TravelStream™ news feed for member philly427 on TravelPod's free travel blogs service http://www.travelpod.com/syndication/rss/philly427 en-us Copyright ©2009 TravelPod.com Wed, 23 Jul 2008 14:05:17 -0400 http://www.travelpod.com http://www.travelpod.com/travel-blog-entries/philly427/1/1216868640/tpod.html http://www.travelpod.com/travel-blog-entries/philly427/1/1216868640/tpod.html#comments Travel Blogs http://www.travelpod.com/travel-blog-entries/philly427/1/1216868640/tpod.html Wed, 23 Jul 2008 14:05:17 -0400 Vital Links for Humanity Vietnam Trip 2008

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Thanh Phu Ho Chi Minh, Vietnam

So I tried to order an interesting lunch today, but they were out of rabbit. Turns out they were also out of teal (its a bird), Loris (picture looked like a skunk), chameleon, venison, wild boar, pidgeon, dove, and frog...so I had to settle for grilled eel. All of these foods are commonly available in restaurants, often you can pick them out of a tank. There is alot of seafood served too...can anyone say shrimp, squid, octopus, etc for less than $4/meal?

Its actually starting to feel like the rainy season. Rained for a few hours yesterday, and until 2pm today. I actually had to buy a rainponcho from a street vendor. They are available everwhere for $5,000 dong (about 30 cents). Spent alot of time walking around gathering info for my class assignment, but also stopped in at a optometrist where I got an eye exam and new glasses for $33 total...gotta love it!

Stopped in a Mitsubishi dealership where I learned that I could walk out the door with minivan for $40,900 USD. It was only this cheap because gov't tax on cars produced in VN only have 5-10% tax. If the car is assembled elsewhere and imported, the import tax is 83% or higher, depending on the car. I've been told that a Toyota Camry is about $100,000 USD, a Lexus is $200k. Anyone who owns a car is considered rich.

Turns out construction companies here are corrupt too. Apparently a US company will start a new project (e.g. sewer upgrade) but use VN workers. As soon as the supervising engineers leave, workers stop working, even tear up their work to drag out project. On one street, they didn't remove the old sewer, just put in the new, bigger sewer pipes on top. Somehow they didn't factor in that someone might figure it out when the one side of the street was a couple feet too high....pure genious.

Spent a day earlier this week at the local medical university. All medical majors are taught under one roof and you enter med school, etc directly after HS. Nurses are taught by Doctors, with a resultant subjugation of the profession to "doctor handmaiden" status. The lack of teaching material is appalling. Most nursing textbooks are in English (unreadable to most students), and the Vietnamese ones date back to mid-1990s and are incredibly basic. The nursing professors are currently in process of translating more recent texts during their limited free time. The nursing practice lab is full of equipment that looks decades old, and lack of basic supplies forces nurses here to resort to laborious and time-consuming procedural variations.

Most of the nursing instructors are diploma school graduates, few have a Bachelors degree and only a couple have a Masters. This means that there is no capacity for training advance practice nurses or even getting the Nursing instructors trained adequately. Instructors must go to Thailand, New Zealand, Australia, etc. to earn a Masters (the minimum training for an instructor in most Western countries). Two of the instructors I worked with seemed very young, around maybe 22 years old. Another, a Medical Technologist who teaches microbiology and MT classes is 25 and has been teaching for 4 years. She teaches full time, works in the hospital lab, works in the International Cooperation office, and runs her own mini lab on the side...people here work very hard. The nursing instructors are stretched pretty thin. Our three nursing professors from ASU worked with them for 3 days and will be following up to implement Evidence Based Practice improvements and greater educational quality.

Went out for a drink last night of Che Thai, a Thai drink supposedly. I got the Che My (Che American) which consisted of angel hair noodles, some kind of huge beans, small fruits, and various flavored jello-type bits with yoghurt and crushed ice over the top..yummy sounding right? Actually wasn't too bad, but I won't be putting it on my favorite foods list.

We had our last English class/Bible study tonight and I covered part of Matthew 7, ending with the wise man and foolish man building their houses, then tied in Psalms 18 and Acts 4 where Jesus is my rock, fortress,etc. and "no other name...whereby we must be saved". We gave away most of the rest of the literature too. To liven things up we did the wise man, foolish man song w/motions and some other contemporary songs too with the guitar. It was strange to say good-bye to the friends that I just made...they all said see you next year, but I'm not sure if i'll be here next year. There is so much work to be done here, and not just in the medical arena....I'd love to come next year if God wills.

I know that this is not even the area of greatest need. In the rural areas things are much worse, in other countries conditions are more appalling. This has been a good introduction to the world outside the comparative comforts and insanely rich lifestyles of the US.
]]> http://www.travelpod.com/travel-blog-entries/philly427/1/1216291080/tpod.html http://www.travelpod.com/travel-blog-entries/philly427/1/1216291080/tpod.html#comments Travel Blogs http://www.travelpod.com/travel-blog-entries/philly427/1/1216291080/tpod.html Thu, 17 Jul 2008 07:40:07 -0400 Vital Links for Humanity Vietnam Trip 2008

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Pho Nang Ho Chi Minh, Vietnam

Second day at Peds hospital, didn't lead a class...our team was led by Tom and Carol (directors) as we taught English medical terminology and conversation. We had a good time with that, but the most interesting part of the day was touring more of the wards.

NICU: this unit is the highest level of care available in southern Vietnam, some babies get transferred here from northern provinces even. There are 30? beds, 32 nurses and 8 MDs on staff to cover all the shifts. Last year they saw 1,113 patients, shortage of nurses is so bad that one NICU nurse is often assigned 5 patients, 4 of whom are probably on vents.

Nurses have hand sanitizer next to each isolette, but don't use it. The hospital cannot affort paper towels, so washcloths are folded up and put into the dispensers. Almost no bathrooms have any sort of towels in the hospitals here...I did see ONE in the nursing office of the OB hospital. The chief nurse walked around the unit talking about the babies and touching many, didn't wash hands once. When we entered we had to put on lab coats and plastic shoe/sandal covers but noone was asked to wash their hands. We didn't touch any of the babies without first washing. Supposedly Infection Control dept in hospital runs all nurses and MD through training 2x/year.

We saw oophalocele, many congenital heart defects (CHD), babies with multiple CHD and TEF (hole between esophagus and trachea). So many things I've only seen in texbooks are common here. Most of the babies were on vents, some only on CPAP or puffer. Smallest baby I saw was 800 grams. The Ministry of Health supplies equipment and only gives this unit 5 disposable pulse oximeters/month, so they rely on donations from NGO's like us (we brought a bunch). Many of these tiny babies have adult-size reusable clip-type oximeters on their feet as there is no other option...this results in very unpredictable readings. Families are not allowed to stay in this ward, they can visit every 12 hours for a short time.

Neonatal Special Care Unit: Kids here are graduates from NICU, many have had surgery. Simple CHDs can be fixed here, but not until the neonate hits 6 kg. Complicated CHDs are treated with supportive care until they die. We didn't even have to put on shoe covers in this department. Like the NICU there was a separate section for isolation patients, however there were 4 cribs/warmers in the same room.

PICU: Sickest children >1 month old (post normal gestation) are treated here. There are 28 beds (none of which have side rails (in fact don't think I saw any in hospital except maybe ER), most of which were together in the main room. Common illnesses include Dengue fever (this is the season and there is an epidemic this year), congenital heart disease (VN has very high rates, no one sure why), pneumonia (CHD increases susceptibility), snake bites, bee swarm attacks, and sepsis. Bee attacks get so bad that they have to do dialysis to remove the venom from the blood. There was a burn patient in an isolation room who was about to graduate to the burn unit. Other Isolation room I saw had two patients and family members inside (no PPE visible). Encephalitis due to various viruses is common and leaves permanent damage (hypertonia, MR, etc). Mosquitos and infection from rivers is common source. The hospital also receives many orphan children from the city orphan center who have Chlamydia pneumonia. This is usually treatable but no one can seem to find how it is being transmitted within the orphan center, so the problem continues. Family can stay with the children in this ward during the day and many will sleep in a hospital courtyard or hallway at night as they are are impoverished and/or from provinces over 50 miles away.

We took a quick walk around the outside of the hospital to assess the surrounding community, and as we walked back in got a look at the outpatient clinics. Waiting rooms are just lines of attached plastic chairs outside, most under a roof of some sort. Patients had to take a number. Walls on the outside of the hospital buildings are painted with disney scenes, but inside walls are all blank white. All the units have a very cold and sterile feel to them. Some of our team members suggested that they put health teaching on these walls as there are literally hundreds of family members who sit around in the hospital complex all day...not to mention the families of the 5,000 daily outpatients. There are few resources for doing public health teaching in the community and little time for proper discharge instructions. There are little merry-go-rounds and carnival-type rides for the children in the compound also, but pretty sure u have to pay.

Got more feedback on our classes yesterday. They want us to teach more about assessment next year and do more case scenarios and hands-on practice. NICU chief nurse told me she'd like to bring more nurses to the US for training as there was no time or resources for proper training here. Throughout the day, almost every nurse and even a few doctors asked me if I would be back next year. Lord willing I'd love to return to help out, will have to pray about it and see how God leads.

The nursing professors on the team are already busy making plans for next year. A couple have written textbooks or at least textbook chapters and will push the book manufactureres to produce editions in vietnamese. They are also going to point the nursing leadership towards online free translation websites. According to the NICU chief nurse, there is only one publishing company that prints medical textbooks in Vietnamese, and they only do it for one medical school. VN nursing textbooks or journals are nonexistant. Teachers develop their own curriculum from their knowledge or whatever materials they can get their hands on. No wonder nurses are still "doctor's handmaidens" here!
]]> http://www.travelpod.com/travel-blog-entries/philly427/1/1216259700/tpod.html http://www.travelpod.com/travel-blog-entries/philly427/1/1216259700/tpod.html#comments Travel Blogs http://www.travelpod.com/travel-blog-entries/philly427/1/1216259700/tpod.html Wed, 16 Jul 2008 11:54:20 -0400 Vital Links for Humanity Vietnam Trip 2008

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Pho Nang Ho Chi Minh, Vietnam

Taught Pediatric Advanced Life Support at Saigon Pediatric Hospital #1 today. This hospital is like a little village, complete with little shops and patient laundry hanging outside the buildings. They are not kidding when they say the family can stay with the patient. In an orthopedic ward where we handed out beanie babies we had to step over and around siblings and parents who were sitting on the beds and floor. There were 6-8 beds in a room, no one wore gowns, and family walks in an out as they wish. Many of the families were sleeping on thin mats in the courtyard and had temporarily moved into the hospital complex to live. The hospital has 1000 patient beds, and some patients share beds. Outpatient is 5000 kids per day, kids under 6 are free, max age is 15.

Dads of children sat along the floor of halls outside the burn unit, where the kids were 6 beds to a room and almost all tied down stretched out on the bed. There is nothing to look at except the white walls and ceiling, other patients, and anyone in the hall outside. Most were completely naked except for bandages over their burns. Alot of kids get burned by knocking over the big cooking pots that are on fires or stoves near the floor I guess. We had to gown, put on hairnets, masks, and change into hospital sandals to enter, but there were no gloves in sight and noone asked us to wash our hands. Nurses did not seem to wash hands either.

One child was on nine IV drips/medications and was intubated. A nurse was assigned to provide ventilations by hand with a bag-valve mask as there are not enough ventilators...usually the family is trained and assigned to do this around the clock. We bring bag-valve masks with us every year as there is a severe shortage and they get reused after a patient is finished. Apparently some families fight over access to a bag-valve mask.

I got a chance to check out the emergency room and was pleasantly surprised. It has 5 beds, 2 baby beds, and an ICU holding room. One room off to the side is the training room complete with mannequins and seems pretty well set up. There is a Broselow-type peds crash cart with color-coded drawers for different sized children and common equipment sizes for that child size. They saw the design on the internet and had it locally produced as they cannnot afford the incredibly expensive genuine article. The one old defibrillator in the department only has the old paddles and is an adult model.

We covered some of the more basic material in Advanced Life Support (by American standards). The ICU doctor who was translating said most of the material was new to the nurses. We covered a review of CPR, management of endotracheal tube placement and troubleshooting, Intra-osseus needle insertion (ok...even alot of US MDs and RNs are scared to do this one even though safe and easy), a structured approach to assessment of life threatening emergencies, and the resuscitation team concept. We also went through 2 case scenarios where the nurses had to apply the assessment skills in an organized manner.

Some of the more experienced members of our team said that the material was a little above these nurses' level of training. Nurses here are very limited. There is no certification or licensure available, and they are often not expected to know basic assessment and management of intubated patients. The head nurse in the NICU asked me at lunch who can put in IO needles, which they do use sometimes here. In the states, the expectation is that MD, RN, EMT-P can all put it in, but in my experience only paramedics put them in. In peds hospitals the MDs probably do too. I would be very surprised if nurses in VN are allowed to insert IOs any time in the next decade, but at least some will hopefully be more comfortable with managing them once placed.

When we did the assessment piece the nurses ate it up...some were taking note furiously despite having some of my lectures translated into VN ahead of time and side-by-side with the english on the handouts. They especially liked the video scenarios with real patients we put them through to practice preliminary problem categorization and emergency treatment.

One of our Ph.D nurses on the team (Susan) taught Kangaroo care in the NICU while I was teaching in the classroom. Apparently the nurses here are not taught that babies will lose heat if not kept warm...thermoregulation is only taught to MDs. Basic, basic things are missing in their education...we will bring this up when we visit the BSN program the the medical school.

There are no nurses aids, respiratory therapists, etc here it seems, have only seen MDs and nurses in the wards. People go straight into their medical training after high school, bachelors degrees are rare...most graduate with a diploma and that is enough.

About 15 showed up for English class tonight and we covered the same topics as last night. One of the MD's brought a few nurses and most of our usuals were there, some who have known our mission leaders for 10+ years. More took teaching materials from my dad's work home this time, and we went a little late due to doing some singing and dancing (chicken dance...painful). One of our VN regulars also organized a massive, hilarious game of Simon Says.

Tomorrow we are back at Peds to teach Biomedical ethics and English. I hope to see the NICU and some of the other wards. I also need to start on my Community Assessment project for nursing school. Hopefully will see more of Saigon soon as one of the English teachers who brings her students to our classes wants to take me out on the town with all of them.
]]> http://www.travelpod.com/travel-blog-entries/philly427/1/1216164600/tpod.html http://www.travelpod.com/travel-blog-entries/philly427/1/1216164600/tpod.html#comments Travel Blogs http://www.travelpod.com/travel-blog-entries/philly427/1/1216164600/tpod.html Wed, 16 Jul 2008 06:52:03 -0400 Vital Links for Humanity Vietnam Trip 2008

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Pho Nang Ho Chi Minh, Vietnam

Had a small English Class/Bible study today with some teen folk. One was teaching me about the heritage of VN via postcards he had bought showing Halong Bay, the Mekong Delta and the Imperial City...really cool stuff. Halong Bay is featured in alot of movies that want an exotic shoot. We also discussed traditional music and clothing, including the "ao dai" (pronounced ow y'eye) long flowing outfits that women wear. Apparently all high school girls must wear them on Mondays. In the old times only rich women could afford them so it is somewhat a symbol of higher status..now education. Students must wear white (symbol of purity/virginity) but school teachers can wear colored. Men's version of course is baggier for comfort while women's are tighter and as my student described it "charming". I can hear the women's libbers screaming across the ocean.....

We had a very good study on the birth of Jesus (they have only heard of "Virgen Mother") and Paul's discourse on Mars hill. They had never heard of the Jewish religion, no idea what I was talking about when I mentioned it. Their lack of knowledge about world history was on some levels shocking, on some levels expected in a communist country. They were more familiar with Buddism and Islam, there are many mosques and temples here in our neighborhood and throughout Saigon. There is a Baptist church up the street and a Catholic cathedral downtown, so there are some Christian chuches..not sure if SDA's still have much presence here, they evacuated out their hospitals around 1975 when Saigon fell. At the end they asked for me to summarize everything, so I gave them the simplest overview of Bible and God's plan of salvation that I could in about 10 minutes. The rest is in His hands... there will be another study tomorrow night, but these kids will not be back due to work conflicts.
]]> http://www.travelpod.com/travel-blog-entries/philly427/1/1216072680/tpod.html http://www.travelpod.com/travel-blog-entries/philly427/1/1216072680/tpod.html#comments Travel Blogs http://www.travelpod.com/travel-blog-entries/philly427/1/1216072680/tpod.html Wed, 16 Jul 2008 06:30:12 -0400 Vital Links for Humanity Vietnam Trip 2008

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Pho Nang Ho Chi Minh, Vietnam

Visited Hung Voung Public OB hospital today. Some interesting stats as shared by the hospital director Dr. Thach:
-800 liscensed beds
-942 actual beds (extras are in hallways to avoid putting 2 pt/bed)
~150-160 MDs on staff
~300 midwifes
~600 total midwifes, nurses and technicians in all
-33,000 babies delivered last year
-average 80-100 babies/day delivered this year (slower than last year)
-1/3 of pregnancies are high risk: mainly precclampsia/hypertension
-30% of deliveries C-section (Saigon as a whole has 35% C-section rate)
-private hospitals have 70% C-section rate
-120,000 babies delivered in Saigon annually
-Ministry of Health does not permit elective C-section in public hospitals, so surgeons must justify each case
~100 abortions/day in this hospital (surgical D&C and medical:IV fluid forced into uterus until labor is induced, delivered baby (often around 7 months gestation) is left to die)
-IUD most common birth control method..usually left in about 4yrs avg. in cities (longer? in rural)
-HIV rates slowly increasing
-Gov't has set up volunteer testing centers for HIV
-almost all patients at this hospital are HIV tested

Hospital architecture is open design, only necessary areas (delivery rooms, nurseries) are enclosed. Many post-partum patients are in open-air hallways for the 2-3 day stay after delivery. Others are in rooms off the hall with 3 beds/couplets per room. Most of the walls are very dirty, and conditions are very crowded, with family of the mother-baby couplet present to help out. Waiting rooms for family were good sized, often outdoors. Lines of sleeping bats can be seen up in the eaves of the hospital courtyard.

Paying and nonpaying moms have separate antepartum, delivery, and postpartum areas. Delivery rooms have a wall down 70% of the middle with two delivery beds on each side. Each delivery area had about 11 women actively delivering. Women are mostly silent during delivery and are attended by a doctor or midwife and some nurses or technicians. We had to put on long lab coats, face masks, and plastic bag shoe covers before entering delivery room on paying side. Nonpaying side had no face masks and we changed into sandals. Women generally stay 2 hours in delivery room after birth, then go to the crowded postpartum room for 4 hours before being moved to bed where they will stay until discharge. Babies get mom's name written on leg with permanent marker to avoid mixups.

In the neonatal unit some isolettes had 2 babies...one room had a line of abandoned babies. It is common for babies with birth defects such as cerebral palsy to be abandoned...this hospital gets about 15 babies a day. If defects are found during antenatal care it is common to get an abortion.

About 500 women are seen per day at this hospital, only about 100 women a year attend childbirth classes due to lack of instructors and people not wanting to miss work to attend as classes are in the early afternoon. Alot of the teaching materials we saw were "Johnson's baby"...provided by good old Johnson & Johnson.

Our group presented lectures on the "March of Dimes" prenatal education class curriculum (we gave them a copy of the entire curriculum, they will have to translate it), prenatal care in the UK (by our British medical student), late preterm baby care, and OB Stat team implementation to promote faster treatment babies who become acutely ill. Tomorrow we will cover English for the healthcare provider and have a English conversation class.

Must go eat now..btw they fed us at the hospital Can tin (canteen) and they had the most amazing spring rolls that we dipped in a fantastic sauce. Also had a red-broth beef and potato/vegetable soup into which we dipped awesome french bread. The meat we dipped in little dishes of salt/pepper mix that we squeezed fresh limes over. There was also a seafood soup and angel-hair rice noodles. We stuffed ourselves, then retired to a conference room to nap in reclining lawn chairs for an hour before starting class.

9 pm: PS- had frog stir fry for supper at a nicer restaurant called Hoang Yen. There is nothing exotic about frog! It tastes exactly like chicken and is a pain to eat cuz there's a million little bones to pick the meat off of. It was a good yellow curry dish though. Oh yah, one of the ladies ordered red wine....it came chilled and in a small glass filled to top. They have no idea how to serve wine here. The guave juice was just fine though. There was a waiter standing next to our table at all times, just waiting in case we needed anything. When I picked the mushrooms out of my dish, he leaned over and started helping...just a little weird.
]]> http://www.travelpod.com/travel-blog-entries/philly427/1/1216001160/tpod.html http://www.travelpod.com/travel-blog-entries/philly427/1/1216001160/tpod.html#comments Travel Blogs http://www.travelpod.com/travel-blog-entries/philly427/1/1216001160/tpod.html Sun, 13 Jul 2008 11:28:26 -0400 Vital Links for Humanity Vietnam Trip 2008

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Ho Chi Minh, Vietnam

This afternoon we had a birthday party for two young girls who have been sponsored by Americans. They live in the slums of Saigon and their house is two floors, each smaller than my hotel room, only about 10' by 10'. The stream running past the little alley they live off of is so polluted that the dirt near the water is stained black...the water is oily looking, but some reeds and plants have somehow managed to adapt to the sludge.

After a dinner of Xi Muoung (red, dried plum with salt and sugar drink) and a shrimp soup with bean sprouts, okra, hot peppers, tomato, and pineapple (surprisingly good), we had our second English class (Bible study).

Mary, a 4th year Med student from Britain, put together a study on the story of Naaman in 2 Kings 5. She drew pictures to help with the translation, and I looked up a VN Bible online so they could read it out loud in their native tongue too after reading around the group in English. After the story she wrote out two main points about God's love for all people great and small and God's desire to use us, no matter our social station. References: Joel 2:28-29 and Acts 2: 38-39. New words we had to explain were: warrior, mighty, repent, baptized, gift, prophet, and names and places in the story.

Some of the students seemed to really understand, one was interested enough to get the address of the church we went to this AM. Several took materials we had brought in VN. I added extra classes onto the schedule as there is desire for more by a few of the young students.

Tomorrow I get my first look at a large hospital in Vietnam!! This one is OB/GYN and several of our nurses will be teaching there. Incidentally, as with many countries, nursing is a very low status occupation in Vietnam. I have been aware of this for some time and expected it here, but had been curious to see how people here would express that viewpoint. Most have been pretty neutral, probably to be polite (almost certainly our status as Americans affects things too).
]]> http://www.travelpod.com/travel-blog-entries/philly427/1/1215966120/tpod.html http://www.travelpod.com/travel-blog-entries/philly427/1/1215966120/tpod.html#comments Travel Blogs http://www.travelpod.com/travel-blog-entries/philly427/1/1215966120/tpod.html Sun, 13 Jul 2008 01:55:16 -0400 Vital Links for Humanity Vietnam Trip 2008

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Ho Chi Minh, Vietnam

Today we went to an evangelical church in Saigon for morning service. They run 3 services on Sunday, a gospel service on Thursday night, and some worship services on Friday and Saturday nights. The service was very similar to an American church, complete with projection screens for scripture and hymns, a worship leader, announcements, prayer requests, memory verses for the week (Psalm 103: 1-2 this week). The church was packed! They run a video camera and project the service onto screens on the third floor as there is not room for everyone in the main room. The main room has seating for about 230 people, and the back corner has seating for English speakers, complete with headphone jacks in the pews so we can listen to the English translation via the provided headphones. Bottom floor has 7 rooms, some were being used for Sunday School, I saw at least 4 in use..about 15+ kids in each. One of the pastors mentioned during the service that there are over 100 young people in the church (assuming meant teens, young adults).

I recognized at least 3 tunes of hymns, one was "Blessed be the Lord, God Almighty". It brought tears to my eyes to witness the Lord's name being worshipped and proclaimed clearly in this nation. The gospel was clear and 4 new believers were welcomed and prayed for this week.

The topic of the main sermon was Manna with Thematic Verse: "Moses said to them, "It is the bread the LORD has given you to eat" Exodus 16:15b." The pastor focused on how precious God's word should remain to us even now that millions of Bibles are permitted to be printed. We need daily spiritual feeding to stay close to God and value His teachings.

After the service I was able to talk to one of the pastors and he told me about the family in the church. The authority figures in the church do alot of traveling, even attending conferences in the US. The more mature, bigger brothers make sure to have a presence in each church and make sure to meet foreigners and keep an eye on their well-being as they travel, especially making sure they don't lose any of their documents in public. It is good to know this to avoid any travel problems.
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