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Mission To Transform Lives
A collaborative Haemodialysis Care Project brings together healthcare professionals from Singapore and Vietnam to help raise standards of renal care in the region.
BY GOH HWEE KOON
hen your kidney health deteriorates to the point of being unable to filter wastes and extra fluid from your blood, undergoing a treatment like haemodialysis becomes necessary. At least 2.9 million people in Asia need dialysis, according to a 2015 report from the National Library of Medicine.
Although a lifesaving therapy, dialysis is also an expensive treatment, which explains its limited use in countries with fewer resources in this field. Among the countries in Southeast Asia that have taken strides towards improving the standard of renal healthcare is Vietnam. In 2018, the Haemodialysis Care Project (HCP) was launched in northern Vietnam. The three-way collaboration involved Hanoi Medical University (HMU), Tan Tock Seng Hospital (TTSH), as well as the Singapore International Foundation (SIF), with Bach Mai Hospital and Viet Duc Hospital as the main participants.
The five-year initiative was focused on enhancing the training of haemodialysis caregivers to deliver safe treatments, and updating them on the current standards of care. Led by Dr Manohar Giliyar Bairy, a senior consultant in the renal medicine department at Singapore’s TTSH, the project aimed to build capacity within the healthcare system in Vietnam by grooming a group of master trainers, who would then cascade the training across north Vietnam.
The main components of HCP included clinical training that covered modules on topics ranging from the principles of haemodialysis to management of complications and quality assurance, as well as leadership engagement sessions. One module included a study visit to Singapore to learn about the country’s standards of care and clinical practices, and a symposium where healthcare professionals from both countries shared current standards, the latest research, and public health collaterals in haemodialysis.
“We did not meet a single trainee or
Hanoi faculty in the programme who
was not passionate about enhancing
the standards of their practice, even
when resources were scarce.”
Dr Manohar Giliyar Bairy, Tan Tok Seng Hospital, Singapore
THE RIPPLE EFFECT
As the programme gained momentum, Dr Manohar and his team did not just find great satisfaction in sharing their knowledge and expertise, but also deep appreciation for the passion and commitment of the participants.
“Healthcare workers could well turn cynical and jaded in resource-poor settings, and that would be understandable,” he explains. “But we did not meet a single trainee or Hanoi faculty in the programme who was not passionate about enhancing the standards of their practice, even when resources were scarce.”
By the time HCP ended its run in March this year, 12 Vietnamese master trainers had graduated from the programme. It is estimated that more than 230 Vietnamese haemodialysis care workers had honed their skills via cascade training, while 3,960 haemodialysis care workers and patients in northern Vietnam had benefited from it.
“Apart from the numbers, it is important to note that the local participants were able to change the culture of haemodialysis care practices such as on asepsis, catheter care and infection control in their hospitals — and hopefully amplify this effect in other centres in the region,” says Dr Manohar. “In healthcare, like in society, once the wheel of change is set in motion, it tends to gather momentum.”
One of the greatest improvements is in the area of catheter care. The procedure, which is used on patients who have trouble passing urine normally, involves using a hollow, partially flexible tube that collects urine from the bladder and leads to a drainage bag.
Just five years ago, only doctors in Vietnam could perform catheter care on, and monitoring of, haemodialysis patients. Today, however, even nurses are trained to perform catheter care work for haemodialysis patients.
“We are certain that the
friendships and spirit of
cooperation between our
communities will continue
for many years to come.”
Ha Phan Hai An, associate professor, Hanoi Medical University
MAKING A DIFFERENCE
Among the challenges that Dr Manohar faced, the language barrier was a big problem, as English was not the medium of instruction. But translators and English-speaking students in Hanoi managed to help overcome this problem. “Additionally, the resources available to our trainees were not comparable to Singapore. This required improvisation and resilience in finding solutions,” he adds.
“They were always responsive to our suggestions and took pains to develop training videos in the local language. When we learnt that they were vigorously disseminating the training across the province, the reach of the programme staggered us, albeit pleasantly.”
Although the HCP has ended, the door remains open for collaboration opportunities between Singapore and Vietnam. Moving forward, HMU is keen to explore sustainability plans that include a review of the hospitals’ internal standard operating procedures based on the guidelines currently being developed by the Vietnam Kidney Association, and continue digitalising training resources to achieve wider outreach.
There is also potential for a new nephrology project in Ho Chi Minh City, and a submission of a scientific paper based on the HCP project’s positive outcomes for publication in medical journals.
“We are pleased to have worked with the SIF and TTSH on this meaningful project,” says Hà Phan Hai An, associate professor, HMU. “We are grateful for the warm support from the Singapore International Volunteers, who have worked tirelessly to impart knowledge to Vietnamese trainees over the years.
“We are certain that the friendships and spirit of cooperation between our communities will continue for many years to come.”
HCP’S DEVELOPMENTAL IMPACT
A boost in the confidence of nurses, due to having gained new skills and knowledge. All trainees under five years of service achieved a 100 per cent passing rate last year and are currently certified to train their peers.
INSTITUTIONAL Internal training is now conducted within hospitals to share knowledge among nurses – to help create standardised procedures and develop curriculum for new trainees.
Master trainers now have a mandate to conduct training for other institutes and haemodialysis care workers, as well as new healthcare workers and medical students. An annual plan is also in place for the continuous training of medical staff.
Patients can now receive catheter care right after dialysis without waiting for doctors to be available. Closer monitoring and evaluation of new patients, as well as long-term management plans for existing patients, are also available.