Maternal & Child Health Program & Projects
Dien Bien Province, in the remote, mountainous north-west of Vietnam, is home to 21 ethnic minority groups with low literacy levels and poor access to health care. The province has one of the highest rates of maternal (4 per 1000) and infant (>35 per 1000) mortality in the world. However, health professionals have few educational opportunities and limited equipment.
A multi-disciplinary group from Sydney conducted an educational needs assessment in 2005. The group subsequently developed and delivered a tailored, interactive, skill-based, small group education programs to clinicians throughout Dien Bien Province.
The Học Mãi Foundation, through the Dien Bien Phu Project, has provided educational opportunities not otherwise available for doctors and nurses in Vietnam, documented gains in knowledge and skills among course participants and increased use of evidence-based practices in Dien Bien Province.
DBP Annual Report 2010
2010 International Program Development Fund
Developing the capacity of the Microbiology Laboratory at Dien Bien Phu Provincial Hospital
Monica M Lahra, Elizabeth J Elliott, Peter C McMinn, Heather E Jeffery, with Emily J Bek
Project Outline: Developing the capacity of the Dien Bien Phu Provincial Hospital Microbiology Laboratory by providing equipment, consumables, education and training and educational resources to enable it to operate as a diagnostic service. In the longer term this will provide epidemiological data to inform the Hoc Mai Maternal Child Health clinical education program and the opportunity for collaborative research about infectious diseases involving Vietnamese and Australian research teams.
In late 2009 EJE, HEJ, MML along with Dr Jane Hirst and Dr Gaston Arnolda conducted clinical teaching in DBP and Tuan Giao Hospitals. Part of this program focused on the diagnosis and management of acute diarrhoea in infants and children, and the role of laboratory diagnosis was included as an introduction to this project.
In 2010 our team made two visits to DBP and one to Hanoi to support and supervise the training of two DBP Hospital Microbiology scientists in the Microbiology Laboratory at the National Hospital for Paediatrics in Hanoi.
In March a visit to the DBP Hospital Microbiology Laboratory by MML, PCM and EJB was undertaken to meet the staff, discuss and assess their needs and determine the level of function of the laboratory and the existing infrastructure. During this visit we were hosted by Dr Son, the Director of DBP Hospital, and met with the Deputy Director Dr Trien and the Head of Microbiology Mrs Son. Priority needs identified were a Biological Safety Cabinet to create a safer work place and the need for a computer for record keeping and data management, internet access and a camera to enable video conferring with the training institution and our team. Power sources and back up supply systems were investigated and preferred placement sites for equipment were identified.
In August we (MML, EJB) visited DBP to meet with Dr Son and staff and to deliver a laptop computer with a Vietnamese keyboard, software, relevant supportive texts, a mouse, external hard drive, web camera, cooling pad, and lock. The training to be held in December was discussed and appropriate staff members were subsequently selected to participate in the training. A class II BSC was ordered from a local company, and the cabinet was delivered and installed on the 24th of December.
Training for two DBP Hospital Microbiology scientists (Dr Nguyen Thi Minh Khuyen and Dr Luong Thi Thao) was conducted at NHP Dept Microbiology in December, arranged and supervised by our team (MML, PCM, EJB) with the support of the Director of NHP Dr Lien and conducted by Ms Phung Thi Bieh Thuy. It was identified that the DBP staff needed training in laboratory safety, working in a BSC, and the diagnosis of rotavirus infection in faeces using latex particle agglutination assays. Further training is planned in 2011 and beyond with the support of the NHP.
Laboratory diagnosis will be incorporated into our planned clinical teaching for 2011.
We would like to thank our Vietnamese colleagues Dr Son and his staff at DBP Hospital and Dr Lien Kien Ngai Infectious Diseases Physician at NHP for his excellent advice, help and translation during these visits.
Maternal Health Workshop 2010
The highlight of a busy and successful year for the Maternal and Child Health team was our visit in November, 2009 to Dien Bien Province (DBP). During this visit we ran two Maternal and Child Health Workshops for 40 health professionals. These workshops were specifically developed in 2009 by the Hoc Mai MCH team following a request from the Provincial Health Department to deliver additional education programs in acute paediatrics, neonatal care and obstetric emergencies to doctors and nurses in both the major provincial hospital and surrounding district hospitals. A particular request was to conduct workshops in district hospitals, to negate the need to transport participants from remote areas and accommodate them in DBP for the course. The first workshop was run in a new district hospital in mountainous Tuan Giao, several hours drive from DBP and included participants from three surrounding districts. For this setting basic and emergency neonatal care was the focus. The team used best evidence for teaching methods, clinical practice and content; and this was supported by the donation of a much needed neonatal resuscitaire for the newly built labour ward.
The second workshop was conducted at Dien Bien Provincial Hospital in the provincial capital Dien Bien Phu, which is situated some 500 km north west of Hanoi. In addition to this workshop Hoc Mai donated a neonatal pulse oximeter for monitoring oxygen saturation in sick babies, and phototherapy equipment to treat jaundiced newborns. We were privileged to be visited there by the Australian Ambassador to Vietnam, Mr Allaster Cox and his team, who were able to observe first hand a SCORPIO workshop in neonatal resuscitation, and to join with the team for lunch. This was an opportunity for the Hoc Mai MCH Team to demonstrate the efficacy of the interactive SCORPIO method in this setting. Professor Bruce Robinson, Dean of the Sydney Medical School, joined the MCH team in DBP observing the SCORPIO workshop on the management of acute gastrointestinal infections in children, and to join the participants and the teaching team at the course dinner.
Other activities by team members included:
- April 2009: Visits to Dien Bien Phu and Tuan Giao by Elizabeth Elliot, Heather Jeffery to identify the priority of needs with the Heads of the DBP and TG Hospitals and the Director of Public Health for the Province.
- April, July 2009: Contribution as trainers in both Hanoi (April) and at RNSH, Sydney (July): (Professors Elliot, Jeffery and Hill), in the Hanoi-Sydney Medical School intensive post graduate program entitled “Medical Curriculum Development and Enhancing Clinical Teaching Methods in Vietnam’. This was initiated by Emeritus Professors Kerry Goulston and Kim Oates.
- October 2009: University of Sydney International Development Program Grant awarded for the development of the Diagnostic Microbiology Laboratory at DBP awarded to Dr Monica Lahra, Professors Peter McMinn, Heather Jeffery and Elizabeth Elliott.
- November 2009: Team members joined the Dean Professor Bruce Robinson to attend the opening of the water fountain at Bac Mai Hospital by Her Excellency the Governor, Professor Marie Bashir, and 10th anniversary dinner, and Fellows dinner.
- November 2009: Nomination of DBP Hospital as one of the ten best in Vietnam where attributes included developing international relationships.
- November – December 2009: Hoc Mai Scholarship funded Master of International Public Health student Scott Mills for his praxis at DBP and Hanoi on the advertising and social marketing of Breastfeeding in Vietnam.
Hoc Mai MCH Team 2009: Professor Elizabeth Elliott, Professor Heather Jeffery, Dr Monica Lahra, Dr Jane Hirst, Dr Gaston Arnolda, Hon Associate Professor David Hill, Ms Jenni Bonnitcha, Dr Ha.
Interpreters: Dr Ngai, Dr Nga, Dr Van Anh, Dr Tan, Dr Lam.
Thanks to our colleagues in Vietnam, with whom we have enjoyed such a successful collaboration since the commencement of the MCH Project. We are especially indebted to Dr Son (Director, Dien Bien Provincial Hospital) and Professor Liem (Head, The National Hospital Paediatrics in Hanoi).
Dr Jane Hirst
Dr Hirst is the recipient of the RANZCOG Early Career Researcher Award 2010 for her presentation "Stillbirth In Vietnam" at the RANZCOG Annual Scientific Meeting in Adelaide. This award was worth $1000.
Diagnostic Microbiology Laboratory at Dien Bien Phu Hospital
Infection is a major cause of death and disease in Vietnam. Since 2004, the Học Mãi Australia-Vietnam Foundation Maternal and Child Health (MCH) Project has provided an educational program, medical equipment and support to health professionals in Dien Bien Province in remote northern Vietnam.
As part of the MCH project, two Microbiologists from the University of Sydney (MML, PCM) assessed the capacity and needs of the Microbiology laboratory at Dien Bien Provincial Hospital. The aims were to determine the standard of practice in the laboratory, the most commonly identified infectious organisms, and testing and reporting practices for antibiotic susceptibility testing. This information was sought to inform our teaching on best clinical and prescribing practice, and to develop strategies for preventing infection and minimising emergence of antibiotic resistance.
However, it was identified that the Microbiology laboratory in DBP was not equipped with the basic equipment for safe work practice and that this, combined with an inadequate supply of laboratory consumables, prevents the laboratory from providing a good service to clinicians. As a result, the laboratory is not well utilised, diagnosis of infection is based on clinical assessment and, therefore, there is no directed antibiotic prescribing. Therefore there is no information regarding the causative organisms and as a result the epidemiology of the infectious diseases in this region is not known. The absence of a microbiological diagnosis results in a cycle of unnecessary or inappropriate antibiotic use, sub-optimal clinical management, and contributes to existing risks of laboratory and hospital-acquired infection. All of these factors contribute to poor clinical outcomes.
In response to this we have designed a project to develop the diagnostic Microbiology laboratory at DBP Hospital and have successfully applied for funding from the University of Sydney International Program Development Fund. This project has support from the DBP Ministry of Health, the Hanoi Medical University and The World Health Organisation in Lyon. This will provide equipment, consumables, educational resources, education and training for the laboratory staff. Education of local clinicians will be incorporated into the MCH Project clinical teaching workshops. Once the laboratory is functional, research is planned to inform our teaching on infection treatment recommendations and to guide infection control practices. This project will establish and foster links for education, research, training and exchange between the participating centres in Sydney, Hanoi, Dien Bien Province and the World Health Organisation in Lyon.
Dr Monica M Lahra, Professors Peter C McMinn, Heather E Jeffery, Elizabeth J Elliot
‘Train-the-Trainer courses’ (Professor Heather Jeffery)
In Hanoi in 2007, a team of Health professional and medical educators trained 80 clinical leaders in Vietnam in teaching methods. This activity was funded in part by the United Nations Population Fund (UNFPA) on the basis of the Học Mãi Foundation track record in education. Subsequently, the UNFPA adopted the SCORPIO method for use in seven of Vietnam’s poorest provinces. Our interpreter program strengthened collaboration with the National Institute of Paediatrics (Hanoi Medical University), the National OBGYN Hospital Hanoi and Tu Du Hospital in Ho Chi Minh City and provided opportunities for clinicians to improve their use of the English language and their teaching skills.
Other 2007 achievements
- Our activities have been publicised in Australia and Vietnam, in the Dien Bien Provincial newspaper and television and through presentations at scientific meetings, at one of which Dr Foster was awarded a prize for best presentation.
- Prof Jeffery won the 2006 Học Mãi Australia Vietnam Foundation Chair’s Award for Achievement and Dr Kirsty Foster & Louise Cocoran won the 2007 Học Mãi Australia Vietnam Foundation Chair’s Award for Achievement and for contribution to the project
- Dr Lahra won a scholarship from the Royal Australasian College of Physicians to evaluate pathology services in Dien Bien Province.
- One of our interpreters (Dr Phuc) won a Hoc Mai Foundation Scholarship (AusAid funding) for 3 months in Australia.
- Medical student Elizabeth Pearce (supervised by Prof Jeffery) completed a research project and presentation to identify gaps in use of evidence-based interventions in perinatal management at Tu Du Hospital, Ho Chi Minh City on a Hoc Mai student scholarship and Dr Hirst undertook a clinical exchange at Tu Du Hospital to complete a research project on Perinatal Outcomes for Preterm Premature Rupture of Membranes.
This project was supported financially by the University of Sydney’s International Program Development Fund, the United Nations Population Fund and, in kind, by the Faculty of Medicine (Disciplines of Paediatrics and Child Health, Perinatal Medicine, Obstetrics and Gynaecology and Public Health); NSW Health (Children’s Hospital at Westmead, Royal North Shore Hospital, Royal Prince Alfred Hospital); Học Mãi Australia Vietnam Medical Foundation; and the Office of the NSW Governor.
Equipment has been donated by Laerdel, Dräger Medical and Welch Allyn.
In kind support was provided by the Vietnamese Ministry of Health; Vietnamese Consul in Australia; Prof Liem National Institute of Paedaitrics (Hanoi Medical University); Dr Koi, Dien Bien Provincial Health Department; Dr Son, Dien Bien Phu Provincial Hospital; Tu Du Hospital, Ho Chi Minh City; The National OBGYN Hospital, Hanoi; The People’s Committee in Dien Bien Phu; and the Vietnam Women’s’ Union.
|Team members 2007
Prof Elizabeth Elliott
Dr Nguyen Thi Thu HaDr Tran Duc Hau
Dr Nguyen Xuan Hoi
Ms Pham Thi Mai Huong
Dr Le Kien Ngai
Dr Nguyen Tien Dzung
Dr Vo Thi Kim Hue
Dr Phan Huu Phuc
Dr Le Thanh Hai
Ms Pham Thi Mai Huong.
In 2007, The Học Mãi Foundation was successful in its application to the University of Sydney’s International Programme Development Fund for a project that will strengthen ties with the largest maternity hospital in Vietnam, Tu Du Hospital in Ho Chi Minh City. There are over 40,000 babies born at this remarkable hospital every year, with many women travelling considerable distances to receive their medical care.
The aims of the project are to:
- introduce small group multidisciplinary teaching to Tu Du Hospital;
- train local doctors and nurses in new educational methods; and
- lower perinatal mortality and morbidity.
Specifically, a workshop will be held at Tu Du Hospital in 2008 that will focus on the teaching of important perinatal skills such as fetal welfare assessment, emergency obstetric management and neonatal resuscitation. These techniques in perinatal care have been successfully used by Học Mãi Foundation teachers in Dien Bien Phu and Hanoi and have been well received by the participants. The Học Mãi Foundation teachers will have skills in educational methods as well as expertise in obstetrics, midwifery, neonatology and nursing. It is hoped that such an educational interventional will encourage further uptake of evidenced based practice.
The project will also develop the teaching skills of a number of scholars from Tu Du Hospital who were recently in Australia as part of the AUSAID programme. Their ongoing involvement will ensure that capacity is built within Tu Du Hospital for modern educational methods. Strategically this is very important and the Học Mãi Foundation is excited by the potential for the work at Tu Du Hospital to have an impact on the health and wellbeing of many of Vietnam’s mothers and babies.
The team led by Professor Jonathan Morris visited TuDu Hospital from 10 to 14 Novemeber 2008.
During November 2007, Dr Jane Hirst (then a Senior Registrar, Obstetrics & Gynaecology, Royal North Shore Hospital) was fortunate enough to spend three weeks in Tu Du Maternity Hospital Ho Chi Minh City. Click on the image at right to read more.
In 2008, Dr Jane Hirst's work with and committment to Maternal and Child Health in Vietnam through the Học Mãi Foundation has been recognised and she has been awarded the Christopher Kohlenberg Medal at the RANZCOG NSW/Qld Annual Scientific Meeting and the Shan S Ratnam Young Gynaecologist Award to attend the Asia Oceania Federation of Obstetrics & Gynaecology Biannual scientific meeting.