Vietnam Trip

Orientation

This was my third visit to the Center for Traumatology and Orthopaedics (CTO) with HVO. After arriving in HCMC on Friday, March 19th, I spent two and one half weeks teaching anesthesia and organizing a trauma course at CTO. As always, I appreciated the step-by-step description given in the HVO Orientation Packet for obtaining permission to enter Vietnam and work at CTO.

My advice (unsolicited as it is) to new volunteers, is to keep an open mind and be flexible in your expectations. No matter how you try to prepare yourself before arriving, there will be something that will be different than the way you thought it would be. Although I was last in Vietnam just two years ago, HCMC is undergoing changes at such a rapid rate that I experienced many surprises- both positive (mostly) and negative.

Activities

Monday I attended the morning staff meeting and was introduced to the physicians and nurses. It was interesting to see the emergency orthopedic cases of the previous evening being presented. Case after case of traumatic lower extremity fractures was presented with x-ray pictures. The emergency operative cases were presented first (usually 20-30 per day). This was followed by the closed reductions which are casted by technicians (usually 20 per day). Fractures which require casting but not reduction are not presented and there are often 100 per day of these.

Although CTO is a 500 bed hospital, there are often too many patients admitted to fit in the allotted beds. I saw many rooms with two patients in narrow beds meant for one and patients on stretchers overflowing into the corridors. It was evident that trauma is very prevalent in HCMC and is a burden on resources.

The approximately 100 surgeons at the hospital see about 1,250 outpatients per day. They do so very efficiently because by mid-afternoon the clinic waiting room, which is packed in the morning, is almost empty. The hospital has 9 physician anesthesiologists to cover the ICU and 11-12 operating rooms. They are aided by several nurse anesthetists.

During the rest of the week I gave lectures on regional anesthesia at 7 AM for the anesthesia department. CTO had managed to get a projector so that I was able to use my laptop to show the Power Point slides I had prepared. After each lecture I spent several hours in the operating room demonstrating and observing the regional anesthesia techniques that had been discussed. The department as a whole seemed much more interested in learning these techniques than they had been when I covered similar topics 6 years earlier.

Work in the operating room was often followed by lunch in the hospital cafeteria. Here we discussed topics ranging from medical care to popular culture while we ate typical and excellent Vietnamese food. In mid-afternoon I returned to my hotel and prepared for the next days lecture. The hospital activities in general start early and slow down significantly by 3PM.

I gave the traffic accident talk to surgeons and anesthesiologists at CTO on Monday and at Cho Ray Hospital on Tuesday. It was based largely on a study done by the Hanoi School of Public Health which was presented at the Road Traffic Injuries and Health Equity Conference held in Cambridge, Massachusetts in April 2002.

I was shown around one day at Cho Ray Hospital. At 1,000 beds, it is one of the largest in HCMC and is known primarily as a neurosurgical and trauma hospital. This was my second visit and it was nice to see that there have been improvements in equipment in the operating room and the recovery room. Despite its large size, the hospital has more cases than it was planned for. I saw two patients undergoing craniotomies side by side in the same room because of a lack of available operating rooms. Visits by AO can probably best be done in coordination with CTO in the future.

On Thursday and Friday I ran a two day Primary Trauma Care course for 22 participants. Five of the instructors were Vietnamese physicians from CTO who had participated in the first PTC course that was taught two years earlier. A general surgeon from Boston, and I were the only outside instructors. The course was taught using standard lectures, scenarios, skill stations, and discussion groups. My impression was that the students were quick to absorb and open to the concepts and knowledge of the PTC course. They seemed to especially enjoy the skill stations and discussion groups. This years students did not get into the scenarios as much as the participants of two years ago. My impression from previous visits, that Vietnamese physicians prefer to start their work early and finish early, was reinforced on this visit. Teaching after 3PM is pretty much not tolerated.

Assessment

I did feel that some of my lectures were more welcome than others. I believe the regional anesthesia lectures and demonstrations were appreciated as there were many questions and my colleagues seemed eager to try the techniques we discussed. Each time I visit CTO I see progress in equipment and anesthetic technique. As AO volunteers we contribute by supplementing teaching and by exchanging ideas and experiences.

Working with my colleagues at CTO is as rewarding as anything I do in medicine and as long as I can find the time, energy and finances, I will continue to visit. I am thankful that HVO makes the logistics of visiting so easy.