completed Long Term IFCC Fellowship/Professional Scientific
Exchange Programme Scheme
From: Nguyen Thi Muoi
Duration: April 1999 - June 1999
Occupation: Medical doctor, Biochemistry doctor.
Address: Biochemistry Laboratory.
Department of Biochemistry - Hematology- Blood bank.
Viet nam- Sweden Uong bi General Hospital.
Uong bi Township, Quang ninh Province, SR Viet nam.
Tel: + 84 338 54038
Fax: + 84 338 54190
E-mail : email@example.com
Supervisors (Visited institutions: University Hospital
Umea, Boden Hospital, Pitea Hospital, Gallivare Hospital,
The Vietnam-Sweden General Hospital
is a central regional hospital. It is under direction of the
Ministry of Health of Viet nam. The hospital is located at Uong bi
town-ship, Quang ninh province, in the North - East of the North of
Viet nam. The population in the catchment area is about 1,5 million
The hospital was built with Swedish
support 1980 and has been supported since by Sida -Swedish
international development authority for nearly 20 years.
Number of beds : 400.
- Diagnosis and treatment of the patients.
- Primary Health Care for the people in the commune.
- The UBGH is a Teaching Hospital and belongs to the Hanoi
- Support the " lower" hospitals in the catchment area.
In the beginning when the Hospital
started to operate, the Biochemistry Laboratory was equipped with a
system of rather sophisticated equipment compared with other
Hospitals in the North of Viet nam. All chemicals and reagents were
bought from abroad. After nearly 20 years, most of the machines are
outdated or not in good working conditions, but we were replenished
by some new equipment to replace the old ones and with the last
budget from Sida we has just bought some new modern equipment. So,
this Laboratory has provided good services for diagnosis and
treatment for the patients and also for other activities.
I was sent to study in Sweden by
scholarship from IFCC, with the aim to improve the laboratory
activities of the hospitals, especially important were methods for
diagnostic, follow up therapy for the patients and research.
Additional with closely friendship with Clinical chemistry in
Sweden via Piteé-Uong bi Association.
during the stay in Sweden
- University hospital of Umeå.
- Boden hospital, Pitea hospital and Gûllivare hospital.
- Primary health care centers in Piteé.
- From April 4, 1999 to June 24,1999.
Aims for the
- To study procedures and laboratory technique of biochemistry in
the areas of:
- Lipoprotein, Protein Electrophoresis.
- Tumor markers.
- Tests for diabetes Mellitus and Myocardial infarction
- To study and collect new information about screening programs
for Cardio-Vascular Disease and Diabetes Mellitus.
- To study the organisation of utilising laboratory resources
within the health care system.
I have successfully completed my
education in the following areas:
- Biochemistry Laboratory technique:
- Routine dailly test:
- Training on Laboratory technique of Myocardial infarction
makers : CK, CK-B, LD, AST.
- Training tests
- Which are beside my intended programme, frequently used in
Sweden but not in our hospital e. g CRP( C- reactive protein),
Cerebro Spinal Fluid examinations with spectrophotometer.
- Study on HbA1c with DCA 2000- dry- immuno- method.
- Study the technique with the HPLC method.
- Discussion about possible method to use in our laboratory
- Protein electrophoresis:
- With protein electrophoresis I was trained to improve the skill
of interpretation for the plasma and urine,CSF protein
electrophoresis pattern to help clinicians. Discussion about some
essential tests needed to assist interpretation of such as: CRP,
alpha 1- antitrypsin, haptoglobin, globulin.
- About the technique:
- Study of the latest techniques to qualitatively determine
protein and urine electrophoresis, determine specific protein by
using immunofixation with specific antibodies (Sebia).
- How to concentrate urine sample for urine protein
- Discussion on how to improve protein electrophoresis with an
immunogical method, how to set up Mancini method as below: how to
immunised scheme to get anti serum for Mancini method in our
- Lipoprotein electrophoresis and lipids disorder
- Discussion about lipoprotein electrophoresis and tests for
lipid disorder. The value of these tests to evaluate the disorder
- Study about the technique of lipoprotein electrophoresis with
- Tumor markers
- Discussion on the value of tumor markers in diagnosis and
monitoring the effect of therapy. The ability to set up some tumor
markers such as: AFP, HCG, CEA, with ELISA technique.
- Discussion about ability to use AFP to follow up the high risk
group (HBSAg positive ) and follow up therapy of liver cancer.
- Study about principal of some tumor markers and Hormone markers
(TSH, free T4, Insulin) with Ax system from Abbott
- On Screening and Follow up of high risk factors of Cardio-
Vascular- Disease and Diabetes Mellitus:
- Collecting documents on screening high risk factors on CVD and
Diabetes Mellitus( DM).
- Discussion about Screening and follow up Diabetes Mellitus:
which tests are needed for screening and follow for DM, screening
program, the tests and clinical symtom which are needed for
differientiate DM type 1 and type 2.
- Attending the day working of the MONICA team for MONICA-
international - health - project, that happened to have a data
collection. (MONICA: Multinational Monitoring of Trends and
Determinants in Cardiovascular Disease.)
- Observe the activities from the beginning to the end of
examination for the participants with proposal that have reliable
data for making correct diagnosis.
- Discussion about the laboratory tests, which are needed for the
- Training on measuring blood pressure( with HAWKSLEY RANDOM
zErO), body height, body weight, waist circumference, hip
circumference and collecting the blood sample for lab
- Discussion about making questionnaires for proper data
- Observe and discuss about the activities as below:
- Collecting samples from "lower level hospitals", and primary
health care centres
- Sending samples to other "upper level hospitals"
- Gather information about safe transport of laboratory samples
for reliable analysis. Local organisation of sample handling
between primary health care and the local hospital
- Discussion about practical details when planning transportation
routines of medical samples.
activities of laboratories in Vietnam:
There are several differences
between laboratories in hospitals in Sweden and our
- In Sweden almost all equipment are automatic machines, while in
Viet nam some Labs in provincial or central hospitals have such
equipment, whereas other hospitals, especially district hospitals,
are not equipped with automatic machines. In our province, the
district hospitals can't even buy the reagents for biochemistry
- In Sweden all activities in the Labs are computerised, ours are
- Swedish labs in an geographical area unite together to utilise
the personnel, their knowledge and skills and the equipment to do
labs tests for their hospitals and for primary health care. But in
Viet nam, we often use our equipment for only our own hospital,
while other nearby hospitals, less equipped, might not benefit from
the knowledge and equipment that is available. So now I think we
use our equipment less effectively, and we should use our equipment
( please see in proposal 1).
setting up some new tests in biochemistry laboratory in Uong bi
In the Biochemistry laboratory, we
have two medical Doctors work as biochemistry Doctor, 2
biochemistry Technicians, and 4 general Nurses who have worked as
biochemistry technicians for some time. We could be able to set up
and cover main routine ordinary chemical tests with new automatic
machine and other equipment which we have got already.
Useful for several cases,
especially for detection of the M- component. Anyhow, the equipment
was installed nearly 20 years ago without proper manuals for
reading and interpreting the results. We also have problem with
power supply .I have presented this problem for Prof. Kjell
Grankvist in Ume�. He promise that he will help to look for
equipment and send to me soon. So with old equipment we can improve
the analysis, using protein electrophoresis. But to assist for
interpreting we should set up some special protein tests.
Lipoprotein and Hb electrophoresis
are two lab tests is addressed to be a subject for further
HbA1c is a useful
test for following up diabetes mellitus.
We can not do this test with our
existing equipment. I also discussed with Swedish colleagues about
the methods for this test. With HPLC method or other immuno-
methods it is impossible now because we have limited economical
resources. With DCA 2000- dry immuno-method, the technique is not
complicated, it is convenience for us in our status now, but the
reagent is rather expensive. It is recommended that Hb
electrophoresis is used to determine HbA1c: so if it will be
possible I will try to determine HbA1c using Hb electrophoresis. We
will use the old equipment for electrophoresis, although I don't
think it is the best solution.
we have a system for ELISA
technique. We can set up some necessary markers such as: AFP, PSA,
CEA, beta- HCG and some hormones: TSH, free T4 with these
equipment, but now the prize will be high.
Diabetes mellitus and heart attacks
are not as common in Viet nam yet, as these conditions are in
developed countries, Stroke, on the other hand, is common. But the
incidence of diabetes mellitus is increasing and patients often
come to see the doctor with obvious signs and symptoms, often very
late. An early diagnosis will reduce the cost of treatment and will
enhance the opportunities to control glucose metabolism, thus it
will reduce the risk that every person with diabetes has, to
develop complications. Unfortunately, we have a long way to go, as
we do not yet have any relevant figures of the incidence and
prevalence of diabetes in the Vietnamese community. More research
is also needed on how to use blood glucose test in order to make
Screening for diabetes appear to be
an important area for research. I think that it is useful for
health care, especially for primary health care in Viet nam.
Also with high risk factors on
The problems are: We have a very
limited budget and limited experience in doing research in a
Our existing budget should include
scientific research. We need a supervisor to assist us in doing
this research in a scientifically reliable way. Such supervision
should have an aim to make Vietnamese professionals independent
researchers in the future.
About language and
English was used during the study
visit and the education programme. I could manage to communicate
with doctors and staff in Laboratories. And I also lived in Swedish
families. Therefore I had a very good opportunity to improve
professionally, and in using the English language as well as
activities of laboratories of the hospitals:
- Enhance the use of lab tests in the hospitals: including set up
some new tests and discuss with other colleagues some necessary
knowledge on using the laboratory tests.
- Enhance co-operation in the use of laboratory techniques and
professional knowledge and skills with some large hospitals in our
province in order to provide support on laboratory techniques to
district hospitals and primary health care stations within Quang
- An organisational project is suggested as a pilot project,
limited to co-operation in the field of laboratory technique in the
health care system of the province. The aims with such a pilot
project would be to create an organisation that supports an optimum
use of existing equipment and professional knowledge available in
the laboratories of large hospitals and make these facilities and
skills available on all levels in the health care system.
- Screening and follow up of diabetes mellitus.
- Screening and follow up the group of high risk factors on
With purpose to carry out above
proposals I would like to propose IFCC, Piteé- Uong bi -
Association and Laboratories in Sweden to assist in applying for
grants for budgeting further research, supervision inclusive.
The study visit and education
programme were supported by Scientific- Exchange - Programme of
IFCC and Piteé- Uong bi -Association.
I would like to thank Prof. Do Dinh
Ho( president of Biochemistry association of SR Viet nam), Dr
Nguyen Ngoc Ham( director of Uong bi General Hospital) for
I would like to thank Dr Jan
Hultùn, Dr Rolf Johansson, Mrs Terttu Hòggtrøm who have arranged my
schedule and collected a lot of valuable scientific papers.
Special thanks to Prof. Kjell
Grandvist and Dr Kia Kalman for their teaching, documents, books
I would like to thank Dr. Gòran
Brattsand, Dr.Kim Ekblom, Dr. Johan Kumlien, Dr Staffan Wikstròm,
Dr. Brjan Eriksson, Dr. Robert von Essen, Mr. Ove Kastebo and other
doctors, assistants in the laboratories in univesity hospital of
Umeé hospitals in Piteé, Boden, Gùllivare and for all their help,
Dr Kennet Läng, and Dr Peter Mostrøm for their experience on
screening Diabetes mellitus, staff in the MONICA -project team.
Doctors and nurses in Horlax health care centre.
I would also like to thank Jan -
Margareta Hultùn, Britt Westermark, Knut-Terttu Hòggstrøm and other
friends of Piteé- Uong bi association very, very much for giving me
very good life during I visit in Sweden.
Uong bi August 13,1999.
Dr. Nguyen Thi Muoi.
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Chemistry and Laboratory Medicine (IFCC). All rights