The 600 Bed Hospital- Da Nang, Vietnam Women’s and Children’s Hospital

Written by Andrea  Bowen, MD PGY4 at the Kaiser Permanente Santa Clara OBGYN Residency Program while on global health rotation at Da Nang Women’s and Children’s Hospital in Da Nang, Vietnam; April 2015.

The ‘600 Bed Hospital’ is in fact a misnomer, as frequently 1300-1400 patients are hospitalized under its roof on any given day!  It is the region’s tertiary care center, with a NICU dedicated to caring for preterm infants born from 26 weeks gestational age onwards.  There are 15,000 deliveries each year, with a 50% Cesarean section rate.  Patients pay the equivalent of $40 out of pocket for a delivery, with the remaining cost subsidized by the nationalized health care delivery system.

As a 3^rd year OB/GYN resident physician, I chose the ‘600 Bed Hospital’ in Da Nang, Vietnam as the location for my Global Health Rotation. During April of 2015 I worked in the Labor & Delivery and Gynecologic Surgery units at the ‘600 Bed Hospital.’  While many conditions (including labor, preeclampsia, fibroids, and menorrhagia) were similar, the overall conditions for the provision of care were markedly different.  Most surgery is performed with the abdominal approach, except for a few laparoscopic and vaginal cases.  The abdominal surgeries are almost exclusively performed with spinal anesthesia.  Almost all of the equipment is re-usable, including laparoscopic trocars and Bovie cautery devices and pads.  Nothing goes to waste and patients are billed for each and every sponge pad utilized during their procedure.  The suture is especially tightly conserved, so only instrument ties are used to minimize the length of suture required to complete a surgery.  A Cesarean delivery, for example, would require a maximum of 2 sutures.  An abdominal hysterectomy would usually also only require 2 sutures, perhaps 3 for a complicated procedure.

The attitudes towards the patient-physician relationship and privacy are markedly different as well.  Physicians have authority there to be more paternalistic than would be acceptable in the Kaiser system in Northern California.  In order to receive surgical care, a patient attends a pre-operative clinic held each Thursday morning in the hospital.  Patients wait outside the room with a crowd of other women and their families.  Each woman is called individually into the examination room by a nurse.  Inside the bare room with a single fan await 20 physicians and 10 nurses who have 1 minute to present her case.  Then any physician who desires can examine the patient.  While the prior patient is finishing up her exam and climbing off the examination table, the next patient is called into the room.  Afterwards, the patients are told whether or not they will receive surgery and which surgery they will receive.

In Labor & Delivery, 4-10 women share the same room for antepartum, labor, and postpartum care.  The delivery rooms are restricted to up to 3 delivering patients.  Midwives provide the majority of care for vaginal deliveries.  Patients are hospitalized for up to a week following delivery.  Breastfeeding and skin-to-skin bonding between mother and infant are highly encouraged.  The hospital and its physicians work hard to adjust their care according to the WHO recommendations.  Skin-to-skin bonding was recently introduced for even Cesarean section patients, and was enthusiastically received by both patients and staff.

My overall impression of the people of Vietnam, from hospital administrators to patients to kitchen staff, is very positive.  They were very welcoming to me, seeking out opportunities to practice their English skills, and patiently and smilingly accepting my attempts at communication in garbled single Vietnamese phrases.  They are open and willing to hear how obstetrics and gynecology are practiced at Northern California Kaiser.  They want to engage in factual conversations on how to improve care for their patient population, while bearing in mind the financial and other resource limitations they are faced with.

An ongoing relationship with this ‘600 Bed Hospital’ would be value added  for residents here to experience surgical procedures as performed in Vietnam while educating doctors there with regard to latest surgical techniques and procedures. I hope to be able to return the kindness and hospitality shown to me by the physicians at Da Nang Women’s and Children’s Hospital by inviting one young physician to visit northern California to observe in our Kaiser Hospital system.  I greatly appreciate the support from both my residency program and the Global Health Program of Kaiser Permanente in providing me with this opportunity.  There are experiences and learning opportunities I encountered there that will stay with me for life. I will forever be amazed by the staggering number of patients that they perform surgery on and provide care for given the minimalistic resources at their disposal!