Hoc Mai Dien Bien Maternal and Child Health Project
University of Sydney staff members were recently involved in a Maternal and Child Health Project in Hoc Mai. Professor Elliot has provided this report on behalf of the team which included Professor Heather Jeffery, Professor Jonathan Morris, Dr Kirsty Foster, Dr Adrienne Gordon, Ms Cathy Adams, Ms Margie Cochrane, Ms Kerry Watson and Dr Jane Hirst
In Dien Bien Phu we ran a three day, small group, skills-based workshop at the Provincial Hospital for 30 doctors, nurses and midwives from all the districts in the province. Each group of 6 students rotated every 30 minutes to a new room for a tutorial with a tutor from Australia (there were 9 of us in total) and a Vietnamese interpreter (there were 6 from either the National Institute of Paediatrics or the UNFPA in Hanoi).
We used an interactive teaching format with wide use of models (of babies, placentas, pelvises etc) and other props, which the students all seemed to enjoy. Needless to say this was a huge logistic exercise in which we were well supported by the Assistant Director of the Provincial Hospital, Dr Son.
The topics we covered were those we identified as being of high importance during our previous visits to the Province. They included Prevention of Infection in Infants and Mothers; Resuscitation of the Newborn; and Management of anaemia and post partum haemorrhage (the major cause of maternal death).
At the end of each day the students were evaluated (by written and practical assessments) and given feedback on their performance. They were also asked to provide us with an evaluation of each day and to offer any suggestions for improvements to the teaching. We ran a graduation ceremony on the last day with strong branding of both Hoc Mai and the University of Sydney.
We were also able to leave with the students a considerable amount of equipment (bag-and-mask resuscitation sets; heamoglobin test kits; laryngoscopes etc.) to take back to their districts. Most of this was donated equipment, which is absolutely necessary to optimise maternal and child outcomes but is unavailable in the districts health centres in the province.
The feedback from students and interpreters was excellent and we have been invited to return to both Dien Bien Phu and Hanoi. The course even appeared briefly as an item on the provincial news.
Following the course four of our group (myself, Heather Jeffery, Jonathan Morris and Cathy Adams) travelled a further 150 km to the Tua Chua district in the north east of the province. We then travelled a further 50km into the mountains along dirt roads to visit the district and commune health services and to interview village health workers.
We were also fortunate to run two focus groups with young mothers to gain information first hand about their experiences of pregnancy and childbirth. We were distressed to find a large outbreak of measles - an entirely preventable disease - in the district, but not surprised when we found that even the Commune Health Centre had no fridge. We witnessed poor nutrition and lack of access to health workers for both mothers and babies and lack of even basic therapy such as iron for pregnant women.
We also noted the failure to vaccinate or provide vitamin K at birth to infants and heard of children dying of diarrhoeal disease due to lack of oral rehydration therapy. We witnessed widespread severe malnutrition in young infants. The commune health clinic had no water,let alone a fridge in which to store vaccines. One interesting observation was the lack of female health workers - largely a result of the fact that few of the girls in these ethnic groups (mainly Moung and Thai) do not attend school - even at primary level. This is a particular problem in these remote communities where women are very shy and will not attend male health workers.
Thus, there is much to be done before health outcomes will improve significantly and this will also require input in the areas of provision of clean water, sanitation, education and basic supplies. Nevertheless, our practical medical education course should help improve clinical diagnosis and care and I hope will make a just a little bit of difference for mothers and babies.
We are currently seeking funding to enable another visit to Vietnam.