Balance global demand and local need in Family medicine HCM city Vietnam

Pham Le An, MD, Ph.D Director of Center for Training Family Physician Lecturer of Center for training teacher University of Medicine and Pharmacy in HoChiMinh city Vietnam

Causes of Global Neonatal Mortality

Developed Post neonatal

SIDS Congenital anomalies Injuries Infection LBW Congenital anomalies Maternal complications Ratio NM:PNM ~ 34:1

Developing Post neonatal

Infection Malnutrition Injury

Neonatal

Neonatal
LBW Trauma/asphyxia Tetanus Pneumonia Ratio NM:PNM ~ 1:12

Causes of Global Infant Mortality

Leading causes of infant death in US
Congenital anomalies Pre-Term Birth/Low Birth Weight Sudden Infant Death Syndrome Problems related to maternal complications of pregnancy Problems related to complications of placenta, cord, membranes Respiratory Distress Syndrome Leading causes of infant death in Developping countries India, Nigeria, China, Pakistan, the Democratic Republic of Congo, and Ethiopia account for 50% of the 10 million child deaths annually Conclude that 2/3 of the 10 million child deaths worldwide could be prevented

with existing knowledge and treatment

Focus on community-based interventions to identify and treat pneumonia (Series of articles in Lancet in 2003 on reduction of global childhood mortality)

HIV/AIDS & T.B

SOCIAL AND ENVIRONMENTAL DETERMINANTS

Diabetis typ 2, H.T.A COPD/ASTMA

Viral Evolution
Coxsackie virus
Levander & Beck. Selenium and viral virulence. Br Med Bul 1999;55:528

Malnutrition & disease burden

Chandra RK. Nutrition and immunoregulation. J Nutr 1992;122:754

Stress proteins & mutations

Immune surveillance system

Emerging new disease: SARS

Severe Acute Respiratory Syndrome

CORONAVIRUS

1. Species X-over
2. Genetic reshuffling 3. Farming practices &

food handling $50-100 BILLION

TRADE, TRAVEL, TOURISM
Bio Economic Research Associates, Cambridge, MA

HURRICANE MITCH 1998 HURRICANE MITCH

HURRICANE MITCH
IMPACTS ON HEALTH AND DEVELOPMENT

DISEASE CLUSTER
-- Malaria (>30,000 cases)

-- Dengue fever (>1,000) -- Cholera (>30,000) -- Leptospirosis

Definitions
A disaster is a destructive event that causes a discrepancy between the number of casualties and their treatment capacity.

In health and medical care, disaster means a situation in which the need of medical care exceeds the immediately available resources and in which extraordinary and coordinated measures are necessary if normal quality standards are to be maintained
Vilius Grabauskas

To maintain the normal quality standards

Emergency for disaster attend to and treat injured persons within a injury area transport the injured and give treatment during transport attend to and treat injured persons in hospital take preventive measures against psychological sequelae in the injured, relatives and staff involved in rescue work. Vilius Grabauskas

Health Impacts of Climate Change

HEATWAVES
May 2003 Andhra Pradesh T 122F >400 deaths

HUMIDITY & HEAT INDICES TMINS

Emerging Infectious Diseases

30 DISEASES NEW TO MEDICINE SINCE 1976
HIV/AIDS Legionnaires Ebola E. coli O157:H7

SARS

Antibiotic-Resistant Agents

Hantavirus Pulmonary Syndrome

Lyme Disease
Vibrio cholerae O139

Nipah Virus
Arenaviruses

VECTORS
Mosquitoes Ticks Rodents Bats Tsetse Flies Fleas Lice Snails Algae

RESURGENT & REDISTRIBUTING Malaria, Dengue Fever, West Nile Virus, Cholera

Costs of Extreme Weather Events

Insurance & Reinsurance, FEMA, OFDA, NGOs, Nation States, Companies

UNEP

$150b/y w/in this decade

Protection of health from climate change calls for a Preventive Public Health Approach

What Medical Educational Sector Should Do - Educate medical students/ health providers on the impacts of climate change on health and global health. - Aware that primary care and family physician promise the important solution. - Focus on relationship center care that means foster a group of new scientists, engineers, health professionals and political leaders.

Global health is a field at the intersection of several disciplines: epidemiology, economics, demography and sociology--that is concerned with international health issues. The term global health, as opposed to International Health, implies consideration of the health needs of the people of the whole planet above the concerns of particular nations (Wikipedia)

Global health is a field at the intersection of several disciplines-epidemiology, economics, demography and sociology--that is concerned with international health issues. The term global health, as opposed to International Health, implies consideration of the health needs of the people of the whole planet above the concerns of particular nations (Wikipedia)
Situation Problems Events Results

Society

Increase the gap between the poor and the rich globally. Both rich and poor population have to deal with the same risk of health due to the phenomena of traveling and imigration

Urbanization/globalization

Increase of the population Decrease of the resources for health care

In developing countries: Child health care: high neonatal mortality. Energy -malnutrition Infectious disease - Emerging new disease such as H5N1, hand foot mouth disease.. - Bacteria resistant of antibiotic: TB, SRSA... - outbreak of cholera, H5N1 Problem of developed countries : Chronic disease care like HTA, Diabetes type II, Cancer Problem of cost effectiveness Overload at central health care level

Threats to global public health security [2] Need to collaborating at global level. Need to share experiences and information as soon as posible at global health

Increase the economical burden.

Need to improve the quality of care in provincial and district level

Global health is a field at the intersection of several disciplines-epidemiology, economics, demography and sociology--that is concerned with international health issues. The term global health, as opposed to International Health, implies consideration of the health needs of the people of the whole planet above the concerns of particular nations (Wikipedia)
Situation
Environment

Problems
Global warming phenomena

Events
Change the climate => increase of disaster

Results
Increase the need of emergency rescues in disasters Increase the outbreak of tropical disease: DHF, cholera Increase the trouble of psychology after disaster Strategy expanded vaccination to all the member in the family

Scientific

Vaccination Era

More new vaccine then new antibiotic every year Vaccines prevent cancer such as Hepatitis B, HPV. To master the medical information and apply them daily to health care. Outbreak of: Metabolic diseases, COPD/asthma Depression Family physician network help to improve the quality of health than specialties network

Evidence Based Medicine

Behavioral science

Bad behavior => fast food, tobacco, stress

Increase the cost effectiveness and improve the quality of health care services Need to changing bad behavior

Health care philosophy

Primary health care change to Primary care

Relationship center care

Impact of Global health to the local health cares needs in HCM city

The gap between urban care and rural care in the health care network. Competition among specialties: lack of cooperation in chronic care => increase the cost of management. Overloading at central health care level Barrier in teaching ambulatory care and doing the outpatients research.

Solution: need to prepare the manpower follow the trend of primary care such as Family physician training system.

Global health Old approach Multi-tasks approaches in one places: mother care, children care, dental care, chronic care.. Multidiscipline approaches

Family Medicine concept Match to this totally in the health care network Need to change to relationship centered care

New approach

Build up the cooperation among the expert in medical field at international level: teaching, managing, does research with the win-win strategy => promote relationship center care Teaching Relationship center care through the patient club in chronic care:

Activities
Patient club and Panel expert from different specialties that leading by Family physician

Content of knowledge
Give the advice or consultant to help patient maintain their health

Skill

Attitude

Communication Accept to build Negotiation up the relationship centered care among specialties

How to deal with the new issue Global health in FMs training curiculum? In Vietnam we established our health care network more than 40 years and the new specialty: Family medicine (2003). Family physician play the important role in primary care so we have to include the topic Global health into Medical Doctor and Family Physicians training curriculum for being sure about the quality of primary care. Such as:
Trainees
Clerkship

Subject
Global health Awareness

Knowledge
- Burden disease in the world : TB, malaria - Preventive care: vaccination - Burden disease in the world : TB, malaria, bacteria resistance - Preventive care: vaccination for family - Emergency care in disaster

Skills
- Clinical making decision - Communication

Attitudes
Accept to build up the relationship center care among diferent specialties Accept to build up the relationship center care with WINWIN theory for both developed and developing countries => increase of cooperation

Residents

Global health

Do research Emergency care in disaster Behavioral care after disaster Team work

Videoconferencing is a very useful technology for practice & teaching Family Medicine in the 21st century at global level

The barrier for teaching global health in HCM city : - the lack of up to date the information in this field - sharing the experiences of the expert from developed countries on time . = >the ADSL with video conferences promise the good solution, that means for solving: The gap in the information among developed and developing countries In time/ good reaction to new accidents. Long distance learning for developping residents National and International training course/team research on Medical issues. Cost effectiveness and good quality of teaching.

Videoconferencing is a very useful technology for practice & teaching Family Medicine in the 21st century at global level

-the lack of up to date information in this field and sharing the experiences of the expert from developed countries on time will be the barrier for teaching global health in HCM city. => the ADSL with video conferences promise the good solution for solving: The gap in the information among developed and developing countries In time/ good reaction to new accidents. Long distance learning for developing residents National and International training course/team research on Medical issues. Cost effectiveness and good quality of teaching.

Problem with Student Assessment: standards and quality The Vietnamese perspective:

4.1 Solution: Need to be standard at national levels and improve continuously the quality of care Solution: need to establish the core curriculum and blue print and blue print test of learning objectives at national levels for standardizing the quality of Family physician at national levels.

Conclusion

Global health, the new issue will be added in the medical curriculum with the support of videoconferences that make Family physicians more focus in relationship center care. That will be a promising solution and will improve the quality of Primary care with good cost effectiveness