Doctor's mission is modernizing Vietnamese medical care

June 15, 2011

By SUZY FARREN

HANOI, Vietnam — The taxi ride to Bach Mai Hospital is harrowing. Pedestrians rarely have the advantage of a stop sign or traffic light as they step off curbs and walk into an onrush of traffic, parting the motorbikes, pedicabs, bicycles, cars, buses and trucks. The choreography of the city streets is reminiscent of a Busby Berkeley musical — only it's unrehearsed, faster, noisier — and, if the rhythm goes awry, potentially lethal.

Finally, the taxi pulls up to the formal entrance of the storied, sprawling Bach Mai Hospital. Built a century ago during French colonial rule, it was bombed by American forces in December 1972 when ordinances intended for a nearby airstrip missed their mark. A memorial in the courtyard recalls the hospital staff members who died in the bombing. Bach Mai (which translates to white flower) was rebuilt and today it is one of the largest hospitals in Vietnam. With nearly 2,000 beds that hold some 3,000 patients (patients share beds), the halls and offices bustle with staff, patients, families and other visitors.

Dr. Carl Bartecchi, a clinical professor of medicine at the University of Colorado, got his first look at Bach Mai in 1997. A veteran of the Vietnam War (in Vietnam, they call it the American War), he returned to Vietnam as a visiting teacher hoping to give something back in peacetime. He found ample opportunity at Bach Mai, and he's been aiding the hospital and the country since with support from Catholic Health Initiatives and Centura Health, both of Englewood, Colo.

He helped establish the first professional paramedic program in Vietnam. And evidence of what he has given back can be seen in almost every department at Bach Mai. But the true measure of his gift is most visible in the eyes of the doctors and nurses who have been forever changed because of him.

Luck of the draw
In September 1964, Bartecchi got his draft notice. With his medical internship just completed, he deployed as a flight surgeon in an ambulance helicopter unit stationed in the Mekong Delta.

In a 1966 letter to the editor published in the Journal of the American Medical Association, Bartecchi said his medical support role took him to a large number of small towns and villages. He treated over 1,000 Vietnamese civilians at an American military compound. He was struck by the country's lack of medical resources and personnel, and, in response, he helped establish a clinic for indigent care in Soc Trang.

When he returned home, he began to feel America had been wrong to intervene in the conflict between North and South Vietnam. "I felt we'd done a disservice to the Vietnamese people," he said. And he wondered if there would ever be an opportunity for personal redress.

Flash forward more than 30 years. Vietnam had begun to emerge from international isolation, attracting international investment and intrepid travelers. Bartecchi had the opportunity to return to Vietnam, this time as a visiting professor of critical care medicine.

He lectured and worked at Cho Ray Hospital in Ho Chi Minh City (formerly known as Saigon). In that southern city, he found himself "bumping into" other philanthropic foreign physicians. He traveled north to Hanoi to teach and work as an attending physician at Bach Mai. He recalled thinking to himself, "This is the place I should be."

Making the rounds
He began making biannual trips to the hospital, giving lectures in critical care and spending entire days rounding with physicians to connect his lectures with their reality. He wanted to do more, so he formed the Bach Mai Hospital Project, a nonprofit company, to seek grants and donations of equipment and textbooks. The program brings Vietnamese physicians and nurses to the U.S. for advanced training at St. Anthony Central Hospital in Denver, and other Colorado hospitals. St. Anthony is part of Centura Health, a joint operating agreement between CHI and the Adventist Health System.

A few years ago, Mayo Clinic physicians joined the project. They train Vietnamese doctors at their hospital in Rochester, Minn., and they send lecturers to Hanoi. In all, 26 physicians and nurses have studied in Colorado and Minnesota under the auspices of the Bach Mai project.

Diane Jones is vice president of healthy communities at CHI. She also oversees the Mission and Ministry Fund, whose mission is, in part, to use the size and scope of CHI to create healthy communities throughout the world. Between 2006 and 2010, the fund gave $650,000 to the Bach Mai Hospital Project. The contribution helps fund the training rotations at U.S. hospitals for Vietnamese clinicians. Jones said that investment has a ripple effect: Vietnamese physicians and nurses return to Vietnam and teach clinicians in rural villages, helping modernize medical care throughout the country.

One degree of separation
In a Bach Mai conference room in February, the day before the hospital's 100th anniversary, some top docs gather to greet a visiting American reporter and photographer. Most are alumni of the training fellowships, having studied at Mayo or St. Anthony (which has become a sister hospital to Bach Mai). Each physician present has personally experienced Bartecchi's kindness.

When they speak of him, it is with reverence. "We love him." "He pays attention to everyone." "When I came to the U.S. for a conference, he came to the airport to meet me and spent five hours with me." "He is kind." "I've never seen him angry." "He is a special person." "He works hard to bring knowledge." "He's always trying to do something new to meet our needs." "He's like my parents." "He opens his heart." "The U.S. and Vietnam are closer because of him."

Save a life, save the world
A tour of the hospital reveals the myriad ways Bartecchi has made a difference — not all by himself, of course, but through his efforts.

In the emergency department, Dr. Nguyen Van Chi, vice dean of Bach Mai's emergency department, explains how Bartecchi's contributions have helped improve care: A simple color coding system is used to triage patients. A lab situated next to the ED returns results quickly. The ED has ventilators to help the most severe patients before they are sent to the intensive care unit. "There is no waiting," he says proudly.

A defibrillator in the poison center — a product of Bartecchi's efforts — is used to reset the heart rhythms of patients poisoned by eating incorrectly prepared toad meat, which can cause arrhythmia. Venomous snakes and spiders on display in glass jars remind viewers of other indigenous threats.

The hospital is encouraging the government to move to childproof tops for medicines, another result of learnings in the U.S.

Signs of Bartecchi's influence can be found in the neonatal intensive care unit where ventilators for preemies save fragile lives, and in the intensive care unit where nurses, physicians, pharmacists and nutritionists work as team members now, supporting patients and delivering care according to preset protocols, a discipline known to improve patient outcomes.

In Vietnam, Bach Mai has achieved a reputation as the country's best teaching hospital. It is known and supported in certain circles in the U.S. too. Many donations come from individuals, including veterans of the Vietnam War. When Bartecchi's 2007 book, A Doctor's Vietnam Journal, was reviewed in the New England Journal of Medicine, money started coming in from other physicians.

Bartecchi still teaches at Bach Mai twice a year, in April and November. His symposia, which are delivered in English and simultaneously translated, draw up to 700 attendees. So great is the demand for information that the November 2011 symposium will offer three topics for the first time ever. Bartecchi would like to do more for Bach Mai, but at 73, he's also realistic. It's a long and grueling trip to and from Vietnam. And so he's looking for someone younger to take his place — someone who could phase in over the next few years.

A legacy
The Mekong Delta is 700 miles south of Hanoi, but it feels a world away. Hanoi is a large and chaotic city; much of the delta is lush, rural and sleepy. It was in the delta where, nearly 50 years ago now, Bartecchi served during the Vietnam War. Today, while there is still only one clinic in Soc Trang, some of the doctors have trained at Bach Mai.

 

Copyright © 2011 by the Catholic Health Association of the United States
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