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She nodded and he paused for a second. ‘Lien, can you organise some supplies to take with us, and I’ll brief Viv and arrange some transport for us.’
Lien’s tight shoulders dropped, as if some of the tension had just left her body. It was clear she was relieved that Joe wasn’t going to be left in that situation alone.
Duc hurried down the corridor with Viv close behind him. ‘I’m going to give you some crib sheets.’
‘What?’
He smiled and reached for a folder above the desk. ‘Sen found a whole pile of things randomly filed by my dad. It seemed he made crib sheets for some of the international doctors on conditions that crop up in Vietnam that aren’t so well known in other countries. Just to give them some first line information. She’s duplicated and filed them all in here.’ He raised his eyebrows. ‘Apparently, in future we’re going to have induction packs for staff. Maybe even send the information beforehand to let them study it.’
Viv looked around the office and smiled. ‘This place looks a whole lot tidier.’
Duc paused and gave a thoughtful nod. ‘It is. My parents loved being doctors too much to worry about the paperwork. Sen has been a blessing. She’s gone through this place with military precision. I think half the contents ended up shredded because they were out of date or not important any more. She’s scanned some things for electronic filing and cleared out the filing cabinets and reorganised the rest.’ He gestured to the seat behind the desk. ‘I can actually pull the chair in now, instead of having to dodge the boxes under the desk.’
He pulled out the sheets for Viv. ‘And watch out. She’s got her eye on how we deal with patient records. Apparently, she’s also getting us a quote about electronic prescribing.’
Viv nodded as she stared down at the crib sheets. For the first time since she’d got here she looked a little swamped.
Duc put his hand on her shoulder. ‘Don’t worry. Lien and I will talk you through anything.’
Viv shook her head. ‘Zika. I heard news reports about it, but I just never had a patient who’d been exposed.’ She pulled a face. ‘So I didn’t really read up on it. Now I’m feeling like a prize idiot.’
Duc squeezed her shoulder. ‘You’re never an idiot. This is an entirely new place. Look at what you did a couple of hours after you arrived.’ His face grew serious. ‘And you have no idea how relieved I am that you were here.’
He waited for a few seconds, giving her time to get over the little burst of nerves. ‘Now, let me talk to Sen and organise the transport. Sit down for ten minutes and give yourself the chance to read the basics. I’ll shout for you when we’re ready to go.’
Duc walked back down the corridor, giving some instructions to Sen and then pulling his phone out of his pocket and calling Joe’s number. ‘Hello, crazy Scot number two, tell me what you’ve got.’
* * *
It was the first time since she’d got here that she felt nervous about her clinical skills. She’d always known that there were diseases endemic to Vietnam, and if this had been a job she’d applied for, she would have researched them completely. But there hadn’t been time, and she’d just been so caught up in getting to Duc that she hadn’t really thought about the job properly.
Her first experience had thrown her in at the deep end. She’d quickly taken stock of the fact there was no functioning obstetrician and had taken steps to try and put safety measures in place.
But all her running around and organising had left her at a disadvantage. How could she really serve as an efficient and competent midwife or nurse if she didn’t know the basics about the population? She was letting them down, and she was letting the hospital down. A single bead of sweat trailed down her back and she shifted uncomfortably. It was unbearably hot today.
She tried to memorise everything on the sheets—then pulled out her phone to search for specific effects on pregnant women. The conversation between Duc and Lien seemed accurate. At first glance, any of these conditions could be mistaken for each other—but all had different results. It was important to diagnose correctly.
Lien appeared at the door. ‘Are you ready?’ she asked.
Viv nodded and stood, but Lien pointed at the table. ‘Put on some more mosquito repellent before we go.’ She handed Viv a lightweight long-sleeved jacket. ‘Just to be safe,’ she added.
The journey only took ten minutes. Duc, Viv and Mai Ahn were packed into a four-by-four with a pile of equipment.
Viv watched out the window as they turned into a street on the outskirts of Hanoi. The street was cluttered with bikes, mopeds and trash cans. A number of washing lines hung between the tightly packed buildings.
She climbed out the car and watched as Joe opened a door nearby and gave them all a wave.
His brow was creased as they approached. ‘Eight people. Most dehydrated and likely requiring some IV fluids. One of them is elderly, two are pregnant and two are kids.’
‘Then we’ll deal with them first,’ said Duc. ‘What about the rest of them?’
Joe handed over a notebook where he’d scribbled some notes. ‘Most of them are pyrexial. Some are also hypotensive.’
Duc looked around and split the patients between them all. Viv found herself with the two pregnant women. Mai Ahn stayed by her side.
Vivienne looked around. The house was clearly in disarray—but when every member of the household was sick, that was no surprise. During her variety of jobs as a midwife she’d often worked in people’s homes both during delivery and post-delivery.
Her first woman was paler than could be reasonable and was lying in bed, her breathing shallow. Vivienne sat down at the bedside and introduced herself, asking her name and for permission to check the woman over.
‘This is Mai-Lyn. She’s twenty-four, and sixteen weeks pregnant.’ Mai Ahn pulled a sympathetic face. ‘She didn’t realise she was sick at first. She thought maybe she just had late symptoms of early morning sickness. She’d been fine up until that point.’
It only took Vivienne five minutes to do some general checks. Mai-Lyn was very dehydrated. She had marks on her skin that looked like infected mosquito bites. Her blood pressure was low and her temperature high and a quick finger-prick blood test also revealed low blood sugar. Vivienne asked some pregnancy-related questions. Mai-Lyn had been having severe stomach cramps, but there had been no bleeding.
Vivienne pulled out her portable sonogram machine, and smeared some gel on Mai-Lyn’s abdomen, breathing a sigh of relief when the rapid noise of a heartbeat could be heard.
Duc appeared at Viv’s side. ‘What have you got?’
‘Are we moving these people to hospital or treating them here?’
He looked around and sighed. ‘They could all do with hospitalisation, but there is still a chance this could be infectious. For now, we’ll treat them here.’
Viv nodded and stood up. ‘In that case I need to set up some IV fluids, including some dextrose. I also want to administer some antipyretic for her temperature. She needs fluids quickly in the first instance. I think she’s got some infected mosquito bites. What the mosquitos might have carried?’ She looked up into his dark eyes. ‘I’ll let you experts get to the bottom of that. It could be anyone of the three conditions you showed me earlier.’
Duc nodded. ‘Let’s treat the symptoms and put the pieces together once we know all the patients are stable.’ He handed her some blood bottles. ‘Get some samples when you set up the IV.’
Vivienne nodded and got to work, quickly taking the sample and then setting up an IV, then moved on to the other pregnant woman. Her symptoms were almost identical but her history of mosquito bites went back a few days earlier.
She treated her patient and made her way back through to Duc, who was conferring with Joe.
‘I’m concerned by just how much joint pain both my ladies have. They’ve been bed bound for the last few days.
One has a particularly nasty rash too. Is there anything safe to give them for the mosquito bites? A cream perhaps, as well as the antibiotics? I’m worried they’ll end up breaking the skin they’re both scratching so much.’
Joe pulled out a medical bag and rummaged through it, pulling out a mild steroid cream. ‘This should stop the itching and inflammation.’ He gave her a look. ‘If we were back home, I’d recommend a bath with porridge oats.’
She smiled. ‘The well-known remedy for itchy chicken pox. I remember it well.’ It was like a blast from the past. ‘But, considering I wouldn’t trust either of my pregnant women in a bath right now, I’ll stick with the cream, thanks.’
She looked around the room. Most of the others had IVs running. She’d basically never seen such a dehydrated bunch of patients in her life.
‘This has hit really hard and fast,’ she said. ‘What on earth does this?’
‘We’re just deciding,’ said Duc. ‘It’s crucial we get this right. Particularly for Zika—because that could have real implications for your pregnant women.’
Inside the pocket in her scrubs Vivienne secretly crossed her fingers. They still had to recruit another obstetrician. And if Zika was the diagnosis they needed one quickly.
Joe frowned. ‘Most of the symptoms fitted with being unwell days after being bitten by mosquitos. The sudden fever, muscle and joint pains all fitted. Some have had headaches, fatigue and nausea. A few have GI symptoms—and most have the nasty rash.’
Duc turned to him. ‘You’re thinking chikungunya?’ He gave a considered nod.
Joe nodded. ‘For me it’s the joint pains being so intense and prolific. Other than that, the symptoms could literally be interchangeable.’ He turned to Duc. ‘What do you think?’
