Josh - Medical Elective in Vietnam

Dear BIT Trustees,

Thank you so much for your contribution towards funding my medical elective in Vietnam. It was a once in a lifetime experience that provided me with great insight into how healthcare is practiced in a different part of the world.

I attended the Emergency Department in Cho Ray Hospital, Ho Chi Minh City for 4 weeks where I got to learn about Vietnams public health challenges and how they’re managed. Ho Chi Minh City has a population of 9 million equalling that of London. The main format of transport around the city is motorcycle making road traffic accidents a common presentation in the ED. Infectious diseases spread fast in a dense population, particularly Tuberculosis which I saw a lot of. Unfortunately, the amount of treatment people receive is directly proportional to their insurance cover meaning chronic disease, like diabetes, which is so well managed in the UK, isn’t in Vietnam. Therefore, late-stage manifestations e.g. ulcers, necrotic digits/limbs, widespread cancer was common. Consequently, the management of patients would be more radical i.e. amputation of affected limb. Due to the financial burden of healthcare, Vietnamese people tend to self-manage their health however they can, turning to over the counter steroids and herbal remedies for relief. Although, long term steroid abuse brings about its own complications like Cushing’s disease – rarely seen in the UK. This was eye opening to me having only seen how the NHS operates.

Having grown up and now working within the NHS has made me take a well-functioning healthcare system for granted (albeit under great duress!) Cho Ray Hospital was incredibly overcrowded with patients filling corridors and sleeping on the floor. This coupled with the intense heat (upwards of 35 degrees Celsius) made the hospital a tough environment to get comfortable in. Patient beds aren’t spaced out, and at peak business 2 patients occupied one bed to meet demands. Upsettingly but unsurprisingly, COVID-19 spread easily accounting for 50% of all hospital deaths. Vietnamese Doctors are far more casual with their attire and antiseptic practice, wearing white long sleeve coats with open-toed shoes whilst in the UK all hospital doctors are bare below the elbows and wear scrubs. The patient – doctor relationship is different too. In the UK it’s imperative that patients are kept well informed with their current health status and are involved in their plan of management. In Cho Ray hospital Doctors had complete control over the management of patients – who weren’t involved in decision making.

The stark differences between the NHS and Vietnamese healthcare were shocking at times but provided great learning opportunities and perspective. I’ve come back from my elective invigorated and thankful for the position I’m in. This experience has undoubtedly improved the way I practice medicine before I start my career as a doctor. For that I’m truly grateful.

I hope to meet you all and thank you in person soon.

Regards

Josh