May 29, 2012
By David Martin
|Carl Weiner, M.D., trained medical educators in Vietnam in an effort to lower the country's maternal mortality rate.|
Carl Weiner, M.D., was grateful for the arrival of daylight savings time. It allowed him to catch an extra hour of sleep on the days he sat in front of a high-definition web camera and taught an obstetrics course to medical students and physicians in Vietnam. When clocks ran on standard time, Weiner began the lecture at 5 a.m.
Weiner, the K.E. Krantz professor and chair of the department of obstetrics and gynecology, recently finished his second semester as a U.S. Faculty Scholar. He was one of six American professors working with faculty and students at Vietnamese universities. The program is sponsored by the Vietnam Education Foundation, an agency created by the U.S. Congress to improve science, education and health in the Southeast Asian country.
In addition to his weekly videoconferences, Weiner committed to making two trips to Vietnam. Last September, he traveled to the medical college in Hue, a city a few miles inland from the South China Sea. Weiner gave more than a dozen talks while he was there, devoting much of his attention to ultrasound technology. The hospital, Weiner says, had obtained its first portable ultrasound machine just a few months before his arrival.
Vietnam is a poor country. It also has a maternal mortality rate almost three times greater than the rate in the United States. The lifetime risk of a woman dying during childbirth in Vietnam is 1 in 850, compared with 1 in 2,100 in the U.S. Weiner worked to create an infrastructure so that the medical school can provide on-the-ground training that will reduce the risk of maternal death and disease while improving pregnancy outcomes.
Weiner says women in Vietnam die during and after pregnancy for the same reasons women die in industrialized countries. The deaths are just more common, especially in rural areas, where most of the population is based. “We have women who will hemorrhage here in the hospital that we have trouble keeping up with, they’re bleeding so fast,” Weiner says. “Can you imagine if that happened in a small village?”
In the cities, Weiner saw first-hand that the best research evidence is not always incorporated into the clinical experience.
One day when he was at the hospital in Hue, Weiner looked at the “board,” a summary of what was happening with a woman who was in pre-term labor. His eyes paused on the name of a drug that he didn’t recognize. Weiner, who writes a book on drugs and pregnancy, asked about the medication. He was told it stopped contractions and had been in use for 20 or 30 years.
That evening in his room, Weiner, still puzzled, searched for the drug on the Internet. He found two reports: one in Russian, the other from the drug’s manufacturer in India. The drug, he learned, was supposed to hasten labor. “The good news is, it probably didn’t work for that either,” Weiner says.
In any case, the hospital has stopped dispensing the drug.
Addressing obstetrical emergencies
Weiner recently returned from his second scheduled trip to Hue University of Medicine and Pharmacy. While there, he worked to establish a simulation training course for obstetrical emergencies.
Five years ago, Weiner took a safety program developed in the United Kingdom and tailored it for use in this country. The course, PROMPT, short for Practical Obstetric Multi-Professional Training, puts doctors and nurses through joint exercises in an effort to prepare them for birth complications. PROMPT has helped The University of Kansas Hospital cut its rate of cesarean sections by 25 percent and the injury rate for babies by 50 percent.
The training helps doctors and nurses stay sharp. “It’s very easy to get lulled into thinking, ‘Everything’s going to be OK. After all, taxi cab drivers can deliver babies,’” Weiner says. “But then you miss those warning signs of impending disaster.”
Weiner took PROMPT to Vietnam. He trained trainers and then put on the two-day course for faculty, students and nurses. “The goal being that when I leave, they will continue to acculturate it, make it appropriate for Vietnam and then begin to roll it out nationally,” he says.
Weiner is accustomed to lecturing abroad. He’s made more than 100 presentations in 24 countries. He believes strongly that universities should cultivate an international reputation. For one thing, world standing helps recruit graduate and undergraduate students. “It’s not the average student who finds a way to leave a small city in Vietnam or India or China or Thailand and come to the United States to study,” he says. “It is the most motivated, ambitious of the group.”
International contacts create opportunities for homegrown students, as well. Before his most recent trip, Weiner looked forward to visiting a hospital in Hanoi that supposedly delivers more than 30,000 babies a year. “Our students could go and see more deliveries there in five days than they will see in most of their career,” he says.