Developmental Clinic at Can Tho General Hospital

A few years ago, Stacy (our team PT) and I made a connection with a local community pediatrician who had a special interest in autism. During that earlier visit, I went to this pediatrician's home, where she offered autism-related clinics and consultations.

This year, we had the opportunity to collaborate again. For the last two days, Stacy and I worked with this pediatrician to run a developmental clinic; this time, we were based out of the General Hospital (= air-conditioning!). The pediatrician offered appointments to families already on her caseload, in addition to posting an invitation to families who are a part of a developmental disabilities/autism shared chat on Zalo, Vietnam's social platform that combines chatting with facebook-like groups. Families came from a 200 km radius-- long trips for kids with developmental challenges.

Over the course of the two days, I met with 24 kids and their families. Fortunately, Stacy was with me to support families in understanding and addressing their children's physical activity needs and challenges! We both have a lot of experience wrangling kids, and had a great time working together again!

Our treatment room was ready!
The pediatrician and I worked together to decide what materials to have on hand,
and I brought some of my most reliable materials, too-- bubbles, balloons, foam rocket launchers...

Pediatrician briefing me on the first few cases. In the light blue shirt to the left is a neonatologist from the pediatric hospital who has an interest in developmental disabilities. 

Our crew of translators, including a local high school teacher, English teacher at Can Tho University, the neonatologist, and our pediatrician's teenage son, home for break from school in Australia. 

Our treatment room was marked by a fun tangrams puzzle.
It is usually the "Traditional Medicine" treatment room at the hospital. 

So, in no particular order, here are some of the terrific cases I worked with in clinic. The children were between 2-6 years old; most had diagnoses of developmental delay or autism, but some did not have diagnoses that the families were aware of. A few children were old enough that I would consider "learning disability" a better diagnosis.  

Across the board, parents were concerned about their child's communication and learning. Some parents expressed concerns about their child's behavior.

Stacy and I are always reminded of a powerful lesson during this open clinic times-- we've been volunteering with this project for 15 years, and are always struck by the recurring recognition that the children here demonstrate the same developmental strengths and challenges as the children that we both work with in our clinics in the US.

This information-- that the kids in Vietnam with developmental problems look a lot like the kids in the US with developmental problems-- is always interesting to the doctors and clinician we work with. It also seems to offer some solidarity (and maybe comfort?) to the parents that we talk with.

Just as in any kind of therapeutic interaction anywhere, some children need a little more coaxing and wooing than others. 👩

Most of the children I worked with have very few words in their expressive vocabulary. Many of them have difficulty imitating an adult's movements, actions, or words to communicate.

My primary goals in these consults are to learn about:
-what the child likes to do at home
-what the adults in the family like to do with the child
-what the family is concerned about
-what the family wants to learn today
-what the child does for school and/or therapy
-how the child engages with their community

Then I try to model some play and communication intervention activities that would apply to their home setting.

Finally, I work on coaching the family members to practice a couple of strategies.

We typically end with discussing and writing/drawing what the "first steps" home practice can look like.

 

 


Providing some parent coaching and directing her daughter's attention to her mother doing something fun!

Bubbles are always a hit, no matter where you are!

Families typically have questions about what they can do to help their child, whether their child should take any special medications, and what their child's prognosis and future might be. These questions will sound pretty familiar to anyone who works with children with developmental problems and their families in the US, right? 

One noticeable difference from my experiences in the US was that I did not hear questions from this group of families asking why their child has this specific set of problems.

I don't know whether this difference relates to
health literacy, expectations for what is
discussed in a medical visit, or variability in overall cultural perspectives on disability and community life.

In the last 5 years, 2 "special schools" have opened in the larger Can Tho City area for children with developmental disabilities. Some children I met attend these schools exclusively and some have some classes in the "special school" and the "normal school." Other children have teachers that come to their home. A few children were not participating in any kind of school, education, or therapy services. Weekly specialized therapies for speech+language development or physical development are not a regular part of the families' schedules.

I'll be interested to see what happens to perceptions of disability, specialized education, and parent involvement and advocacy in the next 5 years, as the Vietnamese middle class continues to develop. More families reported consulting the internet to learn more about how to help their child, and families in rural and urban areas may have a big opportunity to find community and support online. [GREAT!]

As in the US, online misinformation and real-life knowledge gaps about developmental disabilities and autism abound in Vietnam. [uh-oh]

We saw a few children who were prescribed medications for a particular diagnosis that did not match with what would be considered best practice in the US.

Parents reported that doctors advised them that "the door to improvement closes at 6 years old."

We met a parent of twin boys with profound developmental challenges and aggressive behavior who took the advice of a complementary medicine doctor from Australia and is providing aryurvedic herbs as the children's only treatment.

Stacy providing some good proprioceptive input for a fast-moving kid!

I wrote these lists and our pediatrician will translate them for families and for use in her future consults. These are the same kinds of activities and interactions that I build with the children and families I work with in the US. By the end of our two days together, Stacy and I had practiced all these strategies and activities multiple times with the local clinical team.

The local pediatrician is planning to build a website for Vietnamese families to counter misinformation and provide positive and developmentally-focused information for families about autism and developmental differences. I'm looking forward to working with her!

NEXT UP: Stacy and I head a few hours (traffic willing) north to Ho Chi Minh City, where we will work with clinicians and patients at the large Pediatric Hospital #1. Bustling does not begin to describe HCMC! I'll keep you posted on our next steps. 

For more information about the lower extremity surgeries performed by the surgery part of the team: http://www.extremityproject.com/

Stacy is also a very conscientious blogger while we are here, and has a much better memory for details than I do! You can check out her blog: https://vietnammissiontrip2019.blogspot.com/