At Pediatric Hospital #1, Ho Chi Minh City

It's hard to believe that a day that starts with this caphe sua da could get any better, 

but I'm happy to report that today was a good one from start to finish. First day back at Pediatric Hospital #1 in Ho Chi Minh City!

This Pediatric Hospital is considered a national leader for pediatric treatment. The therapists are trained at the bachelor's level as "physiotherapists," which includes physical therapy, occupational therapy, and speech therapy. It is very generalized training, and the physiotherapists start to distribute themselves into the different domains once they join the staff of the hospital, and are always looking for additional learning opportunities.

Most of the public space and waiting areas in the hospital are outside.

Stacy in the hospital parking lot

If you look closely at the group of people sitting under the overhang, you might notice that they have sleeping mats on the ground. Families are responsible for much of the care of children in the hospital and often sleep outside the patients' rooms.

Entrance into the hospital

Two of the therapists at the hospital have recently completed a 2-year speech certificate program run by a group of Australian speech-language pathologists in Ho Chi Minh City. The Vietnamese therapists have gone on to provide training to the rest of the speech therapy staff at the hospital. 

The Vietnamese speech therapists have some big challenges in developing as professionals. This trip, we talked a lot about developmental milestones in all the communication domains: there are no Vietnamese speech sound production milestones (what sounds are typically produced by what age), and very limited research about typical and atypical language development in Vietnamese. The therapists are trying to figure out how to evaluate what they see a child doing, write relevant goals for therapy, and gauge progress. 

This year, our collaboration with the department here followed the same pattern as our visit in 2013. The department selects some patients to come in and we are able to consult with the treating therapists and the parents, and demonstrate treatment strategies. This year's focus was on children 3 years and under with global developmental delay diagnoses-- more profound neurological, motor control, cognitive, and communication challenges. 

These case studies were attended by around 30 people; the group included hospital therapists and visiting pediatricians and therapists from other pediatric hospitals. The staff prepared case summaries for us for each child and described the cases in Vietnamese and English:

Stacy and I have been co-treating for a long time, it's great to get a chance to work together again:

15-month old boy who is not yet walking or bearing weight on his feet and is not actively communicating with other people

Working on getting his attention

...while Stacy helps him change positions and bear weight

2;6 year old girl with vision impairment, very limited mobility, and low cognitive levels

We learned a lot by talking with her parents

2;3 year old girl with motor delays and emerging communication

The man in the yellow shirt is her father-- he was a great partner

Talking about and working on joint attention

It starts to get a little bit steamy in the room-- no consistent airflow.... 

Bubbles are always a hit, anywhere you go...

On our second day at the Pediatric Hospital, Stacy and I did 3 hours of lectures to a group of 75 professionals-- the group included many of the folks from the day before as well as other physiotherapists from neighboring provinces. I talked about speech and language assessment and intervention for young children with global developmental delays, and Stacy did the same for physical therapy. 

Hung is a department PT and the default tech guy

Stacy consulting with Giao, the department head

Giao is also our primary translator for lecture day. We can't manage to thank him enough for all the work he does. 

(details that may be interesting only to pediatric therapists to follow...)

After our lectures, we had questions from the participants:

1. What to do with a 30-month old boy who is very active. He was given some kind of medicine that made him sleepy, but then he is just active again. His mother yells at him but that doesn't seem to help him change his behavior. 

2. How do you determine frequency of physical therapy? Who gets to make that decision-- the therapist or the physician?

3. How do work with a child with spastic cerebral palsy to improve his communication? 

I post these questions because, much to the Vietnamese participants' surprise, they are not dramatically different from questions and concerns that we grapple with in the US. The Vietnamese therapists' training and access to resources is not as abundant as in the US, but the issues are largely the same. We work hard to make sure that our responses and recommendations reflect what is accessible to the therapists. 

This is the marquee for our lecture

We had lunch after the morning lectures, and then had a full afternoon of open discussion. Think of oral comp exams, and then take away any air conditioning! We joined the group from the previous day to respond to the following questions:

1. How do you establish head control in a 3 month old? A 2-year old?

2. What are exercises to target the vestibular system?

3. How do you differentiate between Autism and Global Developmental Delay? When? How do you talk with parents? What differential treatment decisions do you make?

4. How to work on motor control with a 5-year old girl with cerebral palsy

5. How do manage hip abduction

6. How do you score the Rossetti Infant-Toddler Language Scale?

7. What is echolalia and how do you treat it?

8. How do you treat in-toeing in a child with diplegia? 

We were able to hear from the Vietnamese therapists about what their current strategies were, in addition to making our own recommendations. This year, we felt like many of their questions were indicative of a higher level of understanding of what was going on with their patients-- great to be a part of!

 

We were treated to a good-bye dinner that night:

This year's trip was a whirlwind, to say the least. We had much less time in each location than in the past, but we made good use of the time we had, thanks to our fantastic and prepared US and Vietnam colleagues. Every time we are here, we think of a million more things that we'd like to do-- our relationships here are strong enough to make me feel confident that each "next time" will be even richer than the one before. 

Thank you for all your interest and support this year, and every year!