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fosters family medicine program in Vietnam
If someone from a poor, rural family being treated at one of Vietnam's
state-owned commune health centers is fortunate enough to see a doctor
rather than a midwife, a nurse, or a physician's assistant, that doctor
is likely to have received no postgraduate medical education or residency
That soon will change because of the efforts of several U.S. universities
and three Vietnamese medical schools to better train the country's primary
care physicians. As part of the Vietnam Family Medicine Development Project,
BU's School of Medicine this year is partnering with Hanoi Medical University
to help create a family medicine program, where for the first time those
training as general physicians will receive modern training in primary
care as well as residency training before practicing medicine. The partnership
is a six-year project funded largely by the philanthropic China Medical
Board, of White Plains, N.Y.
"My hope is that in six years there will be an established department
of family medicine and a residency program at the university, and that
research projects in family medicine will be conducted there," says
Brian Jack, a MED associate professor of family medicine and the school's
head consultant to Hanoi Medical University. MED this academic year is
hosting Pham Nhat An, a pediatrician and the head of Hanoi Medical University's
postgraduate training program, who is working with Jack to develop a plan
for implementing a training program, as well as conducting research.
"Our goal right now is to show Dr. An how we've organized our department
of family medicine and how we've developed our clinical practice, our
research programs, and student teaching, resident teaching, and fellowship
teaching programs," says Jack. "Over the next five years we'll
have our key faculty in each of those areas travel to Hanoi to provide
As part of the Family Medicine Development Project, the University of
California at Irvine has been paired with Ho Chi Minh Medical University
and the University of Massachusetts with Thai Nguyen Medical College to
establish family medicine programs. The Maine Medical Center is among
institutions that have played an integral role in the project since 1995,
when a five-year needs assessment was begun to lay the foundation for
the development of family medicine programs in Vietnam. The needs assessment
was funded by the McKnight Foundation of Minneapolis, Minn.
At American medical schools, Jack says, family medicine departments prepare
physicians to work mainly in a nonhospital, outpatient environment. Family
medicine is recognized as a "specialty in primary care," he
says, and doctors of family medicine offer preventive health services
and treat all of a patient's basic needs, instead of specializing in the
treatment of a particular organ, system, or disease.
Establishing family medicine programs in Vietnam is crucial, Jack says,
because the general practitioners churned out by the country's medical
schools get no residency training. Those who find a job as a doctor, and
many are unemployed, most likely work at one of the nation's commune health
centers, are paid poorly, and are the sole doctor at the facility. The
few doctors in the country who have postgraduate training beyond their
six years of medical education, on the other hand, often get jobs in urban
hospitals or at the private medical practices that have sprung up recently
as the government has relaxed control of the health-care system.
"Medical care is improving in my country, step by step," says
An. "We have programs now that are improving the health service for
immunization, nutrition, and primary care, etcetera, but care is expensive
in the cities, and the quality of care is not good in the rural areas.
Developing family medicine is one of our priorities."
Faculty at Hanoi Medical University now are laying the groundwork for
the new department, which An will head when he returns to Hanoi next September.
Once the family medicine program is operating, An says, his first priority
will be to retrain doctors now working in Vietnam's commune health centers.
"Doctors in my country know they need more training," says An.
"Family medicine is a new field in Vietnam, and I would like to learn
all the activities of family medicine in the United States and consider
which parts can be applied in Vietnam."
The collaboration between MED and Hanoi Medical University currently includes
two consulting trips to Vietnam by two BU faculty each year. Jack hopes
to secure additional grants to increase the number of annual trips as
well as to bring more Vietnamese doctors to Boston. As part of the Family
Medicine Development Project, partnerships will be built between the Vietnamese
universities and the country's commune health centers so physicians in
the centers will receive ongoing training from medical school faculty.
MED is in an ideal position to contribute to the project, Jack says, because
it helped establish family medicine programs in Hungary and in Romania
in the past decade. Jack spent 1995 in Hungary, helping medical school
faculty there develop family medicine residency programs and consulting
with them on modern family medicine teaching practices. He's traveled
to Romania twice a year for the past several years to provide similar
services to medical school faculty in that country.
"The mission of our own residency program at the MED family medicine
department is to train people to work in the community health centers
in the neighborhoods of Boston, providing efficient and high-quality care
to the underserved people in the area," says Jack. "The lessons
we've learned here are very applicable to providing care to the people