My elective placement was at Cho Ray Hospital, the largest general hospital in Ho Chi Minh City, Vietnam. I spent two weeks in the Emergency department followed by two weeks in the Tropical Disease & Toxicology department.
The emergency department was incredibly busy and very confronting at times.
After patients were triaged by a team of nurses, they would be transferred to either the main emergency department, the temporary ICU or the plaster room.
There were so many patients that their narrow steel beds would be pushed up against each other, with row after row of patients lined up in this manner.
A significant amount of manoeuvring was required in order to reach a patient at the back of the room – almost like a game of Tetris.
When they started allocating two patients to the each bed, you knew it was really busy.
A very common presentation was head trauma from motorcycle accidents, which is not only devastating for the individual and their families but also a huge and costly public health problem in Vietnam.
I was fortunate to shadow an experienced doctor, with whom I practised doing targeted histories and physical examinations, and then working up patients.
The language barrier was definitely a challenge, so I wasn’t able to see my own patients, but I was able to see patients with my supervising doctor.
I also got to practice my cannulation, catheterisation and basic wound cleaning/dressing skills under the supervision of experienced nurses.
Often the department was so busy that there understandably wasn’t much time for teaching, however the experience was really important for me – I left with admiration for all the ED staff and a newfound appreciation of the Australian healthcare system.
The tropical disease & toxicology department was incredibly interesting for the range of cases I got to see.
This was the most enjoyable part of my elective, especially because the doctors were so keen to teach.
I attended daily ward rounds and was involved in discussions about investigations and management for each patient.
There was a broad range of tropical disease cases – sepsis, meningitis, cellulitis, leptospirosis, rickettsia, dengue fever, measles and malaria to name a few.
Some of the toxicology cases I saw included snake bites, paracetamol and amlodipine overdoses and organophosphate poisoning.
I wrote up a case report of tetrodotoxin poisoning with my supervising doctor.
I also participated in the weekly toxicology teaching sessions with the junior doctors.
Once again however, I was reminded of how lucky we are to live in a country with universal public healthcare.
Every day my supervising doctor and I would have discussions to try to convince patients (and their families) to stay at least until their final IV antibiotic dose.
The cost of drugs, wound dressings, lab investigations and imaging were almost unaffordable for many of our patients – it was imperative that the doctors prioritised tests and medications to minimise the financial cost to the patient.
The beginnings of this skill of only ordering the most necessary investigations was one of the most important things that I took out of my time at Cho Ray Hospital, and I am sure that I will continue to practise and refine this throughout the rest of my career.