Editor's note: Welcome to the Global Health page. The purpose of this feature is to raise awareness of global health issues with an academic spirit to help improve the quality of care provided to patients. E-mail globalhealthnews@musc.edu.

by Van Tran
First year, College of Graduate Studies
Although the Vietnam War ended more than 30 years ago, many Westerners still visualize the country through a dated lens. As the most severe war in Vietnam, casualties included 3 to 4 million Vietnamese, 1.5 to 2 million Laotians and Cambodians, and 58,159 U.S. soldiers. Weak health care growth was another result of the war, leaving Vietnam medically and technologically behind for decades.
 
The Vietnamese are recognized for being short and thin, with a short life expectancy and a high rate of infant mortality. Following the war, the Vietnamese population expanded rapidly due to traditional habits. Most families tried to produce at least one son in order to maintain the family tree, and having more children was beneficial for labor and income purposes. Unfortunately, this increased population suffered from a destroyed country, ruined economy, extremely poor infrastructure, pollution, and lack of any health care system. Many suffered from extreme malnutrition, weak immunization systems and weakened bodies.
 
Up until the late 1980s, almost half of the population had no access to clean water. A deficiency in clean water supply and sewage systems promoted such infectious diseases as malaria, cholera, dengue fever and typhoid.
 
Inadequate funding led to a shortage of nurses, doctors and hospital services. According to the World Bank, Vietnam had roughly 250,000 hospital beds or 14.8 beds per 10,000 people by the end of the 20th century. Health insurance was provided by the government for students, government employees and retired people; others had the option of buying or not buying insurance. Most couldn’t afford the insurance and many private clinics do not accept any type of insurance to this day.
 
The 21st century economic boom marked an improvement in the health care system when private clinics and health centers opened in urban areas, and people began to earn enough money to cover their health costs. The upper class is seen by private hospitals/doctors, where they get better services; while the lower class visits public clinics.
 
A simple comparison: a regular screening service at the women’s health center in a public hospital may cost around 15,000 Vietnam Dong (about 1 U.S. dollar,) but can range from 50,000 to 100,000 Vietnam Dong at a private hospital in Hanoi, the capital of Vietnam, depending mostly on the reputation of the doctor. Vietnamese citizens requiring emergency care often bribe doctors and nurses for efficient service.
 
A huge demand in health service from a population of 86 million people has made it extremely difficult to improve these services. Most hospitals are outdated; they lack sufficient beds and have old equipment, especially in small towns and rural areas. Those who travel to bigger cities from rural areas often stay there, which results in the poorer regions lacking well-educated professionals.
 
Inadequate funding also has contributed to a poor education system and resulted in a highly illiterate population. According to the United Educational, Scientific and Cultural Organization institute, the current adult literacy rate in Vietnam is 92.5 percent.
 
Vietnam is still recovering from a war that happened more than 30 years ago, and health care remains a prevalent concern for the Vietnamese community.

Vietnam population facts

• Population posted at 85,789,573.000 by April 1, 2009 (13th highest worldwide with the territory equivalent to half of Texas, where population is around 25 million)

• Growing rate 947,000,000 from 1999-2009

• Population estimates at 117 million by 2050

• Handicap estimates at 7 percent of population

• Life expectancy 60.2 (world average 70.2)
  

Clinician’s corner
A 5-year-old boy presents to the emergency department a few days after returning from a trip to Vietnam via ambulance after suffering a prolonged seizure. He has had two to three days of fever, headache, vomiting, and fatigue, and now also has neck stiffness. His parents have noted that his speech has been slurred and he has had some unusual behaviors. On physical exam the child has lethargy, meningeal signs, and a left hemiparesis. He has no rash, but you notice several scattered papules on his extremities that the parents confirm are healing mosquito bites. The most likely diagnosis for this child is:
A) Typhoid fever          
B) Japanese encephalitis
C) Malaria                      
D) Lassa fever

Answer: “B” This child most likely has Japanese encephalitis (JE), a mosquito-borne flaviviral infection. JE is the leading cause of childhood viral encephalitis in Asia. Most cases are asymptomatic but of those that come to medical attention, meningitis or encephalitis is usually present. Symptomatic cases often start as a flu-like illness that can worsen and cause high fever, neck stiffness, brain damage, coma, or death. Younger children are more likely to die and have neurological complications and sequelae. An inactivated JE vaccine was recently approved for use in the U.S. for persons 17 years and older who plan to travel to an endemic area.

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Meet at Riverfront Park Downtown

Global and Tropical Medicine Interest Group talk, “Challenges to the Elimination of Childhood Cataract Blindness in the Developing World.” Oct. 5 at 6 p.m., Storm Eye Institute Auditorium (8th floor)

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Friday, Sept. 25, 2009