There are other groups coming to DaLat as well as people in DaLat who provide assistance to people less fortunate. Clearly, as “donors” it is not useful to provide assistance if:
♦ it is not needed
♦ it is not what the “recipient” actually wants
♦ our time would be better spent in DaLat, Lam Dong or elsewhere (in Vietnam or another country)
♦ we are unintentionally doing harm, even a tiny bit, by providing this assistance.
In preparing this report, we were guided by the principle that, as an organisation, we needed to understand our effectiveness and to be honest and self-critical. In reflecting on our involvement, we considered how it reflected the stated objectives of MESCH – not simply whether it was “good” or not. There are plenty of organisations that do “good”!
The last five years have been extremely rewarding for us and have allowed us to get to know the Vietnamese people and specifically parts of the Da Lat community very well. Each year we ask them the same questions ....how can we help?....What do you need? Each time we have gained more insight into how they do things. It is because of this increased familiarity and insight that we could see how they have developed and improved
At 14 people, this was the largest group that has gone to Vietnam under our organisation to date. Apart from English education, community and hospital health, a new modality of general paediatrics was added. This brought a new level of interaction with both the community of DaLat and within the group. As previously, there were staged arrivals. In surname alphabetical order the members were:
Dianne Brown, John Cassey, Narelle Cassey, Amelia Ham, Mark Ham, Anne McGeechan, Garry Pearce, Michel Poppinghaus, Amy Sales, Maureen Sales, Michael Sales, Milton Sales, Alison Tattersall, Bill Tran
.LAM DONG BLIND ASSOCIATION
Narelle Cassey, Alison Tattersall, Dianne Brown, Garry Pearce, Mark Ham (photographer)
Visits were arranged for Monday to Friday with two groups. The community here is very motivated to participate.
The younger group enjoyed various games, songs and activities with enthusiasm. Diane's blow up kangaroo was a huge hit. The older group moved into role playing with learning English for their massage business. The English of the residents who have been there during the years of our visits has improved considerably, enough for them to be able to communicate simple instructions in English to massage clients. Over the years of our visits a good relationship of trust has developed and they want our continued involvement.
Mr Truong would like to build a cafe on the grounds where disabled people, not just the blind but those with any disability, can work and play music. The idea also for people to come to the cafe and then have massages at the Association since the travelling and unfamiliar surroundings make it more difficult at hotels.
Lena, an interpreter who worked with us in 2010 and again this year, were continuing to visit the community after we left. We were grateful for Lena's constant involvement as our interpreters changed around a bit. Mr Truong and the Blind Association are involved in the Nhóm Tình Th??ng (“Oz-Harvest”) trial in Da Lat.
CAM LY MINORITY CHILDREN'S HOME
The children were looking well and there had been a change in the population of the home. They now have 60 children (10 more than last year) and they have just accepted 20 new younger children from a poor area about 135kms away. The previous improvements to the buildings have allowed them to accept more children. The water bore has had some problems but these seem to have been resolved.
Their situation regarding food supplies from the community has improved considerably as their store room was more than half full. This was reflected in the shopping list which consisted mainly of pots, pans, laundry and bathroom supplies, 55 foam mattresses and a large box freezer.
Sr Dao said that they did not currently need food but that other things they did need our help with (like mattresses etc and that they wanted to continue with Newcastle East PS. Cam Ly also has the opportunity to be part of the Nhóm Tình Th??ng (“Oz-Harvest”) trial if they wish, but to date have not opted to do so.
A Skype session between Newcastle East Public School and Cam Ly was not successful because of equipment issues. The video conferencing computer has now been set up to communicate with Newcastle East PS.
Efforts should now be concentrated on establishing direct communication between NEPS and Cam Ly, independent from MESCH. This can be done by utilising the video link and finding a way for money from their fundraising each term to be transferred to Cam Ly throughout the year. Receiving money more than once a year would be the most helpful way to sustain Cam Ly through the yearly feast and famine cycle they have.
Their situation had improved with more community support. They were also very keen for the Nhóm Tình Th??ng (“Oz-Harvest”) trial to happen and asked us for a larger refrigerator to store extra food.
The children were looking well and healthy. We left three of the magnifying goggles after testing them with one of the older boys who weaves wool to make hats. We made pom poms with the wool which they liked for decorations on their knitted beanies. We were there each day playing various games. Alison's parachute was a huge success as was dancing Gangman Style. Sr Quyen and Sr Nhan tell us how good it is for the children when we go there. They say they are really happy and motivated during our visits. Even the shy ones enjoy themselves.
If we continue in Da Lat we should continue to go there to work with the children.
Milton Sales, Maureen Sales, Amy Sales, Michael Sales, Bill Tran, Anne McGeechan, Mark Ham (photographer)
Community health screening is labour intensive.We visited 6 places in 2013 (Cam Ly, Happiness House without Red Cross involvement and Dha Tho kindergarten, Don Bosco, Buddhist temple, Mercy House with the Red Cross).
249 children were medically screened. The usual “general practice” problems were seen. Cam Ly, Happiness House and Don Bosco reported that their children had improved health – including less chronic conditions (eg abdominal pain, diarrhoea, sinusitis, discharging ears).
We conducted education again and left instructions on when to treat common conditions with antibiotics, ear drops etc. These were to be dispensed by a responsible person using a decision tree. This built on information we gave in 2012, when the focus was mainly on ear problems.
People want to learn how to prevent diseases and keep healthy. Our advice would be highly regarded. The content of this health education will have to be thought out carefully.
Dental decay was common and severe. We identified 54 children needing dental acute care from visiting 6 institutions. Worst teeth were in Dha Tho kindergarten and Mercy House. Preventative education was provided in areas of technique, diet and fluoride toothpaste to children, parents and teachers
Resources provided include Info sheets, tooth brushes and toothpaste as well as Xylitol gum
♦ Any future development in either education or dental health would require either:
- involvement of the Red Cross – not a good alternative
- official government recognition as an independent NGO – not a pathway we want to go down
- involvement of a private NGO by a Vietnamese person/ group with our involvement subsequently
Paediatric Surgery, anaesthetics and nursing
Michel Poppinghaus, Amelia Ham, John Cassey, Mark Ham (photographer)
Observation by Dr Tam and Guang Hung that there is a sinusoidal pattern of “happiness” and co-operation between staff associated with our visits. They feel this does not return to baseline and that the trend is upwards. There also seems to be a corresponding sense of satisfaction between community and hospital. There may be contributory reasons for this.
120 children were screened -including surgical and anaesthetic checks. These included 96 (80%) general surgical, 12 (10%) medical and 12 (10%) orthopaedic.
Although there are some down sides in transitioning to a VN-led screen, these are not considered sufficiently significant issues to move away from that plan.
Orthopaedic department have been doing hand and foot abnormalities since the program started in 2009. It seems that parents mainly bring their children forward when they hear about the Aus team visiting.
We were still needing to keep our case records separately rather than as part of the hospital software
b. Uptake of previously taught practices:
Whilst there had been a clear take-up of some, others had been forgotten. How to maintain expertise in the absence of currency of practice or supervision is vexed. In an attempt to address this:
Two videos were made, given to relevant key clinicians and placed on the theatre's hard drive.
Summary sheets of important aspects of practice were made and distributed
c. Staff changes:
2 new surgeons, several new anaesthetists (nursing background) and at least 1 nurse had left and a new and enthusiastic theatre nurse with graduate training (BNurs) in HCMC.
We have disquiet over some surgeon’s capacity to both recognise problems when they occur or to ask for assistance in that circumstance. This defeats the purpose of the visit – build capacity in the hospital and confidence in the people of DaLat/ Lam Dong.
2 new anaesthetic techniques were shown and trialled and some simple surgical safety techniques explored. In the absence of a directive from Dr Hy, the theatre safety ideas are unlikely to be used.
3 second hand monitors, 20 transducers, a paediatric instrument set and capacitive diathermy mat left along with sutures and catheters.
f. Other ideas:
Impact and potential prevention of hypothermia: discussed with Dr Sinh extensively during this visit
Dr Quang Hùng is keen to take parents into induction. He needs our support. We will attempt to progress a research paper with him on this.
Of the potentially available cases (ie excluding orthopaedic), 90% were operated on by or with Dr Tam as the co-surgeon (rather than assistant)
Dr Tam able to: recognise variants and procedures she should not undertake; complete routine neonatal and child procedures without difficulty; troubleshoot and resolve the ones she had difficulty with. She is doing similar cases herself on an ongoing basis.
h. Australian training:
Neither Dr Tam nor Dr Guang Hung will be coming to Aus due to personal reasons
i. Further education and research
Research proposal proceeding. Will be looking for local interested persons and ?appointment of director of post grad training
>Nurse exchange confirmed as needed. Ns Phuong (director of Nursing) would like to see both ICU (neonatal and older) and student nursing from Aus in the first instance. Student nursing suggested late yr2 or 3 from University of Newcastle. UN has promised to: send their skills set by year and a sample MOU, cover indemnity and all hospital costs, cover 1/3-1/2 student costs.
Summary recommendations Hospital group:
Email to be written to Dr Hy:
Anaesthetic machines have all approvals except duty importation exemption by Ministry of Finance. Shipping imminent.
Anne McGeechan, Bill Tran, Mark Ham (photographer)
This was a fact finding visit.
Paed services observed: Emergency department, birthing suite/Post natal, childrens’ ward, neonatal unit, Out-patients
Generally, all areas have limited equipment (often in poor condition) with some disorganisation. Nurses and doctors were able to find innovative solutions using local equipment which worked reasonably adequately
15-29 deliveries/day including 4-5 Caesarean sections/day
70 beds spaces in open plan rooms and 10 bed area for high dependency/intensive care children.
‘Care by parent’ common
24 hour shifts, 1-2 middle grade staff, 5‘consultant’ staff
Limited opportunity to train outside of Lam Dong
Nursing staff, 8 hour shifts
20 beds with some ventilators and monitors
NICU nurses can go to Saigon for a three months neonatal intensive care course
Two formal educations sessions were held
The doctors are able to get the job done despite a lack of resources. They are willing to take new things on board and will adapt it to their own way. Quite rightly, they will not accept change without evidence. It is possible that they might see our presence as a hindrance to complete their work – slow them down.
Dr Soai is the head of paeds, and is very keen and enthusiastic to have MESCH on board.
The paediatric department LDGH is in a transition stage. As is typical in other units, physical and human resources are stretched or unavailable. There seems to be a willingness to engage in collaborative projects.
Potential opportunities are:
♦ Education and training opportunities developed within the resources in the hospital
♦ Provision of resources and equipment
VN harvest (Nhóm Tình Thuong)
John Cassey, Giao Chi Nguyen
Two face-to-face meetings with beneficiaries (LD Blind association, Happiness House and CamLy) and multiple phone conversations with them, drivers and donors (Sammy DaLat, Saphir, Thang Li 1, Sunrise) resulted in an MOU signed by all parties with a series of rules and clear lines of engagement between all parties; entity name “Nhóm Tình Thuong”; agreement to appoint a director; agreement to maintain the donor and beneficiary base as is until an evaluation period of 3-6 months has passed
It seems likely that there is insufficient local experience with this type of entity and system. No director has been appointed and despite various suggestions to the contrary, the beneficiaries have individual control. Hence, email contact is mandatory to give any chance of success
Sr Dao has not been involved so Cam Ly is not partaking
The others have been picking up food regularly
LDBA is sourcing other food outlets as well independently
Feedback to OzHarvest director Australia, Aus Ambassador in HaNoi to be established by JC
Need to employ someone in Dalat to administer the programme and push it forward. Mr Chuc (contact of Bill Tran) to be contacted initially (?salary -3000000 VND/ mth)
Need to identify others who are more in need of this project.
School building project at Cha Rang Hao Hamlet, Ta Nang Village, Duc Trong
Narelle Cassey, Alison Tattersall, Giao Chi Nguyen, John Cassey
Narelle, Alison, GiaoChi, John and a builder recommended by Mrs Dung visited the proposed site with Mr Bao and local Red Cross and peoples’ committee members on Sunday afternoon 21/5/2013
The builder was not permitted by Mr Bao to ask questions or to voice his opinions (except privately)
The project is ill advised (header tank and pump without a source of power, no retaining wall or drainage system at substantial cut out at rear of building).
A new plan with proper drainage and power source specifications was requested
Water, the major issue in the village could be fixed by a series of small dams in the multiple spurs and new coffee species could be introduced. These were not negotiable options
*MESCH not to support the building project nominated by Red Cross – both because it is intrinsically ill-conceived and because of its’ association with Red Cross (see below)
John to send email to Mr Bao
e Red Cross
The operating principles of the Red Cross in LamDong province are inconsistent with those of the MESCH organisation – particularly in relation to transparency and funding
This is not really a partnership - we have no say in where we want to go, we can’t influence their decisions
An association with the Red Cross puts the MESCH organisation in an invidious situation. Any high profile association of MESCH with the Red Cross will damage our credibility, integrity and effectiveness in working with the local people.
MESCH should not engage with the Red Cross unless there are no other alternatives. We need to find other ways of achieving the same aims.
It might reasonably be explored as to whether we could provide health education only. This would need to be done at executive level.
If MESCH engages with Red Cross, we must be prepared to follow their recommendations completely.
DEAF INSTITUTE: This community appeared to be very well organised and well-funded.
BUDDHIST MONASTRY: One of our interpreters, An, belongs to a Buddhist community of about 200 students that want to learn English. We had a discussion with the heads of the order and suggested Australian Volunteers International.
LUNCH AT PEACE CAFE: Alison and I met an American (Bill) during lunch one day. He was leaving Vietnam the next day and had a motor bike that he purchased for travelling. He now wanted to give it to CamLy and for the donation to be anonymous. Sr Dao is very happy with her new motor bike - named “Bill”
Resource poor. Lots of foreign aid in infrastructure and some ongoing assistance. English one of 3 national languages.
Chief surgeon Richard Walsh (Leona) is currently acting director of health. Estimated medical care available to 40% of population. No secretary for all of administration – cost ~$300AU/mth. Plans to have outreach and a hospital on Pentecost. No GP care on many islands and especially in the north.
Aims, experience and breadth of aid were of particular interest to Richard. He suggested we work in Santo in May’ish.
♦ Should explore MESCH options with Dr Walsh (Narelle, Lisa and Stephanie in October; Mich., Milton in November.
♦ Support for secretary for 2 months and for 2 years pending a successful MOU and partnership
♦ John to write to Richard
1) There is an urgent need to set and understand strategic directions has been discussed at previous meetings and we used this trip to discuss:
- issues of development V welfare
- a response to a rejection by AusAid for OAGDS
- the importance of developing formal MOU's and partner assessments using the templates that we have developed for this
♦ It was agreed that there was scope within our organisation for both welfare and development. At times, welfare is part of relationship building – though it should not be an endpoint
* If AusAid rejects our submission, we will not pursue this
* MOU’s need to be updated after each trip
* It is suggested that the MESCH group be informed of the goals and processes of individual groups at least 8 weeks prior to a visit. This will give time for discussion, group perspectives and modifications as appropriate.
♦ Some of the repercussions (chiefly from Red Cross) resulting from a relative inexperience with operational strategies needed to work within the Vietnamese environment focused attention on the importance of following these strategies. The Red Cross relationship is discussed below.
2) Size and functioning of the project group:
At 14 people, this was, by far, the largest group of MESCH volunteers. Having larger numbers of people for each sub-group significantly enhanced their effectiveness. We were able to improve communication and cross-fertilisation between groups by an end of day meeting. The size of the group and the amount of things covered/ day means that daily ‘ideal’ meetings are not a sustainable objective.
There seems no reason why the community and hospital health teams need to be present in DaLat at the same time. The separation of the 2 groups may have significant advantages in relation to interpreters and other simple logistics.
♦The group size needs to be limited ? <10
♦ At least some groups to come separately
♦ Communication over projects is critical. No residual elements of a project can be left for other groups to do unless that group(s) has free time and is fully informed
3) Dak Lak or Pleiku? Decision not to explore these
4) Semiautonomous functioning of MESCH within Vietnam
a) Unofficial local Vietnamese charitable organisation (under a Vietnamese citizen’s name), which “subcontracts” to MESCH.
Bill has spoken with a friend (Mr Chuc) about how to go about identifying people in need. He suggested that we can hire a person/s to go around Lam Dong identifying people or groups in need. This person has to be very capable and of high moral integrity
b) New legislation (2012) may permit MESCH to apply to the central government to be an official NGO in Vietnam.
Details of this are limited (eg need local community committee and police approval?). However, one Australian organisation (Vietnam Vision) is in the process of doing this
Bill and John to follow up both
5) Other ideas
Narelle and John have been speaking about ways of making money for Lam Dong Blind Association. Lena is in the process of assisting production of a CD of music from LDBA that we would sell in Aus.
Support this with limited financial support
John Cassey 17 August 2013 for MESCH