September 14, 2009
June 15
June 15
The humidity that morning was so intense I was awakened by my own sweat before sunrise. My aunt had turned off the air conditioning so all that was left was a fan blasting the hot air into my face. A cold shower brought instant satisfaction but left me with a headache. My aunt made up her mind to come along to see my work, and there was nothing I could do or say to stop her. Since Hoi An Foundation could only afford to spare one driver, my aunt hired a “xe om,” more accurately described as an individually-owned taxi service on motorbikes. I thought I had gotten used to the extreme sun exposure by then, but my body was sending mild signals that I had overestimated my endurance.
The blazing sunlight directly over my head did not do as much harm as the scorching heat on my skin. After half an hour of sitting on the motorbike with the breeze constantly blowing into my face, I arrived at the district where I was going to screen my random sample of residents for hypertension and diabetes. It was a particularly disappointing morning with nearly a 40% non-response rate from the households initially chosen to be in the stratified random sample. The heat had destroyed my usual patience, and I gave in to the cultural custom that I had considered so inefficient until that moment – lunch break.
Lunchtime is not just one hour of the day in Viet Nam — it is a way of life. I had to get used to the idea of empty streets bounded by two rows of closed businesses at noon. Almost everyone in the work force, including street vendors, goes home around noon for lunch followed by a one to three hour-long nap. It was rude to visit people’s houses at noon because everyone was busy having a family meal, and it was hard to find anyone awake to complete the survey immediately after lunchtime. I cannot quite pinpoint whether it is a trace of French imperialism or a natural adaptation to the dangerous noon heat, but I decided to take a long break so my ibuprofen would have time to kick in before I had to work again.
We stopped in a small restaurant known for its Cao Lau, a Hoi An specialty dish, and it was the filthiest place that I could imagine, even by street restaurant standards. The breakfast and lunch crowd had left a floor full of used, grey napkins and cigarette ash on the ground. Between the heatstroke and the upset stomach, I was ready to call it a day and make up for it on the weekend, but I could not get myself to quit. I sat on the motorbike for what felt like an endless journey until we arrived at the second village. Even though I was excited to get off the motorbike before the nausea could hit my body, my excitement quickly turned to astonishment when I saw the first house.
Comparatively narrower that all the other houses on the street, this one was about 150 meters from the main road and stood out as if it were the only house in the middle of the desert. I had on a pair of flip flops and felt the pain of my little toes being buried in burning hot sand with each step. A woman no more than 40 stepped out with a straw hat on her head and two large baskets filled with fresh produce. I was especially alert to make up for the morning’s low response rate and jumped to tell her how lucky she was to get a free screening for hypertension before she could tell me that she was too busy. She agreed and invited me to the house for a drink only to discover she was out of tea. I took off my shoes and quickly screened the room for the closest chair, but there was none. Out of common courtesy I placed all the equipment for screening on the floor so she did not have to apologize for the lack of furniture. As if she understood my gesture, she silently came over and sat across from me. She was a very short woman and could have been easily mistaken as a dwarf if she were in the western world. I placed her tiny arms on my left thigh while she continuously apologized for not having any furniture. Once we were done, I asked her about some of her responses to the survey, particularly about her family and income since she would most likely have to start treating her hypertension and diabetes.
The participant had never been married and lived alone in an empty house with only her produce and one portable stove for company. Even the poorest houses that I have seen had a bike or large pot of rice — she had nothing. She earned about $35,000-$50,000 for a ten hour work day — one hour walking to and from the market and nine hours selling her produce. That is approximately 20 cents an hour and $2-$2.80 a day. I asked her to go to the hospital for a more accurate BSL and blood pressure screening because my informal screening revealed that she had both stage one hypertension and diabetes. I carefully explained the chances of death from a stroke or heart attack. Since her lunch could have affected her BSL, a formal screening, where she would be under the doctor’s directions to fast, was absolutely necessary to provide the precise results.
She stared at me for a moment and said, “It is too bad if I die. I do not have time to get a check-up, and I do not have money to treat those diseases you speak of. As long as I am careful not to spread my diabetes to anyone else and live for as long as can, I will be okay.”
I dug into my pocket for whatever money I had left — absolutely nothing. I reiterated the necessity to get the formal screening and left her house in astonishment. I was more than one mile away from the empty house before I realized that I forgot to tell her that diabetes, although a chronic disease, was definitely not contagious. What could have possibly prompted this myth that diabetes is communicable? I felt guilty for forgetting to explain this detail for her, but I knew that mythbusting had never been a part of my job description; I had neither the credibility nor the experience to correct medical beliefs that have been around longer than I have.
By the end of the day, I had forgotten my role in Viet Nam. Am I going to be a stoic researcher that simply stands back to observe the poverty, injustice, and death in this country? Am I going to be a philanthropic student that eats ramen instead of rice to donate my unused fellowship money to the poverty-stricken? Everything that I have learned in the classroom about participant observation seems so vague. I think the heat has really gotten to me today. A good night’s rest is what I need to apply what Professor Symonds taught me about anthropological research to my medical work.
Posted by Cherilyn VyVy Tran at September 14, 2009 11:22 PM
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