We will be performing site maintenance on our learning platform at learn.aaos.org on Sunday, January 29th at 12 AM EST. The site will be down for up to 5 hours. We apologize for the inconvenience.

Fig. 1 Emergency department, Hospital for Traumatology and Orthopaedics, Ho Chi Minh City

AAOS Now

Published 10/1/2009
|
Annie Hayashi

Building bridges over once-troubled waters

AAOS launches educational program with Vietnam

Although many Americans associate Vietnam with a divisive war, 86.5 million Vietnamese—two thirds of whom are younger than 30 years old—call Americans friends. That friendship was reinforced when the AAOS accepted an invitation from the Vietnamese Orthopaedic Association (VOA) to start an orthopaedic educational exchange program.

After more than 3 years of planning and preparation, the first phase of the AAOS-VOA Visiting Faculty and Professional Development Program was successfully completed in May 2009. The program—held at St. Paul’s Hospital in Hanoi, Hue Central Hospital in Hue, and Hospital for Traumatology and Orthopaedics in Ho Chi Minh City—involved four AAOS fellows and a 9-day intensive course for 103 participants. In the second phase, four Vietnamese surgeons will come to the United States for additional training and observerships this year.

Volunteer effort produces excellent results
In Hanoi, Miguel E. Cabanela, MD, conducted training in arthroplasty and adult reconstruction. Arthroscopy was taught by Pietro M. Tonino, MD, and Howard J. Sweeney, MD, in Hue. Stuart L. Weinstein, MD, focused on pediatric and young adult spine patients in Ho Chi Minh City.

In addition to live patient case study presentations, grand rounds, outpatient clinics, surgical skills workshops (in Hue and Hanoi), and didactic lectures, the educational program included a first—live surgery, including 4 spinal, 7 reconstruction, and 9 arthroscopic procedures. The results, for patients, were dramatic.

Planning key to success Before the program began, Dr. Weinstein and Lynne Dowling, director of the AAOS international department, conducted site visits at the three hospitals to evaluate the facilities and assess their resources—from the number of surgeries performed and the formal orthopaedic training provided to the quality of their imaging equipment and blood supplies.

Serving the 3 million people in Hanoi, Saint Paul’s Hospital, the oldest of the three hospitals, was founded 100 years ago during French colonial rule. Although this municipal hospital is in good condition, especially considering its age, it is extremely overcrowded. The 45 orthopaedic beds, out of a total of 450 beds, are always above census, with 25 trauma admissions and 5 trauma surgeries per day.

Hue Central Hospital is one of the country’s largest, with 2,400 beds. The hospital provides medical care to more than 15 million people in the central region of Vietnam. Under the supervision of the Ministry of Health, it has 32 clinics providing more than 250,000 medical examinations—and 20,000 surgical procedures—each year. With 15 orthopaedic surgeons, the hospital has 80 beds for orthopaedic patients but daily bed census averages 100 orthopaedic patients.

As the training facility for the Hue Medical College, the hospital is where Vietnamese surgeons often learn and first perform surgical procedures such as hip replacements (1997), knee replacements (2002), and arthroscopic procedures (2003).

Fig. 1 Emergency department, Hospital for Traumatology and Orthopaedics, Ho Chi Minh City
Fig. 2 Outpatient clinic waiting area, Hospital for Traumatology and Orthopaedics, Ho Chi Minh City
Fig. 3 Vietnamese family on a motorbike

In Ho Chi Minh City, the Hospital for Traumatology and Orthopaedics has only 440 beds, but 900 to 1,000 inpatients. On a daily basis, this municipal hospital has 100 trauma admissions (Fig. 1), 30 trauma surgeries, and 1,000 outpatient visits (Fig. 2). The hospital’s 9 operating rooms are used 24 hours a day, 7 days a week; 24,000 major surgeries and 36,000 minor surgeries are performed there each year.

High rate of trauma due to motorbikes
Compared to other developing countries, Vietnam has a high rate of road traffic trauma and deaths. In 2007, according to the country’s National Traffic Safety Committee, 12,800 deaths were due to road traffic accidents. Other sources suggest that official statistics underestimate the actual number of deaths by more than 30 percent and injuries by more than 90 percent.

In this developing country, the primary mode of transportation is the motorbike, which also causes the largest number of traumas and fatalities. Entire families, from parents to infants, ride motorbikes piled high with parcels, grocery bags, and other items (Fig. 3). The bikes are driven with and against traffic, on the right and left sides of the road, on sidewalks, and even in the hotel lobbies.

According to the Vietnamese National Traffic Safety Committee, 95 percent of the 26 million registered vehicles in Vietnam are motorbikes. Motorbike collisions account for 73 percent of all road trauma.

Stay tuned
In the coming months, AAOS Now will cover the experiences of Drs. Tonino and Sweeney in Hue, Dr. Weinstein’s experiences in Ho Chi Minh City, and Dr. Cabanela’s surgeries in Hanoi, as well as the first visit under phase 2 of the program, by Le Thua Trung Hau, MD, who came to Chicago to meet with Dr. Tonino and attend a course sponsored by the Arthroscopy Association of North America at the Orthopaedic Learning Center.

Annie Hayashi is the senior science writer for AAOS Now. She can be reached at hayashi@aaos.org

A team effort
The AAOS-VOA Visiting Faculty and Development Program would not have been possible without the generous support of industry, orthopaedic societies, and the surgeons themselves. Thanks go to the manufacturers who donated implants and equipment; to the Arthroscopy Association of North America for its donation of educational DVDs and knot tying instruction boards and booklets; and to the AAOS, which not only managed every aspect of program planning and implementation, but also provided educational materials, workshop equipment, and anatomic models and covered all shipping expenses.

References:

Bailey K, Ansell T: Nursing together—Australian and Vietnam: Trauma nursing in a developing country. Australian Emergency Nursing Journal 2004;7:23-27.

Pervin A, Passmore J, Sidik M, McKinley T, Nguyen TH, Nguyen PM: Viet Nam’s mandatory motorcycle helmet law and its impact on children. Bull World Health Organ 2009;87:369-373.