Be pissed off. Then, be the change.

Highlight of the post: Be pissed off.  Be very pissed off when something is fundamentally wrong and it hurts people.  Then change it so you're less pissed off.

Holy heck ya'll.  I stepped foot inside a hospital in Vietnam.  I truly realize I'm in a 3rd world country.  This is a picture I stole from the internet, but this is exactly what its like.  8 beds a room.  Sometimes 2 patients per bed.  No handwashing between patients.  Doctors examined wounds without gloves and moved onto different patients.  I was in the same room as active TB and lots of other things that we normally use negative air pressure rooms for.  For every patient there are at least 2-3 family members. One nurse per room sometimes.  Your family member is your own nurse.  There is just simply no personnel, time, resources, or hope. Oh, but wait, there is one thing.  If you have wads of cash, you can tip your MD or nursing staff for extra care or to get your sheets changed.  Honestly, if hell had a look, a hospital room here would be it.

Imagine the level of bacterial resistance.  When antibiotics can be just bought anywhere for any little infection or indication, that's a bad sign.  When people don't wash hands, that's a bad sign.  Excuse: we don't have time.

I'm upset.  Upset that I can't change the culture here.

On the last day of the week here at the hospital, presented a clinical case retrospectively.  We talked about all the things that pharmacists could've intervened on and they just say very helpless things.  Then we present on Clinical Pharmacy in the US and they have this look like "these girls are so far off".  But really.  The US Clinical Pharmacy was where they were 30 years ago.  It's doable.  We're proof.  At the end I did my inspiration soap box talk, "you can make the difference if your department works together to start little initiatives i.e. all use hand sanitizers on the floor, get out on the floor and be available, start tracking your interventions."  I wish I was more inspirational because again, excuse: we're not there yet.  Yes, I know, but how will you ever freaking get there with this attitude?  If you're scared to offend your physician colleagues, you're wrong because when I was on the floor with my UCSD friends, they bombarded us with questions!  They want a pharmacist brain.  They'll demand it when they know how much you know!  Do it for the patients, do it for your education, for you.

The pharmacy school impressed me but the system in general is disappointing.  There is a 1.5 hour nap at lunch in the office and somehow, "there is no time" is an excuse.

Benchmarking: if you haven't heard of it, it can be a really good thing.  I.e. hotels didn't always used to have complimentary soap.  But one did, then other ones had to do it to stay on the same level.  Then came along complimentary breakfast.  Then wifi and HBO.  End result: the experience you and I, the consumers get to experience in hotels.

In the context of hospitals, your consumers are your patients.  If ya'll start using hand sanitizer, other people will see.  Physicians will see you do it.  Then patients will wonder why they don't do it too.  End result: best patient care.

All that said, it was an extremely learning experience.  We are very grateful for the opportunity to learn about a different side of things from the pharmacists here.  We just wish we could do more.  Next week, we'll go to a different hospital.  I want to be less shocked but I never want to stop being shocked.  Things like this should always piss one off.

So take away point: please don't stop being mad at things that are not right.  It's okay to complain as long as you do something about it.  I hope to successfully deploy this therapeutic drug monitoring program for Vancomycin at the next hospital and expand the scope of the pharmacist.  Be the change you want to see in the world.
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On the lighter side of things, the photoblog portion.

Wednesday was a national holiday, visited grandpa's grave with the entire family.

Then we visited a temple where Uncle 4 bought a 10 birds for me to free.  I'm praying really hard for the same 3 things: 1) for world pleace, 2) for those I love to be healthy and happy (5 minutes of imagery of each specific prayer for each person here) 3) for the strength to be who I want to be.

The Phamily that really misses Daniel. 

 I talked to someone really close to me about what he wants to do with his body when he's gone.  Cremate/burial.  VN/US.  And I am shocked at the response.  I have to give you some background on our culture.  You get buried in one piece or else your spirit will be stuck or something or another.  Well, this person's answer blew me away because I'm like what?!  He told me that he may decide to donate his body to science.  Jaw. Dropped.  What type of psycho progressive thinking is this?  Yes, I did learn anatomy dissecting cadavers and many people have made the sacrifice so we can advance in science etc. But I never thought this.  He said, "what you did, the schooling you went through, made me seriously consider this."  One of the reasons what this man is so loved and respected by me and others around him.  So logical, full of integrity, fair, and honorable.

Went to a legit amusement park called Dai Nam via bus an hour away from Saigon.  In this picture, you see a duck feeding fish!

This is also part of Dai Nam.  I'm with the leading lady of my life.  The woman that has the hardest job in the world.  She is all that I am.  All that I could ever wish to become.  Mommy.  Too often this trip is Mommy followed by, where is this? how do you do this? etc etc etc.  I'm completely useless.

Can I just talk for one second about another conversation I had?
Daddy said, "Your mom and I did two best most amazing things for you and Daniel..."
Me: "What? Take us to all these countries?  Like 40 of them?  Guide us through life and school?"
Daddy: "1) I love your mom. 2) Your mom loves me.

Lovebirds in DaiNam.  My parents dating life is more lively than mine at the moment.

This is terribly amazing.  Chris, our relationship benchmark is as such. :)

Just another picture at Dainam.

 Friday, we went out to my beach condo for the weekend which is in Vung Tau, approximately 2 hours away by bus.  The four of us had a legit time with seafood and all that.  Totally warm waters.

Missed you Dan!

Missed you Fatcat!

Vietnamese culture = hours as garden coffee shops that have wicked trees like these.  Bunch of the family today.

Obligatory kitten picture from a crazy cat lady :)  My uncles baby.

So when it rains here it pours.  For 45 minutes.  So hard that bubbles come up from the ground.  And storeshop awnings break.  And then the streets flood and I have to wade across the street to get home.

Vince, this portion of the blog is dedicated to you once again.  I just wanted to officially document that you owe me boba for eating 4 silkworms!

My friends, I leave you today with another quote: 

 If we could change ourselves, the tendencies in the world would also change.  As a man changes his own nature, so does the attitude of the world change towards him.  [...] A wonderful thing it is and the source of our happiness. We need not wait to see what others do.

[From VOL 13, Ch 153, General Knowledge About Health, Page 241, Printed in the Indian Opinion on 9/8/1913 from The Collected Works of M. K. Gandhi, published by The Publications Division, New Delhi, India.]

Namaste, I'll be back sooner than you think!  Officially the halfway mark! <3

Maria, Nick, I'm just testing if you guys are reading this. :)

I've been terrible at blogging!

Highlight of the week: Worst and best of both worlds.

I'm learning that I don't fit in here.  Not a terrible thing, it's not like I'm planning to live here, but its an interesting identity to have. A guest lecturer from America told me that in a room full of Asians, he could pick me out easily.  Of all 100 people or so, me.  "Why?" I ask. "Your demeanor, the way you dress, everything."  Not sure how to take that but sure, I stand out.  I'm used to it.  Next.  

When I walk along the riverbank at night for exercise, people whisper and gossip.  When I speak English, it is said that I'm being uppity.  When I speak Vietnamese, it is said that I'm a foreigner.  Yes, I'm totally American, but no, I'm not blond and blue eyed.  I'm so out of place, even the way I walk is telling that I'm not from Vietnam.

When I lecture, I use my hands, I ask questions, I beg for participation, I try to engage.  They don't even know what to do with me.  I think I'm hilarious and so do Kare and Thu but I don't know if they're too shy to laugh or if they don't get my jokes?!

Best of both worlds is that I'm looking in from the outside so I'm removed enough, but inside enough to be in the know and to care.  This place is beautiful.  The hustle and bustle of city life.  The calmness at the end of the day when everyone realizes they've survived yet another one and couples enjoy each other's innocent company and the cool breeze along the riverbanks.  Makes me wonder, will I learn to enjoy the little things like a cool breeze along the riverbanks more when I get home?  I spent 4 years in San Diego and I've been to the beach way less times than I wish I did.  Why didn't I go?  I was busy doing things, making things move, elevating the field, forging relationships.  Is that right?  I'm always seeking to do things with more intention and this may just be the push I needed.  I've never stopped to think of why I haven't been to the beach much ever before?  This trip is changing me, it is changing my paradigm.  

________________________

Another note: you guys.  Everyday is a near-death experience.  Everywhere you go.  But here especially.  Remember when I was being all dramatic about my totebag (filled with other totebags) was snatched?  

Look at this:  "Police in Ho Chi Minh City have arrested four thieves after they chopped off the right arm of a 28-year-old woman in an attempt to steal her SH scooter"

http://tuoitrenews.vn/society/4589/woman%E2%80%99s-arm-chopped-off-by-thieves

What the hell man.  I mean the scooter costs like $8K. Come on.

_______________________

It's been a week since I last blogged.  Too much has happened.  Don't even know how to account for it.  Lets just go through my pictures.  Photoblog!

So my first impression of clinical pharmacy education in Vietnam: I'm impressed.  They learn things we learn in therapeutics.  Like delve deep into mechanisms of action and molecular explanations as well as SOAP each disease state as well as the big picture.  HOWEVER, the system fails them.  Clinical Pharmacy in Vietnam is where it was in the states 30 years ago.  Pharmacists are not respected as a healthcare team member and are not consulted on what they're educated on.  Much progress is to be made in this country to elevate the profession.  FURTHER, options are quite limited  i.e: Parkinsons.  We went over all treatment options but the conclusion of the case was that: "most of the time you'll see Levadopa/Benzamide because that's all we got".

When I say mechanism of action, I mean it.  They go into CYP and stuff and how PPI like omeprazole will decrease efficacy of clopidogrel, but then it's also incorporated into this lecture to not confront physicians regarding this because essentially you must "pick your battles".  I mean that's true anywhere, but it's unfortunate that this dynamic is reinforced in class.  My Rx for this: interdisciplinary CEs, professional school core classes...etc...

Food!  Bun Rieu Oc!  I'm obsessed with this.  Kare actually got this and I copied here thereafter.  At this point I've had this dish 3 times. :)  

We had an extended lunch so guess what we opted to do?  We each got our nails done. :)  50,000VND = $2.50 for finger and toes painted!  Megs this is for you girl.

All this is the same day guys.  Went to a talk on Asthma at the Institute of Health.  Did some networking and learned that they learn exactly we learn.  Step therapy etc.  Long day. 530pm home.

 Day 5: Project day.  Spent the entire day laboring over how to translate my lecture on diabetes into Vietnamese!  So I'm fluent in Vietnamese, I really am, but I barely know some of these technical words in English.  Back in the states, we were asked to present in English.  No big deal.  Can do that with my eyes closed.  Diabetes?  I got this!  But at the end of day 4, we were told that on day 6, it is recommended that we present in Vietnamese.  So I spent the day rehearsing/practicing (which I never ever do under any circumstances) and using google translate (which I also never do).

Day 6: Collectively, we presented on the curriculum and pharmacy system in the States.  So well received.  Where pharmacy now in the states is a snapshot of what will hopefully be achieved in these pharmacy student's lifetime and I hope we were engaging and inspirational enough.  I kept going back to the ROLE OF THE PHARMACIST.  I hope I guilt-tripped some of them into it.  Fiduciary responsibility etc... (Ching are you reading this? I used the world fuduciary)

So Kare, Thu and I divided up Hep C, Pneumonia, and Diabetes respectively.  Go figure.  For non pharmacy friends, I want to go into the type of pharmacy called ambulatory care pharmacy. Which essentially is when a patient comes in to see a specialist (i.e. diabetes specialist) for intensive management of their chronic disease states.  Usually it's when a patient is so out of control where physicians say, "I'm not going to tinker with all the meds etc...Defer to pharmacist for 6 months and send them back to me when they're better".  I'm motivated to do this because I've been in a dialysis unit (where your kidneys fail and you rely on a machine to filter your blood for 4 hours at a time 3 times a week).  2/3s is caused by daibetes, 1/3 hypertension.  Most preventable.  So if you're my patient. nononononono. You will not get dialysis.  If I have to walk you through a unit to make sure you gain control of your life, I freakin will.

Day 6: Me lecturing about diabetes.  In Vietnamese!

Ya'll, lecturing to this crowd was difficult for me.  1) not in my native language. 2) culture shock! there's a sense of respect to just sit and listen and not interact much with the lecturer.  I found it very hard to engage regardless of how much encouragement I gave them!

Handmade gift from a student we helped.  Mine is the green one!

 Cute story: we helped edit a student's personal statement, academic statement, etc.... for her application to pursue graduate studies beyond her pharmacy degree abroad and we whipped her stuff into shape.  So as a small token of appreciation, we have these precious keepsakes!

Quan Ngon.  High end Vietnamese restaurant walking distance from school.  Turns out, we're walking distance from huge sightseeing touristy places!  Jackpot!  Because.... that's exactly what I freakin am!

This is a carved out coconut with ice cream in it! <3  Thu looks happy.  

One of the sightseeing places.  Notre-Dame of Saigon

Post office turned tourist site.  I may have written 2 postcards to two special people.  If you want one, PM me your address and I'll spend a buck on you!  I'm planning to go there once a week!  For those of you that don't know, every week, I write a letter of thanks to someone I appreciate.  Want me to write one to you with a wicked picture of Vietnam in the front? :)

My grandma, she totally can walk but not super long distances.  This weekend, we took her to the condo, 40 minute from where she lives and in the evening, by the Saigon river, it's nice and cool and we walked her around for an hour or so.  Change of venue for her.  Relaxing weekend for us.  Got a haircut.  Forgot to take pictures.  I suck. :)

 Week 2: Almost caught up.  Dr. Joseph Bertino a PharmD from upstate NY was gracious enough to volunteer his time to lecture at the school of pharmacy on antibiotic stewardship which is in great need here and is up and coming.  Delved into PK/PD and TDM.  It's just so great to meet other people from back home that feel ya!  Lovely gentleman, will be in touch.  Lectured 2 days straight.

Quan Nem: what we had for lunch.  No regrets.  http://www.travelfish.org/blogs/vietnam/2012/11/29/review-quan-nem-ho-chi-minh-city/

Tomorrow is a holiday.  I will be visiting my grandfather and great grandparents grave to pay my respects.  Will update again later.  It'll take you about a week to read this anyway. Chris, I expect you to read this faster. :)  I miss you all back home and can't wait to get back to spend time with the rest of the people I love--Dan, I'm talking about you man.  I get to spend a few months in San Jose with you! <3  Fatcat, you're out of luck.  Too far.  Just wait for Dan to come to LA.

Leaving you all with a quote: There are only two days in the year that nothing can be done. One is called yesterday and the other is called tomorrow, so today is the right day to love, believe, do and mostly live. -Dalai Lama

Day 2 and 3

Dear world,

Day 2 and 3 in this entry.

Day 2: Highlight of the day: I legitly maneuvered a moped!

Started at 0900 the day after I got here!  Did not feel like surviving!  Everyday is a battle, a near death experience.  1) the weather is 10000 degrees, 2) crossing the street is worse than playing frogger, 3) commuting via moped is expecting the unexpected.

So anyway, I was not feeling so hot at orientation, my tummy hurt!  Anyways I feel better now.  But I loved meeting our primary preceptor.  He is a a pharmacist who completed his PhD in France and I'm thoroughly impressed by his clinical skills as well as his worldliness.  First day was brief that basically positioned us to have a set schedule of hospital visitations and lectures that we will give and partake in.  It was explained to us that clinical pharmacy is in its infancy to say the very least and that we will learn about that during hospital visitations.  Pharmacist roles in hospital are primarily research focused to review prescription decisions by physicians after the fact.  Interesting.  A stark difference from what we experience in the states on rotations where it truly is a collaborative team effort during a patient stay.

When I got home, I played catch with my grandma for a good half hour or so.  I was sweating like crazy! She's a hundred years old.  A HUNDRED!  She is still completely lucid, more than appropriate and sassy answers, copies poetry from a book and memorizes the whole damn thing.


Later in the evening, we went to Crescent Mall.  Tell me this is not superb by any standard!  Heard in the evening on weekends, theres a watershow!  Anyways this is the high end of Saigon, it is the one place where I can be myself.  When I say that, I mean not completely mute to hide my Americanized accent or trying to fake being a local.  It's hard.  I always give it away.  But here I could be my foreigner self.  Theres lots of stores just like back home: Aldo, Guess, Mango, etc but I'm so not paying real money for that.  I'm on Vietnamese currency bros!  :)

So a few things I picked up from here:

1) I drove a Vespa scooter from condo Era town to here.  I gave my dad a huge fright!  My uncles were sandwiching me and I had my own motorcade essentially but its still lots of unexpected shit like people coming out of alleys or sedans/taxis making a right pushing into the moped lane.  

2) Chatted up a security guard.  He has a cushy job.  He makes $210.00 a month but he works 12 hour shifts every day of the week.  What the heck mannnn.  Let me get back to the part where his job is highly coveted and cushy!  My rent is $450 a month.  $210 doesn't even cover my boba expenses.  Different currency!  

3) Stopped by a pharmacy in the plaza.  There's two sections behind the counter.  One says "Over the Counter" and the other says "Prescription" in Vietnamese.  So I walked up and said I need erythromycin but I don't have a prescription.  She says, "Oh, well technically I need a prescription, but if I've had it before, it's fine, I can sell it to you." As a soon-to-be pharmacist deeply invested in antibiotic stewardship, I was horrified, said okay thanks and awkwardly walked away.  Sigh....

Okay, so after, I stopped by to visit the house where my grandfather passed away and prayed.  I met my baby niece and she is so precious.  She laughs like, belly laughs at just about anything!!!!!  3 month old.  She'll go far in life.  And It's the first time I carried an infant niece.  I'm an adult now and I'm in love with her!

Went home, chitchatted with my youngest aunt for hours and tucked in.  Talk about a well balanced lifestyle.

Day 3: Highlight of the day: Head massage!

God if you still care to read.  I'm sure there's only 2 of you or so still reading to the end of this.  :)  

So today, I learned about Asian time-- it doesn't exist.  Arriving at 0800, he shows up at 0900.  Learned about pharmacist in academia salary.  So top of the top.  Tenured professor = $500.00/ month.  300 people get admitted yearly, 7000 students take a national exam and top performers get admitted.  Tuition = $0.  Just wanted to give you some numbers. 

Got a 2 hour grand tour with each department and learned about Eastern medicine, illicit drugs being a problem in this country.  Picture of herb garden here!  

Despite the lack of resources, researchers are highly resourceful!  We met many PhDs and MSs who did their post graduate training overseas and returned to be faculty.  They are make doing with a bit older MS, HPLC, GC machines and using computerized docking and modeling using free trials to elucidate structures etc.

After a long tour, we got lunch with a junior faculty who is younger than us -_-.  Pharmacy in Vietnam is as such where students are admitted straight after high school and they study for 5 years, and they have to work for the gov't for 5 years afterwards in order to receive full licensure.   Anyways, we grabbed smoothies afterwards. Closest thing to boba so far.  Its been 72 hours or so guys.  No DTs from boba withdrawals yet.  Oh, DT = delirium tremor for non health friends.  It happens with alcohol withdrawal and can be fatal.

 Here's a selfe of the power team:

Okay last parts of this blog for tonight cuz its 10pm now.

So at 130 we went back to school lecture discussion.  Due to an unexpected visit by inspectors, the professor did not show up until 345pm so guess who they paraded around in the front of the class to discuss topic of the day: Parkinsons Disease?  Oh yeah, yours truly, power team 3.  So we led the discussion after a quick review of the powerpoint from therapeutics on the weaning on off effect of Levodopa and fielded questions of all sorts: antioxidants, interactions, and everything else in the world.  Funny of the day: English and Vietnamese barrier.  It's like a chicken talking to a duck.  Every time team 3 is at a loss for words in Vietnamese, we supplement with English, followed by laughter.

When the teacher finally got there, he soaped the cases: Parkinsons, GERD, BPH, hyperlipidemia.  Like SOAPed and went into as much mechanistic clinical stuff as we do in therapeutics.  Highly impressed.

Productive day so I celebrated with getting my hair washed, head massage etc.  It cost a total of $1.50 for 30 minutes of pampering.  I'm okay with that.

<3  JPham