Twinning Update – March 2012

In March 2012, IHS staff members Brian O\’Mahony, CEO, Debbie Greene, Administrator and Fiona Brennan, Children\’s Programmes and Volunteer Coordinator travelled to Vietnam as part of the WFH Twinning Programme. IHS member Shay Farrelly accompanied the staff on this visit. Below is a day by day account of the visit by Shay, taken from his website www.shayfarrelly.com

 
Day 1
Up early at 4am for the flight to Paris, a 4 hour stop-over in Charles De Gaul airport, and then on to Hanoi with Vietnam Airlines. The flight is 10.5 hours so in fact the first day is gone on travelling as we arrive on Paddy’s day, Saturday 17th at 5.40am. Not much to say about long flights except I think the plane we flew on had many, many, many hours clocked up on it!!!

Anyway we arrive, and the sun isn’t up yet. Next we have a two-hour wait to get our visas. With that eventually sorted, our bags are waiting for us and so is our taxi to bring us to the hotel. This is great as you hear all sorts of problems with scams between taxi drivers and hotels.

So the first impressions? Typical Paddy’s day, it is raining and misty. The drive from the airport to the city brings us through some countryside and we get our first sight of Paddy fields. As we get closer to the city we see a very industrial city with a mixture of typical communist type buildings with a mix of factories: Panasonic and Yamaha to name a couple and more historic buildings that look Vietnamese with their beautifully ornate roofs. Although it\’s 8 am the traffic is building up and the ubiquitous motorbikes and push bikes become even more prominent. Some stacked high with wares for the market and others with two or three passengers. The traffic runs in all directions with no apparent control, and then the pedestrians trying to cross the road, what havoc!! I’m not looking forward to trying to cross the road.

Our hotel is nestled in the middle of the old town and it is very nice and well appointed. So we decide to get a bite of breakfast and go to bed for a few hours before exploring.

 

Day 2
The hotel is a lovely boutique hotel right in the middle of the old town. The rooms are well appointed with a laptop in each room with internet as well as WiFi. Mind you, you’re not allowed access Facebook.

After a few hours rest, we head out in the afternoon for a stroll. The drizzle persists, and we start to get used to the manic traffic. Motorbikes and cars weave all over the street with horns constantly hooting and the pedestrians are also weaving in the traffic. It’s next to impossible to walk on the pavements as there are either people sitting on the streets or else there are motorbikes parked on the sidewalk.

The streets in the Old Town are narrow and the smell of cooking abounds. It must be the ubiquitous Poh – a noodle soup. As well as standard cafes here are people selling food from bikes or baskets. Every so often there are people cooking on the pavement and people sitting on little plastic seats eating and drinking. There are shops selling all types of knickknacks and small supermarkets.

We return at 6 pm to meet Dr Mai and her Assistant Ms Hang. We discuss the workshops for the following week before heading off to dinner. The schedule looks very good with visits to people’s homes to see how they cope with their haemophilia. We are also invited to an evening celebrations of a nurses wedding on Wednesday. Dr Mai and Ms Hang are very friendly and bring us to a specialist fish restaurant where we have a fantastic meal. Everything is cooked at the table, the sauces, vegetables and fish are lovely and I manage the chopsticks quite well. Afterwards we head to the nightly market that runs at every Friday, Saturday and Sunday. The streets are thronged with people. To finish the night off, after we leave the girls back to the hotel, Brian and I go in search of an Irish bar to get a drink for Paddy’s day.

Tomorrow the plan was to go to Halong Bay, but today due to the heavy mist the boats were not allowed out so we’ve decided not risk the 3.5 hour drive there and just do our own thing. In the meantime, I listen to the Ireland v England match on my iPhone app, amazing what you can do!!

Day 3
Did I mention it was drizzling here, so much for the long range forecast that made me go out and buy sun cream, you are more likely to rust than get sunburn! And now see what the forecast says!!

Silly boy I am, last night I stayed awake until 2 am listening to the commentary of the Ireland rugby match on my iPhone. It wasn’t even worth listening to! So this morning I slept on a little while the others were half way through their breakfasts. It was a Sunday and our last free day before the workshops begin. To be honest, we didn’t do too much just wandered around looking at the sights. Thankfully most of the museums closed early or Brian would have dragged us around a load more. We are getting used to the streets and being able to walk between the cars and motorbikes. Also, it didn’t drizzle all day, however, it didn’t get sunny, but we didn’t get wet at least.

Tonight we will have another look at the night market and then go for a meal. We are being collected at 8 am in the morning to go to the hospital that I think is about 45 minutes away from our hotel. Looks like it will be a busy day.

As we sat having a cup of coffee, we watch these balloon sellers who sold their balloons in the middle of the traffic with cars and motorbikes whizzing around them. The funny thing is that people on motorbikes would stop to buy balloons and head off holding their purchases as they drove along!

Day 4
Last night we ate out in a lovely little restaurant. Upstairs in a small room with no more than eight tables, but lovely Vietnamese food. I had spring rolls and we all had their speciality, chicken five spices, I think it was called, with steamed rice. Anyway, the whole thing was gorgeous and all for only €5.50!!! Then off to the last night of the late market.

Up early today, quick breakfast and we are taken to the hospital. This involves a 40 min drive from our hotel and it was a real experience driving through rush hour traffic. I’ve never seen anything like it! We arrived at the combined blood bank and hospital. It is an impressive building with very good laboratories, inpatient facilities and dedicated staff but, unfortunately, they lack enough treatment to treat everybody sufficiently. We are introduced to a large number of inpatients and outpatients and it is really heartbreaking to see such young men who are severely crippled due to haemophilia. We are very fortunate in Ireland that no one suffers like this anymore and it is a great pity to see such suffering with the extensive knowledge and treatment that is available in today’s world. We have a busy day with meetings and I cannot say much about these except it was great to see so many people, some who had travelled a great deal to meet us. They were very enthusiastic and energetic which hopefully means that conditions will improve in the future.

Afterwards, we were taken to another fantastic restaurant and I have to say Vietnamese food is gorgeous, well worth trying if you ever get the chance.

Day 5
Michael asked me if I travelled all this way just for the food, so just for today I won’t mention how good the food is, oops to late I’ve done it again!
The hospital is a fine modern building but still sometimes there are more patients than beds and at times there may be two to a bed. I also forgot to mention yesterday that the hospital deals with both adults and children. And it was just brilliant to see how happy the kids were when they received the simple toys and gifts we brought for them, one little lad jumped and ran around the corridor for joy. I have a feeling Fiona would happily steal one away; they are such wonderful little boys.

Seeing and listening to these young men and their parents brought me back to the 60-70s in Ireland before there was an effective treatment. Here they are stuck into a vicious circle. There is not sufficient treatment so the boys miss a lot of school, they are becoming disabled with impaired limbs and their education suffers greatly, so they cannot get proper jobs due to their poor education and disability. So, they have a poor quality of life that is very frustrating for them. The funny thing is that they have a lovely modern hospital, albeit with too few beds at times. They have great doctors and just as important good nurses, but they don’t have enough treatment to allow these young men live a full, healthy, and good quality life. They are looking to the I.H.S. to help them organise an efficient and effective Society that will help them over time to deliver the comprehensive treatment they deserve.

Tomorrow we visit one of the regions about 100km from Hanoi where we will meet some families and see some of the sights. We have also been invited to part of a traditional Vietnamese wedding, so early to bed tonight!

Day 6
We were picked up this morning at 6 am, we were being brought out for a day sightseeing and to see a family with a Haemophilic boy. The province of Hoa Binh is a good 2-hour journey though we have to stop off at the hospital first to pick up all those going on the trip. We have Dr Mai and some of her team including another doctor, a few nurses, one of the nurse’s daughters who acts as a volunteer, a young man with haemophilia and Ms Hang, who is an administrator at the hospital in the centre.

On the road in a bus for a couple of hours, and it’s interesting to see the countryside and small villages along the way. Where we are going isn’t too far away, less than a hundred kilometres, but the roads are not great, we come across slow moving vehicles, and the odd small herd of cattle. It appears that it takes forever to drive any sort of distance.

About 9 am we make it to the hydroelectric power station that produces about 20% of the country’s electricity. It was built with the expertise of Russian engineers and some 37,000 Vietnamese workers. It took 15 years to build and some 167 people lost their lives in its construction. It was built on a mountainside to prevent its distraction during a war. It was completed in 1982.

We were then taken for a long boat ride on the lake, perhaps to make up for the fact we didn’t get to Halong Bay. We are taken to a small temple on a tiny island in the lake. Here Dr Mai buys some freshly barbequed fish that we eat on the boat. These are lovely people and even with a bit of a language barrier we had a great laugh and they are so hospitable.

Sorry Michael but I have to say we had another great lunch. We were taken to an excellent restaurant. The food is so fresh and great vegetables and dipping sauces.

Next we are brought to a very entertaining and ethnic dance show. We shared some local wine from a large pot using long bamboo straws.

We are then welcomed into the house of a local boy with haemophilia, our whole crew of 12, are invited in to sit at two long tables they have prepared with food. As well as his parents there is his grandmother, aunts, local doctor, 3 of his school teachers and he also had a friend there with haemophilia. We were made most welcome with, food, drink, flowers, speeches and a gift each. They are truly wonderful people and hopeful that our twinning programme can produce dividends through improved overall health care for their boys and all boys with haemophilia.

It’s just gone 5pm and time to set off. We’ve been invited to the after celebrations of a wedding party of one of the nurses in the Haemophilia Centre. As can be expected weddings are slightly different here, the ceremony is actually tomorrow and tonight we were invited to the bride\’s party in her house (sort of a hen’s party) meanwhile hubby to be is having a party in his home. The wedding album is already produced. They took the photos in all the wedding garb about 2 months ago. The family treat us like royalty, we are taken into the house and given the best chairs and introduced to all the important members of the family. Then of course there’s even more food. Overall a fantastic day and they have looked after us very well. Here are some photos from my iPhone today on the lake.
Day 7
We set off at 6.45am for our flight to Ho Chi Minh City (HCM), formally Saigon. Vietnam is a long country, it being some 1900 km between these two cities and takes 2 hours by plane.

The first impressions of HCM is a slightly more modern city to Hanoi with wider streets though the traffic is still fairly hectic.

In the afternoon, we are to visit the blood bank and three hospitals that treat haemophilia. It’s when you visit hospitals like these that you realise how lucky we are, there are many problems with our health service, but here things are much worse. The doctors and nurses are excellent but they cannot work miracles with the resources they have. We see crowded hospitals with no privacy and in many cases patients are sharing beds. The worse part of this is that haemophilia is readily treatable, and patients can treat themselves at home with modern treatment. When this is done there are less strains on the medical system, with patients being more healthy and requiring less hospitalisation. Instead, here there is limited and poorer quality treatment which means these young men are severely disabled, which means they cannot get full education and hence appropriate jobs. Also, here the patients must pay a contribution towards their treatment (20%) except if they are destitute. Salaries are poor and one treatment can cost as much as one month’s salary. So it is not uncommon for people to sell their possessions and homes to pay for treatment. Because these children and men are not getting sufficient treatment, most are disabled with deformed joints and in many cases they have lost limbs. It is a very humbling experience.

Tomorrow we are to return for the formal set up of a branch of the Vietnamese Haemophilia Society in HCM city and for workshops.

Again we are treated to a very nice seafood meal in a fine restaurant by the health care professionals in HCM city, our hosts are extremely hospitable and friendly and it is a very enjoyable evening.

Day 8
The morning started with a very formal inauguration of the HCM City club, which essentially is a branch of the Vietnamese Haemophilia Society.

There are over 50 people attending, with high-powered doctors there and we are invited to the top table as guests. There is a TV camera for local news reporting. The opening ceremony lasts two hours, the most touching contribution being from a man significantly disabled with haemophilia who is obviously overcome with emotion at the set-up of this club, and what he hopes may improve overall treatment. After it finishes, it gives us an opportunity to mix and talk to the PWH’s and parents attending. They are extremely friendly and talk freely and ask us about our services and the level of treatment we receive. In fact, it’s a little humbling as I soon realise that in perhaps two or three treatments I would have used up an entire years treatment for one of these young men. They can only live in hope, and repeatedly I am told our position is a dream for them.

After another fine lunch with the doctors, we have a couple of workshops to discuss the way to organise a society and how to get and train volunteers.

That finishes our work for the day so we have three days left to enjoy ourselves.

Day 9
A lie on at last, up at 8.30, breakfast, store our main luggage at the hotel. Let’s hope it’s still there on Monday when we return and off the catch the hydrofoil to Vung Tau. Our boat leaves at 11.30am and will take 1.5 hours. Vung Tau is a beach resort outside HCM that the Vietnamese visit at weekends, apparently it’s famous as the place that Gary Glitter frequented!!!!!!

Anyway, we check in, it’s not Ritz but will do fine and relaxing and taking in the sun is the order of the day.

Days 10 – 12
The last few days have been about relaxing and getting home. Sunday in Vung Tau (admittedly forgettable), back to HCM city on Monday to walk around city and night market and finally 24 hours getting home via Bangkok and Amsterdam.

What are my impressions? Well, much of the time was spent at meetings though we did get to sample some of the country. But based on my limited experience Hanoi and the north appears more traditional Vietnamese whereas HCM City in the south is more cosmopolitan and western as evidenced by the newer, bigger city and shops like Gucci, Armani, Burberry, Channel, etc, etc. Though we did see a Gucci store in Hanoi as well but not on the same scale. Though I am sure that not many locals purchased here, the wealthy international visitor I expect makes up the majority of the customers. As I understand it even well-educated professionals may earn only $200 a month and we saw plenty of people living on much less, and inflation is rampant now.

I love Hanoi and some of the local areas we saw and were taken to. It whetted my appetite for more. It would be nice to visit and travel widely with other photographers to get some great images of the very varied landscape and seascapes as well as the beautiful people. The people themselves are, friendly, welcoming, quiet and sometimes shy. There are many different ethnicities with varying traditions that would be great to explore and to get to know more about. In the time available we really didn’t even scratch the surface.

 

The food is great, a preponderance of fish and seafood, but it all seems so fresh, plainly cooked and embellished with lovely sauces, and the use of vegetables is great. Though we also sampled some of the very unusually: uterus, pigs intestine, testicle, liver and a dessert which contained frogs stomach, fortunately, we avoided snake! Unfortunately, they did not inherit good desserts from their French invaders but they have an abundance of fantastic fruit to make up for this.

For those of a more cultural bent, than myself, there are also plenty of museums and places that commemorate the struggle against their previous invaders, the USA and the French.

What, though, of their Haemophilia care? Well, there are some very good points. Firstly there are some Haemophilia centres around the country; this is excellent as I have no doubt that without these centres there would be many more injuries and indeed deaths. General hospitals just don’t treat as well, they don’t have the expertise or the treatment and the delay or denial of treatment, or inappropriate treatment can lead to permanent injury or death. Even in Ireland, where we have good comprehensive care in centres there is a concern about being treated in centres without this expertise. Steps are being taken to try to improve on this. The problem here in Vietnam is that many patients live a long way from the centres and most do not have a decent mode of transport except perhaps on the back of a motorbike which isn’t exactly the best mode of transport with a bleed or injury! This delay causes further problems.

At these centres, there is very good and dedicated staff who look after their patients as well as they can, but the problem is two-fold. The lack of access to sufficient and appropriate factor replacement treatment. As a developing country, it is difficult to access the most modern factor replacement concentrates so less efficient plasma-derived products are used. And although these are made locally to high standards with proper screening for viruses and contaminants, sufficient treatment cannot be made to allow patients treat themselves at home when they get injured, which, would revolutionise the standard of care. Secondly, people with haemophilia here must pay a contribution towards their treatment, 20%, which for the vast majority here is a great burden and has led to great hardship. In circumstances of poverty, this contribution is reduced to 5% and in these cases the treatment manufacturers will pay the final 5%, but this only encourages poverty.

The outcome is that patients lose out on their education, can’t get jobs and find it difficult to support themselves. Seeing this is very humbling and makes me appreciate the very good level of care we get. But also it reminds me of how it used to be in Ireland many decades ago. It has been a long road, a very hard fought road, to get us where we are and this road has been paved with many instances of hardship, through lack of treatment which lead to deformity and disablement, poor education, lack of job prospects, families ashamed of their haemophilia, poor quality of life, and indeed lives cut tragically short through injury. In the last three decades, poor safety measures in the manufacturing of the treatment has had its own tragedy through contamination with HIV, AIDS and Hep C, where the lives of many friends and families have been devastated. So my visit here reinforces in me that we should not be complacent about what we have achieved, irrespective of our economy. We need to retain and continue to improve our level of care so that we should not fall back into the abyss of inadequate treatment, and we must insist on the highest level of care. In this way people with haemophilia and bleeding disorders can have full and fulfilling lives, and can contribute to society rather than be a burden on it.

So finally a country I would love to return to and explore more fully.