Barriers to health care for vicitms of agent orange in the A Luoi District of Vietnam

The A Luoi district of Central Vietnam was sprayed with over 434,812 gallons of Agent Orange during the Vietnam-American War. The chemical was especially toxic and still creates a scarcity of crops, dangerous livestock meat, unsafe water, and a whole host of genetic defects which are being sustained in successive generations. Despite recent attempts by foreign governments and NGOs, the burden has largely been placed on the Vietnamese government to provide access to medical care for individuals affected. In order to examine recent interventions and barriers to healthcare for those affected we sampled 350 households, conducted 6 focus groups, and completed interviews with local and foreign health workers throughout 6 communes. The sample included households that had at least one member with medical complications resulting from Agent Orange, and was taken from local registries at commune level Red Cross offices. Results show that only 1.93 percent of households had been to a private healthcare provider, confirming the huge burden put on the public system. One of the barriers to treatment is distance, with our data showing an average distance of 13.41 kilometers to the district hospital. Commune health centers (CHCs) are closer with an average of 1.25 kilometers, and are cheaper with 84.13 percent reporting they had a free check-up at the local CHC; although they are usually unmanned, understaffed, and lack basic medications. Another barrier is language, with over 52.68 percent of our sample lacking knowledge of the country's main dialect. The language barrier not only effects quality of care, but also restricts them from moving from poisoned areas. With a seeming increase in Agent Orange related health problems, combined with over 89.45 percent of Agent Orange victims in our sample reproducing, the effect will be a steady increase in health complications. Although there are many difficult challenges posed by these and other barriers examined in our study, we have found considerable improvements in number of people treated, health insurance coverage, funding and interventions introduced. Increasing access to healthcare for these individuals is possible, but will require action from actors in many different sectors that look past the war, look toward the future, and see public health without borders.