Not in Kansas anymore, that's for sure
Trip Start
Jul 09, 2008
1
6
7
Trip End
Jul 26, 2008
Pho Nang Ho Chi Minh,
Vietnam
Thursday, July 17, 2008
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!
