Fun and Frolics in the Ancient Capital: Annual Summer Trip to Huế for Children Living with HIV

It’s already warm at 7am as we wait in the minibus for our traveling companions – and the mid-summer day promises to be as hot as a firecracker. The occasion is the annual summer vacation for a group of children infected with the HIV virus, and their caregivers. This year, the trip, sponsored by the Viet Nam Health Improvement Project (VNHIP), will take us from Hội An to the ancient city of Huế - former capital of the Nguyến lords, a feudal dynasty which dominated much of Southern Vietnam
from the 17^th to the 19^th centuries. Our party includes VNHIP staff members Hayley Tristram, An Luu Phuoc, Nguyen Thi Thu Quynh, Le Thi Hoang Yen, Nurse Sagan Wilks, and marketing volunteer Gillian Eborn.

We are off to a slow start. There have been faulty bus connections, some of our family members have yet to arrive at the meeting point in the town of Vĩnh Đien – and our large vehicle is prohibited from entering the town precincts until 8am…..but finally, we are off. The children in our group range in age from 7 to 16. Most are accompanied by a parent, one in the care of her vivacious 80 year old grandmother. Most of the families are of very modest means, and for some, this trip represents a rare opportunity to travel beyond the boundaries of their home village.

Our path takes us North through the city of Da Nang and skirts the glorious sweep of Da Nang Bay before beginning a tortuous climb through the eastern extremity of Bach Ma national park. The highway, Đèo Hai Vân  (Ocean Cloud Pass) is a grueling series of switchbacks offering stunning views back across the bay, and, over the crest of the mountain, down into the beautiful beach landscape of the fishing and resort town of Lăng Cô. We pause at the summit for a rest stop and coffee break – 'the best coffee in Vietnam', and indeed, it is good coffee. Children and parents alike swarm the memorabilia stands, where the costume jewelry is a major attraction.

We roll in to Huế along a broad four-lane boulevard. It is close to noon, and everybody is hungry. In a tourist bus corral, promoters from a dozen small restaurants swarm the bus, but our driver has already made a recommendation – the Cóm Xuân Nhan, which advertises 'món ăn ngon' – 'delicious cuisine'. The restaurant is packed with customers, but within 10 minutes tables have been marshaled and set up on the sidewalk, and, amazingly, food begins to appear almost immediately, and is fresh and spicy. We supplement the meal with a sandwich confection made from crisp rice crackers filled with a sweet mixture containing nuts and ginger.

Our hotel is located 50 meters down a narrow alley, where we are soon installed in basic but clean rooms, and an hour is allotted for a rest before the afternoon schedule.

The party is divided into two groups for the first activity of the day: the children are to have a lesson on personal hygiene conducted by Quynh and Sagan, while the adults will have the opportunity to discuss the challenges associated with the special status of the HIV positive.

After an introductory chat with the children,and a quiz on hygiene issues, a demonstration of hand-washing technique is conducted by our nurse, Sagan. A glittery liquid soap is distributed – the glitter, transferred to any surface the children touch, is symbolic of germs. The point is quickly established, and the cleanup process in the bathroom a cheerful ruckus.

Predictably, the main topic of conversation among the adults relates to the isolation and widespread stigma resulting from fear of HIV and AIDS. Although the Vietnamese government has acted aggressively in issuing decrees prohibiting discrimination against those living with the virus, fear of casual infection stemming from a lack of understanding about the nature of the virus and modes of transmission is widespread. Often such fears combine with beliefs that all those with HIV acquired their infection through moral misconduct, and so should be avoided or excluded from society.

Lessons and discussions over, we board the bus for our first stop – The Citadel.

The history of the city of Huế for almost 400 years was virtually synonymous with the history of the Nguyễn family – one of the major families of Vietnam dating back to the end of the 14^th Century, and the days of the hero-emporer Lê Lợi. In 1558, Nguyễn Hoàng – the first of 9 'Nguyễn Lords' – prevailed in a dynastic struggle, and was given 'lordship' over the southern provinces of Vietnam. He ruled from the city of Huế, and established the dominion of the Nguyễn Lords in the southern part of the country.

In 1802 Nguyến Phúc Ánh, a descendent of the Nguyến Lords, succeeded in unifying what is now modern Vietnam – founding the Nguyến dynasty, and taking the reign name Gia Long. Construction of a capital city – the current Citadel - began in 1805. The design included four fortified enclosures contained within a massive defensive wall. The main structures were the Kinh Thanh (Capital City), for administrative buildings; Hoang Thanh (Imperial City) for Royal palaces and shrines; Tu Cam Thanh (Forbidden Purple City) for the Royal residences; and Tran Binh Dai, a bastion designed to control movement on the Perfume river which flanks the fortress.

Our children are a colorful sight, clutching balloons as we pass through the spectacular Nga Môn gate in the perimeter wall. It is brutally hot - many of the Vietnamese women in our group are covered from head to toe, with thick stockings, long-sleeved jackets, face masks, and wide floppy hats, in many cases, with only their eyes exposed. 

It's hard to know how much attention our group is paying to the presentation of our guide. Several of our number seem more interested in capturing the popular Vietnamese snapshot with a 'V for victory' sign. Our children are, for the most part, cheerful and uncomplaining – although one stylish little girl in pink sunglasses has a spectacular meltdown, and refuses to budge until her mother picks her up and carries her piggy-back for the rest of the visit.

Although many elements of the Citadel have been diminished by time, careful restorations of many significant structures evoke the grandeur of its heyday.

Our tour completed, we trudge back wearily to the bus, and return to the hotel for a freshen-up before dinner.

We gather in the early evening at a lovely restaurant with a terrace overlooking the Huong (Perfume) river. Our table extends along the parapet with a grand view across the water. The food is tasty, the beer warm – although there is plenty of ice. Gillian has volunteered her digital camera to one of our young charges, who has become an instant convert. Her free-form pictures of her companions are great fun – and are complemented by endless 'selfies'.

Bún Bò Huế is rightly famous in Vietnam. After an early checkout from our hotel, we stop at a sidewalk café where, sitting at low plastic tables, we are served bowls of this spicy beef noodle soup, iced tea, and strong, sweet, Vietnamese iced coffee. 

There is considerable excitement when one of our children tosses a shoe in the air and loses it in a tree. Fortified, and having tracked down a new pair of shoes, we set off for the tomb of Khai Đinh.

Nguyen Phúc Buu Đao was the 12^themperor of the Nguyến dynasty, becoming the nominal ruler of French occupied 'Annam' in 1916. He took the name Khai Đinh (Auger of Peace and Stability) for his reign. Although his stated agenda was to restore the prestige of the empire, his policy of close collaboration with the French colonial rulers earned him the contempt of many Vietnamese. His popularity was further diminished when he authorized a dramatic increase in taxation on the Vietnamese population, in part to pay for the palatial tomb we are visiting today.

The structure is a muddle of Vietnamese and European architectural styles. The tomb interior, a wild reflecting chamber of glass and porcelain – contains a central life-sized bronze statue of the emperor wearing an expression that might be chagrin….or melancholia. Certainly he does not seem to have been a happy fellow. Reputedly of frail and sickly disposition, he died of tuberculosis at 40.

Our colorful troupe is in sharp visual contrast to the mildewed gray concrete of the stairs and terraces as we pause for a group photograph outside the main temple.

Back on the bus we head for our final destination of the day, the Thiên Mu Pagoda (Chùa Thiên Mu). The original structure was built in 1601 on the order of Hoang Nguyễn, the first Nguyễn lord, who at the time, was governor of the city now known as Huế. The original pagoda was a simple structure, but renovations and additions over the years have greatly increased the size and grandeur of the site. The brick 'Phuoc Duyên' tower was erected in 1844, stands 21m tall, and is of octagonal shape with seven stories, each dedicated to a different Buddha incarnation. The great tower, overlooking the Perfume river, has become the unofficial symbol of the city.

The inner courtyards of the pagoda are serene and un-crowded. In a dining hall monks are chanting before their mid-day meal. A garden of bonsai trees stretches to the rear perimeter wall. In a garage off the central courtyard, a pale blue Austin Winchester automobile is parked. Mounted on a wall behind it, the famous photograph of the self-immolation of  Thích Quang Đuc, a Buddhist monk who, driven to the site in this car, burned himself to death at a busy Saigon intersection in 1963. Quang Đuc was protesting the persecution of Buddhists by the American backed South Vietnamese government led by Ngô Đình Diem.

At the foot of the pagoda, we board a brightly decorated 'Dragon' boat for a brief cruise down the Perfume River which bisects the city of Huế. According to local lore the river derives its name from the fact that it passes through forests of aromatic plants before reaching the city, bringing with it a pure and fresh aroma. In this central part of Huế, development has been restricted on the riverside, most of which is devoted to an attractive pedestrian park. We are a large group for the relatively small boat, but, reassuringly, there are sufficient life jackets for all. Our host has a captive audience in mid-river, where she presents us with a range of memorabilia for sale.

We stop for one final meal before boarding the bus for the return journey. Rather than the long haul back over the mountains, our route is through the new Hai Vân Tunnel linking Huế and Da Nang.  Opened in 2005, it is the longest tunnel in Southeast Asia.

There are high-fives and smiles as our companions disembark in Vĩnh Đien. It has been a privilege and an education to share a vacation with this lovely group of children and their parents. 

Austin Trevett

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.

Exciting trip to Nam Giang

The roadsides are lined with freshly harvested peanuts drying in the early summer sunshine as our minibus climbs out of the central Vietnamese plain into the mountainous district of Nam Giang.  Spread out on tarpaulins or wicker mats, the nuts are turned several times a day by farmers with wooden rakes.

Although our destination, the village of TaBhing, is barely 50 miles as the crow flies from the coastal city of Hội An, the route is along narrow provincial roads congested with motorcycle and commercial vehicle traffic. As we enter the remote Nam Giang district, our progress slows further as the road paving deteriorates.

Nam Giang is the largest – and western-most – district in Quang Nam province. It is mountainous, rugged, and poor. The ethnic homeland of the C’tu people, the district contains 11 semi-autonomous communes, each encompassing  8 to 14 villages of between 30 and 60 households. About half of the population - estimated to total around 50,000 - live in communes in the eastern ‘lowland’ areas, the remainder in the rugged highlands bordering Laos, where access can be difficult, and sometimes dangerous.

Nam Giang district is among the poorest and least developed parts of the country.

Although the Vietnamese government has provided considerable investment, infrastructure and essential community services are basic or non-existent. Community health (and health education) facilities are rudimentary; education, and education support, inadequate. 

Medical services for the area are provided by one hospital, and additional outpost clinics – one in every commune - staffed by health care workers  (physicians?) who have received only basic medical training. The hospital, located in the capital of Thạnh Mỹ, relies on a system of ‘village health workers’ to facilitate  health education.

In 2002 Dr Joshua Solomon, having completed a residency in Internal Medicine at University of Texas, had taken a sabbatical. His vacation travel took him to Vietnam, where he met some Australian volunteers who had been providing medical services at an orphanage in Hoi An. What had been planned as a brief sojourn for Josh became a year of commitment, working individually, and collectively with other volunteers, to develop programs for the provision of high quality health care to the poor and disadvantaged in Vietnam.

As a result of this experience, and in recognition of the desperate need to improve medical knowledge and skills in rural central Vietnam, Dr. Soloman established the Vietnam Health Improvement Project (originally ‘The Hội An Foundation’) in 2004. The project has two related dimensions: 

*To train local doctors in the management of chronic conditions, with a focus on pediatric HIV, heart disease, and hypertension and diabetes. The program provides specialized training and equipment to familiarize community physicians with current trends and methodologies.

*To facilitate the training of village health care workers - the ‘boots on the ground’ liaising between local communities, clinics, and physicians at the hospital in Thanh Mỹ.

A protracted negotiation with the district ‘People’s Committee’ has since resulted in the signing of a ‘Memorandum of Understanding’ (MOU) which permits the operation of the Vietnam Health Improvement Project  on the Tà Bhing, Tà Pơ, and Cà Dy communes – encompassing 32 villages.

Our visit today is to be a training session for village health workers on the TaBhing commune. The schedule has been arranged by the director of the local ‘clinic’ – Ms Chien - whose responsibilities include contacting the workers and arranging for them to meet us at a local community center. Ms Chien joins our retinue in Thanh Mỹ and guides us to the village of  PaSua, and to the meeting house – a traditional thatched building known as a Guol.

The Guol is an airy structure with a steeply pitched roof. The seating platform, enclosed by an abbreviated wooden wall, is raised a meter or so off the ground, and is surrounded by a bank of wooden steps. The exposed woodwork – beautiful clear boards harvested from the hardwood forests that surround us – is fancifully decorated with images of animals and bizarre humanoid creatures. Portraits of Ho Chi Minh are mounted on a ceiling beam, and certificates of merit issued to the village for various conformities are prominently displayed. Sited in the middle of dusty courtyard, the Guol is the epicenter of village life. Regular monthly meetings are scheduled by the village ‘head man’, to which residents are summoned by the sounding of a bell. Attendence is mandatory. Failure to participate in community affairs can result in a reprimand or other recriminations at the next village meeting.

We are here today to present a powerpoint presentation to a dozen or so village health care workers on the subject of infectious diseases. Our team includes Hayley Tristram (in-country Director), Lê Thị Hoang Yến  (project manager), and Sagan Wilks, a nurse/volunteer. The presentation, assembled by Sagan, is based on the ‘Health Education Program for Developing Countries Handbook’, a document that presents the latest evidence based guidelines available through the World Health Organization (WHO) and its numerous collaborating partners.

The health care worker holds a position of considerable responsibility in village life. Their duties include the organization of vaccination programs, instruction of villagers in basic sanitation techniques, and the conduct of mosquito eradication drives. While health care workers play no part in treatment, their role is critical as liaison between the commune clinic and the village communities. The position is well compensated by local standards. Workers receive 500,000 VND/month ($25US) for their services.

The workers, an even mix of men and women, are seated on the woven bamboo floor of the Guol. A digital projector and portable screen are set up for the presentation. An initial series of slides follows up on earlier sessions covering basic hygiene methodologies, before moving on to a catalog of subjects of particular relevance to rural villagers:

*In Vietnam, there are 7 million cases of diarrhea a year, resulting in 46,000 deaths. Strategies for managing diarrhea, and techniques for treatment – particularly in infants – are discussed.

*Studies have consistently shown that upwards of 80% of sampled rural populations in Vietnam are infected with eggs or cysts of at least one parasitic worm species. The presentation identifies the different worm infection risks, modalities of transmission and prevention.

*Tuberculosis is still a major health risk in Vietnam, which ranks 12th in the world for most TB cases, with nearly 200,000 new infections and 30,000 deaths recorded every year. Symptoms of tuberculosis are discussed, and treatment protocols outlined.

*According to the Vietnamese Ministry of Health (MOH), as of October 2013 there were over 200,000 people in Vietnam living with HIV/AIDS, of whom more than 70,000 had developed AIDS. Approximately 66,000 people died of HIV/AIDS in the first nine months of 2013. Process of transmission, and treatment options are outlined.

*Dengue is endemic in Vietnam and although peak infections occur during the summer rainy season, dengue virus transmission occurs year-round. Vietnam’s hospitals see 50,000-100,000 cases a year, but the overall total may be five to ten times higher. The use of repellants and mosquito nets is discussed, together with the identification and elimination of mosquito breeding sites – issues common to the control of malaria. While the coastal and flat delta regions of Vietnam are almost malaria-free, there is still a risk of infection in remote, mountainous rural areas of the country.

Although the C’tu tribal residents of the Nam Giang highlands speak a unique dialect, our presentation today is made in Vietnamese. Ms. Yến reviews the slides and the information they contain. There is a high level of participation by the health care workers. Questions posed by the participants are translated into English for Sagan, and her responses are re-phrased in Vietnamese. 

It is early afternoon, and hot, by the time our meeting ends. In the open area around the Guol, farmers have spread red and black beans on a tattered tarpaulin to dry in the sun. A child, wearing only a t-shirt, stands on the seat of a motorcycle and leans on the handlebars. The health care workers disperse to their villages, and we head back to Thanh Mỹ for lunch, and the long drive back to Hội An.

By Austin

Blog from our new volunteer

Around the hamlet of Tịch Yên on the Bình Nam commune, the topsoil is mostly white sand. Incongruously, for Central Vietnam, it looks a lot like a light dusting of snow! Summers here are arid, little will grow, and the sand gets so hot, I’m told, that chickens must wear shoes. The truth turns out to be a little more prosaic.

Nguyễn Thị Ngân is a 45 year old farmer. Two years ago she was thrown from the back of her husbands motorcycle when he swerved to avoid a child in the road. She fell heavily, severing a tendon in her leg. A six-inch scar across the bridge of her left foot indicates recent surgery.

While she was receiving treatment for this tendon injury, tests revealed evidence of stenotic mitral and aortic heart valves.

Mrs Nguyễn says she has no memory of a specific illness – but heart valve failure is a commonly diagnosed condition in Vietnam, and is often the result of childhood Rheumatic Fever. Untreated streptococcal infection, such as strep throat, is usually the cause. Although Rheumatic fever occurs most often in children aged 5 to 15, the symptoms of valve disease may not be seen for years.

Stenotic valve disease requires the heart to pump harder, which can strain the coronary system. Untreated, heart valve stenosis can cause chest pain, shortness of breath (due to heart failure), and fainting. In a small percentage of patients with heart valve stenosis, the first symptom is sudden death, usually during strenuous exertion.

Without treatment, the average life expectancy after the onset of heart failure due to heart valve stenosis is between 6 and 24 months.

The Nguyễn family is poor. Mr Nguyễn works as an occasional farmer and itinerant laborer, and, since his wife’s diagnosis, has become the sole provider for the family. In addition to maintaining the household of four, he must generate additional income to pay the interest on a 20 million VND bank loan, which finances the education of their two children.

With a combined income of less than 400,000 VND a month, the family qualifies for medical insurance funded by their Commune. Of the 80 million VND fee for the necessary heart valve operation, insurance will cover 30 million. The family has requested assistance from the VNHIP to cover the additional 50 million VND.

The living room of the family home is dominated by a shrine dedicated to ‘Cao Đài’ – topped by an image of the ‘All-Seeing Eye’. A relatively modern syncretistic, monotheistic religion, Cao Đài stresses ethical practices, including prayer, veneration of ancestors, non-violence, and vegetarianism. When I ask Mrs Nguyễn how she maintains a positive outlook in the face of her life-threatening condition, she cites the comfort of her religion – together with the kindness of neighbors and friends, and the care and support provided by her family.

The two children both attend Quảng Nam University in Tam Ky. Her daughter is studying for a career as a music teacher, and travels the 12 km to and from school by bicycle. Her brother, an Information Technology student, gets a ride on a friends motorcycle, and arrives home from school while we are visiting. He will graduate next year. In the meantime, he works as a laborer with his father on weekends to help support the family.Before I leave, I ask him about chicken shoes. Improbably, he knows all about them (gà mang dép su – literally: rubber chicken slippers) and can demonstrate their use. Rather than considerate footwear for the bird, though, they are an ingenious improvised shackle – a restraint to keep the poultry out of the vegetable patch. 

By Austin

Training at Nam Giang Hospital

Date Apr 10th, 2014

We came back to Nam Giang for the first training for doctors at district hospital after Dr Josh came and identified the need of the hospital.  We gave talks on cardiovascular disease management, hypertension and diabetes. Even though the incidence of these chronic diseases is increasing, the doctors at the hospital haven’t treated patients with diabetes and are referring patients to the far off provincial hospital. They all were very interested in the topics and asked a lot of questions and were very eager to see our treatment protocol – asking us to come next week to teach more but Dr Josh wont be here!

 So we will come back soon to introduce the protocol and provide them with advanced information on these diseases.

Thêm chú thích

We also brought them 4 pulse – oximeters and a nebulizer which they really appreciated. They said they only have one pulse – oximeter and one nebulizer that they have to move around from ER to OR to the internal medicine department.They hope to have more to bring to Chaval clinic that is bigger than a commune clinic and covers all the high land communes far away from the hospital. We are looking for more medical equipments to help these doctors care for the large amount of patients they have.