The villagers sit in small plastic chairs as they watch Project Vietnam volunteers set up a medical clinic at the Truong Th - Thcs Thanh Mai school in Northern rural Vietnam. Adults and children fill in the chairs and clutch their medical record forms as they wait their turn for treatment. Among them is Ng Thi Tham, an 86-year-old resident of Bac Kan, who lives three kilometers from the school.
She is one of the many who hiked and rode motorbikes through Bac Kan’s mountainous terrain, making long treks in order to see the American doctors, optometrists, dentists and pharmacists of Project Vietnam. The non-profit organization assembles medical missions throughout the year to visit impoverished villages in Vietnam where medical aid is not readily available. To visit doctors, villagers are directed to nearby schools and sub par medical centers that have been fashioned into Westernized clinics where they will make their way through four stations: vitals, physical assessment, pharmacy and optometry.
With her frail, calloused hand resting on her chin, Tham stares off into the distance, her pale brown eyes peek out of a face filled with wrinkles so deep that they resemble the crevices prevalent throughout the mountainous areas of Bac Kan. Surrounded by a courtyard composed of four crème colored buildings, she sits with a permanently arched back that is concealed by a heavy, deep purple sweater, one that fits one size too large and further exaggerates her tiny frame. Her hair is stylized into a bun and is secured with a black headband; though wisps of her salt and pepper grey hair escape to create subtle bangs that surround her face.
She snaps out of her contemplative state momentarily to pick off crusts of dirt sandwiched between her fingernails. Her skin is as rough as sandpaper and etched with fine lines that reveal a body that looks closer to the age of 100 rather than 86. She is dressed in her best outfit and aims to present herself to the doctors by looking as clean as possible.
“I have not seen a doctor for 30 years,” said Tham, who has lived in Bac Kan her whole life. “I have many problems: I can’t sleep, I can’t eat and I can’t see well… I want to get help.”
Tham’s situation is characteristic to those who live in Northern and Southern rural areas of Vietnam. Since many individuals wait so long to seek immediate medical treatment, conditions that aren’t treated immediately can lead to extreme long-term health problems. This, paired with the bureaucratic health process regulated by the government, leaves many individuals to make what seem like pilgrimages to visit medical centers or, like Tham, forego seeing a doctor at all.
When a volunteer calls Tham’s name, she rises slowly from her seat and takes small steps to reach the vitals station, which is housed in one of the two abandoned classrooms that inhabits each building. Making her way passed remnants of the previous days’ math and writing lessons inscribed neatly on green chalkboards heading the classroom, Tham sits with a nurse. Weighing in at 42 kilograms with a height of 146 centimeters, the nurse taking her vitals immediately says that Tham is underfed and malnourished. Her body is so rail thin and weak that she needs a helping hand in order to move from vitals to the physical assessment station.
She sits across from Dr. Douglas Nguyen, who begins checking her blood pressure. While getting her assessment from Nguyen, Tham begins talking about her family.
Tham’s husband died when she was 40-years-old, leaving her to take care of herself as well as her children. She tended her own farm and earned enough money to take care of her family. When her son became an adult, he moved in with his wife and cut off communication with her. Tham now lives alone and receives money from the government in exchange for harvesting crops.
While the government provides some assistance, it’s still hard for Tham to actually obtain her allotted money because it is treated as an all day affair. It takes time for her to travel by foot back and forth to government locations to collect her allowance; she travels alone and finds the task difficult because she cannot walk far distances without taking multiple breaks. The little money that Tham receives is used to purchase medicine unofficially, from people who sell herbs and drugs off the market at reduced rates.
“It’s much cheaper than going to a doctor,” Tham said, with tears welling up in her eyes. “It’s hard to get help when you’re old and living by yourself.”
Nguyen finishes off Tham’s physical by checking her stomach and her heartbeat with his stethoscope. He reaches the diagnosis that she is anemic and requires more vitamins and minerals in her diet. Though, his assessment is partly inconclusive.
“Since most people who live here live off the land, it’s hard to figure out what they use to cure their afflictions,” said Nguyen. “She’s been using unknown herbal medication, mostly roots, so I don’t know what her diet is and whether it’s causing her lack of sleep and body pain.”
After getting two bags from the pharmacy, one containing 30 pills of ibuprofen for her pain and the other containing 30 multivitamin pills, Tham goes to the gift station and receives a small plastic orange bag filled with an assortment of dry and canned food products.
Tham smiles, showing her toothy, yellow teeth as she rounds up her treatment at the optometry room. Aside from her hope of getting treated for her constant pain and insomnia, Tham was most excited about getting a prescription for glasses. Optometrist, Dr. Ky Nguyen, had Tham take a vision test that required her to read directional queues from about 20 feet away.
Placing a black plastic left eye occluder over her eyes, Tham begins to read from a vision chart with 12 rows of circular shapes, ranging from a font size of about 72 at the top and 14 at the bottom.
“Left, right, right, down, left…” Tham stops at the third row and is unable to read further.
“Her vision is extremely poor,” said Nguyen. “At 86-years-old, she has severe cataracts in both eyes that can only be corrected through surgery. She cannot have glasses, they won’t do anything for her.”
According to Nguyen, many of the older villagers are not eligible to receive glasses because of the lack of lighting in their homes. The classrooms, which are illuminated by a combination of low lighting and natural light that peers through doors and windows, are an example of a common contributor to poor vision.
As Nguyen advises Tham to get in contact with a doctor to perform the surgery, she shrugs off his suggestion. Since Tham lives alone, she believes that getting surgery would be problematic because she would need help during the recuperation stage post-operation. All she wanted was a pair of glasses that would help improve her vision, even if they did so marginally.
“Surgery and operations are something that I don’t want to worry about,” said Tham, who then brought up how she misses her family.
It’s been five to six years since Tham has seen her son or daughter-in-law. She wishes everyday that they could visit, but they are poor and they are incapable of setting aside time and money to visit her. As Tham reminisces about her last encounters with her son, she begins to cry. With tears filling and flowing down the cracks of her cheeks, she says that she wants to see her son and mumbles incoherently about her life and how alone she feels.
“I feel pity for myself,” Tham said as she clutches her chest. “I have to beg just to get clothes. I am poor and old and I have to beg for everything. I am sick and cannot even receive a pair of glasses to see.”
After wiping her eyes, Tham thanks Nguyen and slowly exits the building. She chooses to forgo visiting the dental team and decides that it’s time for her to leave. She has to make her journey home and return to her farming duties before nighttime.
“I’m thankful that the government cares about my well-being and that I’m able to visit doctors close by,” Tham said while walking toward the school entrance. “I thank God that I’m fortunate enough to be alive even when I’m so poor and alone.”