DaLat Vietnam (Lam Dong General Hospital – LDGH)
Paediatric surgery projects at LDGH concluded with Dr Tam’s death in 2013. Whilst there is no surgeon at LDGH with the commitment to benefit from further paediatric surgical training, both the anaesthetists and operating room nurses have expressed a desire for ongoing training. As John Cassey was in DaLat in November, an offer was made to review children previously operated on during MESCH visits. 25 children were reviewed and 4 of these had issues benefitting from surgery. 2 were counselled to delay this and the others were operated upon with LDGH nursing staff and Dr Sinh (director of Anaesthesia LDGH). Postoperative care was shared with Dr Son (director general surgery LDGH). No complications reported in the following 3 weeks.
Conclusion and recommendations: We acknowledge the need but currently do not have time to develop new projects for paediatric surgical care in LDGH
Advanced trauma care courses were initiated as part of the long term solutions to clinical problems described by Dr Hy (director LDGH) to MESCH over a number of years. We co-partnered with LDGH (chiefly, Dr Nhuan, director quality improvement) and the course was largely presented by Dr Sinh (director anaesthetics LDGH) and Dr Duong (trauma surgeon LDGH) under guidance from us. It consisted of a 2 day doctors’ course, a 1 day instructors’ course and two 1 day nurses’ courses. They were run over 5 days at LDGH in November 2014 with ~20 attendees at each of the trauma courses and 10 at the instructors’ course. They had come from over 15 hospitals in Lam Dong and Ninh Thuan provinces and included emergency doctors, surgeons and nurses. MESCH (John Cassey and Peter Armstrong) adapted it from the internationally recognised Primary Trauma care course (PTC). PTC was designed for low resource environments by A/Prof Marcus Skinner (Anaesthetist and PTC Co-Founder) and Dr Haydn Perndt (Anaesthetist and PTCF Trustee). There were several meetings with the Vietnamese instructors, the MESCH team and the interpreters going over the power point slides content, the practical exercises and how to deliver the course.
The interactive nature of the course with active participation from the audience and the relevant Vietnamese scenarios was new to many participants and enthusiastically received.
Feedback is that all attendees wish to see it rolled out into their own hospitals and to address the cultural and logistical issues thy see as impeding outcomes for trauma in Vietnam.
Outcome measures were tentatively explored in evaluation questionnaires and are yet to be analysed through collaborative research with LDGH. We seek to understand factors impacting on transfer of knowledge, skills and capacity to participants.
Vietnamese ownership of the course has been established although our role in course preparation and delivery is likely to be maintained for a while yet. Our indispensable interpreters were Nguyen Hanh Phuoc An, Võ Xuân Khang, Truong Bao Khuê. La Cuong Vu (biomedical engineer) acted as negotiator, co-ordinator & interpreter. Dr Peter Armstrong and Dr Haydn Perndt were guest lecturers. Lois Meyer (senior research Fellow UNSW) remains educational advisor.
Conclusion and recommendations: This was a new course delivered by committed and energetic lecturers with the strong support of management. Having regard to the track record of previous PTC courses in Vietnam, what was achieved here was truly remarkable. Conversations with local staff and medical directors are ongoing. Evaluation of the effectiveness of the course is ongoing with Dr Nhuan and University of NSW.MESCH is keen to continue support once we have an agreement on outcome measures and they are in place.
Upskilling in orthopaedic surgical techniques was initiated at the request of Dr Dung (chief of orthopaedics LDGH). After many discussions, Richard Verheul (Orthopaedic surgeon), Erica Russell (theatre nurse) and La Cuong Vu (Vn born Australian National) arrived in LDGH in November. The original plan was for 1week of joint consultations followed, possibly, by endoscopic surgery with equipment supplied by the manufacturer/ supplier. Although things started well with outpatient sessions appropriately booked and considerable interest by at least Dr Duong (trauma surgeon), the number of outpatient cases rapidly diminished. An operating session was organised somewhat hastily by the local surgeons within the first week and several local and visiting surgeons participated. As a result of some conflicting information and events (including the revelation that ongoing care for patients treated would not be provided by Vietnamese doctors after the MESCH team left), we had meetings with Dr Dung and subsequently with the hospital director (Dr Hy) and executives. Given that Dr Dung’s previously espoused objectives had "changed" (he simply wanted equipment) and this was not MESCH’s organisational objective, we did not continue this visit. There are quite complex and influential personal agendas within the orthopaedic department and the project has been temporarily suspended pending changes in that department’s structure and goals. To anticipate realistic changes in the next 2years would be optimistic. The hospital administration is acutely aware and agrees with the above. Dr Duong is interested in training and would benefit from this. There was a commitment from Richard to be re-involved in LDGH once there was a satisfactory resolution to the orthopaedic internal politics.
This was very disappointing for the team. However, as a result of this, a pre-existing request for involvement of MESCH with Phan Rang hospital in Ninh Thuan province was explored. A visit was arranged and Richard, Erica and LaVu visited the hospital at Phan Rang. A positive response resulted in an MOU from Phan Rang and a project will be developed with the aim to begin in April/ May 2015.
Conclusion and recommendations: Suspend project pending changes in the orthopaedic department’s structure and goals. Assist Dr Duong in his quest for further training in Australia.
Supply and train in use of 8 anaesthetic machines LDGH was completed in November 2014. Thanks to the generosity and persistence of MESCH and donors (including overseas partners), 6 machines were installed in LDGH, 1 to Bao Loc GH and 1 to a medical centre in Duc Trong district in 2013. Training in user level machine set-up and daily testing was started for 19 staff from LDGH and outlying centres. Steve Threlfo returned for the final follow up steps to previous training in the use and servicing of the 8 donated anaesthetic machines. In association with Ngoc (his interpreter) and Hai (the hospital engineer) they rewrote the operating manuals in user-friendly Vietnamese. Steve also added to the hospital’s store of spare parts. Steve has been keen to promote trouble shooting concepts.....a little used idea in the medical equipment maintenance department. This experience has been a new approach for the bio-med service department in Da Lat in demonstrating the importance of upkeep of equipment for staff and patient safety as well as greatly reducing replacement costs. The success of this project beginning in 2011 has been the result of the help from invaluable interpreters over the years; assistance and support from Stein (a work colleague) on the first trip, from La Vu (Vietnamese born biomedical technician based at St George Hospital Sydney) who provided support, significant technical assistance and communication skills. Finally the success is largely due to Steve's expertise and gentle, respectful approach with measured instruction, thorough preparation leaving behind useful and practical applications that are meaningful for the Vietnamese. Despite a number of logistic and bureaucratic obstacles during this 2 year project, MESCH did not pay any additional fees or bribes. The improvements in patient safety and cost savings due to reduced volatile agent use are enormous.
Conclusion and recommendations: Project complete
Phan Rang, Vietnam
Phan Rang hospital in Ninh Thuan province had expressed request for involvement of MESCH and a large delegation visited LDGH to put their case in November 2014. Two meetings were held and subsequent visits were made by Richard, Erica and LaVu (as a result of the unexpected outcomes in LDGH orthopaedic project) and, subsequently, by John.
Conclusion and recommendations: A positive mutual response resulted in an MOU from Phan Rang and projects will be developed with the aim to begin in April/ May 2015
An in-country visit to establish the possibility of a combined anaesthetic/ nursing/ surgical project was made in July 2014 by Amelia Ham, Michele Poppinghaus and John Cassey.
This was a meet and greet, needs assessment and relationship building visit. For a multitude of reasons outside our control, there was some confusion about our purpose. This led to embarrassment and reaffirmation of previously held perceptions by local staff of their “distance” from DOH decisions and processes.
For our part, we welcomed the numerous discussions with local staff including Dr Andy Ilo (anaesthetist and current hospital director), Dr Carl Susuarara (contracted general surgeon from Solomon Islands) and Dr Basil Leodoro (Ni-Van surgeon). Andy has a vision for Santo which involves employing consultants to act as “magnets” to attract junior staff and raise the reputation of Santo hospital. He has already budgeted for 5 consultants for 2015.He acknowledges the entrenched issues and instability within public health in Vanuatu. Most surgery is semi-urgent or emergency. Paediatric services, like most other services, are ad hoc. There are 2 nurse anaesthetists - Theophil and Simeon. They will not do elective patients < 2 years old. 17 ni-Van medical students are due to return to Vanuatu in July 2015 and there are, currently, insufficient senior staff to mentor them.
Conclusion and recommendations: The unpredictability of the health department makes planning very difficult. . The option of medical involvement in Espiritu Santo is temporarily on hold pending changes that will occur with the return of the new graduates.
Medical: Primary care
Improve knowledge and resources at Mauna Health Clinic, Abwatuntora began in April 2014 with in country assessments of need and logistics for ongoing visits by primary care doctors and nurses. A variety of donated equipment and supplies were given for the use of Amos Tabi (Nurse Practitioner), Rolline Tabi (Registered Nurse) and Philip Brown (pathology technician) at the clinic. Process of joint consultations and procedural work with local healthcare workers seemed to be a good model. They had realistic, community centred requests for resources.
Conclusion and recommendations: As this promising project developed, it appeared to be more "service delivery" than development. The organisational issues arising from that mean we will not pursue it at this time. However, we hope it will continue outside of MESCH and, as circumstances change, we may become re-involved.
6th visit to DaLat March/ April 2014). Narelle and Alison visited all previous partners. There were no new communities presented needing educational help
Lam Dong Blind Association community is thriving. There have been a few marriages and new babies have joined the community. The massage group's improved English has resulted in a 40% increase in business on last year and they are now able to make a reasonable living – though still reliant on some handouts. See community projects for prospects of further involvement.
They remain keen on pursuing a coffee shop with assistance from “friends” and staffed by partially sighted people and others with disabilities. We have discussed sustainable income support options. The most relevant is to improve income from their massage business. The educational component of this would be to continue to improve their occupational English speaking skills. They will also need logistical support to develop both their massage business and their café.
Conclusion and recommendations: MESCH will be involved in the educational aspects as part of a co-ordinated and clear business plan.
CamLy minority children's home has a new director, community support is still strong and enrolments are up. The water bore has failed and they would like a new one. As this is also likely to fail and the idea of water catchment tanks holds insufficient appeal to the director, we have declined further involvement. There has been no desire for ongoing educational involvement
Conclusion and recommendations: No further involvement
Happiness House involvement with VnHarvest program for the last year has meant a good, consistent diet and they were healthy and had grown more than in past years. Sr Nga is very happy.
Conclusion and recommendations: Happiness House has no current need for new projects.
2 trips to Pentecost (April and August 2014) to establish and monitor “The Raga Sewing Project”. The community have a passion for this project which fulfils needs in relation to employment (especially for women), empowerment for women, community achievement and commodity acquisition. There is a well organised business structure and the beginnings of a business plan. One electric (button holes), 2 hand and 1 treadle machines are operational, material and other supplies have been provided and school shirts and other items have been produced. There appears to be a trustworthy and balanced “board”. Money has been placed in an account with the National Bank of Vanuatu on Pentecost. $10,000 budget for the next year allocated for more machines and supplies. A local project manager has been advertised.
Conclusion and recommendations: This project has progressed very quickly and is fully supported by MESCH. Organisational changes are anticipated in 2015 to accommodate its’ expansion.
Café Lam Dong Blind Association community remain keen on pursuing this with assistance from “friends” and staffed by partially sighted people and others with disabilities. We have discussed sustainable income support options. The most relevant is to improve income from their massage business. The educational component of this would be to continue to improve their occupational English speaking skills. They will also need logistical support to develop both their massage business and their café.
Conclusion and recommendations: To what extent MESCH will be involved in these projects needs to be decided – largely by the amount of time we have to devote to them and the availability of other volunteers
HCMC and DaLat, Vietnam
VnHarvest was established in DaLat in 2013. In October 2014 a meeting with Jimmy Pham (founder KOTO foundation http://www.koto.com.au/about-koto/koto-foundation) LaVu Cuong, Sven (Compassion VN) and John Cassey was held in HCMC. The aims of this project have broadened so that in exchange for the redistributed excess food, recipients must show that they can do something to eventually bring themselves out of need. An example might be sending their child to free school to learn English. We have established that a financially sustainable project can be established comparatively easily. We would use a central warehouse in HCMC to repack food into “lunchboxes” for sale and larger amounts would be distributed to nominated recipient communities
Conclusion and recommendations: This project has considerable potential though needs considerably more input than we currently have human resources to fill. To progress it, we need to find a suitable western volunteer, prepare a business proposal and prepare some advertising material.
2) Legal and structural changes
We now have DGR status from ATO having been gazetted by the minister as a relief fund. This means that we are able to offer donors (both volunteers and sponsors) tax deductibility. Given our focus on development and our commitment to working "with", as opposed to "for" partners, we do not need a large income (~ $30,000AU/yr). The utilisation of funds by various projects varies considerably. We have streamlined processes for membership, volunteering and project assessment.
3) Volunteers and support
We have been uplifted by new and enthusiastic volunteers. Quite apart from whatever overseas projects they may become interested in, they have fast-tracked many of our stalled organisational processes, allowed us to catch our breath and focus on the quality of projects.
4) Our most important challenges for 2015 are:
Reassessment of current projects and developing realistic plans for their ongoing implementation
Continuing to apply the rigor and honesty expected of us by our objectives and maintaining the fun and energy that makes us do this in the first place