US embassy cable - 02HOCHIMINHCITY55

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