The Leap of Faith - By Sarah Painter

I awoke to the sound of the furious morning streets of Long Xuyen. There was a feeling in the air that was distinctly different from Ho Chi Minh City. I curiously peered out the window as the skies appeared to be gloomy; my mind curious about what the day had in store. To my surprise the false presence of rainy skies was endorsed by condensation on the double pane glass. A bright sun danced in the early morning sky over the bustling streets of the city. Today, as everyday, would be scorching.

I emerged from the shower refreshed and ready. My roommate Anne and I donned our official uniform for the next week and a half: a CHKV white t-shirt with green scrubs pants and sandals. I felt crisp, clean, and ready for a day of challenge and excitement; relishing in the feeling of this early morning sparkle. I have now learned how quickly the sticky Vietnamese heat can chip away at your sense of freshness. One mustn’t take these precious moments for granted.

Our team meets at the magnificent roof top restaurant for breakfast. Rows of tables await us under the spectacular daytime sky of Long Xuyen. An impressive buffet of food beckons our empty bellies. Trolling through the various dishes, one is to discover a variety of noodle dishes, spring rolls, rice gruel, and hardboiled eggs. How very unusual to have dinner for breakfast, I thought, as I perused the options. At the end of the line, a fellow in a dashing white uniform stood at attention in front of his petite cooking station. On command, fresh-to-order scrambled eggs would come to life in his frying pan. Adjacent, ready-made bowls of noodles, greens, sprouts, and meat eagerly awaiting a suitor to request it be filled with piping hot broth. How unanticipated it was for me to begin a Vietnamese love affair with hot pho for breakfast. There is something so wrong with this, yet simultaneously something so right. 

We gather in front of the hotel, enthusiastically awaiting instruction. Our journey today would take us to the An Giang Hospital. I felt a knot in my stomach, but different from yesterday. I sensed the subtle calm before the leap; the feeling I imagine you would experience just before leaving the edge of a cliff. There was no return now and in this danger there was freedom. Side by side, each one of us had committed to this adventure; and come what may, we would share the experience together. We bravely entered our vans and muscled our way through streets thickly lined with the busy, apportioned mopeds. Our adventure had truly just begun.

Our van narrowly passes a precarious gate that holds what appears to be a side entrance to the hospital. We have arrived.  Amidst congested narrow streets of moped traffic, street carts, and tiny vendors fanning grills filled with specialty food items, the intricate economic tapestry of the streets thrives in the mid-morning heat. Our van stopped just short of the gate, pedestrian foot traffic dense and unyielding. We disembark and enter the fray of the front of the hospital. We are met by the familiar faces of Dr. Trung Pham and Phat, a pharmacist who would be serving as a translator and guide during our time here. I stood on the walkway and took in my surroundings. People walking and seated everywhere, the occasional metal gurney carting seemingly lifeless individuals to and fro. There was a method to this madness that my naïve eyes were not yet able to discern. I had arrived to teach, but standing in the eye of this storm, it suddenly struck me that I was here so much more to learn.

We are escorted to the top floor of the main building. A tiny elevator furiously hauling people from bottom to top and down again beside a staircase - our options for ascension. In the spirit of taking one for the team, several others and myself opted for the stairs. My early morning shower felt miles away from me now, as I hauled my sticky physique up five flights of stairs. Our reward found at the top of this mountain was a large, air-conditioned theatre. What bliss was found here in our classroom.

Rows upon rows of eager participants already in chairs awaited our arrival. We are ushered to the front of the room where our seats have been reserved for us. Bottles of water meticulously positioned in front of each of our chairs. Details such as these are the grand gestures of gratitude. Easily missed, but incredibly resonant. We are being welcomed by people eager for the opportunity to learn. I can feel the discomfort caused by being in a new place and tackling a new challenge slowly becoming disarmed. We are among friends here and we accept the uncertainty and incredible opportunity of this adventure together.

As I sit and watch the final preparations for the morning session coming together, I can see that there are many people orchestrating an impressive Telehealth arena filled with numerous rural hospitals calling in so they too can partake of the learning. Clearly the good news of our symposium had spread far and wide. Dr. Trung Pham and his hospital had put much work into ensuring other providers were able to access this gift of free education. Unbeknownst to us before our arrival, all participants were to complete a pre- and post-test as part of this event, indicating how seriously this opportunity was being taken.

An opening ceremony commences once we are organized into our seats. Ambassadors of the hospital and CHKV declared gracious meaningful messages: our hosts humbly welcoming the team and CHKV, equally unassuming, accepting with gratitude. Once the speeches were complete, the entire team was invited on stage for photographs with various teams of providers from Vietnam.

We are whisked away from the auditorium by an eager team of physicians excited to show us the new hospital. Dr. Trung tells us the facility that they currently occupy is more than 100 years old. Their new hospital is constructed, nearly ready, with a moving date in March 2016.

We arrive at the spectacular structure, standing tall in its splendour over the crowded streets. As we file out of the van we are offered hard hats, as this is still very much a site of construction. We enter the building into an atrium of sorts. There are rows of chairs and wickets with bank teller style glass with fenestrations for exchanges of voice and currency. In Vietnam, the emergency area is completely different from what we are familiar with in Canada. The purpose of this entrance way is to register and collect payment. Only a few beds can be found juxtaposed to the registration area. There are limited resources here as it serves as a master triage area, patients ultimately being decanted to other areas of the hospital for any type of care, including emergency interventions.

The new hospital is an impressive ten stories in stature. It will hold 600 beds in total.  The old hospital will stand to function as a Women's Hospital with 400 beds. What is interesting is that the old hospital currently has to hold all 1000 beds, a testament to the need for greater capacity and incredible strain on the current facility.

The second floor boasts an extraordinary 28 bed intensive care area with pods of four beds under the daylight glow of the massive picture windows. Florence Nightingale often referenced the critical importance of natural light and fresh air to assist in one’s restoration of health. Impressive to me was this principle alive in living colour in this modern ICU. 

From there we are toured through a robust 16-theatre surgical area, post operative suites, general ward areas, and a stunning high rise roof area where a charming walkway leads you to a modern education auditorium, reminding me of facilities that we would have in Canada.

Brent and I are aware that there is a helipad and inquire if we might visit, initially believing it is on the roof. Dr. Trung explains that this was the initial plan, however the building structure could not accommodate it, so it was made ground-level. Still incredibly impressed, we are escorted to the site. Dr. Trung explains that there is currently no helicopter emergency medical service in Vietnam as it is very expensive. However, the new hospital was constructed with the dream of one day realizing this time and lifesaving possibility. What incredible foresight.

Sand had drifted briskly through our hourglass and it is realized that we are running out of time for lunch. Motivated by our need to set up tomorrow's skill stations as well as an aggressive start time of 1:30pm sharp, we find a mall with a food court and are mobilized through the process of ordering and money-exchange by the steadying hand of Thu.

We quickly return to our auditorium and set up our stations.

Stasa and Hareishun prepare pediatric sepsis and trauma cases:

Dave and Aaron assemble an ultrasound guided central line insertion and Advanced Trauma Life Support station:    

Christian and Brent arrange an incredible airway management station featuring opportunities to performing basic manoeuvres, insertion of endotracheal tubes and laryngeal mask airways, and hands on simulated experience for surgical airways (open and melker techniques):

Chau and Anne convene with two more ultrasounds to facilitate a station for FAST and bone, joint sonography:

Stephanie and Joanna organize a gynecology and obstetrical area where they will lead cases for postpartum hemorrhage, eclampsia, child birth with focus on difficult vaginal deliveries (i.e. shoulder dystocia, breech), and IUD insertion.

Lisa and I prepare for an Advanced Cardiac Life Support station with pre-planned cases for pulseless, tachycardic, and bradycardic patients.

After our furious prep work was completed, it was time to begin presentations.

Chau had bravely planned to go first as there were many moving parts. A main screen housed the English PowerPoint slides/video. There were two screens bookending the large one with the translated version of the presentation. Simultaneous translation would occur to clarify all statements made by the presenters. In addition to all of this, the Telehealth system would broadcast live to enthusiastic learners at other hospitals. Even with as much planning as we had done, we were all anticipating that there would be tremendous learning from this afternoon’s proceedings.

Lectures ensued with the exciting awkwardness that we had all anticipated. Our English presentations on the main laptop would not show our presenter notes, so we also needed to have our own computers to ensure that no information was left undelivered. A designated staff member was positioned at a table facing the screens whose role was to anticipate the changing of English slides and attempt to synchronize the Vietnamese slides. All of this activity is punctuated by the awkward cadence of the stop and start presenter narrative, permitting a mysterious Vietnamese translation to bellow out over the crowd, decoding the English into a more familiar version for participants.   

Nothing could have prepared us for the folly of the afternoon. We had found ourselves at the interface of our separate worlds, attempting clumsily to somehow find a way to fuse our cosmoses together. With each passing presentation, we learned new things and subsequently shed awkward layers. First Chau, then Brent and Anne, each skilled presenter uncovering more and more about the process and how to make it effective. By our final presentation, we had slowly developed momentum and cadence. An encouraging sign of hope and promise for our first full day tomorrow.

An exhilarated but exhausted team returned to the hotel by late afternoon. Our reward was a beautiful evening stroll for a delicious Korean BBQ dinner. It was truly an occasion to eat, drink, and be merry, celebrating in the success of the day.

Resting in bed at night, I found myself thinking about the entirety of the day and the journey up to this point. It was daunting to know that we would be charging into the unknown. It gave rise to the instinct of retreat that many of us feel when success is not certain. But seldom do we find reward by turning away from challenge.

Sometimes in life, we find ourselves at the edge of a cliff. We are vulnerable, anxious, uncertain of what the future may bring. We consider turning back to preserve our safety and comfort. We believe we are in the wrong place and long for the familiarity of home. We stand with our path laid before us but our ability to fly confounded by the powerful presence of doubt. But on days like today, if we can manage to will ourselves over this ledge, our leap of faith opens us to possibility of flight.