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Sierra Schmiedt wanted to stretch herself by learning in an unfamiliar setting.

Tony Tran wanted to build on a favorable study abroad experience as a high school student and visit the country of his heritage.

That is how the then-South ��ֱ���� State University pharmacy students ended up in Vietnam for five weeks for their final Advanced Pharmacy Practice Experiences rotation. For Schmiedt, getting there was the biggest challenge. For both of them, it was an unforgettable experience they wholly recommend to other pharmacy students.

Pharmacy education is highly structured with no opportunity for a study-abroad semester except in their final year, when students take a series of rotations.

Classmates Schmiedt, originally of Wessington Springs, and Tran, originally of Windom, Minnesota, each wanted to make that happen. They worked through Work the World, an agency that handles overseas placements for health care students and graduates. Vietnam is among the locations where it has partners.

By taking that option, they became the first SDSU pharmacy students to complete a rotation in Vietnam, according to Jodi Heins, who oversees the College of Pharmacy and Allied Health Professions experiential education program.

Why go to Vietnam?

Their experience there was March 22 to April 26, coming home one week before graduation.

Their decision definitely was not spur of the moment. Schmiedt explained that pharmacy students choose in the prior year what five-week internships they will take. “I wanted to experience health care beyond health care in the U.S. Tony was going to Vietnam, and I didn’t want to go alone,” thus Vietnam became Schmiedt’s choice.

For Tran, the interest in learning outside the borders of the United States stemmed from a two-week study abroad trip to Europe after his junior year of high school. At college he attended a study-abroad fair and later met with Heins, who suggested the Work the World program. When Tran learned that Work the World had a program in Vietnam, the deal was settled.

His grandmother grew up in Da Nang, two hours from Hue, where the pharmacy students were assigned. Tran’s mother grew up in Ho Chi Minh City, formerly known as Saigon, a 17-hour car ride from Hue.

Language not a barrier

Tran wasn’t fluent in Vietnamese, but the language came back to him during the rotation. He learned Vietnamese as a child when the family lived in the southwest Kansas town of Holcomb. His grandmother, who lived down the street, spoke only Vietnamese, and there was a significant Vietnamese population in nearby Garden City.

When Tran’s family moved to Windom when he was 13, English became the primary language. The rusty Vietnamese skills were polished during the internship, and one of the hospital nurse’s taught Vietnamese on Mondays and Tuesdays during their internship, Tran said.

Schmiedt said it was good to be able to rely on Tran. She added that the Work the World house where they stayed taught basic Vietnamese one night a week.

When at Hue University of Medicine and Pharmacy, English was spoken by the doctors and pharmacists, Schmiedt said. “They need to speak English because their medical guidelines are in English. When we were there, there was a conference with California instructors. I thought the language barrier would be a huge thing. It ended up not being a problem at all,” she said.

Students’ knowledge impresses

Both found a lot of contrasts between the American and Vietnamese health systems, and they had different shadowing experiences each week.

The first week was hospital outpatient pharmacy followed by internal medicine, psychiatric pharmacy, chiropractic and traditional medicine, and oncology.

Tran and Schmiedt both said the internal medicine rotation was their favorite. They would go on rounds with a doctor or a resident.

“Most of the time we had  various topic discussions because the physicians and medical residents wanted to know how much knowledge we had,” Tran said. “I remember one question that really opened the door for discussion. There was a diabetes patient that had an A1C reading of 12.

“Sierra and I looked at each other and said that patient needs to start on insulin. Each of the medical residents and attending physician were surprised by how much we knew as pharmacy students.

“From then on, they would ask, ‘What would you choose or do first?’ They liked to pick our brains,” Tran said.

Schmiedt said internal medicine doctors in Vietnam do not work with pharmacists. “They didn’t think we would know as much about health care as we did. Doctors in Vietnam hold a lot of roles pharmacists do in the States,” such as counseling and dosage recommendations. “They were asking us about a patient with pneumonia. They asked us for the first line of treatment. We were able to cite first, second and third lines of treatment. They were so surprised.”

Practices open eyes of students

The students were surprised with some of the things they saw, too.

For instance, Tran vividly recalls that during an internal medicine round, he went into a room where there were 11 patients sharing a room. One caught his eye. He had fluid in his lungs and was hunched over a chair. A large needle was inserted into the patient’s side. One end of the IV tubing was attached to the needle while the other end was placed into an Aquafina water bottle that was sitting on the floor. Within minutes, copper-colored fluid started flowing into the bottle.

“It was like a makeshift device, ‘this is what we’re going to do’ type of deal,” Tran said.

The choice of medications also was limited, he said. If patients needed a statin, everybody got the same dosage and the same kind of statin—10 milligrams of pravastatin—regardless of their condition. Tran said, “Vietnam is still a developing country. Thus, if you were to see a doctor, you would get a hard copy of the prescription to hand to the pharmacist to fill because the doctor writes the directions in a hard copy book that the patient keeps. There is no counseling when dealing with pharmacists at the retail level.”

Students find cordial hosts

He added that the Vietnamese providers were quite welcoming to the U.S. students.

“The department head of the internal medicine floor invited us to a meal with her and other pharmacy students from Vietnam. We sat and talked about where we see ourselves in the future. The pharmacist we worked with invited us to go on a hike with her. We left at 5 a.m. to see the sunrise. It was fun, but more strenuous than I thought. The pharmacist carried a watermelon up the hill. I barely made it up there.”

Schmiedt said that after the international rotation, “I’m much more outgoing now, and I found out I could do a lot more than I thought I could. I missed four flights, and it took me a day and half longer than Tony to arrive to Vietnam. I said to myself, ‘If I can get there, I can do anything I set my mind to.’ I was alone in an airport in a foreign country for the first time.”

Schmiedt explained, “I flew from Sioux Falls to Minneapolis, and we were waiting for a flight to Seattle. Tony got on the flight. I was canceled off the flight. I spent a night in Minneapolis and had to buy a new ticket to Taiwan.

“I get there, and my visa doesn’t have my middle initial. So I had to go to another line and buy an expedited visa. I spent five hours in the Taiwan airport. Then I was to fly from Ho Chi Minh City to Hue. I was in Ho Chi Minh City airport for five hours and had to buy another ticket to Hue. 

“I was so hungry. It was 3 a.m. I couldn’t figure out the vending machine because none of it was in English. I finally found a granola bar in my backpack.”

‘Would 110% do it again’

Once she got to Hue, it was a great rotation, Schmiedt said. The students had the weekends off, and they traveled every weekend. That included a two-day cruise to Halong Bay in northern Vietnam, where unique rock formations make it one of the wonders of the world, Tran said. Schmiedt added, “It looked like it was out of a movie. It was so beautiful.”

Schmiedt, who now works as a community pharmacist in Huron and Mitchell, said, “I would recommend this internship to anyone seeking an international internship. I would 110% do it again.”

Tran, now a pharmacist with the Indian Health Service in Fort Thompson, urged other pharmacy students to choose internships “that will challenge you in your educational experience. Opportunities like this don’t come around very often. The memories from this rotation will stay with me for a lifetime.”