Medical Clinic Field Notes
Finally, the medical clinic day has arrived. The medical team consisted of 5 physicians: Dr. Hoang Phi, an internist from Houston, TX, Dr. Mai Anh Mai, an internist from Saigon, Dr. Thai Nguyen, an internist, Dr. Tito Nguyen, à radiologist and acting pharmacist, and myself, an ear, nose, and throat doctor from Orange County, CA. Dr. Bich Loan Pham, a pharmacist from Saigon, had obtained all the medications we needed about 3 months before this trip. We also had assistance from Dalton Bui and Tri Pham in the pharmacy department and Kim-Oanh Phi, Thanh Bui, and Stephanie Nguyen in the registration and check-in department. Our medical clinic was set up in an old and shabby house belonging to the local government. It had an antique tractor in the corner, which cannot be moved. We arranged 4 old school tables for the 4 physicians and several tables for the medications for our pharmacy department.
By 9 AM, when we arrived to the clinic, our patients were already waiting for us in front of the clinic. We immediately went to work: measuring blood pressure and weight, directing patients to the physicians and to the pharmacy counter. We had several Red Cross volunteers assisting patients from station to station. Our first patient, an elderly woman in her 80’s who could not walk, had to be piggy-backed by her grandson to the clinic. Moving from station to station, she has to be carried. All patients were older than 65, yet they appeared to be much older than their age. One by one, each patient got to see an internist and were referred to me for any ear, nose, and throat problems. The number of patients increased rapidly, and we had a temporary backlog. I was asked to see more patients, usually those who had back, leg, arm pain, without any internal medical problems.
One 68 year-old patient complained of the usual back pain that keeps her awake at night. It turned out on her exam that she had severe ear bone erosion and complete ear drum perforations due to chronic infection. However, the chronic ear drainage and hearing loss were not priority on her list. She has been living with severe hearing loss and has accepted it as facts of life. It was the back pain that she wished to seek treatment. I thought how in United States, we ENT specialists would panic to find such severe ear diseases. We would immediately obtain a CT scan and advise immediate ear surgery since severe chronic ear infections would cause intracranial complications, meningitis and death. Looking at my patient, she seems to be adjusting quite well with her ear problems. I quietly advised her to keep her ears dry, and prescribed antibiotic ear drops and antibiotics if her ears got worse, and pain medications for her back pain. She laughed shyly when I told her to do back exercises and bedrest. She told me gently: “I have to work everyday, chopping woods, to keep foods on the table for my family.”
In the afternoon, after we have seen about 200 elderly patients, we went back to the school site to help the pediatricians and dentists to finish seeing the remaining 120 children. The line was so long, and the children were mostly accompanied by an older sibling (older by 1-3 years). I saw mostly healthy children with poor dentition. One 8 year-old child had very large tonsils. He had difficulty with swallowing, loud snoring and apnea at night. By appearance, he looked like a 5 year-old. I advised his mother to bring him to see an ENT specialist to get the tonsils removed. He would definitely eat and swallows better and will grow normally.
It was a rewarding experience. Even during brief contacts with the patients, the stories of their lives have profoundly touched me. Thinking about how I was so burned out in the last few months with my solo practice, with the amount of unnecessary paper works, uninvited interference from insurance companies, government rules and regulations, billing problems, and hiring and dismissing employees, I now have a different outlook in life. I hope that I will be able to go back to work in a better state of mind, appreciating what I have to face with everyday, my problems are really minimal compared to what my patients in Tam-Kỳ, Quang-Nam have to face throughout their lives.