Agent Orange, Disability, and HIV/AIDS in Vietnam

Before arriving in Vietnam, the Vietnam War in my mind was a very impersonal piece of history and only implied basic dates, events, battles, and concepts. As I have been living here and truly immersed in the culture, however, I've realized how personal this war and all the history that goes along with it truly is. This realization came about initially during my trip to Can Tho during a Vietnamese lecture. Our cute little professor, who is about 5'2" and all smiles with a very adorable Vietnamese-English accent, mentioned his family. By this point in the experience, we were pretty comfortable with asking him questions since we had already spent about 30 of the 90 total hours of VN language classes we will have with him by the end of this week (and the end of my VN language studies!). We ended up spending an hour speaking (in English) about his story during the war and how his family was ripped apart because they were from Da Nang in central Vietnam. Through his incredible stories about surviving during this war as an aspiring student, dealing with the death of his siblings, and his moving throughout the country to stay safe, he made me realize something about Vietnam: everyone has a story from the war. Even the most ordinary people, the poorest people, the richest people…if they were alive during the war, they are guaranteed to have an unbelievable story. I think about this a lot when I walk along the streets and observe people. It is rare to have someone actually talk about their experiences from the war because Vietnamese tend to keep fragments of the past like these to themselves in the attempt to move on and progress. At the same time, however, I have come to realize that these stories are there, even if they are untold.

When we were in Da Nang, we visited an orphanage where nearly 90% of the children are severely disabled primarily from Agent Orange effects. It was a really difficult experience for me. Children were not only disabled in ways I have never seen children disabled before, but the facility lacked the technology or equipment to support the disabilities. Most children could not walk without a person holding them up. Children's legs were permanently bent backwards and many had misshaped spines. I had my first interaction with a Vietnamese child who had down syndrome at this orphanage. Keep in mind that any kind of disability that physically manifests itself in a child here results in the child's isolation from society. When I first saw this small child, he was coloring a picture with intense concentration. When he looked up and saw our group, his eyes just became locked with mine. I ended up coloring with him and a few other boys that came over for about half an hour. They were all about five to seven years old, I would guess. I couldn't even get myself to go into the more severe disability room of the orphanage, which had children younger than these kids. This young boy was not able to speak, but he showed me what color and where to draw with hand gestures. Even though the entire visit really upset me (I get upset when just visiting regular orphanages in this country, let alone ones with Agent Orange disabled children), I loved getting a chance to do a little arts and crafts with this boy. It was definitely uplifting to interact with the kids, rather than just observe them and their very serious disabilities.

A note about HIV/AIDS in Vietnam- Vietnam is facing increasingly serious problems with HIV/AIDS transmission, which is mostly through injected drug use (IDU) and sex workers. The problems are concentrated in the cities (Hanoi and HCMC) due to IDU and in the southern Mekong Delta in particular with sex workers. I know this may all seem general to you, but I have had more exposure and experience with some of these issues than I thought I would. A few weeks ago I was running in the park a block away from my home stay. The park is completely exposed to the main street and even has security guards, who just sit at the entrance in their army green uniforms on little plastic stools while they smoke and drink glasses of iced coffee. Although they didn't seem to be patrolling or enforcing any laws at all, they were there nonetheless. As I was running along the path during this early AM run and minding my own business as I listened to my IPOD tunes, I was completely flustered and to be honest, frightened, with what I saw on the curb to the left me. There squatted four or five young men, probably around my age, with their sleeves rolled up, shooting one another up with heroin. They were giggling and so conspicuously injecting drugs into one another's forearms that it was not as if they were even trying to conceal their illegal actions. I literally jumped to the side after I did a double-take look at these men. I did not initially realize that what I thought I saw could actually be happening in such an exposed part of the park, let alone at all in a public location. The security guards obviously don't do anything to prevent this from happening, nor do the large billboards hanging around the park with HIV/AIDS warnings. There is so clearly a problem in city with IDU, but there is limited prevention, if any at all. We did have a lecturer who is the vice chairman of the HIV/AIDS committee of HCMC who spoke to us last week. He explained that he had just returned from the PEPFAR conference in Uganda and was very adamant about making the distinction between HIV/AIDS problems in Africa and in Vietnam. Vietnam, a country receiving the third largest amount of money from PEPFAR in the world, does not have the same governmental structure and system to fight HIV/AIDS as other countries in Africa with similar levels of HIV/AIDS prevalence. There are no NGO's that work to fight the spread, rather the government here has complete control of the situation. They provide the funds and set up the support system. I was impressed to hear that the government does provide free treatment for those who seek it out. ARV treatment is free as long as the individual seeks it out and complies with the treatment, with requires daily visits, consistency, and discipline. The government also provides identification cards for those who visit these clinics, but they are working on preventing the growing stigma associated with the disease by not putting the person's name or picture on the card, but rather only an identification number. The laws surrounding IDU, which is one of the two main modes of transmission here, usually go unenforced, which prevents recognition that HIV has been contracted, and thus results in the disease spreading (in particular to women).

This past Sunday we went to a nearby park and played with HIV/AIDS children and spoke with their mothers. It was a group of about six mothers and six children. Actually, the women were not all mothers because many of the children's mothers have already passed away, but instead they were aunts or even grandmothers who have taken over the care of these children. Although they were reluctant to talk about these issues at first, the women opened up to us and we got to hear about their experiences with HIV/AIDS, the ways they contracted it, the ways they deal with it, and the challenges of living in Vietnamese society while facing treatment. All of the women contracted HIV from their husbands, who contracted it from sex workers. In Vietnamese society, when a husband is disloyal, it is very, very, very rare for the woman to leave him. She is considered to lack the means to survive herself with her children and the terrible image of her in society if she were to leave him would not be any better than just staying with her husband. I honestly can't even imagine having a husband cheat on me with a sex worker, let alone cause me to contract HIV. Even more than that, I can't imagine having a husband cheat on me with a sex worker, cause me to contract HIV, and then not leave him! If it were America, I would take my children and leave any man who did this before even being able to blink an eye. It blows my mind that this never happens here. Instead, there is a passivity about women's responses, it seemed like from speaking with these women. They just deal with it – they deal with losing their jobs once their boss finds out they have HIV, they deal with their children's friends' parents who don't allow their children to play with one another, they deal with the stigma that creeps up on them in so many other ways. Although Vietnam is a developing country, it is so far at the beginning of development. This, coupled with the fact that Vietnamese society is quite traditional, results in women like these to really face significant stigma. These women not only have to deal with the challenges, pain, and sickness of their own treatment, but they have to do it alone (in most cases the husband was no longer living either) and without a job (they will literally lose their job instantly once the boss finds out). To make extra money, the women made little key chains out of small beads that they sell. We all bought at least one. Mine is a little Santa Claus made out of red, green, white, and blue beads. I bought it for less than a dollar. Somehow this money is enough to really impact these women's lives.

I'm sorry for such a depressing post! I just felt like I needed to write about these issues since they have gone unmentioned as of yet. Things here continue to be great. It is getting more stressful as we finish up our VN language this week and have our exam on Friday. We also have a cultural exchange with the English club of the university on Friday night, so we have been practicing for this too. And, our ISP's are coming up too! We have all been working on our proposals. I have changed my topic too, so it's requiring much more preparation than I expected. My project will now be about the cultural importance of fish sauce in Vietnam and how it can be utilized to improve micronutrient deficiencies. My research will aim to answer: How can fish sauce, a staple of Vietnamese cuisine and culture, be used to alleviate national micronutrient deficiencies? In what ways has Vietnamese culture and history impacted the prevalence and significance of fish sauce in the Vietnamese diet? How might fish sauce be used as a unique food vehicle for fortification? I'm really looking forward to the research, which will start on November 12. It is really crazy that I am almost at this stage of my study abroad experience (and that our group will be separate from one another for a whole month!). It is quite an incredible learning experience though. I have never done this kind of intense research before at all, let alone in Vietnam, so there can only be room to grow.