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Journey to Vietnam_ Cambodia rev by wuyunyi

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									         Journey to Vietnam, Cambodia reveals health challenges

On 1 December 2008, 15 members of an interdisciplinary nursing delegation and four
guests departed from San Francisco International Airport to Ho Chi Minh City in
Vietnam. The delegation, which was part of the People to People Citizen Ambassador
Program, worked to get a better understanding of health care systems and challenges in
Vietnam and Cambodia. What follows are excerpts from the recorders’ journal entries, as
well as photographs.

                          1 December 2008, San Francisco
                              Recorder- Carol Huston

Our flight from San Francisco to Hong Kong on Pacific Cathay Airlines lasted 14 hours.
Because we left a few minutes after midnight and crossed the International Date Line half
way through our journey, much of our flight was in darkness. Following a two-hour
layover in Hong Kong, the group continued on to Ho Chi Minh City (formerly Saigon),
Vietnam. We arrived 3 December.

After arriving at the hotel, delegates and guests were given time for a brief lunch before
meeting for a delegation briefing. Delegation leader Carol Huston welcomed delegates
and thanked them on behalf of the People to People Citizen Ambassador Programs.
Delegates and guests then introduced themselves and provided a brief overview of their
professional backgrounds and reasons for joining the delegation.

Then the group completed a tour of city sights within walking distance of the hotel.


                 4 December 2008, Ho Chi Minh City, Vietnam
                          Recorder- Desiree Tritle
                            Additional notes by Carol Huston

The first professional meeting of this delegation began early morning at Pham Ngoc
Thach Medical University, one of the most prestigious medical universities in Vietnam.
The delegation was greeted by Nguyen The Dung MD (deputy rector), Cao Van Thinh
MD (head of department of nursing and head of department of thoracic and vascular
surgery) and Nguyen Xuan An (Secretary of the Office for Research and International
Cooperation). Here, we learned about education and certification for physicians and
nurses in Vietnam; that nurses earn about $2/hour and supplement their income with tips;
and that there are many challenges nurses face in Vietnam, including lack of qualified
nurses and midwives, substandard education and lack of motivation related to limited
opportunities to migrate elsewhere.

                 4 December 2008, Ho Chi Minh City, Vietnam
                         Recorder- Sheila Sprague

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                             Additional notes by Carol Huston

The second professional meeting of this delegation began at Nhi Dong Children’s
Hospital. The hospital provides health care to children from 0 to 15 years old in Ho Chi
Minh City and southern provinces of Vietnam. The hospital focuses on providing health
care to the children in a safe and friendly environment, with high qualified staff and
modern equipment. It’s considered to be the best children’s hospital in the south of
Vietnam.

Currently, the hospital has 1,000 beds for inpatients in all specialties but the average
inpatient daily census, however, is closer to 1,300-1,500. In fact, many of the beds we
saw had 2 or 3 children sharing the same bed and we were surprised to see that children
with infectious diseases were mixed in with those without. More than 4,000-5,000
children are seen every day as outpatients, 51 percent of them coming from rural
provinces.

The delegates considered the hospital to be generally progressive, and we were impressed
with the technology available. A neonatal ICU, SICU, and burn unit existed. There were
120 NICU beds, although the census on the day we were there was between 250 and 300,
since the hospital cannot turn anyone away, regardless of census.


                  4 December 2008, Ho Chi Minh City, Vietnam
                           Recorder- Carol Huston

Our local guide shared on our bus ride back to the hotel that health care is free to all
Vietnamese children under the age of 6. School age children have health insurance they
can buy through school for the equivalent of about $7per year. Minority groups in
Vietnam get free health care. There are 54 ethnic groups in Vietnam, but 86% belong to
one group. In addition, the poor who live in the country have access to free health care
but the poor in the city do not. Of the 86 million people who live in Vietnam, about 24
million have health insurance, so the government picks up the tab, at least in part, for the
majority of citizens.


                  5 December 2008, Ho Chi Minh City, Vietnam
                           Recorder- Carol Huston

Today was a cultural day. We took a two hour bus ride (each way) for a boat ride down the
Mekong Delta. The Mekong Delta is in the southernmost region of Vietnam, and was formed
by sediment deposited by the Mekong River. Silt deposits extend the delta shoreline at the
mouth of the river by as much as 79 meters per year. The area is known as Vietnam’s “bread
basket” and produces rice, which feeds the entire country.




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Our adventures today included a large boat ride, transit via small flatboats in the sloughs
(Vietnamese women do the paddling), a horse-drawn rickshaw ride,and some shopping.

               6 December 2008, Travel to Siem Reap, Cambodia
                           Recorder- Carol Huston

After a leisurely breakfast, the delegation boarded the bus for the airport to travel to Siem
Reap, Cambodia. During our transit to the airport, gifts were presented to our local guide
and bus driver. After a one hour flight, we arrived in Siem Reap, Cambodia, in early
afternoon. Our first priority was obtaining Cambodia visas at the airport and then having
lunch.

Siem Reap is a small city of 200,000 so this was a big change from the bustle and throngs
of people in Ho Chi Minh City. Most Cambodians live in the country, however. We also
immediately noted that most residents here travel around on bicycles instead of motor
scooters.

The Angkor Victoria hotel we were housed in was lovely and was reminiscent of an
African lodge. Mosquitoes, though, are a real problem as are dengue fever and malaria.
We put on lots of bug spray before going out for our open air dinner.

Several delegation members have experienced minor digestive upset. One delegate
required hospital care for fever, chills, and GI distress and stayed behind in Ho Chi Minh
City.

                     6 December 2008, Siem Reap, Cambodia
                           Recorder- Jessica Beattie
                             Additional notes by Carol Huston


The third professional meeting of this delegation was at the Angkor Children’s Hospital.
The delegation met with both Dr. William Housworth (executive director) and Mr. Som
Sophal (director of nursing). With a country-wide population of 13 million, nearly half of
Cambodian citizens are under the age of 15.

ACH was funded by Friends Without a Border and founded by Kenro Izu, an
internationally acclaimed photographer. The Web site for this hospital suggests it has
treated almost 500,000 children since it opened in 1999. Currently the outpatient
department sees 300-400 children each day and maintains 50 inpatient beds. Patients are
asked to pay a nominal fixed fee per visit if they can afford to do so – all treatment and
inpatient care is free of charge.

Cambodia has the highest infant and under-5 mortality rates in the region, at 97 and 141
per 1,000 live births, respectively. Vaccine-preventable diseases, diarrhea, and respiratory
infections are among the leading causes of childhood death. One out of 7 children dies in



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Cambodia here before the age of 5. Leading causes of death are pneumonia, starvation
and diarrhea.


                      7 December 2008, Siem Reap, Cambodia
                             Recorder- Carol Huston

This was our final full day in Siem Reap, and we spent it touring the unique architectural
monuments of the Khmer civilization. This morning we toured Angkor Wat, identified on
some lists as one of the seven wonders of the world. This is an amazing temple built
almost 1,000 years ago. It covers 81 hectares. It is about the same size as the Imperial
Palace in Beijing, China, and took us almost two hours to walk from end to end. The
temple’s distinctive five towers are emblazoned on the Cambodian flag and the 12th
century masterpiece is considered by art historians to be the prime example of classical
Khmer art and architecture.

It was a challenge navigating the steep stairs and grossly uneven surfaces, but we all
made it! It was fun to see the wild monkeys trailing us at Angkor Wat and to hear the
parrots screeching at us from the trees.

We did get to see more countryside during our bus travels to and from the temples today.
Cambodia is such an interesting contrast of beauty and poverty. The hotels in Siem Reap
are new and beautiful--- clearly directed at the tourism industry, which is bringing a lot of
money into this country. Just behind the gates of the hotels, there are many
peddlers/beggars, especially children. With 85 percent of the population being illiterate,
the hopes for doing much else to make a living are pretty slim.


     8 December 2008, Siem Reap, Cambodia to Phnom Penh, Cambodia
                         Recorder- Carol Huston

We were up in the early hours of the morning for our 35-minute flight to Phnom Penh,
the capital of Cambodia. Phnom Penh is a city of several million people, most of whom
are very poor.

Health care is supposed to be free, but it is not. In order to receive quality health care, one
must pay money under the table to even be seen. Quality of care is related to such bribes.
There are no formal support systems available to the disabled or mentally ill.

The same goes for education. Education is supposed to be free, but many teachers will
require their students to pay the equivalent of about US 25 cents each day to be allowed
in their classrooms. (Remember that the weekly salary is typically less than $7). Less
than 10 percent of the children are expected to finish high school. So many children
repeat grades that it takes on average more than 10 years to complete primary school.
Less than half of all students make it that far.



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We learned more about the sex slave industry from our national guide. In particular, the
female children from the country are lured to the cities with promises of high paying jobs
in restaurants, hotels and as servants. Families are paid a cash bonus and the girls are
encouraged to leave for what many parents think will be a better life. Then the girls are
sold to brothels. The government says it is cracking down on the practice, but it is still a
fairly common thing for tourists to seek our young girls for sexual gratification.

As one might expect, HIV/AIDS and sexually transmitted diseases are common. So too
are landmine injuries and deaths. The government offers no support to landmine victims
so they must resort to begging on the streets.

After seeing so much poverty, it was difficult to tour the National Palace and to see the
floors made of solid silver and the roofs covered in gold. All this wealth is held by a
figurehead king with little formal power.


                    8 December 2008, Phnom Penh, Cambodia
                           Recorder- Susan Morrison

Our fourth professional meeting occurred this afternoon with the Reproductive Health
Association of Cambodia. Dr Ping Chutema MD, director of clinical services, greeted the
delegation and shared information about their facilities and services. The mission of the
RHAC is to enable the Cambodian people to exercise their right to achieve optimal quality
of life through model services, gender sensitive health communication, and training
focusing on family health, including sexual and reproductive health, maternal and child
health and HIV/AIDS.

In 1994, the Family Planning International Assistance (FPIA), the international service
division of the Planned Parenthood Federation of America, set up a Family Health and
Spacing Project in Cambodia with funding from the United States Agency for
International Development (USAID).

RHAC currently serves Phnom Penh and 13 provinces. Clinical services include family
planning, detection and treatment of STDs, HIV testing and counseling, prenatal care,
cervical cancer screening, and treatment of minor gynecological problems such as those
related to menopause.

The clinic also employs an extensive volunteer system to provide health teaching on
various health care topics, including family planning, prenatal care, newborn care, and
the need for immunizations and Vitamin A for the children of Cambodia. The number of
clinics has increased since RHAC was established in 1994, to 16 today.

                    9 December 2008, Phnom Penh, Cambodia
                           Recorder- Carol Griswold
                            Additional notes by Carol Huston



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The day began with our fifth professional visit by meeting with staff at the National
Pediatric Hospital (NPH). Professor Chan Ry MD, deputy director of NPH, and Khem
Chanthorn, deputy nurse and chief of emergency care, along with other staff members in
the facility, received the delegation.

Currently, there are 150 inpatient beds and future expansion plans will increase the
number to 400.
Overcrowding has been a major problem during dengue fever outbreaks, the most recent
of which was last year. Dengue hemorrhagic fever (DHF) outbreaks occur typically every
two to three years. This results in dengue shock syndrome (DSS). Outbreaks occur during
the rainy season (June-September) when the mosquito population is at its highest.
Nursing staff do not use “nursing process” although this is a goal for the future. The
hospital staff also expressed hope for exchange opportunities for nurses in the future,
particularly to countries in North America and Europe.
                    9 December 2008, Phnom Penh, Cambodia
                            Recorder- Carol Huston

Later in the day, the delegation also visited the School of Nursing affiliated with the
National Pediatric Hospital (NPH), our sixth professional host. This school is called the
University of Health Science, and the program is called the Technical School for Medical
Care. Dr. Huy Sovath MD is the Director of the School for Nursing and proudly wore his
honor society jacket and pin to greet the delegation.
Dr. Sovath said that the school began as a nursing and midwifery school in 1950 and is
the only nursing school in Cambodia, although it has outreach sites. The school was
renamed the Technical School for Medical Care in 1997.

In 2001, several meetings were conducted at the University of Health Sciences to develop
a new nursing education system. A new 1-year post-basic training for midwives was
established and a three-year program for registered nursing was begun.
Nursing faculty are required to have a medical background, have three years of work
experience in health care and have some specialization in their content areas.

To attend the university, students must now pay half their tuition. The remainder is paid
for by the government.


                    9 December 2008, Phnom Penh, Cambodia
                            Recorder- Carol Huston

The delegation then began a tour of the Killing Fields of Choeung Ek, a concentration
camp. Of the 129 communal graves, 43 have been left untouched. Between 1975 and


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1978, about 17,000 men, women, children and infants were detained and tortured at the
S-21 prison and then transported to the extermination camp of Choeung Ek. Over 8,000
skulls, arranged by sex and age, were visible behind the clear glass panels of the
Memorial Stupa, which was erected in 1988.


                   10 December 2008: Phnom Penh, Cambodia
                          Recorder- Susan Morrison

Professional delegates met with representatives from UNICEF, including Mr. Richard
Bridle and Dr. Rasoka Thor, for our seventh and final professional meeting. UNICEF
believes that nurturing and caring for children are the cornerstones of human progress.
With this purpose in mind, UNICEF works with others to overcome the obstacles that
poverty, violence, disease and discrimination place in a child’s path.
Both Mr. Bridle and Dr. Thor noted that UNICEF is concerned with looking at policies
and capacities and working within the current Cambodian Ministry of Health
governmental system to improve the health of women and children.

Dr. Thor noted that maternal survival rates must be improved in Cambodia. Currently,
2,000 women die every year during pregnancy, delivery and postpartum. Maternal
mortality is 472/100,000, which is higher than in 2000 when it was 437/100,000.

Also, fewer than half of Cambodian women have access to contraceptives, and abortions
are used for family planning—but women must pay for this private service.
Conditions are poor, and many women who have abortions get infections. Vasectomies
are supported, but a low percentage of men have them. Despite this, the birth rate is
decreasing in Cambodia.

                   10 December 2008, Phnom Penh, Cambodia
                           Recorder- Carol Huston

Our farewell dinner was this evening. Gifts were presented to our national guide, the
local guide and the bus driver.

         11 December 2008, Phnom Penh, Cambodia to San Francisco
                         Recorder- Carol Huston

All the delegates and guests left Phnom Penh this morning and flew to Hong Kong.
Although half of the delegation stayed in Hong Kong for an optional three-day excursion,
at least some of the delegates began their long journey home via San Francisco.




                                      (continued)


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Pictures of the People to People Citizen Ambassador Program’s Trip to
                         Vietnam and Cambodia




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(more photos on next page)




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(more photos on next page)


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