Monday, July 29, 2013

The silent warriors

silent warriors seeing a patient with stroke
We met with Dr Thanh, director of district Health Center after 4 years. We was busy with the pilot NCD (non-communicable disease) program in Phu Tho, northern Vietnam so we had to discontinue the program due to the shortage of staff.
He called us to ask if we can help him with the NCD management in the district. Even now, these diseases have become national program but the staff is not trained to treat the diseases. Dr Thanh said “There is higher awareness in the community through the media so the health staff and patients know the importance of managing the diseases and it is easier to implement the project, not like back at the time you started it, you were THE SILENT WARRIORS”

That reminded us the time we first started the program on managing hypertension and diabetes at commune level clinics in rural area of Quang Nam in 2008 with 2 staff, 1 physician and 1 health educator. We provided a training session to talk about these chronic diseases for the doctors and nurses with a simple algorithm. We convinced the director to make changes to the available medications and we helped to train the staff by seeing the patients with them. Although it was difficult, we were happy because we could show Ministry of Health and World Health Organization the model and results.  We then got involved in developing a model for national pilot program.

Friday, July 5, 2013

The first exciting trip for children with HIV

Last month we organized a trip to Ba Na for the kids with HIV living in Quang Nam province and Đa Năng city. were 11 children and their relatives participated in this trip with every child or 2 children accompanied by an adult. So in total there were 23 people in total including An Hayley, who volunteers for us, and I. Ba Na is a famous mountain tourist resort in Da Nang with cable systems and a spectacular amusement park that everyone had heard about through the media daily. But is is also pretty expensive for most Vietnamese people with low incomes and most are unable to afford to go there. The children with HIV and their relatives who are living in difficult circumstances, told us this was a place where they dreamed of coming to. So when they knew we were organizing a trip there, everyone was excited. One grandmother of a little girl who was sick in the hospital gained permission for her to be discharged from the hospital to join us. Our group also had a 70-year-old grandmother of a little girl with us. To save costs and provide better care for the children, we prepared some nutritious food and some essential items: milk, bread, fruit, drinks, and even some medical devices as needed. We also hired a bus and made hotel reservations...
At 6:30 am, the bus picked us and our things up at the office. Then we went to Vinh Dien and Da Năng to pick up the children and their relatives. After I checked the number of participants, we went to Ba Na. While sitting on the bus, they talked and exchanged information with each other. Everyone was very excited. Although it was Monday, there were so many tourist there. An, Hayley and I had much trouble organizing 20 people who had never been there before! After we got the tickets for the cables, we had to wait for a long time as the long queue moved very slowly to get to the cables. I can not describe the excitement and pleasure of even touching of them while they sit on the cable car.
Especially the children, they were so excited. They were also slightly worried when sitting up there hundreds of meters high. We walked to the sightseeing mountain pagodas. The children were very excited to get photographed together. Then we went to the big amusement park on the mountain. It was a paradise for children. There are many exciting games and most are free. So the kids were excited and played, appearing virtually tireless. The adults had to follow them to wait their turn to participate in all the games that they have never been part of before. There are also many games for the adult that relatives of children eagerly to participate, even grandmother of a little girl played the adventure game. She seemed very interested. We laughed when she told us that. The elderly grandmother of a little girl, who was carrying a plastic basket (something that housewives used to go to the market) for clothes and other things, was too tired to go follow her niece.
So Hayley had to help her bring the plastic basket, took the little girl to attend the games. She loved Hayley and just wanted to go with Hayley throughout the trip. At night we stayed on the mountain hotel. We booked 7 rooms for 23 people. As each room has 2 beds. But many kids just wanted to stay together. It was the first time they had stayed in a hotel. So everything was new to them. They did not know how to use hot water, showers and other things. Even a grandma and her granddaughter felt afraid to be in separate rooms. So I had to stay with them. 
We had a really delicious dinner after a day of fun. After dinner, people lingered at the restaurant and the kids were singing and dancing together. The atmosphere was very cozy and happy. Morning on the mountain is great, with people enjoying a shroud of mist and the cold air of winter. Very different with the hot weather below. After breakfast, while I, An and Hayley walked, the kids to ask their relatives led to the amusement park. They almost never get tired of playing. After lunch, we got into the bus to back home. On the way home, the kids still regretted not being able to stay there longer. They also asked that next time, where we will go? We discussed the places they want to see as Hue, Da Lat...if we have a budget for next time. 
Any way, we had a meaningful trip that is not only a trip, but it also helps everyone closer, loving each other. It was wonderful to watch the children and their carers form friendships over the two days. That is a beautiful memory that everyone can not forget. We took group photos that we will be sending to all the people who came on the trip with us.


Thursday, May 16, 2013

Cardiac patient


This case was referred to us by Dr Trieu from Da Nang Hospital. He called us couple times to ask our help for this case. He said that the lady come to hospital many times because of shortness of breath and unconsciousness. But after that she just go home and back to work continuously. They are too poor to think about a surgery. I did home visit on Sunday. It was  very difficult for me to find her house which is in a slum area,  near Danang beach.
The old house they rent to live
Her family’s small house in An Hai Dong ward (Da Nang) was unfortunately destroyed by a storm. She and her husband borrowed from banks to rebuild. However, about a year later, while selling food to earn money for her family, she was badly burned by boiling water. She sold the house to get money for treatment and repay bank. Since then they have to rent a small house in the slums to live. There are 6 people live there and they pay 1,2 million dong($70) per month for that house. Their life has become more and more difficult.  However, they still try to give their children an education at school.                                                                       
In 2010, she developed pancreatitis and was also   diagnosed with congenital heart disease and told she needed surgery soon. But surgery cost tens of million of dong($1000s) and with little income just enough for everyday life, she can not think about a surgery. Although seriously ill, but she has always worked hard to earn money for her family any way she can:  selling tickets, collecting bottles for sale...
We met her when she was working near her house
 Her husband worked as porters in rice plants, an unstable job. Furthermore he is not healthy to be able to do heavy work. Her oldest daughter has been separated and bring 2 kids returned to live with her. She has to take care of 2 grandchildren are also frequently get sick. That day when we speak, she looked very tired. 

After home visit, we decided to support her remaining amount is 10 million for surgery (surgery of her cost 37.5 million, 20 million insurance payment, and they had 7,5m).
After surgery, when we went to visit her at the hospital, she looked much better and very happy. She said from now on she is healthy and working hard to care for her family.  
She is happy after surgery



Monday, April 22, 2013


Would you like to be a part of us in bringing joy to children living with HIV? We would appreciate any contribution. 
Summer planing: “ Joy for children”
Date: middle of June
Place: Ba Na Hills.
People: - 25 kids and parents

ITINERARY
First day
Morning: 8:00 AM Pick up at Vinh Dien then transfer to Bana Hills Station.  The children have a chance to ride on a modern system of cable cars helps them get a bird's-eye view, very miraculous and attractive while enjoying a feeling of flying in the blue sky amidst the clouds and wind. They will visit some old French villas en route, as well as the suspension bridge, Linh Ung pagoda. We will then enjoy lunch.
In the afternoon, Its cool climate for active games. We will ẹnjoy the Fantasy park “Based on novel named “Adventure to The Center of The Earth” and “Twenty Thousand Leagues under the Sea” of French writer Jules Verne, Ba Na Hills Mountain Resort had published an international indoor entertainment amusement park with 21.000 square meters area, has divided into 3 levels.
Young boy Jules Verne and pretty girl Claudette will please you discovery many thrilling, adventure games and variety ones. You will enjoy unforgettable adventures with their friends: Monkin, Spunky, Skiver and Gubly when you come to this beautiful place”
Overnight in hotel, gathering time.
Second day
Morning, have breakfast then take free time
Check out the room and take the cable car down to Ba Na station.

Back home with full of energy!!!

BUDGET:
Car: 2,400,000 ~ 120$
Ba na cable ticket: 7.760.000 ~ 388 $
Hotel: 7,200,000 ~ 343 $
Foods: - 1 breakfasts and 1 lunch and 1dinner: 3,750,000 ~ 188 
Bring foods to save money: Fruits, water, snack.... 1,500,000 ~ 75 $
Total: 22,610,000 ~ 1114 $

Monday, March 25, 2013

Clinic at Children's Hope in Action (CHIA)

We have been lucky enough to staff the pediatric clinic at Children's Hope in Actions (CHIA, http://www.childrenshopeinaction.org), a charity in Hoi An run by Robyn Morley.  The clinic is managed by Ms. Thao and Sagen Wilks.  We have been working with them for many years and have seen a number of children with various conditions like seizures/epilepsy, congenital heart conditions (like VSDs, Tetralogy of Fallot and TGA) , intra-uterine infections with Rubella, low blood counts and kidney problems.  We utilize a wide network of specialists both for diagnosis and management in the complex cases.

Three conditions we see a lot of deserve special mention.  Seizure disorders in children (whether it be febrile seizures, those associated with disorders of brain development or those without cause) are difficult to manage in Viet Nam.  Seizures are not viewed in the same way they are in the west and often tolerated by families.  There are prevailing concerns about medication side effects and getting families to titrate up on anti-epileptics to stop seizures is an ongoing battle - many children have ongoing seizures on low dose medications.  Intrauterine infections with Rubella is a problem in Viet Nam.  Rubella is not part of the routine vaccination schedule and, when mothers acquire it during pregnancy, children can be born with heart defects, cataracts and deafness.  We have seen a few children at CHIA with this condition which usually requires surgeries both for the cataracts and the heart defects.  Often these children require lifelong care by their families.  There is an initiative to vaccinate Vietnamese (http://www.measlesrubellainitiative.org/) to help prevent these problems in the future.


Finally, rheumatic fever (a systemic inflammatory condition following an infection with Streptococcus that can affect the heart valves) is common and both our foundation and CHIA have found a number of cases.  You can help prevent progression of the valve problem with daily prophylactic penicillin (though some cases require surgery).

Getting the families to give the children a daily tablet for 10 years (the recommended duration of medication) when they do not feel poorly is an ongoing challenge.  Vietnam needs a national program to work on prevention of rheumatic fever by appropriate treatment of Strep infections.
These are some of the issues that CHIA is working on in their clinic. The children are wonderful as are the families.  CHIA has done a great job in providing support for these children and their families and we are happy to help.

NCD Management in Viet Nam



I spent the morning with An and Yen in one of the clinics where our model for NCD management has been implemented.  There is a nurse practitioner seeing the patients and titrating medications for the patients with hypertension and diabetes.  Our staff monitors her progress, helps her with patient education and assists in following the protocol.  She reviews some of the more complicated cases with me and we discuss management strategies.  This clinic is doing a great job with these patients!  They are conscientious and caring.  They thank us for the increased knowledge and equipment to take better care of their patients.  The patients also are happy for the education and to get more time with their health providers.  Blood pressures and sugars are improving using the provided algorithms.  This model of rural commune clinic management of hypertension and diabetes is the key to getting control of the rapid increase in these conditions and the subsequent cardiovascular disease (the leading cause of death in Viet Nam).  The average rural Vietnamese patient with the chronic diseases will not travel to the distant hospital where there is overcrowding, long waits, short visits, little in the way of teaching and no scheduled followup (not to mention that most of the chronic diseases dont make them feel "bad" so convincing them to travel distances for management is tough).   A model for local management of these cases is what we are working on and what this clinic is doing well. Translating these small achievements at a local clinic into nationwide change in practice style is our challenge for the next few years.

Josh Solomon