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MED fosters family medicine program in Vietnam

By David J. Craig

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 training.

	Pham Nhat An, a pediatrician at Hanoi Medical University, and Brian Jack, a MED associate professor of family medicine, are coordinating a collaboration between the schools to build a family medicine program that will improve the quality of primary care in Vietnam. Photo by Vernon Doucette

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 consultation."

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 of Vietnam."

2 November 2001
Boston University
Office of University Relations