A huge achievement from NCD program

We conducted the Non Communicable Disease program (NCD) in Duy Xuyen, a rural district in Quang Nam province. Our goal was to trial the protocol in a setting with less resources and presumed lower community knowledge on chronic disease. 

We began with training sessions for the health care providers at all local clinics in the district. We helped the staff to screen for hypertension and diabetes following the protocol that had been developed by our founder Dr Josh Solomon. Bedside training was conducted by our physicians. We equipped these clinics with glucometers, strips, lancets, medication and other supplies. We have continued to do regular follow up with these 3 clinics. We also conducted refresher training for medical staff to share about its effectiveness and the different experiences they have encountered in controlling NCD disease.

Each clinic manages about 30 patients with the medications provided by VNHIP. These patients live in a remote small village accessed by boat. Although they live in peace with picturesque green fields, river and fresh air, they however lack medical knowledge because transport is too difficult to access the center hospital. When they become unwell they are often not aware of what they should do. They listen to the guidance of other people to try many different ways instead of taking prescribed medication. Some of them stop taking medication when they feel better and suffer relapses of their illness.

After six months 3 clinics applied VNHIP’s NCD protocol, Doctors and nurse now have confidence and a sound understanding of how to make NCD’s easy to manage. They report their patients are now attending to their appointments at the clinic on schedule without their reminder. The patients told us that they are happy that they get more education on the diseases, diet, and lifestyle that they were unaware of before.

It was a pleasant surprise when we heard the patients talking to each other about how to control their disease with VNHIP’s NCD protocol. They said that not only do they take medication, they also focus on changing their eating habits and lifestyle. The diabetes patients know the signs of hypoglycemia, do not skip meals, and when working hard they know to have a snack, to control their blood sugar. The patients also said that they share the knowledge they have gained about NCD’s with their immediate and extended families. This is a great achievement for VNHIP.

An unlucky little girl in Da Nang

Khue is a lovely girl who is 9 years old. Khue has a rare condition which requires special and expensive medications. She is experiencing early puberty which leads her body to develop rapidly. Her body is unable to produce enough calcium to provide healthy bone growth. Her brittle bones affect her ability to enjoy playtime at school and with friends, a broken bone can easily be the result of daily childhood games. Khue has had orthopaedic surgery already approximately 5 years ago to insert a plate and screws in her thigh. We have had a long association with this family and therefore understand their difficulties.

When we met her in 2007 she lived in a happy family with both her parents and her brother. Khue’s father was unable to overcome the pressure of sustaining family life and he disappeared in 2010. As a result the financial burden became the responsibility of Khue’s mother. She has three jobs -fish processing, cleaning houses, assisting her sister in law with cooking for weddings. Even though she works tremendously hard, she struggles to support Khue and her brother who is in grade five and is studying well at school. The school fees for the two children equate to two million VND per month.

Khue also suffers from otitis media resulting in the hearing in both ears to be severely diminished but the family has not money for corrective surgery. The cost of the surgery is around 10,000,000 VND.

Khue’s mother developed goiter (a thyroid condition) for which she has had surgery. Due to her high stress levels, it has recurred and she now needs to take on going medication, which costs 700,000 VND per month. Once again, there are no funds available for this medication.

Now Khue’s family is living with her grandma and uncle’s family. They are hopeful that one day they will be able to have their own home and live independently.

Last week, Khue felt aches and pains in her bones she went to Da Nang hospital to check up. The doctor asked that Khue be seen in Ha Noi to determine whether Khue needs to get the screws in her leg replaced or not.  The screws are supposed to be replaced after two or three years, Khue has had hers for five. The transportation cost alone is too great for Khue’s family to bear. It costs about three millions VND for Khue and her mother to go to Ha Noi by train.

It is an impoverished life without a escaping way. They are grateful to any person who can make a difference for their family.

$35 USD per month will help Khue mother to manage her health condition, $500USD will enable Khue to hear well again. $150 USD will enable Khue to be assessed at the hospital in Ha Noi. Any donation to achieve these funds will make a significant difference in this little girl family life.

A memorable story!

As you know cardiac is one of the main VNHIP projects. I think ít’s also one of our  most  success projects. We have done about 100 surgeries so far and had great results post surgery for our clients. All our patients have memorable stories. This is one of them

Ha is a 42 year old woman, who lives in Hoi An -Quang Nam (near our office) with her family. In July when Dr Josh was here, we had a clinic for some of our patients who we have managed for a long time. She heard about us from some of these patients and came to our clinic with a desire to get "foreign medicine" from us to help her condition. She did not know that we don't provide medications for all patients and that in fact medications cannot fix her condition. Dr Josh saw her and asked her to get some tests done so he can know how to help her. The next day she came back with test results.. After looking at the results, Josh said she needed surgery soon. But suddenly she became very upset, yelled at us and cried and said that we wasted her money for those silly test and why did we not want to give her some medications. We explained to her that meds can't fix her heart condition. But she did not trust us and remained angry with us. Then she went home. 

We felt very upset with her words and worried about her health as we knew she didn’t believe our medical advice. After some team discussion, the next day we decided we have to go to her house and talk to her and her children. We took an hour to explain to them about her condition and that she really need a surgery or it was clear she would have a further stroke and her condition could only worsen without this treatment. Fortunately they were listening to us and understood. It turned out she was diagnosed with valve disease 4 years ago but she never believed she should get  surgery. This family are not so poor as some other cases we have worked with so finances were not so much of a barrier, but she wanted to save money for her children,  and she was very scared of heart surgery so avoided it .She  had heard from some people that after heart surgery, she may get worse and not be able to work. Then she had a stroke 6 months before we met her and after that she had hemiplegia on the right side. We convinced her that surgery was the only option she had for her health, and that without surgery she would have further strokes. Before her stroke she worked as a motorbike driver with an income of about $100/month. But since she had a stroke she has been unable to work. Her husband is a motorbike driver also with income $150/month.  They have 3 children. One of them got married, 2 others still at high school. Finally, she agreed to surgery and got it just 5 days after  we talk to the family. Our biggest success. In this case I have to help patients overcome the fear and have  successful surgery. She looks great now and can ride a bicycle, or even cart to work.

NCD refresher training in Duy Xuyen District

Our NCD Program exists to improve patient and physician knowledge of NCDs. We focus on understanding risk factors and controlling diabetes and hypertension at a low cost. Dr Hoa, a local doctor has partnered with us to develop a model that can change the "culture" of commune level health centers, he does this by sharing his skills and understanding of how to make NCD’s easy to manage. Last week, Dr Hoa helped VNHIP conduct refresher training for medical staff who have participated in the program and staff who are considering using this protocol, the training was held at Duy Xuyen District Health Medical Center. Training is a great opportunity for physicians to network with staff from other communes who have also applied VNHIP’s NCD protocol or who are thinking about it. Doctors and nurses from many clinics were able to share about its effectiveness and the different experiences they have encountered in controlling NCD disease.

One of the barriers that these district hospitals face is that their doctors and nurses are overloaded with work. Doctors who have been trained now understand the complex issues around NCD’s, however; they do not have enough time to educate their patients. Dr Hoa has a sound understanding the problem. At the end of the training about, he emphasized the important role that doctors need to play in helping patients understand how to help themselves in changing their eating habits and doing exercise regularly. He also said that the medical staff needs to take the time to explain to diabetic patients how to understand signs of hypoglycemia. Dr Hoa shared a story of a diabetic patient who was uneducated and took such high doses of medication that he became hypoglycemic and ended up in a serious diabetic coma. If patients know the signs of low blood sugar they can aid themselves and treat themselves quickly by eating  a small candy or drinking some sugar water.

When asked by a nurse at Duy Nghia clinic about why there are sometimes different results between patients who have been diagnosed with diabetes at the commune health centre and the hospital Dr Hoa explained in some detail about four methods of diagnosing diabetes and explained that the different methods used at different health care levels within Vietnam are all relevant. He also emphasized that doctors need to pay attention to the patient’s age in order to give effective drugs.

Dr Dung who is the head of Duy Nghia clinic shared that NCD protocol is very effective in his clinic. Many of his patients now understand the importance of changing their bad habits such as eating salty or sugary foods, drinking too much rice wine and not being active. Although his patients are busy with their farms and businesses they always remember to go to visit the clinic and listen to the doctor’s advice.

It is so encouraging for VNHIP when we hear stories of many patients who have learnt to take better care of their health and who control their NCD. We are excited and overjoyed that physicians in all levels in Vietnam are improving the capacity for health care management of NCDs.

A is for Assessment

Have you noticed some changes in what we have been posting lately? With your help VNHIP recently provided a little girl and her grandmother who had no mode of transport with new bikes! We are also in the process of raising money for a family to build a life changing toilet in their home! Our aim at VNHIP is to improve the health of individuals and communities in Vietnam and our organization is growing and understanding that the concept of ‘health’ is multifaceted and that health needs are not limited to medical care and treatment. 
 

Earlier this year the team developed a tool to assess the holistic health of children living with HIV currently in our program. Each child and their family are now being assessed annually on not only their physical health but also their emotional, social and environmental health. Evidence is stacking up internationally that all of these dimensions of health are intrinsically linked http://www.who.int/social_determinants/en/ . This assessment helps us identify needs (like those mentioned above) and you, our wonderful supporters, generously help us meet them!

The information gained in this process has invigorated not only those in the program but also the team at VNHIP. It has definitely challenged us to put our thinking caps on as we partner with these children and families while they hurdle obstacles every day. The assessment is breaking down barriers and helping us gain a deeper understanding into the lives of these children and their families, their joys, their challenges and their sorrows. One thing which we have learnt is that many of these families have multiple health needs which they can not possibly meet on their own and that there is a constant battle in choosing which of these needs is the bigger priority.

While this assessment can be somewhat confronting and emotionally challenging for everyone involved there are some truly beautiful moments. My favourite part of this assessment is when we ask the child and their carer what their personal strengths are. Even though I don’t speak Vietnamese I know when this question is asked – the general response is a startled look and either a laugh or a shake of the head. Sometimes there is no answer, sometimes there is a blush in response, and sometimes the child says 'I am strong' or 'I am caring' or 'I am honest' and every time it totally blows me away.

Free dental care for those in dire need

The problem of dental decay in Viet Nam is escalating rapidly. According to a National Oral Health Survey (2001), more than 85% of 6-8 year olds are affected by tooth decay. It’s a particularly significant issue for the children with HIV that we work for whom oral hygiene is even more important for a range of reasons. For example, such decay and possible systemic infection if untreated are much more serious.

East Meets West http://eastmeetswestdental.org/   is an international NGO who sees private clients which in turn helps fund the charity work they do in schools and with other identified groups in need such as VNHIP.  Recently we partnered with East Meets West in Da Nang city to have the children we work with assessed, something we now hope to do annually.

We had noticed that many of the children we work with had frank and visible decay. While there are local dentists this is not without its problems. On one such visit recently at a large public hospital, the dental staff were clearly discomforted that they were treating a child with HIV. They also suggested there was no issue with the several rear molars that were brown and broken off half way down the shaft and that we should just wait for them to come loose. This is in stark contrast to western thinking  re oral care, and likely represents a lack of up to date training for the staff.

The staff at East Meets West were extraordinary in their warmth and commitment to making the kids comfortable and giving them the time they needed to adjust to the unfamiliar environment and the work that needed to be done. The director showed them how to brush their teeth on a model jaw, they watched DVDs to reinforce the message, and took home new toothbrushes.

To give you some idea just how necessary our dental visit was, one young person alone had 7 fillings and one extraction in just one side of his mouth and will need to return for further work. Another young girl had frank and visible decay not only on her rear molars but on almost every visible tooth. For all the children that were seen we know that this work has prevented much more serious dental, and broader resultant health, issues down the track.

VNHIP is very grateful to East Meets West for their support and expertise.

A REWARD

During Non- Communicable Diseases (NCDs) project implementation, it’s always satisfying for the VNHIP team when we get to witness the patient’s disease become better controlled and the capacity for health care management of NCDs at the local level improved. One of the districts we are currently working in is Duy Nghia - a beautiful island where the living standard is still relatively poor.

One client presented with both Hypertension and Diabetes. Five months ago, doctors at Danang hospital where he initially sought treatment suggested he needed insulin injections, which he commenced. This proved very difficult. Too frightened to inject himself, he attended the clinic in his local town daily for them to inject him. He then decided to seek treatment at nearby Duy Xuyen district hospital instead. Although he took the medicine as it was prescribed to him, his blood pressure and blood sugar level were not controlled to acceptable levels.

He was recommended for the VNHIP NCD trial where he has attended for around one month now. Within one month’s treatment following our NCD Management protocol and guidelines, his blood sugar decreased to 7.1 mmol/l and his blood pressure was down to 130/80 from 160/100.

While the medication used in the VNHIP protocol is the same used in Duy Xuyen hospital or Da Nang hospital, one of the major differences of the VNHIP protocol for commune health center is its focus on patient counselling and education, which happens on a fortnightly basis to begin with. Throughout this process, local medical staff come to more easily understand the personality, circumstance and condition of the clients. They also get to know whether the medication is working, side effects and any other barriers to compliance with treatment. Just as importantly where NCDs are concerned, conversations happen about lifestyle factors contributing to disease and to self-management. While such information counselling has become pretty standard fare in the West, it is still a rare phenomenon here in Viet Nam.

During a follow up meeting with Quang Nam Department of Health, Dr. Dung who is the director of Duy Nghia clinic, has reported positive results and clear behavioural differences in patients who have applied VNHIP’s protocol.

This is one of the greatest rewards for team VNHIP.