|Unhealthy situation: The Central Endocrine Hospital in Ha Noi is often overcrowded with patients, leading to lengthy delays.
Home visits from family doctors are a growing trend with many Vietnamese preferring the friendly service over a trip to the hospital. But a lack of infrastructure and the popularity of home remedies means the future of this vital service is by no means assured. Ha Nguyen reports.
"My only son has had regular medical check-ups at the centre since he was born in 1998," said Hoa, adding that when she called the centre, Dr Nguyen Thu Thuy often arrived at her house within 15 minutes.
"Dr Thuy gives him very careful check-ups and explains to me the way the medicines should be used and possible side-effects. She also advises me how to protect my son from epidemics."
Hoa said Thuy gave her encouragement and support when her son went down with double pneumonia in 2000.
She said Thuy had built up a deep knowledge of her son's health after attending him at the home, time and again, for almost 15 years.
"Thanks to Dr Thuy, my son grew up healthy and escaped epidemics.
"But another important thing is that we didn't have to take my son to hospitals, which are so crowded, and wait for at least half a day or more, and pay VND200,000 (US$10) return for a taxi to the hospital," said Hoa.
|Frontline services: A medical worker, at Ha Noi's Family Doctors Centre, performs an ultrasound scan on a patient. The centre has provided early health care for people in the capital's inner city.
A medical check-up by a family doctor nowadays costs VND100,000 to 300,000 ($5 to 15) a time, she said.
Hoa's neighbour, Bui Thi Mai, said she and her husband also preferred the family doctor centre. They suffered from arthritis and hypertension but wanted to avoid going to crowded hospitals.
At the centre they were allowed to choose a doctor to regularly watch their ailments.
"The doctor often gives us a very careful check-up and consults our records before writing out a suitable prescription.
"We are confident in the services and our health is stable," Mai said.
HCM City has also set up several family doctor centres since June last year.
Dr Le Thanh Hung, deputy director of District 10 Hospital, said the family doctor centre, worked from 7am to 6pm, often treating a total of 200-250 patients a day.
"We are improving the clinic, and plan to duplicate the model in other wards in the district to serve increasing demand," Hung said.
Dr Tran Van Khanh, director of District 2 Hospital, said his family doctor centre, set up in October last year, had 18 doctors treating 40-45 patients each a day.
"I hope to develop the model to serve more people from surrounding districts," Khanh said.
|Vital work: The Family Doctor Centre at 50C Hang Bai uses modern technology to meet the increasing medical demands of local people.
However, family doctor centres still faced huge problems, said Dr Nguyen Thanh Hiep, head of the Pham Ngoc Thach Medical University's Family Doctor Faculty.
Difficulties included the lack of software to manage electronic case-reporting and connection to medical units to diagnose ailments and exchange views and information.
"These are big challenges as we try to multiply the model," said Hiep.
"In addition, the health insurance fund has not joined in the family doctor service," said Hiep.
Luu Thi Thanh Huyen, deputy director of HCM City's social insurance fund, said the fund was ready to support the family doctor centre model but it needed concrete rules before it could implement it.
"We have signed a contract with public hospitals and private medical centres to pay health insurance for patients but we haven't signed any contract with a family doctor centre, so the model should be connected to a hospital ward medical centre to receive health insurance from the city insurance fund.
Meanwhile, Professor Didier Giet, head of the Belgian Liege University's General Medicine Faculty, said at a conference on family doctors held by the Agriculture Ministry Hospital in Ha Noi, that early health care at home had been a priority in many developed countries, including Belgium.
Over the past 30 years, since 1978, the family doctor network in Belgium had been improving and played an increasingly important role in medical care, the professor said.
More than 95 per cent of the Belgian population had family doctors.
Giet said to become a family doctor in Belgium, the doctor had to pass seven years of general medicine at a medical school, and after that two years of professional family doctors.
"These doctors work directly with people and each will take care of several thousand people," Giet said. "They need a wide knowledge in all fields, including paediatrics, obstetrics and gerontology.
"In addition, they should be qualified in community healthcare and have good skills in dealing with patients."
Giet said Viet Nam had favourable conditions to develop a family doctor network. They include priorities from the Government on community health care, such as an open vaccination programme.
But the country still faced the problem that patients often self-diagnosed and self-medicated from a private pharmacy.
"It is very dangerous," Giet said.
Another problem was the number of people who went to a central hospital without getting a local medical check-up first, that caused the central hospital network to become overcrowded.
"When working in HCM City I realised that general hospitals and emergency rooms had to work very hard to meet the increasing demand of not only the city population but also people from many surrounding provinces. It would be very difficult for medical workers to give high quality care for such a number of patients," said Giet.
If the country had an early health care intervention and protection programme, as the Western countries had in the family doctor network, 80 per cent of health care demand would be solved, Giet said.
Like other countries, Viet Nam's economic development was accompanied by an ageing population and lifestyle changes. This has caused more people to be faced with chronic diseases, such as heart diseases, diabetes and hypertension.
|Learning the ropes:An on-the-spot training course for medical workers at commune level in the north-western province of Son La.Le Thi Hoa in Ha Noi's Hai Ba Trung District was very interested in a health service provided by the Ha Noi Family Doctor Centre.
Family doctors should play an important role in long-term care of these patients, Giet said "Building and developing the model is not easy so Belgian experts in the field are ready to help Viet Nam to train a qualified family doctor team in order to take care of the community and help reduce pressure on central hospitals," Giet said.
Meanwhile, Health Minister Nguyen Thi Kim Tien said the ministry has just approved a project to build and develop a network of family doctors for the 2013-20. The project would reduce overcrowding in hospitals, particularly central hospitals. "This is the first time the model has been officially implemented and joined the country's health insurance," she said.
Tran Quy Tuong, deputy head of the Health Ministry's Department for Management of Medical Check-ups and Treatment, said family doctors would do clinical check-ups, watch and take care of patients with chronic diseases and advise people and the community on how to prevent ailments and protect their health.
The family doctors would provide house-calls for medical check-ups and take care of the patients during their life.
"Demands for these services are increasing, particularly among families having patients with ailments needing medical workers to take care of their relatives at their homes," Tuong said.
Pham Luong Son, head of the Viet Nam Social Insurance Policy Department, said there would have to be concrete criteria and suitable regulations for the health insurance fund to pay a private clinic.
Dr Nguyen Thi Phuong Hoa, deputy head of the Family Doctor Faculty of the Ha Noi Medical University, said family doctors would undertake three main tasks: do clinical check-ups and preventive medical care and act as a psychological doctor for patients.
These doctors would also help to discover and treat emergency cases while promoting management of out-patient treatment in order to meet 80-90 per cent of health care demand, said Hoa.
Doctors would set up an electronic case record of the patients in order to follow the development of their ailments. The case record would also keep health information of the rest of the family members.
Dr Pham Le An, head of the HCM City Medical University's Family Doctor Faculty, said although the system came into being in Viet Nam more than 10 years ago, the family doctor system seemed to be new in the thoughts of many people.
They thought family doctors were those who gave medical check-ups and treatment for rich patients at their house.
According to a pilot programme of the Ministry of Health, from now until 2015, Viet Nam would build 80 family doctor centres in Ha Noi, HCM City, Hai Phong, Can Tho, Thai Nguyen, Thua Thien-Hue, Khanh Hoa and Tien Giang.
From 2016-20 the model would be expanded nationwide. — VNS