KHOA NHI

Tucked away from the main building is the paediatric department (Khoa - ward, Nhi - children) of the hospital, where sick children with different infectious diseases are being looked after. It has a certain different feel to the rest of the wards - with balloons and stickers on the wall, a room for parents/carers to rest in, and two rather vivaciously decorated wards for inpatients (with strings of origami cranes hanging by a young girl's bed, small desks for children to do their homework, always full of sounds of chattering, or the occasional lull when people doze off after lunch). Though nothing here is mere small matter - children are often referred here because they have contracted a serious infection, mostly from the countryside through close contact with animals, mosquito or water.

The range of differential diagnoses expands by manifolds. A parotid swelling - is in fact an abscess caused by Burkholderia pseudomallei which is found in paddy fields and still water (Could the young boy have caught it through swimming since he has otitis prior to having the abscess? - No, the bacteria is not found in running water - we had some interesting time trying to get the whole story from the father who is a farmer, with too many questions and answers lost in translation). Meningitis - here the major causative organism is in fact Streptococcus suis (as opposed to Streptococcus pneumoniae or Neisseria meningitdis in the UK) transmitted from pigs to human, and of course, one must not forget TB. A non-specific rash in children with fever - the probability of dengue is high when it is July to December each year.

In the past few weeks I have been going to see this 11-year-old girl elsewhere - who has Japanese encephalitis (JE) and is supported (fluids, feeding, ventilation - there is no specific treatment for the disease) in ITU. She lies there between two equally ill adults, quietly battling while drifting in and out of consciousness. The young ITU doctor explained to me how to differentiate between herpes encephalitis and JE (the former often affects the temporal while the latter affects the limbic region, as seen in MRI imaging; we had to hold the film up to the window in order to see more clearly. Things are mostly analogue here) - and also the range of possible outcomes. He has seen children fully recovered and going to back to school after a month, but there are more who will have long-term cognitive impairment.

Currently, there is a vaccination programme for JE in northern Vietnam when children are 1-5 years old but only in high-risk areas. With JE virus still widespread among swines, it is unlikely to be fully eradicated and unvaccinated children are still largely at risk of this debilitating disease.

*

Further reading | Effectiveness of the Viet Nam Produced, Mouse Brain-Derived, Inactivated Japanese Encephalitis Vaccine in Northern Viet Nam (PLOS Neglected Tropical Diseases)

Immunisation schedule in Vietnam