Before infancy

Monday, February 28, 2005

Editor, HME News

Editor’s note: Jim Sullivan is traveling in Vietnam, visiting family, for two months this winter. This month and next he will file reports on home medical equipment issues in Vietnam.

HUE, Vietnam - After nearly three weeks here in Hue, the old imperial capital of Vietnam, I’ve seen just one wheelchair as we know them. It was a Quickie 2, and its user was a middle-aged woman on her way to the market. She carried a conical hat wedged between her legs and the footplate, and a bag in her lap.

“Where did you get the wheelchair?” I asked.

“It’s American,” she said, and then she went into great detail about something I couldn’t understand. But I knew she wasn’t telling me about her rehab provider. She didn’t have one. Whatever specialty seating the chair may have had was now gone, a casualty perhaps of the high humidity and the hottest, summertime temperatures in the country. Instead, she sat on a board, coated with gray tape.

Otherwise, people needing mobility here resort to modified tricyles with a single lever and a chain for propulsion. I’ve seen a half-dozen men in these vehicles over the last several weeks, plying the sides of roads thick with motorbikes, bicycles and the occasional bus or car.

These are the lucky. Because it gets worse here. In Saigon, I once felt a rap on my shin and looked down at a legless man, lying supine on a low-slung, four-wheeled dolley. As I looked at him, he craned up from the mid-section and held a battered tin cup aloft, looking for a hand-out. And still, it gets worse. A radiologist at the hospital in Hue said that some people with disabilities resort to pieces of wood.

“With wheels?” I asked.

“No wheels. Not so lucky.”

I couldn’t quite picture what he was trying to tell me but the upshot was this. Rather than drag their skin over the ground, they buffer the dragging with wood. I asked the radiologist whether there was a market for home medical equipment here, and he laughed, agreeing that indeed there was. But there are no suppliers. “Charity associations, they take care of some people.”

The lucky people.

I asked about home oxygen, and of course there isn’t any. No neb-meds for emphysema. No CPM for rehab. No reimbursement. No hearing officers. No packaging that sells lifestyle (I want) as opposed to medical (I need).

We sometimes talk about the infancy of the home medical equipment industry in the United States. If we’re infants, I wonder what they have here in Vietnam. Just a gleam in the eye?