Medical and Dental Care and a Milestone

Several experiences over the past few weeks allow me to pause and talk about medical and dental care here. First, there are some significant positives in a system where the under the table or relationship component of care supercedes the more formal expectations of insurance coverage. While this does seem to make the level of care one receives uneven, it also is one that affords choice and demands scrutiny to see that one is truly benefiting from the added expense. So our friend C's mother was noted to have an enlarging thyroid nodule. It appeared to be about 3 cm, and had been previously noted without being biopsied, so the enlargement was cause for concern and evaluation. The place where she got the ultrasound was a stand-alone storefront, without much of a referral network. (Point one for a fragmented system.) So I called one of our pathologist friends who was working at the K Hospital near her home and asked her to arrange for an FNA and referral. She did so very promptly, performing the FNA herself and providing me some of the slides for review. She then introduced them to the head of ENT surgery at the new K Hospital. Although her insurance was not acceptable at that hospital (good only at the provincial cancer hospital of the Hanoi City) he worked a way for her to be admitted under an urgency clause and performed the surgery last week (financial and professional incentives at work.) Her tumor was entirely a low grade papillary tumor, although it did extend slightly beyond the limits of the thyroid. After a five day stay or so she should return home and then get her radioactive iodine, although I have not heard whether they wish her to stay and do that while in the hospital this time.

When our daughter Elizabeth was visiting for Christmas, she stumbled and fell causing a rough laceration on her chin. The bystanders were very accomodating providing water to clean her up and some sponges to staunch the bleeding. Although they suggested we go to Viet Duc hospital, which was pretty close, we opted instead for the Family Medical Practice, which is somewhat of a general practice, urgicare center with various specialists focused on caring for the ex-pat community. They quickly ushered her in and assessed the situation, then cleaned her wounds and scrapes and stitched the laceration with a few stitches. Meanwhile KC worked on the insurance arrangements. That ended up requiring more time than the entire medical encounter (though I'm pretty sure the clerks are paid on the same scale as the doctor and nurse.) While there we saw people coming in for routine check-ups, vaccinations, and other purposes. I would grade the care as equivalent to any received at a similar clinic in the US, and the service as more timely.

One of our elders, got a little rambunctious on his preparation day last week and pulled his ileopsoas muscle. He soldiered on for a day or so, but by Wednesday afternoon was unable to urinate. The Noordas took him to VietPhap hospital, the higher quality French collaboration in town. A CT scan disclosed the cause of the problem, a sizable retroperitoneal and peri-cystic hematoma. The doctor suggested that while it might resolve on its own, surgical evacuation could hasten his recovery, and so they went ahead. (We learned this when Pres and Sis Christensen came to dinner late, just happening to be in town, and on an earlier flight than planned with enough time to minister to him- I'm sure just a "coincidence.") He had it done laparoscopically, and carried a drain for a couple of days, before coming home today.

      

I think he contacted all the people on his floor and several others in the process of recovery, and with a smile like his, he would be hard to resisit.

My encounter with the dental system came courtesy of a guava seed. The seed proved harder than the cusp of molar #2 at the juncture of an old filling. The gap didn't really bother me, but I thought it best to get it taken care of. We know two or three dentists here fairly well, so I opted for the one who works closest and happens to be my home teaching companion. He doesn't own the office, which has three chairs, though none of them were occupied in the morning hours when I went in initially, or the second time for placement of the restoration. He worked with a hygienist/assistant who was less adept at keeping the excess water from the drill aspirated from my mouth than I was accustomed to, so much of the time I felt I was really guarding the airway. The drilling was done without any anesthetic, and he avoided the pulp so I didn't feel any significant pain. Many dental offices have glass front windows to the street, perhaps so that when they do have a patient everyone knows that someone trusts them, but this office was more discreetly placed on the ground floor of an apartment building. I get stared at enough, so I was glad for some measure of privacy. His work was supervised by the senior dentists in the practice, who made knowing comments about where to drill more or how to structure the base for the restoration. I paid the bill after the first visit, which with my friend discount, came to just about $200, but probably would have been at least four times that in the US. Even then, much of the cost was for the US-derived materials for the cap, and the polymer-based, UV-activated adhesive they used (let's hear it for chemistry!) The only problem was that the temporary filling material came out with the first sandwich I ate so I had several days with my tongue feeling over the structure of the gap in my tooth and chewing very tenderly on one side of my mouth.

The Milestone that was announced officially last Thursday on the church's media site and in the on-line Deseret News has brought an outpouring of congratulations, supportive prayers and encouragement. And a few questions as well. The creation of a mission within Vietnam, separate from Cambodia, is a significant step, and reflects the groundwork done by so many people over the decades. My friend Ryan Bird pointed out that it will this year be 50 years since Pres. Hinckley as a young apostle dedicated South Vietnam for the preaching of the gospel from atop the Caravelle Hotel during a time of war. It's been 25 years since the first senior couples returned here as church representatives, and just a few years since branches began in HCM and later Hanoi, sparked ironically by members from Cambodia bringing the gospel back with them. I've heard from many of the previously unknown (to me) people who have loved and served in some capacity pertinent to this marvelous work and who like us, shed tears of gratitude to be part of His marvelous work and a wonder (VN edition.) In another sense, things may not change dramatically, even as we now look forward to the next milestones on this journey of salvation. But the keys of the priesthood will be here, and councils will convene, and that can lead to miracles, which we feel grateful to witness. 

The missionaries serving in the Vietnamese program gathered by Skype to listen to Pres Christensen answer their questions on Friday afternoon, eager to understand what it will mean for them. They are the true heros in the story, the ones who will faithfully live and teach in a way that cannot cause offense, and love in a way that cannot be resisted. They are his living epistles, the palpable manifestation of his love (which casts out fear) and his life or teachings (which shows the way to happiness.)

     

Elder Khanh, Sister Diem, and Sister Dao gather in front of the computer screen for the skype call regarding the mission changes.