IHP Health and Community: Globalization, Culture, and Care (Spring 2)
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Spring 2011 Letters
Vietnam Letter Home
Written by Trustees Fellow Siobhan Brewer with contributions from HC students Carl Bellin, Coline Ludwig, Jeremy Levenson, Anna McKinsey, Mike O’Leary and Graham Sager-Gellerman
A mix of old and new, our fair Hanoi,
Smoggy and dirty and the traffic-- Oh boy!
Don't bother to look when crossing the street
Just pray that you won't be turned to lunch meat.
In this market-oriented socialist economy we're in
You'll see a real mix-up of communist sin
But the socialist-oriented market economy instead
You'll see the distinction is all in your head!
Doi Moi and globalization have hit this land fast
As all push for the top to avoid being last
For the rich and the poor live differently
The urban and rural, so different you see.
But still one thing makes this country one,
Every mother-- every mom-- just wants a son
So when I look back this last month here
And think how to describe a city so dear
I think of the street sellers and motorbikes
Chinese influence meets the Western likes
All here in our one little Hanoi
The one we now leave, oh Hanoi, oh Boy!
~Mike O’Leary, Harvard College
After a grueling flight halfway around the world, we arrived at the Ha Noi Airport in Viet Nam. Greeted by our country team, Nguyen Vu and Than Ha, we grabbed our bags and our disheveled selves and headed for our bus. The heather grey sky, a mix of fog and pollution, welcomed us upon arrival, and stayed close by our side for the rest of our visit. Our drive from the airport to the “Old Quarter” was our initial introduction to Viet Nam: surviving the street traffic. Although traveling in a large bus, we were not protected from the chaos of motorbikes swerving in and out of road lanes, honking as they came from behind or directly at us, seemingly without order or regard. Subsequently, we’d come to realize that underneath the haphazardness of driving there laid a foundation of shared “street culture”, a common understanding that allowed the city to function and move forward. In some respects, this became a metaphor for understanding Viet Nam as a developing country, the concomitant influx of globalization and loss of local efficient enough for the people.
Before coming to this country, most of us knew of Viet Nam solely as the name of an American war. We had learned about the war briefly in our history classes or through stories recounted by family members or as contentious comparisons to the present occupations of Afghanistan (and Iraq), but not much beyond that in terms of the history, culture, and the present day situation. The majority of our time was spent in the city of Ha Noi, in northern Viet Nam. Ha Noi has long been a city fought after, and a symbol of the resilience of the Vietnamese people. Navigating the busy streets of the capital, however, it’s easy to forget the Country’s exhausting history of war and resistance to colonial occupation by the Chinese, French, and Americans. Except for the images of “Uncle Ho”. From public buildings to framed photographs in family homes, the face of Ho Chi Minh is everywhere. The former leader of the communist party and Viet Nam, is a symbol of the struggle the Vietnamese have gone through as well as a reminder of the values, morals, and principles for which the people live by.
Once we had settled in and worked off some of our jetlag, we were met by Lady Borton, a guest lecturer and friend of one of our faculty members. We had all read Borton’s book, After Sorrow: An American among the Vietnamese, on the plane ride over, so we knew a bit about her unique life story. Her contribution to our experience and understanding in Viet Nam, however, turned out to be more valuable than we had expected. Not only did she provide us with helpful tips for crossing the street and vacation ideas, but more importantly, she offered us an honest perspective of a country she loved deeply but had witnessed change before her eyes. Borton was the first American to come to Viet Nam after the end of the American war. In 1986, Viet Nam adopted a policy of renovation known as “Doi Moi” which promoted participation in the free market economy, more personal freedom, and an openness to the world. Doi Moi turned Viet Nam into an open, “socialist-oriented market economy” where the state plays an important role in the economy, but private companies manage and influence commodity production. This idea was somewhat puzzling to us, although we realized that most of our trip items, from our Northface backpacks to our Canon cameras, could be found on the streets of Ha Noi.
Through Doi Moi Viet Nam was quickly thrown into the modern economic market and into the throws of development and globalization. This has brought overall improvement in terms of quality of life for all Vietnamese, but with development has come a greater and growing disparity between the rich and poor, unequal access to health and educational services, insufficient infrastructure, and large scale environmental problems of air, water, and waste pollution. Similar to the situation we found in Brazil, development has led to the double burden of diseases, with non-communicable diseases increasing while communicable diseases remain. But unlike Brazil, access to subsidized health care is not universal. Providing us with an overview of the system, Dr. Tien from the Ministry of Health, explained that free access is provided for vulnerable groups only, these being children, the elderly, revolutionaries (or veterans), victims of dioxin, and those at a specific level of poverty. The government spends little on health care, which seems to go against our notion of what a “communist” state generally provides for its people. Over 50% of the country is forced to pay high out of pocket sums to access curative care as many are not covered by private insurance. As Viet Nam develops into a middle income country, Dr. Tien explained, a percentage of the health care funding from foreign aid will be lost. In order to address these funding issues, the government is proposing a requirement that all non-covered Vietnamese buy health insurance by 2014. To us, it seems as though Viet Nam is taking its cues from the US health care system.
Most of the country, nearly 70%, still remains outside of the urban centers of Ha Noi and Ho Chi Minh City. Traditionally, the Vietnamese are farmers who have survived many hardships on the cultivation of rice, a food that takes a lot of work to produce and provides generally little nutritional value. This staple crop, however, has helped the country through difficult times, and is currently one of Viet Nam’s largest exports. Taking a break from the city, we took a three day trip to the rural village of Mai Chau, in the Lak province. Mai Chau is actually a more “developed” village in terms of rural communities, as it has been set up to accommodate tourists who want to spend a night experiencing the traditional life of the ethnic minority communities. During our visit, however, we were confronted by the economic challenges and difficulties of providing quality health access and care to rural mountainous areas. These regions face geographical barriers to emergency care, as well as a shortage of skilled personnel, adequate equipment and supplies, and high rates of maternal mortality due to inadequate reproductive health services. To address these challenges, 87% of rural villages have health workers who provide health education to the community members. A group of us were able to visit elders living in one of the poorer neighboring villages, led by one of the health workers who goes from house to house every several months to a year to check on the community members.
Back in the city, we observed the combination of tradition and modernity. All around the country you can find temples or pagodas where families come to honor their ancestors. Many Vietnamese are deeply spiritual and pay respect to their ancestors through rituals, altars, and prayer. Families are close knit, with many of our homestay families being comprised of 3 generations under one roof. Traditions are often passed from grandparent to grandchild, especially when it comes to gender roles. Within our homestays, we witnessed how gender informs the behavior of our family members.
In class, we were able to learn about the present health challenges facing men and women. To our surprise, nearly 50% of men smoke while less than 2% of women do. Within the country, abortions are legal, although the responsibility to provide sex education and family planning remains a ping pong game between the school system and the family. Sex preference for babies is common, with families desiring boys over girls. And since 1990, the rate of STIs and HIV have increased steadily. Over the last 7 years, however, Viet Nam has taken steps to promote prevention and treatment through education. With the help of PEPFAR, these programs are able to provide training, supplies, equipment and ARVs to the people.
One of the most interesting experiences we had came from a site visit to the Hospital for Traditional Medicine. Here we were able to see how medical pluralism allows the population to use both traditional and modern medicine in a coordinated way. During this visit, and supported by discussions in our Health, Culture and Community class, we learned how each type of medicine is aware of the other and how procedures, remedies, and therapies can enhance each other. For many, especially those of the elderly population, traditional medicine is valued and used regularly. During case study interviews, one woman expressed to the Elderly and Aging group that she prefers using Traditional and Modern Medicine because they “both are drinkable”.
Being from American Institutions, we were surprised by the warm reception from our host parents and from the Country overall. Many of us assumed that the “American War” had left a bitter taste in the mouths of the Vietnamese and that we would encounter aggression and negativity from the people. However we found the people to be extremely friendly, cordial, and eager to talk with us. Doi Moi and globalization have brought American culture to the people of Viet Nam, and many from the younger generations are eager to embrace this through music, food, television and fashion. Governmental relations between the US and Viet Nam are strong as a result of foreign aid and economic markets. To us it seemed that however recent the war, it remained something distant and removed from the minds and daily experiences of the people. One afternoon after we’d been in Viet Nam for a week or so, we were visited by Ms. Tran Thi Tuyet Hanh, an Environmental Health professor at the Ha Noi School of Public Health. She talked to us about the most painful reminder and remainder of the war: the effects of Agent Orange.
During the 9 years of war, 80 million liters of Agent Orange, an American made defoliant, was sprayed across several regions of the country, with some parts experiencing repeated series of spraying. Once sprayed, the lush vegetation of the country-side died almost immediately, and the dioxin seeped into the soil making it difficult for plant regeneration. Adversely, the dioxin entered the blood stream of the people living among the forest, either directly by being sprayed or indirectly through consumption of produce coming from the sprayed area. The affects of Agent Orange are present to this day. Three generations or so after the end of spraying in 1971, civilians living in those sprayed areas continue to have negative health effects as a result of the dioxin. Most significant is the effect on children, who are born with severe birth defects. These children are unable to care for themselves and depend entirely on the love and support of their parents and grandparents. Because the areas that were sprayed heavily tend to be rural communities, access to basic health services along with decent paying jobs is difficult. Currently, there are 28 “hotspots” in the country where the presence of Agent Orange pollution (i.e. in water and soil) is most severe. 90% of the dioxin in the body comes from consumption of food, and although scientist have been doing research, the Government, both Vietnamese and American, have not done much to address the current issues.
After the lecture, we were able to watch two documentaries that followed families affected by Agent Orange, one of a Vietnamese veteran and his family, the other of an American vet. Although painful to watch, the films deeply moved us. These films exposed the resilience and love among and within these families affected by Agent Orange. As American citizens we felt responsible for this tragedy and powerless to help the problem. Reflecting on this, Richmond University student Graham Sager-Gellerman says, “I have learned things about the actions of our country which has been very difficult to deal with -- namely, the country's actions in the Viet Nam war, and their seemingly generationally genocidal actions in the mass usage of Agent Orange. I am trying to come to terms with how our government could have ever approved the use of something so deathly, so harmful -- or rather, if they truly did not know the long-lasting effects of Agent Orange at the time, how could they have ever approved its use? On civilians? These realities are tough to come to terms with, but I have come to think that it is important to think about them, and to try to learn something from them.”
Although the US government and aid foundations have promised monetary compensation to fund projects that help victims, provide rehabilitation, and treatment, more must be done to clean up the “hot spot” sites and provide prevention education. For us students, this is yet another example of how this experience will really impact the work we do in the future. Thinking back to our time in DC, we have the tools of advocacy and lobbying and can bring attention to this issue and encourage the US government and aid foundations to support Viet Nam in research, program development, and health care assistance in order to one day end the pain that Agent Orange has caused this nation.
After living in Viet Nam for 5 weeks, we can’t and won’t forget this special experience we’ve had. We’ll carry it in our hearts as we move to our next country and on to our home lands.
Next stop: The Rainbow Nation, South Africa.
Duration: Spring, 16 weeks
United States, Vietnam, South Africa, Brazil
Prerequisites: None. Coursework in public health, anthropology, biology, or related field recommended. Learn More...
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