My life with pediatrics:
A foot soldier's saga
Exactly 40 years ago, to the month, I left the Military Second Rehabilitation Center (Trung Tam Hoi Luc) in Cam Ranh Bay, on the coastline of South Vietnam, on a small fishing boat to escape the wave of communist invasion from North Vietnam. One month later, on April 30th, 1975, I lost my country, my whole way of life. The only things left to me were my family and my medical diploma, and they remained as the only threads of continuity around which I rebuilt my life over the next four decades. From the position of a vice commander of a military facility, I was going to become a furtive doctor in communist prison; a doctor in people’s hospitals; an illegal alien and volunteer physician in refugee camps across South East Asia; an American intern learning modern medicine and English at the same time; and finally a pediatrician, and an accidental writer of science, healthcare, history and culture.
Saigon after April 30th, 1975
After the fall of Saigon, I had to go to three different re-education camps (in fact concentration camps) before I was sent to a remote “new economic zone” to learn how to earn a living with my own hands, working in the fields instead of being an “intellectual” (preferred term for “white collar" or professional job) who "exploited" the “tears and sweat” of the working class." Once I volunteered to work at a remote district clinic, but they refused my help because I did not have citizenship rights, as I was under parole after my discharge from the camps. I had only the opportunity to give emergency care to my neighbors as I was the only doctor living in this backwoods area.
Soon however, as large numbers of doctors in the private sector left the country, the new communist government of Saigon found out that they really needed the help of professionals still held in the camps to run the show and released them back to the city.
I was initially assigned to the pediatric section of a newly established clinic in Thu Duc, a satellite city about 10 miles from the center of Saigon. It was formerly a hotel confiscated from its owner, and its guest rooms became our exam rooms. There were very few Southern doctors left, and the hospital direction was in the hands of two aged party member doctors (trained on the job, without formal medical education) and one young recent graduate from the Hanoi Medical School (communist North Vietnam, with a much shorter curriculum). I did have significant experience with treating children during my years in the military and we all learned as we practiced, in rather primitive conditions. The only ancillary services we had at our disposition were a makeshift laboratory operated by a pharmacist (CBC done manually), and a portable fluoroscopy machine operated by a radiologist, who had to close his private practice and donate the machine as a token of his willingness to cooperate with the new regime.
A few months later, a large Catholic seminary nearby was confiscated. Its Redemptorist priests, accused of possessing weapons, were put in prison and the property became the site of our new People's Hospital of Thu Duc. Their library was ransacked. Large, old and beautiful books were burned as unwanted vestiges of superstition. We took over the building. A younger doctor and I were charged with creating a pediatric service with an inpatient ward and an outpatient clinic. We moved the priests’ beds into the patients’ rooms, we swept the floors and voila, a new hospital. The two pharmacists were recently discharged from the concentration camps, one of them with graduate training in America, “heroically” tried their best to perform as many tests as they could with very scarce supplies scavenged from old military depots. The younger one, after failing many escape attempts to get out of Vietnam, killed himself a few years later.
Because my back pain worsened with the bicycle commute and, preparation for an escape from the country required a work place closer to home, my wife paid some bribery money for my transfer to a larger hospital near home. Our chairman was a French woman married to a Vietnamese high ranking doctor at the ministry of health. She came from Hanoi, was extremely fluent in Vietnamese and treated us professionally. Interestingly, she insisted that we write our clinical notes in Vietnamese. Unlike in the North where Vietnamese was the only language used in medicine, some of us who had completed our training in French or English, were not totally familiar with formal Vietnamese medical terms which were not standardized still. It was a little ironic that a French woman had to remind us about this language use. As an aside it is also interesting to note that English is used more and more nowadays in higher education in Vietnam. We practiced "heroic" medicine with our limited knowledge and few means available, dealing with infectious diseases such as measles and even rabies, poisoning by insecticides, severe asthma attacks, purulent meningitis with thick and green cerebrospinal fluid, pericardial effusions, and worst of all epidemics of dengue hemorrhagic fever, shock and rampant malnutrition.
Besides working full time in the pediatric department with a meager salary, I was informally allowed to operate a small clinic after hours and on weekends. A middle aged couple, my wife’s family’s friends, allowed us to use their town house living room for this purpose, and their young and intelligent daughter volunteered to help my wife as an assistant nurse. We bought used instruments and medicine left over from the "prerevolutionary" era on the black market, as “pharmacies” (drugstores) had been closed down. We boiled disposable syringes, needles and gloves to recycle them. Our patients became very attached to us as we shared a common plight and understood each other, in a society that had been turned upside down. People knew that doctors “from the jungle” had no formal medical training, and even troops that came from the North sought out southern doctors for their own or their families’ health needs. Patients knocked at my door all times of the day for emergencies. On my last night in Vietnam, on the eve of our escape by boat, a child with an asthmatic attack was brought in late in the evening for help. His parents insisted that we allowed them to stay in our tiny living room overnight so that I could monitor his breathing. Even after we reluctantly let them know our plan to go away early the next morning, they still begged us to let them stay. They did not leave until 3 am, with their child in much better condition, wishing us all the luck for our trip.
Medical volunteer in refugee camps
On Christmas Eve of 1980, we arrived at a small island on the east coast of Malaysia. Together with a former classmate from the Saigon Medical School, we were assigned to running a small hospital on the island, taking care of a few inpatients, running an outpatient clinic and screening the refugee population for tuberculosis. There were two fatalities that I will never forget: a toddler drowned in a well and a case of poisoning by unidentified lamp fuel. A few months later, we were moved to the transit Camp of Sungei Besi A in Kuala Lumpur where I worked at a “sick bay” with a pediatrician and an internist from the US, a French general practitioner whose husband worked in business in nearby Singapore, and a British nurse. As I spoke French, English, in addition to Vietnamese, and I lived in the camp and was available all the time, I served also as a translator between the medical staff and also between the staff and the refugees. This was the first time I practiced medicine outside of Vietnam, working with non-Vietnamese medical professionals, and learning from an American pediatrician who would later give me her generous help in my application for an internship position in the US.
Afterwards my family and I had to spend a newly prescribed stay of six months in the PRPC (Philippines Refugee Processing Center) in Bataan, near Manila. The refugees had to take basic English classes given by Filipino teachers and the so called “cultural orientation” courses, taught by qualified Vietnamese refugees who formerly had spent time in the US and who received a short training for the purpose. I was given the opportunity to give lectures in English about health care and preventive medicine to these teachers of “cultural orientation” classes. It was the first time that I gave lectures in English, but according to the Catholic sister who ran the program it worked out alright. It was a good opportunity for me to review my medical knowledge with a few textbooks available, most importantly a Nelson Textbook of Pediatrics that Dr Laura Brandt, the American pediatrician, had given me as I left Kuala Lumpur.
American residency in Pediatrics
I had passed the ECFMG in Saigon, Vietnam in 1972. It is an exam that certifies foreign medical graduates’ competence in medical knowledge and in English before they could apply for an American internship. I did not take it by necessity. Some of my friends suggested I join them in taking it to see how we would compare with international and American graduates. The 70 dollar fee was waived, until we pass and apply for a position in a US residency program, which to me at the time was quite an unimaginable occurrence.
It was then with great satisfaction and pride that I could apply to a residency in Pediatrics only a few months after I left the refugee camps. I quitted my short stint as an evening supervisor of an office cleaning company and started my first rotation at the neonatology service of the Columbia Hospital for Women, an affiliated hospital of the Georgetown University Residency Program. The residents had to rotate through at least five teaching hospitals located in the District of Columbia, Maryland and Virginia . The program gave us exposure to different patient populations and different styles of practice from diverse groups of teaching attendings, and was dubbed as “The Beltway University”.
It was quite a shock when I was suddenly immersed in the high tech medical environment of an NICU (Neonatal Intensive Care Unit), in one of the most sophisticated hospitals in the capital city. Luckily, the other residents, who were much younger than I, gave me a lot of support. The foreign graduates came from many different countries: Palestine, Iran, Egypt, South Africa, Iceland, India, Russia and Korea. All, except a soft spoken young intern from Korea (before her country’s recent rise to prominence in the developed world), had something that I did not have: they all spoke English very fluently, and despite their different backgrounds, they were familiar with American culture and bonded easily with each other. Language and culture were the major obstacles I had to overcome to be able to share the camaraderie of the group. Day by day, I survived my first rotation and, then the next. The first year passed without incident. Even after after long work days at the hospital, I had to stay late at night to update my rusty basic sciences knowledge in addition to studying pediatrics. All of that had to be done within three years, perhaps the most challenging years of my whole life.
One of my senior residents once posted a note in the residents’ on call room, quoting me: “Residency is worse than reeducation camps”. I suppose, concentration camps in Vietnam were to them something as remote and unreal as the nine circles of Dante’s inferno, and it gave them some pride as well as some validation of their complaints about the hard life of a medical officer in training. By the end of my second year, I decided that I would not apply for a subspecialty fellowship after my residency. In the 1980’s, pediatric residents had to spend a lot more time in the inpatient wards than they do nowadays, and emphasis on outpatient care (the “bread and butter”) and continuity of care came much later in medical education. I felt most uncomfortable in the intensive care units (ICU). Many of the tiny patients would graduate with significant sequelae and at enormous cost, financial as well as emotional, to their parents. The ICUs were like austere laboratories with the newly adopted computers continuously spitting out lab test results on long and wide sheets of paper. Although I had more clinical experience brought from another world, I did not have good hand skills and I did not perform as well as recent graduates often more than ten years my junior.
Georgetown University, Department of Pediatrics, circa 1984-85
I requested and was allowed to spend my last year of pediatric training away from the highly technical tertiary care at Georgetown before going into private practice. As the chief resident of pediatrics at its affiliated Arlington Hospital, I was also incorporated into the Georgetown University Medical School faculty. In the more relaxed atmosphere of a community hospital, I was allowed more leeway in managing patients. I could spend more time searching and reading medical journals from the library for case presentations at noon rounds with the chairman, Dr David Reese III, interns, residents and students from Georgetown. It was a very gratifying period because the chairman and attendings seemed to be very appreciative of my performance. The staff was very friendly, and as they said, considered me like family.
These three years of residency ”reeducated” me into a physician in the “first world” of developed countries , creating my new identity as a pediatrician, completed a year later with the certification by the American Board of Pediatrics as well as membership in the American Academy of Pediatrics.
Georgetown University, Department of Pediatrics, circa 1984-85
This is still the most important gift that I received from the US educational system, and in a larger sense, from my new country. Each year the US residency system takes in thousands of doctors from different educational, professional, ethnic, and cultural backgrounds, and in a matter of years, transforms them into extremely efficient, well equipped health care professionals. They are standardized not only in their technical knowledge, but also in the way they work and how they feel about their profession. To me, someone who had crossed cultural boundaries many times, American doctors are a special breed, with their blend of scientific compulsiveness, a sense of social responsibility, and a dose of entrepreneurial spirit.
However, there was something I missed. Left behind was "heroic medicine” that I had practiced during less fortunate situations, where the physician acted alone, sometimes in the worst environment: hospital in a remote, nearly razed, under siege town; or a communist reeducation camp; or a clinic in a refugee camp.
Private practice in Falls Church, Virginia
Falls Church takes its name from an 18th century church located on a tobacco rolling road from the Little Falls of the Potomac River that runs through the capital. It is one of the wealthiest communities in America. However, our mailing address at 6319 Castle Pl, Falls Church, Virginia, might be misleading in that it was actually outside of the City of Falls Church, next to the seven corners created by the intersection of five major arteries that cross this busy area of Northern Virginia. President Eisenhower brought Soviet Premier Nikita Khrushchev here as a showcase of capitalist lifestyle with its new Seven Corners Shopping Center.
In December 1982, when I moved my family to the area, Seven Corners Mall had been eclipsed by the new Tysons Corner Mall a few miles away, and had lost its glamour as well as its wealth. The area was flooded with refugees from waves of boat people leaving Vietnam to escape its Maoist socialism, which eliminated the private sectors of the economy and denied most human rights. With our family of five and practically no income, a rundown apartment near Arlington Boulevard was the only thing we could afford.
After two years, we bought a small house with a nice, shaded yard. It was for sale at a heavily discounted price (we were unaware that there was a housing bust then). I discovered it by pure serendipity only a short distance from our apartment after the manager decided to evict us for being overcrowded. That also explains how, after my residency, in order to be close to home and not too far from the hospitals, I chose an office in the same Seven Corners area. Additionally, there was a growing Vietnamese community in the surrounding neighborhoods.
In the last year of my residency, I allotted the entirety of my holiday weeks into the last month (June, 1986), so that I could open my private practice a little earlier. The real estate agent showed me the basement of an old office building, The Seven Corners Professional Building in Falls Church, Virginia, which made it more affordable and also made the owner more lenient regarding my credit history which at the time was negligible. I took the small office formerly occupied by an American family practitioner, who reportedly had died on the job, a few years earlier and whose medical records were still littered on the floor. I decided to practice general medicine in addition to pediatrics to have a broader patient base.
There was a growing community of Vietnamese expatriates in Northern Virginia and nearby southern Maryland, many of them spoke little English and knew little about American culture. My wife had been operating a small home child care business at home, and many of her customers easily became loyal new members of our practice. There were also people who had known us even from the time I was offering my free service as a doctor in the refugee camps in Malaysia and the Philippines. They were happy to find me here again in America. There is a Vietnamese saying for that emotion laden situation: “Tha hương ngộ cố nhân" (In other people‘s village, meeting old people, or simply: finding old acquaintance in a foreign land).
Seven Corners Pediatrics, in Seven Corners area, facing Arlington Boulevard
However, the situation was not that simple and loyalty from fellow Vietnamese immigrants could not be taken for granted. There was always a certain self doubt in the mind of Vietnamese people who had been through decades of internecine warfare, in a country colonized for centuries by more dominant cultures. There was still in the recent immigrants' mind a difference between the “American doctors” (that included any doctors who did not speak Vietnamese), and the “Vietnamese doctors” (those who spoke Vietnamese). Many Vietnamese professionals fluent in English did not feel comfortable with the care given by Vietnamese doctors, even when they knew well that we had the same kind and amount of training. A friend once relayed an incident when he was doing his internship in anesthesiology at Georgetown University Hospital soon after his arrival in the US in the late 1970's. As a patient was crying for help, he recognized quickly that she was from Vietnam, immediately ran to her, offering his help in Vietnamese. To his surprise, the woman waved him away and said ”No, not you, I want an American doctor!”. This is to say that it was not at all a ”captive audience" that I had among the Vietnamese parents. However, it helped that I came from a well known university of the capital city, and that I was the only remaining board certified pediatrician in the community after the other Vietnamese pediatrician moved out of the area.
After three years, while waiting for my wife at a dental office, I discovered a 50 year old empty colonial house next door. It was a three leveled colonial brick house, which had been converted into an office for a real estate agency whose name was still on its oversized lighted sign box, facing Arlington Boulevard. Again, it was only a few hundred yards from our first apartment. Our new sign read, in blue letters, quite predictably, “Seven Corners Pediatrics."
Seven Corners Pediatrics
Education for patient’s parents
From the beginning of my practice, I saw that Vietnamese Americans badly needed information about health care written in their own language. Before the communist invasion of the country, South Vietnamese had very few health care related information readily available to them in plain native language. In the 1980’s, a few books, written by doctors in the 1960’s or 1970’s and reprinted in the US, were already obsolete with many inaccuracies. They were available at the bookstores at the nearby Eden Center where scores of small businesses ranging from grocery stores and restaurants to tax and medical offices were attracting Vietnamese customers from the mid- Atlantic states. There, one could get for free tabloids in Vietnamese with occasional articles about adult health care, authored by a local internist-novelist or by a few doctors in other states who were eager to help with the education of the new immigrant community .
Vietnamese as teaching language was used at the Saigon Medical School only since the mid 1960’s, and even before that, when French was used a the teaching language, education in medical schools stressed facts memorization over learning the mechanism of diseases and keeping up with advances in medicine. Most doctors, after they graduate, did not believe in explaining to patients about how the body worked or how to avoid diseases. Even if they did, Vietnamese medical terminology was not standardized yet and mostly foreign even to the educated public. This matched with the patients’ own expectations however. Doctors had to give them pills (usually antibiotics) rather than advice or lectures, or even better, a shot or an intravenous drip of vitamins to make them feel better, and quickly. Otherwise, they would switch to another doctor to get the job done more to their liking.
Taking care of Vietnamese children in the 1980’s, I had to deal with many particular cultural issues. In Vietnam under economic embargo, food was lacking and condensed and sweetened milk or powdered milk (to be reconstituted with boiled water) were rationed as the only baby food available. New mothers had to let doctors or nurses examine their breast and certify that there was not enough milk production before they could get their ration of milk for their babies. Also, traditionally, for Vietnamese as well as for Chinese, ideal babies were big and fat babies. When they came to the US, many parents fed their babies as much as they could with formula, instead of breastfeeding them which is universally considered to be the best nutrition for a baby. Women had the widespread belief that their breasts were too small to give enough milk to feed the child, or for some reason the milk was not of a good quality. A free package of formula dispensed at the discharge of the baby from the hospital did not help the cause for breast feeding either. Besides, many of them were employed in low paying jobs in nail shops and restaurants that required them to leave home very early in the morning and come back home in the evening very late, only for sleep, seven days a week. Child care was delegated to babysitters or grandparents who did not know any English and could not tell the difference between whole milk and baby formula. Nutrition then was a major topic for discussion with a newborn’s parents, and it remained one of their major concerns as the child grew older, with the growth curve characteristic of their parents’ genetic and ethnic background. The next big question to be addressed then was ”why my kid is so thin? why do his ribs show? why his height is not above the 50th percentile [of the US population]?"
Soon after I graduated from Georgetown, my former program director once told me in passing that he heard I had an “ethnic practice”, a term that caught me off-guard then and puzzles me still. However, “cultural and linguistic competence” has become since the an item of medical school curriculum. I suppose my former professor assumed that I treated only Vietnamese patients, straying from the mainstream, which was not true. However in a sense, the immigrant majority of my clientele had its own special medical issues. A condition I frequently had to deal with at the beginning of my pediatric practice was severe iron deficiency anemia of toddlers due to excessive amount of cow milk intake, as cow milk contains very little iron necessary for the production of red blood cells. The child would be full all day long with milk, not wanting to eat anything else, which alarmed the caretaker who then tried to feed him with even more milk. Babies would become obese and quiet, related to anemia. Noticing the baby’s pale face and weight, doctors would take a blood sample only to find one half or one third the normal red blood cell count. The treatment was rather simple, just doses of iron drops, but the prevention required a lot of one on one explanation of basic disease processes, instructions and perseverance from the pediatrician.
Similar problems became less frequent over the decades. As Seven Corners became “revitalized” with its thriving large chain stores like Home Depot, Barnes and Noble and Target, the Vietnamese moved out to better off suburban houses and the local apartments, now advertized as “luxury apartments”, are populated with new immigrants, mostly Hispanics. The Eden Center with it colorful Lion Arch and its Clock Tower, a replica of Saigon downtown landmark Ben Thanh Market, contains about 120 stores, and itself as “the heart and soul of the Vietnamese-American Community for the entire East Coast”. My patients now mostly speak English. Very few teenagers are fluent in Vietnamese, even those whose parents had compulsively taught them their mother tongue in their preschool years. Socialization in middle school, peer pressure and even their parents’ assimilation over the years are the main reasons for this language shift. This generation of patients is becoming more like the mainstream in that they have more obesity and allergy problems than those I saw three decades ago.
Virginia Hospital Center
However, the need to help parents understand their children’s medical conditions and navigate the American health care system remains the same over the years. Besides, there have been successive waves of new immigrants from Vietnam which is now more open to emigration.
In trying to educate my patients’ parents, I wanted to introduce them to something I had learned from American medicine: a scientific approach to their health problems, and a basic understanding of modern concepts of diseases and treatment, in opposition to superstition and faith healing, or even blind submission to the doctor’s orders. The next important thing was empowering patients or their parents in the decision making process, which is intertwined with the American culture of informed consent and doctors liability.
In the 1980’s and 90’s, for printed educational material for patients in their language, I could not get them from Vietnam as it was still under American embargo. This motivated me to write, in Vietnamese, not only about the new American healthcare system but also about problems that new immigrants from Vietnam had to face and understand. I wrote about child development, bilingualism, child abuse and neglect, the safe use of drugs in pediatrics, attention deficit disorder, autism (two relatively new topics in the 1980’s), controversies about circumcision in the newborn, air pollution, vaccinations. Of high priority, I had to create fact sheets about vaccinations in Vietnamese, even before the mandatory VIS [Vaccine Information Sheets] were available from the CDC in different languages. Nowadays, even as communication between the US and Vietnam is easier and faster, there is still no useful education material that I can get from Vietnam, and I still have to write new articles about arising issues for my patients’ parents as well as for the Vietnamese media.
Outreach to the Vietnamese diaspora
For more than 10 years I have given my free service to the Vietnamese section of the US government sponsored VOA (Voice of America). In the last 5 years, I have been giving hundreds of weekly recorded sessions where I responded in details clinical questions, submitted by Vietnamese inside Vietnam as well as expatriates all over the world. Initially I discussed about pediatric problems only. After a few years, as the only consultant left in the program, I tried to answer all questions received and spent extra time in research to produce referenced short articles about a variety of topics, from the familiar “bread and butter” like allergic rhinitis or diabetes to the unusual inquiries like urotherapy (a question from a doctor in Vietnam about the use of urines in therapy) or the treatment of autism with acupuncture. My ambition is to create with those weekly mini-lectures an online “mini-medical Wikipedia” in Vietnamese that is readily and easily accessible to the Vietnamese diaspora in radio emissions and online. Indeed, quite a few Vietnamese doctors have told me that they followed my broadcasts to learn about the most recent updates in medicine as there is limited access to medical literature in Vietnam.
My health care columns started to appear on Vietnamese newspapers in the area since 1986. I found out later that they were reprinted frequently in other Vietnamese newspapers as far as California, Washington, and Canada where there were sizable Vietnamese communities. Later, I edited them into a book with the title: “Raising Vietnamese Children in America, A Vietnamese pediatrician's discussions on healthcare and education of children of Vietnamese origin in America". I had it printed in hundreds of copies that I gave free to my patients’ families. It came out eventually in two volumes, followed by the third part which was only published online. Many of my articles appeared years later in websites and online newspapers published inside Vietnam. A new market economy there created drastic improvements in socioeconomic conditions, and the newly created middle class needed answers to their questions about child care and education in this globalized age.
One of my other favorite topics is the teaching of the Vietnamese language, traditions and culture to the next generation of Vietnamese Americans, its importance in maintaining a healthy relationship between generations and its role in the process of identity building.
This online writing activity of mine came to life before the emergence of the now ubiquitous blogs. One of my nieces in Vietnam got a copy of my book that her brother sent back from America. She had a daughter and found the book answered many of her parenting questions. She spent some time to put it in digital form and shared it with her circle of friends. Then her father created a website to make it available online, creating the first website in Vietnamese dedicated to pediatrics, around the year 2000. People in Vietnam still had limited access to the internet, even less the ability to publish their writings online. After multiple transformations, the web page now incorporates my articles about general medicine, advances in sciences that I found interesting and relevant to the Vietnamese community, and texts of hundreds of question-and-answer recordings that I have done for the VOA. Also included on the web site are articles about Vietnam’s history, tales and legends that I hope would help Vietnamese parents have something to say to their children about where they came from, thus hopefully contribute to their mental health and their identity building.
One outcome of this latter effort that I treasure was a book with a long title that I co-wrote with Dr. Chat Van Dang. “Vietnam History, Stories Retold For A New Generation”, was published in 2011, with an expanded edition in 2012. This was the result of the cooperation of two old friends who only met twice in the last 40 years, since we lost Saigon. I also contributed many chapters and served as co-editor of another collective effort led by Dr Dang with thirty seven authors, among them thirty two physicians. “The Vietnamese Mayflowers of 1975” and its twin bilingual version “Across Shining Seas”, were “a compendium of genuine stories of overseas Vietnamese” sharing “their war and peace actions” and featuring extensive background articles about Vietnamese history and culture. It could not have happened without the internet that connected both of us together by emails, that allowed us to do our researches mostly online in our spare time and late at night, and that provided us with so many new findings and researches made available by so many people the world over who graciously contributed to a body of knowledge about Vietnam , inconceivable before this digital era.
Looking back over the years, it was like a dream come true. I was able to build from scratch a small medical center facing one of the busiest boulevards of booming Fairfax county. (A few years ago, we added a new name “Seven Corners Medical, Eye and Dental Centers” as my eldest son, a pediatrician and his wife, an ophthalmologist joined our group, followed by my third son Hiep, a dentist and my second son Hieu, a family doctor.) I am affiliated with Fairfax Hospital and Arlington Hospital (now The Virginia Hospital Center) which over decades have grown into prestigious giant medical centers. I have seen thousands of young people walk through my doors over the years. They now warmly and politely say hello when they see me at local restaurants or at community meetings. I have the privilege to speak regularly on the radio and the internet to an international audience of Vietnamese to discuss questions about their health. As I see much fewer patients at my office, I am able to contribute more regularly to Vietnamese medical journals in the US and in France about healthcare, medicine and culture.
On the other side, there are also changes that made me weary of what way medicine will become in this country. In the last two decades, approximately since the year 1993 when Hillary Clinton tried and failed to implement her drastic health care reform, the way we work has changed drastically. The care of our patients admitted to hospitals has been taken over by hospitalists, disconnecting the independent pediatric generalist from secondary and tertiary care. Weekly hospital rounds where new and relevant topics are discussed are becoming less and less relevant due to the new internet resources, which can now link the pediatrician to a wealth of technical knowledge, more and more easily accessible with smartphones. On the other side, with a more stringent payment system from healthcare insurance companies and the government, community hospitals become competitors of the private physicians’ offices. They open their own outpatient clinics staffed with their own newly graduated doctors, creating their own closed circle of referral and excluding the same doctors who have very limited resources and who had helped build them up at the beginning. The American pediatrician, kept up to date on everything from the treatment of rare diseases to the mundane topics of school bullying and temper tantrums, has a very limited field of therapeutic intervention where he may act without consultation with his subspecialist colleagues. This reminds me of an old Vietnamese story that my father told me years ago. A woman used to work in the king’s kitchen in the forbidden city before being discharged back to her village. As the country people were preparing for a special festivity with guests from the court, they proudly invited her to lead the kitchen team, expecting esoteric culinary chef d'oeuvres. The poor woman protested: “I can’t cook anything, the only thing I did was chop onions”. The current trend in over specialization in medicine reminds me of this famous quote from Rabelais: “Science sans conscience n’est que ruine de l'âme” (Science without conscience is but the ruin of the soul).
Age and wisdom
I am approaching the age of seventy. Vietnamese consider septuagenarians rare occurrences: “since antiquity, people rarely live to the age of seventy”, said the Chinese poet Tu Fu. Confucius also said “at the age of seventy, follow your heart and you cannot be wrong”. If I did not go to medical school and become a doctor, of course my life would have been totally different. I probably would not have lived long enough to approach my seventies, given the war times, the concentration camps and the refugees camps that I passed through. Regarding wisdom that Confucius expected from this age group? Enough wisdom learned from my studies, my life experiences and my mistakes to be able soon to follow just my conscience, my heart and still stay on the right path? If the answer is a yes, any achieved level of wisdom should not have been possible for me without my decades with medicine, married to medicine, I could say.
The American health care system is going through massive changes that inevitably affect the lifestyle of doctors in this country whose practice becomes more and more monitored and regulated. For example, according to Medscape, there is currently an “outrage at the ABIM (American Board of Internal Medicine)—as well as other specialty boards—for forcing doctors to jump through an ever-greater number of hoops to maintain their certification, when the doctors are already voluntarily undergoing continuing medical education (CME) to keep their knowledge up-to-date.” However, after everything is said and done, I still love medicine as a calling and a profession. I am happy that all my children are in health care but in different practice environments: pediatrics, family medicine, dentistry, and radiology. I am trying to make the most out of my long "love affair" with medicine, even as I am already in half retirement. I am trying to relay to my people what I know, what I have learned, hopefully disseminating knowledge with every medium available to me: one on one preceptorship for medical and nursing students, science articles in Vietnamese newspapers and professional journals, radio talks, books, web page, even direct talks with people who want my advice. I feel that as I have reached almost all the things that I had ever reasonably dreamed of when I was still under communist regime, I still have to pay a debt to the people who for so long suffered with me, nurtured me before I came to this promised land which wholeheartedly adopted me. To many Vietnamese people inside Vietnam and all over the world who are still hungry for knowledge, for a more equitable participation into the modern “flat” world that had been denied to them for so long by forces beyond their control, I am trying my best to do something, even trivial, for them.
Hien V. Ho, MD, FAAP