Working in Vietnam 101, a crash course for foreigners, Part 2

The last post was on the difficult, yet precious art of distinguishing the various level of yeses you would have to deal with in Vietnam. Today, a more practical case on how I’ve got crashed by a health care official in Vietnam in my previous job, and how she gave me that one lesson I needed to get it right.

So, I arrived as the Medical Coordinator for Médecins du Monde in Vietnam in January 2007 to help out with the implementation of a comprehensive HIV harm-reduction, testing and treatment outpatient-clinic in Hanoi. First experience in Asia, didn’t know how to read between the lines, a real noob. The first few months were just what most of our colleagues working in the aid sector would experience when filling in a new position in a complex environment: rushing the development of technical guidelines, keeping partners involved, recruiting staff, writing overdue donor reports whilst running for data, well the usual mess.

And then came August 2007. The clinic was directly managed by the local district governmental body. And they had a critical issue with the staffing of the their central preventive center and needed to withdraw staff from the OPC (Outpatient Clinic) that we were supporting. Quite a usual problem linked to overstretched public capacities, but coming at the worst moment for our program. The project was picking up speed and efficiency, patients were actively identified and put on treatment (the Tay Ho OPC soon became one of the most important HIV OPC in Vietnam), and we were already short on well-trained medical staff. And they wanted to withdraw the one most trained MD…. this would have had the medical component of the project coming to the verge of collapse. So I reacted. During a meeting with our joint staff in the OPC, I declared that it would be catastrophic to lose a staff at that point. And I added that it would be even more damaging to the program as they wanted to withdraw the best HIV specialist we had. And we continued debating the outcome of such a potentiality. Well… it was just awful. Can you guess why? Can you tell the huge mistake I made? Well… so obvious to me now.

A few days after, our partners manager, Miss My, came to me with rather a stern face, a bit like a mother coming to her 6-year old after he broke the DVD player while trying to make it float in the family’s fish bowl. She went like “Vincent, we have a problem. Did you say that Dr Phuong was the best doctor we had in the clinic?”, and I answered candidly “Yes!”. And she continued “Well, now the district director wants no longer to discuss the issue with us, and wants to withdraw more MDs, and don’t want to talk with you anymore”. I was stuck and pale in my chair. What the hell did I do??

Well, fairly simple. I singled out someone, yet positively, doesn’t matter. I singled out someone. I mentioned a person as being the best… which implies quite directly that the others team members are more or less worthless. People work as a team in Vietnam, and this team is pretty near to a family. People know who is strong and who is weak. But they would do their best to dissimulate Junior’s lasted mischief. I broke a rule. And they were resenting it. As a result, I infuriated our key partner, Dr Lan, the district director, and the other MD wanted to quit. Instead of securing that one medical position, I put in danger our entire team and our relation to local authorities.

How did we sort it out? In a very simple way. I was 31 at that point. And Dr Lan was 54, the age of my mother. So I played that string. Ms My set up a private meeting with her and the 2 doctors working in our OPC, both and their 50’s. We went there. Dr Lan offered me tea, and let me talk first. I apologized, played the dumb young western guy who doesn’t know well about Vietnamese rules, and I braced for what was up to come. Dr Lan accepted by apologies, and slowly, yet steadily started a rant on what I have done, explaining all the problems she had to deal with in the corridor to keep the team together, and how I hurt the feelings of the entire team, and so on and so forth… And I can tell you, she has a voice that would tear the ear of an elephant. She yelled at me for about 10 long minutes.

I waited for the storm to pass, and all of a sudden, she concluded that it was now behind us, that she sorted out her HR issue and that doctors would not be withdrawn! The 2 other MDs that witnessed my little humiliation smiled back at me really nicely, like aunts sharing the task to educate the youngling. And in a moment of bliss I understood everything:

  • I was a member of a family;
  • they were ready to keep me in that family;
  • I finally understood this concept of the “face”, so critical in Eastern-Asia;
  • I understood she yelled at me to restore pride in the MDs I  put in such a complex position. Right after the meeting and after the 2 MDs left, she kept me for a minute and gave that plain, frank and friendly look saying like “OK, now you’re no longer a noob, you passed the ritual“;
  • and I understood that everything has to be solved in private. You come to public ONLY when you have consensus.

Dr Lan then became my most important partner in the years ahead. She treated me as a key interlocutor and as a son. I treated her as my most important partner and as a mother. We remained both highly professional, each of us with our own perspective, yet with a common goal: to make it work.


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