numbers and no the guidelines. the male doctor intermittently tells me what is being said. at some point, he tells me he has to go back to the hospital and pawns me on a resident (3rd years, 3rd out of 3).
we take a walk around the university building, with medical students sitting in groups on the floor (sweaters, no shoes). we stop short before the anatomy lab ("are you afraid of anatomy?" "no, but it's been a really long time since i've taken anatomy") apparently, it's the biggest in the nation, unclear why, other than they have a lot of bodies there.
back to the conference. i am introduced to more residents. some confusion happens at first as they realize i (the visiting professor) am not an old gray dude, and am in fact "quite young and beautiful" (this is immediately followed with 'are oyu married?"). i am force-fed raisins, i guess i have to work on my asian no. we listen to more guidelines and protocols. one of the residents keeps asking me questions about our practice, which i sort of feel like i'm not always certain and certainly dont want her to think i'm stupid and/or lying to her. although, apparently, in vietnam they follow ACOG guidelines. after the last speaker, a terrible thing happens: the faculty and residents take pictures, on stage, and drag me with them. so there i am, front and center, at a random vietnamese CME conference. then the residents have a meeting and i am asked to please wait a little. the meeting mainly consists, as it seems, of the residents being yelled at. good to know some things are not all that different. then, i am quickly escorted into a cab. super productive day!

jet lag

actually, after taking a ridiculously long flight, i'm not really jet lagged. i did get like two hours of sleep after figuring out the noise situation (the window faces a street, and although there are no chickens/roosters across the street, at least not the ones that makes noise, there is plenty of honking noise), then headed out to work.
first thoughts: it is hot. really hot. i'm not even sure if i'm more distressed about the heat here or when i was in tajikistan. oh, who am i kidding, it doesnt matter because it is hot. technically, the temperature in HCMC is lower than in Dushanbe, but the humidity is killer. I am sweating, profusely. i feel as ridiculous as i look. amazingly, of course, the vietnamese apparently are not bothered. in fact, they wear jeans and sweaters, like actual sweaters, stockings in their sandals, and i am the crazy white girl barely making it down the street. i got lost looking for the right building. well, i didnt get lost, i just could not find the right building. found the hospital and the map of all the buildings, but, let's say it was not true to scale. so i arrived at the head of the department's office, after a significant amount of wandering around, completely disheveled.
next, everything is in vietnamese, which obviously makes sense, but makes it incredibly difficult to find anything. i stood in the soy sauce isle for like 15 minutes staring at the soy sauces, trying to figure out if it's really soy sauce or if they're trying to trick me into buying fish sauce. because none of the bottles had any indication what was in them, well, not in not vietnamese. ok, maybe that story also approves that i'm neurotic, but it's the similar situation with spoken words. whenever someone tells me to go check something out, the tonality of the spoken word makes it impossible to understand or even visualize what is being said. and street names. i swear they all begin with ngyuen and have a different combination of other words in them, which sounds terribly culturally insensitive, but makes it hard to walk around the city without an actual map.
the other thing that makes it hard is stupid traffic. it is unreal. the amount of motorcycles, cars, bikes, mopeds, whatever that moves as one, in different directions, right or wrong, and across is terrifying. crossing the street is a feat and requires a great amount of magical thinking in firmly believing that you will not die and must step out and walk with purpose while the traffic spreads around you like seas around moses. the problem is once you've mastered that, thinking that the sidewalk is your safe place, you're wrong: the fuckers drive on the sidewalk! come up behind you, completely startling. i am terribly jumpy, feeling very ptsd. the drivers and the passengers behind them wear face masks. some plain blue surgical ones, others personalized fashionable ones with patterns, stripes, curious george. some of them are strictly face masks; others extend into these elaborate neck and head covering, like a jihhadist's uniform. they also wear full on gloves and sleeves, so i initially thought the masks were for dust protection, but given the neck covering, i think it's more of a sunscreen thing, since one's neck in not that likely to get dusty (although what do i know). and that again makes it more fascinating: as i'm sweating my way through the city, wondering how i can minimize my clothing more, the locals are covering up, head to toe, before getting on their motorized vehicles to try to kill me.

asia 2.0

speaking of trips. i am currently in montreal (in a starbucks, i know, just could not get away from corporate culture, or free internet, really)at a conference that i am whole-heartedly ditching. in 3 days i leave for vietnam.
this is the part of asia i've never been to. having survived (and perhaps even mastered?) the deserts of central asia, i am embarking on an adventure in the southeast asian jungle.
this is a medical/educational thing. no more research (at least not active research), no candid sobbing interviews this time. i will be working in a hospital, doing some clinical work, but also educating residents and my colleagues in new and proper ways of contraception...which sounds like a daunting task.
how did vietnam happen? so as part of my fellowship, i am supposed to complete an international rotation. while picking a place, i pretty much was open to going anywhere, except latin america since i speak no spanish, or west africa because i did not want to eat goat stew for the duration of the trip. some very important folks (my super senior boss and some national heads) talked about it, and decided that vietnam would be a perfect destination for me. that remains for me to determine.
i'm excited, but also slightly anxious. the average temperature in vietnam in april is about 98 degrees with crazy humidity (there is actually a tiny little temperature bump up if you look at the overall upgoing curve of temps, damn), which means there will just be more sweating. while getting vaccinated, the travel nurse went over foods to avoid, in order to avoid violent diarrhea. street vendors are off limits, so are fruits and veggies, cooked meat is a go, and carbs are ok. so lots of meat and no fruits and veggies...oh and also, i am not to pet monkeys! so far, this trip does not sound fun at all. sweaty, full of meat, no veggies, and no monkeys. sigh.
i keep freaking out, with bridget jones' diary 2 playing in my head, with me being imprisoned in vietnamese prison, and having to trade my bra or sing madonna, and i'm not sure which one terrifies me more. and while i continue to panic over how many pairs of shoes to bring, i keep having flashes of apocalypse now and wondering if i should take the captain willard approach and trust no one, while mysteriously immersing deeper into the jungle. or if i should emanate tony (bourdain) and follow his steps while marveling at the cuisine...while also chasing kurtz. although tony would not have liked to travel with me. i guess the adventure, like i said before, remains to be determined. i must not pack too many shoes.

coming out

It's been a while. i realize the blog often relates strictly to travel and it should not, or rather...i've been thinking about this for a while. as many of you know i am in a fellowship. a family planning fellowship, which in and of itself is a bit controversial. family planning, for those who dont know, refers to contraception and abortion services. as such, i am a trained contraceptive expert and an abortion provider. and while i love what i do, what i do is controversial.
i take care of women every day. i take care of women who are young and old, pregnant and not, but mostly, or at least in this particular time in my life, i take care of women who are needing to terminate their pregnancy. there is no singular reason for it: some women are really sick, some are facing a pregnancy complicated with terrible abnormalities in the fetus, such abnormalities that would condemn this future child to medical problems, surgeries, and likely stifled and diminished existence. for some women, the time is not right to become a parent. i provide care, a legal procedure, that is safe for them. for this, however, my colleagues and i are frequently ostracized, victimized, threatened.
i wanted to write about my experiences, experiences of my friends, who face protestors and threats of violence for them and their clinical staff. i wanted to write about the need i feel to speak up, and just lie about what i do, not to hide this abortion talk amidst some polite bullshit about how i do research (ok, i also do research, but you get the point). but i think, instead, it is important to focus on my patients. they are women, just like you and me. sometimes they are young, sometimes they are older. many have kids, and many choose to seek abortion services out of love, both for their existing children, and for their unborn fetuses. many struggle financially, scrape just enough money to cover this procedure. for many, by the time they find enough money, figure out how to leave work, and arrange child-care, they are further along in their pregnancy and the money they've got is not enough. many travel from far away. illinois happens to have less strict laws surrounding abortion care, so women travel from out of state--ohio, kentucky, wisconsin--to obtain a procedure that is actually legal federally and in all states. many have to leave their kids, with strangers, just to make it over for their procedure. many are single mothers, many have loving and caring partners and are making this decision with their love and support. many are brought in by their parents or sisters, or older women who have been through the same thing (did you know that one in 4 women has an abortion?)
for many, this is a hard decision. many cry, many are scared. and i hold their hand and tell them it will be ok, because it will be. but regardless, my patients are making a decision that they are sure of, that is right for them, and that is the right guaranteed to them by the constitution. i dont want to get political here. the point of this coming out story is to share, with my friends who may not know, and to speak up on behalf of my patients and my colleagues, against violence and stigma that often surrounds the medical work that i do.