Tuesday, 3 September 2013


I was sitting in the living room with my landlord (him teaching me basic Vietnamese phrases, me playing with his 2-year-old son) when my supervisor came on his motorcycle to pick me up. Heiman is a medical microbiologist from the Netherlands and has worked in Vietnam for several years and during my time here I would be working on the data analysis of his Vinares project. Doing the Vietnamese way he non-chalently signalled me to sit on the back of his motorcycle and off we went navigating the most packed street of Phuong Mai - You can only appreciate the somewhat orderly chaos from the back of a motorcycle, there is barely any space in between cars and bicycles (a relative rarity) and motorcycles but everyone just keeps moving, moving steadily. Slowly moving forward amidst the motorcycle jam we made a right turn into the hospital complex. Comprised of the French Hospital, Bach Mai Hospital (teaching hospital of Hanoi Medical University), Hospital of Dermatology, National ENT and Hospital for Tropical Medicine, the complex is like a small city of its own. There is even a barber by the side of the pharmacy!

While Heiman is parking his motorcycle in the car park I met Binh, who is a lab scientist working just below our unit. She studied in South Korea for 2 years and afterwards she felt paralysed by the sight of Hanoi's traffic, but now she is off on the road again. We walked up 7 stories and on the way I was introduced to the different divisions of the hospital. Triage and outpatient clinics on the ground floor, emergency department on the first floor (for more ill patients, akin to the acute medical unit in a general hospital), wards for hepatitis, virology and parasitology (currently overflowing with patients with dengue fever or influenza) and HIV. Sandwiched between the floors there are also the intensive care unit - which I would be going next week onwards and the children's department ("Mostly fever, meningitis or diarrhoea").

Our unit is nestled on the top two floors of the seven-stories hospital, which run multiple projects at the National for the past seven years on various subjects such as dengue, influenza, antibiotic resistance and CNS infection. Heiman described it as a happy long-term marriage, where the research unit works alongside with the hospital collaborating but also not interfering with what each other is doing.

In the morning I was teaching myself how to use the WHONet for data analysis on antibiotic resistance (now finally all that microbiology reports make sense! Studying the resistance profile of bacteria is almost akin to zoology/ecology, where you can see the usual 'wild type' who is susceptible to the usual antibiotics but also the emergence of the resistant type where the bacteria develop several mechanisms to counteract the effects of their nemesis, I have found this even more interesting than before and have been thinking about its implication also in antibiotic stewardship in hospital and also primary care setting. More thoughts later)

For lunch (Vietnamese lunch hour is 11:30-13:30, what a treat) four of us headed over to the local market opposite to have noodles. Heiman has the best command of Vietnamese and ordered a bowl of soup noodles with everything in it (tofu, snails and beef - it looks delicious), Annette helped me order a mien (golden vermicelli with soup served on the side) while Sophie got iced tea from the stall opposite. Annette is an immunologist who has done much research in dengue and influenza and she is due to move to Melbourne to take up another post later in the year, and Sophie is a specialist registrar in Infectious Disease/General Medicine working at Imperial and also University College Hospital before moving to Hanoi to carry out dengue research for her Academic Clinical Fellowship. It is refreshing to be able to discuss scientific ideas during lunch but also a bit about buying piano, children and expat life here in Hanoi.

In the afternoon I went with Sophie to recruit newly admitted patients for her dengue study and also see how automated vascular analysis were performed, with the lovely research nurse Lien - by looking at the blood flow into vasculature underneath the tongue plus how occlusion of the arm alters pulse pressure during the course of dengue in different patients, the extent of endothelial dysfunction caused by dengue fever can be recorded. Her project aims to look at whether the extent of endothelial dysfunction in the early phase of the disease can predict patient's course of disease (either gradual, spontaneous recovery or in some cases developing bleeding or capillary leak - dengue shock syndrome or haemorrhagic fever) and therefore may facilitate early intervention and closer surveillance for vulnerable patients. Dengue fever is a fascinating disease not only because it manifests in many ways but also of its feature of antibody-dependent enhancement: if you are infected with one type of dengue (there are four types) you develop life-long immunity for that one type, but if you are infected with another type of dengue then it would significantly increase your risk of developing a more serious disease. They are still looking into explanations into this and it has posed additional challenge for vaccine development, because a vaccine must target all four types in order to prevent this phenomenon. (Again, more later! This is becoming a never-ending medical rant)

In the evening I got home quickly and got changed to go for a much needed run. The local park has the third biggest lake in central Hanoi (the Ho Bay Mau) and there were many locals running, playing badminton, fishing or dancing aerobic which is a lovely sight. To cool down I walked around the lake as the night falls and the lake glows quietly with a blue hue. There was also an interesting choice of background music: first some Mandarin classic love song followed by Shostakovich's Jazz Suite, which were both surprising fitting - although it really did make me chuckle.


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