rehabilitation situation in vietnam

REHABILITATION SITUATION REHABILITATION SITUATION

IN VIETNAMIN VIETNAM

Cam Ba Thuc. MDCam Ba Thuc. MD

ContentsContents

• Vietnam in brief

• Overview of medical history of Vietnam

• Overview of rehabilitation medicine in Vietnam

• Policy and strategy of rehabilitation medicine

development to year 2020

• Rehabilitation Medicine: network and

achievement.

ThankfulnessThankfulness• First of all, I would like to give special thank to Rector

of Mahidol University, Dean and Deputy Dean of Faculty of Medicine Siriraj Hospital, give me a special chance to see a beautiful country Kingdom of Thailand and also a special occasion to study, improve my knowledge and exchange challenge with Prof, Dr, PT and OT in Siriraj Hospital.

• I also to give special thank to Prof. Chirayu Auewarakul, Associate.Prof. Witsanu Kumthornthip had helped me so much when I was preparing documents to leave for Thailand.

• Thanks every body in here to give me a gold time to give talk. I hope that I will become familiar with every people in here soon;

hot dispute regionwith China

Thanh Hoa province (my hospital)

Middle region

South region

Equatorial line

South East Asia Region

North region

Hanoi capital

Vietnam in briefVietnam in brief

• Region: South East Asia

• Area: 331.698 km², divided into 63 provinces.

• Population: about 90.000.000

• Ethnic: 54, in those Vietnamese are 73.594.427 people,

occupied 85%; and 53 is minority ethnic occupied 15%;

• Economic: developing country, orientation market

economic, open to every countries world wide.

• Dr. Cam Ba Thuc is Thai minority ethnic with

population of 1.550.423 people (1.8%) (Statistic 2009).

History of Healthcare in VietnamHistory of Healthcare in Vietnam

Healthcare at feudal periodHealthcare at feudal period• Period 1010 – 1026: Ly Dynasty open Health Care

Bureau, most of medicine man were Monks.

• Period 1226 – 1339: Tran Dynasty established Health Care Institution, starting training medicine man. At this time, Sir Tue Tinh (born 1330) was a distinguish medicine man.

• 17th Century (Le Dynasty): Sir Le Huu Trac (1720 -1791) was a distinguish medicine man.

• Till now, many prescriptions and publication of two distinguish medicine man still being used in Vietnam.

• Therapy: manual medicine and acupunctures.

• Medication: most of medication were herbs.

Sir Le Huu Trac (1720 Sir Le Huu Trac (1720 -- 1791)1791)distinguish medicine man of Vietnamdistinguish medicine man of Vietnam

• Religion of medical arts dedicated to protecting human life, take care of the worry….

• Medical profession is an honorable profession, practitioners must study hard and well….

Healthcare at French colonial timeHealthcare at French colonial time

• Since 1858, French people occupied Vietnam

• Year 1888 French colony established Department of

Indochina Public Health, and started to set up some

hospital in North, Middle and South of Vietnam.

• Year 1902: Indochina Governor (of French) established

Indochina Medical School (Ecole de Médecine de

l’Indochine) in Hanoi (now known is Hanoi Medical

University), this Medical School consist of a school, two

hospital (now known are VietDuc and BachMai) and an

Institute of Anatomy. Training doctor (4 year in Vietnam

and two year in France); nurse and resident practice.

Healthcare at French colonial timeHealthcare at French colonial time

• The first Rector of Indochina Medical School was Doctor

Alexandre Yersin (very well-known person), He found

bacteria named Yersinia pestis caused Plague Disease.

• At this period: founded 4 Pasteur Institutes: Hanoi,

Nhatrang, Dalat, Saigon (Hochiminh city).

• This was a starting point of modern medicine in Vietnam,

many field quite good such as operation, internal

medicine, bacteria, parasite and immunology were

developed but I don’t know that the rehabilitation

medicine were noticed or not.

Dr. Alexandre YersinDr. Alexandre Yersin

First Rector of Indochina Medical SchoolFirst Rector of Indochina Medical School

BBig friend of Vietnamig friend of Vietnam

Healthcare at Vietnam war timeHealthcare at Vietnam war time

North of Vietnam: Democratic and Republic of VN

- Subsidies and close economy, lack of food and many facility, this is very difficult time in the North;

- Every provinces has provincial general hospital; and has district medical centre;

- Has several Medical School, training doctor and nurse.

- Lack medication and medical equipment, has low quality of health care;

- Several central hospitals and provincial general hospitals has department of physical therapy, all physician were trained from communist nation such as Soviet Union (Russia), East Germany, or China ..etc..

Healthcare at Vietnam war timeHealthcare at Vietnam war timeSouth of Vietnam: Republic of Vietnam:

- Open and market economy, has some modern hospital;

- All medical standard based on American Standard.

- Has Saigon Medical School;

- Has many qualified doctor

- Rehabilitation medicine were quite developed;

- Till now, some Hospital in Hochiminh city has old

rehabilitation department in good condition.

- Published some Textbook of Physical Therapy and

Rehabilitation;

- Published Dictionary (English-French-Vietnamese) of

Physical Therapy and Rehabilitation.

Rehabilitation MedicineRehabilitation MedicineFounded and Development in VietnamFounded and Development in Vietnam

After 1975, ended Vietnam warAfter 1975, ended Vietnam war

• After the war We have many invalid people, many people suffer from orange agent and many people had mental illness because of war.

• Several Centre for Care Invalid and Centre for Orthopedic were established, provide services for invalid people such as:

+ Healthcare

+ Provide prosthesis and orthotic devices

+ Orthopedic surgery

+ Care for invalid people with spinal cord injury; brain injury; amputee …etc…

After 1975, ended Vietnam warAfter 1975, ended Vietnam war

• Some doctors was sent to study in Netherlands about

care and rehabilitation for invalid people with spinal

cord injury (SCI), most of them are retired now,

• Many invalid people with SCI still alive and well now.

• Many invalid people can not return their home, they

have to spend their lifetime in these centre.

• Period 1975-1989: border dispute with Cambodia.

• Period 1979-1980: border dispute with China

• Now many Centre for Care Invalid People still

existence

Founded and Development Founded and Development of Rehabilitation Medicine in Vietnamof Rehabilitation Medicine in Vietnam

• Year 1988, Founded Rehabilitation Faculty in Hanoi

Medical University.

• Training for medical students

• Training for doctors

• Since 1996, training residents doctors in Rehabilitation

Centre of Bachmai Hospital.

• Since 1997, traning master and fellow doctors in

Rehabilitation Centre of Bachmai Hospital.


• All middle level medical school has rehabilitation department, training for middle level medical students.

• Most of Central Hospitals has Rehabilitation dept.

• Many Provincial Hospitals has Rehabilitation dept;

• Several district hospitals has Rehabilitation Medicine Unit in Department of Traditional Medicine .

• Vietnam Rehabilitation Association (VINAREHA) was established in 1991.

• Three school of medical technique was established (Haiduong – Danang – Hochiminh city) to training Physical Therapist.


• Year 1999: established Central Rehabilitation Hospital

in Thanh Hoa province;

• Many province established Rehabilitation Hospital;

• Community Based Rehabilitation (CBR) was carried out

since 1987, this program was sponsored by Health

Volunteer Oversea (HVO), Vietnam Veteran American

Fund (VVAF), AIFO of Italian ..etc..

• Since 2003, Handicap International (Belgium) helped

Vietnam to set up Spinal Cord Injury Network.

Law and Policy related to disable personLaw and Policy related to disable person

• The Nation Constitution (1946, 1959, 1980, 1992, 2012) confirm that disabled persons are equal citizens;

• The Ordinance on disabled persons adopted by National Congress in 1998;

• State president signed agreement with International Convention on the rights of persons with disabilities in 2007; this was adopted by National Congress in 2014

• Law on disabled persons adopted by National Congress in 2010; had effected since 1st day of January 2011.

• Prime Minister had approved scheme assistance for disable person period 2006 – 2010.


• Prime Minister had approved scheme developing healthcare network to year 2020: consist of developing rehabilitation hospital;

• Prime Minister had approved scheme assistance for disable person period 2012 – 2020; some major aim are:

“ Every year, 90% of people with disabilities have access to health services under various forms; 90% of children from birth to 6 years old be screened for early detection of congenital defects, developmental disorders and early intervention; about 70,000 children and adults with disabilities are provided service of orthopedic surgery, rehabilitation and appropriate aids”./.


• Prime Minister had approved Target Health Programs

period 2012 – 2015; in this consist of CBR program;

• Most of disable person are provided health insurance,

monthly living expenditure.

• The Circular Letter No12 year 1993 of Ministry of

Health, Its regulation: every hospital around nation must

have department of rehabilitation.

• Since 2007, Minister of Health directed to enhance

developing rehabilitation.

• Rehabilitation Medicine was concerned in recent years

Rehabilitation MedicineRehabilitation Medicine

Network and AchievementNetwork and Achievement

NetworkNetwork

• Central Line:

Rehabilitation Centre of Bach Mai hospital is the highest of academy

Central Rehabilitation Hospital (Thanh Hoa province)

100% of Central Hospital has Rehabilitation departments

NetworkNetwork• Provincial line:

Vietnam has 64 provinces, in those 38 provinces has

Rehabilitation Hospital.

98% of Provincial General Hospital has Rehabilitation

department;

There are 23 hospitals or Medical Centers belonged to

other Ministry (such as Ministry of Defend, Public

Security, Labor – Invalid and Social Affair, Industry

and Trade, Transportation), all of these has

rehabilitation department.

NetworkNetwork• District Line:

Most of District Hospital has Traditional Medicine

department, there are Traditional Medicine Doctors

works in these place;

Under the Regulation of Ministry of Health, all

Traditional Medicine department of district hospital

take over rehabilitation service for disable patients.

In these, Doctors and Nurses were trained Physical

Therapy and Rehabilitation;

NetworkNetwork

• Commune Line:

Every commune has a CHS (Community Health

Station);

Every CHS has a staff who take over the task on

rehabilitation medicine;

Task on rehabilitation medicine consist of rehabilitation

for inpatients and outpatients, follow up patients in

community, participate community based rehabilitation;

Vietnam Rehabilitation AssociationVietnam Rehabilitation Association

• Abbreviation: VINAREHA

• Consist of over 1.500 participants

• All participants are professor, doctors, nurse, physical

therapist from central line to commune line

• Chairman: Prof. Tran Trong Hai

• Office: Hanoi School of Public Health

• Has its regulation, approved by Ministry of Inside Affair

Human ResourcesHuman Resources

• Doctors:

Rehabilitation doctors

Residents doctors on Rehabilitation

Fellow doctors on Rehabilitation

Associate Professor: 08 (retired 05)

Professor: 01 (retired)

• Physical Therapist

Not have Occupation Therapist

Education and TrainingEducation and Training

• Hanoi Medical University: training doctor, resident,

fellow doctor.

• Hue University of Medicine and Pharmacy: training

doctor; bachelor of rehabilitation.

• Hochiminh University of Medicine and Pharmacy:

training doctor, physical therapist.

• Haiduong University of Medical Technique: Training

physical therapist;

• Danang University of Medical Technique: Training

physical therapist;

• Viet cot School (Ministry of Labor Invalid and Social

Affair): training technician of prosthesis and orthotics

AchievementAchievement

• Consultation: every year 1.092.405 patients (statistic 2012)

• Inpatients: every year 190.466 patients (statistic 2012)

• Community Based Rehabilitation (CBR): CBR program

cover 51 province; every rehabilitation hospital has their

own CBR program depend on policy of province;

• Screen for patients under 6 year old and early

intervention: every rehabilitation hospital has their own

program depend on policy of province (till now not have

any statistic).

ChallengeChallenge• Some province not have Rehabilitation Hospital;

• Some provincial general hospital not have rehabilitation

department (remote area);

• Lack of Human Resource (especially rehabilitation

doctor; Occupation Therapist);

• Low investment; Lack of Medical Equipment

(especially high technology equipment);

• Not have much experience on building rehabilitation

network, training doctor and PT, not have any

Curriculum on training OT in medical school

Orientation in futureOrientation in future• Training human resource,

• Building medical rehabilitation network

• Invest more modern equipment for rehabilitation

hospital and rehabilitation departments

• Improve quality of rehabilitation service

• Continuing community based rehabilitation

• Making appropriate policy on rehabilitation,

especially for rehabilitation workers.

Orientation in futureOrientation in future

• Increase research sciences on medical rehabilitation

and publish more documents

• Enhance ability of rehabilitation faculty of all

Medical School;

• Enhance prevention of accidents, screen for early

detection and early intervention

• Building curriculum for training OT

• International cooperation on rehabilitation

Thanks for your attention !