Broadening Scopes of Practice: Insights from Tropical Diseases at Cho Ray

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Written by: Curtis Plante

University of Vermont Larner College of Medicine Global Health Elective Dates: June 24 - August 2, 2024

Broadening Scopes of Practice: Insights from Tropical Diseases at Cho Ray

Starting Global Health last January, I was told rotating at Bệnh viện Chợ Rẫy was an opportunity to engage with medicine on the systems level. It was a chance to witness a drastically different healthcare system at a time when ours fails so many. As I entered the Department of Tropical Diseases, I knew I would see many infections endemic to Vietnam, though I was unsure how they would impact my future care of patients. I never imagined the experience to illustrate a culture of family-centered care in medicine or how a specialized department can be tailored to meet the broad needs of the community it serves.

Walking up the stairs to Tropical Diseases, I was first struck by the large, locked, prison-like gate unique to this department alone. Each room held eight patients with overflow in the hallways. They were further crowded with a family member beside each patient, responsible for all non-medical care. Family members slept under the beds of their loved ones to support them at all times. With non-medical care covered, nurses were able to focus solely on their medical duties. Those without family were assigned a caretaker paid by the government, illustrating this role’s importance in the medical team. Nonetheless, culture centered around family seeped into the wards and became an integral part of the healthcare system.

Rounds began, and I was quickly overwhelmed at the variety in the single room I was covering. This department encompassed much more than just infections, including animal bites/stings, intoxications, adverse drug reactions, autoimmune diseases, paraneoplastic complications, toxic ingestions, and more. Suicide in Vietnam is most attempted through ingestion of insecticides. Therefore, Tropical Diseases treated suicides as well and the locked door’s purpose became clear. Some rooms better resembled a neurologic or psychiatric ward, holding almost exclusively patients with altered mental status. Throughout my time on Tropical Diseases, I watched more sternal rubs than any other physical exam.

The physicians managed this wide range of conditions, showing their flexibility and deep care for their patients. In a country with intense stigma against suicide, they cared for those disregarded by others. For patients with no family, stuck in a culture deeply dependent on family support, they acted as social workers to work with the government and get them help. They broadened their scope of practice to care for their patients through any means, even while overcapacity in sweaty, overcrowded rooms.

As medicine in the United States becomes increasingly compartmentalized, it is easy to limit your scope of practice and push to pass patients onto the next service. It is easy to draw a sharp line in the sand because a patient’s needs may not fall within your specific job. As I progress through my career, those in the Tropical Diseases Department at Bệnh viện Chợ Rẫy will be a constant reminder for me to think twice before drawing that line--a reminder to continually look to broaden my scope of practice without overstepping my role and to support my patients in every possible way.