It does not happen very often that a place chooses the traveler instead of the reverse – but this was the occasion of my visiting Vietnam. Not having been to Southeast Asia I did not really appreciate the distinct geographic regions that can be impacted by socio-cultural and economic life. For example: due to the humidity and lack of fresh milk, Vietnamese use condensed milk (that is very sweet to preserve its shelf life) instead of fresh milk. This has popularized a preference for Vietnamese coffee to the point that they consider fine-grinded “brewed” coffee distasteful and irregular. Even that cultural preference has developed from previously deeply rooted French cultural influence.
The north and south of Vietnam are conspicuously different. The north tends to be a milder climate; they usually have less rain, and different taste preferences. This may be, in turn, related to the political climate in the late 70s and the Vietnam War. However, one can see cultural divides notwithstanding the north-south hostilities prior to the integration of Vietnam into one socialist state. I saw this when I spoke to a Vietnamese friend who was from rural “central” Vietnam and would not let me forget it.
While my time in Vietnam was, for all intents and purposes, a clinical skirmish with healthcare disparities – it was difficult to escape the tacit knowledge that I was an outsider. There was an even thicker air of perplexity when I was introduced into the conversation.
“Where are you from?”
“The USA.”
“No, your homeland.”
“Oh, well…North Africa.”
“Ah… knew it. You don’t look American.”
There was a sense of consecration that was due to your heritage, which at its foundation is a dominant East Asian trait. Nevertheless, when you were introduced to a Vietnamese person they asked about your age, your origin, and your profession. I did not receive any derision from my responses – they were genuine interests. I suppose these interests came from the sense of trying to place a person into the vast social infrastructure that is our friendships, families, and colleges. What was extremely interesting was that the Vietnamese (or rather those that I was exposed to) had a precise vision of America. They often derived these images from movies, shows, and music. In fact, many Vietnamese learn a substantial amount of English from these avenues. In a sense, I did not fit the physical and ostensible features of a typical American. I know how this works, as I had the same misconceptions when I first stepped foot on this country. It was not until I had experienced the American culture (or cultures) first-hand and wiped clean my mis/preconceptions did I really understand what an American life really entailed.
As mentioned before, there was a sense of exaltation about American culture – that it had easiness to it, that the easiness was accessible, that the American life had a precarious smoothness to it. One can perhaps attribute this judgment of American life to how doctors in Vietnam stand in contradistinction to doctors in America. Throughout my conversations with Vietnamese doctors, I developed the idea that it was difficult to be a doctor in Vietnam. Despite the intrinsic value of being a doctor (which does hold weight in Vietnam), Vietnamese doctors do not make the “same amount” of money as American doctors. This, one can say, is a feature of the Vietnamese healthcare system. While the tenets of socialism are inexorably misunderstood in relation to colleagues across the ocean, “socialistic healthcare” does have considerable merit. My impression of the Vietnamese healthcare system was that of a Japanese one – where people buy insurance from centralized insurance agencies while the cost of healthcare itself is very low. This inevitably leads to low reimbursement rates for the physician.
However, no healthcare system is without faults and I saw my fair share of people who could not “afford” healthcare. I was made aware that surgeries were not expensive themselves but the equipment sold by pharmaceutical companies was expensive (eg. valves, grafts, catheters, etc). It seemed difficult but the hospital did pull its own weight. There were 2,000 beds and around 6,000 people in the hospital at any given time (family, patients waiting for referral/beds). It really made me question: who is the victim – the doctor or the patient? There is a to and fro notion to healthcare sustainability and resource allocation. Was the idea of a victim inevitable? Certainly, however, the doctors did not live in poverty; they were well-off.
As if it was already not difficult enough to weigh the healthcare inconsistencies between American and Vietnamese healthcare, it was surprising to find even more blunder with American healthcare when compared to a Scottish colleague of mine. We had spoken about the necessary vaccines in order to do a clinical experience abroad. The necessary vaccines were not very expensive or had already been administered (HAV, HBV, Typhoid); however, the “optional” rabies vaccine was an intangible financial endeavor. The rabies vaccine (alone) would have cost ~ $1,000 USD while my colleague mentioned she received all required and rabies vaccines for the equivalent of ~$60USD. I will leave the reader to contemplate this difference.
Observably, there were not very many differences between doctors in the USA and Vietnam. There was the obvious, unrelenting, and assiduous need for perfection, the constant reading, reassessing, and calculating of data, and the perfunctory and ubiquitous coffee run. In short, this was an unbelievably valuable experience that I could never forget. Long live the virtues of globalization.