A model for global surgical training and capacity development: the Children's of Alabama-Viet Nam pediatric neurosurgery partnership.

INTRODUCTION: Training capable and competent neurosurgeons to work in underserved regions of the world is an essential component of building global neurosurgical capacity. One strategy for achieving this goal is establishing longitudinal partnerships between institutions in low- and middle-income countries (LMICs) and their counterparts in high-income countries (HICs) utilizing a multi-component model. We describe the initial experience of the Children's of Alabama (COA) Global Surgery Program partnership with multiple Vietnamese neurosurgical centers. METHODS: The training model developed by the COA Global Surgery Program utilizes three complementary and interdependent methods to expand neurosurgical capacity: in-country training, out-of-country training, and ongoing support and mentorship. Multiple Vietnamese hospital systems have participated in the partnership, including three hospitals in Hanoi and one hospital in Ho Chi Minh City. RESULTS: During the 7 years of the partnership, the COA and Viet Nam teams have collaborated on expanding pediatric neurosurgical care in numerous areas of clinical need including five subspecialized areas of pediatric neurosurgery: cerebrovascular, epilepsy, neuroendoscopy for hydrocephalus management, craniofacial, and neuro-oncology. CONCLUSION: Long-term partnerships between academic departments in LMICs and HICs focused on education and training are playing an increasingly important role in scaling up global surgical capacity. We believe that our multi-faceted approach consisting of in-country targeted hands-on training, out-of-country fellowship training at the mentor institution, and ongoing mentorship using telecollaboration and Internet-based tools is a viable and generalizable model for enhancing surgical capacity globally.

Heavy metals and polycyclic aromatic hydrocarbons in municipal sewage sludge from a river in highly urbanized metropolitan area in Hanoi, Vietnam: levels, accumulation pattern and assessment of land application.

Concentrations of heavy metals and polycyclic aromatic hydrocarbons (PAHs) in sludge from Kim Nguu River, Hanoi, Vietnam, were analyzed to understand the contamination levels, distribution and accumulation pattern of municipal sludge from a highly urbanized area that receive direct discharge of wastewater. High concentrations of heavy metals such as As, Cd, Pb, Cu and Zn were observed in sludge, which were exceeded the Vietnamese regulation threshold values. In general, contamination status of heavy metals in sludge was in the similar range or slightly lower than those previously reported in sludge from the same area. The mean concentrations of As, Cd, Cr, Cu, Ni, Pb and Zn were 24.3, 2.65, 105, 166, 60.8, 73.7 and 569 mg/kg dry wt., respectively. Our result also indicates increased levels of PAHs, which are among the first data on PAHs accumulation in municipal sludge from metropolitan area in Vietnam. PAH concentrations ranged from 218 to 751 mg/kg dry wt. (mean: 456 mg/kg dry wt.), which were greater than those reported in sewage sludge from other countries as well as in sediments and soils collected from the same area. Accumulation pattern revealed the predominant of higher-ringed PAH compounds. Indicator ratios suggest the sources of PAHs were probably derived from biomass (wood and coal) and fossil fuel combustion and petroleum emissions. Most of the sludge samples contain PAHs concentrations exceeding various international guidelines values for sludge and sediment, such as probable effect levels, suggesting the possible risk for adverse biological effects in the study area and in the landfill sites where dredged sludge was dumped.