Mellifluous music filled the taxi cab as it winded through the crooked streets of Ho Chi Minh City, maneuvering carefully through the random onslaught of motor bikes and pedestrians as we made our way to the Cho Ray general hospital on our first day in Vietnam.
The scenery shifted for each district we passed as the streets were characterized by their manufactured products. Blocks overflowing with steel products gave way to blocks lined with rubber tires, and so on. Eventually, the taxi cab ventured into packed streets filled more with people than with motor vehicles, and stopped at a set of double gates surrounding what looked like an apartment complex. We had arrived.
On June 20, 2012, we landed in Ho Chi Minh City (HCM), Vietnam with the intent to study whether Vietnamese culture influenced the health decisions of Vietnamese breast cancer patients. Different countries have varying beliefs about health that may influence the treatment decisions of breast cancer patients. More importantly, we hoped to explore this topic through the patient perspective. We believed that culture as well as accessibility to treatment may impact the women’s perception of their quality of life after being diagnosed with cancer.
Salman Rushdie, a British Indian novelist, once wrote, “Reality is a question of perspective; the further you get from the past, the more concrete and plausible it seems – but as you approach the present, it inevitably seems incredible.” As we entered the double gates into the hospital, our formulated background research and hypothesis made the reality of what we would expect in Vietnam seem plausible.
We believed that culture did influence Vietnamese breast cancer patients, and that perhaps their use of Oriental medicine was deterring the women from early diagnosis of breast cancer. Our preliminary research had detailed a logical network of potential factors and reasons for the outcomes we expected. From the weeks of reviewing journal articles, planning hospital visits and physician interviews, and orchestrating the trip as a whole, we believed we were mentally and physically prepared for Vietnam. The 24-hour flight only added to our momentum as we propelled into our first destination.
However, from the very moment we passed the hospital’s double gates, the Vietnamese culture and environment challenged our foreign paradigms in ways that we did not anticipate. Their reality was even more incredible than we had imagined.
The First of Many
On that eye-opening first day of field work, we realized that our sterile-white perception of U.S. health care was not the norm here. We passed swarms of people lounging in every hospital corner. Families and friends holding plastic bags filled with food squeezed themselves into roped-off lines and waited for a security guard to motion them into a small elevator so that they could visit their loved ones. There was no space to comfortably sit or stand in the hospital, although priority was given to the elderly and visibly ill as a common courtesy.
When we both raised our cameras to snap a quick picture of the hospital, the police quickly chided us and swatted the cameras away. As we weaved through the packed hallways filled with the humid odor of body heat, Vietnamese spices, and general hospital illness, we finally entered the physicians’ air-conditioned room. We observed a small consultation area where three doctors flipped through an X-ray film and determined the treatment of the current patient as the next patient came to the table. From our brief observation, each patient consultation took only five minutes or less.
After a short meeting with the physicians in the consultation room, we were ushered up the hospital stairs onto the second floor, where the vast majority of patients was held. We maneuvered our way through the tight corridor of the second floor into a larger room lined with individual chairs, much like the ones seen at a dentist’s office. A patient lay in each chair with his or her IV line hooked up to a metal rod that ran along the center of the ceiling. That morning at Cho Ray, we interviewed one old woman who was scheduled to receive chemotherapy that afternoon.
Afterward, we drove to the Ung Buou National Cancer hospital. The hospital was oriented as a central quad surrounded by buildings with an entrance resembling an urban back alley. Without the taxi driver, we would have easily missed this hospital as well. Much like the Cho Ray hospital, a multitude of people sat in the quad on any bare patch of the ground while waiting to gain entrance into the hospital. If the patients were lucky, a chair would sometimes open. Most of the people waiting had cancer, or had a loved one diagnosed with cancer. As we looked around, we could see adults as old as 80 to children as young as 8 bearing the same hair loss that is so often a prominent sign of cancer. Again, no pictures were allowed – police-enforced.
Soon we began our work. We asked ladies lounging on the floor whether we could interview them. A large number of breast cancer patients flocked to us, and a huge gathering occurred; all of them were very willing to tell us their stories. Most came from the countryside about 10 hours away from the hospital. They paid a five dollar appointment fee to see the doctor and receive subsequent treatment. However, since some of them could not pay the fee, they slept outside in the quad and ate from charity trucks until they could collect enough money for an appointment. The patients cited the long distance from home as another reason to sleep outside the hospital until their next treatment.
After we had conversed with a few of the ladies, it was apparent that the breast cancer patients preferred a mastectomy as their method of treatment. They would eagerly point to the tufts of hair on their head and show us their flat mastectomized chests as they explained their journey with breast cancer. Some spilled tears as they described the social stigma that they felt from their neighbors who believe cancer is contagious. Each woman laid out her griefs, hopes, and autobiography.
They thought we could help them medically or financially. They wanted us to tell them what the slips of paper from their doctor meant. They even believed that we could end their monthlong wait to be treated. There were many aspects of the situation we had accounted for in our survey, but in reality, their needs and their stories could not easily be quantified in our systematic questionnaires.
That afternoon, we visited the private hospital, Medic, as well. The Medic hospital was nicer than Cho Ray, but not comparatively. The hospital had many floors, and each floor dealt with a different body condition. The breast cancer ward was up five steep flights of stairs. There were no elevators. As we ourselves climbed up those stairs with shaky breaths, we could only imagine how hard it must be for an old woman, fatigued from her chemotherapy treatment, to walk up the same flights of stairs.
Once we arrived at the fifth floor, we looked around for any area that might resemble the breast cancer ward. Oddly, at this hospital there was no one around whom we could ask. The floor was deserted except for rows of empty chairs. Finally, we walked up to a small glass paneled room and correctly entered the breast cancer ward.
The breast cancer ward was a small two-room area equipped with four chairs and two beds. It was air-conditioned and contained a television in each room. Breast cancer patients either sat in chairs or lay down while hooked up to their chemotherapy. It was apparent that most of the patients at this hospital were more affluent than the average Vietnamese citizen. The patients wore clothes made of nicer material, and all of them sported a full head of hair, courtesy of the wigs they wore.
However, that was where the differences ended. Although their economic status varied vastly from that of the patients we had seen at the other two hospitals, their similarities were discernible. These women underwent the same mastectomy treatments and harbored similar worries about breast cancer. All of them worried about their ability to continue to care for their family.
Similar Realities, Each of Them Incredible
Each hospital we visited did not significantly differ from the others (with the exception of the private Medic hospital being somewhat less crowded and focused more on individual patient attention). The hospital in Hanoi, K Hospital, was just as crowded as the hospitals in HCM.
At the K Hospital, five to six women all receiving their chemotherapy sat in one hospital bed. Each woman screwed in and changed her own chemo bottle and put in her own IV line. When she was done, she pulled the IV out, handed it to the nurse, and then left. The women endured this procedure every day as they received their chemotherapy from 8 a.m. to 4 p.m. One woman even drove six hours on motorbike to and from the hospital for her chemotherapy. Many of the women must have undergone similar journeys because they were from distant rural areas as well. If not, the women opted to lay mats on the corridor floors and spend their months there instead.
When we arrived in one of the hospital rooms, we saw only four beds; however, each bed held more than four people. As we entered the room, it was a challenge in itself to figure out where to stand in order to survey the women. At the K hospital, the women were lucky if they found a resting area for their back; they didn’t dare to drink or eat anything for fear of losing their spot if they had to go to the bathroom. We realized that many of the women also did not know the proper things to eat. One woman enjoying her corn on the cob was surprised when we explained to her that corn was not easily digestible and could upset her stomach during treatment. We gave the women crackers, something that was easily digestible, instead.
All of the women told us powerful and moving stories at the various hospitals. Pretty soon, each day of our trip started to blend together. The stories followed the same pattern, but the emotion was no less mitigated. Despite the lack of standard U.S. medical precautions such as prescribing anti-nausea medication before cancer treatment, the women rarely reported adverse side-effects to their treatment besides the common fatigue. However, they gladly accepted the bits of cancer knowledge and general advice we imparted to them. For them, life moves on, whether with cancer or without.
Past, Present, and Future
We came away with more than just numerical figures and circled surveys on this trip. We listened to the women’s biographies, immersed ourselves in their culture, and were inspired by their strong mind-set.
Returning to the States does not signify the end of our research. Preliminary research may have sparked our initial interest in understanding these breast cancer patients’ circumstances, but listening to their stories firsthand provided us an entirely real and incredible perspective on the strong women who battled their disease armed with hope and compassion for their families.
This experience fuels our motivation to not only use our research for educational awareness purposes, but to also develop an outreach program for Vietnamese women that could bridge the gap in breast cancer knowledge and health information.
Looking back at our experiences, we had entered Vietnam prepared to face the realities of health care as systematically as our proposal had outlined. However, the plausible became incredible as we immersed ourselves in the cultural manners and customs that allowed us to converse with patients and oncologists alike, exposing us to the complicated web of variables that affects breast cancer patient care in Vietnam. Yet, it is precisely this new perspective that defines our reality now – this unconditional hope in a better tomorrow and our willpower to make that happen.