In September of 2017, I went for a week to Can Tho Children’s Hospital in the south of Vietnam with the group IPSAC (International Pediatric Specialists Alliance for the Children of Vietnam). Our mission was the first time IPSAC was going to Can Tho, and the goal was to evaluate and make recommendations on how to strengthen the pediatric surgical program at Can Tho Children’s. This trip was also special as it was the first time two pediatric surgical nurse practitioners (both sponsored by OneNurseAtATime) had gone on a trip with IPSAC at the same time. The goal of the organizations founder Dr. Holterman was to try to involve nursing care in the pediatric surgical care of the patients in Vietnam for a more multidisciplinary, holistic, family focused practice model.
At the hospital, the local nurses and administration were welcoming. They were eager to know how we “did things in the U.S.” and were eager to improve their nursing care with new information and techniques. The nurse practitioner role is not one seen in Vietnam, and the more traditional nursing role is largely dictated by the physicians. For example, in a lecture we (myself and the other pediatric surgery NP) gave to the local nurses on staff (see picture 6), the nurses asked us when we were addressing how to do a simple dressing change with aseptic technique why we did not use betadine to clean the granulation tissue. When we explained that it was not needed the nurses said that they always did this as directed by the physicians and they would not be able to change their practice unless the physicians gave a new up to date order. This highlighted to me the hierarchy established and the need for up to date evidenced based care, which were themes I saw repeatedly throughout the trip.
In addition, there were the usual issues you would expect in a developing country. These included a lack of supplies (Like in photo ), like ostomy bags and lack of resources (for example the nutritional specialists in the hospital could only consult on what to eat but they did not actually provide meals for the patients and there were no medical social workers). However, as always, parents were dedicated and traveled miles to the hospital to get care and then lived in the hospital with their children (often times sleeping on the floor). They were also ingenious in giving the best care they could in the given situation (the mom of the child featured in photo made him home made ostomy bags out of a feminine napkin and a toy plastic ring and condom).
However, through all of this the spirit of the people is of course what grabbed me as everyone we met at the hospital worked so hard, was so grateful for any suggestions, eager to learn more, and were trying to do the best with what they had. I got to interact with young medical students in training and the younger doctors especially were open to new ideas. In general, the medical professionals (doctors and nurses alike) are very well trained on how to operate, but do so with basic operating instruments and equipment. Highlighting this trend as well the hospital itself has 14 operating rooms, but is only able to operate 4 of them due to equipment, and often medical professionals have to work in addition in private practice in order to make a living while also working at the local government hospital. So I had to admire their dedication.
Finally, the themes that I came away with was that education can definitely help bridge the gap in places like Vietnam when it comes to healthcare. I think this trip especially also highlighted for me the importance of working within the system, being creative and critically thinking about how to use health care resources. They do not need us to change their health care system, but rather organizations like IPSAC can bring them up to date information, help them learn new skills and techniques, and therefore help them provide top of the line care in a place where resources are not always the top of the line. Again, the wonderful, kind, hardworking spirit and eagerness to learn was pervasive. The children were of course adorable, and the staff open to working with us. I could not have been more grateful for this chance to travel, learn, and help, and thank OneNurseAtATime for making it possible. Trips like these are so important to the wellbeing and health of our global community and I hope to continue to advance my knowledge and practice in global health in the near future, one nurse, at a time.