Support Network for People with Disabilities
Below is an analysis written by Nguyen Thi Minh Thu, Program Development Director of EMW, as part of the research behind forming the Support Network for People with Disabilities program.
Analysis of the current situation for People With Disabilities in Quang Ngai province
The chemical dioxin, found in defoliants used during the Vietnam War, is the source of many health problems in Vietnam. Dioxin was a chemical ingredient in the millions of gallons of defoliants like Agent Orange sprayed over the Vietnamese countryside by the American military during the war between the U.S. and Vietnam. Dioxin is a powerful carcinogen, mutagen and teratogen that is associated with deformities, birth defects and other negative health outcomes.
In Vietnam, the Vietnam Association to Aid Agent Orange Victims (VAVA) is an important service agency charged with assisting dioxin victims. According to VAVA, there currently are 4.8 million of people believed suffering from the effects of dioxin poisoning in Vietnam.
Quang Ngai is a southern central province lying on the coast in the middle of Vietnam. The province was devastated during the war. Quang Ngai has fourteen districts, including Son Tinh, the site of the infamous My Lai Massacre (1968). In some areas such as Duc Pho district, accidents from unexploded ordinance still cause casualties. The chart below reflect statistics provided by the local government on PWDs in Quang Ngai.
Disabilities can come from many sources of course, including accidents, and not all those people who are considered to be dioxin-affected are disabled. Many are ill with cancer and other diseases. Nonetheless, according to local authorities, there 14,800 registered dioxin victims in Quang Ngai, and a total of 47,000 PWDs in the province. According to the latest survey done by Duc Pho District Health Care Center in 2006, there are 284 people with limb deformities that medical personnel believe are related to dioxin, and 751 children under 16 with disabilities. Most of these disabilities go untreated; the Duc Pho District Health Care Center staff report that only a small portion (about 85) of the 284 people with limb deformities they believe were congenital anomalies causes by dioxin received any treatment, therapy or financial help.
The Quang Ngai economy is based on farming and fishing, although both are somewhat marginal compared to other provinces due to poor conditions. Offshore fish stocks are limited, and the soils of Quang Ngai are nutrient-poor. There are many people living in poverty in Quang Ngai, and the situation for the disabled is worse. According to the provincial Department of Labor, Invalids and Social Affairs (DOLISA) more than 50% of PWDs are living under poverty line, with only 2,500 people receiving government support. This support allowance is quite modest, about $11 per month to cover some medical and living expenses.
Services for PWDs in Quang Ngai are inadequate. Although the provincial and district health care directors have worked hard to improve medical care and care for PWDs, resource limitations have severely hampered their efforts. At present, care for PWDs is limited to providing some preliminary examinations, small surgeries and rudimentary physical therapy to patients who have recently received surgery.
In Quang Ngai, the Duc Pho District Health Care Center is one of the only two health care centers in the province that have rehabilitation facilities. The center was built in early 2002 with co-funding from a Korean NGO. It has 140 beds in 11 functional wards, which include a bare-bones rehabilitation ward. The ward also offers eastern medicinal services as part of the therapy.
To better assist PWDs in Quang Ngai, the Da Nang Orthopedics and Rehab Center has been helping develop the Quang Ngai Orthopedics Station. This is a branch facility of the Da Nang orthopedics center. Funds have been provided by various sources, including the Hong Kong International Red Cross and the Fund for Prosthetics, Orthopedics and Rehab of Vietnam (FPORV).
It is hoped that this new center will greatly improve the services available to PWDs in Quang Ngai. The station is staffed by a resident doctor, four orthopedics technicians and two physical therapists. The facility also includes an orthopedics manufacturing workshop to build prosthetics. The physical therapy ward is the last remaining planned component of the facility.
More complicated surgical and rehabilitation cases have to be transferred to the Da Nang Orthopedics and Rehabilitation Center, over 130 kms away. However, most PWDs are too poor to afford the surgery, lack good information about the medical options available to them, and are too far from the Da Nang center to learn about possible treatments. Unfortunately, the truth is that most PWDs are left to care for themselves, often helped only by family members.
The Duc Pho District Health Care Center is charged with management of a health care network in 15 communes and 93 villages. Each commune health care station is staffed with two doctors and three technicians and midwifes. At the village level, there are 93 village health care workers. All these staff is working under professional and administrative supervision of Duc Pho Health Care Center. The staff can manage both supervision of care for all the PWDs in the district, and referrals – if the resources were available.
Son Tinh District has 21 communes and 106 villages. Each commune health station has one doctor and three nurses and technicians. Each village has one health care worker. This health care network, including the district CPFC and DOLISA, are lacking in the skills to care for and attend to PWDs' needs. The provincial and district support is limited to some cash allowances for living and medical expenses.
In the first six months of 2006, there were 657 patients who were admitted to the Duc Pho District Health Care Center for medical treatment and rehabilitation. Of this number, 10% were considered to be dioxin-affected, with the rest considered to be disabled from other causes, including accidents. To serve more people, the management of the Duc Pho District Health Care Center has been proactively involved in acquiring financial as well as technical support from various sources to strengthen their staff network capacity and hence benefiting their patients in the last three years. The director, Dr. Huynh Thanh Phuong, has raised significant funds to help the poor with the costs of medical treatment and hospitalization.
Son Tinh district is the central district of Quang Ngai province, and the district with the highest number of PWDs (1,500) that local authorities believe are dioxin-related. Despite the availability of basic rehab facilities at the district health care center, most PWDs are not enrolled in a regular check up system nor do they receive much in the way of medical and rehab treatment. For rehabilitation and orthopedic intervention, those PWDs who are fortunate enough to have or find financial support often go directly to the Da Nang Orthopedics and Rehab Center for corrective surgery or rehab services due to the lack of such effective services in Quang Ngai.
Most children with disabilities do not attend school. Many parents say that they do not have time to take their disabled children to school, but if their child was mobile, they would allow them to attend. These children get very little attention from education or health authorities, leaving the families to help them in any way they can.
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