By Kevin Crimmons and Karen Evans
In June Kevin Crimmons and Karen Evans travelled to Vietnam to speak at the Vietnam Theatre Nurses Association Conference, at Hue. The theme of their key note lectures was quality, safety and efficiency and how to balance this with care and compassion for the benefit of patients. The conference was attended by 300 perioperative nurses and consultant and junior surgeons from around the country. This is the Associations only national conference, and gives perioperative nurses an opportunity to share best practice, research and discuss potential service development with their colleagues and surgical leads. The visit included visits to Viet Duc Hospital in Hanoi and Quang Ninh Provincial Hospital in Halong Bay, where Karen and Kevin were able to observe at first hand and discuss with the nurses and doctors the challenges of clinical care delivery in the Vietnamese acute care setting.
The hospitals contrasted greatly from the inner city, Viet Duc with 500 inpatient beds, and 18 operating theatres. It is one of the leading centres for trauma in the country, particularly head trauma, and specialises in ‘septic’ surgery e.g. patients with TB and other chronic infectious diseases. Whilst 500 beds are not notable in comparison to large UK hospitals, it should be noted that length of stay is significantly shorter, so patient turnover is higher. Although not apparent at Viet Duc, bed-sharing is common in many hospitals, with a recent measles outbreak causing reports of 3-4 children in a bed. This is partly to do with the complex and expensive healthcare funding system within regions, and the chronic lack of hospital beds, approximately 20 beds per 10,000 residents, however hospitals are concentrated in the main cities, and travelling 100’s of kilometres and selling worldly goods to fund treatment is not uncommon.
Whilst in Hue, we were lucky enough to be serenaded on an evening boat trip along the Perfume River during a local River Festival
Quang Ninh, by contrast is a larger DGH delivering care in a beautiful tourist setting; Halong Bay where the population doubles during the holiday season. It is built around an old colonial hospital and is in a beautiful position overlooking the Bay. As well as providing acute care, what was apparent was the primary care function that this hospital fulfilled for its local population. The lasting memory was of visiting the Emergency Department, which was confined and small by western standards for the size of the hospital/population, in contrast with the co-located triage and pharmacy areas which had at least 15 bays each. There is no funded community healthcare system in Vietnam and increased outpatient numbers were notable, and those attending appeared more unwell (and patient) than those we would traditionally see in the local GP surgery; perhaps having delayed travel or treatment due to socio-economic impact.
Most notable throughout despite the different catchments and population demographics was theconstant presence and involvement of families in hands-on patient care, even in Intensive Care where relatives provide all non-technical care.
In both hospitals relatives outnumbered Viet Duc the family room, which sadly we did not photograph, was 600 bunk beds in very cramped and spartan surroundings; for which relatives were charged 1 Vietnamese Dong per night. The relatives stay in this accommodation for the duration of the patients stay, if they cannot afford to rent a fold-out bed to sleep beside their relative, which in some cases can be weeks. Although cheap to us, in households with average income under VND 3,120,000 per year (equivalent UK £ 90) are regarded as poor households.
Nursing Management “Suite” Viet Duc- 1000 nurses are co-ordinated from this office by 4 Nurse Managers, who also arrange and deliver all training and development.
Vietnam has not had the luxury of developing innovation alongside development of its health infrastructure and workforce, unlike those of us in Europe and it was fascinating to observe the advanced surgeries and interventions which are provided in both hospitals without what we may feel are necessary supportive frameworks e.g. physiotherapists. Viet Duc for example performs over 800 open heart surgeries annually. After discussing this with both medics and senior nurses, the challenge is developing a workforce with the expertise to support patients throughout their journey; however, the commitment to this is high and both the medical and nursing workforce actively are seeking to improve care delivery for the benefit of their patients. It was both a stimulating and rewarding experience, the passion and enthusiasm shown by the Vietnamese nurses for learning with and from us, and about our practice was exciting and humbling.
A VERY early boat trip around Halong Bay (this is about 6 am) with staff from Viet Duc and Quang Ninh plus our very own Joy Notter
View from Quang Ninh Provincial Hospital