Nguyen is a physician from Vietnam explains what made him apply for an IAHPC Traveling Scholarship to the US.
He is a palliative care physician and oncologist from Ho Chi Minh City, Vietnam. In October 2016, he received an IAHPC Traveling Scholarship grant to attend the first part of the Palliative Care Education and Practice (PCEP) program at Harvard Medical School, Massachusetts, US, a course that is designed for palliative care clinical and education leaders.
We asked Nguyen to tell us about more about his experiences . . .
Why did you apply for an IAHPC grant?
Nguyen: I work full time in the palliative care department of a cancer hospital and am responsible for clinical care and teaching. I realize the importance of communication skills – for sharing information with my patients and their families, for teaching medical students and younger physicians during their placements in our palliative care department, and for my lectures on the palliative care basic training program held each year at our hospital. However, I lack confidence in my communication and teaching skills, since we had no specific training for these in medical school. I thought that the PCEP would give me the skills to improve my efficiency as well as to share my knowledge with other palliative care practitioners.
What new knowledge and skills have you acquired so far?
Nguyen: I attended the first part of the PCEP in October/November 2016. Topics such as Communication, Teaching Skills, Developing a Program, Pain and End-of-Life Care were very relevant to my practice. But what I enjoyed most was getting the emotional cues when we are sharing information about disease, prognosis and treatment plans with patients and/or their families. In Vietnam, physicians don’t usually have much time to talk to patients, and we almost always ignore any emotional responses that we encounter. Thus, physicians, patients and families are often not at the same level of understanding about what we share and how we feel. PCEP has made me realize the importance of emotional cues and that inappropriate responses may lead to communication failures. But now, I’ve developed some essential communication skills such as exploring psychosocial issues, or reflection. I hope that these skills will help me to develop better conversations with patients and families and increase their trust in me, which will lead to improved care for patients and their families. I will share these skills with my students and colleagues so they too can understand the importance and necessity of emotional cues and will know how to respond appropriately.
What are the main challenges that you face in the provision of palliative care in Vietnam?
Nguyen: Many patients are diagnosed with cancer in the advanced stages; more than 80 percent of patients are no longer candidates for cancer treatment of whom over 50 percent have moderate to severe pain. Most of these patients do not have access to palliative care and their pain is not assessed or treated adequately, let alone other physical and psychosocial problems.
This causes increased burden and worry for patients and their families/caregivers. As palliative care’s influence grows in our country, more people realize the importance of symptom control and psychosocial issues, yet we still have many barriers and challenges:
- Lack of essential medicines – many essential palliative care medications are still unavailable, such as megestrol acetate, methylphenidate and the only oral opioid is morphine.
- Lack of public and professional awareness – palliative care is still very new in Vietnam, thus many concepts and treatments may not be well understood by patients, caregivers and physicians.
- Lack of specialist staff – our palliative care department has only physicians and nurses; we do not have other specialists such as a social worker or a psychologist.
Do you have any tips that may help to overcome these challenges?
Nguyen : The first step is to get a greater understanding of palliative care concepts through teaching and training. I hope that with improved teaching skills I can better share my knowledge and inspire other healthcare workers to see the necessity and meaning of our work. I’m particularly interested in how to create tension in teaching sessions. This skill is so important because many people still don’t understand what palliative care is and why they should do it. If I can create tension, participants will be more interested in what I teach and my lectures will be less boring and more efficient.I hope my students will develop palliative care programs in their own institutions and hospitals, join a palliative care department, or at least apply what they have learned to provide better care for their patients.
As the number of palliative care practitioners grows in our country, and more people become aware of the same issues that I have now, then our voices and actions will bring greater influence.
Nguyen will return to Massachusetts in April/May 2017 to complete the final stage of the Harvard Medical School's Program in Palliative Care Education and Practice.
From the entire IAHPC team, thank you for your generosity.