Rehabilitation situation in vietnam

1. REHABILITATION SITUATIONREHABILITATION SITUATION
IN VIETNAMIN VIETNAM
Cam Ba Thuc. MDCam Ba Thuc. MD

2. ContentsContents
• Vietnam in brief
• Overview of history of healthcare in Vietnam
• Overview of rehabilitation medicine in Vietnam
• Law and policy related to disable person in Vietnam
• Rehabilitation Medicine: Network and Achievement
• Orientation in the future

3. ThankfulnessThankfulness
• First of all, I would like to give special thank to Rector
of Mahidol University, Dean and Deputy Dean of
Faculty of Medicine Siriraj Hospital, give me a special
chance to see a beautiful country Kingdom of Thailand
and also a special occasion to study, improve my
knowledge and exchange challenge with Prof, Dr, PT
and OT in Siriraj Hospital.
• I also give special thank to Prof. Chirayu Auewarakul,
Associate.Prof. Witsanu Kumthornthip had helped me
so much when I was preparing documents to leave for
Thailand.
• Thanks every body in here to give me a gold time to
give talk. I hope that I will become familiar with every
people in here soon;

4. hot dispute region
with China
Thanh Hoa province (my hospital)
Middle region
South region
Equatorial line
South East Asia Region
North region
Hanoi capital

5. Vietnam in brieVietnam in brieff
• Region: South East Asia
• Area: 331.698 km², divided into 63 provinces.
• Population: about 90.000.000 (Statistic 2002)
• Ethnic: 54 race, in those Vietnamese occupied 85%
(73.594.427 people) and 53 race are minority ethnic
occupied 15%;
• Economic: developing country, orientation market
economic, open to every countries world wide.
• Dr. Cam Ba Thuc is Thai minority ethnic; with
population of 1.550.423 people (1.8%) (Statistic 2009).

6. History of Healthcare in VietnamHistory of Healthcare in Vietnam

7. Healthcare at feudal periodHealthcare at feudal period
• Period 1010 – 1026: Ly Dynasty open Health Care
Bureau, most of medicine man were Monks.
• Period 1226 – 1339: Tran Dynasty established Health
Care Institution, starting training medicine man. At this
time, Sir Tue Tinh (born 1330) was a distinguish
medicine man.
• 17th
Century (Le Dynasty): Sir Le Huu Trac (1720 -
1791) was a distinguish medicine man.
• Till now, many prescriptions and publication of two
distinguish medicine man still being used in Vietnam.
• Therapy: manual medicine and acupunctures.
• Medication: plant, herbs and aroma.

8. Sir Le Huu Trac (1720 - 1791)Sir Le Huu Trac (1720 - 1791)
distinguish medicine man of Vietnamdistinguish medicine man of Vietnam
• Religion of medical arts dedicated to protecting human life, take
care of the worry….
• Medical profession is an honorable profession, practitioners must
study hard and well….

9. Healthcare at French colonial timeHealthcare at French colonial time
• Since 1858, French people occupied Vietnam
• Year 1888 French colony established Department of
Indochina Public Health, and started to set up some
hospital in North, Middle and South of Vietnam.
• Year 1902: Indochina Governor (of French) established
Indochina Medical School (Ecole de Médecine de
l’Indochine) in Hanoi (now known is Hanoi Medical
University), this Medical School consist of a school, two
hospital (now known are VietDuc and BachMai) and an
Institute of Anatomy. Training doctor (4 year in Vietnam
and two year in France); nurse and resident practice.

10. Healthcare at French colonial timeHealthcare at French colonial time
• The first Rector of Indochina Medical School was Doctor
Alexandre Yersin (very well-known person), He found
bacteria named Yersinia pestis caused Plague Disease.
• At this period: founded 4 Pasteur Institutes: Hanoi,
Nhatrang, Dalat, Saigon (Hochiminh city).
• This was a starting point of modern medicine in Vietnam,
many field quite good such as operation, internal
medicine, bacteria, parasite and immunology were
developed but I don’t know that the rehabilitation
medicine were noticed or not.

11. Dr. Alexandre YersinDr. Alexandre Yersin
First Rector of Indochina Medical SchoolFirst Rector of Indochina Medical School
BBig friend of Vietnamig friend of Vietnam

12. Healthcare at Vietnam war timeHealthcare at Vietnam war time
North of Vietnam: Democratic and Republic of VN
- Subsidies and close economy, lack of food and many
facility, this is very difficult time in the North;
- Has several central hospital; every provinces has
provincial general hospital; every districts has district
medical centre;
- Has several Medical School, training doctor and nurse.
- Lack medication and medical equipment, has low quality
of health care;
- Several central hospitals and provincial general hospitals
has department of physical therapy, all physician were
trained from communist nation such as Soviet Union
(Russia), East Germany, or China ..etc..

13. Healthcare at Vietnam war timeHealthcare at Vietnam war time
South of Vietnam: Republic of Vietnam:
- Open and market economy, has some modern hospital;
- All medical standard based on American Standard.
- Has Saigon Medical School;
- Has many qualified doctor
- Rehabilitation medicine were quite developed;
- Till now, some Hospital in Hochiminh city has old
rehabilitation department in good condition.
- Published some Textbook of Physical Therapy and
Rehabilitation;
- Published Dictionary (English-French-Vietnamese) of
Physical Therapy and Rehabilitation.

14. Rehabilitation MedicineRehabilitation Medicine
Founded and Development in VietnamFounded and Development in Vietnam

15. After 1975, ended Vietnam warAfter 1975, ended Vietnam war
• After the war We have many invalid people, many
people suffer from orange agent and many people had
mental illness because of war.
• Several Centre for Care Invalid and Centre for
Orthopedic were established, provide services for
invalid people such as:
+ Healthcare
+ Provide prosthesis and orthotic devices
+ Orthopedic surgery
+ Care for invalid people with spinal cord injury;
brain injury; amputee …etc…

16. After 1975, ended Vietnam warAfter 1975, ended Vietnam war
• Some doctors was sent to study in Netherlands about
care and rehabilitation for invalid people with spinal
cord injury (SCI), most of them are retired now;
• Many invalid people with SCI still alive and well now.
• Many invalid people can not return their home, they
have to spend their lifetime in these centre.
• Period 1975-1989: border dispute with Cambodia.
• Period 1979-1980: border dispute with China
• Now many Centre for Care Invalid People still
existence

17. Founded and DevelopmentFounded and Development
of Rehabilitation Medicine in Vietnamof Rehabilitation Medicine in Vietnam
• Year 1988, Founded Rehabilitation Faculty in Hanoi
Medical University.
• Training for medical students
• Training for doctors
• Since 1996, training residents doctors in Rehabilitation
Centre of Bachmai Hospital.
• Since 1997, traning master and fellow doctors in
Rehabilitation Centre of Bachmai Hospital.

18. Founded and DevelopmentFounded and Development
of Rehabilitation Medicine in Vietnamof Rehabilitation Medicine in Vietnam
• All middle level medical school has rehabilitation
department, training for middle level medical students.
• Most of Central Hospitals has Rehabilitation dept.
• Many Provincial Hospitals has Rehabilitation dept;
• Several district hospitals has Rehabilitation Medicine
Unit in Department of Traditional Medicine .
• Vietnam Rehabilitation Association (VINAREHA) was
established in 1991.
• Three school of medical technique was established
(Haiduong – Danang – Hochiminh city) to training
Physical Therapist.

19. Founded and DevelopmentFounded and Development
of Rehabilitation Medicine in Vietnamof Rehabilitation Medicine in Vietnam
• Year 1999: established Central Rehabilitation Hospital
in Thanh Hoa province;
• Many province established Rehabilitation Hospital;
• Community Based Rehabilitation (CBR) was carried out
since 1987, this program was sponsored by Health
Volunteer Oversea (HVO), Vietnam Veteran American
Fund (VVAF), AIFO of Italia ..etc..
• Since 2003, Handicap International (Belgium) helped
Vietnam to set up Spinal Cord Injury Network.

20. Law and Policy related to disable personLaw and Policy related to disable person
in Vietnamin Vietnam

21. Law and Policy related to disable personLaw and Policy related to disable person
• The Nation Constitution (1946, 1959, 1980, 1992,
2012) confirm that disabled persons are equal citizens;
• The Ordinance on disabled persons adopted by National
Congress in 1998;
• State president signed agreement with International
Convention on the rights of persons with disabilities in
2007; this was adopted by National Congress in 2014
• Law on disabled persons adopted by National Congress
in 2010; had effected since 1st
day of January 2011.
• Prime Minister had approved scheme assistance for
disable person period 2006 – 2010.

22. Law and Policy related to disable personLaw and Policy related to disable person
• Prime Minister had approved scheme developing
healthcare network to year 2020: consist of developing
rehabilitation hospital;
• Prime Minister had approved scheme assistance for
disable person period 2012 – 2020; some major aim are:
“ Every year, 90% of people with disabilities have access
to health services under various forms; 90% of children
from birth to 6 years old be screened for early detection
of congenital defects, developmental disorders and early
intervention; about 70,000 children and adults with
disabilities are provided service of orthopedic surgery,
rehabilitation and appropriate aids”./.

23. Law and Policy related to disable personLaw and Policy related to disable person
• Prime Minister had approved Target Health Programs
period 2012 – 2015; in this consist of CBR program;
• Most of disable person are provided health insurance,
monthly living expenditure.
• The Circular Letter No
12 year 1993 of Ministry of
Health, Its regulation: every hospital around nation must
have department of rehabilitation.
• Since 2007, Minister of Health directed to enhance
developing medical rehabilitation.
• Rehabilitation Medicine was concerned in recent years

24. Rehabilitation MedicineRehabilitation Medicine
Network and AchievementNetwork and Achievement

25. NetworkNetwork
• Central Line:
Rehabilitation Centre of Bach Mai hospital is
the highest of academy
Central Rehabilitation Hospital (Thanh Hoa
province)
100% of Central Hospital has Rehabilitation
departments

26. NetworkNetwork
• Provincial line:
 Vietnam has 63 provinces, in those 38 provinces has
Rehabilitation Hospital.
 98% of Provincial General Hospital has Rehabilitation
department;
 There are 23 hospitals or Medical Centers belonged to
other Ministry (such as Ministry of Defend, Public
Security, Labor – Invalid and Social Affair, Industry
and Trade, Transportation), all of these has
rehabilitation department.

27. NetworkNetwork
• District Line:
 Most of District Hospital has Traditional Medicine
department, there are Traditional Medicine Doctors
works in these place;
 Under the Regulation of Ministry of Health, all
Traditional Medicine department of district hospital
take over rehabilitation service for disable patients.
 In these, Doctors and Nurses were trained Physical
Therapy and Rehabilitation;

28. NetworkNetwork
• Commune Line:
 Every commune has a CHS (Community Health
Station);
 Every CHS has a staff who take over the task on
rehabilitation medicine;
 Task on rehabilitation medicine consist of rehabilitation
for inpatients and outpatients, follow up patients in
community, participate community based rehabilitation;

29. Vietnam Rehabilitation AssociationVietnam Rehabilitation Association
• Abbreviation: VINAREHA
• Consist of over 1.500 participants
• All participants are professors, doctors, nurses, physical
therapists from central line to commune line
• Chairman: Associate Prof. Tran Trong Hai
• Office: Hanoi School of Public Health
• Has its regulation, approved by Ministry of Inside Affair

30. Human ResourcesHuman Resources
• Doctors:
 Rehabilitation doctors
 Residents doctors on Rehabilitation
 Fellow doctors on Rehabilitation (PhD)
 Associate Professor: 08 (retired 05)
 Professor: 01 (retired)
• Physical Therapist
 Not have Occupation Therapist

31. Education and TrainingEducation and Training
• Hanoi Medical University: training doctor, resident,
fellow doctor.
• Hue University of Medicine and Pharmacy: training
doctor; bachelor of rehabilitation.
• Hochiminh University of Medicine and Pharmacy:
training doctor, physical therapist.
• Haiduong University of Medical Technique: Training
physical therapist;
• Danang University of Medical Technique: Training
physical therapist;
• Viet cot School (Ministry of Labor Invalid and Social
Affair): training technician of prosthesis and orthotics

32. AchievementAchievement
• Consultation: every year 1.092.405 patients (statistic 2012)
• Inpatients: every year 190.466 patients (statistic 2012)
• Community Based Rehabilitation (CBR): CBR program
cover 51/63 province; every rehabilitation hospital has
their own CBR program depend on policy of province;
• Screen for patients under 6 year old and early
intervention: every rehabilitation hospital has their own
program depend on policy of province (till now not have
any statistic).

33. ChallengeChallenge
• Some provinces not have Rehabilitation Hospital;
• Some provincial general hospital not have rehabilitation
department (remote area);
• Lack of Human Resource (especially rehabilitation
doctor; Occupation Therapist);
• Low investment; Lack of Medical Equipment
(especially high tech equipment);
• Not have much experience on building rehabilitation
network, training doctor and PT, not have any
curriculum on training OT in medical school

34. Weak points of expertiseWeak points of expertise
• Evaluation:
- Evaluation of perceptive, cognitive, intellectual,
- Evaluation of language, speech,
- Evaluation of swallowing disorders (dysphagia),
• Rehabilitation:
- Training for patients with disorders as above
- Respiratory rehabilitation undeveloped properly
- Robotic, engineering and informatic application

35. Orientation in futureOrientation in future
• Training human resource,
• Building medical rehabilitation network
• Invest more modern equipment for rehabilitation
hospital and rehabilitation departments
• Improve quality of rehabilitation services
• Continuing community based rehabilitation
• Making appropriate policy on rehabilitation,
especially for rehabilitation workers.

36. Orientation in futureOrientation in future
• Increase research sciences on medical rehabilitation
and publish more documents
• Enhance ability of rehabilitation faculty of all
Medical School;
• Enhance prevention of accidents, screen for early
detection and early intervention
• Building curriculum for training OT
• International cooperation on rehabilitation

37. Thanks for your attention !