Viet Nam Journal: Over 11 Years, Atlantic Grants Help Spur a Country’s Transformation in Health

Several of the staff of the Hue Central Hospital were kind enough to come to work last Sunday morning to give my Atlantic colleagues and me a tour of what has become a world-class facility in the ten years since our Founding Chairman, Chuck Feeney, first paid a visit.  The hospital’s director, Dr. Bui Duc Phu, recalled that initial meeting for us, obviously relishing the memory of a remarkable exchange. It started with Chuck inquiring: “What do you want to do next?” Dr. Phu replied that he wanted to replace the hospital’s paediatric wing. Chuck asked, “How much do you need?” and went on to say, “How quickly can you get it done?” That, as Humphrey Bogart says to Claude Rains in Casablanca, was the beginning of a beautiful friendship, mirrored in many of the nation’s other leading medical and educational institutions.

I returned yesterday from a week in Viet Nam visiting Atlantic-supported institutions and organisations in Ha Noi, Hue, Da Nang and Ho Chi Minh City. Since Chuck Feeney’s first trip, inspired by an article he read while waiting in an airport about the work of East Meets West Foundation, now a key partner in our Viet Nam efforts, Atlantic has spent over $300 million in Viet Nam – ranging from $20-45 million a year – on a variety of construction and other projects in higher education and medical care.

Here are a few highlights from my week in Viet Nam, drawn from a daily journal I kept. I hope they convey a flavor of the challenges the country faces, the energy and effectiveness with which Atlantic’s grantees are working to meet them, and the enormous leverage they have achieved with our support.

January 14, Ha Noi
The National Pediatric Hospital, virtually destroyed by bombing during what the Vietnamese call the “American War,” is at three times its capacity at the time of Atlantic’s first grant in 2003. Its director, Dr. Nguyen Thanh Liem, proudly rattled off a list of the institution’s firsts, including conjoined twin separation, open heart surgery, bone marrow transplant, kidney and liver transplant and endoscopic surgery. Sitting in on the meeting was Colin Partridge, a physician from UCSF-Mission Bay in San Francisco, another Atlantic-supported institution, a partnership made by Chuck Feeney’s desire to forge stronger links among key medical facilities in Viet Nam, California and Australia.

Along the way to the Atlantic office for lunch with staff, we marvel at the remarkable sight of thousands ofmotorbike riders wearing helmets, the culmination of a key Atlantic campaign that has resulted in dramatic reductions in traffic injuries. We even saw a helmetless rider get pulled over for a ticket. The longtime Atlantic country representative for Viet Nam, Dr. Le Nhan Phuong, also heads our global Population Health Programme. Forced to flee the country at ten in 1975, in the closing days of the war, Dr. Phuong and his sister spent a year in foster care in Oregon before being reunited with the rest of their family. Raised in Georgia and trained as a paediatrician, he returned to Viet Nam in 1999. The two other terrific programme executives in Viet Nam, who accompanied my Belfast-based colleague Martin O’Brien and me on our travels, Nguyen Trong Hau and Duong Hoang Quyen, are also physicians.

On to the Ha Noi School of Public Health. The school is at the cutting edge of the country’s preventive efforts; it is beginning to focus on the needs of the growing ageing population – only government jobs in Viet Nam carry pensions, and those are modest – and on mental health challenges like suicide, and on child injuries through drownings and other preventable accidents. There is no social work profession in Viet Nam, and addressing these issues and drug and alcohol dependency will require one, something Atlantic is working with the school’s faculty and government ministries to build.

Also housed in the school is another grantee launched with Atlantic support, the Viet Nam Public Health Association, which has played a key research and advocacy role pressing for smoke-free policies. A national campaign to discourage tobacco use, a key Atlantic priority in the country, was underway with street-wide banners everywhere in Ha Noi and also promoting implementation of stronger social welfare measures for older adults and steps to reduce the risk of exposure to dioxins that are the grim legacy of U.S. saturation of the country with Agent Orange during the war.

For dinner that evening we joined Charles Bailey from the Ford Foundation, with which we have a collaborative relationship to address the problems of environmental dioxin contamination in Viet Nam, and Professor Nguyen Tran Hien, the Director of the National Institute of Hygiene and Epidemiology, where Atlantic and Irish Aid are co-funding the establishment of the Ireland-Viet Nam Blood-Borne Virus Initiative. The initiative will include building a top-level national diagnostic facility for blood-borne viruses and developing a cadre of experts in diagnostic virology and epidemiology in Viet Nam.

Friday, January 15
I spent much of the day at a roundtable of Atlantic grantees, government representatives, and diplomats and aid officials from Ireland, Australia and the U.S. in a followup discussion to a groundbreaking conference supported by Atlantic last October on the link between public health and human rights standards. I was struck by the candor of the state officials who participated in acknowledging the dimensions of the country’s health problems and seeing them in human rights terms, exacerbated by growing inequity that has accompanied Viet Nam’s remarkable economic growth over the last decade. At the same time, in a country which has far to go in acceptance of dissent and free expression, a number of our grantees spoke freely and critically about the shortcomings of government policies toward people using drugs and sex workers, and on the need for more civil society voices to be heard in health campaigns and debates.

Overall, the roundtable reinforced for me the soundness of recent developments in Atlantic’s strategies that build on our initial support for institutions to add focus on policy issues like traffic safety and smoking prevention, investing in the steady strengthening of non-governmental organisations and other vehicles for a more prominent public voice, particularly by communities most affected.

Saturday, January 16, Hue and A Luoi
Having flown to Hue the night before, we spent the morning visiting with provincial health officials there and accompanying them after lunch to a rural commune health center in the A Luoi district, a two-hour drive over the mountains, not far from the Laotian border. Over seventy per cent of the commune’s residents are members of the minority Pako tribe, and as with indigenous people and minorities everywhere, they have not had equitable access to health services, so this is an increasing emphasis in Atlantic’s funding. Ten such communes in the A Luoi district are being upgraded with Atlantic funds. The commune’s midwife talked with us about her work and showed us around the small facility – there has been a steady decline in maternal and infant mortality – and during a visit to a nearby community center we dropped in on a childbirth education class taught by a village health worker using poetry and song along with more traditional methods. Most impressive is the emphasis placed on training and supporting community residents to provide for their own health needs.

Atlantic has provided support to Marie Stopes International, along with Save The Children and the Vietnam Veterans of America Foundation, to set up community-based and client-centered innovative service delivery models like this one in five provinces to complement the physical facility improvements that Atlantic has funded. Each province is then responsible for bringing those models to scale. By working with local governments, international and local NGOs, and the donor community in these efforts, we are able to address primary healthcare in a holistic, comprehensive and sustainable way.

Sunday, January 17, Hue
At the Hue Central Hospital, we learn more about how our partnership with East Meets West Foundation works. The Cardiovascular Centre at the hospital has become the leading centre for heart care in Viet Nam and has been selected by the Government to perform the first heart transplant in Viet Nam later this year. Other Atlantic-supported constructions at the hospital include the Pediatric Department, the Ophthalmology Department and the Training Centre. Virtually all of the construction projects Atlantic has supported in Viet Nam have been directed through EMW, enabling buildings to come in at costs substantially lower than those sponsored by other donors. Economies of scale, avoidance of corrupt practices, and use of local materials and workers make Atlantic’s dollars go much further.

Monday, January 18, Da Nang
In Da Nang, we visit the General Hospital, its new wing painted an Irish green as a gesture of respect for Chuck Feeney, who famously opposes having his or Atlantic’s name on buildings we help to construct. Patients no longer have to fly to Ha Noi or Ho Chi Minh City for challenging oncology treatment, and for a few minutes we watch open-heart surgery on a 15-year old girl, an operation that would have been unthinkable in Hue and Da Nang just a few years ago. No one should have to travel great distances for lifesaving intervention. And yet the absence in most of Viet Nam’s hospitals, even the best ones, of facilities for patients’ families to stay while they are receiving care is starkly evident in the straw mats and neatly-folded belongings we see under many stairwells in the hospital.

On from there to the Da Nang Eye Hospital, whose director, Dr. Pham Binh, is eager for me to come back for the official opening of the new facility – its entrance guarded by marble lions sculpted by a grateful patient after his eyesight was restored – in March to coincide with the 35th anniversary of the end of the war in Da Nang. In addition to surgery and treatment at the hospital, where 60 per cent of the patients are from outside the city, the hospital operates a community eye programme and provides free eyeglasses for students.

Tuesday, January 19, Ho Chi Minh City
Today we get a look, accompanied by staff of an non-governmental group, Family Health International, at the way Viet Nam is handling the treatment of drug users, an area at the intersection of health and human rights. We spend the morning at the Binh Thanh District Health Center, a community-based facility working with an integrated approach on drug addiction through counseling and methadone treatment (methadone was only legalised in Viet Nam in 2008, part of the liberalisation of the country’s punitive approach to drugs). As everywhere, there is a strong link between substance abuse and poverty – 60 per cent of those who visit the facility are unemployed, and they also get vocational and family counseling. The center also deals with men who have sex with men (we drop in on a peer training workshop attended by gay men and transgendered people), HIV/AIDS, and tuberculosis.

We then drive to the outskirts of the city for a rare visit to Nhi Xuan, one of the country’s drug rehabilitation centers for treatment of drug addicts. (About half of the clients of the Binh Thanh Center that we just visited have just been released from such a facility.) The center’s staff is earnest and eager to discuss their work – they have been heavily influenced by the U.S. Daytop Village programme, which has helped to train them – and the few dozen of the 500-plus residents we meet, all idle in their dorms after lunch due to an unseasonal rain, seem bright and friendly, but no one is there voluntarily, having been committed by their families or through the criminal justice system, and we later learn the center has a very high relapse rate. This is an emerging area in which Atlantic and Viet Nam have much work to do.

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The story of Atlantic’s work in Viet Nam over the years is one of steady support for the transformation of a poor country, battered by decades of colonialism and war, into one which is working hard, with ever-increasing capacity and sophistication, to meet the health needs of its burgeoning population, particularly in remote rural areas where the fifty-three ethnic minorities are concentrated. But it also holds larger lessons about the importance of leverage – of consistent and growing emphasis on using our funds to draw in ever-larger commitments from governments and other donors, even more crucially important since Atlantic is in its last decade of life.

Here the numbers tell the story: approximately $10 million in Atlantic support for the National Pediatric Hospital in Ha Noi has yielded $3 million in equipment from the Japanese Government and a $40 million commitment from the Vietnamese government toward the full redevelopment of the hospital; $12 million to the School of Public Health produced an equivalent donation from other sources for construction, training and equipment; the Hue Central Hospital has turned $20 million of Atlantic investment over ten years into over $50 million from other donors; the Da Nang General Hospital has pivoted $11 million in construction support into over $20 million for equipment; the Da Nang Eye Hospital also raised additional equipment and training support from other donors. The list goes on. Atlantic’s investment in the upgrading of rural health communes like the one at A Luoi district comes in the form of a grant to provincial health departments that is matched on a one-to-one basis, and on the evidence of this success, the Vietnamese government is now prepared to commit $400 million for the next three years to scale up this model nationally.

There is much work to be done in Viet Nam, but I came away with a renewed optimism that those who are striving to transform the country’s health system are using our resources to great impact and will be well placed to thrive when the turn of the next decade arrives and Atlantic has completed its work.

Gara LaMarche

Links to organisations mentioned in this column:

• East Meets West Foundation
• UCSF-Mission Bay
• Viet Nam Public Health Association