Preparing for Treatment in Viet Nam

ICEHA and TREAT Asia partner to train health care workers

July 2004—In two rural provinces of Viet Nam, nearly 200 doctors, health care workers, and government representatives came together in May for two three-day workshops on how to treat their growing numbers of patients with HIV/AIDS.

Viet Nam has one of the lowest HIV prevalence rates in Asia—well below one percent nationwide. But, according to the World Bank, low national prevalence rates in large and diverse countries such as China, Indonesia, and Viet Nam often mask “hot spots” where transmission takes place at a much higher rate.

To prepare for a possible HIV explosion and treat those already living with HIV/AIDS in the country, the International Center for Equal Healthcare Access (ICEHA), with support from TREAT Asia through a grant from the Pfizer Foundation and in collaboration with Viet Nam’s Highlands Educational Development Organization (HEDO), is helping create the health care infrastructure necessary for the successful treatment of patients with HIV/AIDS.

Dr. Marie Charles, founder and President of ICEHA, explained that the workshops, which follow a successful model ICEHA has been employing since 2002 in Viet Nam’s Langson province, are intended to impart information on HIV/AIDS treatment in very simple terms, so that all levels of the health care workforce can develop an understanding of how to help their patients.

TREAT Asia, ICEHA, and HEDO organized the first workshop in Lao Cai, the capital of Lao Cai province, May 22–24. Lao Cai is a large highland province on Viet Nam’s northeast border with China. The province is home to a successful cross-border tourism industry and is contending with a serious injection drug use epidemic and an emerging commercial sex industry.

HEDO’s Director, Professor Trinh Ngoc Trinh, welcomed the participants to the conference. Opening the first session, Dr. Pham Manh Hung, Vice Chairman of the Central Commission for Science and Education and Chairman of the Immunology Department, gave an overview of the epidemic in Viet Nam.

Dr. Hung reported that studies conducted among military recruits in 2002 showed a three percent HIV prevalence rate, and a greater than one percent prevalence rate in blood donors, patients with other sexually transmitted diseases, and women at antenatal clinics, evidence that the epidemic is entering the general population.

More than 80 doctors attended the training in Lao Cai, among them 15 directors from district and provincial hospitals. During an intensive three-day program, they heard lectures and participated in seminars on antiretroviral treatment, treatment of opportunistic infections, HIV/TB co-infection, and the epidemiology of HIV in Viet Nam. British physicians Dr. Mark Nelson and Dr. Mark Bower provided overviews of the basic biology of HIV, the clinical course of HIV infection, and strategies for treating opportunistic infections and providing care with limited resources.

An identical workshop followed in Hoa Binh province, May 25–27, attended by approximately 100 doctors from throughout the province.

“The workshops went very well,” said Dr. Charles. “The participants came up to us afterward and said that we had given them tools they could apply in their clinics immediately—the next day.”

Following each workshop, Kevin Frost, amfAR’s Vice President of Clinical Research and Prevention Programs and Director of TREAT Asia, Dr. Charles, and Drs. Nelson and Bower accompanied representatives from HEDO to visit provincial hospitals and local clinics. The visiting physicians were able to follow doctors and nurses as they met with and treated patients, learning directly what the challenges are to providing care in the country.

All participants agreed that there is a serious need to return to Lao Cai and Hoa Binh in the future, not just to reinforce what was learned in these workshops, but also to expand upon that knowledge base. The goal of workshops like these is to help create sustainable health care infrastructures in resource-poor settings, leveraging the wealth of expertise available in the West.

This approach differs from that of Médecins Sans Frontières, which provides treatment directly. Instead, workshops like these support local physicians as they treat their own patient populations.

Dr. Charles founded ICEHA in 2001 because she understands that lack of training for physicians and health care workers is a significant obstacle to providing treatment in developing countries. Her first goal for the organization is to provide an opportunity for physicians from the United States and the United Kingdom to help their colleagues in developing countries fight HIV/AIDS while “learning how to think outside their resource-rich experience, returning home with new ways of dealing with diverse patient populations.” Her greater, and admittedly more ambitious, goal is to build those experiences into medical curricula and the health care system in the United States, so that a part of every doctor’s training will be to spend some time each year in a province like Hoa Binh or Lao Cai.

HEDO was founded in 1990 with the objective of supporting the Upland ethnic minority communities. Viet Nam has more than 50 different ethnic minority groups, many of whom live in remote, mountainous, and often very poor areas on the border with China. HEDO, which was instrumental in coordinating the workshops and drawing participants to them, supports culture, education, and health-related programs within these communities through collaboration with international organizations.