Think Appalachia in the United States. Small remote villages, little economic opportunity, scattered resources, and a sense that the people are not part of the rest of the country. That describes mountainous areas in both countries. In Viet Nam, another issue is added: many of the residents in the mountains are not ethnically Vietnamese. They are called “ethnic minorities” by the Kinh people (Vietnamese) and were once called “Montagnards” by American soldiers. They are only a small percentage of the population, yet there are fifty seven identifiably different groups. In the area southwest of Hue live the Katu. That’s where I am as I write this.
If you are Katu and get sick, you go to your village clinic. There is a doctor on duty four days a week and a midwife on duty all the time. The clinic is equipped to provide basic care, but sends patients to the larger district hospital for more serious cases. Normal births are handled at the clinic. After being screened by
the nurse or doctor, you are placed in the “emergency room” for a more complete examination and diagnosis. The family stays right with the patient – notice there are two people in the far bed. One is the sick wife and the other is her husband. As you can see, there are no privacy laws.
The American student nurses paired up with two Vietnamese student nurses and went to work. In one bed was a woman who complained of severe chills and high fever. If you guessed malaria, you are correct. Malaria is not a problem in most places in Viet Nam – only in these remote areas. (If you travel to Viet Nam, you needn’t take antimalarial drugs.) She was sent on to the larger district hospital in Khe Tre.
On the other side of the room was a 77 year old man with a very severe cough. His son
had brought him to the clinic, quite concerned for his father. The nurses prodded and thumped and listened – and even asked if he smoked. Almost all Katu smoke a pipe – even the women. The more experienced Vietnamese doctor took one look and realized the old man had tuberculosis. Though he was sent on to the hospital, I am sure the old man will go home to die with his family around him.
On this day, there were more patients than usual because a government family planning team was visiting the clinic. Viet Nam has a very high birth rate among the poor and the government is trying to lower it. One of the strategies is to have women have an IUD contraceptive device implanted as most men refuse to use a condom. The team brought along a portable sonogram and used it to see if the IUD has been correctly inserted. Notice the pattern on the woman’s pants – it is indicative that she is Katu.
Scabies is a scourge, but controllable. This itchy and uncomfortable skin condition results from tiny
mites that get into the skin. Often, patients are cured, only to go home and sleep in the same bed with other members of the family with scabies – and get reinfected. Dr. Nguyen Thi Anh Phuong passes out medicine to cure the problem after she led an impromptu public health class in the cure and prevention of the disease.
I’ve also been working with some community health efforts and a safe water project. More on those later.