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Health Care, Marginality, and Social Change in Vietnam
Organizer and Chair: Lynn M. Kwiatkowski, Colorado State University
Discussant: Laurence Monnais-Rousselot, Université de Montréal
Health concerns of Vietnamese people and forms of health care in Vietnam have historically emerged in relation to cultural, political, and economic processes and shifts. Changes in these areas have been particularly prominent during political and economic transitions, including colonial conquest, attainment of independence from the French empire during the mid-twentieth century, and the shift from state socialism to a market economy during the late twentieth and early twenty-first centuries. These transitions have involved changing forms of marginality, social inequality, and stigmatization that have affected health care providers and individuals suffering illnesses. Marginality has waxed and waned in intensity for social groups, shifting in either direction in relation to the contemporary political and economic context. The panelists will address some of the unexpected ways that individuals have become marginalized in relation to political ideologies, policies and power shifts, or how institutional and political changes have reduced the stigma attributed to certain groups. Marginality and inequality associated with conceptions of health, nationalism, class, gender, and sexuality will be addressed. Issues to be raised in this cross-disciplinary panel include class division among healers historically in Vietnam and the changing status of Vietnamese families involved in the indigenous healing arts; changes in sexual behavior, HIV/AIDS, and “bad behaviors” among urban men in three Vietnamese cities; the impact of Doi Moi on the changing modes of health inequality, through the investigation of women’s experiences pursuing treatment for infertility; and battered women’s shifting experiences of marginalization in the health care arena.
The Implications of Gia Truyen: Social Class within the Healing Community in Vietnam
C. Michele Thompson, Southern Connecticut State University
Vietnamese gia truyen (family transmission) medical texts consist of prescriptions and medical advice handed down within one medical family. Gia truyen do not have a high reputation in the history of Vietnamese medicine and their low status as a genre is clearly connected to the status of those who wrote them. They were written by members of medical families rather than by members of the elite classes. By the late 1920s there was a broad class divide between young members of medical families and the educated, somewhat westernized, younger generation of the Vietnamese elite who were likely to attend the prestigious Hanoi Medical School. The anti-French movement prompted a rapprochement between the two groups and this interaction eventually produced a hybrid medical service for the army of the Vietminh and a national health care system with both a traditional Vietnamese and a bio-medical component. However, the health care system set up by the Democratic Republic of Vietnam, even those institutes devoted to traditional medicine, was dominated by the same scholar gentry elite who had attended the L’Ecole de Medecine de Hanoi and other French educational institutions. So, what happened to the members of Vietnamese families traditionally involved in the indigenous healing arts, those who produced gia truyen? This paper will examine the remnants of class division among healers working in Vietnam in recent times and will also explore the continuing involvement of medical families in health care in Vietnam.
Unsafe Sex as a Public Health Issue in Vietnam in a Time of AIDS and Doi Moi Policy
Marie-Eve Blanc, Université de Montréal
In the context of the HIV/AIDS epidemic, unsafe sex seems to be one of the main public health problems (after intravenous drug use, which is problem number 1) for the Vietnamese Government. Also, Doi Moi policy is seen to be a worsening context for and factor of sexual behaviour changes. I will use mainly data from a study on men in an urban context. This study surveyed 1,475 men, from 18 to 55 years old, and aimed to provide a general picture of sexual behaviour and to focus on commercial sex, condom use, and their relation to HIV in the Vietnamese cities of Ha Noi, Hai Phong, and Da Nang. The study has been funded by the National Agency for AIDS Research (ANRS- Paris, France), identified as ANRS 1251 project. Results indicated that recourse to commercial sex is increasing in Vietnam. This study explained how generations of men have changed their behaviours. However, social change did not occur recently and we could not say that a “Sexual Revolution” happened with the Doi Moi policy. I will try to analyse what “bad behaviours” are. Marginality, discrimination and social inequalities also will be raised, to give some keys to understanding the “bad behaviours.”
Changing Modes of Inequality Under Doi Moi: The Pursuit of Fertility Treatments in Vietnam since 1986
Melissa J. Pashigian, Bryn Mawr
Vietnam’s Communist Party initiated unprecedented and dramatic economic, political and social change with the 1986 Doi Moi (Renovation) policy. This policy promoted an “open-door” and “international economic integration” intended to reverse a dire economic situation and stimulate development through infusions of technology and aid from overseas institutions. During this dynamic period, access to health care services and patients’ geographic mobility has shifted tremendously, magnifying existing class inequalities, but also creating new opportunities to obtain medical services (both biomedical and traditional). The policy has also resulted in the availability of new imported treatment forms. This paper will examine the impact of Doi Moi on the changing modes of health care inequality through the investigation of women’s experiences pursuing treatment for infertility in Vietnam since 1986, that include seeking traditional medicine (thuoc bac) and a range of biomedical treatments from the most basic, to recently introduced and technology-intensive in-vitro fertilization. The impact of the influx of biomedical technology on treatment inequality will be discussed. The paper argues that while Doi Moi has intensified economic inequality through decreased subsidies for medical care, the complexity of new forms of access and mobility have given certain groups of infertile patients new avenues for accessing care that they could not in past decades. Finally, the paper explores the marginalized social status experienced by many childless women seeking infertility treatments and suggests their use of treatment seeking, coupled with mobility during the Renovation period, mediates (to both their benefit and detriment) their experiences of social inequality.
Battered Women, Marginalization, and Health Care in Vietnam
Lynn M. Kwiatkowski, Colorado State University
Battered women in Vietnam often bear and treat their injuries derived from their husbands’ abuse in private, particularly if they evaluate their injuries to be minor. They may acquire assistance from their children or other family members when attending to their injuries at home. Yet battered women are frequently treated at hospitals and clinics by health care providers practicing biomedicine or traditional Vietnamese medicine, particularly when the women interpret their injuries to be serious and in need of medical attention. Also, some battered women are brought to health institutions after attempting suicide. Battered women have been experiencing different forms of marginalization in Vietnam’s health institutions, some of which have emerged in relation to changes that have been occurring in the provision of health services in Vietnam with the transition to a market economy. These forms of marginalization have involved health providers’ neglect of the social sources of their injuries, some battered women’s limited access to higher level health care due to poverty, and some health providers’ blame of battered women. Each of these forms of marginalization can impact battered women’s health status. New internationally sponsored programs have been introduced in an attempt to change some of the health providers’ perspectives and practices. In this paper, I will investigate the ways that forms of marginalization experienced by battered women in the health care arena have been shifting, and diminishing for some women, with recent cultural, political and economic changes stemming from the government’s Doi Moi policy.