GIA LAI PROVINCE HEALTHCARE: LEPROSY AND HIV/AIDS

UNCLAS SECTION 01 OF 02 HO CHI MINH CITY 000055 SIPDIS DEPARTMENT FOR EAP/BCLTV AND EAP/PD/MSPEER DEPARTMENT ALSO FOR PRM DEPRTMENT PASS TO DHHS OIRH FOR ABHAT CDC ATLANTA FOR SBLOUNT E.O. 12958: N/A TAGS: SOCI KHIV PREF VM HIV AIDS SUBJECT: GIA LAI PROVINCE HEALTHCARE: LEPROSY AND HIV/AIDS REF: (98) HANOI 3067 UNCLASSIFIED PAGE 02 HO CHI 00055 01 OF 02 220631Z ¶1. SUMMARY: IN A DECEMBER MEETING, THE DIRECTOR OF THE GIA LAI PROVINCIAL DEPARTMENT OF HEALTH CALLED LEPROSY HIS MAIN PUBLIC HEALTH CONCERN. HE ALSO DISCUSSED OTHER HEALTH PROBLEMS, INCLUDING HIV/AIDS, AND AMBITIOUS PLANS TO IMPROVE THE STAFFING/FACILITIES OF THE PROVINCE'S HEALTHCARE SYSTEM. THIS CABLE WAS CLEARED WITH OUR CDC REP IN HANOI. END SUMMARY. LEPROSY: PROGRESS, BUT ERADICATION STILL OUT OF REACH -------------- -------------- ¶2. VIETNAM HAS MADE SIGNIFICANT PROGRESS IN BATTLING LEPROSY (HANSEN'S DISEASE),REDUCING THE ANNUAL RATE OF NEW CASES FROM 0.64 PER 10,000 PERSONS IN 1996 TO 0.23 NEW CASES PER 10,000 PERSONS IN 2000. THROUGHOUT THE LATE 1990S, THE CENTRAL HIGHLANDS PROVINCES OF KON TUM, GIA LAI AND DAK LAK STILL PURSUED THEIR GOAL OF ERADICATING LEPROSY BY THE YEAR 2000 (SEE REFTEL). THAT GOAL WAS NOT ACHIEVED, BUT PROVINCIAL LEADERS' ADVOCACY HELPED LAUNCH A CENTRAL GOVERNMENT CAMPAIGN TO ERADICATE LEPROSY NATIONWIDE BY THE YEAR 2010. ¶3. THE INCIDENCE OF LEPROSY IS HIGHEST IN THE CENTRAL HIGHLANDS AND THE REMOTE NORTHERN MOUNTAINOUS AREAS, WHERE IT DISPROPORTIONATELY AFFLICTS VIETNAM'S ETHNIC MINORITY GROUPS. ABOUT 1000 OF VIETNAM'S 13,000 PATIENTS WITH ACTIVE LEPROSY RESIDE IN GIA LAI PROVINCE. IN A MEETING ON DECEMBER 13, DR. MANG DUNG, THE DIRECTOR OF THE GIA LAI PROVINCIAL DEPARTMENT OF HEALTH, TOLD CONGENOFFS THAT THE PROVINCE HAD REPORTED 50 NEW CASES OF THE DISEASE IN 2000, COMPARED WITH 471 UNCLASSIFIED PAGE 03 HO CHI 00055 01 OF 02 220631Z NEW CASES IN 1994. DR. DUNG ATTRIBUTED THE REDUCTION IN LEPROSY TO CENTRAL AND LOCAL GOVERNMENT PROGRAMS TO EDUCATE VULNERABLE COMMUNITIES IN PROPER HYGIENE AND CARE OF LEPROSY PATIENTS. THE PROVINCE HAS ALSO REDOUBLED ITS EFFORTS TO DIAGNOSE THE DISEASE IN ITS EARLY STAGES AND FOLLOW UP WITH AGGRESSIVE MULTI-DRUG TREATMENT. ¶4. DR. DUNG LISTED TUBERCULOSIS, MALARIA AND GOITER AS THE NEXT MOST SERIOUS PUBLIC HEALTH PROBLEMS IN GIA LAI PROVINCE. HE SAID THAT ALTHOUGH THE NUMBER OF MALARIA CASES HAD INCREASED IN THE PAST YEAR DUE TO THE WEATHER, THE PROVINCE HAD SEEN A 60 PERCENT REDUCTION IN MALARIA MORTALITY AS A RESULT OF EARLY DIAGNOSIS AND TREATMENT. TUBERCULOSIS REMAINS A SERIOUS PROBLEM, WITH THE DISEASE AFFECTING THREE PERCENT OF THE PROVINCE'S POPULATION. THE GOVERNMENT REDUCED THE INCIDENCE OF GOITER BY FIVE PERCENT IN THE PAST YEAR, ACCORDING TO DR. DUNG, BY PROVIDING IODIZED SALT TO THE REMOTE AREAS WHERE THE DISEASE IS MOST PREVALENT. DR. DUNG ACKNOWLEDGED THAT IN MANY PARTS OF THE PROVINCE, MALNUTRITION AND INADEQUATE MATERNAL AND CHILD HEALTHCARE WERE SERIOUS PROBLEMS. HIGH HIV RATE, QUESTIONABLE BLOOD SUPPLY -------------- ¶5. SURPRISED THAT DR. DUNG HAD NOT LISTED IT AS AN AREA OF CONCERN, POLOFF ASKED ABOUT THE INCIDENCE OF HIV/AIDS IN THE PROVINCE. DR. DUNG SAID THAT 3300 PERSONS HAD BEEN TESTED FOR HIV IN THE PAST YEAR. OF THOSE, 45 HAD TESTED POSITIVE FOR THE HIV VIRUS. CG UNCLASSIFIED PAGE 04 HO CHI 00055 01 OF 02 220631Z ASKED IF THE 3300 PERSONS TESTED WERE FROM HIGH-RISK GROUPS. DR. DUNG REPLIED THAT THE SAMPLE POPULATION HAD NOT COME FROM VULNERABLE OR HIGH-RISK GROUPS; THEY WERE ALL PEOPLE WHO HAD UNDERGONE VARIOUS TYPES OF SURGERY AT PROVINCIAL AND DISTRICT HOSPITALS. AS SUCH, DR. DUNG SUGGESTED, THEY COULD BE CONSIDERED RANDOM SAMPLES. WHEN CG ASKED HOW SAFE THE PROVINCIAL BLOOD SUPPLY WAS, DR. DUNG SAID HE BELIEVED IT WAS SAFE. WHEN PRESSED, HE ACKNOWLEDGED THAT THE PROVINCE "DOES NOT HAVE STATE-OF-THE-ART TESTING CAPABILITY." ¶6. COMMENT: WE WONDER IF THIS POVERTY-STRICKEN PROVINCE HAS THE RESOURCES TO TEST ITS BLOOD SUPPLY AT ALL. WE WERE ALSO STRUCK BY DR. DUNG'S APPARENT NONCHALANCE IN RELATING THE HIV STATISTICS - CDC STAFF FAMILIAR WITH THE TESTING PROGRAM NOTE THAT IT WAS NOT A RANDOM SAMPLE, AS ONLY SELECT SURGICAL PATIENTS ARE SCREENED (THOSE THE SURGEONS CONSIDER HIGH RISK). BUT EVEN WITH THIS SAMPLING BIAS, THE NUMBERS SUGGEST A MAJOR PROBLEM IN THE MAKING. UNFULFILLED NEEDS IN THE HEALTHCARE SYSTEM -------------- -- ¶7. DR. DUNG SAID THE PROVINCE PLANS TO CONSTRUCT A NEW 500-BED HOSPITAL IN PLEIKU AT A COST OF VND 32 BILLION UNCLASSIFIED PAGE 02 HO CHI 00055 02 OF 02 220631Z (USD 2.2 MILLION). SPAIN HAS PLEDGED USD 3 MILLION IN ODA ASSISTANCE FOR EQUIPMENT AND SUPPLIES. THE PROVINCE PLANS TO SPEND AN ADDITIONAL VND 10 BILLION (USD 0.7 MILLION) ON ADDITIONAL EQUIPMENT. (NOTE: THIS IS A SUBSTANTIAL INVESTMENT FOR THIS EXTREMELY POOR PROVINCE. REFTEL REPORTED THAT FROM 1975-97, GIA LAI HAD BUDGETED ZERO/ZERO FUNDS FOR THE PURCHASE OF ANY NEW HOSPITAL EQUIPMENT. END NOTE.) ¶8. DR. DUNG SAID THAT EACH OF THE PROVINCE'S 12 DISTRICTS BOASTS A 50- TO 100-BED HOSPITAL. NINE OF THESE HOSPITALS HAVE SURGICAL CAPABILITIES. GIA LAI HOPES TO BUILD SURGICAL WARDS IN THE REMAINING THREE DISTRICT HOSPITALS AS WELL. IN ADDITION TO THE DISTRICT HOSPITALS, DR. DUNG SAID, EACH COMMUNE WITHIN A DISTRICT IS SERVED BY A CLINIC, AND SMALLER HEALTH STATIONS ARE SET UP AT THE HAMLET LEVEL. ¶9. DR. DUNG ADMITTED THAT RECRUITING AND RETAINING TRAINED STAFF AT THE COMMUNE CLINICS AND HAMLET HEALTH STATIONS IS PROBLEMATIC. ONLY 17 OF THE 175 COMMUNE CLINICS HAVE A PHYSICIAN ON HAND. THE PROVINCIAL DEPARTMENT OF HEALTH WANTS TO INCREASE THAT NUMBER TO THE 50 PERCENT LEVEL, BUT SEEMED TO LACK A SPECIFIC PLAN ON HOW TO ATTAIN ITS OBJECTIVE. DR. DUNG SAID HE WANTED TO PROVIDE MEDICAL SCHOLARSHIPS TO STUDENTS IN RETURN FOR A COMMITMENT TO WORK AT THE ISOLATED RURAL CLINICS. "WE ARE LOOKING FOR INTERNATIONAL ASSISTANCE FOR THIS," HE STATED. (NOTE: VIETNAM GRADUATES A SURPLUS OF PHYSICIANS. IN THE LAST FOUR YEARS, ONLY ABOUT 60 PERCENT OF GRADUATES END UP IN MEDICAL ROLES. UNCLASSIFIED PAGE 03 HO CHI 00055 02 OF 02 220631Z MANY PURSUE CAREERS IN OTHER FIELDS, AS THEY PREFER TO STAY IN THE BIG CITIES RATHER THAN WORK IN REMOTE AREAS. CURRENTLY, THERE ARE TWO EMBASSY FSN STAFF WITH MEDICAL DEGREES WORKING IN NON-HEALTH RELATED JOBS. POST ALSO KNOWS AN ETHNIC GIA RAI PHYSICIAN FROM GIA LAI PROVINCE WHO WORKS AS A BUSINESS CONSULTANT IN HO CHI MINH CITY. HE WOULD LIKE TO RETURN TO HIS HOME VILLAGE, BUT HE WOULD NEVER COME CLOSE TO THE INCOME HE EARNS IN THE CITY. END NOTE.) ¶10. IN RESPONSE TO CG'S QUESTIONS, DR. DUNG NOTED THAT CLEAN DRINKING WATER WAS CENTRAL TO THE PUBLIC HEALTH OF A COMMUNITY, BUT THAT WATER SANITATION WAS THE RESPONSIBILITY OF THE PROVINCIAL AND DISTRICT PEOPLE'S COMMITTEES. SIMILARLY, HE SAID PUBLIC HEALTH EDUCATION SHOULD BE AN IMPORTANT PART OF THE PROVINCIAL SCHOOL CURRICULUM, BUT HIS OFFICE HAD NO INPUT INTO OR KNOWLEDGE ABOUT PUBLIC HEALTH EDUCATION IN THE PROVINCE, AS THAT WAS THE RESPONSIBILITY OF THE DEPARTMENT OF EDUCATION AND TRAINING. COMMENT -------------- ¶11. WHILE DR. DUNG IS VERY CONCERNED AND IS ACTUALLY BETTER INFORMED THAN SOME OF HIS COUNTERPARTS IN OTHER PROVINCES, THERE WAS NO PRIORITIZATION OF HEALTH PROBLEMS IN PROPORTION TO THEIR POTENTIAL IMPACT. FROM A PUBLIC HEALTH STANDPOINT, ADDRESSING THE CAUSES OF MATERNAL, INFANT AND CHILD MORTALITY RATES (IN ALL THREE CENTRAL HIGHLANDS PROVINCES) SHOULD BE A HIGHER PRIORITY THAN LEPROSY. ALSO, WHILE GIA LAI PROVINCE UNCLASSIFIED PAGE 04 HO CHI 00055 02 OF 02 220631Z NEEDS A NEW HOSPITAL IN THE PROVINCIAL SEAT, THERE SEEMS TO BE LITTLE INVESTMENT IN PERSONNEL AND FACILITIES IN THE MORE REMOTE AREAS WHERE LEPROSY, TUBERCULOSIS AND MALARIA CONTINUE TO TAKE THEIR TOLL. ¶12. THE DISCUSSION WITH DR. DUNG ALSO RAISES CONCERN ABOUT HIV/AIDS IN GIA LAI, AND BY EXTENSION, IN THE REST OF THE CENTRAL HIGHLANDS. IN A VERY POOR PROVINCE WITH EXTREMELY LIMITED RESOURCES WHERE HEALTHCARE PROVIDERS STILL CALL THE AGE-OLD DISEASE OF LEPROSY THEIR MOST DIFFICULT CHALLENGE, HOW CAN THEY POSSIBLY BATTLE A DISEASE THAT WILL REQUIRE MODERN AND EXPENSIVE TECHNOLOGY TO DETECT AND TREAT? YAMAUCHI UNCLASSIFIED