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The recent rash of maternal deaths is the latest symptom of Vietnam's ailing healthcare system

 
Patients at the Children Hospital 1 in Ho Chi Minh City. Experts say the increase in maternal deaths in recent years is emblematic of problems facing Vietnam's healthcare system.

The Hanoi Obstetrics and Gynecology Hospital has admitted it was responsible for the death of 32-year-old Nguyen Thi Phuong after she gave birth to twins on June 11.

Hospital officials said the doctors involved misdiagnosed her postpartum hemorrhage as mere digestive bleeding.

The mistake caused Phuong to fall into coma due to massive blood loss. She was then transferred to Bach Mai Hospital where she died nine days later.

The hospital did not release any information concerning compensation for the woman's family or what measures would be taken against those responsible.

Health officials have said the increase in maternal deaths is not due to it being a dragon year on the lunar calendar, believed by many to be an ideal time to have a child, but that blame should be placed squarely on doctors, nurses and hospitals.

The maternal mortality rate in Vietnam was 75 per 100,000 live births, more than five times the rate in developed countries, according to statistics released at a conference held by the HCMC Health Department in May. In 2008 the maternal mortality rate was just 54 per 100,000 live births.

Between 1980 and 2008, the maternal mortality rate was continuously decreasing. It is only in the past four years that the trend has reversed.

"The number of maternity deaths will increase along with the birthrate in general. But it is wrong to consider these deaths unavoidable," said Dr. Vu Thi Nhung, chairman of the HCMC Obstetrics and Gynecology Association.

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Dr. Nguyen Ngoc Thong, director of the HCMC Maternal Healthcare Center, said there has been an abnormal increase of maternal deaths and that health authorities must investigate every such case and ascertain the causes.

According latest statistics from the Ministry of Health, there were 22 such cases in 11 cities and provinces between April 20 and June 29, killing 18 mothers and some of their newborns, leading to the suspension of several medical workers.

In mid-June, Deputy Prime Minister Nguyen Thien Nhan instructed the health ministry to identify the causes of the recent maternal deaths and to punish all individuals responsible, while reviewing the field of obstetrics within the healthcare system.

Following the instruction, the health ministry submitted a report to the government on July 6, reporting the latest maternal death statistics and committed to take swift and strict measures against violators.

However, Deputy Health Minister Nguyen Viet Tien said in the report the families of many deceased mothers refused to allow autopsies, giving health authorities no choice other than to rely on the conclusions drawn by hospitals and provincial health departments.

Tip of the iceberg

Insiders said the increasing number of maternal deaths is one of several problems endemic to the healthcare sector in Vietnam along with corruption, low quality services and other unethical medical practices.

According to a report released in March by the Hanoi Medical University, less than a third of Vietnamese doctors consider it necessary to inform the patients of mistakes which take place during the course of their examinations and treatment.

Just 30 percent of doctors said they think their patients have the right to be informed of such information, according to a survey of 1,000 doctors in Hanoi, HCMC and Hue released in March by the Hanoi Medical University.

Many patients also said their examinations were exceedingly fast and did not have the chance to ask doctors all of their pertinent questions.

Nguyen Dac Hieu, 62, was recently examined at a Hanoi hospital. When he told the doctor he was suffering from what he thought was high blood pressure and kidney stones, the doctor prescribed a medication instantly without any further questions or examination.

"Soon after returning home, I felt dizzy from high blood pressure. Luckily, it was not a stroke. If the doctor had offered careful tests, I might have not been placed in such a dangerous situation," he said.

According to a recent investigation by Vietweek, many patients the K Hospital in Hanoi routinely pay under-the-table bribes in order to be treated properly.

The reporter witnessed several patients in queue to be examined each place VND10,000 into the pocket of a nurse when it was their turn.

"This is not a large amount of money, but it tarnished the image of medical workers," said a patient from Ha Nam Province, identified only as L.

The hospital's director, Dr. Bui Dieu, admitted to the reality of unofficial payments, saying that hospital leaders are doing their best to limit the situation.

"There should be a two-side view into the issue. In some instance, doctors and nurses may have demanded [extra] money, but patients have also decided to voluntarily award them as a way of saying thank you," he said.

Many patients said they have been allowed to pay higher examination fees in order to jump ahead in line at several hospitals.

Nguyen Thu Ha said a doctor at a hospital in Hanoi told her to have test performed by a private clinic and then pay an extra VND2 million, apart from the official fee of the same amount, to have her surgery within ten days instead of one month.

At the Children's Hospital 2 in Ho Chi Minh City, six-year-old Nguyen Ngoc Van Anh was finally examined recently, after waiting all the morning with many other patients jumping the line because they had paid higher fees.

"This has hurt many poor patients as they know they have to wait just because they are poor," her grandmother said.

Systemic problem

According a recent survey released by the Transparency International Vietnam and the Vietnam Research and Training Center for Community Development, "unofficial payment" for health services in Vietnam became popular around 2000.

Those in the health care industry have continued to receive cash, gifts and other "opportunities," such as the chance to purchase real estate at reduced prices or send their children to elite schools, according to the survey that interviewed 17 policymakers and management officials, 119 doctors, nurses and patients in Hanoi, Son La, Dak Lak and Can Tho.

Huu, a doctor at a public hospital in Ho Chi Minh City, said it would be difficult to eliminate unofficial payments because the problem has become engrained within public health care services.

"A new doctor's monthly salary is only around VND3 million ($144). They can work for private clinics to earn more income, but it's far easier to accept "˜bonuses' from patients," he told Vietweek.

After two years working at a district hospital, he said he and other doctors have recently invested in and worked part-time at a private clinic nearby to improve their meager incomes.

Nguyen Chan Hung, former director of the Tumor Hospital in HCMC, said people should not expect too much from doctors, as working in the healthcare field is far from an ideal job.

Asked what should be done to eliminate the "envelope" problem in health care, he said it would be "difficult because this is a problem endemic to every public sector of society."

"What should be expected in medical sector are truly skilled doctors," he said, adding that paying doctors higher salaries and investing in hospitals is what will benefit patients most.

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