Building infection control expertise in Vietnam.

When Wellington infection control (IC) specialist Clo Taylor arrived in Viet Nam's Binh Dinh province to begin working with the province's 23 hospitals, she commonly found health professionals wearing one pair of gloves all morning. Her two-year VSA assignment, which ended earlier this year, was to identify priorities for the province's health department that would help develop an IC framework. The will was there, she said, but often the knowledge or the equipment to see it through was not.

"Despite Viet Nam having a history in the French tradition of IC, the colonisers left 50 years ago and, with them, much IC knowledge and practice," said Taylor. "What little hand washing I observed when I arrived had to be done with laundry powder and that was only when there were basins in the wards and when the taps worked. There were no towels."

But of equal concern were resistant organisms caused by over-the-counter sate and over-use of antibiotics. "It's a dense population, the fifth most populous in the world. Drug resistance happens quickly."

The first lesson Taylor learnt was to "take it slowly. I was there to advise and influence whole systems. To do that effectively depends on relationships and relationships take time to build." During her first few months, Taylor gave herself a list of priorities. At the top was hand hygiene, then appropriate antibiotic use and thirdly sterilisation. She looked at applying ideas that were used elsewhere, inexpensively and effectively.

One was alcohol which has been used as a hand cleanser in continental Europe for years and more recently in the rest of the west. "With the use of an IC reference book for countries with few resources, we came up with a recipe for a hand wash that could be made relatively cheaply by the provincial, state-owned pharmaceutical company."

Next on the List of priorities was control of antibiotic use. For this Taylor sought help from infectious disease clinician Tim Blackmore, clinical Leader of Laboratory Services at Capital and Coast District Health Board (CCDHB). "We needed doctors to buy into this, as the Vietnamese health system runs on a medical model. The message had to be delivered to the doctors by a doctor," said Taylor.

Blackmore made two trips to Binh Dinh while Taylor was there, paid for by the New Zealand-Vietnam Health Trust, a group of health professionals in New Zealand that supports health projects in Binh Dinh.

As well as drawing on Blackmore's expertise, Taylor also enlisted help from manager of the Sterile Production Centre at CCDHB, Alison Stewart. "Alison's job was to convince health planners of the need for training on the ground and then training the staff in effective use of equipment. Most of the staff in the area were untrained, but desperate to learn new skills. It was great to see people working in that area being seen as the specialists they really are." Taylor is grateful to CCDHB for giving her two years' leave without pay to enable her to volunteer in Viet Nam. She has been working back in IC since her return, but earlier this month took on a staff nurse rote in cardiothoracic surgery in order to refresh her clinical skills. She may contemplate more overseas work sometime in the future.

Taylor will be speaking at the National Division of Infection Control Nurses' conference in Christchurch next month and hopes another IC nurse will be enthused to volunteer to Binh Dinh province.

For further information, contact VSA (email [e-mail]) or email Taylor on [e-mail].