Ensuring a higher standard of care during a neurological emergency in Vietnam

While visiting a potential supplier in Vinh, Nghệ An Province, the patient suddenly collapsed and had an epileptic seizure. The patient's Vietnamese hosts arranged for him to be driven to Vinh International Hospital, accompanied by his colleague (also a US citizen). The major challenges in this case included language barriers and varying standards of care available in-country.

Upon notification of this case, Healix's medical team proceeded to take a full account of the emergency from the patient's colleague. We recommended that especially in the early stages, the patient should be accompanied at all times, ideally by someone who spoke both English and Vietnamese. This approach addressed communication difficulties between the patient and the Vietnamese medical staff and ensured that someone had "eyes-on" the patient at all times. This meant that we could keep track of him and be alerted swiftly if there were any changes in his condition.

One of the first priorities was to determine the quality of care available at the treating hospital, as well as other nearby facilities. Our Global Network Team advised that Vinh International Hospital was a small private hospital. Although the facilities at the hospital were clean and offered a superior level of comfort, the hospital was only suitable for treating relatively minor conditions. More complex cases in Vinh would usually be treated at the state-run University Hospital in the city; however, that hospital is under-resourced and over-crowded, offering a standard of care well below Western standards. Better care was available in Hanoi, but that would require a six-hour journey via road ambulance.

In speaking to treating doctors, we learned that the patient had not made a full recovery from his seizure because he remained confused. In addition, the patient noted weakness on his right side. An eye examination revealed signs that the pressure inside the patient's skull might be raised, and there was clear evidence that this patient's symptoms were likely to have a serious underlying cause. It appeared likely that the patient would require specialist treatment beyond the capabilities of the local medical facilities.

Although road transfer to Hanoi was an option, even in Hanoi's leading private hospital medical care is not completely up to Western standards. There was the additional disadvantage because a road transfer would be lengthy. We therefore determined that the best option for this patient was likely an air ambulance evacuation to Bangkok, flying directly from Vinh Airport (just nine minutes away from the patient). Bangkok is home to some of Asia's most advanced private hospitals; we were confident that no matter how challenging the patient's condition turned out to be, appropriate treatment would be available in Bangkok.

Our medical evacuation coordinators contacted the air ambulance providers in Bangkok to obtain options and availability for an air ambulance transfer to Bangkok. Healix uses Bangkok as a regional evacuation centre, so we have a very close working relationship with the local air ambulance operators.

Meanwhile, the patient underwent a CT scan which revealed that the patient had a sizeable brain tumour and there was marked swelling of the brain tissue surrounding the tumour. The CT also confirmed the doctor's clinical suspicion that the pressure inside the skull was high. The Healix doctor and the Vietnamese doctor discussed the case and agreed that the best options for treatment were in Bangkok. While the patient remained clinically stable, there appeared to be an immediate window of opportunity to move the patient safely. The Vietnamese doctor also agreed to start the patient on a course of intravenous steroids to reduce the swelling around the tumour and therefore reduce the pressure inside the skull.

Our medical team called the patient to explain the situation. Although the patient still had mild confusion, he was lucid enough to follow the conversation; it was essential that he was informed of our plans. We then telephoned the patient's colleague to go through some practical details, such as packing a small bag for the patient and ensuring that his passport was available. The air ambulance was then activated, along with ground ambulance transport in Vietnam and Thailand. The patient transfer went smoothly, and the patient was admitted to Bumrungrad Hospital in Bangkok.

After the patient's arrival in Bangkok, Healix's medical team remained in close touch. We deal with this hospital every day, so we have very good lines of communication between our medical team and their doctors. At this point, our focus was no longer on the quality of care, but on ensuring that the treatment given in Thailand was coordinated with the patient's ultimate requirement to return home to the United States. We also spoke frequently to the patient and we kept in touch with his wife in the United States (sharing information with the patient's consent to do so).