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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.
Founded and Development Founded and Development of Rehabilitation Medicine in Vietnamof Rehabilitation Medicine in Vietnam
• 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.
Founded and Development Founded and Development of Rehabilitation Medicine in Vietnamof Rehabilitation Medicine in Vietnam
• 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.
Law and Policy related to disable personLaw and Policy related to disable person
• 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”./.
Law and Policy related to disable personLaw and Policy related to disable person
• 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 !