Planning and health

I stuck to the official schedule on Thursday, in order to meet my counterpart at the Hanoi People's Committee Authority for Planning and Investment, and tour a local hospital. Not surprisingly, the number of people on the official schedule is dwindling -- our hosts have arranged some alternative activities, like a back-alley photographer's walking tour, which are drawing more interest than the formal meetings. But I enjoyed the official stuff nonetheless.

The Authority for Planning and Investment is responsible for drawing up Hanoi's master plan, which is presented to a national Ministry for approval. The plan is very much oriented to facilitating rapid industrial development -- quality of life issues don't appear to be nearly as critical, although the plan sets goals for living space and number of trees per capita. When I asked about citizen participation in planning, I was assured that the Hanoi People's Committee provides all the stakeholder input required! (However, a newspaper article in the English language party daily indicates that the planning model is likely to change for the country's next round of master planning, post 2010.)

As in all these official meetings, our delegation was asked to share opinions. Today's question: Hanoi spends 40% of its budget on social development (education, health, etc.). Is that enough? This led to a lively discussion about government spending and taxation.

An even smaller group of delegates visited the Viet Duc hospital in the afternoon -- and it was amazingly up close and personal. The hospital, founded by the French in 1906, is a regional surgical center with 630 beds and 1000 staff. (Family members are responsible for much of the patient care, like feeding and bathing.) It is the main surgical training hospital in Vietnam, and doctors there perform 26,000 operations annually. They handle a lot of trauma surgery, 70% of it generated by traffic accidents. (You take your life into your hands every time you cross the street, so that's no surprise.) Industrial accidents and knife wounds account for most of the remaining trauma cases.

After a formal briefing, we began our tour with a very well-traveled hospital director. First stop: the ICU, in which we walked from bed to bed and learned something about each case. We did the same in the emergency room, pediatric cardiac care unit, and neurosurgery ward.

The hospital operates at about 125% of capacity, so patients are discharged while they still need considerable care. I asked how the patients return to their homes -- a small number go by ambulance or hired car, and many go home on the back of a scooter.

Viet Duc is better than a third world hospital, but not up to western standards. We saw technology in the ICU and cardiac care areas, but none elsewhere. We were told that most of the monitoring equipment came from donations from Germany and France. The need for additional philanthropic support or foreign aid is obvious. The hospital is visited by about 100 foreign delegations annually; I hope that vigorous outreach effort results in more equipment and money for a very overtaxed facility.

Doctor training in Vietnam requires six years of classroom work and three years of residency; medical students start immediately after high school graduation. Several of the surgeons we talked to were trained in France, and we met visiting medical students from Germany and Singapore.