Another success for VNHIP protocol

It's a brilliant late spring morning as we pull in to the Social Center for homeless and disabled people in Hoi An – a State run facility for elderly Vietnamese, where The Viet Nam Health Improvement Project (VNHIP) under the direction of it's founder, Dr Josh Solomon, has been conducting a program for the identification and management of risk factors for cardiovascular disease (CVD) since 2011. Of the 50 residents, a high percentage had previously been identified as ‘at risk’ for CVD – many already diagnosed as hypertensive.

Statistics provided by the Vietnamese Ministry of Health suggest that 60-80% of deaths in Vietnam are attributable to chronic disease – those long-lasting medical conditions that can be controlled, but not cured. The lives of many patients with these conditions can be extended using relatively simple protocols.

In Vietnam, the implementation of this kind of regimen is minimal or non-existent. They require a relatively labor-intensive continuity of care, which is uncommon – particularly in low-resource areas of the country, where patients are rarely seen more than once by a physician, and there is virtually no follow-up care.

One of the most common causes of death from chronic disease in Vietnam is cardiovascular disease. Dr Solomon and the staff of VNHIP have spent years working in clinics in central Vietnam studying prevailing models of care, and attempting to develop a treatment protocol for the control of CVD risk factors, and the management of hypertension and diabetes, using international guidelines.

In 2011 the foundation signed an agreement with the World Health Organization (WHO) to implement the protocol, and to develop a teaching procedure for the training of health care providers in commune health care facilities.

Hypertension (high blood pressure) and diabetes are major risk factors for CVD

The protocol identifies a set of basic interventions to integrate management of hypertension and type 2 diabetes into primary health care. Blood pressure is tested using a standard inflatable cuff, and ‘point-of-care’ devices (glucose meters) are used to measure blood glucose in the diagnosis of diabetes. 

Our visit today is enthusiastically supported by the center’s director, Ms Nguyện, and her associate Trung. Project manager, Ms Yen, interprets for Dr Solomon.

The patients – all women on this occasion – provide a brief review of their medical histories, and receive a blood pressure test. A ‘Fasting Plasma Glucose’ test is conducted to identify diabetes risk – the glucose strips analyzed in a machine provided by VNHIP. A majority of the patients tested today have readings that fall outside target blood pressure, and a small percentage have blood glucose readings that are consistent with ‘prediabetes’. For those at risk, Dr Solomon stresses the need for lifestyle changes for both conditions. Obesity has been closely associated with both hypertension and risk for diabetes. Dietary changes to include more whole grains, fruits, and vegetables are recommended for weight loss, together with regular exercise.

With information provided by Josh, Ms Nguyễn and Mr Trung will provide follow-up on the dietary and exercise recommendations. Type 2 diabetes is a relatively slow developing disease, and will be monitored on subsequent visits by our team.

The warm reception we receive at the Adult Center is gratifying, and confirms that the simple, low-cost model implemented by VNHIP for increasing awareness of hypertension and diabetes as risk factors for cardiovascular disease is already paying dividends.