Two years ago a REI team visited the Women’s Hospital in Hanoi, and sought to introduce and encourage certain practices with newborns, such as skin-to-skin, where the newborn is placed on the mother’s chest immediately after birth, as well as encouraging breast feeding. There was also encouragement of meeting with new mothers for instruction on early child care, delaying the first bath, and encouraging the use of mother-child ID bracelets.
When members of our team visited Women’s Hospital this year, they found that virtually all of the suggestions and recommendations made two years ago had been put into practice. When Dr. Elaine Goehner, our Team Leader, saw the vast improvement over two years ago, she was literally moved to tears. These were exactly the changes hoped for and encouraged—and it had happened. Healthier babies. Healthier mothers. Less risk of a mother-child misidentification. We are gratified to see these improvements, and Women’s Hospital is only one of our healthcare venues.
This year’s Team was composed of five members, led, as always, by Dr. Elaine Goehner, and accompanied by long-time volunteer Kathie Cowie, Dr. James Miser, and first-timers Dayna Holt and Kate Stonecipher. Dr. Aja Lesh, Dean of the School of Nursing at Azusa Pacific University, also joined the team for several days midway through two-week period of service. Kathie Cowie actually served for a much longer period of time. She was the first to arrive, working for three weeks at the Hanoi Medical University (HMU) and then at Viet Duc Hospital (the premier surgical hospital in Hanoi) for another week before leaving for Nepal to join another REI medical team there.
Kathie, pictured at left below, describes her recent investment in Hanoi as follows: “During my time at HMU I worked almost exclusively with five young nurses in the ICU. They were chosen by the leadership as being the best nurses who could work with me and in turn would be responsible for teaching their peers. I worked with them daily, focusing on patient assessment and standards of nursing care. Several of the doctors also joined in daily and asked many questions. Three of the doctors have expressed a desire to write letters to my hospital leadership here in Canada to ask for support to allow me to come back. At the end of our three weeks together I met with my young nurses to review our time.
"One of them, Huyen, said, ‘You have inspired me. Until now I have been going about performing tasks like a robot day after day, but I see how you focus on the patients and I want to be like you.’ Ngoc said, "Before you came I didn't know that my knowledge was limited. You were the first person to work beside me and teach me that I can do more. I think there is no one else like you in Vietnam and I wish you could stay.’ The five young nurses and I are now members of a Facebook group, and plan to continue to work together through that medium until I can return to work with them again next year. Just yesterday I received an email from Ngoc asking for help how to teach the other nurses in the department about proper nursing assessment and hourly monitoring as we discussed. They plan to change their charting based on what I have shown them starting in November.
“At Viet Duc I continued the third year of a five-year MOU for Nursing Champions. I have worked with many of the nurses for several years already. This year we focused on individualized patient care plans. Each day we chose a patient from a different ICU within the hospital and discussed the patient at length, going beyond the basic care they are now providing to focusing on International Standards. By the end of the week they were beginning to ask questions that showed understanding of autonomous critical thinking skills and not simply routine or tradition. One of the greatest challenges nurses face in Vietnam today is breaking out of the traditional role of "doctor's helper" and moving forward as a recognized and respected profession. On my last day, the nurses at Viet Duc and I decided together to write a paper about this issue and began the process of writing an abstract that we plan to finish in the next 4-5 months about the Challenges of Becoming a Profession (title to be finalized later). So far we haven't decided if we will attempt to publish this or present it at a conference, but will continue to work together on a plan for the future."
While Kathie served at HMU and Viet Duc, the other members of the team invested most of their time at National Children’s Hospital (NCH, formerly called the National Hospital of Pediatrics). REI enjoys a remarkable relationship with NCH, in part due to our ties with Azusa Pacific, where Dr. Elaine is a professor in the School of Nursing. A few months ago APU sponsored an 8-week Leadership Seminar and two of our good friends at NCH, Cao Thi Hoa, the Head of Nursing, and Bui Thi Thuy, the Deputy Chief Nurse, were both able to attend. They learned much and their relationship with Dr. Elaine and with Dr. Aja also greatly deepened. As a result, the doors swung wide open for our team, and Dayna and Kate spent many hours making rounds with the hospital doctors and nurses in the different Intensive Care units and in the Emergency Room, observing, encouraging, offering suggestions to make the hospital a safer place with better outcomes. Dr. Jim primarily worked with the Pediatric Oncology department, as well as co-presenting lectures with Dr. Elaine on Patient Safety and other topics.
Other teaching was done as well. Some of the sessions took place in a lecture hall in a formal context, some were done with small groups. One of Dayna’s more interesting sessions on locating suitable veins for IVs (her specialty is Venous Access) required the use of a whole raw chicken and an ultrasound machine. (We wonder if people glancing into the room thought, man, that’s an ugly baby!) From the theoretical to hands-on—whatever works best to promote better health care!
New territory entered included launching local clinical research by nurses. Up to this point NCH has had very limited experience in setting up research projects that would help determine Best Nursing Practice in their own situation. With Dr. Aja’s and Dayna’s encouragement, NCH is developing a study on the use of betel leaves as part of the dressing for children who have undergone an ostomy, to see if that will help reduce skin degradation. Bach Mai Hospital also requested and received training on conducting and presenting research in a larger context.
When asked about her takeaways from this trip, Dr. Elaine said, “I appreciate the continued openness of the hospital staff, their eagerness to learn and improve. I also see just how hard the nurses work, under taxing conditions. And while I still see areas where we can help, such as wound care and pain management, as well as working toward better patient safety, I am so glad to see significant improvement in OB care!” Dr. Elaine also envisions increasing her investment in Vietnam from one trip per year, to two. The needs are great; the opportunities many.
Healthier babies. Healthier mothers. Healthier Vietnamese in general, as our service is not at all limited to pediatric care. As REI’s Nurse and Physician Team partners with dedicated medical caregivers in local hospitals and medical universities, we are seeing it happen, and we are thankful. And we are thankful for you, too, as part of the team making change happen.