Dr Nang Du - USA trained doctor

A Refugee's Refuge
Psychiatrist's Journey Leads Him to Help Others
By Linda Castrone
04.07.08

Nang Du, MD, doesn't relish revisiting his past. He escaped Communist Vietnam in 1981 aboard a tiny refugee boat, worked menial jobs when he arrived in the United States, and years later reestablished his career as a physician by caring for the mentally ill.

But he knows his background has given him a singular insight into the minds of his patients and has made him a compassionate ally for his patients at San Francisco General Hospital's Asian Focus Inpatient Unit (see sidebar.)

"He has a unique understanding of the refugees' values, background and adaptation to new societies," says Renee Binder, MD, Professor of Psychiatry and one of Dr. Du's supervisors when he was a psychiatric resident. "He has extraordinary cultural sensitivity, is devoted to those populations and has special contributions he can make to them."

Since completing his residency at UCSF in 1989, Du has specialized in the study and treatment of depression among immigrants who come from developing countries, especially political refugees. He identifies two types of stress commonly felt by recent arrivals: The first comes from learning how to cope in our highly modernized society. The second involves overcoming the loss of status, wealth, title, connection, friends and family members.

Immigrants must also cope with extremely traumatizing experiences. Du uses his own memories to help him relate to the patients he treats at SFGH's inpatient units and those he serves in community clinics in Oakland and Richmond.

Du originally set out to study internal medicine at the University of Saigon. He was about to graduate medical school in April 1975, when Communists took control of Vietnam. Rather than flee, as half his classmates did, the 24-year-old sided with the other half who chose to stay. "We thought there would be no more war and we could rebuild the country," he explains.

They were wrong, of course. By 1979, the government waged war against Cambodia and China and began encouraging citizens who were ethnically Chinese to leave the country or risk imprisonment. Du's father was half Chinese. Still, he remained as the first wave of "boat people" fled to other Southeast Asian countries and to Hong Kong. "We still had hope then," Du says.

But in 1981 he took the counsel of two brothers who were held captive in the Communist's notorious "re-education" camps. "I had the chance to visit them and bring food and supplies," Du says. They told him they were worried their father would also be arrested, and they feared they would die in the camp. "They told me 'Get out so you can help the family!'"

A Refugee's Journey
Since Du had no money to pay for his passage, he found a small vessel bound for Malaysia and volunteered his medical services. He joined 92 others packed cheek to jowl aboard a boat no more than 12 meters long and 3.5 meters wide. After five days and six nights at sea, they arrived in Malaysia, but not without incident.

Thai pirates intent on robbery found them four days into their journey and would have towed them back out to sea if soldiers aboard the boat hadn't pulled out weapons. "When they saw the weapons, they withdrew," Du says.

The next day, passengers saw land and people who were waving from shore. Du remembers feeling "pretty happy to get to someone who could help." Once the boat had landed, however, he realized the "friendly" villagers were actually waving knives and hammers. By then, the soldiers had thrown their weapons overboard, knowing that an armed boat would be turned away. "The villagers took rings, watches, gold, everything they could."

Malaysian marines arrived soon after, but instead of helping the passengers, they surrounded the traumatized refugees, searched them and took what was left. Official humanitarian aid did not arrive for another two days, because they had landed on Friday, the first of the Muslim country's two weekly Sabbath days. "The children were really starving by then," Du says.

Finally, a Red Crescent (similar to our Red Cross) van arrived on Sunday, drove the group to a safe house and, three days later, took them to their final destination, a refugee camp on the island of Paulo Bidong. Du volunteered to work in the camp's sick bay. There, he was discovered by an American delegation visiting the camp.

"They asked, would I like to go to the United States," he says. "I would have gone anywhere I was asked."

Overcoming Homesickness By Caring For Others
Like many other refugees, Du took the first jobs he could find – washing cars and working in restaurants – so he could begin making money to send to his family. That gave him firsthand experience with the kinds of stresses he now helps other Asian immigrants cope with.

"I knew no one and had nothing," Du says. "You have to learn everything new, how to make the bus stop, how to buy a subway ticket, how to put coins in the machines at the laundry. You have to learn English and still earn a living. People become depressed or break down when they move over here."

Du experienced adjustment emotional disturbances "You cannot sleep, so you watch TV until late at night," he says. "I avoided listening to Vietnamese music. When I did, I felt homesick and couldn't focus for a few hours."

He became a counselor at Conard House, a transitional residential program for mentally ill patients, and he volunteered at San Francisco General Hospital's Asian Focus Inpatient Unit as an interpreter. That's where he met Francis Lu, MD, a professor of clinical psychiatry.

Lu was touched by Du's patience and compassion. "He was a Vietnamese-speaking MD, which at that time was very, very rare. He was kind. He was caring, and he related very well with our Asian patients and families," Lu says.

Du attended City College to learn English, passed the ECFMG (Educational Commission for Foreign Medical Graduates) exam that allowed him to transfer his Vietnamese MD degree, and he managed to obtain a residency in UCSF's Department of Psychiatry.

"Dr. Lu became a great mentor," Du says. "He spent an hour a week to teach me psychiatry and to discuss clinical cases. He coached me and recruited me into psychiatry."

Spoken and Unspoken Messages
San Francisco has one of the nation's largest Asian populations, accounting for more than 33 percent of its residents. Asians who come here with past traumatic experiences are particularly vulnerable to mental illness. One of the barriers in treatment is the social stigma of mental illness among Asians.

"It's a challenge," Du said. "They keep the patient at home. They bring him to the temple or get herbal medicine until he becomes unmanageable. He has been severely ill for a long time before they bring him to the hospital, and his improvement is slower than if we start at the beginning."

Du approaches treatment with great respect for his patients' religious and cultural beliefs and those of their families. He not only speaks their language, but also has come to understand the unspoken messages they express through body language and cultural traditions. And he has developed a talent for encouraging his patients to express emotions that are often difficult. His own experience with reeducation camps, pirates, starvation, and constant fear for his family's safety has given him an understanding of experiences that were similar or worse. He knows that patience is the key.

"Trauma memory is like old wine," he said. "In therapy, you have to wait for the right time and the right moment to open what has been sealed up for so long in order to get the breakthrough. When patients are mentally strong and feel safe enough, they can face their memories."

Du hopes to help the Vietnamese people nowadays, as the Vietnam government policy has changed to welcome Western technology and knowledge. He was a member of the UCSF psychiatry delegation to Vietnam in 2006, which explored the mental health system in Hochiminh City (HCMC) and provided support to the department of psychiatry of the HCMC University of Medicine and Pharmacy (UMP).

He traveled to Vietnam again recently as a UCSF Global Health faculty scholar to work with the department of psychiatry of UMP.

(The article is from http://medschool.ucsf.edu/news/features/patient_care/20080410_Du_Nang.aspx)