2017 Report

Project summary:

Name	Site	Duration	Status	MESCH category	Co-ordinator
Raga	Pentecost, Vanuatu	2013- current	Ongoing	Development	Narelle Cassey
Trauma care	DaLat, Vietnam	2014- current	Ongoing	Development	Peter Armstrong & John Cassey
Thanh Huyen	DaLat, Vietnam	2016-current	Ongoing	Development	Narelle & John Cassey
Trauam care Ninh Tuan	Phan Rang, Vietnam	Planned 2018	Planned	Development	John Cassey
First aid  DaLat	DaLat, Vietnam	Idea	Discussion	Development	La Vu and John Cassey

Members: John C, Peter, La Vu, Amanda

Local ownership of the PTC has occurred and MESCH served in a purely supportive role this year. This August was the fourth time the PTC course was run – the first was in November 2014. It was the second time the Instructor’s Course was delivered and the first time it had been done close to a standard we would anticipate to be effective..

The course was again presented entirely by Vietnamese doctors in the Vietnamese language and this year ran over 2.5 days. Both doctors and nurses again participated in the course, and there was representation from various  centres including Lam Dong General hospital, Duc Trong and Lam Ha. Drs Nhuan, Hiep and Sinh were the backbones of the course and brought in a younger doctor from emergency department  to present topics with which they were familiar. La Cuong, Peter, John and Amanda assisted as mentors with the practical sessions and left the daily conduct of the course to the local presenters. Peter’s wife Angela assisted with media (photography and video). Time management and organisation was an issue throughout the course.

The Instructor’s Course, began at lunch time on the 3rd day after the completion of the PTC. The participants for the Instructors Course were practically identical to those who attended the PTC. This year the main instructors were Dr Nhuan, La Cuong and Khue. Despite all course slides being sent to all presenters well in advance, the material was still being decided in the days prior to commencement which was a significant source of stress for the presenters.and led to curtailment of really important aspects of the practical sessions  In addition, time management was an issue throughout the course. It did appear however that a few potential ‘instructors of the future’ were identified and this was encouraging.

We found the trip in 2017 frustrating and disappointing and provided the follwoing feedback to Dr Nhuan via emial :
The PTC course was poorly run (and provided examples, including no review of MCQ's by LDGH - so wrong answers and poor questions maintained; no new scenarios  - old ones left out and the same scenarios repeated; no-one in charge of time keeping)
We were not informed about the seriousness of the situation at Duc Trong hospital until we got to DaLat. In the end, we had to make a decision to cancel the course - wasting a whole week of our time.
The MOST IMPORTANT aspects of the instructor's course (the practical sessions) were changed by Dr Nhuan without discussing that decision with us -even though we were in DaLat and had already discussed the course together at a long breakfast meeting. What was most disappointing were that the "teaching skills" and "scenarios" sessions were almost completely ignored.
No attempt had been made by LDGH to look at community first aid.

We reaffirmed that:
1) Our focus is making changes that help Vietnamese people and, only if we can achieve that by these courses, should we continue. If not, we will move to something else. 
2) We have no interest in coming to any future PTC courses since we had helped with that for 4 years, mentored instructors, provided equipment and translated and provided all the course material.
3) We have considerable interest in the instructor's course and will assist with that in 2018 only if the practical sessions are run according to what we have ALL previously agreed.
4) MESCH would be prepared to be involved in discussions with local leaders and community representatives and to assist with running community first aid courses as this provides first-line care.

 

First aid:
First aid at community level is seen as critical part of trauma care by community, LDGH and us. It is clear that LDGH both understands this and does not wish to deal with it.
In 2017, Bao Khue introduced us to 5 people who have significant personal reasons to promote a first aid course. Three of them have industry (Prudential insurance and local business community) and party contacts. Motivation and capacity!
We have contacted several doctors without uptake, though there is no need for doctors to deliver the course. The course will need to train instructors for the future.
There are community members in VN who may be able to deliver and volunteers from Australia who are willing.
This cannot happen without Vn champions. Bao Khue has agreed to get all influential people together and get back to us before Tet.
 
We endeavour to work with Lam Dong Hospital to evaluate how the course has impacted the management and outcomes of trauma for this area. Research aims remain to:
    increase international awareness of issues in ED Vietnam
   increase national pressure to improve current situation 
    improve doctors sense of "self" (pride) by having their names on an internationally recognised publication
    show them that this is relatively easy and encourage further research by them (alone or in collaboration with us )
    follow on to tackle other "impossible" tasks to make change
    increase "identity" of LDGH or Duc Trong
    encourage collaboration between LDGH and Duc Trong
    increase credibility of MESCH for funding

Drs Thuan,  Hiep and Nhuan are supportive of evaluation research  with MESCH. We elected to do this via:
1)  review of video surveillance footage monitoring of ED area by "security" camera located in ceiling above resuss beds to ascertain adherence to the systematic algorithm and , potentially, also through written checklists. However, they are unkeen to do this until refurbishment of the ED occurs. If this does not go ahead, we will re-approach regarding install in current set-up.
 2) a 3 month log of safety events (categorising them in a meaningful way) - Pros: Good to get hard data from which to show improvements Cons: Unlikely that all staff will record incidents and therefore loss of data. There is no local champion for this and it is on hold
3) anonymous evaluation of "western" approaches to de-escalating AND escalating safety issues by every staff member of ED – rating the likelihood that these might succeed in their hospital/ Vietnam;  personally,as opposed to organisationally prepared to try them; reasons why/ why not. Pros: Find options to try in future, make them aware of options, relatively easier project, internationally relevant. Cons: No hard data on which to base assertion that safety is an issue..though we can simply use their ratings from the PTC courses.
We have given up on LDGH for this research. Negotiations currently rest with Doctor Truong at Duc Trong hospital and are being facilitated and mentored by Hien Trinh (a new, and amazing “find”. She had a PhD obtained from UoN and is based in Newcastle with her husband and family for the next few years. Has shown remarkable astuteness, has excellent English, is very time aware and translated sensitive documents to LDGH regarding future roles of MESCH there. 
Part of this evaluation will depend on their emergency department remodelling.
We endeavour to work with Duc Trong hospital to evaluate safety initiatives

 

Updating the Emergency Department – Local Vietnamese people would be employed to complete project.? Australian project manager.  Adam McDean also has some building contacts in Vietnam, he intends to follow this up in March.

 

As it appeared that the projects with Lam Dong were coming to a conclusion, we reconnected with Ninh Thuan Hospital in Phan Rang. It is by the coast, approximately 2.5 hrs by car from Lam Dong.
Ninh Thuan Hospital had previously made contact with MESCH 3 years ago, asking for assistance with a variety of projects. At that time MESCH was unable to commit due to our ongoing plans with Lam Dong.

After making contact in the first week of our trip a meeting was arranged for the Monday.
We had a productive meeting with the Director, Vice Director and executive 
They presented to us their main concerns and requests within the hospital including:
1. Education regarding primary trauma management
2. Education regarding paediatric anaesthesia and surgery
3. Education regarding knee arthroscopy and/or replacement
4. Education regarding interventional cardiology
5. Education regarding ECHO interpretation
6. Education regarding MRI interpretation

We subsequently signed a memorandum of understanding with the hospital which would involve  2 years of   PTC, Instructors and First aid  courses. Current suggestion is August 2018. It is unclear as yet whether they would assist with recruitment of interpreters (however it appears our regular interpreters from Lam Dong may be able to assist if necessary). Since they are a trauma course naieve hospital, it was great that they were also amenable to the idea of evaluating the course from the outset.

We intend to send the PTC slide set from Lam Dong once we have answers to some details about organisation.  and await ongoing discussion regarding this. They assure that they have a foreign communications department which should be able to provide correspondence expediently. Minimal outlay MESCH. Will suggest they buy mannequins if they do not have
Bottom Line: We will be working with Phan Rang to develop the trauma “bundle” for 2 years and, subsequently,  provide education regarding anaesthesia/surgery. Need to clearly define who is interested in joining the project and in what capacity? Questions we are awaiting answers to include: timing, hospital program and staff/faculty, interpreters, delivery of the courses.

 

Members: Narelle, Penny, Steve, John C
Raga 2017 was certainly team building - thanks to cyclone Donna! The hard beds, no sleep, 4am roosters, intermittent mobile signal requiring speaking with what seemed like the entire call centre staff of virgin to re-schedule flights home…  We were reminded of the NiVan response when you say you are going to Pentecost to work - a stare and “why???”.

We have had no contact from Pentecost since the trip. From a MESCH perspective we have reached an impasse.

Options moving forward are:
1.Lini. It is a school – no one has ownership. They do not look after or maintain the property or equipment. Staff also tend to get moved on. We feel that Lini cannot continue and that Ephraim/Isaiah are not the right personnel.
2. Port site
Haniel - Deborah’s husband, already have a space that would be suitable. Marketing goes against their culture but if we created a workshop with a shop front that would address this issue as it would allow customers to come to them. Furthermore, this site is ideal as it is just down the road from the port/beach and has a lot of space associated with it. There would be opportunity for a training site, workshop and guest house. During a previous visit this had been quoted as costing approximately $10000.
Is there an option for any other pre-existing building to be used near the port to avoid this expense?
One of the questions for Haniel – does he really want to do this? 
3. Ambae
This opportunity arose after a chance meeting with Hollingsworth, a solar technician trained at UQ, and his wife Mel.  Hollingsworth is coming to Australia in February 2018. His main request during the last visit was actually asking for a trainer. Mel was already selling things locally in central Pentecost. Pursuing this further would require a visit to Ambae in 2018.

The rural training project could be incorporated into this. This would empower the women (training them in skills such as sewing skills, repairing machines, creating internships).

We will speak to Andrew about community perception, are there any other spare buildings around and would he know about any other managers in the country?
We continue to encourage more female involvement and ownership
Chase transactions from Bank of Vanuatu. During the April trip it was found that there was significant discrepancy in the financial records (over 1.4 million Vatu which approximates AUD $16800). It is not clear whether this is due to misrepresentation in the financial records or whether it has truly been misappropriated. There were no financial reports or books from 2016 and the computer that had been set up from the last visit was broken and all the information was lost. The generator appears to have only been working for 500 hours over the past 6 months. We discussed openly with the ladies about what had happened and it was obvious that they knew what was happening.

We spoke frankly and in detail with the staff about accountability, particularly with the resources (e.g. materials being paid for prior to being made, no staff to take fabric home for own use) and emphasised that this was their business.

The current plan is that MESCH will receive monthly financial reports. The business has to prove itself in the next 6 months that all moneys are received and banked before we can take the next step of looking at another site to build a workroom and shop. We will evaluate how this is progressing in a further 3-6 months. If the business has not improved its practices we may take our machines over to Hollingsworth on Ambae
There is to be ongoing discussion with Mullanes plumbing regarding building another sewing business site.

There have been several conversations with Debra concerning the situation. There is a major and seemingly irreconcilable rift between Ephraim (accountant) and Isaiah (manager) resulting in Ephraim withholding money on occasions for business expenses and the ladies wages…this is not acceptable but we are unable to deal with it from Australia due to the usual no communication. Some options to consider are moving from the current site at Walter Lini School. The culture there is different to what you find in a village. In a village there is ownership and the people look after their homes , surrounds and animals. At Lini it is a school and there is no ownership of things in a school in the minds of the people so maintaining and looking after the machines and generator does not happen. We have been offered an alternate site at Haniel’s village which is nearby. Haniel is Deborah’s husband and also chief of the village so we would be negotiating only with him and the elders at the village. At Lini we need to negotiate with the principal, the school board, the Anglican church Bishop and the local chief. We also need to train other people to move into the roles of manager and accountant preferably females. There is an imbalance in the genders in the culture and even though Isaiah is friendly and approachable I believe we need to try an all female staff.

Building a new building at Haniel’s village would be a leap of faith and would require a field trip with people from Mullane’s to view the site and talk with Haniel and the people so they could see for themselves what the situation is and whether they would like to proceed.

Another option is to ask the original person, Richard Leona who was responsible for us going to Pentecost in the first place, to speak with Ephraim and Isaiah to mediate a solution for their conflict. Due to changes in Richard’s standing with the people over the last couple of years (he entered politics and lost and made promises about a medical centre that have not been realised yet) he has lost some face in some of the communities. So I am undecided about this option. There is also the option mentioned above about moving completely from Pentecost to Ambae. It seems that we have reached a crossroads so we need to discuss these options at the meeting.

 

Trip Dates: TBC 2018
Members: John C, La Vu, (Amanda T)
Background:
Mr Khiem is a blind person. He left Lam Dong Blind association (LDBA) because he felt the manager was neither transparent nor fair. After formal academic training, he tried to get a position in the computing industry. Cultural issues made this impossible and he returned to massage to support his family. MESCH had attempted to set up an enhanced massage business with LDBA in 2016. However, concerns about business practices within that organisation led us to withdraw support.

Mtr Khiem and his wife, Huyen currently rent a business in DaLat and employ 3-4 other visually impaired masseurs. Building a successful business would not only greatly assist Mr Khiem, his wife and their employees to lead dignified and independent lives but also improve opportunities for their children – hence building the community. As Mr Khiem has a strong sense of social justice and a desire to build his business, a successful business will also lead to more blind people being employed and trained in both business and massage skills. Khang’s, Narelle’s, Jason’s  and John’s  discussions with them were supplemented this year by Vy and La,
We made 2 videos (now on you tube) to promote their business to Vietnamese, Korean and Western clients  and provided business cards (designed by Dianne and Stu). No feedback form them after we left in August except they claim not to be able to use cards (,pdf format). ?Lost in translation
We discussed signage and future directions for growth/ involvement
Khiem and Huyen do not want money and they are very cautious about making change. That said, they change their minds a lot and are obstinate in one view until they change to a different obstinate view
They are not particularly collaborative.

The business is clearly growing quickly with clients still present until 10pm at night!  Since the trip, John has created further promotional material for their business and uploaded it to the MESCH YouTube page both in Viet and English. We have not had any direct contact from the business with respect to their visions for the future of the business. Khang has become completely frustrated with them. Recommend we await specific request from them

 

Staff safety is a key issue brought up by Vietnamese doctors and nurses. There continue to be difficulties dealing with aggressive family members. Dr Hiep, the director of Emergency has settled into his role but as yet has not succeeded in plans to re-design the Emergency Department. In fact, plans that had been previously designed with MESCH’s assistance were vastly different to those ultimately approved by the administration. Those too have been delayed due to ongoing debate with staff of the emergency. They again requested assistance with the designs to improve patient flow and reduce access of the public to acute treatment area.
We have received the preliminary designs and have approval from the executive of Lam Dong General Hospital.
Vy An has been liaison between MESCH and LDGH (Dr Nhuan, and Dr Hiep)
LDGH will not commit any money though will assist with permissions and materials sourcing.
Mullane's have not expressed a lot of enthusiasm.
We may have an Australian project manager.
We are seeking EOI’s from Australian companies working in Vietnam and the March 2018 meeting with Newcastle clubs may provide more interest. Once the renovations are completed we can revisit evaluation of the course.

 

New members: La Vu Cuong warmly welcomed in 2017

 

External recognition
We have been talking about “home grown Hunter” and “doing things differently” for a while now. Getting that message out to those beyond our immediate contacts has proven elusive. Steve Threlfo spruiked at 3 community groups this year, Newcastle Herald gave us some space twice and, at the time of writing, Hunter Business Monthly are going to run an “ad” for us with the new “Friends of MESCH” logo (designed by Stu McDonald of SUM studio). Maitland library and Hunter Clubs have invited us to give presentations in 2018.

In order to continue to deliver meaningful project support and evaluation we need financial backing, input from individuals with specialist skills and support for both the project co-ordinators and executive. Although we have made some in-roads with presentations and contacts, this has been frustratingly slow.

 

Strengths
Our greatest strength is our commitment to socially relevant and achievable goals.

 

Foundation Board
Proposed to act as a support mechanism to ensure MESCH members’ time is freed up to deliver actions achieving worthwhile outcomes without the waste of time resources on non-critical activities.
MESCH membership currently has limited business experience and no one with high profile community and/or government contacts. Pragmatically, it doesn’t seem to matter how good an idea is, getting a foot in the door to present that, takes people with such a profile/ contact base.

 

ANCP process and application 
John has been emailing a contact at the ANCP about the process and received a response eventually in October. He has handed this process over to Steve who is investigating further. Suggest we put this on hold until we get more money.

 

Private Clinician Support
After the success of contacting private clinicians at Warners Bay Hospital for financial support, John has plans to reach out to clinicians from Lake Macquarie and Lingard.

 

Review of University of Queensland data on fundraising by executive

 

Newsletter
So far first edition has been released. We are hoping to release an edition in December along with our Christmas message.

 

 

Website update
New website has been launched and looks great although there are some small areas which will need polishing.
“Meet the people” was an interesting experience and provided a wider range of texts than I anticipated.  La’s unedited version described his love of beer as being his “why”..

Facebook has not been as active a tool as it is for other groups. Every interaction I have with potential funding sources eventually come down to good news stories with the expectation that these happen weekly!
 
Hunter Business Review Monthly
John has been working with the Hunter business review monthly to promote MESCH. Editor has been provided with text and graphic for the December edition.

 

New Videos: new MESCH organisation (Garth Russell) ; “personal stories” (Garth Russell) , Biomedical technicians (Vy An, Steve Threlfo, John Cassey - VN language), Pneumothorax (Bao Khue, Peter Armstrong, La Cuong Vu and and many VN actors and assistants - VN language), Thanh Huyen (La Cuong Vu, Amanda Taylor, Hien and Khiem, John Cassey -  VN and English language), Trauma video (John Cassey with Limelight creative media)

Invited speakers
Executive have approached Steve to potentially have a “spokesperson” role for MESCH to which he has kindly agreed. Avenues which we still haven’t spoken to/explored include Probus group and Collective Heart.
Maitland City Library’s “Look Who’s Talking Local Stories” program have invited us (local people with unique, diverse and engaging stories that may be interest to the community) to speak in 2018. By presenting the stories of individuals from different cultures, different walk of life and with different life experiences, the library aims to increase understanding and acceptance of diversity within the community.

 

Current organisational memberships: Statutory (ACNC, Dept Liquor, Gaming and Racing); Google not for profits; Giving circle.

 

Current organisational associations/contacts: MedEarth (medical supplies); Newcastle Global Health; WHO road trauma; AVI; ABV; Application to UN submitted June 2017

 

WhatsApp - shelved for now

 

Trades and Skills and Equipment review - ongoing

 

Other activities by MESCH members
Overseas volunteers 
 - Raga (Narelle Cassey, Penny Wayne, John Cassey)
 -Trauma course (Peter Armstrong, Amanda Taylor, La Cuong Vu, John Cassey)
 - Thanh Huyen (Amanda Taylor, La Cuong Vu,  John Cassey)
 - Emergency department LDGHupgrade (La Cuong Vu, John Cassey)
Executive (Amanda Taylor, Penny Wayne, John Cassey) assisted by Adelaide May-Parker Dafo and Grace Parker
Steve Threlfo, Amanda Taylor, Narelle &John Cassey met, variously, with Leigh Bryant (Scorpion), Adam McDean (CEO QMS Certification Services and CEO “Variety”), Tony Sansom (regional director – Hunter and Central coast office of regional development, Department of Premier and cabinet), Garry Hardie (Publisher & Editor, Hunter Business Publications) and other supporters. 

 

Support by non-MESCH contacts (alphabetical)
ABC radio did an interview with John
Adam McDean has offered ideas about media exposure and ED builders – no result (not enough time)
Adelaide and Grace organised new banners and did mail out of requests for funding (supported by Narelle)  Anthony McGavin (owner “The heights” café) donated food, venue for the Trivia night 2017
Bao Khue organised VO for pneumothorax and trauma videos and the first aid meetings and videos
David Woodcock continues to support MESCH auditing and accounts
Dianne Swain continued to assist with website development
Ferdinand Lehnard (director WOLFE, Australia) gave medical instruments
Garth Russell (independent producer) renewed the current MESCH organisational video (pro bono) and  produced another one
Garry Hardie (Publisher & Editor, Hunter Business Publications) and other supporters.   
Giao Chi made a VO for trauma video
Hien Trinh spoke several times with Dr Truong and Nguyen in La Dong about research and translated  sensitive docuemtn to LDGH regarding future roles of MESCH there.   
Khang Võ (friend and interpreter living in Vietnam) translated documents and PowerPoints for the trauma  course and continued to assist with Thanh Huyen 
Leigh Bryant (Scorpion international) has continued to assist with networking for sponsorship
Limelight creative media (Ian Hamilton, Anna Kelly and Johnathan Burrows) are producing a video on  trauma course in Vietnam
Minh Tran did voice over for Thanh Huyen videos
Newcastle Herald and Newcastle weekly printed interviews with Narelle and John (organised by Adelaide  and Grace)
Spanline, Edgeworth provided ducting for generator exhaust Raga
Stewart (Mr Stitches) refurbished industrial machine and updated Steve Threlfo’s knowledge on repairs
Stu McDonald produced graphics and cards for MESCH, Thanh Huyen and “Friends of MESCH”
‘telligence (website design and hosting) continue to host website pro-bono and development costs at  reduced rate
Tony Rhodes (Mullane’s) considered and has not fully taken up involvement in LDHG ED refurbishments
Tony Sansom has organised a presentation by John to Hunter clubs in March 2018
Trident plastics donated plastic material for sliding generator out of shed at Raga
Varley engineering produced reverse engineered drawings for crash trolleys in Vietnam
Vy An (friend and interpreter living in Vietnam) translated documents and PowerPoints for the trauma  course, assisted with the VN versions of the videos for the trauma course and liaised with LDGH about the  proposed changes to the ED LDGH (pro bono) 
 
Proposals for 2018:
1) Continue to look for a secretary to supplement our executive
2) Build community recognition of MESCH – continue to look for PR support
3) MESCH turns 10 in 2019 - identify and event
4) Foster support for project co-ordinators.
5) Pursue meetings with individuals we have identified as potential sponsors – individuals, corporate. 
6) We need more money, more assistance in administration and marketing and more project volunteers.