Thank you means no? Gia Dinh Hospital, Ho Chi Minh City, Vietnam

It's hard to live between culture, and I've found myself floundering a few times. Americans are so earnest, so honest, so straightforward at times, and I've grown to love this way of being. But I forget.

When my grandmother suffered a series of devastating strokes in Romania, we very sadly had to admit her to a nursing home, I'm sure with plenty of guilt of soul searching on the part of my parents. In addition in this country of transition we had to negotiate the usual channels of official and unofficial understandings. 

When my parents brought the gift for the director of the nursing home, she declined the gift so persistently they almost backed down. Then they remembered where they were, insisted, and the gift was accepted in the end. 

Observing this shifts in customs is familiar to anyone who has traveled across national borders, or even from one part of the US to another. 

In Vietnam I had to recalibrate my social compass. 

I don't fully understand how this works, and will need more experience, but the importance of "saving face," on a having a good outward interaction will often lead the Vietnamese to make promises and plans that will likely not pan out. They may have no intention of lying, and assume you have the experience to understand the situation. 

Several junior physicians had been cajoled into "inviting" me to various activities by my more senior host. They were clearly aware that I was foreign, and needed some guidance to settle in to the country. 

I was hesitant to accept the invitations, afraid of becoming indebted in some way I would not understand.  Not meaning to be rude, I accepted any persistent invitations, and sought out appropriate gifts. Once I replied to a text message asking what I would like to do with "thank you for thinking of me," and I'm thinking of these things.... There was no reply. The next week, in the hospital, I learned that "in Vietnam thank you means "no."" Or just thank you, of course.

Oh. OK. So I explained my own confusion, and we made plans, and carried a few out.

Since then there were a number of promises, plans, and many of them where carried out. Generally repeated confirmation and planning steps were a good sign of future activity. No reminders meant I could make other plans. 

One good friend is working for the CDC in Vietnam. Like many other Americans she was frustrated that agreed upon projects and goals were simply not pursued by their Vietnamese counterparts despite many promises and smiles. She was frustrated. I tried to work on her expectations a bit, understanding that "thank you" without any promises is a pretty clear no, while "yes" is very often maybe, and she'll have to take it easy and see when yes becomes real. 

She was only mildly relieved, but decided to reconsider her position.

Initial expressions of confusion or disbelief will not be very helpful. Anger is never helpful, and mutually embarrassing. Smiling always helps. East Europeans are not great smilers, and this may have been a problem even in Boston, but I'm learning, and Vietnam has been a good teacher. 

Just keep smiling. 

Dan-Victor Giurgiutiu

Partners Neurology