Scholarships for Stage 3 medical students
Danielle Diem Pham, Da Nang Hospital for Women & Children
December 2014, the first 4 weeks of my elective started at Da Nang Hospital for Women & Children. The hospital is fairly new, opened in April 2011, and is the first major specialist paediatric and maternity hospital of the central region of Vietnam. The hospital provides a full range of reproductive health care services including obstetrics, gynaecology, fertility and genetics testing. It is also a designated neonatal training centre of the region. Its NICU admits over 250 newborns per months from inborn patients (60%), referral from other hospitals, and direct admissions from the community.
My coordinator, Dr Hoang Tran is the head of Neonatal Department where I spent my first week. Based on my learning objectives, Dr Hoang also arranged for me a week in PICU, a week in maternity and the last week as my free choice which I ended up spending in HDU (high dependency unit) where premature babies or babies discharged from NICU are looked after with their mothers. Unlike in NICU where babies and mothers must be separated, in HDU the mother or a relative, often the father or the grandmother, stay with the newborn to provide skin to skin kangaroo care. There, they also taught the mother breastfeeding and massaging the baby before discharged them home.
The NICU team was very friendly and helpful. Most NICU doctors can speak English very well and were keen to teach. Every morning we had an English ward round where a junior doctor presented the progression of each patient on the ward and the current management plan. When all the doctors went to their meeting with other departments, the nurses took us for some procedures skills from cannulation, taking blood, inserting NG tube to feeding and bathing the babies.
I found the setting in NICU here is relatively similar to at RNSH NICU where I’d done my OB/GYN rotation. My experience in PICU the following weeks was, in contrast, quite different from expected. I felt more like in an Emergency Department most of the times. It can get quite chaotic in PICU, there was a day when new patients didn’t stop coming in, every single bed was full and they put out extra trolley-beds on the walkway to accommodate more patients. Almost all patients in PICU had pneumonia; either came in with it or developed during admission. There were also numbers of patients with meningitis and encephalitis, and other conditions including many severe congenital heart defects, severe hydrocephalus, Lyell’s syndrome, etc. which are rarely seen in Australia. This provided excellent clinical experience.
A newly graduated nurse - also from University of Sydney- was with me on this placement, and I am grateful that the teams here were happy for us to stick together. It’s always valuable to discuss and share experiences with a fellow student. From her nursing standpoint she stressed to me how poorly infectious control was implemented. Indeed, bed sheets were changed between patients but no cleaning of the surroundings; Isolation of patients with diarrhoea and airborne diseases in PICU were impossible due to bed shortage and overwhelming number of patients. The importance of hand hygiene was well acknowledged but not performed correctly. Hand rub was applied but examination of the patients occurs while the hands were still wet providing perfect moist and warm environments for bacteria to spread and grow; Hand-washing basins were there but hand towels might not be available.
The week in delivery and maternity was even far more different from what I’d seen back in Sydney. As one of the major maternity hospital of the area, there were about 30 normal deliveries a day on average, not including C-section. Spending a morning in delivery, I was able to observe 5 or 6 normal births easily, which is more than I had seen in my entire 8 weeks of O&G at RNSH. There were plenty of chances to assist delivering a baby if you ask for. This was a fantastic opportunity to have some hand-on experience. On the other hand, the practice of obstetric and gynaecological care here is very different and can be quite confronting at times, especially for someone who have seen or known how it is done in Australia. First of all patient’s privacy does not really exist. In antenatal care, pregnant women queuing up for their turn was asked to take off their bottoms in advance whilst in the same room, the doctor was doing an internal ultrasound on another patient.
In delivery, one delivery room would normally accommodates 4-5 patients at once, all in active labour, all were put on their back in the pushing position, and all fully exposed even though it may take another hour till they actually start pushing. Repeated digital vaginal examinations were performed at anytime by midwives, midwifery students, and obstetricians rather than being done by one person, recorded and communicated to the others. Another main difference in practice was that here there is no option for pain relief during labour and normal vaginal birth. A senior midwife explained to me that they were not familiar with nitrous oxide; Opiates were not an option due to the risks of adverse effects on the newborns; And epidural wasn’t practical as the risk of infection was high in a share room like this and also the anaesthetists were flat out in the theatres and often not available. Also, episiotomy rate was almost 100% as contrast to 1% in Australia.
The overall experience in Da Nang was incredible. The people are lovely; the doctors are very friendly and outgoing. Outings are countless and often involve lots of eating and drinking, followed by karaoke session.
Danielle Diem Pham, The National Hospital of Paediatrics Hospital, Hanoi
My 2nd placement is at the National Hospital of Paediatrics (NHP) in Hanoi. The hospital is located 15 minutes’ drive from the CBD, on a very busy street of Hanoi. I spent most of my time in paediatric emergency units.
In emergency department (ED), there is an admission desk where 2 doctors assisted by a nurse would do the triage and decide whether patients will get into emergency room or monitoring room. In the emergency room, there are doctors and nurses available at all time, while in the monitoring room, parents are instructed in how to care for their child and will need to come to the admission desk to ask for a doctor or a nurse for any assistance. ED at NHP also acts as a transit bay where all patients being transferred from different hospital must come first and get their documents ready before being transferred to the appropriate ward.
In Vietnam, people go straight to the hospital when they are sick rather than seeing a GP beforehand like in Australia; GP doesn’t really exists. Thus, to reduce congestion in ED, just outside the hospital there is a clinic areas where all patients who come to the hospital need to be seen firstly by a doctor, who will then decide if the patients need to go to ED or can be sent home with medication. Other patients who are transferred from other hospitals or come in by ambulance may go straight to ED. On a normal day, there are around 3000 patients came to the clinics, of these, 5-10% (around 300 patients) will get to ED.
ED at NHP has a good range of presentations providing excellent opportunity for clinical practice. I spent the first few days in triage learning about assessing, categorising and distributing patients. For the rest of the placement, each week my supervisor assigned a body system to read about, and during the week I could assess and examine patients who present with problems of that system.
The ED team of NHP are welcoming and enthusiastic. Many doctors and nurses are very keen to show me around. Similar to the NICU team in Da Nang, at NHP there are English meetings three times a week when the doctors take turn presenting a case so that everyone can learn medical English. We were asked to present a few cases and topics of our choice as well during our time there.
There are also training sessions and simulation including anaphylaxis shock, cardiac arrest management, setting up medical ventilator, etc. We are welcome to join but some are in English and others are in Vietnamese.
Every Wednesday afternoon, I also got to follow Dr Duy to the paediatric endocrinology clinics where we normally saw 50 or more patients for an afternoon. It was an eye-opening opportunity to see how the doctors manage so many patients. There is a good range of conditions including precocious puberty, Prader-Willi syndrome, Turner Syndrome, growth hormone deficiency, etc. Surprisingly, according to Dr Duy, the most common presentations at the clinics are Rickets, and congenital adrenal hyperplasia, whereas type 1 diabetes is not on the top list.
Social outings in Hanoi were quite similar to the time in Da Nang. There were more outings which involved much more drinking. I could easily refuse alcoholic drinks during lunch-break outings since the doctors were all well aware of the inappropriateness although they still drank; but outing after work was a different story.
Overall, I have gained priceless experience from this elective placement in Vietnam, and I am very grateful for this opportunity, thanks to Hoc Mai Foundation. Not only I got to see and experience a very different healthcare system but also I have learned not to judge but rather justify my own understanding and belief in medical practice. The best evidence-based medical practice does not necessarily work out the best everywhere. In different circumstances like in Vietnam where overpopulation with large health disparity between urban and province are dealt with by already overcrowding hospitals with very limited resources, the best evidence-based practice may not be so effective, nor practical.
Report by Amy Nolan
“Much of Vietnamese society is founded upon the strength of its women”
-Prof Jonathan Morris
She looked like a child, tiny and afraid. Patient T had been labouring for close to 24 hours, and she was clearly exhausted. As another wave of contractions gripped her small body, the midwife climbed up onto the bed beside her, placed her fists on Patient T’s swollen abdomen, and bore down with all her weight. With little more than a silent grimace, Patient T gave one final push and her child slipped quietly into the world. A baby boy, and what should have been a joyous occasion for the young Vietnamese mother. But I watched with confusion as Patient T turned her tired face to the side while midwives quickly swaddled her baby and took him away. The silence in the delivery room echoed what everyone else already knew: her son had died in utero several days earlier, and Patient T would be returning to her home in the countryside only to bury her tiny son.
That day, Patient T was one of approximately 130 women to give birth at TuDu Obstetric and Gynaecological Hospital in Ho Chi Minh City, where I spent my 8 week elective with the Hoc Mai Foundation. Fortunately not all women experience such devastating outcomes, but the sheer volume of patients passing through TuDu means the hospital runs very differently to maternity wards in Australia. With the helpful guidance of the Vietnamese Hoc Mai fellows, I was offered the opportunity to practice obstetrics clinical skills such as assisting with spontaneous deliveries, suturing, and scrubbing in for caesareans and other gynaecological operations. However, I believe my most valuable learning experience came from observing the enormous differences between our two systems.
Report by Cam Hollows
Blood, Bone and Metal:
Report on a Student Hoc Mai Scholarship placement with the Trauma and Orthopaedic Surgery Department at Viet Duc Surgical Teaching hospital Hanoi. (KHOA CHẤN THƯƠNG CHỈNH H'NH - BỆNH VIỆN VIỆT ĐỨC)
The treatment of Motor Vehicle Accident (Road) Trauma in the developing world is an area of need that is expanding in parallel with the horrific toll such trauma takes on societies. MVA’s particularly in developing countries with recent surges in economic development have been labeled the “unsolvable epidemic” of the 21st century. Vietnam is a nation that continues to experience rapid economic growth and a concurrent mechanical mobilization of its populace, along with this mobilization comes the specter of road trauma and polytrauma from MVA’s. Road trauma management is complex and challengeing because each case has unique elements due to the huge variety in the mechanism of injury. Motorcycles play a large and important part in Vietnamese society but there can be no doubt (even following introduction of compulsory helmet legislation) they also impose a terrible cost.
Report by Ji Li
I went to Vietnam with a very open mind. As we were foreign students going to a very big and busy hospital (Bach Mai), I half expected us to fall through the cracks somewhat and be left to fend for ourselves. I am very happy to report that I did not feel like that at all.
As soon as I arrived at Bach Mai Emergency, I was warmly welcomed by and taken under the wings of Dr Tu, who was a previous Hoc Mai scholar. He was very kind and explained interesting medical presentations to me with a lot of patience. I was also introduced to 3 more emergency doctors who were all Hoc Mai scholars; they spoke English well and were all keen for me to see their patients.
Report by Christine Duong
The first four weeks of my elective was spent at the eye hospital in Ho Chi Minh city Vietnam. Ho chi minh city is the largest city in Vietnam and has a population of 10 million. This eye hospital is the largest eye hospital in the south of Vietnam and serves a radius of about 33 million people. It is a very busy hospital in a very busy city. Most nights there would be patients who sleep on hospital grounds because they are from rural Vietnam and there would be no early morning buses to make their 7am appointments, hence they would arrive at night and sleep there to wait for their appointments.
During my time at the eye hospital I went to many different departments such as outpatients (with residents and specialists), trauma, glaucoma, paediatric ophthalmology and the operating suites. Each department was very welcoming and my concern of a language barrier was rarely an issue. I think it helped that I spoke Vietnamese however I speak no medical Vietnamese and most of the time it was easier to communicate in English since I didn’t know the medical words, however the doctors always knew the English words since they learn medical Vietnamese and English. I made many friends at the eye hospital since many people were so friendly and willing to teach. They were also willing to learn conversational English from me, so I felt I could give back a little.
Report by Jane Stuart-Carberry
Arriving at Từ Dũ hospital on the first day I felt like a celebrity! I was welcomed by Dr Hoan, ushered to collect my ID badge and to meet important people. I spent most of my 2 months at Từ Dũ in the delivery ward, where I was encouraged to participate in everything involved in the birthing process from cardiotocography interpretation to vaginal births and C-sections.
One of the highlights of my experiences was night shifts and emergency department shifts with Dr Võ Minh Tuấn. He would either teach us while he consulted in the emergency department, or assign us to a registrar who would take the time to answer our burning questions, and take us into the operating theatre to watch and assist in cesarean sections and gynaecological surgery. I was amazed by the surgeons’ and anaesthetists’ technical skills. Their dexterity, speed and precision was impressive, especially in placement of epidurals, they explained that the sheer number of patients they have treated allows them to fine tune their skills.
Report by Sara Clarke, Tu Du Hospital, Ho chi Minh City, Vietnam
I completed four weeks of my elective term at Tu Du hospital. Tu Du is the largest maternity hospital in Vietnam. It is situated in Ho Chi Minh City and plays a major role in the education of local medical and nursing students as well as midwives from the remote, minority tribe regions. On average 100 newborns are delivered each day at the hospital. In addition to obstetric services the hospital also offers gynaecological, fertility, NICU, genetic testing and pathology services.
The activities that I undertook during my time at Tu Du hospital were based on my learning objectives. As such I spent the majority of my time in the delivery department. This department consisted of a large room separated into six smaller rooms, each containing two lithotomy beds (see photo). The typical process of entry into this room begins when the labouring woman presents to the emergency department at Tu Du. Due to difficulties with transport and the scarcity of ambulance services, she will usually present early in the first stage of labour and remain at the hospital for the entirety of her labour. This ensures that emergency transport to the hospital, due to unexpected complications or fast progression of labour, is not required. The pregnant woman is then admitted to the maternity ward which is a large room containing approximately 40 haphazardly arranged beds, without privacy curtains. When delivery is imminent the woman is moved into the delivery room.
My Học Mãii four week clinical experience in Hanoi promised to be a wonderful opportunity to improve my medical knowledge and skills, as well as to form friendships with Vietnamese health care workers.
The scholarship not only exceeded my expectations in these key areas, but also offered me the opportunity to form relationships with allied health care workers back home and to gain an insight into the Vietnamese culture and way of life.
The four weeks I spent in Bach Mai Hospital - one of the largest in Vietnam - provided me with a chance to complement the last two years of predominantly university based learning with an extended period of clinical exposure. I was able to observe a wide range of medical procedures and clinical care, particularly in the area of surgery. Continued...
As a recipient of a Hoc Mai Foundation scholarship, I was fortunate enough to be able to spend four weeks of my Elective Term at the National Hospital of Paediatrics (NHP) in Hanoi. My time was primarily spent with the surgical department, however I did have the chance to visit other departments around the hospital to gain a deeper insight into medical practice in Viet Nam. This leg of my elective ran from July 20th to August 14th 2009, that is, during the Hanoian summer. Continued...
Hoc Mai Foundation – A Month at Bac Mai Hospital Dec 2009 (Hanoi), by Uma Selvanathan
Between Dec 5-Jan 2, I spent a month in Hanoi, Vietnam with a group of students from Sydney Medical School, 2 Nursing students, 1 speech pathology student and 1 physiotherapy student. Having just completed my second year of medical school as I arrived in Hanoi, my experience with the program was a phenomenal one that permitted me to consolidate my “classroom learning” from the past 2 years and translate it to a clinical, hospital-based context. Additionally, I was able to learn a lot about the Vietnamese culture and the practice of medicine in a developing country.
I spent my 4 weeks at Bac Mai hospital, one of the largest hospitals in Hanoi. The first two weeks were spent in general surgery and ICU, and the last 2 weeks with the Obstetrics and Gynaecology department. Initially, we were unsure as to how much we would be able to see and do as none of us spoke any Vietnamese and most of the patients spoke no English. We soon found out that many aspects of medicine is in fact, universal and we were able to follow surgeries and the ICU rounds and clue in on what was going on. Continued...
Vietnam – a nation of delicious food, amazing people, breathtaking landscapes…and minimal pain relief.
The Học Mãi scholarships provided seven University of Sydney students with the opportunity to experience both the culture and the medical practices of a nation vastly different to Australia. On placements at hospitals in HaNoi, DaNang, and Ho Chi Minh City, we viewed first-hand the horror of motorcycle accidents, the joy of childbirth, and the effects of limited resources.
At Viet Duc Surgical Hospital in HaNoi, we witnessed many families queuing every morning, waiting to visit their loved ones; case after case of mangled hands and severed limbs due to unsafe occupational practices; brain tumors left to grow in patients who cannot afford medical care; and major head and limb injuries due to motorcycle and car accidents.
As one of the Học Mãi scholars described it, “there was a mixture of emotion in the air; a sense of uncertainty in the eyes of family contrasted to one of pragmatic brashness of the doctors trying to help the overwhelming number of patients.”
However, despite their horrific injuries and illnesses, we were constantly amazed at the stoicism and resilience of the Vietnamese people, whose pain appeared to be controlled with the most basic forms of pain relief, such as intra-venous paracetamol ¬– even for major limb injuries, such as amputations.
It was eye-opening to come from a medical system where syringes, sutures, and neck braces are expected as standard care to a country where these are limited.Limited resources notwithstanding, we observed excellent surgical and clinical skills, and felt privileged to be accepted into the Vietnamese medical community. Despite the time constraints, these talented doctors still took the time to share their knowledge – and practice their English!
At Tu Du Hospital in Ho Chi Minh City, we assisted with childbirth, took patient histories, and collected data for public health studies. Everyday we would learn something new, such as the differences in the relationships between patients and doctors, the impact of cultural beliefs on health care, and the difficulties faced in working in a developing country.
Outside of medicine, the Học Mãi scholarship provided us an opportunity to embrace a culture, make new friends, experience the excitement of Tết (Lunar New Year), and refine our palates in relation to the subtleties of regional beers and spring rolls.
We are very grateful to the Học Mãi Foundation for making this opportunity available. It has contributed invaluable experiences and memories, and allowed us to forge bonds with other medical professionals in a country vastly different to our own.
Tamara Rickersey and Paula Conroy
We have just spent four weeks at the Tu Du Maternity Hospital in Ho Chi Minh City. It was an inspiring and eye-opening experience and we are grateful to have been given the opportunity from TuDu Hospital, the Hoc Mai Foundation and the Northern Clinical School to be able work in such an incredible environment.
Tu Du Hospital Delivery Suite staff attends to approximately 200 deliveries per day and over 70,000 each year. It was in the engine room of this amazing machine, the delivery department, that we spent our time for this placement. We were overseen by Madame Trinh, the Head Midwife of the department and midwife extraordinaire and were very fortunate to have such a wonderful tutor teach us about the practice of obstetrics and gynaecology in Vietnam. Ms Trinh was a 2007 Hoc Mai Foundation/AusAID Fellowship recipient.
From day 1, we were made to feel extremely welcome and were encouraged to get involved in all aspects of the delivery process. The numerous midwifes, midwifery student, doctors and medical students were happy to teach us the art of delivery at Tu Du as well as immediate post-natal care for both mother and baby.
The overall experience has made us more confident in the practice of obstetrics and gynaecology and has also taught us much about the Vietnamese culture – we are very grateful to the Hoc Mai Foundation for this opportunity.