Orthopaedic surgery in Lam Dong General Hospital (LDGH)
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Why was it initiated?
MESCH had worked in LDGH since 2009. Situated ~300km from Ho Chi Minh City, LDGH is both the district general hospital in DaLat city and the major provincial hospital. The rapid economic growth in Vietnam has led to an increase in longevity and expectations of medical care. An ongoing urban-rural disparity means that local surgeons, nurses and anaesthetists find it difficult to be trained in new techniques in major centres specialising in orthopaedic surgery and orthopaedic surgeons from HCMC do not teach in rural areas.
In 2009, LDGH had no surgeons or anaesthetists trained in the safe care of babies and small children or in the performance of elective or emergency surgery for them. Involvement of MESCH in anaesthetic, nursing and surgical care of this group has improved the skill level of local clinicians. Based on the success of this previous project, both the hospital director (Dr Hy) and the director of orthopaedics (Dr Dung) had sought assistance to improve orthopaedic services for many years. We decided to progress to formalisation of the project.
What were its aims?
Identify and teach low risk, efficient and cost effective techniques
All surgeons engaged in the project would meet Australian training standards for the procedures taught, including the ability to operate independently
All anaesthetists engaged in the project would be able to anaesthetise patients according to Australian training standards for the procedures
Nursing staff would be able to prepare instruments, anticipate needs and assist in the procedures.
Increase long-term partnerships and provide guidance to ensure systems, processes and policies meet the emerging challenges within Vietnam.
When did it run?
2014
Who has been involved?
LDGH Dr Hy, Dr Nhuan, Dr Dung, Dr Duong
MESCH John Cassey, La Cuong Vu
Other Dr Richard Verheul (orthopaedic surgeon, Newcastle, Australia), Ns Erica Russell (theatre nurse, Newcastle, Australia)
What happened?
After many discussions via SKYPE, telephone and email, it was determined that there was sufficient enthusiasm and capacity for this training project.
Richard, Erica and La Vu arrived in LDGH in November 2014. 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.
Evaluation?
This was very disappointing for the team and has reinforced our belief that nothing can replace an in-country visit prior to formalisation of any project. Although not guaranteed, this particular circumstance is likely to have been avoided. There is a commitment from Richard to be re-involved in LDGH once there is a satisfactory resolution to the orthopaedic internal politics.
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. Richard’s personal circumstances changed and a project plan was put on hold.