Columbia Dermatology Trains Vietnamese Physician to Read Skin Biopsies

By Joseph Neighbor

As he prepared to retire from a 40-year career in dermatology, Harvey Weinberg, MD, began thinking about ways to stay busy. After leaving a private practice in New Jersey in 2013, he accepted a one-year assistant clinical professorship at P&S, where he completed his final year of residency in 1973 and has volunteered training residents in clinic ever since. But with that year over, he looked for his next endeavor, which he found through Health Volunteers Overseas, a Washington, D.C.-based organization that sends physicians to developing countries to train local doctors.

Through the organization, Dr. Weinberg learned about an opportunity to teach dermatology for three weeks in Hue, Vietnam. Vietnam holds a special significance to Dr. Weinberg, as it does for many men his age. “In 1970 I essentially took a residency in dermatology to avoid going to Vietnam,” he says. “And here I am, more than 40 years later, returning to Vietnam to teach dermatology. I feel really good about the arc of these events.”

In March 2015, Dr. Weinberg traveled to Hue’s University of Medicine and Pharmacy, the fourth largest medical university in Vietnam, armed with 11 presentations on dermatological topics suggested by the host physicians, lessons to be augmented by hours of outpatient clinical work with students.

But the situation that greeted him was profoundly frustrating. His students had little formal training and were unfamiliar with most of the lab tests, treatments, and drugs he described, many of which were not available in Hue. Most could not speak or read English, so one-hour lectures took three hours for him and the translators to deliver. How much was really learned remained a mystery.

The clinic was a single room with an old inefficient surgical light and no privacy. Physicians worked without gloves, washing their hands infrequently. Patients were seen fully clothed because gowns were not available. Patients were expected to bring their own medical records, but many did not bother.

Most alarming was the absence of skin biopsies—or anyone qualified to interpret them. Biopsies, which are analyzed by specially trained pathologists or dermatologists, known as dermatopathologists, are a cornerstone of modern dermatology. “If you see a bump on someone’s nose, or a rash, you often know the correct diagnosis, and that’s fine, but many times you can’t be certain. You can only make an educated guess but it could be many different things,” says Dr. Weinberg. “If you’re not certain, the only way to know for sure is to take a biopsy and send it to a lab.”

Before and after leaving Hue, Dr. Weinberg encouraged the vice rector of the university to add a trained dermatopathologist. “Without one, dermatological treatment is largely guesswork,” he stressed. He suggested sending one of the physicians at Hue abroad for training. He also shared a few words of encouragement: “In the United States 40 years ago, dermatology wasn’t valued in the university setting. Today it has evolved from an orphan specialty into one that is highly respected and an integral part of the university. Much of this is a direct result of the evolution of sophisticated dermatopathology and other diagnostic testing services. Having a trained dermatopathologist and making biopsies routine,” he added, “could be a first step toward establishing a formal residency program that would raise the profile of the department. It happened at Columbia. It could happen in Hue.”

Dr. Weinberg thought CUMC would be an ideal place to provide training for a Hue dermatologist. He even had a particular physician in mind, Thanh Phuong Nguyen, MD. Her English skills were exceptional; she served as a translator for Dr. Weinberg’s lectures.

Dr. Weinberg enlisted the help of his friend, David Silvers, MD, director of the dermatopathology lab at CUMC, and the support of dermatology chair David Bickers, MD, to train Dr. Nguyen to reach a basic proficiency in reading biopsies, thus creating the “Columbia University Department of Dermatology Tutorial in Dermatopathology.”

During a six-week tutorial, Dr. Nguyen was a student observer in the Silvers lab, studying alongside residents and other physicians. “We focused on the conditions she would see most often in Vietnam, avoiding the rare things that would be largely irrelevant to her,” says Dr. Silvers. “The goal was to make her very good at recognizing a core group of conditions microscopically. Then when she sees something she doesn’t recognize, she’ll be able to use one of the many teaching tools on the internet. As time goes on, she’ll be able to self-teach the nuances.” Dr. Silvers has made himself available for long-distance counsel via email.

The daughter of two physicians, Dr. Nguyen moved from the impoverished province of Quang Tri as a teenager to study at Quoc Hoc Hue, one of the finest high schools in Vietnam, before going to medical school. She has volunteered in Laos and throughout Vietnam, providing basic medical treatment and distributing food and clothes to poor residents, even teaching them how to wash their hands with soap and brush their teeth.

During the tutorial in New York, Dr. Nguyen stayed with Dr. Weinberg and his wife. “They hosted me, encouraged me, showed me around the city,” says Dr. Nguyen. “They treated me like a daughter.” That helped keep the cost of the tutorial down, says Dr. Weinberg. The other costs were funded by donations from dermatology department faculty and a scholarship Dr. Nguyen received from Health Volunteers Overseas.

“I think it’s a wonderful opportunity to bring value to her community,” says Dr. Silvers. “It didn’t take a lot of effort. It didn’t take a lot of money. I think the contribution we’re making for dermatologic care in the Vietnam community is going to show that if you know what you’re trying to accomplish in terms of focused, directed teaching, it doesn’t have to take a long time to get someone to perform at a very high level.”

“I know six weeks cannot make me an expert,” says Dr. Nguyen, “but in a short time I’ve learned so much with Dr. Silvers, the residents, and other physicians. This has been such a memorable time in my life thanks to my great professor, my beloved host parents, and the very nice New Yorkers.”

When Dr. Nguyen returned to Vietnam, she became the resident dermatopathologist at the university. She is now the only person qualified in that region to interpret skin biopsies.

“This was an endeavor that developed as a reaction to my frustration,” says Dr. Weinberg. “You give a series of lectures and don’t really know how much your audience has learned and what impact, if any, it will have when you leave, especially when your students don’t speak English. The mission statement of Health Volunteers Overseas is to make something happen, to impart new and usable skills to a population that lacks them. I think what we’ve done for Dr Nguyen here at CUMC is the ultimate fulfillment of that mission.”