lundi 10 janvier 2011

Toi La Bacsi: Vietnam Cross Cultural Medicine at 38 000 feet AF 7770-300

TOI LA BACSI: Cross Cultural Medicine at 38 000 feet

I kept on saying to the very old lady, now slumped on her seat. She was flailing her arms and there were already a French doctor in attendance and one of the attendants was translating for the French doctor who didn't speak much English.

But neither did the patient. She looked well into her 80s. I had watch them board because there was a young couple with a baby with a mother and a grandmother I thought. The baby was very Asiatic looing baby and in fact quite an attractive baby I thought when I saw them boarding the flight.

She is Vietnamese but have been living in France for a long time. She speaks French but her current problem was incoherence, so language skills were not of any use but certainly cultural skills would be useful.

Very quickly I found out that this old lady who is living in France is being taken to USA for a visit, by her grand daughter and her husband and a family member who spoke no English, who might be her mother. A French speaking Grandmother, A Vietnamese speaking mother and an English speaking grand daughter..

Medically from her pills, I could say that she was a diabetic and that she must have some allergy problems. She also had medicines for diarrhoea.

Her grand daughter who had seen her for the first time just four days ago said that her grandmother was an active lady, in fact very sarcastic in her outpourings and was behaved absolutely normally until we were over the atlantic and there were four hours of flight time left.

It reminded me of patients at the Repat Hospital in Melbourne, who went hallucinating after an alcohol withdrawal. I couldn't find a focus to say that she might have suffered a stroke. She felt warm and was moving in a fashion which was not far from a normal old person. There was no gaze preference or blurred speech. She could speak even though she may not make sense. Are you thirsty? I have drunk water already, she would say.

There was a dentist who came into the foray who couldn't even take blood pressure. Blood sugar taken showed it was 235 mg/dl which the French Doctor said , it is okay. I thought to myself, she probably has been running at this high blood sugars all the time and dehydrated, and this flight had been the final blow and that something must be happening in the brain. I also felt confident that this reversible. The French doctor was concerned about a stroke.

I did notice that the flight attendants preferred to speak to the French doctor, and he did not seem very high up the hierarchy of French medicine, since he was flying Economy class. ( a slight jab at him?)

In any case, the captain spoke to him and it was decided that she would be met by ambulance on arrival in Houston.

The very efficient Purser, a lady , arranged for her to be moved to the First class so that she could lie down properly and that alone would give some comfort to the lady.

The flight attendant and I virtually carried her from her economy seat through premium economy and business class to the first class. There was a bed free there and put her there and she lied down quietly.

I came back to my seat to write this. I also noticed that she had that peculiar odour and that the famlly might have decided to bring her to the USA because she was not being cared for properly there in France.

In any case, the granddaughter asked me, do you think they will take her French medical insurance? I told her, first of all they will take her to a public hospital and because of her condition is acute, she will be attended to . and she will be discharged as soon she comes around. Worry about that later. Call with the help of the flight attendants, your family in Houston and ask them all to come to the airport if they are not already planning to come. The ambulance will take her to the hospital and you all go later to the hospital.

I better go and see how she is doing. But the afternoon snack just arrived.

When I went up to see her, she was lying down flat and still moving her arms but much calmer. The French doctor for his credit had put in an IV and it was running too! He didn't speak English at all and I couldn't find out from him whether or not he put some Diazepam in the liquid. When the flight touches down, Ambulance and EMT would be on board and will take her to the hospital.

What a Welcome to America! But I felt very strongly at heart for the granddaughter with her baby of just a few months, also the husband didn't speak much English so it may have been a match made in Vietnam as it happens very often in Viet Khieu communities in USA.

I went back to find her and told her that it is my feeling that once she gets a little sedation and fluid on board by tomorrow morning she should be fine. I gave her my card to send me an email to inform me of the progress of her grandmother.

She took my arm and said, thank you so so much.

Where does the cross cultural part come in?

I could see that the old lady calmed down and had less movements the minute I told her Toi La Bacsi, which is Vietnamese for I am a doctor. In 2002 on my fist visit to Hanoi with my brother Eliyahu we had stayed at a hotel at Hang Bao street in Old Hanoi and the girls at the reception had taught me that phrase which I had used many times to excellent effects all over Vietnam. Here is an elderly lady and I saw that a doctor, is with her, she may not known that the French guy was a doctor, he was too busy doing things to her to notice anything like that.

I held her hands and put the arm around the shoulder and kept on telling her Toi La Bacsi, I am a Doctor and I could see her calming down. Even when I went to see her the second time, the french doctor was busy looking at the drip and the rate it was going, and no one was looking at her, the elderly lady who might have grown up in Cholon during the French Protectorate and who came to France for a better life! I put my arm on her arm and comforted her, Toi La bacsi..Never before learning one short sentence in another language has come in so handy.

When the plane landed at IAH in Houston, the rest of the passengers waited as she was wheeled out.

I send a little thought to her: Good Luck, Grandma.

As I am member of the trusted traveler programme, The Global Entry, I was through the Immigration and got the bags and they have a special line at customs for global entry passengers. It was the fastest entry into the USA and as you know I enter once a month into the USA.

Who says there are no spirits who look after you?