IPSAC VN News

IPSAC Service Trip #13 - March 2018

 

At the request of our VN clinical partners, IPSAC returned for continued clinical program development at 3 of its previously established pediatric sites (the Children's Hospital 1 (CH1) in HCMC, the Can Tho Children's Hospital (CTCH), and the Danang Women and Children's Hospital (DWCH)). IPSAC also made its first official clinical exchange at City Children's Hospital (CCH) in HCMC. After a briefing lunch meeting to introduce the volunteers and team leaders, logistics guidance, and to share IPSAC cultural pearls with the participants, the CTCH and DWCH teams travelled to their respective locations.

 

The CH1 team was led by Dr. Mike Chen, providing pediatric surgery and urology services.

Dr. Mark Holterman led the CTCH team for pediatric surgery and pediatric anesthesia services.

Dr. David Lashley led the DWCH team for pediatric surgery, pediatric urology, pediatric anesthesia and pediatric neurosurgery support. IPSAC and the Mayo Clinical delegates participated in a joint 2-day symposium on child health. IPSAC and DWCH leaders discussed a 2019 multidisciplinary colorectal course on patient care program for anorectal malformations, to be led by a large team from Nationwide Children's Hospital.

 

At the new 1,028-beds modern City Children's Hospital (CCH) in HCMC, Dr. Marilyn Butler and AiXuan Holterman made IPSAC final need assessment, discussed areas in program development of joint interest for a future CCH-IPSAC MOU. Our collaboration will include a sustainable program for pediatric general surgery and urology workforce capacity building, a train the trainers program in essential emergency pediatric surgical patient care for front line health professionals from low resources health facilities, and implementation of a pilot project for CCH patient care quality improvement and safety.

 

The common threads for our visit at each of the sites are hospital and team briefing, complex congenital malformations surgical and anesthetic activities by the joint VN-IPSAC team with preoperative patient evaluation, lectures, patient care management challenges, postoperative ward rounds, end-of-vist debriefing and teams farewell dinners.

 

IPSAC service trip #12- MARCH 2017

 

IPSAC has 5 main teams and supported 2 additional groups. They began to travel to their respective locations after a briefing lunch meeting.

 

 

1. Kon Tum General Hospital in the highlands: The team of pediatric surgery (led by Dr. Browne), pediatric anesthesia (Dr. Nguyen Tan Phuoc), pediatric surgical nursing (led by Nancy Browne), rehabilitation specialists and volunteers returned to conclude its 3-years MOU. The team spent a lot of time on didactic, bedside (ICU, ward) and OR teaching.  The team delivered tools and supplies requested from last year by the hospital. The week ended with a debriefing meeting re the hospital needs.

 

2. Children hospital 2 CH2 in Ho Chi Minh City:  IPSAC pediatric surgery (led by Dr. Butler) and Urology (led Dr. Klauber) with pediatric surgical residents returned for its 4^th year. The requested surgical supplies were donated. Both teams started with joint clinic visits of preoperative patient evaluation.

 

General Pediatric Surgery: The pediatric surgical cases ranged from neonatal surgeries such as long gap tracheoesophageal fistulas to tumor resections. IPSAC started the concept of interdisciplinary meeting for oncology care several years ago. During this visit, the team was consulted on oncology cases.

 

Pediatric urology: repair of complex hypospadias, several cloacal malformations, urogenital sinuses, pyeloplasties.

 

 

3. Can Tho Children’s Hospital CTCH- IPSAC pediatric surgery (led by Dr. AiXuan Holterman), neonatology (led by Dr. Ho), pediatric anesthesia (led by Dr. Vo), surgical residents and volunteers made its first visit to the newly opened 750-beds children’s hospital. This visit was in support to a request by Children’s Hospital #1 to help relieve CH1 of its surgical volume burden through capacity building of its affiliated secondary Children’s Hospital of Can Tho and (see below) Danang.  The goal of this visit was to do an initial assessment of the hospital capacity, with tours of the emergency room, neonatal intensive care unit, the operating/recovery room and surgical ward. After donation of pediatric surgical journals and surgical supplies, the team screened 4 patients for surgery. Since our time was limited, the team proposed limiting its surgical and anesthesia activities the next day to a few minor cases and joint surgery for one major case, a patient with choledochal cyst. This allowed IPSAC to better evaluate the operating room work flow and capacity. Medical students from CT University of Medicine were welcomed to observe the OR activities.  Dr. Ho spent her time with NICU work rounds and lectures. The day concluded with a dinner by the beautiful CT river, hosted by CTCH Director and the surgical unit.

 

The team conducted joint postoperative rounds with the local surgeons the next day. IPSAC distributed graduation certificates to a multidisciplinary group of 8 CTCH (pediatric nurses, anesthetists, emergency medicine physicians, intensivist and surgeons) which participated in the Pediatric Acute Surgical Support workshop. This workshop was funded by the US Congress through the VN Education Foundation Scholar grant. The workshop goal is to enhance the readiness of first responders at the hospital in the initial assessment, stabilization, transfer and as appropriate the definitive care of children with acute surgical emergencies through blended didactic, skill training, simulation and case scenario discussions.

 

The visit ended with a debriefing meeting and discussion for a future MOU.  Considerations for areas of program development include anesthesia and surgical upskilling, nursing care, perioperative management, neonatal support.

 

This team traveled next to Danang Women and Children’s Hospital.

 

 

4. Danang Women and Children’s Hospital. IPSAC pediatric surgery (led by Dr. Mark Holterman), pediatric urology (led by Dr. David Lashley), neonatology (Dr. Ho) surgical residents and volunteers return for the team 6^th visit. The team feels quite at home with this site, in the final days of its 2^nd MOU for enhancing activities in anesthesia, urology and general pediatric surgery, & neonatology. The team started right away for preoperative clinic evaluation with our colleagues

 

Pediatric Surgery: 4 days of joint care of children with complex gastrointestinal problems including imperforate anus, Hirschsprung’s disease, sacrococcygeal teratoma. Surgical case management was discussed during joint work rounds in the pediatric surgical and the neonatal intensive care units.

 

Pediatric Urology: Simple and complex hypospadias repair, urological reconstructions, lectures and patient joint work rounds

 

Pediatric Neonatology: Workshops and introduction of the concept of neonatal “golden hour” with practical skill training for delivery room and NICU staff to enhance the outcome of neonates.

 

The team work ended with a debriefing meeting and a discussion for a 3^rd MOU with DWCH Board of Directors. IPSAC assessment of the 6 years of collaboration was the significant progress in the division of pediatric surgery and anesthesia. The future collaboration will add a focus on radiology support to enhance perioperative management, upscaling the complexity of urology training, standardized anesthetic care, a training curriculum for pediatric surgery, and IPSAC support for international travel fellows from DWCH to visit a US pediatric institution as a team of 3 with anesthesia, surgery and nursing. 

 

 

5. Bioengineer Team:

 

The team blog can be found at:

 

 https://sites.google.com/view/uic-ewh-vietnam/2017-trip?authuser=0

 

 

With the support and introduction of IPSAC to Children’s Hospital #1 CH1, the University of Illinois at Chicago chapter of the Engineering World Health organization Dr. Miiri Kotche has been working on the design and build of a laminar flow hood to support infection reduction in Nhi Dong 1 Children's hospital in Ho Chi Minh City, Vietnam since 2015.  In 2015, Dr. Kotche and two students accompanied the IPSAC team to conduct a site assessment and identify areas of collaboration with ND1 hospital.  An issue unique to the neonatal unit at ND1 is that the medications, TPN, IV fluids are not prepared in the pharmacy, but in the NICU ward. The bioengineering students have been working to design a low-cost laminar flow hood to provide an aseptic environment for preparing medications and fluids by controlling the flow of air through filter media and ultraviolet lamp to sterilize microbial contaminants.  On this return visit, 5 bioengineering students traveled to ND1 hospital to further assess the workspace and practical issues for the hood use and location in the NICU. The team met with the hospital engineers, the head of NICU and hospital leadership for more discussion on the device prototype intended use, on-site testing, subsequent building of additional hoods for further use in the clinical departments, its future impact on patient care, and the steps to pursue to continue this project.

 

 

 

Other activities The week following IPSAC official clinical activities:

 

 

6. National Hospital of Pediatrics NHP at Hanoi. IPSAC hosted Dr. Robert Cusick and a training fellow in pediatric surgery from the Children’s Hospital at Nebraska for their first visit at NHP. They visited the hospital, the surgical unit, gave grand rounds toward an assessment for areas of joint interests in pediatric surgery training or capacity enhancement. Further discussion of future activities is pending. Current IPSAC activities at NHP include a multisite prospective randomized interventional clinical trial for newborns for congenital bile duct malformations under a US FDA Investigational New Drug approval.

 

 

7. Thanh Hoa Children’s Hospital THCH. Under IPSAC sponsorship through an IPSAC-THCH MOU, Children’s Surgical International CSI team of urologists, anesthesiologists, volunteers and post surgical recovery support unit returns for its 3^rd and final year to THCH. CIS donated surgical supplies and successfully delivered surgical care in urology to a large number of patients. CSI non-profit group, now in its 9 years of operation, has a focus on direct clinical service delivery and outpatient-based procedures.

 

 

 

 

 

 

 

GAP TRAVEL FELLOWSHIP

 

This year, IPSAC is delighted to sponsor Dr. Thanh Dinh, a young pediatric surgeon from the Children’s Hospital #1 in Ho Chi Minh City for the GAP travel fellowship.  She was selected among many pediatric surgeons from the developing countries in the Pacific Rim to attend the 2016 Annual Meeting of the Pacific Association of Pediatric Surgeons in Kauia.

 

For an additional 4 weeks, Dr. Dinh was hosted at the Kapiolani Medical Center for Women and Children in Honolulu, at Comer’s Children's Hospital at Chicago and at the Children’s Hospital of Illinois in Peoria, with a final stop at the American Pediatric Surgical Association 2016 Annual Meeting in San Diego. IPSAC hopes that she will gain valuable insights through her encounters with US surgical team and US health care system to transform the care of pediatric surgical patients at her institution.