An is leaving VNHIP

It has been nearly seven years since I started to work with the Hoi An Foundation (VNHIP). Time has passed really quickly, and I will be leaving soon to study in the US.

I have really enjoyed working for the organization. Dr Josh, Dr Brian, Carol and Hayley trained me to be a medical translator, then a health educator and project manager. I have had many opportunities to work with the doctors and nurses from the US and Australia, who volunteer with us and have gained so much knowledge and experience.

I still remember when we first started the Non Communicable Diseases (NCD) project in Dien Ban and Duy Xuyen, there was so much work to do, and I had very little experience. We would ride to the local clinics by motorbike very early in the morning carrying medicines, medical equipment and patients' charts. Sometimes we went to a clinic very far to the West and Dr Brian kept asking if we were in Cambodia yet.

Counseling a patient at a clinic in Duy Xuyen

I am inspired by the way Dr Josh, Dr Brian and all the other volunteers are so devoted to the community. I am proud of VNHIP; it is a small organization that achieves such a lot. VNHIP is very lucky to have Quynh and Yen; they manage their projects efficiently, and I am confident that they will manage the foundation well after I leave.

Josh, Carol, Quynh and I at a clinic in Phu Tho (WHO project)

I was encouraged by many of you to believe more in myself and move forward in my career. Thank you for being so supportive, it was because of you that I was awarded the Fulbright Scholarship. Thank you Quynh and Yen, for taking on extra work so that I could prepare for the interview and exams.

I feel so lucky to work with you all, and I hope to work with you again when I come back. I have so many pleasant memories of my time with VNHIP, and will continue to support your work when you need me.

beautiful scenery when doing patient home visit that I will miss

I would also like to thank the volunteer teachers at CHIA who have helped me to improve my English and my friends at CHIA, PIC who shared their experience with me during my time with VNHIP.

The good, the bad, and the inspiring

I had been working as marketing and communications volunteer with VNHIP for three months when I was asked to accompany Yến (Nam Giang Project Manager) and Hayley (In-country Director) to Nam Giang. I had seen photos from previous trips: the stunning scenery, the ornate meetinghouses, the beautiful smiling children and stately women in traditional dress, so I didn’t need much persuading.

The health worker at Pa Ting was an unexpected
star presenter.

This was VNHIP’s third visit to Nam Giang and it was going to be very different. Instead of VNHIP delivering health education to the ethic minority villages, this time the village health workers and village leaders would be delivering the sessions themselves. VNHIP’s Primary Health in Nam Giang Project started in December 2013 with VNHIP delivering hand washing training to seven ethnic minority villages in the remote Central Vietnam province of Nam Giang. The purpose was twofold; to promote the importance of hand washing for the prevention of infectious diseases, and to show the village health workers and village leaders the type of training VNHIP hoped they would one day deliver themselves.

A warm welcome awaited VNHIP in Pa Ting

The Village health workers and village leaders from seven villages came together in April to learn about common infectious diseases, and how to present the information to their villages. (See Austin’s Exciting trip to Nam Giangblog). VNHIP’s original intention was to co-deliver the training, but the village leaders and health workers felt it would be better if they delivered the training in their local dialect. This may not sound like a big deal to you or I, but it meant that each presenter would have to make a formal presentation, their first, to their village.

Glossophobia, the fear of public speaking, is common the world over. In the hills of Nam Giang, we are a world away from the nearest Toastmasters in Hanoi. Nerves set in as we set up the equipment, some of our presenters jokingly try to get out of it, others plead with Yến for her to deliver the training instead. This is capacity building in action and Yến firmly but gently reminds each of them that if we are to effect lasting change in their village they need to deliver the training.

Villagers leaving the meetinghouse in Pa Sua

The presenters at our first village, Pa Ting, completely blew us away. Both the village health worker and village leader have studied the resources we provided in advance and even added extra information themselves. Their presentations were professional and enthusiastic, and we were surprised and impressed by their level of commitment. We could have happily gone back to Hoi An after this one village, proud of their accomplishment and thrilled to have our expectations exceeded to such an extent.

Pa Ting was a tough act to follow for the remaining six villages. Most of our other presenters were not as committed, skilled, or enthusiastic, and the blistering heat made it difficult to hold their audience’s attention. I couldn’t help admiring our presenters, as it must have taken a great deal of courage to speak in front of their whole village for the first time.

Creative play Nam Giang style, Pa Va

The infectious diseases training proved that this model of village led training works. VNHIP will be returning to Nam Giang in late June to help the village health workers and village leaders deliver training sessions on nutrition. We will continue to support them by providing additional presentation skills training and will evaluate the program’s success by surveying the villagers to assess information retention and changes in behaviour. With limited access to power and proper sanitation, the information our presenters shared with their villages has the potential to save lives. It was an honour to catch a brief glimpse of their way of life and pleasure to be able to add many new photos to VNHIP’s growing Nam Giang photo library. 

By Gillian Eborn

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.