Wednesday, February 27, 2008

Two sides of the same coin

I spent the morning in a public surgical hospital today and, to say the least, it was eye-opening.

My friend, who is in her last year of medical school in Saigon, was so kind as to let me join her and her classmates while at the hospital. The hospital is a rather large collection of buildings, all of it open-air (i.e. no air conditioning), and full to the brim with patients. Literally. In one room about 15 x 40 feet, there were about 12-14 beds lined up, much like what you see the barracks look like in military movies. In that room would be about 20 patients - so, yes, there is sometimes more than one patient per bed. The patients and their families are responsible for food, water, and miscellaneous other things that we take for granted in most developed countries - so, in addition to the 20 patients in this room, add another 20 for visitors, 3-4 nurses, and 3 medical students and you have a very packed room. There is no patient privacy to be had (HIPAA has yet to be uttered here) and prevention of hospital-borne infections is non-existent. I had to look hard to find a sink in the entire room, and that's because it was hidden in the corner, behind a patient bed, and never used the entire time I was there.

This is dramatically different than the clinic I have been working in. The clinic I work in is an international clinic, with Western standards and both Vietnamese and Western trained physicians. You walk in and it's much like any doctor's office in the United States - except that you pay for every service up front. And pay, you do. A doctor's visit is $100 and you pay for all lab tests and medicines prescribed. Needless to say, the patient populations in the private and public hospitals rarely overlap, if at all.

No system is perfect. The private clinic has its drawbacks - it cannot be entirely Westernized because you depend on Vietnamese workers, supplies, and medicines; some lab tests are impossible to get in Vietnam; and all emergency cases are evacuated to Singapore, where the medical standards are higher. Of course, I would prefer the private clinic style because that is the one that I am accustomed to. However, you cannot leave the public hospital without thinking, "How can this become better?" Sometimes, when I leave work in the United States, I ask myself the same question.

Now, everyone's favorite past-time of late is bashing the American healthcare system (and thinking up new proposals to fix it). However, after spending a few hours in a public hospital in Vietnam, I can say that the American healthcare system really isn't that bad. It's not perfect, but it's definitely not that bad.

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