Friday, December 23, 2005

I Want to BE the Patient

Elective surgery is one of those mixed things in life, where you try to turn a blind eye to all the potential dangers of surgery, in hopes that YOU won't be the one in a million case that went wrong; even more so with elective Lasik eye surgery!

I took the plunge. After living in Vietnam for a few months, I kept meeting people who told me how happy they were with their post-Lasik vision. Being a man of many glasses with slowly progressing myopia over the years, I couldn't help but want to be free. Contact lenses never agreed with me; since I had a problem with dry eyes.

After hearing what a "deal" the corrective vision surgery was in Bangkok, I booked an appointment at Bumrungrad Hospital in Bangkok. You can hear NPR's take on this well-regarded hospital in Asia: "Tourists Seek Cheaper Medical Procedures in Asia".

When I showed up for my appointment, I registered in a busy outpatient opthomology clinic within the hospital. The opthomologist briefly assessed my potential success for the procedure and easily came to a "yes, can do." Forget about any discussion if this corrective eye surgery was right for me. Little did I know how quickly things would progress to the first incision!

By the next day, I was on the operating table. I was scheduled to have both corneas laser reshaped within a total of thirty minutes. Everything progressed along without much of a hitch. I had my eyelids forced open by small clamps that I had seen in the movie "Clockwork Orange". I couldn't blink and had to keep my eyes looking straight ahead at a small ring of light, that made me think of a sun eclipsed by the moon. The threat was that if I couldn't keep my eyes focused straight ahead during the procedure for 15 minutes, then the laser would not perform the perfect job on my cornea, and I would not achieve perfect vision. In other words, an unsuccessful outcome to the surgery would have been my fault!

In the end. I did it. I survived the feeling of a knife slicing open a thin flap of my eye open. I survived the feeling of the Lasik machine pushing up against my eyeball with such an intense pressure and sound; although I felt myself on the fringe of blacking out but somehow pulled through the weakness. I survived the procedure done twice over, one eye after the next!

Shortly after the surgery, I was wisked away to the recovery room, where I rested for two hours, then began my next ordeal. I was fitted with plastic eye shields taped to my face, that would prevent me from touching my eyes for 24 hours. The eye shields had little pinholes through them, where I could see the world in a peeping-tom fasion. I walked out of the hospital like this, and found my way to a nearby hotel two blocks away from the hospital--where I checked in for complete room service for 24 hours.
thailand 056.jpg

Once the eye shields were removed, I moved onto the next stage of fun. The schedule of 6 different eye medications for several weeks was aweful. It involved Saline tears to both eyes 10x/day for 1 week; Solumedrol (steroid) drops to the left eye 12x/day for 2 days and to the right eye 6x/day for 2 days; Tobradex (antibiotic) drops to both eyes for 5 days, Visilube (moisturizing) drops to both eyes 4x/day for 1 week; Visdisc gel (moisturizing) to both eyes 3x/day for 1 week; and Restasis (immunosuppressant) drops to both eyes 2x/day for 4 weeks. All of these medications were used on the same days, with some medications finishing before others.

My opthomologist told me my vision would stabilize to its permanent form after 6 months. Prior to surgery, my eyeglass prescription was -3.00 in both eyes. 5 days after surgery, my vision was corrected to -0.25 in both eyes; which has persisted to the 6 month point! Way to go!

Woo hoo! All for $1795 USD.

Wednesday, December 14, 2005

Around the World in 60 Hours

Had another evacuation recently, this time to my home country. Flew from Ho Chi Minh City to Denver Colorado with multiple transfers. Not fun when traveling with an immunocompromised (Chronic Myelogenous Leukemia) patient with myelosuppression from severe infectious dysentery and malaria. My patient was quite weak, but her hematological derangements put her at increased mortality while in Vietnam, and I did not want her to receive any more blood product tranfusions that the various Vietnamese physicians were recommending. She is a brave woman, to come to Vietnam for a vacation, given her chronic medical condition. Despite her newly worsened condition, she made it home safely.

I spent only 12 hours in Denver, before heading back home to Vietnam. It's a long flight, totalling about 17,632 miles (28,376 km) roundtrip. I never enjoyed the long flight from the USA to Vietnam, which feels like the exact opposite side of the earth. To perform the roundtrip in such a short span of time put my circadian rhythm into the twilight zone.

Wednesday, December 07, 2005

Old To Me, New To You

Did some browsing on the internet and found some very interesting tidbits about doctoring in Vietnam.

Bogus doctor executed in Vietnam (story by Agence France Presse on 31 October 2003):

Pham Thanh Tuan, 40, was executed by firing squad on Wednesday in Dong Thap province after his appeal for presidential clemency was rejected last month, a clerk at the provincial People's Court said. He was sentenced to death in June 2002. His death takes the number of people executed in the communist nation this year to at least 29, according to information compiled from state media.

Vietnam suspends doctor for taking bribes (story by Agence France Presse on 19 June 2001):

HANOI - A Vietnamese hospital has suspended a doctor for six months after he extracted 600 dollars from the family of a seriously ill cancer patient on the basis of false promises of quick treatment, an official daily reported Tuesday. Patient Pham Thi Mat, 50, is now terminally ill with uterine cancer after the oncologist, named only as Dr P., failed to deliver on his promises to move her up the waiting list, the Tuoi Tre newspaper said. Managers at the Ho Chi Minh City Cancer Treatment Centre took the disciplinary action Friday after receiving a complaint from Mat's family. Corruption is widespread in Vietnam's public services, where salaries have failed to keep pace with the private sector since the launch of market reforms in the 1980s. The official media regularly talks of doctors, policemen, teachers, and even driving test examiners supplementing their salaries by demanding bribes but few cases ever result in disciplinary or legal action.

Granted these news clips are old news, but my expat medical colleagues and I still worry about the aforementioned widespread problems in the current medical system--even today.

Tuesday, December 06, 2005

Christmas Orphanage Charity

It's that time of the year again. Charity time in Vietnam! Christine does it again. This one is called Operation Christmas Shoebox. Here's the description:

"This brings joy and hope to children in desperate situations through gift filled shoeboxes... This event provides an opportunity for volunteers to be involved in a simple, hands-on mission project while focusing on the true meaning of Christmas."

"Our donors are people and businesses who wish to share what they have with others who are less fortunate. We impact the lives of vulnerable children through education, feeding, clothing and gifts to help them celebrate and remember this coming Christmas. Any contributions you provide will allow the children to enjoy a celebration they truly deserve."

There are several ways you can donate to the Children’s Christmas Shoebox

_Non perishable foods

_School Supplies (Contact for details)

_House hold items

_Providing local business services or donating goods

_Cash donations

"Donations of old but good-conditioned clothing and toys will also be accepted. If you have any queries or wish to donate other items, please contact me. Friends and volunteers will visit TRUONG KHUYET TAT GO VAP (Go Vap District) to deliver your kind donations on December 24, 2005. We hope that individuals like you will contribute your valuable time and effort to help us deliver immediate and lasting assistance to these children during this time."

"Please provide the information below (We hope to receive your donations by December 18, 2005)"


Name:

Company:

Telephone number:

Volunteer: Yes___ No___

"We are still in need of these high demand items, if you have any inquiries or suggestions please let me know."

Work Permit for Vietnam

Getting the work permit is one of the most painful things about living here. I had to jump through way too many hoops and ask way too many favors of way too many people. So if you are interested in working here, you can follow my outline of the easiest way of getting it done. This explanation is primarily for people from the USA. Protocols for getting your documents acceptable for a work permit in Vietnam, will likely be different if you are from another country aside from the USA.

If you are still in your home country, then you can save on expenses and spare asking too many favors by doing things yourself.

Still in your home country:
1. get together your last degree of education/ training/ certifications, your work permit/ licences, and your criminal record file from your country.

2. make photocopies of all of them.

3. get all the photocopies notarized (can be done at any bank in the USA). If you go to a bank where you already have an account, they may perform the notarization for about $10 USD per document.

4. next get your documents authenticated with your state's Secretary of State office. You can find the location of the nearest office by asking the people from step 3 (there's usually an office in every major metropolitan city). In Massachusetts state, the cost was $6 USD per document.

5. next get your documents authenticated in Washington D.C. at the U.S. Department of State Authentications Office. This is the office of Condyleeza Rice, and her signature will actually appear on your document! The fee is $6 USD per document. There is a walk-in service, where you can have your documents in hand and authenticated on the spot. I don't know how this magically happens, since Condyleeza Rice is not always in D.C., but it does happen. If you can't get to D.C. yourself, you can mail your documents to the office, but the turn around time is about 2 weeks! If you are in a rush, then you should hire a courier service in D.C. to do the walking to the office for you. I used a courier service, which charged me $40 USD per office visit.

6. next get your documents authenticated by the Foreign Embassy. In my case, I was dealing with the Vietnamese Embassy in Washington D.C., which is just as slow and bureaucratic as its home country. There is no walk-in service. You can bring your documents there by hand, and the Vietnamese Embassy will tell you to come back in 1 week to pick it up. The cost is $50 USD per document. If you mail your documents to the Embassy for authentication, then the turn around time is at least 2 weeks. I have run into a few problems with their Embassy. I had my documents delivered FedEx to their Embassy with delivery confirmation. When I had received confirmation that the documents were at the Vietnamese Embassy, I called them 2 days later to ask if processing had begun. The Embassy informed me they did not receive my documents. I gave them the name of the person at their Embassy who had signed, receiving my documents from FedEx. Their reply was that they did not know who that person was! I had to keep repeatedly calling the Vietnamese Embassy back over several days, talking to various personnel there, until they finally found my documents! Their apparent disorganization extends to life in the mother land too.

7. the final step is to submit all of your stamped/ authenticated/ notarized documents to your workplace in Vietnam. They then process your work permit for Vietnam, which as of now lasts for 3 years for physicians. The work permit processing takes about 1 month. Without a work permit in Vietnam, you can still work albeit illegally. It is not uncommon to work in Vietnam illegally. But you will always live in fear that the communist police will come knockin on your door and haul your booty straight to the airport and send you home without any warning.

Many thanks to all of the people who helped me in the authentication process for my papers for Vietnam. Namely Betty, Edite and Anna. Of course, there were several people who refused to get involved.