Making a Difference in Vietnam
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Globally millions of newborns die every year in developing and low income countries and the majority from easily preventable causes. Further reductions in child mortality depend on substantial improvements in neonatal survival rates, typically newborn care is the branch of medicine with the least investment given the staggeringly high number of deaths. The global health worker crisis is also a major factor, it is estimated that the global shortage of health workers will reach 4 million by 2015. Training more birth attendants, community health workers and neonatal nurses would allow many more newborn lives to be saved.
Since 1990 Vietnam has made a significant reduction in child mortality but further reductions depend on substantial improvements in neonatal survival rates. In Vietnam more than half of all under-five deaths occur in the neonatal period, and this proportion is growing. There remain big regional disparities in neonatal morality rates, and poverty, education, lack of equality of access to health care all impact on maternal and new born health outcomes. There are an increasing number of neonatal units and these provide the foundation to develop sustainable models of newborn care that are suitable for each local context. With support, training and investment these units can develop neonatal teams with the skills and knowledge to provide more specialist care and save more newborn lives.
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The hospital infrastructure in Vietnam is improving. As an example, the new regional Hospital for Women and Children in Da Nang provides a modern building and much improved facilities in which high quality care can potentially be delivered. However the benefit to babies cannot be fully obtained until better nursing and medical care is available to sick babies admitted to the hospital.
Many newborn babies in Vietnam die even after admission to regional neonatal intensive care units. Lack of specialist training for neonatal nurses is a major contributory factor. In Vietnam there is no neonatal nurse specialist training within nurse education. Currently individuals develop specialist-nursing knowledge by sharing their experience and understanding but there is little educational material available in the Vietnamese language, and what little is available is often outdated or incorrect. Whilst this passage of knowledge from senior to junior staff has assisted, the information available to the nurses is limited. Shortages of skilled nurses and inadequate training in the care of sick and preterm babies are a major reason for poor progress in further reducing neonatal deaths. It is recognised worldwide that nursing skill and knowledge are critical to neonates’ (first 28 days of life) survival.
In Vietnam there is no formal neonatal nurse training, only a general nursing diploma. There is a huge need to bridge the gap between what is known globally as good practice in neonatal care and what is currently done in Vietnam. A simple incorrect decision in the early days of life resulting in disability can be a death sentence in resource–limited Vietnam as living with a life-time of disability effects a heavy burden on families, society and the health system. Many disabilities can be prevented with simple early intervention and good basic care. For example, a third of all children under 10 in schools for the visually impaired in Vietnam have blindness resulting from retinopathy of prematurity which is a condition which is largely preventable by simple nursing measures at the cot-side such as keeping oxygen levels within safe limits.
As the referral hospital for a large catchment area it offers the opportunity to develop the neonatal unit as a regional centre of excellence; to provide specialist care for critically sick newborns; training for community midwives, nurses and health workers to raise standards at the provincial hospitals and commune centres; education and support for families in the care of their babies.
The Head of Pediatrics and her team’s dedication and hunger for knowledge and new strategies to improve their care for their patients, has inspired everyone who has met them over many years. This combined with the solid support of the Department of Health and the Danang University of Medical Technology provides a sound basis for our three year partnership to train neonatal nurses and nurse educators and to lay the foundation for a national programme of neonatal nurse training,
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Newborns Vietnam is supporting Da Nang Hospital for Women & Children, a regional neonatal referral facility for neonatal care in central Vietnam.
Many of the sickest newborns would survive if experienced neonatal nurses cared for them, but these are in short supply. Newborn care is not optimal. The critical shortage of nurses, and limited knowledge, are major factors in why the mortality rate remains high.
Well-trained neonatal nurses are essential if the Da Nang neonatal intensive care unit NICU is to make sustainable reductions in newborn deaths and to develop its role as a regional centre of excellence and improve newborn care across the central region.
Currently in Vietnam nurses undertake accredited nurse education, which has no specialist neonatal component. For nurses working on neonatal intensive care units, there is no certificated specialist education.
To address this critical we have developed a pilot bespoke neonatal nurse training programme.
The curriculume was approved by Canterbury Christ Church University Faculty Board & the Vietnamese Ministry of Health and commenced in March 2013 and the first nurses graduate in August 2014.
Our medical and nursing volunteer programme is adding value to the nurse training, experienced recently retired UK neonatologists, senior nurses, midwives, health visitors and GPs will be joining the team in Da Nang to provide training for junior doctors and support to the nurses to implement the nursing guidelines developed during the training and implement good practice. The next steps are to train the most able nurses as nurse educators and to cascade knowledge to the provincial hospitals.
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The programme aims to support a reduction in neonatal mortality and enhanced outcomes by developing the knowledge, skills and practice of nurses. The course is taught by academics from Canterbury Christ Church University, it develops nurses understanding of the key principles of neonatal care, builds on these to further develop their understanding of the complexity of neonatal disease processes.
The teaching combines theory and the development of practical skills and understanding of the role of the neonatal nurse, and how this role works within the neonatal team to limiting the effects of disease where possible.
The course aims to develop competent, confident, skilled nurses whose enhanced knowledge and skills will directly contribute to reducing newborn deaths and the outcomes for babies that survive.
Our objective is to support the establishment of a national training programme for neonatal nurses in Vietnam. Wider implementation of our nurse education model will potentially lead to improved outcomes of sick babies born in Vietnam, and through dissemination as a proven model to improve outcomes in other resource poor countries.
Training neonatal nurses and nurse educators and developing the local University’s capacity to teach neonatal nurses in the future is a holistic and sustainable approach to reducing neonatal mortality. Cycling for newborns makes this possible – our nurses’ needs specialist training.
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Through our direct work with the Da Nang neonatal intensive care unit, we will develop an evidence base that will inform our future work to support the advancement of newborn care. Over the next two years our research team funded by a grant from The Peter Stebbings Memorial Trust will evaluate the impact of neonatal nurse training on infant outcomes.
Our work is about developing sustainable solutions to bring about lasting change. Our Cycle a Difference – Vietnam Challenge Rides offer a chance for you to enjoy the beauty of Vietnam, experience a little bit of life in a country with a long and troubled history, that is now moving forward, and see first hand how your support will bring about improvements in newborn care, save lives and help us develop a newborn care model that can be replicated around the region and has lessons for all developing countries.
Essential Basic Equipment
A great deal can be achieved with good nursing care and basic equipment and to support the practical application of the nurse training the neonatal unit needs infant warmers – good thermoregulation is the fundamental tenant of newborn care, Neopuffs, infusion pumps, syringe pumps and other small scale items that cost a few thousand dollars.