forever learning

For the past five years, a small troupe of the University’s leading lights in maternal and child health pack their bags with teaching materials, bound for Hanoi, Vietnam. On arrival they transfer to a local airline and continue on to the isolated monsoonal northwest of Dien Bien Phu. Here, in the district hospital and in villages of the surrounding mountains where the health of mothers and babies is as poor as the worst in Asia, they set up impromptu classrooms.

Lifelike baby models, feeding tubes, heart monitors, resuscitation bags, pharmaceutical samples and more, are laid out and classes begin. The students, who include village midwives and nurses, community doctors and health workers, are organised into small groups. The intensive hands-on training over the next couple of days provides them with the skills to administer lifesaving health care.

Community nurses learn, for example, how to identify when a baby is becoming dangerously dehydrated and if necessary, how to insert a tube to administer fluids. They learn how to assess when a baby needs resuscitation, the techniques to keep babies warm at birth; what equipment is required if a baby doesn’t breathe, and how to use it. Students learn what to do if a new baby has acute diarrhoea, and how to manage postpartum haemorrhage in young mothers. They learn preventive medicine including hygiene and infection control, and in a country where all manner of pharmaceuticals are available over the counter, they learn about rational use of drugs.

The purpose of the classes is to reduce infant and maternal mortality. As shown in recent statistics, there are 33 deaths per 1000 live births in the region – about one baby in 30 dies before age one. That is close to twice the rate for Vietnam overall (in 2007, 16 per 1000 live births) and is no comparison with Australia where infant mortality is less than five per 1000 live births.

“The region has one of the highest rates of maternal and infant mortality in Vietnam,” says Elizabeth Elliott, Professor of Paediatrics and Child Health at the University, based at the Children’s Hospital at Westmead, and a Dien Bien Phu regular since 2005. “People here are desperate to prevent so many mothers and babies dying but they have little in the way of educational opportunities and equipment. It has taken us a while to build relationships, to earn their confidence, but what we now see is incredible enthusiasm for the practical training and the equipment we can provide.”

Elliott, along with professors Heather Jeffery and Jonathon Morris, have been the core of the team behind the child and maternal health workshops in Dien Bien Phu and elsewhere in Vietnam by the Sydney Medical School’s Hoc Mai Foundation. All three are key Sydney Medical School staff – Heather Jeffery is Professor of International Maternal and Child Health and former head of Newborn Care at the Royal Prince Alfred hospital; and Jonathon Morris is Professor of Obstetrics and Gynaecology and head of Obstetrics at Royal North Shore Hospital. They are among the many who have contributed time and expertise to Hoc Mai’s programs over the past decade.

Old Asia

For anyone who lived through the Vietnam War or has any interest in the military and colonial history of Indochina, Dien Bien Phu is a famous name. But if the world was transfixed by Dien Bien Phu in the middle of the 20th century, it has been a different story since. Geographically isolated, with low literacy levels, low incomes, poor transportation to and between provincial villages, and home to 21 ethnic minority groups, Dien Bien Phu has missed most of the benefits of recent economic growth.

It is still old Asia: dusty streets, dilapidated buildings, people and animals living in close quarters, markets crammed with every consumable animal body part. While tourism in Vietnam is booming, it is only a committed few who venture off the regular tourist trail.

Regional health statistics then are no surprise, and it is not only the health of children and mothers that fares poorly. Just weeks after the clinics ended last year, the Vietnamese government reported a death at Dien Bien Phu hospital from avian flu – a local man who kept chickens and geese.

“Being able to contribute to improving health in Vietnam is a great opportunity, and it has been a privilege and an education
to develop relationships and work with the wonderful Vietnamese health professionals,” says Professor Elliott.

“The response we get here is incredible,” says Heather Jeffery, both of the workshops in Dien Bien Phu and others run at hospitals in Hanoi. “We teach in small groups, and our approach is to break down the problem into manageable components. For example, a very common cause of death in a newborn infant is failure to breathe at birth. So we devised a neonatal resuscitation program, broken into four stages, each with clear skills objectives. It is a very practical approach and students soak it up. Maternal and child mortality could be improved significantly if the people knew how to prevent and treat some very basic health problems.”

At last November’s workshop Elizabeth Elliott and Heather Jeffery were joined by Dr Monica Lahra, a microbiologist with a particular interest in perinatal infections, and a senior lecturer in infectious diseases; and Dr Jane Hirst, a young obstetrician based at Royal North Shore Hospital and senior lecturer in the Sydney Medical School, who was recently awarded one of the Prime Minister’s Endeavour Asia Awards.

All bring different skills. Monica Lahra, with her expertise in microbiology and infectious diseases, is helping to develop the hospital diagnostic laboratory so there is improved ability locally to diagnose common infections; the University’s International Program Development Fund grant supports this project. Jane Hirst’s area of research is stillbirth and she spent three months in 2008 working and gathering data at Vietnam’s largest maternity hospital, Tu Du, in Ho Chi Minh City, where an almost unbelievable 50,000 babies are born a year, about 1300 a day.

Hoc Mai was set up by the Dean of the Medical School, Professor Bruce Robinson, with the aim of improving health in Vietnam through practical measures – by improving the skills of Vietnamese doctors and nurses. The foundation brings Vietnamese practitioners to study in Australia, and organises for highly regarded medical educators and clinicians to provide their
expertise in Vietnam.

By 2009, when Hoc Mai celebrated 10 years of medical exchanges, more than 200 of the University’s medical and nursing school staff had contributed to the programs. The legacy is considerable: a growing number of the most senior health professionals in Vietnam have benefited from training provided by the Sydney specialists.

The University’s Chancellor, Professor Marie Bashir, who is also the Patron of the Hoc Mai Foundation, alerted Liz Elliott, Heather Jeffery and Jonathon Morris to the desperate need for education and training in the Dien Bien Phu province.

Last year, the Chancellor travelled to Hanoi to open the foundation’s latest project – installation of a water filtration plant which provides safe drinking water to one of the largest hospitals in Hanoi, Viet Duc, and neighbouring Hoc Mai House. Funds for Hoc Ma i House were raised by the foundation, and it was built in 2005. It provides accommodation for the families of hospital patients, who would otherwise spend their days and nights sleeping on paths or elsewhere in the hospital grounds.

Hoc Mai doesn’t have a big profile in Australia, but that is not the case in Hanoi and Ho Chi Minh City. In 2008, Bruce Robinson along with Professor Kerry Goulston, also from Sydney Medical School, were awarded Vietnam’s highest health award, the People’s Medal, for their work in improving the protection, care and health of the people in Vietnam.

The foundation’s other programs in Vietnam include:

• providing scholarships to young Vietnamese doctors and nurses to do advanced training in Australia
• teaching and train-the-trainer programs for doctors and nurses in Vietnamese hospitals
• courses in ‘medical English’
• scholarships to young Australian medical and graduate students who want to study or work in Vietnam.

More recently, the foundation has been working to develop medical research skills in Vietnam.

“[The] Hoc Mai program started with three young Vietnamese doctors coming to Royal North Shore Hospital to improve their medical skills. It has expanded over the past 10 years thanks to generous support by donors, the Australian government, the University and especially by a large number of medical and nursing colleagues who donate their time and expertise. They do this for absolutely no financial reward, because of their commitment to a worthwhile endeavour,” says Professor Robinson.

“In the latest year, more than 80 senior Vietnamese medical professionals came to Australia for advanced training, funded
through AusAID or from our supporters, and more than 50 medical professionals from Sydney travelled to Vietnam to run training programs or provide other assistance.”

“But it isn’t a one way relationship. Hoc Mai means ‘forever learning’ and the foundation is based on an exchange of knowledge. I believe the reason it has done so well over a decade is that both sides have so much to gain. Our young students who spend their Christmas vacation working in Vietnamese hospitals have their eyes opened to different ways of doing things and benefit greatly from the experience, and that is just one example.”

Words: Beth Quinlivan