New technology and a collaboration between University of Alabama (UAB) pediatric neurosurgeons and the Global Surgery Program at Children’s of Alabama and their partners in Hanoi, Vietnam, have created a unique arrangement to connect surgeons and patients in Vietnam and Alabama, erasing a distance of more than 8,000 miles.
“We began a relationship with Vietnamese physicians in 2013 when Dr. Brandon Rocque visited Ho Chi Minh City with Dr. Jerry Oakes, chief of pediatric neurosurgery at Children’s,” Dr. James M. Johnston Jr., MD, assistant professor of neurosurgery and director of the Global Surgery Program, said in a press release.
“Based on our experiences there, we were asked to provide some of our expertise in total management in epilepsy to the neurosurgeons in Vietnam.”
As part of the collaboration focusing on improving epilepsy care, the Division of Pediatric Neurosurgery in the Department of Neurosurgery at UAB hosted two Vietnamese physicians this summer as visiting fellows in the Children’s Global Surgery Program.
“Because of visits by Rocque, Oakes, and myself to Vietnam, we knew that the surgeons were highly skilled,” Johnston said. “We thought we might be able to be of service in providing ongoing education and, most importantly, by helping to create standardized management protocols for complex surgical diseases which would promote efficiency and efficacy.”
According to Johnston, the Global Surgery Program was established with the aim to facilitate and coordinate the development of comprehensive, multidisciplinary programs to make the most of the expertise and experience of both countries’ neurosurgeons.
“The goal is to help them build more advanced programs to expand and enhance their therapy options for sick children in their countries,” he said.
Rocque said Dr. Dang Tuan and Dr. Nguyen Lien are working on setting up a program in Vietnam that includes understanding which cases have the best prognosis for operation and which would be better treated medically.
“We’re working with them to set up their own EMU — epilepsy monitoring unit — modeled on ours at UAB. Seeing firsthand how one works was of tremendous benefit to them,” Rocque said.
Lien said that “the two months spent at UAB were invaluable for us. The opportunities to learn at the side of our American colleagues will allow us to set up similar systems in Vietnam which will improve our effectiveness and efficiency, ultimately allowing us to provide better care to more patients in the years to come.”
The Global Surgery Program also includes a valuable player in the collaboration, the high-tech telemedicine tool called VIPAAR – Virtual Interactive Presence in Augmented Reality – a piece of technology that uses standard iPads and the internet to stream real-time images with the possibility of interaction between remote locations.
The technology is now being marketed as Help Lightning and was first developed at UAB under the leadership of neurosurgeon Bart Guthrie starting in 2003.
“I can interact from my home in Birmingham with surgeons in Vietnam during the actual surgery,” Johnston said. “It’s as if I’m in the OR with them, providing another opportunity for consultation, training and interaction.”
Johnston, who has mentored Vietnamese colleagues more than 25 times, anticipates expanding the use of VIPAAR in coming months due to the Global Surgery Program.
“VIPAAR is a great way to train fellows and residents from both countries,” Rocque said. “They can benefit from seeing our techniques, procedures and best practices, while their volume and complexity of cases provides great insight to our trainees.”
Researchers Johnston and Rocque have published an article about their VIPAAR experience in Vietnam titled “Virtual Interactive Presence in Global Surgical Education: International Collaboration Through Augmented Reality” in World Neurosurgery.
The Global Surgery Program is expected to continue to fund visits to Vietnam and bring Vietnamese physicians to UAB for summer fellowships.
Epilepsy is not uncommon in Vietnam, but a limited number of pediatric neurosurgeons place a challenge on the medical system. Alabama has a population of 4.5 million people and five pediatric neurosurgeons. The northern district of Vietnam, around Hanoi, has four pediatric neurosurgeons but a population surpassing 50 million.
The technology is now being installed across the CURE Hydrocephalus International network in sub-Saharan Africa and Bangladesh and the Children’s Global Surgery Program is set to continue building strong reciprocal collaborations worldwide, with visiting fellows from countries like Ghana, Angola, and Kenya.