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

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 $

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

Cardiac patient home visit

Day…

We met 2 younger children

There was a young girl who went to the HAF office for help. She knew about us because of the introduction at Đa Nang hospital. She is a student at Đa Nang university. She asked us to help her father get a heart surgery. Her father is 44 year olds and got a severe heart disease. Her mother died 4 years ago. Her parents have 3 children. She is the oldest child and is19 years old, 2 other children still at high school. When her mother was alive, her parents did farming for living. But since her mother death, and father is heart disease, they couldn’t keep up their work. This girl herself has a pituitary gland tumor, too. She usually follows up in Sai Gon hospital by her friends helping. She tutors outside school hours to earn money to cover her living costs in Da Nang. I know this job because I used to do it when I was a student. We only earn 20-30$/ month. When I talked to her, I felt like she is a very energetic girl. And I really didn’t want to make her disappoint. Even though I knew it would be difficult to convince my boss with the case of an over 40-year-old. I just thought that although the father not so healthy after surgery but he can also does a light work and take care of children. More important, he is the only spiritual for kids. She tried her best to borrow 20m for her father surgery. So why can’t we give her hope.

the house is very old now

  The next two days, me and An went to visit their home under heavy rain. Very difficult road to travel and we were quite difficult to find their home. The house was not too bad but it is so old now. They built it when the mother was still alive. We met the father and the 2 younger children. The father was quite tired because of his disease. Our donation for this case will be a 1000$. He hospitalized last week and will have surgery this month. We hope that after his surgery, he will get better soon to take care of his children. 

New Cardiac Patient Home Visit

New cardiac patient

We feel very good that the Hoi An Foundation has helped many people over the last eight years. But, only being here infrequently, I find that I become somewhat insulated from the severe situations that many of our recipients endure daily.

Yesterday we visited a patient whose heart surgery we plan to fund. She lives an hour and a half from Hoi An in an area I would describe as the “country”. Our driver showed his driving skills by avoiding any car damage even though we had to go through about 50 water filled potholes. On every one, you could see his mind churning as he decided to go right, left or the center.

We had trouble finding the home and had to stop and ask questions frequently. As we got closer, people seemed to know the lady with the heart problem. I like that aspect of Vietnamese society - everyone knows their neighbors and they are usually willing to help.

Unfortunately, when we got there, she wasn’t home. This lady has such a severe heart problem that in America, the patient would be confined to their home waiting for surgery. This lady was working in the rice fields, even though she had very little energy and was in fairly constant pain.

The neighbors were able to find her and bring her to us. She looked a little frightened. We were in her mother in law’s house – the four of us, her two brother in laws and about 20 neighbors. Josh and I were probably the only westerners who were in this area in many years.

Patients house build by the government

The family had told us her story – she was 41, a widow, 2 children – both with mental problems, one lived at home, the other in an orphanage in Da Nang. She has a bad kidney problem that has to be fixed before heart surgery. Her home is a very Spartan building. In the west we always divide things into needs and wants. She definitely didn’t have any wants since she barely had any needs. 

She had to work just to live – like many Vietnamese. But because of her condition, she couldn’t work as much as she wanted to. Her husband had died of cancer a few years ago, so her income was all she lived on. Rice field workers don’t make very much.

Talking with the patient and neighbors

It’s hard to see a situation like this and not think about how lucky we are based on one thing –where we were born.

Our donation for the surgery will be a $1,300.  It will allow her to have normal energy again and without constant pain. I’ll write another blog when her surgery is done.

For all the people who donate to the Hoi An Foundation, this is where your money is used. You can definitely know that your funds go a long way here. This lady will not know which ones of you funded her surgery, she will just know that her life is much better.

A blog from a new staff

Day….

6:45am, three of us rode motorbike from Hoi An to go to Binh Tri clinic, Thang Binh District. That was the second clinic for the people who have diabetes and hypertension. The first time we went by car, now we go by motorbike. An drove Quynh, and me by myself. I have to recognize that this time my driving skill gets a lot better because we usually drive long way in very hot weather. Sometimes An jokes that we are like highway heroes. When we just arrived and put the bags down, we met dr Hiep, clinic director. He seemed not satisfied with us. He said that we work with no plan, he not yet knew any information about our work there. We were surprised because his superiors had not informed him. He said that he did not want us to tell him what to do because he is a doctor and we are not. We are very upset. We try to tell him that that is not we mean. We know the protocol better and want to help them to get familiar with the booklets and collecting patients’ info. An almost cried. We finally decided come back Hoi An and will meet his superiors later to talk. But then, after talking the patients and clinic staff, we decided stay to work. We understand that we work because of the benefit of poor people, not for any doctors or us. We explained that we make the plan and send to provincial department of Health and district health Center but for some reasons, they hadn’t sent to the clinic. And the staff had thought we only come to see patients as other charities did before only one time, no following up so they didn’t assign staff to be in charge in this program to manage these patients. Everything finally solved. Dr Hiep even paid for our lunch (3 bowls of noodles and 1 sparkling water).

Day….

6:45 we went to Nam Giang, one of mountainous district of Quang Nam province. I feel familiar here because it is similar to my hometown. It is very hot in the morning. We met clinic staff to collect the information for our hygiene education project. We also came to an ethnic community to see how they live, the people are very friendly there. We took some pictures about their life.

In the afternoon we met the leaders of Nam Giang. I think they are very responsible and principle. I like it. They make us want to work with them rather than in Thang Binh. When we returned in the afternoon, it rained heavily. I even slept soundly in the car. (An did all the driving)

Minority ethnic people in Nam Giang

An and me taking to a villager

Day……….

Quynh and I came to Tam Ky to take part in a communication for a student with HIV. This is the first time I joined in this. I met 2 old people who work for “protection centers for street children” in Da Nang city. I really admire them. Although they are over 60 yo, they still very good in caring for the children with HIV. I wish I can work like them. We attended the flag in Cao Ba Quat high school and acquainted with the student and teachers. The teachers are very good, especially the head master. He is very dedicated with students. He said that all of the teachers decided to donate the money we support them to buy two bikes for poor students (we only support small amount for their time). They made us very happy and touched.

At noon, we went to visit the boy with HIV. The first I met a person has this disease. But I don’t think there is any difference between them and those without disease. He is a sociable and gentle boy. He lives with a big family. And they look very happy.

In the afternoon we attended a talk on HIV by doctor Hai in charge, a good doctor working in ”HIV center”. He is very fun doctor. All of the teachers attended, too. The doctor provided the knowledge on this disease. Before, I knew it with a very vague knowledge. Now I have a better understanding. The speech is not boring as I thought. Everybody very interested in this. We had a day of fun and useful.

Dr Hai talking to school staff and students

Teachers at the school attending a talk on HIV

By Yen Le