July 11, 2012
HO CHI MINH CITY, Vietnam — This summer, two Boston College professors are leading a group of students to volunteer at a clinic for HIV patients who are at the end of their lives in a society where the illness carries significant stigma.
A mile from my hotel, the taxi driver looks at the instructions again, does a U-turn and then speeds down the city's main avenue. A good 45 minutes later we are on the outskirts of Ho Chi Minh City, which most people around here still refer to as Saigon. The driver does a zig and a zag past stores selling pots and portable stoves and through an intersection crowded with commuters on motorbikes. Then tucked away on a side street that meanders past several industrial sites we arrive at an HIV clinic run by the Catholic Church, where I’m met by a woman who calls herself Vee, who tells me the name of the facility, Tieng Vong, is pronounced "Tan Vaughn" and means “Hopeful Voice.”
I’m also met at the gate of the “Hopeful Voice” clinic by Boston College professors Thanh Tran and Rosanna DeMarco. They’re leading a group of BC undergraduates on an eye-opening medical mission to help dying HIV patients at the ends of their lives: learning, relating, struggling with it all and then returning to Boston to make a difference back home.
How the Boston team got involved
“I am an expert in the area. I have been working with black women who are living with HIV who are aging with the disease,” says DeMarco.
DeMarco, a professor of nursing, is far from the HIV clinics of Blue Hill Avenue and the African American and Hispanic women she counsels in Boston. But HIV cuts through boundaries and knows no borders. “I partnered with Dr. Tran and we got five other students interested. All of us came together to try to learn. And see how the health care system works for these patients and what it’s like for them.”
Six students, with plenty of choices for a carefree summer, choose Vietnam instead, a place where HIV carries with it a stigma and a personal and cultural challenge. Says DeMarco:
“Vietnam, although stable in a sense, the rising rates among women and men who have sex with men is very significant. Thus the stigma in the Vietnamese culture. When you are perceived as doing something wrong, like IV drugs or sex working or doing something related to the usual connotation of why people get HIV, then you become ostracized and how painful that is in this culture because there’s so much value on family and connection.”
The students' motivation and the scope of the problem
In the doorway of a one-story suntanned brick building, Pauline Tran of Worcester extends her hand. She is one of five Vietnamese-American students at BC who’ve returned — if you will — to a country they have never known.
“I’ve always had an attachment to my background, to my culture. I’ve always been interested in helping the vulnerable, especially for my family who came from something like this,” she says. Her family escaped to the U.S. after the war. She and the other Vietnamese American students were born in the U.S. They say they have also come to this HIV clinic as a way of giving back to the country of their heritage. And everyone on this trip has a role. For instance, Nguyet Chau, a native of Worcester, helped translate the documents the team uses for the HIV prevention program.
They can use all the help they can get. Vietnam has very limited human resources. In a country of nearly 89 million people, about 300,000 have been diagnosed with HIV. But there are only 1,300 health workers assigned to this population, and many of them are volunteers.
Still, stigma is probably the greatest obstacle to controlling the epidemic, says clinic director Co Vinh, speaking in Vietnamese. “About 13 years ago when we founded this clinic there was no treatment for HIV here in Vietnam and most people had no knowledge about the disease. So their own families discriminated against patients and many of them were thrown out in the streets. Some live in the park under the benches and in the bushes.”
The scene at the clinic
We take a tour of the clinic: There are eight beds, a needle cleaning machine, photos of Jesus and Saigon’s archbishop on the wall; clothing, food and medicine are piled in one corner, medical charts in another. Local volunteers bathe patients, hand out supplies, chart their progress or lack thereof and offer moral support. BC nursing student Mary Gerardo is the only non-Vietnamese student among the six from the U.S.
“I’m from Richmond, Virginia. I don’t travel very much," she says. "They contacted me and I said that would be a great opportunity. Professor DeMarco, after meeting her, I said, 'I can do this.'”
Most local volunteers here are congregants at the Catholic Church that sits on these grounds in Ho Chi Minh City. One is a former clinic patient with HIV who seems amazed by his own survival. “They gave me free medicine starting in 2004,” he says, and that has stabilized his medical condition.
IV drug use in Vietnam is on the rise, as is voluntary and forced prostitution, according to the United Nations. Vinh tells me about a patient who was sold by her own mother into sexual slavery across the border in Cambodia and ended up with HIV.
She says, “The young woman ended up in critical condition with tuberculosis and I met her in a local hospital. I got her address from the hospital and later I was looking for her but the address wasn’t clear. So one rainy afternoon I was looking for her and found her sitting on the streets; coughing on the streets by herself. And when I saw her like that I just could not stand it and I used my own money to rent her a small room.”
To listen and to learn
While most of the Boston College team are visitors to this faraway land, Professor Thanh Tran knows Vietnam well and struggles — perhaps more than we can ever know.
“I was born and raised up here until I finished high school and came to the U.S. at the end of the war," he says. "I’m always very hesitant to return to Vietnam because I belong to a different generation and a member of the Vietnamese community in the United States that’s extremely anti- this government. But I came here with Dr. DeMarco and a group of students to learn about the health care system; how these people find resources [to take care of patients] under very limited conditions.”
And the commitment to reducing HIV infections and the stigma of AIDS outweighs any ideological tug of war between Vietnamese Americans and Vietnam, between heritage and politics, says Professor Tran.
DeMarco agrees and says being here offers an invaluable lesson: “No matter what the care is, whatever level it is, whatever is here or isn’t here, when people come here — they come with their family members and they don’t feel any stigma, they feel respect. When they come here they don’t have people not listening to them. They have people listening to them.”
And that’s perhaps the most important lesson here. These professors and their students are not missionaries. They’re not here to tell Vietnamese clinicians, caregivers and patients what to do and how to do it, but instead they listen and learn, says DeMarco. “As professors we’re interested in helping students not understand research like they are reading it out of a book but understanding that it’s a relationship with people who have real experiences and in order to ask good questions and to figure out the answers to those questions you really have to get to know the problem, up close and personal.”
And “up close and personal,” says DeMarco, is a step nearer to addressing the stigma of AIDS that keeps many from admitting a problem that is worldwide in scope — from Ho Chi Minh City to Boston.