Saturday, June 4, 2011

Please bring food, water, and a caregiver Gia Dinh Hospital, Ho Chi Minh City, Vietnamskss

Since the decades of war ended in Vietnam seems to have always fostered large families (four or five siblings is common), until the recent introduction of a two child limit. The culture and even the language is built around a complex web of pronouns and deferential or authoritative addresses based on relative status drawn from age and kinship, then continuing out into relative social status outside the family.

While I can't cover how this shapes society, I'm particularly struck by the care provided in the hospital. The services that are offered in Boston, from orderlies taking care of bodily needs, to web of care from home visits to nursing homes takes in those who are no longer independent. In Vietnam this is rare, exceedingly rare, and often reserved for the well to do. Nursing homes are reserved for those abandoned by society, who have no one else to turn to.

Instead family steps in, with a rotation of caregivers across multiple generations allowing ailing family members to remain at home. When a hospitalization is required a family member is present throughout the day, and at times at night. Dutiful family members, often but not always a woman, sleep on reed mattresses below the fifty year old beds.

On hospitalization a large container of water, a supply of snacks and several forms of entertainment are arranged on the bedside table, and the patient is bathed and changed into the hospital's pajamas. From that point on feeding, bathing, changing is performed mainly by family. When there is money I understand that helpers can be hired. RNs administer medications, obtain tests, and orderlies help shuffle patients from crowded rooms and hallways to tests.

I wonder how this will change as the post war baby boom ages and the tasks of care shifts to the two children per couple. How will they be able to leave their jobs, or children to care for ailing parents or aunts or uncles? How could they possibly neglect their elder relatives to whom they owe so much? I wonder how the US system of care agencies and locations will be adapted in this country which places so much reverence on family support.

Dan-Victor Giurgiutiu
Partners Neurology

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