2009 Report


Paediatric anaesthetics, surgery and nursing LDGH, Lam Dong General Hospital, DaLat, Vietnam

3-18 July 2009

John, Mich, Sandy David & Hue went on the Lam Dong Hospital bus to outlying district hospitals and screened >200 patients at the various locations.  Unfortunately, although some of the children screened had readily treatable conditions (in Australia), Dr Tien did not communicate this information beforehand and we were unable to bring appropriate agents with us. After day 3 it became apparent that we needed more interpreters in order to deal with the thirst for knowledge from numerous staff. These were obtained through contacts with the education group.
The theatres were, fortunately, not air-conditioned so anticipated child heat loss was minimal.
Parents and families did not have access to VN language written information about their child’s procedure or hospital stay. We were unable to rectify this with the time and support available.
We had spoken with the director of anaesthesia Children’s Hospital number 1 in HCMC about cultural approaches to anaesthesia in Vietnam – in particular about parents being with their child during induction. Knowing that this was not practiced in HCMC simply for “parental reasons”, gave us the confidence to approach the DaLat anaesthetists. We agreed to try and were successful in introducing the practice.
Given our control of pre and intra-operative decisions, postoperative care was, unexpectedly, in the hands of the local staff and it was difficult to make meaningful inroads here.
It was obvious after the first week that there were both surgeons and anaesthetists who could manage the clinical cases with us available to troubleshoot. After discussion with Dr Hy, Dr Sen (chief of anaesthetics) and Dr Son (chief of surgery) we therefore set up a second theatre to run concurrently with ours and run only by local staff. We discussed difficulties on a case by case basis both intra- and post–operatively and utilised anatomy texts provided by the hospital. We kept an ongoing log of individual strengths and weaknesses as well as our own capacity to respond. 74 children had surgery.
Undertaken by us in consultation with Drs Hy, Sen and Son on a daily basis and formally at the end of weeks 1 and 2. At completion, we had 2 other formal meetings – with Dr Hy alone and in conjunction with the provincial director of health. It became clear that, overall, this scouting visit was a success and warmly welcomed.
i) There were no postoperative deaths in the 50 children operated upon and 2 postoperative urethral fistulae – entirely consistent with Australian expectations
ii) The parental presence at induction of anaesthesia was agreed to have worked well and tentatively agreed to continue
iii) We needed:
 * An in-country “champion” apart from Dr’s Hy and Tien. Dr Cuong was appointed to an expanded role and one of our interpreters (Ms Tran Mai Anh ) agreed to remain involved
 * Parent oriented VN language written information – Translations to be provided by Ms Tran
 * More detail about how to orientate teaching to make it more effective
 * More consistent access to interpreters and upskilling of their medical vocabulary
 * More control of postoperative care
 * To increase our welfare contribution if we wished to cover the entire hospital costs of underprivileged families
We continued communication by email and by phone with Dr Cuong, Mr Watson and Ms Hue for the first 3 months after the trip making sure that there were no new or unresolved issues. We were informed that there was a problem in one of the 4 children in whom we did major genital reconstructions. We wre sent clinical photographs and the family took him to HCMC for evaluation. We reiterated our dislike for "operate and run".

Lam Dong Blind assocaition

Narelle, Diane and Betty
This was a very meet and greet session because formal premissions had nto been received to work. A lot of learning regarding possoble roles for MESCH took place. Some fun teaching relating to meet and greet and permissions relating to massge work.