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Cablegate: Gia Lai Province Healthcare: Leprosy and Hiv/Aids

This record is a partial extract of the original cable. The full text of the original cable is not available.


2002HOCHI00055 - UNCLASSIFIED

UNCLASSIFIED PTQ8057

PAGE 01 HO CHI 00055 01 OF 02 220631Z
ACTION EAP-00

INFO LOG-00 NP-00 AID-00 EVG-00 CIAE-00 DODE-00 SRPP-00
ED-01 UTED-00 VC-00 HHS-01 H-01 TEDE-00 INR-00
IO-00 L-00 AC-01 NSAE-00 NSCE-00 OES-01 OIC-02
OMB-01 PA-00 PC-01 PM-00 PRS-00 ACE-00 P-00
SP-00 SS-00 TEST-00 TRSE-00 T-00 USIE-00 FMP-00
PMB-00 PRM-00 DRL-02 G-00 NFAT-00 SAS-00 /011W
------------------5AF6EE 220631Z /38
FM AMCONSUL HO CHI MINH CITY
TO SECSTATE WASHDC PRIORITY 5896
INFO AMEMBASSY HANOI PRIORITY
ASEAN COLLECTIVE
CDC ATLANTA

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

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