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