Happy hearts !

Nam Giang is a mountainous district where we are currently doing Primary Health care. Following a recent day trip up there to present some nutrition education, we added a cardiac home visit to our schedule. It was to become one of the most heart breaking situations that we have come across.

There was some degree of difficulty in finding the correct house. It is located on a bad road which was also under repair. Finally we found her “house”. We should say her house is more like a shed with barely any walls. It is very small and very basic! When we arrived she was there with her daughter who is 7 years old. She is a very cute little girl, a good daughter who  obviously loves her mother very much She did her best to join in the conversation and also answer our questions.

 Hanh is a 34 years old woman who was married 8 years ago, and was diagnosed with Mitral Valve Stenosis shortly after giving birth to her daughter 7 years ago, when the condition was already severe. The doctor indicated surgery but they could not afford it. Unfortunately she then suffered a stroke. Her husband ran away after he found out his wife had a heart defect. He has remarried  and has 2 children. Hanh had to leave her husband's house and bring up her little daughter.She moved back to her family and they now live in a lean-to next to her parent’s house as  the main house is very crowded with other family members.The walls of her house are very thin and certainly not waterproof for the upcoming rainy season. This structure is located right beside the family pigsty. She has a very simple kitchen where she can cook when she feels well enough. Some family members living in the main house were unwilling to provide and care  for Hanh and her daughter. Hanh and her daughter live separately except for the times when she is so sick and unable to walk or do things by herself. Her elderly parents (who are 65 years old) have been taking care of them for a long time. The entire family are farmers and are extremely poor.

After visiting her on that trip, we had many discussions and tried to find the best ways to help her. We contacted other NGO's and the local government to see if they could build a house. They will consider building her a better house. We then bought Hanh and her daughter some lovely gifts : a dress, schoolbag and a blanket for the coming winter.
VNHIP were able to provide her with the remainder of the money for her heart surgery. 3 weeks later she had her surgery in Da Nang hospital. We visited after her surgery and she was crying tears of happiness. We are also very happy  with this outcome and feel sure that both Hanh and her daughter can now look forward to  a brighter and healthier future.

The continuing struggle - NCDs project: 2014, Duy Xuyen, Quang Nam.  

Non Communicable Diseases (NCDs) in Vietnam has become major problem throughout the entire country. VNHIP doctors have spent 9 years working in 32 local clinics to determine the current model of care and identify obstacles to care delivery. Based on this experience (which includes seeing more than 2,000 patients) they developed a treatment protocol with a comprehensive health booklet for the management of CVD risk factors and the management of hypertension and diabetes, using international guidelines.

Vietnamese people do not have good eating habits like eating fruit and vegetables regularly. Alcohol is also a problem, men usually drink a lot of beer and rice wine. Exercise is not a priority here as people have very busy lives. All of these lifestyle factors lead to high risk of non-communicable disease. Encouraging patients to change their lifestyle is paramount, however, the workload of the district doctor is too high and they do not have time to do this. Doctors at a local community level lack training in treating NCD’s and therefore send patients to the district hospital, this leads to overcrowding and means that doctors who are trained and understand NCD’s do not have time to spend educating patients.

As these diseases are chronic, patients have to take medication for life. Another problem is that doctors always prescribe the most expensive medication.

In response to identifying a need for improved management of Non Communicable Diseases(NCDs) in Viet Nam, Dr Josh Solomon of VNHIP, working closely with the  World Health Organization(WHO), has developed a protocol to enable doctors in rural provinces to effectively and cheaply treat NCDs.

Over time, we have changed our focus from treating patients to upskilling the local health staff, in order to contribute to sustainable change in systems of care, one of the primary objectives of VNHIP. A particular aim is to improve the confidence of health staff in health counseling and patient care. This reduces the need for patients to attend district hospitals, which not only eases overcrowding, but enables them to access     quality care closer to home.

In 2011, the WHO and Ministry of Health, Viet Nam, provided VNHIP with a grant to run a pilot project in Phu Tho to assess the effectiveness of the training mentioned above. This project received such positive results, WHO has been working with the Ministry of Health to assess the feasibility of applying it across the country.

During this time, VNHIP has been continuing to implement the model for the management of non-communicable diseases, and are currently with local community doctors in Duy Xuyen, Quang Nam.

Mid-Autumn Festival at the Beach!

The Mid-Autumn Festival is traditionally a special festival for children in Viet Nam. It is held annually on the 15^th day of the eight month of the Lunar calendar. During the week of the Mid Autumn festival, Vietnamese children are very excited for the event and enjoy the dancing of the colourful lion and the sound of fast drumming. According to Vietnamese culture, most houses and shops ask the dancing lion to come in to bring good luck and fortune to their family. However, poor families seldom have the opportunity to experience the lion dancing in their home, especially children living with HIV, many of whom are without a mother or father. VNHIP organized a Mid Autumn Festival event in Hoi An for children living with HIV who have not had the opportunity to join in this cultural event. It is a great occasion for the families who have the same circumstances to catch-up and share their experiences in taking care of children living with HIV.  This is the first time that I have celebrated a Mid Autumn with children living with HIV. I was very emotional when I heard their stories: A little girl often asks her grandmother why she has no parents. One night her grandmother woke up and felt discomfort when she saw Quynh kowtowing (praying) in the dark. She asked Quynh why she was doing this. Quynh said that she wanted her parents to resurrect, and hoped that if she kowtowed many times this would happen. She wishes she could have parent and be the same as her friends. Some of children said that it was the first time they swam at the beach. Although it was hot children still played with each other happily.

 Children felt excited to watch the traditional performance dance of the lion which VNHIP provided. At the end of the event, we presented every child a gift bag which contained milk, notebooks, a mosquito net, lanterns and dominos. When we said good bye the children wished that the party could last forever. The bright faces of the children showed us that the party was special and meaningful. 

Can you help us to raise $500 for a toilet for Hanh and her grandma?





The living room of the tidy house where Hanh lives with her grandmother is flooded with sunlight when we arrive on a recent late summer morning. 

We are visiting today to conduct a comprehensive assessment of Hanh’s health and wellbeing using a detailed HIV checklist developed by one of VNHIP’s professional medical volunteers.

This checklist helps us to better understand the specific needs of each family we work with so we can best support their children who are living with HIV. 





Our visit attracts the interest of a supportive group of neighbours, who crowd into the doorway of the small house to watch the process.





Hanh, 8, has lived with her 80 year old Grandma  all her life, not atypical here in Viet Nam where extended families are still the rule rather than the exception. What is less usual is that Hanh has HIV.
 
VNHIP first met Hanh in 2010 when she was four years old. The family was referred to us by the clinic in Tam Ky(one hour south of Hoi An). During a routine clinic visit, Hanh and both of her parents were discovered to be carriers of the HIV virus, and it is surmised that Hanh contracted the virus at birth.

Hanh’s mother was already in declining health,

 and died a year later. Her father 

was devastated – by the loss of his wife and the knowledge that both he and Hanh had also contracted HIV. We were very worried about how this would affect Hanh and kept in close contact with the family to help them through this difficult time. Hanh.s father went on to find a new partner after his wife's death,  and now lives separately from Hanh.  As is often the case in Vietnam, where there is no mandated child support system, Hanh and her granny receive only token support from her father and his new family.





Hanh takes the local bus with her grandmother once a month to the Tam Ky clinic for treatment. The Vietnamese government makes antiretroviral drugs for the treatment of HIV available free of charge, and both Hanh and her father have been receiving treatment since their diagnosis but even free treatment can be prohibitive for those who can’t afford to get to a clinic.  For a poor family like Hanh’s, it is expensive to get there and takes all day. VNHIP supports Hanh by compensating her grandmother’s lost income and covering their travel expenses so that she can receive ongoing treatment.

In addition to contributing financing for Hahn’s medical expenses, VNHIP is also committed to identifying other areas of need hence our assessment this day. Our conversation with the family reveals that  Hanh and her grandmother have routinely walked to and from the local school. An appeal following this visit secured the generous contribution of a fine ‘dusty pink’ bicycle by one of our wonderful volunteers which has already made life a little easier for them, and we have recently been offered an additional child’s bicycle for Hanh to ride.



Our assessment shows us that Hanh and her grandma's

 simple two-bedroom home is  orderly, but Spartan.

In Hanh’s room, clothes hang neatly from some twine stretched along the wall, a bright yellow sun hat and a ‘barbie’ backpack hang from hooks above the bamboo bed frame.

The floor is polished cement. There is a kitchen – a simple affair with a gas cooker. Outside the back door stands a large stone water container. A concrete platform serves as a bathroom/laundry.





The one huge deficiency in the house is the total lack of a functioning toilet.  Hanh and her grandmother currently rely on a hole dug in the woods for their commode. Arduous at the best of times, this method is made inaccessible during the upcoming rainy season when many homes become marooned, and surrounding land submerged.

Our visit completed, we compare notes. Our conclusion is that we have made strides in addressing many of the needs of the family – but feel that the most important contribution we could make – a contribution that would immediately improve the quality of life for Hahn and her grandmother - would be the construction of a decent toilet. Our estimate of the cost for a simple sanitary facility is $500. Can you help us reach this modest goal?

If you can, please contact us or visit our donation page http://www.vnhip.org/donate.html