Doctors Bartecchi, McGoon, Bell and Allison
Dr. Suri (right) operating on aneurysm
View of large aortic aneurysm
Vietnam National Heart Institute
Dr. Cooper leading discussion with cardiology faculty
Crowded conditions at Vietnam Heart Institute
Dr. Nkomo teaching Echocardiography
Cardiology Symposium teaching faculty
One Cardiologist's Observation
For a westerner, walking into Bach Mai
Hospital in Hanoi, it was an amazing experience. This is the largest
hospital in Vietnam, and hosts the Vietnam Heart Institute. The
hospital was bombed during the war and has been reconstructed since,
with the support of the Vietnamese and certain foreign
governments. This is a large multi building facility, home to 2,000
beds holding 3,000 patients. Doing the math, one realizes that many
beds hold more than one patient. Family members are present in
abundance in the hospital wards, helping to provide front-line
patient care and food for their ill relatives. The cardiac
catheterization lab is a busy facility, having two single-plane
digital imaging systems. Interventional cardiologists at Bach Mai
perform about 500 congenital heart treatments and 900 coronary artery
procedures each year. There is a large base of rheumatic heart
disease, and multiple, non-operative mitral valve disease procedures
are performed on a daily basis. I was asked by our host to scrub in
on cases – this was a fascinating experience. The first case that I was asked to
perform was an acute anterior wall myocardial infarction with a
borderline shock picture. The diagnostic coronary artery dye study
showed that the major coronary artery was occluded. It was a huge
tortuous, calcified vessel. We were able to open the occluded vessel
only with great difficulty. With removal of the blockage in the
coronary artery, the shock picture immediately reversed. Following
that experience, I felt that I was back in the saddle and ready for
my second case. This was an 87 year-old woman who also had an occlusion of the major coronary
artery. She was told that she was inoperable and would probably die.
Fortunately, this was not the case and the procedure went well, I was
able to share some techniques for rapidly opening such blockages. It
was a very rewarding experience meeting the family, who was most
appreciative. They spoke excellent
English and were very warm to us. On
the third day of our visit, I availed myself of the
opportunity to scrub in with some of
the world’s busiest mitral valvuloplasty operators, and performed a
number of mitral valvuloplasty procedures under their watchful eye.
The approach taken in Hanoi is vastly
different than what we use in America, and perhaps the best term to
describe it would be “bare-bones” approach. The procedure is done
with a balloon catheter. These catheters are used seven or eight
times – unacceptable here in the U.S All in all, the experience
scrubbing with my Vietnamese colleagues in the cath lab was very
rewarding, and clearly was a mutual learning experience. I would
highly recommend this experience to individuals wanting to do medical
missionary work in a rapidly developing Asian nation, with a history
that is inextricably intertwined with that of the United States.
 Dr. Rihal at work in cath lab
Foundation President Visits Vietnam
Jack Burke, President of St. Anthony’s
Health Foundation accompanied the April Bach Mai Hospital Project
visit to Hanoi. Jack toured the Bach Mai Hospital and met with the
hospital’s leadership. He noted their problems, discussed with them
their needs and presented ideas as to how we might best assist them.
We appreciated having Jack’s business and financial expertise
available to help with those discussions. Jack, recognizing the need
for future funding efforts in the present “down” economy, began
making contacts with other foundations working in Vietnam. Jack and
Dr. Bartecchi met with John Anner, Executive Director and Thu Nguyen,
Program Development Director of the East Meets West Foundation while
in Hanoi. Their Foundation has a long history of effective
involvement in Vietnam. We are in the process of discussing with them
ways in which we might collaborate with them for future programs of
assistance for the Vietnamese.
Foundation President Jack Burke (left) presenting supplies to Prof. Dinh
Bach Mai Hospital Project Launches a Pediatric Program at Bach Mai Hospital
Andrew Terranella, M.D., MPH, a
Pediatrician with the U.S. Public Health Service helped initiate what
will prove to be a major involvement in the Pediatric Department of
the Bach Mai Hospital. Dr. Terranella spent the first week of April
lecturing to the faculty and students of the Bach Mai Hospital
Pediatrics Department on a variety of pediatric subjects. He brought
with him a much needed pediatric ventilator and instructed the
doctors there on it’s management. We are indebted to Jean Marchant
and Pulmonetic Systems for helping us obtain the state of the art
ventilator. We also received ventilator support equipment from Mike
McDonald of Cardinal Health. The ventilator was purchased in part
from a generous grant from the Bruce & Jolene McCaw Family
Foundation of Bellevue, Washington.
Our Pediatric program will progress to
a major symposium in November, 2009 with the Pediatric Faculty of the
Mayo Clinic, the University of Michigan and the USPHS. We are excited
about the development and potential expansion of this pediatric
program.
Dr. Terranella with Pediatric Department staff
Danang Emergency Medicine Symposium
Our first symposium outside of the Bach
Mai Hospital and Hanoi was held in the South of Vietnam, in DaNang.
The Symposium concentrating on emergency medicine was attended by
over 350 Vietnamese physicians from all over Vietnam. The symposium
covered every aspect of emergency medicine, from the pre-hospital,
paramedic involvement to the clinical to the administrative concepts
so important to the management of emergency patients. Dr. David
Claypool, a consultant for the Mayo Clinic Department of Emergency
Medicine and Robert Joyce, administrator for the Mayo Clinic
Emergency Department discussed the state of the art concepts of
pre-emergency department patient management and suggested goals that
the Vietnamese emergency medicine system might aim to achieve. Dr.
Andrew Terranella reviewed the subject of Pediatric Toxicology, a
subject new to the audience. Dr. Malcolm Bell, Director of the
Coronary Care Unit at the Mayo Clinic gave a wonderful discussion of
the emergency evaluation and management of heart attacks. The Lean
Transformations Group, led by it’s president, John Shook and his
associates Karl Ohaus and Mr. Quan, presented the concepts that
helped improve the efficiencies of the emergency departments of the
Mayo Clinic and other sites around the world. The Lean consultants,
led by Karl Ohaus, have been volunteering their expertise at the Bach
Mai Hospital Emergency Department for the past two years, bringing
about major improvements in patient management at that site. They
have even committed to ongoing observation and follow up of the ER
program through their Hanoi representative, Mr. Quan. We envision
their approach to emergency medical care management as seen at the
Bach Mai Hospital will prove to be a model for emergency departments
throughout Vietnam. We are most appreciative of the partnership that
we have established with this outstanding organization. The
secrets of Lean’s effectiveness can be found in John Shook’s new
book – Managing to Learn.
Symposium principles Tuan, Shook, Claypool, Joyce, Bartecchi and Ohaus
John Shook, President of Lean Transformation Group
Dr. Bell lecturing at Emergency Medicine Symposium
Robert Joyce lecturing at Emergency Medicine Symposium in Danang
Paramedic Teaching Program for Vietnam
Vietnam has no Paramedic Program, but
its medical leadership understands the value and need for such a
program for the entire country. With that fact in mind, we are
training the first Paramedic for Vietnam, Dr. Thanh Nguyen. Thanh
will complete his course this coming June and return to Hanoi to
begin the school for Paramedic training in Vietnam. The school will
begin training students in November. Overseeing the first course for
the Basic EMT will be Roger Japp,, head of the highly regarded St.
Anthony’s Academy. Roger will spend one month in Vietnam, assuring
the quality of the course. The initial students will come from
throughout Vietnam and in turn will train others in the more rural
districts of the country. The school is a cooperative venture
sponsored by the Bach Mai Hospital and the City of Hanoi
Hospital.
Academic Achievements at Bach Mai Hospital
We are always pleased when we learn
that the doctors that we have trained have contributed to the
academic medical literature. Since the last issue of this Newsletter,
Drs. Xuan, Ton and Son have made such contributions, while
maintaining active teaching and work schedules.
New Health Care Trainees Arrive In July
In July, we will welcome four new
Vietnamese trainees to the St. Anthony’s Hospital training program.
The trainees will include a Critical Care Medicine physician and two
Emergency Medicine physicians. We will also bring an Emergency
Medicine Department nurse who promises to be a welcome addition to
the Bach Mai Hospital Emergency Department nursing training program.
New Director Named for Global Health Initiatives (GHI)
Our congratulations to Greg Hodgson who
was recently named Director of the new Centura Global Health
Initiatives. Greg earned a graduate degree in International Relations
from Johns Hopkins University and has worked with medical mission
projects in Peru, Belize, Rwanda and Nepal. He has led international
development projects in 80 countries during the last 25 years.
Emphasis on Disease Prevention-Health Maintenance
We continue to pursue health
maintenance and disease prevention practices in Vietnam through our
book – Living Healthier and Longer-What Works, What Doesn’t,
which is being translated into Vietnamese. This book is updated
every six months with the most recent update available in May, 2009.
The book and updates can be downloaded at healthierlongerlife.org
A Japanese and a Chinese translation will be available soon.
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