Faculty of Medicine instructor Hanh Huynh fled Vietnam 34 years ago. Now he is introducing UBC medical students to his homeland through a clinical elective.
No one would begrudge Hanh Huynh if he had chosen to turn his back on his native land.
He fled Vietnam in 1980, five years after his father was sent to a “re-education camp” by the communist regime. Sensing that he might meet a similar fate or conscription into the army, he became one of the 800,000 boat people who embarked on harrowing journeys through pirate-infested waters to refugee camps in the region. His own boat was besieged by pirates, but he and his sister’s family made it to Thailand before settling in Trail, B.C.
By any measure, it was a wise move. After working at a smelting plant in Trail, he earned a bachelor’s degree and then a double doctorate in neuroscience and pathology from UBC. He spent a year as a postdoctoral fellow in New York, working in the Rockefeller University lab of a Nobel Prize winner, and for the past dozen years, he has been an instructor in the Department of Pathology and Laboratory Medicine, teaching immunology, cell biology, problem-based learning and diabetes to medical students in Vancouver and Prince George.
But Dr. Huynh, who is now a Canadian citizen, has hardly severed his ties with Vietnam, despite the fact that it remains under communist rule. He has returned several times, not only for family reunions, but for extended stays to help the Christina Noble Children’s Foundation rescue street children, to train employees of a French pharmaceutical company, even to start his own family.
Now he is introducing his own students to the richness – and challenges – of the life he left behind.
This year, he organized a month-long elective for 11 fourth-year students in Ho Chi Minh City (formerly Saigon), where they were assigned to hospitals in their areas of interest – infectious disease, emergency medicine, anesthesiology, obstetrics and gynaecology, surgery and nutrition.
“I wanted to get more exposure to diseases that are rarely seen in Vancouver, like malaria, leptospirosis, dengue fever, measles and tetanus,” said Mike Benusic, who graduated in June and is now doing a residency in family medicine and public health in Toronto. “But I think everyone who signed up wanted to see how a health care system operates in a low-resource setting.”
A mutually beneficial exchange
Electives are a standard part of the final year of a medical student’s education, and while most students choose courses under the auspices of other medical schools or hospitals in Canada or the U.S., about 20 per cent of last year’s cohort used the opportunity to learn about medical care abroad.
Dr. Huynh’s motivation for organizing the elective in Vietnam was his sense that medical students hunger for more hands-on clinical experience. Vietnam, he says, is a good place to get it: “Vietnamese doctors see so many more cases a day,” he says.
He also saw it as a way to help Vietnamese clinicians, who hunger to practice their English and have limited opportunities to do so with native speakers. Every year, he has responded to that yearning by spending a few weeks teaching problem-based learning and disease prevention to faculty members at the Ho Chi Minh University of Medicine and Pharmacy (UMP) and the Ho Chi Minh City Nutrition Centre.
Dr. Huynh’s willingness to aid his countrymen, and by extension, the fortunes of the country, might be surprising, considering this is the same country that he felt compelled to flee, imprisoned his father (who worked as a police officer before communist rule), and wouldn’t permit his wife and two children to leave for several years.
“I always look at the people,” he explains. “I try to stay away from the political domain and focus on the human side of it. I would never forgive myself if I didn’t share the things that I learn.”
Overcoming suspicions
Dr. Huynh’s willingness to move forward wasn’t initially reciprocated by the Vietnamese government, which suspected him of being a spy. But he came to win the trust of officials, including Tran Diep Tuan, who became UMP’s Vice President. In 2011, Dr. Tran asked Dr. Huynh to broach the idea of a collaboration with UBC; a year later, an agreement was signed by Gavin Stuart, the Dean of the Faculty of Medicine and UBC’s Vice Provost Health, and Vo Tan Son, the Dean of UMP.
Dr. Huynh used his professional and family connections – including a niece who is an ophthalmologist and a brother who is an orthopaedic surgeon – to set up the placements, provide a warm welcome and maximize clinical experiences for the students.
“I felt like we had a bit of a family in Ho Chi Minh City that was looking out for us, and people with whom we could have pretty frank conversations about the culture, the war and the health care system,” Dr. Benusic says. “I think we would have felt a little more isolated if it was just the 11 of us living in the hotel and doing our own things in the hospital.”
The potential for hands-on learning with patients was realized by Robert Dale, who chose a surgery rotation. Due to the language barrier between him and patients, the doctors decided the best place to spend his time was the operating room.
“Pretty much my entire elective was spent there,” says Dr. Dale, now a urology resident at UBC. “I would have my pick of cases to go to, and I was able to watch – and participate in – a lot of cases involving urology, including cystectomies [removal of all or part of the bladder], prostate resections, and stone surgeries… When I was scrubbed in, they would always offer to let me cut, suture and tie knots.”
The highlight for him was being allowed to do a complete male circumcision on an adult (after some training).
“There were people watching over me, and if I had any questions, I could always stop and ask them,” he says. “It was pretty straightforward, but I would never be allowed to do that here at this point in my training.”
Wards of tetanus patients
Andrew Hurlburt was taken aback by the crowded conditions at one of the country’s premier hospitals, the Hospital for Tropical Diseases, which takes referrals from the southern half of the country.
“The wards were definitely over-capacity by our standards,” he says. “There were usually four or five people to a room that would hold just one or two people in Canada. And there were only a few isolation rooms, so contagious people were often placed in rooms with other patients.”
Dr. Hurlburt also was surprised by the sheer number of people suffering from tetanus, a relatively unknown disease in Canada, thanks to vaccinations. Although Vietnam has dramatically reduced the number of childhood cases through a vaccination program, it does not routinely provide booster shots to adults. Patients with tetanus would often spend a month in the intensive care unit, assisted by ventilators and under sedation to prevent full-body spasms.
“It was a little bit disturbing and disheartening to see so many people really suffering for a long period of time from something that is totally preventable, and that we don’t have as a problem here,” he says.
Dr. Benusic, who also spent the elective at the Hospital for Tropical Diseases, gained a better appreciation for the importance of physical exams and taking a complete patient history, since lab work and technology isn’t as available there as it is in Canada. He also was impressed by the expertise displayed by Vietnamese doctors, trainees and nurses with diseases that would challenge their counterparts here.
“We felt like first-year medical students when dealing with some of these conditions,” he says. “It was certainly humbling to realize how isolated you can be in your medical training. It demonstrated for me the ridiculousness of the notion Western-trained physician parachuting into a foreign countries and ‘fixing things.’”
War, then repair
Dr. Huynh plans to continue organizing the elective, and due to overwhelming demand, he and the UMP will expand it to 16 students in spring 2015. Several other students have reserved spots for subsequent years. In addition, Dr.Huynh arranged a clinical placement
for a UBC dermatology resident.
Meanwhile, he is facilitating another possible contribution to his native land.
He accompanied Michael Allard, the Head of the Department of Pathology and Laboratory Medicine, and officials of the Terry Fox Research Institute on a trip to Vietnam to discuss modernizing the country’s laboratories for diagnosing cancer. Dr. Huynh not only served as a translator, but educated his fellow Canadians about the country, the culture and its medical system.
“When you hear his story, you just shake your head in disbelief,” Dr. Allard says. “His ability to get past that, and his dedication to helping Vietnam move forward, is remarkable.”
Dr. Huynh views his efforts as part of the natural order. He likens it to the immune system that he teaches to first-year medical students.
“In any war, whether it’s between pathogens and our own tissues, or between opposing political groups, destruction will happen,” he says. “But part of the natural process, in our bodies or in our societies, is repair. I don’t preach Buddhism, but I live by its precepts, and one of them is, if you keep hating, it eats away at you, emotionally and spiritually.”