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Vietnam - Health
In 1945 Vietnam had forty-seven hospitals with a total of 3,000 beds, and it had one physician for every 180,000 persons. The life expectancy of its citizens averaged thirty-four years. By 1979 there were 713 hospitals with 205,700 beds, in addition to more than 10,000 maternity clinics and rural health stations; the ratio of physicians to potential patients had increased to one per 1,000 persons, and the average life expectancy was sixtythree years.
Information concerning the health sector in the mid-1980s, although fragmentary, suggested that the country's unified health care system had expanded and improved in both preventive and curative medicine. Medical personnel totaled about 240,000, including physicians, nurses, midwives, and other paramedics. The quality of public health care and the level of medical technology remained inadequate, however, and authorities were increasingly concerned about such problems as nutritional deficiency, mental health, and old-age illnesses. Cardiovascular diseases and cancers were reportedly not widespread but had increased "in recent years." Information on AIDS was unavailable.
The most common diseases were malaria, tuberculosis, trachoma, intestinal infections, leprosy, diphtheria, tetanus, whooping cough, measles, poliomyelitis, chicken pox, typhoid fever, acute encephalitis, and acute meningitis. Hanoi claimed in 1970 that alcoholic cirrhosis and venereal diseases were "seldom found in North Vietnam because of the wholesome and temperate life of the population and the cadres." In November 1984, however, the government admitted that the incidence of these diseases had increased "significantly" since 1976, "especially in the major cities."
Vietnam claimed to have eliminated cholera, smallpox, and typhoid in the North as early as 1959 and poliomyelitis by 1961. Malaria, once endemic, was said to have been eradicated in many provinces of the North by 1965. Much progress was reported also in the containment of trachoma, tuberculosis, and other diseases, but an official assessment made public in November 1984 acknowledged that, except for smallpox, contagious and infectious diseases had yet to be brought under control and that the mortality rate associated with these diseases remained high. The high mortality rate associated with malaria was a matter of particular concern, especially in the provinces along the Vietnam-Laos border, the Central Highlands, the central region, and the northern border provinces. Tuberculosis, responsible for the death of about 1 percent of the national population, or nearly 600,000 persons annually, remained a major problem although the rate fell from the 1.7 percent reported in 1976. In 1984 as many as 92 percent of the people examined in many different localities were found to be afflicted with one or more diseases. Authorities judged from these results that as few as 48 to 60 percent of the people in the localities sampled were in good health. Gastroenteritis and such childhood diseases as diphtheria, and whooping cough accounted for the extremely high 35 percent mortality rate among children, but the annual death rate for the population as a whole in 1983 was 7.4 per 1000 persons, a decline from 26 per 1000 in 1945.
The prevalence of epidemics of bacterial, viral, and parasitic diseases was attributed to the unsanitary environment. For this reason the government introduced programs to improve hygiene habits. Sanitary stations emphasizing water and environmental purification were established in every district, and campaigns such as the Three Cleans movement (clean food, water, and living conditions) and the Three Exterminations movement (extermination of flies, mosquitoes, and rats) were instituted. In addition, officials encouraged district residents to dig wells and construct septic tanks. They recommended regular vaccinations and inoculations against diphtheria, tetanus, whooping cough, polio-myelitis, tuberculosis, and measles.
Although access to health care improved by the mid-1980s, the shortages of funds, of qualified physicians, and of medicines prevented the Hanoi government from providing quality health care for more than a few. Minister of Public Health Dan Hoi Xuan acknowledged in November 1984 that the inadequacy of the public health system was responsible for the proliferation of private health services, the black market in medicines, and the consequent corruption of a number of doctors and pharmacists.
In 1987 the practice of traditional medicine remained an important part of the health care system. The Institute of Folk Medicine in Hanoi, a leading center devoted to the study of ancient theories and practices, utilized acupuncture and massage as an integral part of its treatment programs. Official sources maintained that traditional Vietnamese medicine had given rise to new therapeutic methods that called for the wider application of herbal medicine and acupuncture. The cultivation of medicinal plants and manufacture of drugs derived from these plants reportedly helped to overcome the shortage of Western medicines, which had to be imported in large quantities every year. Some of these traditional drugs were described as "most effective" in curing dysentery, arthritis, gastritis, stomach ulcers, heart diseases, influenza, blood clotting, and high blood pressure. In 1985 the Vietnamese press reported that many cooperatives were using folk medicines to satisfy 50 to 70 percent of their own needs for common drugs. Earlier in 1985, however, an official source had disclosed that efforts to develop Vietnamese medical science by integrating traditional and modern methods had not been systematic and had achieved minimal success.
In the mid-1980s, there were six medical and pharmaceutical colleges, one college-level institute for the training of managerial cadres in the health services, and more than forty secondary-level schools for mid-level paramedics and pharmacists. Physicians at "modern scientific and technical installations," according to the Vietnamese press, performed "sophisticated" heart, lung, kidney, and neurological surgery as well as microscopic eye surgery. Vietnamese doctors also were reported to be abreast of procedures in a number of other disciplines such as nuclear medicine and hematology.
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