MEDRIX, April 2007

Tam Biet, Vietnam

Its time to say goodbye.  By the time you read this, the team will be somewhere over the Pacific

The last few days in Hue allowed the team to decompress from eight straight days of work, and to see the sites and people of the last royal capital of Vietnam.   The city is bisected by the Perfume River.  On one bank is The Citadel, an old gated fortress city built by King Gia Long starting in 1802.  It held the homes of the common people, as well as the fort-within-a-fort where the king lived.  Today, many ordinary people live inside The Citadel, while the Forbidden City is a huge tourist attraction.

(Be sure to click on the photos to see a larger version.)

In America, most people either live on a wide street suitable for autos, or in an apartment.  From an early age, we fear alleyways – we think of them as the places where bad things happen.  But in most of the cities of Vietnam, it is the alleyways (called a kiet in Hue) where people live.  Too narrow for autos, they are perfect for the slower traffic of bicyclers and walkers.  A neighborhood is watched over by an older gentleman who smiles to welcome you to his alleyway.  Some of the team members had the chance to amble around and see the real Hue.

The Perfume River is beautiful – the Vietnamese write poems about it.  Of course, it is also a large part of the economy and many people make their living on the boats that ply its waters.  Some haul gravel for construction, others take tourists for short trips, and others haul farm products to market.  This one is setting out early in the morning to go fishing.

And, maybe the silk shop owners of Hue are sorry to see the MEDRIX team leave – you will soon be able to see the results of some shopping trips.

So – tam biet, Hue.  You will see MEDRIX again.  There is lots of work yet to be done.

The Deep Countryside

(The following post was written by MEDRIX Executive Director LaRelle Catherman.)

The air was thick and heavy, and the thunder rumbled.  The wind picked up and the thought of a cooling rain gave us hope for a little comfort.  But the rain did not come, and the thunder ceased, and the air remained thick and heavy.

We had surveyed 5 village Health Clinics in the mountainous area just west of Hue Vietnam.  And of the 5 Health Clinics, none of them had a GOOD water supply, and 2 had no water supply.

Can you imagine a clinic without water?  Can you imagine a clinic where the nurse or doctor have no water to wash between patients?  Can you imagine having a baby in a clinic where there are 5 covered buckets of water to be used for your delivery?  Each empty bucket will be carried to the closest water source.  The buckets will be filled with water and carried by the mid-wife back to the clinic.

The source of the water is a pipe, tapped into a mountain stream.  The pipe is protruding from the ground.  It is not capped.  It can not be turned on or off.  Imagine yourself as the mid-wife.  You must wait until the water flows and then quickly get a bucket, fill the bucket and then carry it to the clinic.  You will walk up a small path, pass 2 houses, and pig stall with a large sow and a squealing litter.  You will pass 2 mud puddles and standing sewage.  You will have to carry the heavy bucket of water 5 times and you will have to boil the water in each bucket before it can be used.

But there is hope.  Yes there is a solution!  An organization called MEDRIX is now hoping to drill a well at your clinic.  If you have a deep well you will have water year round. Your expectant mothers will not have to worry about safe water not being available for their precious delivery.  Aha, hope is so sweet.  Water is so sweet.  It is life, life for the newborn and life for the all who come to the clinic.

But the reality is neither you or I are the midwives of these clinics.  But we can be part of the solution and part of the midwife's dream. You do not have to be a mid-wife, or a bucket carrier.  You do not have to travel to Vietnam, or wish for a cooling rain.  Your support for a well, or part of a well can and will make a difference.  It costs about $5000 USD to put in a complete water system at a health clinic.  Yes only $5000.  Whether you can afford a complete well system, or a few dollars toward a complete system, you can be a partner with MEDRIX to make the dream of safe water a reality in one more village, in one more health clinic.  Want to work with us?

The University

If you think all photos and stories about Vietnam are about peasants working in the fields, you might be under the impression that Vietnam is a backwards country. 

Vietnam is not a backwards country.  It is a developing country.

MEDRIX recently began a new partnership with the Department of Environmental Science, College of Science, the University of Hue.  College Rector Nguyen Van Tan, Departmental Dean Le Van Thang, and Departmental Lecturer  Le Bao Tuan selected the best and brightest second year students to participate in a three day workshop to learn how to use global positioning satellites to gather data that will benefit MEDRIX projects as well as further the student’s own scientific careers.

(As always, be sure to click on each photo to see a larger version.)

After a short introduction and a few words of theory in the classroom by MEDRIX Director of Safe Water Projects Robert Catherman, (ably translated by Mr. Tuan) the students got their hands on GPS receivers and went outside.  And this is where the real learning took place – how to turn the unit on – how to find three or four satellite signals – how to know when you are ready to use it to navigate.  Robert and Tuan rendered a little experienced help to three students who are using GPS for the first time.

The next day was even better.  Joining with MEDRIX Board member Ivan Ellis, Robert and Tuan constructed a practical exercise that required the students to find landmarks already plotted.  Each group had to find the landmarks using a GPS receiver.  The exercise took place in a beautiful park alongside the Perfume River.  Though the students enjoyed the outing, and learned a lot about coordinates, waypoints, and routes,  they also had to plot the data and keep good field notes.

The final day of the workshop was on Sunday – a day when the college rector’s conference room was available.  It was equipped with a projector that allowed Tuan to hook up a laptop computer.  Each group came forward and dumped their data into the laptop.  Being displayed for everyone to see, the students learned from each other. 

In the future, its hoped MEDRIX can partner with the university to provide practical experience for students and have them plot the location of hundreds of current and future  safe water projects within the province.  Such experience will help them collect data in their own science projects – and continue to develop Vietnam.

And – the students had a lot of fun too!

Rural Health Clinics

American women;  think you’re tough, eh?

Can you guess what’s behind this door at a health clinic in the Vietnamese countryside? 

(As always, be sure to click on a photo to see the full sized version.)

It’s a birthing room, and if you were the wife of a typical Vietnamese farmer, you would give birth to all your children in this room – and your neighbors and friends will have their babies there too.  You will be attended by a midwife who has received nine months of training.

And – the water used in the birthing process and to wash your new baby would come from this.

Or maybe you’re an old man, injured while working in the fields.  A doctor or nurse would bind your wound and care for you – but who knows the quality of the water being to clean the wound.  Maybe it came through a garden hose to a bucket from a well near a toilet.

Moms around the world want the best for their children.  Often, the clinics are the only readily available source of healthcare for rural families.  The provincial health authorities made it a priority to have one physician at each clinic, and that alone raised the level of care considerably.  The next obvious step is to provide good resources to those doctors, and MEDRIX partners with the government to do that.

I could make this posting really dull by showing you more pictures of wells, UV safe water units, latrines, sinks, and pipes.  But, what we’ve been about the past two weeks is not about things, but people.  Here they are.

English Medical Terminology

Think about it - - when you go to your doctor, you expect him or her to know about everything  that will make you feel better.  To do that, your doctor reads research papers, medical journals, and attends professional conferences.  He or she tries to stay current.

Physicians stay current in English.  Why?  Because English is the international language.  More people speak English as their second language than people who are native speakers of English.  International airline flights are controlled in English.  Oil trading is done in English.  And medicine is done in English.

There is a huge need for Vietnamese physicians to learn English – and in particular, English medical terminology.  To medical professionals, it’s not really the jawbone – it’s the mandible.  It’s not the breastbone, it’s the sternum.

MEDRIX provides English medical terminology training to the physicians of Hue Central Hospital.  The doctors met in small classes over a period of three weeks and were instructed by MEDRIX volunteer Cindy Young, R.N.  Her years of experience in the medical field coupled with her 1 ½ years of experience teaching English at the University of Hue make her the ideal teacher.

(Be sure to click on a photo to see a larger version.)

Course study books (which included a CD) were purchased and donated by American physicians for use by their Vietnamese colleagues.  All the bac si (physicians) in the class already have a high level of English speaking skills – they need to know the fine points of their professional jargon.  Having Cindy say the words helps them to pronounce the words correctly, but she is also available to answer questions about the deeper meanings of words and the context in which they will be used.

Cindy is in full control of the class – she keeps things moving and on task.  Words appear on the wet board, are dissected, explained, and pronounced.  Yet she has a self-deprecating way about her that stood her well when the students found an error.  After researching in a medical dictionary, Cindy realized a mistake had been made.  She used the incident to cement a close relationship with her students by “keeping score.”  That brought a chuckle to everyone’s face.  Cindy was always careful to address each student using their title, such as “What is the accented syllable in gastroenterology, Dr. Trang?”

The doctors took copious notes – they knew this was their chance to grow professionally.  The physician who took these notes is scheduled to travel to the United States for advanced studies.  MEDRIX hopes he will return to Hue better trained to care for the people of central Vietnam.

Putting It to Work

They stared out the school house door, past their neatly stored shoes, at the group of tall foreigners who came to their little kindergarten in the village.  They’re too young to know that they have been drinking safe water for two years, thanks to the combined efforts of MEDRIX and its partner, the Thua Thien Hue province water and sanitation authority.

(Be sure to click on each photo to see a larger version.)

Monday was a day to visit five kindergartens that have had MEDRIX safe water units installed for two years or more.  Mr. Niem of the provincial water and sanitation office, has monitored the units on a monthly basis.  Its his job to test the water and be sure the units run correctly.  Here he adds chemicals to a plastic bag to determine if there any microbes present.  MEDRIX staffers had their own role as they wanted too see how the units were holding up under two years of use.  Ken Kimball is the MEDRIX staffer who lives full time in Vietnam, and he is seem here checking a unit while MEDRIX Director of Safe Water Bob Catherman records the data.

At each school, there is a rack near the safe water unit with a plastic cup for each child. The rack allows the cups to air dry, further lessening the chance of disease being spread by the water system.   Safe water means all parts of the system must be clean: tubing, collection containers, glasses – everything.  It’s the teachers who make all of it work on a day by day basis.

Sure – it was fun laughing with the kids.  MEDRIX administrator Corene Den Herder pushes paper in the MEDRIX office everyday, so this was a wonderful way to see how donations and volunteer work affect the daily lives of poor children on the other side of the world.  And the children had a chance to laugh and play with adults from the other side of the world.  They had a good time, and ran out to the gate to say goodbye the Mr. Ken.

But – this is what its all about.  The small child of a poor farmer in a rural village in Vietnam has a drink of good safe water.   The World Health Organization lists safe drinking water as the number of health problem in the world.

Enjoy the drink.

Teach Them How to Fish (Part II)

(If you haven’t done so already, you might want to read Part I first.)

There is electrical work as well – the ultraviolet lamp must be fitted to the sheet metal and the necessary soldering done to make the unit work.  The UV lamp draws very little power (about 8 watts), so complicated and expensive electrical parts are not needed.

Of course, once the entire unit is assembled, you have be sure it works. The three learners watched each other to be sure everyone followed all the steps exactly – they wanted to be sure their own units work perfectly back home.  Water was put in the top container, then the UV unit was plugged in and the flow checked.  A small leak was spotted and fixed quickly with plumber’s tape.

The whole process revolves around testing water – testing at the source to see if it is good water or bad water, and testing it after running bad water through the system to be sure it is drinkable.  Small inexpensive kits are available – a snip of the scissors opens the small container of testing material which is then poured into a small plastic bag.  Water is added and it is easy to see if there are dangerous microbes in the water.  After 48 hours, if the tested water is black and stinks, it is bad and needs to be treated.  If it is clear, your UV system is doing its job.

Three days – three days spent spreading knowledge that will hopefully lead to a better life for more people of Vietnam.

Teach Them How to Fish (Part I)

You know the old story about teaching people to fish so they can continue to feed themselves.  That’s what the MEDRIX safe water project is about – giving the skills to construct and maintain an ultraviolet safe water unit to the people who need them.  Of course, we could truck some water out to a village, or maybe drill a well, but without a long term way for the local people to provide safe potable water for themselves, the problem is not solved.

There were three folks being trained in the construction, operation, and maintenance of the MEDRIX ultraviolet water treatment unit.  They were also being trained to assess drinking water and figure out how to treat it.  These folks are smart- they nailed their three days of training.

After the training in the metal shop, MEDRIX bought the rest of materials to use in making a unit during the training session.  Once they get back home, the trainees will buy their own from their local sources.  Everything in the unit is inexpensive and easily available.  A look at a completed unit helped them to visualize the end goal of building an entire system themselves.

 

To help achieve that goal, they worked from a complete manual written in Vietnamese and English, with lots of illustrations and photos.  The oral instruction was done in Vietnamese by a Vietnamese speaking MEDRIX staffer using the manual as a guide.  Since learning is experiential, there was lots of hands-on work at each step of the way.  We quickly found the learners knew what they were doing with tools.

The entire unit consists of the UV radiation unit made from stainless steel, two large plastic water containers, some tubing to move the water, and a stand to hold it all.  The stand is made from common PVC pipe (though some of the Vietnamese prefer a more attractive but slightly more expensive stainless steel stand) that is cut to specific lengths, then joined together with t-joints and elbows.  Next is the jigsaw puzzle of putting together according to the manual and under the watchful eye of a MEDRIX instructor.  If the new stand is acceptable, a little glue may be added to the fittings.

(To be Continued)

The Shop Teacher

It makes little sense for our team to make some inexpensive water treatment units and put them out in the countryside.  The need is too great.  There are 154 health clinics and over 1,300  pre-schools in Thua Thien Hue Province.  We few North Americans couldn’t make a dent in the problem.

But – show the Vietnamese how to do make the units, and a lot of good things happen.  Besides the obvious benefits of being able to make more units faster, there is the benefit of providing a new small business opportunity for some of the local folks.

In the small, dimly lit metal shop adjacent to his home, Mr. Phuong has worked with MEDRIX from the beginning to design and build the metal parts of the unit.  This is the core of the system – the ultraviolet light housing that inactivates the microbes in the water that cause illness.  Today, Mr. Phuong passed on his knowledge to others.

(Be sure to click on a photo to see a larger version)

Though the students had instruction manuals in Vietnamese provided by MEDRIX,  the new folks took copious notes as Mr. Phuong squatted over his work and cheerfully explained what he was doing.   His students were motivated, and they brought a strong set of skills to the class – they only needed to know how to make the ultraviolet unit.  In his cluttered workshop with a dirt floor, Mr. Phuong proved to be an exemplary teacher  as he showed the students the concepts and answered questions.

Small businesses like this are numerous in Vietnam.  Because they are almost always a part of the home, they a bit different than an American small business.  In Vietnam, most people do not divide their lives into a “business life” and a “home life” - a person has one life.  Phuong and his wife Hang work together – she the sharp negotiator and bookkeeper, and he, the skilled craftsman.  She knows the trade well enough to provide assistance when needed and they work well together as a team.  On occasion, the children wander in to see what is going on.  They are not shooed away – they are allowed to join in.  I wonder if the youngest will follow in his father’s footsteps and become a metal smith.

Mr. Phuong’s tools are not modern, but he uses them with great skill.  Simple tin snips are used to cut an end piece of stainless steel.  I have no idea how old his tools are, but I know he learned his craft in technical school in the 1980s.  He probably began acquiring tools then, but at that time, Vietnam was in dire economic straits and probably no new tools were available.  He used a simple die he designed and built himself to make the end cap of the UV housing. 

A press sat on the floor in a corner.  It had a pipe fitted to the handle to give extra leverage and was used to bend the metal at just the correct angles needed for another part of the housing.  In all this work, the only light came from a low wattage table lamp that either he or his wife put in place to light the work area.  Finally, all the pieces were ready to be fitted together and welded into place.  His electric welding machine looked like an antique, but the work professional.

That ended the first day of training for the new folks – next would be assembling the entire water treatment unit.

It All Takes Planning

Before you do it, you have to plan it. 

The first work day in Hue was spent putting all the pieces together.  Working with the Vietnamese, as well as the MEDRIX staffer who lives  in Hue, the plans began to move off paper and into action.

Of course, sometimes work is tempered with a little pleasure.  Coffee served as a good lubricant for ideas as the Safe Water Team discussed ways to make some of the projects work within the circumstances of Viet Nam.  Ken and Bob confer with a retired American engineer on some possible changes to the systems now in places – changes to improve performance and usability.

(Be sure to click on a photo to see a larger version.)

New equipment has to be set up and tried.  In this case, Ivan and Bob began gathering data on the sunlight available on a cloudy day in Hue – data that may someday lead to an alternative system for  producing safe water in deep rural areas where there is no electricity.

After an afternoon of meetings with senior administrators of the Hue General Hospital, Cindy did detailed planning for teaching a three week class in English medical terminology to a group of physicians.  Learning these terms will help Vietnamese doctors stay current on new research, attend international conferences, and prepare them for further training in English-speaking countries.

All this work, and the real work hasn’t even started yet.