Experiences of a med student with an incurable travel bug.

Archive for May, 2010

Nha Trang

Upon arriving in Nha Trang, we checked into Duy Hung Hotel, one that had come highly recommended by Rot (“Wrote”), the extremely helpful manager of the Pink House in Dalat. After dropping off our things in our room, we wandered the area for bit until we found a
boardwalk/night market sort of set up that had a bunch of little restaurants as well as souvenir vendors. Dinner was at Roses, a little sushi place in the midst of the lantern and string-light ambiance; the rainbow roll was great, but after all the spices of most Vietnamese food, it could have used a little more spices (apart from the wasabi). After dinner we wandered amongst the vendors and then along the beach before calling it a night.

Wednesday I grabbed a baguette with an omelet, cucumber, and hot sauce inside for breakfast from one of the street vendors before our minibus (old van with extra seats and even more people crammed inside) picked us up for the island tour we’d signed up for. The “Nha Trang Boat Tour” took us to four local islands for swimming, snorkeling, and lunch. The water was perfect, and the snorkeling was fun once you got far enough into the coral to find a few schools of fish. The other people on our boat were a lot of fun as well and it was entertaining sharing stories.

While talking about a variety of bizarre encounters, we got talking about the relative size difference between most of us and the locals. Two of the girls, who were both very large in addition to just being taller, told us about how they’d been walking along the street one day when all of a sudden the both got slapped on the backs of their legs; when they turned around, there was this itty bitty little old lady crouched on the ground laughing while exclaiming “So, big, soooo big!!” with her arms spread wide. Considering that even normal sizes around here are large compared to the locals, anyone who is bigger than average does stick out and garner extra attention.

Anywho, back to the boat. After swimming and snorkeling at the second island, we dropped anchor at the third one for lunch. Seeing as how we were on a small boat with a small galley, we weren’t expecting anything spectacular. First they brought out plates of noodles. Then plates of cooked spinach. Then plates of pork, of fish, of chicken, of squid, of spring rolls, of bananas, and of rice. We couldn’t figure out where all this food came from in such a small space, but it was incredible. There was way more than enough for everyone and all of it was absolutely incredible.

While we let our lunches settle, the tour guide and crew set up a little band right there on the boat, complete with electric guitar, bass, and a tin drum set. The “Nha Trang Boy Band” proceeded to regale us with some fabulous music while we waited for the noon rain to subside. The best of their songs was easily “Cyclo”, a song with “Sweet Child of Mine” instrumentation but totally different lyrics:

“Every morning, I ride cyclo,
With my girlfriend, 100 kilo,
Ooh, oooh, ooh,
She very heavy.”

The song continues to detail how she ate all his food, drank all his beer, and broke his cyclo (the motor bikes that somehow manage to be more numerous than people on this continent).

After that fantastic entertainment, it was back in the water for a floating bar! We didn’t sign up for a booze cruise, but that’s what it turned into: we went through a good six to eight 1.5 liter bottles of rum and pineapple juice before all was said and done, all this while singing rousing renditions of “Cyclo,” of course.

There was just one island left after the floating bar, so everyone just grabbed a floating ring and relaxed in the water, most with a Tiger Beer in hand. Very relaxing, and there was still cloud cover so we weren’t being baked, either. By the time we started to head back to the boat, a pretty strong current had developed, and I actually ended up towing in one of the Brits that I’d met because he was a wee bit too drunk to swim against the current, particularly with his precious beer in hand.

By the time we got back to Duy Hung, we were both pretty tired from the day and ended up napping for a while, getting up to watch a little American Idol (did I mention that every hostel here has had cable so far?), and then actually just go to bed.

Thursday was our last day in Nha Trang. I had a baguette with a ham omelet for breakfast at Thanh Thanh, a little café that came complete with two kittens for me to play with until our food was ready. The rest of the day was dedicated to walking around exploring the city and searching for dresses. After looking in several shops and not finding anything that I both liked and was reasonable, I just went to a fabric store to pick out material and have a dress made. Sounds easy, until you factor in the language barrier. After a while it became clear that we weren’t understanding each other, so I headed back to the hostel to see if one of our receptionist friends would be willing to help out translating. When she got off her shift, she accompanied me back to the fabric store. Turns out, they couldn’t actually make the dress there, but they referred us to a tailor. Sure, the tailor could make the dress, it would only take her an hour…once the power came back on. Well, the power was out for about eight hours that day and didn’t turn back on until right before we left, so no dress that day.

After a bit more wandering on the beach, looking at the vendors’ goods, we tried some Bubble Tea. I’ve loved the bubble tea I’ve had at home (ok, so I’ve only had it once, but it was delicious), so I was excited to have it here. It ended up being good, but not great; it was less sweet than I expected and the pearls/jellies less flavorful. Still good, just in a different way.

Dinner was at Fami Café, a little place right across from our hostel. After some delicious stir fried veggies with garlic, we went back to our hotel to wait for our bus. Vong (I’m sure I’ve butchered the spelling), my favorite receptionist friend, shared some spring rolls and two different kinds of cake with us – all of it was fantastic and a great send off. Shortly thereafter, our sleeper bus arrived to take us back to Ho Chi Minh City.



We got back from the Cu Chi Tunnels 45 minutes before our bus left for Dalat, so I asked the travel booker where we could grab some food to go; we’d seen many of the locals eating from take out containers, so we knew there had to be somewhere nearby. She pointed us in the direction of Pho 24, where we each got Pho to go. Pho is a traditional Vietnamese dish consisting of broth, rice noodles, meat, basil, coriander, lime, and a variety of veggies such as onions, bean sprouts, peppers, and lettuce. Everything comes separately so that you can mix it all together in the way that you like it. I got the Pho Bo, which is Pho with beef filets.

Around 4pm our bus to Dalat arrived. I had expected it to be an old thing with uncomfortable, cramped seats and the windows flung open for air circulation. Instead, it was a very nice coach-style bus with plenty of leg room and air conditioning, which was great considering we were in for a seven hour trip. To make things even better, the bus even stopped twice for bathrooms and dinner (Pho Ga [chicken]), another thing I wasn’t expecting. Along the way, our driver even called ahead to one of the hostels in town to book us a room.

When we arrived in Dalat, a taxi took us up to the Pink Hotel, the hostel we were planning to stay at. Upon arrival, there was some miscommunication and the receptionist told us they were full and we’d have to find another place to stay for the night. So, back to the street to head for another place. As we were walking, someone came running up behind us asking if we were there for the Pink Hotel. Turns out, he was the manager, and while his place was full for the night he had made arrangements for us to stay in his uncle’s hostel across the street — these arrangements apparently involved kicking his sister out of the room for the night. The room was nice and came complete with a poster of Titanic, and who could ask for better decor than that?

The next morning we had breakfast and moved over to the Pink Hotel. I ordered the banana bread, thinking it would be, you know, bread made with bananas. Nope. It was a standard bread roll about the size of a sub sandwich that came with two bananas on the side. I pulled the bread into pieces and sliced the bananas on top, which was still delicious.

We had heard there were great waterfalls in the area, so we walked a few miles to the cable car that would take us to them. Of course, the cable cars weren’t running, so we hopped on some motor bikes and asked them to take us to the falls. Total bust; they took us to these piddly little falls that had been turned into a Disney-esque tourist attraction, though it was way worse than anything truly disney. The place was crawling with gross, stinky ponies and taky decorations. Oh well.

We headed back to town to Linh Loi for some lunch — com suon, rice with pork chops. Then we stopped back at the Pink Hotel to use our good friend google to find something better to do in the area. Sure enough, google gave us the name of the Datanla waterfalls, so we grabbed a taxi there and were happy to find some decent, pretty falls. We hung out there for a while before heading back to the market in town. We were hoping to find a monastery in the area, but after ~6 different taxi guys conferred on the matter and called their bosses to figure out where it was, we scrapped the idea since none of them had a clue what it was that we wanted. The market primarily sold fruits and fish, but we eventually ran into aisles and aisles of sweets. One woman was handing out strawberry and mulberry gummy samples; both were delicious, so I got some mulberry gummies for later.

Dinner that night was at Hoan Kim, one of the little cafes just a few blocks from the hostel. Most of the menu looked great, so I let the waiter pick his favorite dish and drink for me to try, something that’s been widely successful in the past. Tonight it brought me a huge plate of deep fried noodles laden with delicious seafood, vegetables, and sauce, along with a glass of carrot juice. Both were good, though I don’t feel the need to stock up on carrot juice anytime soon.

Tuesday morning, the 25th, I had “banana bread” again for breakfast before attempting to hike out to the Valley of Love. We actually followed the directions and everything, but never made it there. Instead, we happened upon a Buddhist Temple on the top of one of the highest points in the city, so we explored the temple and all of the beautiful statues in lieu of continuing to hike to an area we had heard was very touristy anyway. With its high position, we also got more great views of the city; Dalat was much larger than either of us were really expecting.

Back to the Pink Hotel to check out and grab our bus to Nha Trang. We grabbed Pho from a corner stand and ate it sitting on their kiddie stools at the kiddie tables for a quick lunch before the 4 hour trip. This time we actually ended up on a sleeper bus, one that happened to need a tire change 30 minutes into the trip. The rest of the trip went very smoothly. We were traveling along what appeared to be a brand new road; there were construction equipment and dirt piles all along the majority of the road, and at the very end we were actually driving on plain dirt – well, border-line mud considering it had just rained.

We arrived in Nha Trang just in time for dinner.

Cu Chi Tunnels

Yesterday morning we checked out of our room at Yinh Guest House and grabbed some baked goods for breakfast before catching our bus to the tunnels. Once the busses arrived, everything turned into pure chaos; the woman collecting us for the tour didn’t want to store our bags under the bus, so we just left them behind the desk at the hostel. In the 15 seconds it took us to do this, the woman had disappeared…with our tickets. The street was even more chaotic than normal since there were half a dozen busses there all picking people up for different tours, so it was impossible to find her again. One of the ladies from our hostel hooked us up with another tour guide, but after I asked him several times whether his was the half-day Cu Chi Tunnels Tour, he let it slip that his was actually the full day. Seeing as how we needed to be back to catch a bus to Dalat by 4pm and the full day tour didn’t get back until well after 5, that wasn’t going to work. Back to our hostel. We eventually got connected with another tour guide and bus, so it all worked out, but we definitely weren’t on the bus that our tickets were for.

As it turns out, we really lucked out by ending up on that bus. Our tour guide, Bin, had been in the US Navy and served during the Vietnam war. Like every tour guide on the planet, there was definitely a fine line between reality and fiction in his stories, but for the most part there seemed to be a lot of truth — even if the stories weren’t his personal truth, they were someone’s truth. Bin talked extensively about his experiences in battle as well as life, particularly in relation to the war — how his girlfriend/intended fiance was killed while they were at university, how his life was torn apart. Despite all this tragedy, Bin still had a great sense of humor and was joking around throughout the tour. Two particular gems from him:

1. While we were wandering through a souvenir area, Bin asked us where we were from; when Luke replied “U.S.” Bin said “Ah, thought so. You very handsome, like young Bush!” Such a compliment!

2. After showing us the tiny trapdoors that open down into the tunnels, Bin gave us a chance to try getting in and out of it. The opening is ridiculously tiny, so at first only a couple of the super-skinny boys dropped through it and came back out, one at a time. A girl tried to go through next; she wasn’t particularly large or skinny, just pretty normal, but those entrances are not built for “normal.” As soon as Bin saw her starting to lower herself in, he shouts, “Be careful of the boobies, don’t get the boobies stuck!”, and he wasn’t talking about the type of traps. Sure enough, she did have trouble getting out, for which Bin cursed the boobies.

Bin apparently served with John Kerry in the Vietnam theatre while stationed on the Saigon river, very close to Cu Chi, one of the largest Viet Cong bases of operations.

During the war, the Viet Cong constructed an incredibly elaborate network of underground tunnels across much of the country, with a main hub being in the Cu Chi district 65km north of Saigon/Ho Chi Minh City. The complexity of the tunnels is just astounding; there are three levels of tunnels, all connected in a grid-type design. The first level included food storage rooms, a “hospital”/medic station of sorts, a mess hall, and triangular-shaped bomb shelter in addition to passageways, while the remaining levels were exclusively passageways. Primary access to the tunnels was was through very small trap doors hidden in the jungle, some of which were literally right next to US camps and provided ideal access to steal weapons and attack at night.

The construction of the tunnels was positively brilliant; the design included air filtration, water sources, siphoning of smoke from the kitchens far away from the tunnels, extremely narrow tunnels with occasional super-narrow parts specifically to trap “Americans with big asses” from going any further, and many booby traps. The booby traps were vicious and came in many varieties: trap doors that dropped you down onto spears; the “chair trap” that snapped metal spikes onto you like a bear trap; the “rolling trap” where two wheels of spikes that spun on either side of you as you fell between them; and the “door trap” that was specifically designed to impale soldiers in the face with spikes on a lower, hinged piece of wood when soldiers blocked the upper piece. Gruesome…but clever. The Viet Cong knew their enemy and targeted its weaknesses to an impressive degree, and it gave them a huge advantage in the war.

Transit; Seoul, South Korea; Ho Chi Minh City, Vietnam

After 55+ hours of traveling, we’ve arrived in Vietnam! We had a 14 hour layover in LAX, and let me tell you, 14 hours is a LONG TIME, especially when there aren’t computers or anything to keep you occupied. Eventually we starting talking to a couple from Ohio who was on their way home from visiting their son in Australia and had been condemned to the same layover as us. The hands of Euchre that we played may very well have saved everyone’s sanity.

From LAX we had a 13 hour flight to Incheon, South Korea, where we had another 14 hour layover. Fortunately, we got out of the airport and explored Seoul for a while. We took a bus downtown to City Hall Station and then wandered around Namdaemun Market marvelling at all the brand-name knockoffs littering the stalls. After grabbing a $1 sushi roll for brunch, we headed back to City Hall Station to check out the neighboring Deoksu-gong Palace. The palace was amazing; after exploring everything, we just relaxed there for another hour or so before re-embarking on our little walking tour.

Next we wandered around the Namsan area, eventually ending up at the Cheonggyechong River, a river that until recently had be covered up but has been restored as part of a beautification/restoration project. We sat by the river for awhile sipping smoothies (mine was kiwi, mm) and dangling our feet in the water. Side note: the smoothie place had a pitcher of water out for customers, which I helped myself to. I figured that anywhere that was concerned enough about hygeine to give out antibacterial wipes with their smoothies probably purified their water. I was right. Didn’t get sick at all.

From here we headed back to the bus stop, grabbing fish rolls as a last snack. Word to the wise: ordering a shrimp roll, with cooked shrimp baked into the rest of the roll, not necessarily mean that the shrimp will be peeled. Still delicious, but even messier that my usual attempts at eating.

Another 5 hour flight and a ride into the city from Mai Linh taxi service (highly recommended — we narrowly avoided getting totally scammed by other guys), we arrived at Me Them Bed and Breakfast in Ho Chi Minh city! To our dismay, the beds were less than desireable: essentially pieces of ply wood with a 1/8″ strip of foam around them. After all the traveling and total lack of sleep, I was still able to pass out and sleep a bit, but it involved rolling over every 30 minutes because something was in pain.

First order of business this morning was locating a guest house with a bed. Success was found just around the corner at Vinh Guest House, so tonight we’re sleeping on an almost-normal matress for $1 less per night! We also are only on the fourth floor now instead of the fifth; all the establishments here are tall and narrow, so there’s 1-2 rooms per floor and often ~6 floors. Then, going off of tips from Ian, a guy here from Seattle getting an ESL Teaching Certificate so he can run a school in China, we grabbed lunch at Lam Cafe. The sauteed chicken with mushrooms, carrots, and other assorted veggies was fantastic, as was the noodle chicken soup. From there we went across the District to Sieu Thi Tax where we picked up some more shampoo and other items we couldn’t carry with us. As a reference for how ridiculously cheap everything here is, a 5L bottle of water cost us a whopping $0.60.

Our last leg of today’s exploration took us to Chua Xa Loi Pagoda. as we were wandering around, we wandered past a prayer/worship/ceremony with incense and chanting, so we kicked off our shoes and checked that out for a bit. Very cool.

Finally, back to Vinh Guest House to make arrangements for tomorrow; we’ll be doing a tour of the Cu Chi Tunnels and then catching a bus north to Dalat.

I was hoping to upload a few pics with this post, but I don’t have time just now. Hopefully I can get some up soon!

Also, shout out to Aunt Claire: after 3 days of traveling, the “smart socks” are still not horrendously disgusting…

Losing the battle against AIDS

Uganda, which was once a leader in the fight against AIDS, is now struggling to continue the battle. Insufficient funds (“According to the Uganda AIDS Commission, the lifetime bill for treating one Ugandan AIDS patient, counting drugs, tests, and medical salaries, is $11,500.”), insufficient education, insufficient medical personnel, insuffient…everything. Despite cheaper, generic antiretrovirals becoming available earlier this decade, there are still not enough. “‘Family members…will often share one set of pills, an act of love that leads to disaster. Incomplete treatment means both will probably die, but may first develop drug-resistant AIDS and pass it on.'” Furthermore, the medications and treatment strategies are still considered too expensive; donors and world leaders have begun to shift their focus from AIDS to other diseases, such as malaria and diarrhea, that have much cheaper remedies, like mosquito nets and water filters. Read more from the NY Times.

These other diseases certainly deserve attention and need to be addressed, but this needs to happen IN ADDITION to combating AIDS, not instead of. Encourage your government representatives to support the Global HEALTH Act of 2010, which will assist developing countries in recruiting, training, and keeping qualified health care workers. (Check out the bill here.) Give to your favorite organization and make a direct; a friend of mine recommended this fantastic organization as one that is both reputable and brings real, tangible results. Talk to others and educate about this devastating disease and how much more needs to be done globally.

Do something.

ED: Emergency Dysfunction

Considering that I’m a relatively healthy individual, I’ve spent more than my share of time in Emergency Rooms, or as they now prefer, Emergency Departments; who thought it was a good idea to switch the initials from “ER” to “ED” is beyond me, but that’s a point for another day. I’m going to stick to “ER” since I’m not mature enough not to giggle every time I type “ED.”

Last week started with me, bleary eyed and sleep deprived, shuffling over to work (yes, work as in job. I have two. In medical school. Post forthcoming.) when I was notified that my father was heading to the ER.  This is, unfortunately, not an unusual occurrence; I learned at a very young age to be wary of any unexpected phone call, and to this day my stomach drops a little when those calls come in.

Thus began yet another ludicrous ER experience.

Upon arriving at the eerily quiet ER (no cars in the lot and only one room occupied…which never happens…), he was immediately checked in, roomed, and saw the nurse. One would expect the next logical step to be seeing the doctor.

One would be silly to expect such things.

Instead, one should expect to be virtually ignored for the next few hours. The most contact that can be expected will be the ER resident running through the room, pausing just long enough to say that they’re not really sure what’s going on but the attending will be by soon. Oh, and they’ll call transplant since no medical personnel in the contiguous United States are willing to touch a transplant patient unless, of course, they only work with transplant patients. The nurse will stop by again, berate the attending for not stopping in yet but assure you that you’re next on the list. Several more hours will pass, over which time the ER will actually become busy and suddenly every medical staff member in a three mile radius will appear in your room in an effort to treat you as fast as possible so they can put someone else in your bed.

Now that several hours have passed and they have yet to actually do anything aside from verbally acknowledging that something must be wrong since you’re here, the docs finally concede to do some testing. Really, we were fortunate this time; during his last hospitalization for the exact same thing, they didn’t bother to culture the infection until 24 hours later after they’d pumped him full of antibiotics. Now, call me crazy, but my problem solving skills have led me to one universal conclusion in life: if you don’t know what’s wrong, you can’t fix it. Culturing an infection is the only way to find out precisely what’s wrong; if you don’t know exactly what’s causing the infection, you can’t effectively treat it. Like I was saying, we were fortunate this time because they actually remembered to do a culture, so they were able to put him on the most effective antibiotics more quickly. They also managed to both schedule him for and take him to get a CT to positively identify the cyst.

By the time they wheeled him up to CT, the ER was swamped, so they booted my mom from the room so they could put someone else in it. No problem, that’s what the waiting room is for…as long you come back for the people who are waiting. Again with the silly expectations. I mean, when you ask explicitly that 1. Someone come get you as soon as the procedure is over and 2. The patient, your family member, not be taken elsewhere before getting you, and the nurse vehemently states that she will be sure these things happen, why would you believe her? Clearly it’s far more reasonable to just leave the family members in the waiting room indefinitely and hope they just forget why they’re even there and just go home.

As long as patient and family wishes are being ignored here, it’s no surprise that they went ahead and violated stipulation #2 and took the patient straight to the room he’s getting admitted to at the other end of the hospital. In order to do this, a specialist gets called in: you see, the hospital employs highly skilled personnel specifically to wheel patients around the hospital and deposit them in various locales. So, this individual picked my dad up from the CT room and began the trek across the hospital, managing to get within one floor of their destination before things went awry. My dad questioned why they were getting off one floor below the transplant ward, but he was assured that “Oh, they take everybody here!” and was promptly wheeled into “his” room – only to find some guy (I’ll call him Ned) already in “his” bed. After many phone calls and a mild panic involving the concern that Ned didn’t belong in that room and that the guy who did must be missing, they finally realized that all the orders had been crossed – Ned did indeed belong in that room and had, in fact, been in CT earlier that day….someone just forgot to mark that he’d been taken care of , so when this young lady went to pick him up, she instead got the guy who was currently in the room, my dad. Eventually she figured out where he actually belonged (surprise, on the transplant floor!) and, I assume, found the poor orderly who was likely searching for my dad for the past hour.

Eventually, we all end up making it to his room, but the fun doesn’t stop there. The next visit, which of course takes hours to occur, is from the pharmacist. As it turns out, transplant is just about the only part of the hospital not yet utilizing electronic records (ironic, considering the chronic nature of the illnesses and the frequent hospital visits); instead, they keep their own paper charts. This would be fine if they managed to keep accurate records. Emphasis on “if”. Considering that he was admitted three months ago on that very ward, they should have had an extremely up to date medication list, but somehow they had one that was utterly and completely wrong. Shocking, I know.

Ultimately everything worked out; he was treated and discharged in just a few days, and everything is back to normal. But does that excuse the absolutely abysmal experience in the ER? Absolutely not. Was this perhaps a fluke, was this just maybe a bad day and the ER is usually not that dysfunctional? Absolutely not. We have had similar experiences time and again, and not just in our home ER, but at others across both our and at least one neighboring state. This is an appalling, and worse, a DANGEROUS standard of patient care. He was lucky; there were so many opportunities where these mistakes could have easily been detrimental to his health and outcome rather than simply irritating.

Absolutely appalling.

Go. Treat. Heal.

Go. Seek out adventure. Travel. Don’t wait for life and solutions to its problems to come to you; go where you’re needed, meet challenges head on and….

Treat. Address the issues you encounter. Whether it be a lack of clean water in Uganda or inadequate health care access in your community, do something in an effort to…

Heal. Remedy the situation. Whether it’s a physical disease or societal problem, whether you are the one being healed or doing the healing, mend and recover to the best of your ability.