Reverse Gastric Tube

“Experience in the Field” Vietnam 2002-2010

Irish Medical Organisation AGM 2010

Experience to Date

• Background– Ghana 1983-1984– Vietnam 2003-Date– Tanzania 2008-Date

• Work to Date

• Future Directions

Vietnam-2002“Skill Starvation”

• Christina Noble Foundation– Expert paediatric experience– 1-2 weeks per year– Children’s Hospital # 2 Ho Chi Minh City

• No funding available• Foundation would provide local support

Vietnam-Quick Stats

• Population 84 mill• 2 mill communist party• Post War Economy

– Agricultural– Tourism– Manufacturing

• Infant Mortality 30/1000• GDP $550• 10 mill motorbikes• 34 mill ton of rice PA• 15 mill ton of bombs

Vietnam

• Initial visit in 2003 to establish hospital links, exchange credentials etc.

• RCSI and OLCHC - to fund initial team visits

• Initially a 5 year plan envisaged

Typical “4” Bedded 2003

Operating Theatres (4)

Theatre Ho Chi Minh City

ICU- Ho Chi Minh City

• Good equipment– Donated– Not Uniform

• Very busy unit• 350 + neonates• Dedicated staff

Ethical Dilemmas

• Complex Surgery / Anaesthesia

• Fly In – Fly Out (After Care !)

• Planning and Equipment

2004 OPD and Medical Ward

Vietnam PlanningInformation by email

• Patient lists reviewed• Investigations

arranged---CT, Contrast etc

• Equipment prepared• Operating lists

Imperforate Anus: Issues

• Continence• Neuropathic Bladder• Other Congenital

Lesions

• Willis Catheter • Ace Procedure

• Continence rates 90%+

Vietnam : Caustic Oesophageal Injury

Reverse Gastric Tube and “Burger”

Recovery Unit

Anaesthetic Impact

• Equipment • Monitors• Analgesia

• Change in post-op practice

Funding - Irish Aid 2007

• Irish Aid Agree to fund project for three years

• Sufficient to fund 4-5 team visits

• To bring Vietnamese to Ireland

• To expand scope of project

Main Surgical Teams

• Urology - Feargal Quinn• Airway - John Russell• Deformity - Patricia Eadie• Orthopaedic - Dave Moore• Gen Surg - Martin Corbally• Cardiac -Mark Redmond, Paul Ozlislok• Anaesthesia B.O’Hare, B.Casey,

P, Sheerin and D. Mannion

Procedures to Date(20 patients per visit-Approx)

• Complex Congenital Anorectal Lesions– Anorectal Agenesis– Persistent Cloaca– Hirschsprungs disease– Complications post repair vesico-vag fistula

• Complicated acquired injuries – Caustic Oesophageal injuries– Oesophageal strictures post TOF repair

Procedures to Date(20 patients per Team visit)

– 100-125 complex patients per year• Total of 750 patients

– 14 Vietnamese Visits to Dublin

– Significant Upskilling for the visiting teams!

“Educational Platforms”

• Surgical, Anaesthetic, Nursing

• Useful educational platform to provide updates to their experience

• Significant Upskilling!

Paediatric Cardiovascular IssuesPaediatric Cardiovascular IssuesHCM CityHCM City

• 6-8 per 1000 live births6-8 per 1000 live births• Incidence of 0.7 – 0.8% of the populationIncidence of 0.7 – 0.8% of the population• >4000 children in HCM with potentially >4000 children in HCM with potentially

correctable congenital heart defectscorrectable congenital heart defects• >500 deaths from Congenital Cardiac Lesions >500 deaths from Congenital Cardiac Lesions

PAPA

Congenital Heart Disease

Memorandum of Understanding2007

Cardiac SurgeryCardiac Surgery

Paediatric Cardiovascular CentrePaediatric Cardiovascular CentreHCM CityHCM City

“MOU”“MOU”

• Train three general surgeons as paediatric Train three general surgeons as paediatric cardiac surgeonscardiac surgeons

• Train 2 doctors to run the cardiopulmonary Train 2 doctors to run the cardiopulmonary bypass (heart-lung) machinebypass (heart-lung) machine

• Train anaesthetists for theatre and ICUTrain anaesthetists for theatre and ICU• Develop ECHO/cath lab skills of CardiologistsDevelop ECHO/cath lab skills of Cardiologists• Upskill theatre and ICU nursesUpskill theatre and ICU nurses

New Hospital Wing (2007)

Our Goal in Vietnam

• Consolidate Open Heart Surgery and Interventional Cardiology

• Consolidate and Develop Thoracic and Oesophageal Surgery

• Consolidate Urology, Hand, Orthopaedic Surgery and Airways Surgery

Our Wider Goal

• Continue to help develop the local infra-structure to provide for measurable self-sufficiency and standards by a process of sustainable “platform workshops”

• Provide an accessible skills resource where needed and requested for South East Asia, Mongolia and Tanzania (Paed Surg Oncology)

• To continue to highlight the role of RCSI and OLCHC (Ireland Inc)

Mission Statement 2010“HEAL”

“Execute a Best Practice Healthcare plan to underwrite the quality of Paediatric Healthcare not just for Vietnam but ultimately South East Asia and East Africa”

Tanzania

• Delivery of Surgical Oncology – Wilms (12)– Hepatoblastoma (1)– Metastatic

Osteosarcoma (1)

• Platform workshops – skill sharing

• Local Contacts- Irish Oncologist in Dar es Salaam

Tanzania-Wilms Tumour

Main Contributors to Programme

Bill Casey• Padraig Sheeran• Fergal Quinn• David Mannion• Mark Redmond• Karina Butler• Patricia Eadie• Yvonne Bernie• Michael Lyons• John May (RCSI Travel)• Des Hurley (Olhausens)• Annette McCarthy• Brendan O’Hare• Cathail Kelly• Michael Horgan (RCSI)• John Collins (Dell Poirot)

• Mark Tormey• Frances Halligan• Bernie McKeown• Jeanette Neary• Olive Delaney• Siobhan FitzGerald• Sheila Hayes• Anne Fitzpatrick• Evelyn Hempenstall• Lorcan Birthistle• Paula Wilson (RCSI)• Grainne O’Donovan (RCSI)• Ruth Kelly• Eamon Tierney• Rupesh Parimkayala

“Vision without Action is a Daydream”

“Action without Vision is a Nightmare”

Absolute Essentials• A Desire to Help • The Skill Mix• An Invitation to Help• Local Facilities

+Support• Funding• Short –Medium-Long

term plans