In 1999 Dr David Brumley Traveled to:
Cho Ray Hospital and Dieu Duong Hospitals in Ben Tre Province, Vietnam

Dr David Brumley
Medical Director of the Gandarra Palliative Care Unit in Ballarat, Victoria, Australia

Highlights

The lasting result of Dr Brumley’s visit is the development of a training training course in palliative care for physicians and nurses from many hospitals. It will be offered at cho Ray Hospital in May 2000.

Cho Ray staff

A meeting in Hanoi is planned for Y2000 to improve access to opioid drugs for palliative medicine.

Dr David Brumley

Click photo to view larger image

Read excerpts from her report

Read full report

Excerpts from his report

"The Fellowship funded my visit to Vietnam to review the results of previous teaching in Ben Tre Province and to plan teaching for the future.

I travelled with several palliative care nurses to teach at Nguyen Dinh Chieu Hospital, Ben Tre Province. After a five-day workshop, we met with medical school staff to discuss palliative care teaching, and how to form infrastructures at hospital and community level. Dr Vu, Director of Medical Aid for the Province, agreed to form a palliative care team within Nguyen Dinh Chieu Hospital.

Elaine Magruder of Volunteers International and I became involved in a project to develop palliative care in Cho Ray Hospital. We explored the development of inpatient palliative care at Dieu Duong Rehabilitation Hospital. At Dieu Duong there is need for training in AIDS, malignancy and care of severely injured patients.

We agreed to return in another year to train medical staff in Ben Tre Province, at Cho Ray Hospital and at Dieu Duong Hospital. The course will include general training in pain and symptom control in progressive disease, and there will also be training of volunteers in community care.

Following a visit to Australia in October 1999, Dr. Ha will become palliative care physician attending Cho Ray hospital, and will begin to develop an inpatient service at Dieu Duong Hospital.

Good palliative care is difficult in Vietnam as It is hard to access opioid analgesics. After our discussions with government authorities, a meeting in Hanoi is planned for Y2000 to improve opioid access for palliative medicine."

Full Report

REPORT TO IAHPC ON A PALLIATIVE CARE VISIT TO VIETNAM, MAY 1999

INTRODUCTION

This report is provided to IAHPC, who funded my visit to Vietnam for the purposes of reviewing past teaching, planning further teaching and assisting in the promotion of palliative care at Cho Ray Hospital and the development of an inpatient palliative care unit at Dieu Duong Hospital. I sincerely thank the IAHPC for their assistance and financial support.

BACKGROUND

In May and June of 1998, with the support of Volunteers International , I travelled to Vietnam with two Australian palliative care nurses to teach at Nguyen Dinh Chieu Hospital, Ben Tre Province. Before leaving, we translated a series of short articles on palliative care subjects, and provided copies of this to all participants in the course. We ran a five day workshop to a group of 25 nurses and doctors and one pharmacist, teaching techniques of symptom control, social and psychological aspects of care. We gave practical demonstrations of pain relief by seeing patients in the ward of the provincial hospital, district hospital and in patient’s homes both in the city and in the hamlet. We held a one day meeting with the senior staff of the medical school of Ben Tre Province, discussing ways of teaching and promoting palliative care. We also discusssed possible ways of forming infrastructures to begin a palliative care programme at hospital and community level. We held a meeting with the Director of Medical Aid for the Province, Dr Vu, at which he agreed to the formation of a palliative care team within Nguyen Dinh Chieu Hospital.

I was interested to return and review progress, and also, together with Elaine Magruder and Volunteers International, to become involved in another project to develop and implement palliative care within Cho Ray Hospital - a large acute hospital in Ho Chi Minh City - and also to discuss a proposal for the tandem development of an inpatient palliative care unit at Dieu Duong Hospital - a rehabilitation hospital nearby.

PROJECT 1 - BEN TRE

Elaine Magruder, Germaine O’Dwyer and I returned to Nguyen Dinh Chieu Hospital for one day and met with several medical and nursing staff members who undertook the training last year. They had implemented some small changes in practice, such as using morphine regularly and using pain charts. They were keen for further training and proposed a plan for:

1. Teaching doctors working in the community as well as in the hospital, as most patients return home to die.

2. Increasing the practical demonstration of techniques and approach to care by spending more teaching time at the bedside.

We then discussed these plans with Dr.Phan Song Vu, the Director of the Medical Aid Office of Ben Tre Province, and Dr. Vo Van Minh, Deputy Chief of the Provincial Red Cross Society, who agreed to the following:

Agreements Reached with Medical Aid Office, Ben Tre Province

1. Staff will evaluate last year’s course and this evaluation will be used to define the course content for the proposed teaching next year.

2. A curriculum and daily schedule for teaching will be developed by Dr. Brumley on receipt of feedback and submitted as soon as possible for approval by the authorities.

3. The teaching will be for doctors and nurses together.

4. The general content to include pain and symptom control in progressive disease.

5. The teaching will be practical and extend outward to Community and Local and District Hospitals.

6. Elaine Magruder will return early in late 1999 or 2000 to begin training of volunteers under the auspices of the Red Cross.

7. Volunteers International will fund the provision of a teacher in English to hospital staff.

PROJECT 2: CHO RAY HOSPITAL

Cho Ray is the largest acute hospital in Ho Chi Minh City, and is administered by the Central Government. A series of discussions was held with Dr. Hoang Hoa Hai, Chief of the Training Department at Cho Ray. He explained that a Cancer Unit of about 40 beds had been approved by Government. A purpose built building was required, but in the interim scattered beds would be available. Volunteers from the medical staff of the hospital from areas including general medicine, haematology and surgery had been approached. He wishes palliative medicine to be an integral part of this team from the beginning.

Agreements Reached with Cho Ray Hospital

1. Dr. Brumley and a nurse team will return in May 2000 to provide a training course in palliative care. This course will be broad and with an emphasis on pain control, and will bear in mind that the commonest cancers seen in that hospital are lung, brain, hepatocellular carcinoma of liver, stomach, colon and leukaemia.

2. There is concern about overload of this proposed facility, and therefore this training course should include staff from the Dieu Duong Hospital, as below, and also possible training of volunteers in community care.

3. Elaine Magruder will investigate the possibility of a fellowship for one doctor at M.D. Anderson Centre in Houston.

4. Dr. Brumley will remain in contact with Dr. Hai by e-mail and develop the content of the teaching material and necessary translations before returning.

5. All teaching material will be congruent with the previously developed Asian Palliative Care Curriculum.

6. That Cho Ray Hospital would become members of the IAHPC.

 

PROJECT 3: DIEU DUONG REHABILITATION HOSPITAL

Dieu Duong is a large rehabilitation hospital with responsibility for the continued care of those discharged from acute hospitals, as well as a responsibility for outpatient care. There is a large proportion of head injured patients, their injuries caused by motorcycle and bicycle accidents. There is also a group of AIDS patients requiring care. We met with Dr. Do Quang Cuong, Director, Dr. Nguyen Huu Khan Duy, Vice Director, and others. They requested assistance with the development of an inpatient palliative care facility within the hospital, expressing a need for training in the areas of AIDS, malignancy and also of the care of severely head injured patients. We had several further discussions with Dr Duy.

Agreements Reached with Dieu Duong Hospital

1. That Dr. Bui Thi Hong Ha, currently working in the Endocrine and Gastrintestinal Diseases Department of Dieu Duong, would be provided with English language training by Ms. Naomi Weaver, an American nurse currently working in Ho Chi Minh City. Funding for this would be provided by Volunteers International and further supported by $US100.00 provided by IAHPC.

2. Dr. Ha would then visit Australia in October 1999, spending time with Dr. Brumley and others, and attending the Palliative Care Australia conference in Brisbane before return to Vietnam.

3. Dr. Ha would then become the palliative care physician attending Cho Ray hospital, and would begin the process of development of an inpatient service at Dieu Duong Hospital.

4. Dr. Brumley, together with nursing staff from Australia, would provide staff training together with that proposed at Cho Ray above.

OTHER MATTERS

1. There are many administrative difficulties which impede the provision of good palliative care to patients in Vietnam, and prominent among them is difficulty of access to opioid analgesics. Elaine Magruder is currently working towards a meeting in Hanoi next year - perhaps to coincide with the training above, and to which it is hoped some medical input will be able to be provided.

THANKS

I extend my sincere thanks to the IAHPC and in particular to Dr. Roger Woodruff, and also to Volunteers International and Elaine Magruder for the support provided for this travel and the opportunity to assist in the development of appropriate palliative care services in Vietnam.

Submitted by: Dr. David Brumley