the inn keeper

if "Les Mis" is now stuck in your head, you're welcome.
i am staying at this rental studio apartment, the inn. the inn keeper is in his 50s. he studied in the soviet union: first year as his language integration, sometime in the early 70s, in Kiev and then in Moscow at MGIMO (Moscow National University of International Relations, by the way, that's super prestigious, then and now, just think Harvard Law). he speaks fluent russian, which is better than his english. he misses kiev and russia, and goes there sometimes, although he hasnt been back to kiev since 2006. he misses russian winters, mostly snow and change of seasons, and hates Saigon weather (that makes two of us), preferring the weather in Hanoi, which is where he is originally from. although the weather in Hanoi is also not ideal: cold wind from china, but no snow.
after graduating from the university with an international finance degree, he worked in various embassies--russia, cuba, peru--before retiring. the inn is decorated with reproductions of famous russian paintings and originals from cuba and latin america: colorful cuban landscapes, beautiful peruvian vistas. sometimes we chat, usually over vietnamese coffee downstairs in the 'lobby'. we talk about the politics in russia, we talk about the economy in vietnam. things have gotten really corrupt, no one wants to work, everyone just wants to sit outside and drink tea.
every time i go out, i get concerns and practical advise. do not walk alone, better to take a cab (that since like overkill). do not take your (giant) purse with you--there are many pickpockets. there is nothing in my bag so very little to pick-pocket, yes, but they dont know that. be careful of bikers, bikers are crazy, do not get on any bikes, even i dont ride them. that's a very good point. he asks me how i like saigon. when i tell him i like the combination of different architectural styles in historical epochs next to each other, traditional asian with colonial french, he responds with 'so such an ugly picture!"
he, his wife, and their child live in the studio on the first floor. the wife is his second wife, and is lovely, although she speaks no english and communicates with me with gestures and google translate. she is my age and leaves fresh flowers in my room--woman's attention to detail. their daughter is adorable, is 19 months old, and definitely has a name...which i cannot reproduce. the girl, when she is not in daycare, watches "Masha and the bear' glued to the screen, sometimes right in front of the screen, sometimes upside down on teh couch. 'masha and the bear' is a russian cartoon about masha, an annoyingly precocious toddler, who makes life of the bear unbearable, but who out of his sheer love for masha tolerates it nonetheless. the cartoon has adult undertones, not creepy ones, but social and political commentary on life, which makes it very enjoyable for adults. in fact, my very adult brother and i watch it together when i visit dallas. when not glued to the screen, the daughter and i are buds: she waves hello and goodbye, shares her morning bread roll, and stirs my coffee, although i'm pretty sure the coffee stirring is simply her way of getting her hands onto things.
the inn keeper has two children who are in irvine, and he travels to the US frequently to visit and hang out. he also has many friends, most of them former college buddies, who have all spent time in the soviet union and speak some proficiency of russian. the tour guide was one of his friends, the other, 'fedya' is another tour guide whose russian is spotless and who talked non-stop for our entire introduction, about the past, their college life, current business, tourism, and whatever else.
somehow the world seems to be a very small place, where one can find familiarity even in southern vietnam. oh, and if you're ever in saigon, stay at the lucky studio apartments.

seid bereit, immer bereit.

so vietnam is a communist country. it is easy to forget with all the selling, buying, and general economic consumerism that surrounds you. but it is, and the communist posters on every street corner serve as a reminder.
i spent yesterday walking around and taking pictures of awkward communist posters. inspired by an idea from my fried Lee, this will become my own homage to 'ostalgie'--let's call it 'far ostalgie'. Ostalgie is a play on words, from 'ost' which means east in german, and nostalgia. it reflects a cultural, social, and emotional sentiment many former East Germans experienced after the reunification. it is not only a feeling, but a cultural phenomenon of collecting everything GDR, and reminiscing about the country that is gone. dont' get me wrong, i am in full support of the fall of the wall, but i can imagine it is hard to wake up and realize that the past 40 years of your life and existence are obsolete ('goodbye, lenin!" is an excellent movie that parodies that).
so back to vietnam. its communism is more subtle. you wouldnt even think it's here, other than the posters. but it's not just the posters. as i mentioned earlier the vietnamese kids wear party neck-ties; they wear party seals on their uniforms. kids go to school on saturdays, but on sundays, parks are filled with party group meetings. kids, teens, and adults fill the park alleys. sitting in the shade, dressed in identical uniforms, like oversized boy-scouts, they discuss and debate party pertinent ideas or topics, i am guessing. some groups make banners, others chant loudly in unison--excited junge Pioniere. and for a second, you feel transformed, somewhere deep into the warsaw pact circa 1985.
the vietnamese elections are in a month, and once in a while a random truck with a banner and a loud speaker will drive down the street, presumably, announcing the election and calling everyone into democratic action for the good of the party. i'm making this up, of course, as shit is being said in vietnamese and i have no idea. but it is interesting to observe: as the shops, stores, adn general life fills with capitalism, banners and political ideology persist, coexist symbiotically with hello kitty, internet cafes, and prada stores.
there is a lot about economics and politics i do not understand, but isnt capitalism the biggest enemy of a socialist state? so how does this work? how is this political ideology working when so many collapsed? an entire region of the world--eastern europe--could not survive, could not overpower the simple human will to have more, or i guess, just to have. so are vietnamese doing something better in allowing the economy to flow, half-dictated and half-driven by market forces? or are people more willing to shut up and put on a party uniform as long as they can go home to their air conditioned privatized apartments while facebooking from their very own commercially produced chinese laptop? adn in that case, does anyone still believe in the slogans or is it all for show, as long as the masses are left alone to eat, drink, and buy freely?
in talking to people here in HCMC, as it turns out, things are not so great. corruption is rampant. the economy resembles Russia of the 1990s, following the fall of teh Soviet Union, where very few became very rich quickly, and maintained a certain control, oligarchy if you will. things function poorly due to corruption and underlying bureaucracy, permeating different levels of society.
for example, young adults flee Hanoi, teh country's capital because, as the seat of the party, competition there is not just academic. for the tight and coveted university spots, regardless of how smart you are, your place may just go to a party offspring, sometimes undeservingly. similarly, with jobs tht are sometimes assigned, given, or bought. the privatization and corruption has translated into the health care as well. universal healthcare coverage means long lines and overworked physicians. an ob/gyn working for a state hospital has 3min per patient. that's 3 minutes per patient's exam, counseling, prescription, questions. as i was told, patients do not ask questions--there is no time. pediatricians, even worse, see 100 patients in half a clinic day--that's less than a minute per patient. sometimes patients are seen/examined as a group. this is all for a physician salary of about $400 a month.
so many physicians are forced to work in private clinics, on weekends, to amke extra money. here, the few who can afford it can buy time, can buy privacy, and essentially better service. the complications rates are, as i am told, lower, patients have time to ask questions. i am not advocating for privatized healthcare system. in fact, practicing in the US, i am more convinced that our current 'privatized' system is deeply flawed. but i wonder where this hybrid of (communist) state and free market economy is going. i can tell you what happens in russia or ukraine or tajikistan. and it sort of works, but only for those who have the means, not, as marx willed, for everyone according to their needs.

walking saigon

i walk around a lot. the city is actually not so big, at least the downtown area, navigation made only difficult by the heat and the traffic.
i start out in the afternoon, after the heat has peaked. this is the time when the outlying city-center streets are filled with white ghosts: white people, ghosting through the city on their ways back to the hotels, sweaty and heat exhausted, in pairs or singular, hostel folk. the more central city is filled with tourists, older couples and couples with kids, french, german of course, adn obnoxious americans. this is also where the shop owners are most aggressive, inviting you to come in and eat, regardless of time of day, pressing menus into your face.
the city navigation makes me angry, so i traverse the city with a permanent RBF, cursing loudly at people on the street. mostly, traffic. tehre is no traffic rules; lights or direction of traffic do not matter, the only rule is go, regardless, of whose right of way it, who is in front of you or what direction you're facing. bikers ride on the sidewalk, with or opposite of traffic, honking loudly at you as if YOU are in their way. this is why, i curse, because fuckers, are on the sidewalk.
similarly, i curse at dudes that offer rides. they hang out on street corners, lounging supine on their bikes and half a block away will scream at you: 'hello madame, motorbike?" some of them are more persistently obnoxious and will continue to talk to you while you're actively ignoring them. 'no, i dont need a bike, asshole! if i did, i'd talk to you'. cursing also flows in the direction of catcalls and obnoxious comments in my direction. inappropriate and totally disgusting, is that how you talk to your sister, are you fucking kidding me?
the parks is where you can sort of escape the heat. the greenery offers protection from the sun and park alleys, away from traffic, are slightly cooler than the streets. the parks are filled with people working out, running slowly around the park, or exercising on the park apparatus(es??)--these exercise machines, metal, like ellipticals and bikes--all in street clothes. there are group classes--dance, aerobics, martial arts of sorts--one can take for free. the park alleys are lined for badminton; alleys are filled with people playing vietnamese hackey-sac: same idea i think but the hackey-sac resembles a shuttle-cock. park benches are filled with old folk, couples, adn groups of vietnamese youth attacking foreigners. i'm not sure if these are organized or if white people are simply accosted on street corners and are asked to participate in political debates or general english language practice. parks are also where pictures are taken: leaning against a tree, staring into the sunset, looking at a leaf. this is where match.com vietnam happens. on weekends, parks are used for party group team meetings (more on that later).
the sidewalks are filled, at all times, with parked bikes, vendors, people sitting and eating, or just sitting. somtimes it seems the entire city is just hanging out on the sidewalk. there are chickens on the street, belonging to vendors, and it's unclear if they are pets or tonight's dinner. there are cafes that have all of their seating outside on tiny little plastic chairs, or just cart vendors that park on whatever tiny area of sidewalk they can claim. this makes the sidewalk impassable, forcing one (me) to navigate between bikes, carts, people, hanging feet, and stepping into traffic. it's all about magical thinking because no one moves over, ever. large trees and sidewalk cracks frequently have little incents and buddha offerings of food and coffee, presumably, for good business.
ignoring the heat and the anger provoking traffic, the city is quite beautiful. old colonial buildings meet traditional asian architecture in an seamless blend. the city is living, moving, exhaust-ing, cooking, eating. it is green, it is loud and sweaty, obnoxiously forcing itself into your face.

emergency contraception

journal club take 2, and based on popular demand, we are discussing emergency contraception. a 1st and 3rd year residents were supposed to present together, but the 3rd year got busy with something likely more clinically important and could not make it, so the 1st year is left on her own.
it is hot. the room is filled with people all eager to listen, and the ceiling fans are not doing a great job of moving the hot air around. the resident goes through the PowerPoint, then it's question time. the professor (of reproductive medicine) is there again. he asks very specific pimping questions, with theory and mechanisms thrown in. the resident keeps redirecting questions to me, referring to me as Miss ALex. Miss Alex? who the fuck is miss alex? what is this the miss muffett's story hour? you can at least settle on dr. alex! i am, of course, sweating: it is uncannily hot, too hot to think, and all i can think of is slowing down my metabolism and breathing in futile hopes of sweating less.
the first problem is clinical practice: what is used in the US as emergency contraception is different. so while plan b (progestin-based contraception) is available in Vietnam, it is apparently way more expensive than Mifepristone (also known as 'the abortion pill', which in the US can only be dispensed by specially licensed physicians, whereas here you can buy it in the pharmacy). so while i can speak of efficacy and dosing, practically speaking all these questions of use, or even more important theoretical discussions of prostaglandin paracrine effects (yes, we got into that too) is useless because that's not our practice.
then i am asked why women in the US continue to use emergency contraception, adn i am faced with the dilemma of explaining to my culturally and socially conservative audience about prevalence of one-night stands, drunken mistakes, or american dude's dumb inability to put on a condom. the truth is, i dont know. the truth is it is not always drunken hook ups, it is sometimes very responsible contraceptive failure, like forgetting to take a singular pill, or the condom actually breaking. sometimes, it is on again, off again boyfriends; it abusive and coercive partnerships, it is difficulty in getting to one's doctor on time. there is no singular answer. so why, then, despite the ability to buy plan b without the prescription (yes, at someone high price) and even more effective Ella (yes, at even higher price), the unintended pregnancy rate in teh US remains so high? why dont patients take plan b if/when needed but turn to pregnancy termination, the rates of which, also, remain so high? are we as physicians not doing a great job telling women about this emergency contraception thing? or, better yet, are we doing a shitty job contracepting women in the first place? and while as a family planner i fully believe that long-acting reversible contraception is the best-est ever, i cannot place a device in the uterine cavity without my patient's consent. nor can i show up at her house every morning to remind her to take a pill, or stalk her at a bar and remind her to put on a condom. i guess what we can do is continue to remind our patients that emergency contraception does exist, in cases of those unanticipated trysts, OKCupid dates taht have gone too great, or in cases of abuse and domestic violence.
alright, i will get off my soap box. the horse is dead, its beaten body is now rotting in the sweltering heat.

night shift

this may get a bit detailed and graphic, so i apologize in advance for shop-talk.
I am invited to go to labor and delivery with Dr. Huy (i'm pretty certain he has taken pity on my boredom here). He is working the night shift, and I tag along. I arrive at 5p, and we change into scrubs (his—hospital issued, mine—brought from home). I am asked to change my dansko OR shoes into flip flops. This seems sanitary. Then, we tour the unit.
There are two labor rooms: a large room with cots lined along the wall, where women labor in the latent phase. After 4cm dilation, they are moved in the active area. This is set up as a semi-circular room, like a circus arena, with 6 open room on the periphery of the circle, each with two delivery cots. The nursing desk is in the center and this is where nurses chart in paper charts. There are cabinets with medication: misoprostol, vasopressin, nifedipine. One or two infant scales sit in the corner, but no more. Women are brought in, sometimes two to a room. When it is time to deliver, nurses check and deliver patients, with resident or physician assistance as needed.
In the active phase, women labor on continuous monitor; in the latent room, if there are no strip issues, the monitor is applied q2-4hrs. while a woman is delivering quietly, with nursing assistance, another one is climbing out of her cot, laboring un-anesthetized in the cot next to her. I look at the strip and she is banging out contractions every minute. I hold her hand and try to breath with her through contractions, which is, of course, difficult since I do not know how to say breath in Vietnamese.
Following delivery, women are moved into the recovery room for 2-4hours. Sometimes, when the recovery room is full that means they are moved out into the hallway. Infants remain on mother’s chests, inside their shirts for warmth.
Some overly excited (male) medical students decides to ask me questions. How long am I hear, who am I learning from? Learning from??! What specialty are you going into. I am an ob/gyn, as in I am a practicing physician ob/gyn. Oh, I thought you were a med student. Nope, and fuck off, buddy.
Then, I am offered to deliver a baby. There is a lot of plastic and cloth going on underneath the patient, who is laboring with her gown raised, no sheet. I have an audience of about 8 people, all gathered around to watch the weird girl try to deliver a baby. As the head is about to crown, the resident who is there to assist me cuts a giant mediolateral episiotomy as I cringe in my mask. I delivered without problems, and apparently everyone is amazed that someone so young (me) has such great skill. The infant is placed immediately on the belly, cord attached, and although it is great for such swift skin-to-skin, I am pretty certain it is because there is nowhere else for the kid to go. I try to clamp the cord, which apparently is always delayed clamped, again, not because of the believed benefit, but probably because no one actually rushes to do it. I try to clamp the cord but have a hard time reaching the kid’s belly, so clamp sort of long, thinking they can always cut it later. There is commotion, apparently, I just committed a faux-pa of sorts as the cord needs to be 3cm long. I am given another clamp, great. Finally, cord detached, I deliver the placenta, with a giant rope of a cord hanging down. A sterile sheet is placed supra-pubicly just for me because, apparently, no one does maneuvers to deliver the placenta. I ask if they ever run Pitocin. Oh yes, it is running, I am reassured. I look at the line and it is half closed, so yes, Pitocin is very slowly dripping, not the same. Once the placenta is out, the woman’s perineum is watered with water out of a teapot and drenched with betadine. Do you always cut episiotomies? No, only in nullips (first time pregnancy) and with prior C-sections. So the answer is really yes. Now, in the US we never cut episiotomies because it doesn’t make a difference in delivery complications, and I briefly contemplate sending the doctor an article about increased rates of complications with episiotomies, but decide it is somewhat passive aggressive. Before I get a chance to repair the gaping epis, I am whisked away to do a c-section.
We walk into the operating room, the patient is on the table, arms out, gown up. I ask what the indication for the surgery is, apparently, it’s big fat baby syndrome, also known as macrosomia. As the nurses prepare charts and things, an anesthesiologist walks in and places spinal anesthesia, which means that the patient was just splayed out for now reason. No monitor is attached; the physician looks at the chart, but doesn’t talk to the patient. Finally, we are ready to scrub. After gowning, one of the residents arranges instruments. I was worried about not being able to call for instruments, since I do no know their names in vietnamese, well, turns out it doesn’t matter because there is no scrub tech: you reach for your own instruments. The resident is super helpful: she wants to do residency in the US and has already taken her STEPs (I’m pretty sure she did better than me when I took STEP I in 2007. God, I’m old), so she speaks english. We are not using electrocautery (to coagulate vessels and stop bleeding); I frantically search the instrument tray for a Kelly (a clamp to clamp down on vessels to stop the bleeding) and there are none. Ok, so we just wont cut into vessels, that’s totally fine. And there are only about 8 laps…ok, we just won’t bleed at all then.
We start, or rather I start, and it goes smoothly. We get the baby out, and this is where things get confusing. There is some confusion in the process; they do things a bit differently, so i feel like i'm messing up because i am not quite sure what it is that they want me to do, since we do it differently. I feel like Dr. Huy is sweating watching me fuck up. I make a joke about him sweating in nervousness, and the resident laughs…he does not. I am wearing flip flops and I am completely convinced that my right big toe is squashing in a puddle of flip flop contained blood. finally, we are done. After surgery, I unscrub and suddenly the nurses, in a very animated fashion, tell me to take off my flip flops because they are bloody. You want me to take them off, and be barefoot in the OR, is this what oyu’re telling me to do? no, apparently, there is another flip flop pair in the corner and I walk barefoot to change into that. I examine my foot: no blood. Magically, I did not make a mess.
We return to the labor room. It is relatively quiet, only two women: one delivered, one soon to be. I hang out a bit longer, the resident asks many questions about residency. It’s getting late, so I piece out. I think I’ve sufficiently embarrassed myself for today. Two babies, both boys, both Vietnamese.

a wedding and a funeral

apparently, i have an uncanny ability to crash weddings in foreign countries. i am invited to the wedding of the head department's former students. we arrive at the venue and are immediately greeted by bride and groom, pictures are taken. we are lead into the reception area where tables are set up: white flowers as centerpieces, lime green ribbons tied to chairs. The stages is set up with white and magenta flowers. There is a tower of martini glasses on the left, giant 5 tier white cake with cascading purple flowers. the back curtain has the bride and grooms names and the date, back lit in magenta.
we are seated at a table with two other residents. many questions are asked about my (non-existent) husband; i have to convince everyone that i am my age adn not in my twenties. then, i am encouraged to go around and talk to people, because i am such a distinguished guest. that's weird because i dont know anyone. a woman walks up on stage and starts singing in this amazing beautiful voice. about a minute in, someone asks if i understand what she is singing because, apparently, she is belting out celine dion in english, and no i have no idea (but crazy amazing voice). then, the wedding party arrives. first the parents, ushered in by boys (well, men but they look 13) dressed as nutcrackers (or bellhops) and girls (women) in long white dresses. i try to ask who those people are but my questions are misunderstood. then, the bride and groom. everyone lines up on stage; the MC says some things. a hot chick in a LBD reads a letter the bride supposedly wrote for the groom (the groom is sort of not listening). glasses of rose champaign are offered to parents, in sequence, which they drink together. then, the cake is sliced; the nitrogen is placed in the glass tower and same rose is poured over creating a fog cascade. everything is paused adn posed for photographs.
then the food arrives. i mention no meat for me. are you vegetarian? you didnt tell me earlier! i feel terrible, i feel like a traitor who had just sold top secrets to the KGB and betrayed the country. but the kitchen will make me a vegetarian thing, whcih arrives 20 minutes later: zucchini flowers, spring onion, and oyster mushrooms atop noodly noodles (to quote my friend Mo). totally vegetarian, except for pieces of ham carelessly tossed in, which i carefully extricate. i am also immediately handed fork and spoon because i am white adn not to be trusted with chopsticks. sad day. after my noodles, which are way to big to finish, meat that looks like beef but smells like pork in stew form arrives with bread rolls. i am to dip my bread roll (without stew) into soy sauce. the bread tastes oddly as if it was basted with condensed milk but soy sauce makes everything better. then hot pot for hte rest, and i am handed another soup. no, wait, not soup it's dessert: tofu in lychee syrup.
throughout dinner people are getting up on stage to sing. apparently, everyone in vietnam is an american idol contestant. i am asked to go up and sing as well, as a wedding gift. absolutely not, that would be a terrible gift. we go around the table a couple of times to discuss that i am, in fact, older than 23. the bride and groom come over a few times to toast (i am toasting wiht water); at some point, the bride stops by adn is offered a bowl of hot pot (she has not eaten yet), and because everyone else is sitting i hold the bouquet. everyone is amazingly sober, most importantly, me. and after dinner we make our way out.
now we are headed to the funeral. is it ok taht it's so late? yes, the family will stay up all night, so we can come late. is it ok that i am dressed like this? yes, you are a foreigner, you dont know. we drive throuhg the city to find the street where the 'shiva' for lack of a better word is held. the street corner is marked with a flag; same flag is atop the house where the family lives. the funeral is held in the courtyard. the family, dressed in white robes, hospital gown style, and white head bands, greets everyone and offers them drinks. there are funeral wreaths at the door, white and purple flowers. the air smells like incense and jasmine flowers. the family sits around with us at a table. the man who died was 84. his grandson went to school in england and is helping translate. he apologizes for the randomness of me being there. no, i'm sorry for your loss. dont be, he was old and ill, it is better this way. but grandma, who is handling this well right now, may not be ok. so they talk about giving her medication, benzos, to help calm her down. after settling on a med that wouldnt interfere with her hypertensive meds, someone is dispatched to the pharmacy.
i ask some questions about tradition, although it seems weird to ask questions at a funeral. the family will mourn until wednesday, when the body will be cremated. the length is prescribed by the monk who looks into multiple things to come up with the number of days. then, we head upstairs to pay respects. i stand towards the back as bows are offered to buddha first so he may hear, and then to the photograph of the deceased to pay respect. cupboards are covered in newspaper. apparently, buddhists, like the jews, cover their mirrors when there is a death.
we head out, driving through the night city. there are a ton of people out on teh streets; the streets are lit up; traffic moves all around crazy-style. the city is alive.

up the river

today, we took a day trip up the mekong river. i was excited not just about the trip, but internally had this whole retracing apocalypse now... it was not quite like that.
i am going on this trip with the other guests staying at the hotel: husband (tall black british dude), wife (short vietnamese-british lady), and their daughter (about 15 and typically for her age, pissed to be there). our tour guide--a tall vietnamese gentleman, with dyed black hair, false top dentures that move when he talks, and perfectly straight charcoal drawn eyebrows--speaks english, russian, and german, which covers all my bases. he is a journalist and used to work for the foreign ministry. he intermittently comes up to me to tell me i am handsome. there is some debate as to whether i should be wearing sandals. now, i'm dressed pretty much for the beach because we are taking a boat up the river and i have a feeling the boat my flip over (the wife is wearing a business dress and pearls, so there is clearly some discrepancy), but i decide to go with the initial instinct to rock flip flops. "so typical american" according to the british dude. well, buddy, we'll see who is faster when we have to swim to shore.
we drive off, air-conditioned van and make a stop at a local shop where tea, snacks, and weasel coffee (look it up) is served. as it turns out, we are there to buy things, with a discount. people keep asking me, where is your husband? i dont have a husband. you single?--the tour guide starts clapping, the british guy dies laughing. on the road, we pass rice fields and get a history of saigon and all sorts of population facts (population of saigon is 11 million, there are 6 million motor bikes). now, the guide speaks english, the problem is he is not very good at it, and interjects many not english words, so prepositions, verbs, and sometimes nouns come out in russian, in one flow of a sentence, which obviously to others do not make sense. he also is hard of hearing, so many of my questions are simply ignored.
enter a beautiful buddhist temple. there are three huge buddhas outside: standing, sitting, sleeping (sleeping buddhas are very rare, the biggest one is in dushanbe). we walk into the temple and are made to pray (british guy refuses, so i am named captain of the team). as we light incense and bow, we are to dream a dream, 'like a good husband or all the things like that'. the guide is unbelievably loud, with his explanation and commands, in this peaceful subdued place, and i apologetically keep looking at the monk striking the gong.
we reach the river. how far up the river are we going? that information is classified, sergeant. there is a motor boat that will take us there. we are going up the river, into the jungle, or more specifically, one of the islands. there are five--the island of dragon, unicorn, phoenix, tortoise...and the fifth one--we're headed for the unicorn. the first stop is a cocnut candy shop, or rather a coconut candy hut. coconut candy is delicious and can be bought fresh. then, we are excorted towards the back, where multiple little rickshaw/carts are attache to small horses. i am about to pet one, when i am told to get in. oh, apparently we are going on a my little pony ride. the lady driver scoots me away from the front, and midway through the trot, my little pony starts to poop, large caliber turds protruding from its anus. maybe this is why the lady made me move. my little pony is forced into a trot and i feel horrible as this thing must be dying. bcak to the boat.
next, we pull up at a restaurant, or a giant hut--lunchtime. how long have you been a vegetarian? 16 years. huh, i always thought vegetarians were skinny. thanks, british dude, for just calling me fat.the menu is prefixed, which we are not aware of, so the wife (who speaks vietnamese, because...she is vietnamese) orders more food in efforts to avoid me starving. the result? a shit-ton of food arrives. oh boy. there are other big tour groups around, russians, chinese. after attempting to make some progress in the huge table spread we call it quits. back in the boat. the boat takes us to the next stop--a village where souvenirs are sold. this is a tourist trap. never get off the boat. there, we are offered fruit and tea (didnt we just eat?!) adn women in yellow traditional dresses sing songs for us. like the playboy bunnies, minus the chopper adn the stage. then, we are led through a garden, where there is a lesson in agriculture. this is a mango tree, this is a coconut tree, to drink not to eat. in the back, there is a canoe, which we are taking through a canal. beautiful ride through the palm forest, although we first had to navigate a complete boat road block. now, i am sweating as we are in peak heat, the guide's eyebrows remain intact, no running, flawless.
back in the boat, coconuts are waiting to drink on the ride back.
and we're off in the van to home. we talk about US politics, and the healthcare system. the guide, closes his eyes when speaking, and when asked questions, would prop up and recit soccer facts. the manchester city is the number one football team in britain...didn't you ask him about popular locations in hanoi? he has a conversation wiht himself. entering the city, we hear the same facts, population of saigon is 11 million people. we have come full circle.

journal club

Today, as my goal for this trip requires, I am presiding over journal club. Now to me, journal club means sitting around discussing the good, the bad, and the ugly of some particular research article and figuring out what the authors did wrong. In Vietnam, journal club, apparently means a whole formal PowerPoint presentations thing.
I offer to meet with the resident who is presenting the article before her presentation. We meet in the office, it is hot. The windows are draped with heavy green curtains to keep the sun, the hot air, and any air for that matter out. I think i might actually die, in this tiny little room on the fourth floor of this vietnamese hospital (the fourth floor is a misnomer: the first is the ground floor, then there is a pho-floor, then the counting starts with 1st floor, so i htink i climbed like 6 just to get here). air conditioner is turned on, but it's really not doing a whole lot. we go over the presentation and the resident went way above and beyond anything I would have done, adding molecules and things. We still have some time, so we head downstairs to grab lunch.
The hospital cafeteria is semi-outside and is similarly hot. what happens in the summer? does it get hotter? oh yes, it does. that's impossible; it is simply impossible for it to get hotter. we sit in the main area--milk coffee for me, soup for the resident. at some point some chick (a patient) tries to beat another chick (pregnant patient), but the fight is separated just in time. then, head back upstairs. I ask many questions about residency. Ob/gyn residency is 3 years; the schedules are less crazy than the US resident schedules (more like 8-5), but they do take night call, which apparently you're scheduled for once a week (and get half day off), but also, residents volunteer to take call and stay longer to 'learn adn practice'. damn, i'm not that motivated.
some boy (pharmacy student) is enlisted to rig up the projector. at presentation time, an older wiry dude shows up introduces himself and before i get a chance to tell him who i am, he launches into a whole life-story. he is the vice chair of the department, adn for hte past 20 years he has been involved in reproductive health, 16 of which he spent in infertility work. umm...i'm alex? then, he proceeds to tell me all about the curriculum reform they are launching in med school and proceeds to pimp me! (WTF?) about curriculum in my institution and whether we use team-based learning (ok, it's been a while since i've been in med school and i honestly, have no recollection). then, people come and presentation starts.
The vice chair takes the mic adn formally introduces himself (wait, you just told me who you are), then formally introduces me and hands me the mic. damnit! then, the presentation finally beins. The resident does an excellent job reading from the slides. but the discussion becomes very formal. I am asked to speak my opinion (mic in hand); my poor resident gets pimped..2 hours later we are still beating the horse. other people come up with questions. there is a resident who asks about how ot tell what the first day of menstrual period is in someone who just had a medical abortion where she is pregnant again. 1) this woman has no business being pregnant again, 2) you did a shitty job making sure she does not get pregnant again, 3) you always have ultrasound. then, there is question boy, who is really hung up on molar pregnancy and asks like 3 different questions about it. the horse is dying in the heat. but, actually, i'm having great time. we talk about regimens, and medications, and contraception, and contra-indications. i ask what else they want to learn about and we come with a next week topic (emergency contraception). finally, class is dismissed. the helpful male doctor came too, adn he asks me if i'm taking a cab home. no, i'll just walk. walk?? but it's so hot outside?! yes, yes it is.