Around
the hamlet of Tịch Yên on the Bình Nam commune, the topsoil is
mostly white sand. Incongruously, for Central Vietnam, it looks a lot
like a light dusting of snow! Summers here are arid, little will
grow, and the sand gets so hot, I’m told, that chickens must wear
shoes. The truth turns out to be a little more prosaic.
Nguyễn
Thị Ngân is a 45 year old farmer. Two years ago she was thrown
from the back of her husbands motorcycle when he swerved to avoid a
child in the road. She fell heavily, severing a tendon in her leg. A
six-inch scar across the bridge of her left foot indicates recent
surgery.
While
she was receiving treatment for this tendon injury, tests revealed
evidence of stenotic mitral and aortic heart valves.
Mrs
Nguyễn says she has no memory of a specific illness – but heart
valve failure is a commonly diagnosed condition in Vietnam, and is
often the result of childhood Rheumatic Fever. Untreated
streptococcal infection, such as strep throat, is usually the cause.
Although Rheumatic fever occurs most often in children aged 5 to 15,
the symptoms of valve disease may not be seen for years.
Stenotic
valve disease requires the heart to pump harder, which can strain the
coronary system. Untreated, heart valve stenosis can cause chest
pain, shortness of breath (due to heart failure), and fainting. In a
small percentage of patients with heart valve stenosis, the first
symptom is sudden death, usually during strenuous exertion.
Without
treatment, the average life expectancy after the onset of heart
failure due to heart valve stenosis is between 6 and 24 months.
The
Nguyễn family is poor. Mr Nguyễn works as an occasional farmer
and itinerant laborer, and, since his wife’s diagnosis, has become
the sole provider for the family. In addition to maintaining the
household of four, he must generate additional income to pay the
interest on a 20 million VND bank loan, which finances the education
of their two children.
With
a combined income of less than 400,000 VND a month, the family
qualifies for medical insurance funded by their Commune. Of the 80
million VND fee for the necessary heart valve operation, insurance
will cover 30 million. The family has requested assistance from the
VNHIP to
cover the additional 50 million VND.
The
living room of the family home is dominated by a shrine dedicated to
‘Cao Đài’ – topped by an image of the ‘All-Seeing Eye’. A
relatively modern syncretistic, monotheistic religion, Cao Đài
stresses ethical practices, including prayer, veneration of
ancestors, non-violence, and vegetarianism. When I ask Mrs Nguyễn
how she maintains a positive outlook in the face of her
life-threatening condition, she cites the comfort of her religion –
together with the kindness of neighbors and friends, and the care and
support provided by her family.
The
two children both attend Quảng Nam University in Tam Ky. Her
daughter is studying for a career as a music teacher, and travels the
12 km to and from school by bicycle. Her brother, an Information
Technology student, gets a ride on a friends motorcycle, and arrives
home from school while we are visiting. He will graduate next year.
In the meantime, he works as a laborer with his father on weekends to
help support the family.Before
I leave, I ask him about chicken shoes. Improbably, he knows all
about them (gà mang dép su – literally: rubber chicken slippers)
and can demonstrate their use. Rather than considerate footwear for
the bird, though, they are an ingenious improvised shackle – a
restraint to keep the poultry out of the vegetable patch.
By Austin
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