VietNamNet Bridge - If there are no changes, the medical sector in Vietnam will lag behind Cambodia, which has been implementing programs with Australia.

In a report on the global health system in 2000 from the World Health Organization (WHO), VN ranked 160th of  191 countries, through evaluation of five groups of indexes measuring capabilities and responsibilities.

In Southeast Asia, VN ranked above Laos, Cambodia and Myanmar. Vietnam is also among nine countries with the lowest budgets for health.

This is the first, and only time, that WHO issued a list, and whether there was controversy about evaluation methods, the ranking of Vietnam can be considered relatively reliable. Since then, it appears that there was no concrete evidence to suggest that Vietnam has improved the position on the ranking. Why?

The first issue is that medical training in Vietnam has become outdated. In developed countries in North America, Europe or Australia, training of physicians and medical staff involves post-graduate training or professional medical training.

In Vietnam, training of doctors in Vietnam is at a university level with duration of six years, after leaving high school. Vietnam grants a doctoral diploma to the graduate, while with six years of training, Pakistan only grants a bachelor of medicine degree. Therefore, the degree from Vietnam is valid only in Vietnam and some African countries and the Arabian Peninsula, which have cooperation activities with Vietnam.

Some medical schools choose students whose university entrance exam results are very good. But the training process reveals many weaknesses.

The biggest difference is the basic pre-medicine subjects, which are taught over a four year period in foreign countries to give students specific background knowledge, logical thought, and research capacity. It is only one year in Vietnam, for both theory and practice. However, students have to spend one year in general subjects unrelated to medicine.

The curriculum is weak as medical textbooks for many subjects published from the 80s are still being used. Machinery and equipment for laboratories in some medical schools are still rudimentary. It is worse at medical schools that are not at the top. Foreign language is a major obstacle to the integration of medical students of Vietnam.

Also, the involvement of Vietnam medicine in international medical conferences is weak.

For example, Vietnam is one of 14 nations that receive funding of $1 billion of PEPFAR for HIV/AIDS prevention, but in the most recent conferences on HIV/AIDS in Asia-Pacific, the Vietnamese delegations were big but they almost never chaired a plenary session, and they had to use interpreters.

This is different from representatives of other neighboring countries as the Philippines, Myanmar, and even Cambodia. The hope of having a medical school of Vietnam entering the world’s top 200 may be never reached.

The philosophy of training of Vietnamese medical schools definitely needs to be based on three basic pillars: global, intellectual achievement and self-esteem. If there is no change, it is certainly that Vietnamese medicine will lag behind, even in comparison with Cambodia, which has accessed medical training programs of Australia.

Professional code needed to improve behavior of doctors

The second problem is to change the root of the concept of the society and the health sector. At any level or circumstance, the relationship between the patient and the physician must be replaced with the relationship between a service user and a service provider. This is professional behavior.

For a long time, in Vietnam, the default concept from the media and education is that practicing medicine is a "sacrifice and is noble" and that concept purely worships the unnecessary value.

This concept creates the patronizing spirit among doctors toward things that the patient absolutely has the right to demand and to be served by the transparent payment from their pocket or from health insurance.

What to do is very simple: giving the medicine its true value, like all other honest sectors of society, as the soldier on the defensive front, the shift worker in factories, or the farmer in the fields. The patient absolutely does not need to request the doctor’s compassion.

Because of this concept, together with the development of the market economy, the “envelope culture” appeared in the mid-90s, and that is the biggest pain for the patient. It has changed many aspects of Vietnam medicine.

With more than 20 years practicing medicine, the author of this article can assert that the patent will never voluntarily give “envelopes” (black money) to the doctor. They are forced to do so, and this is inequity for the poor. Upon receipt of the envelope, the physician loses his career self-esteem. Some doctors who retain their self-esteem feel isolated and that they have been treated unfairly.

The measure of the value of expertise, sharing knowledge and experience, and investment in research has been distorted by actually making money on the patient through monopoly of technology and grants. This evil must be stopped unconditionally, and it is possible.

The power, duties and attitude of every health worker, from officials to the lowest positions as orderlies, at any medical facility, public or private, must be specified in writing documents and punishment commensurate with the offense.

(To be continued…)

Dr. Nguyen Cong Nghia

University of Waterloo, Ontario, Canada