Since 1975, Vietnam has made major strides toward constructing a comprehensive health care system, including major improvements in the primary care and preventative medicine; percentage gross domestic product (GDP) spending on health care in 2012 was the highest in the Association of Southeast Asian Nations (ASEAN) region. The incidence of HIV and TB has fallen. Maternal health has been improved, perinatal mortality rates improved and more than 90 percent of births are performed by qualified midwives. The 2008 Health Act further increased government spending and set a goal to develop and deliver tertiary health care to international standards comparable to countries in the ASEAN region. This is challenging, due to cost, lack of capacity and the size of the rapidly growing population.
I have been a frequent traveller to Vietnam with my family since 2000 and it is no exaggeration to say that I have developed an overwhelming affection for the country. When I get off the plane in Nam Phat airport in Ho Chi Minh City, or Saigon, I experience smells and sounds so familiar that I get a sense of being home, although clearly this is absurd as my home and my “real” job is 8,000 miles away in Dublin, Ireland. Incidentally, the locals still refer to Ho Chi Minh City as Saigon, a name that conjures up images of mystery, beauty and war, and where stories of life, and death, have been captured in the writings of some of the great authors such as Marguerite Duras and Graham Greene, and have been beautifully told in evocative movies such as Indochine, Cyclo and The Scent of Green Papaya.
Some years back my family and I had just recently returned from Vietnam when I fortuitously ran into a colleague at Our Ladys Hospital for Sick Children in Dublin. It turned out that he had recently been to Vietnam at the invitation of the Christina Noble Childrens Foundation (CNCF), a renowned advocate organization for children, to visit Benh Vien Nhi Dong II (Childrens Hospital No. 2) in Ho Chi Minh City as part of Operation Childlife. The objective, in conjunction with the Vietnamese Ministry of Health, Childrens Hospital No. 2, and CNCF, was to identify clinical areas of medicine and surgery where they could help develop tertiary services to international standards. My colleague asked if I would be interested in supporting the program with interventional radiology input. Needless to say, I jumped at the opportunity.
The role of Operation Childlife embodies a combination of administrative, clinical and educational inputs. It was always believed that simply going to Saigon to do challenging cases would never in itself be useful in helping to develop tertiary services. From the outset, the program emphasized training and education, which were considered to be of equal importance to the success of the program as the clinical work. It took several years to get up and running but now the program is at a point where several disciplines are of exceptional standard and where other disciplines are currently being developed (hematology and oncology). Doctors from Childrens Hospital No. 2 continue to regularly come to Ireland for training as part of the program.
Prior to the first trip, I spent months assembling my travelling IR equipment, equipment that I was not at all sure that I would get to use! I had expected this to be a fact-finding mission but my biggest fear was that I would be of limited use to the group and end up being a “hanger-on.” They had a pediatric cardiology suite and a C-arm, so from an imaging point of view I knew if cases could be identified, then at least I would have somewhere to do procedures. I needn’t have worried. When I arrived in Saigon I went to clinic with the hospital chief of surgery and with my colleague from Operation Childlife. We identified some cases where I couldassist and within 24 hours I was doing my first cases.
The workload has been diverse and challenging and always gives a great sense of fulfillment and, indeed, reminds me why I chose medicine as a career in the first place. I feel that I have performed some of the most rewarding cases of my career in Saigon. I have done biopsies and abscess drainages, renal artery stenting, a pulmonary artery stent, an aortic stent, vascular malformations and lots of straightfoward esophageal work.
A case that comes to mind is a child who swallowed a caustic liquid (a common occurrence in Vietnam due to storage of the fluids in reused plastic bottles). The child had developed complete occlusion of the esophagus from the injury. He hadn’t swallowed anything including his own saliva for some time. He was being fed by a gastrostomy tube. I used the C-arm to perform a rendezvous, approaching transorally from above, and retrogradely via the gastrostomy, to recannulize his esophagus and balloon dilate the occlusion.
We recognised that a single-session dilatation of the stricture was not going to solve his problem so I left a suture extending from his nose through the esophagus to exit his gastrostomy so that the surgical team over a period of many months could continue to dilate with dilators pulled from above and out through the gastrostomy, without fear of losing access through the stricture. The child did very well as a result.
Other cases that are memorable are of two children with liver tumours that I embolized. I also performed an embolization procedure to treat a complex vascular malformation in the liver causing liver dysfunction and cardiac difficulties. I have been told that these were the first cases of pediatric transcatheter embolization procedures done in Vietnam.
As I have already alluded to, the aim of our work is always to do the cases with the local doctors so that they can ultimately learn to do the procedures themselves. They embraced interventional radiology from the outset and were keen to get scrubbed into cases. The talent and enthusiasm of the medical graduates that I encounter in Saigon is on a par with any that I have encountered anywhere in my career.
On each trip I give a series of lectures and tutorials, and I have been impressed by how enthusiastically the audience have embraced the possibilities of IR, indeed often challenging my own thinking on the subject. As a junior interventional radiologist
I was lucky to have mentors who were generous with their time, knowledge and expertise, so I now consider myself fortunate to be in a position to spread the word about IR. I know that some of the colleagues that I have worked with in Saigon have had their interest piqued by the IR cases that they have seen in Benh Vien Nhi Dong II. Hopefully, some will pursue a full time career in IR. I would encourage any IR who has the inclination towards volunteering in a developing health system to grasp the opportunity with both hands. It will be one of the best experiences of your career.
I thank my friends and colleagues in Operation Childlife (operationchildlife.com) for their vision and their extraordinary commitment to the program, and for inviting me to be part of the team. I thank my colleagues in Childrens Hospital No. 2, Saigon. We have become firm friends and I am grateful to them for their hospitality and warmth. I acknowledge the Medical Aid Program of the Christina Noble Childrens Foundation (cncf.org) for their unstinting support, and also members of the Irish Society of Interventional Radiology who have given their support.
