Dũ Vản Lộc

If you squint and hold your mouth just so, the tattoo on the chest of Dũ Vản Lộc might almost resemble a seagull soaring over a coconut palm…. or perhaps a fishhook. The concept may have been more

literal. The design was intended to be a heart, but the decoration – self-inflicted – proved to be too painful, and remains incomplete.

The choice of graphic may have been romantic, perhaps a reference to the Vietnamese idiom ‘simple house, two golden hearts’………or it may have been intended to refer instead to Mr Dũ’s own heart, damaged by childhood rheumatic fever.

Rheumatic fever – often a complication of untreated strep throat – can cause a thickening and narrowing of heart valves, limiting their ability to open – stenosis – and may also scar the valves, preventing them from closing properly. A narrowed or stenotic valve requires the heart to pump harder, and can reduce blood flow to the body. A valve that fails to close properly is termed ‘regurgitant’, or ‘insufficient’ - and can allow blood to leak backwards through the valve.

While rheumatic fever occurs most often in children aged five to fifteen, the long term consequences may not be seen for years. Mr Dũ’s condition was diagnosed at age 11, but not before the disease had caused severe stenosis of the mitral, aortic, and tricuspid valves of his heart. Now aged 32, he has become increasingly weak and short of breath, cannot work, and is unable to support his wife, Võ Thị Luy and their two children. He has been advised that, without surgery to correct his stenotic heart valves, he is at great risk of a stroke or even sudden death.

We have traveled to Tiên Lãnh, one of fifteen communes in the Tiên Phước district of Quang Nam province in central Vietnam. An economically impoverished area of harsh topography, it offers a difficult terrain for the dominant activity of agriculture. Population is sparse, the main source of income the cultivation of pulp wood, pepper, and cinnamon. Ominously, the stretch of the Tiên river which circumscribes the district - and disgorges into the massive Thu Bồn river system – is known locally as the ‘river flowing backwards’.

Our passage has been arduous. From Tam Kỳ on the main north-south coastal highway we have traveled west into the remote mountainous territory of Tiên Phước. Our destination is the tiny hamlet ‘Thôn 6’. The road, narrow and rutted at best, has deteriorated into a rocky unsealed track, difficult to traverse even on a motorcycle. A sudden downpour overtakes us as we crest a hill to arrive at the Dũ homestead.

The family is ‘officially poor’ – their total income less than 400,000VND ($20US) a month. They have no savings. Until recently they lived with Mr Dũ’s elderly parents. Three years ago, with the assistance of a stipend from their commune, they were able to build a small house – one room for the family of four, with an attached partially enclosed shelter for cooking. They have no running water, and no bathroom. Their toilet is a hole scratched in the forest floor. Their only income, supplemented by a small contribution from the commune, derives from casual farming work that Luy is able to obtain. In her absence, Dũ cooks, and looks after the children.

‘Poor’ certification, in addition to entitling their children to free education at district schools, provides basic health insurance for the family. The cost of the operation required to correct Dũ’s heart defects is 80 million VND (approximately $4000US). Of this sum, health insurance will cover about 30 million. While the Dũ family hopes to raise some of the balance in the form of loans from relatives, they have appealed to the Vietnam Health Improvement Project (VNHIP) for financial assistance. We are visiting today to assess the needs of the family, and to consider a contribution to the cost of surgery.

It is VNHIP policy to arrive for home visits unannounced, and we are fortunate on this occasion to meet the whole family. Coincidentally, they have been joined by relatives who have come to offer support, and to help prepare a meal. Rain is pelting down, and water runs in sheets off the blue tarpaulin that covers the cooking shelter, where a duck is boiling in a pot over a wood fire.

The house is a ramshackle affair, with a concrete floor. The perimeter walls are made of rough sawn lumber, poorly fitted. There are large gaps between the planks and below the eaves - providing little protection from the elements. A tile roof is supplemented by plastic tarpaulins – but the combination offers little resistance to the weather. In the driving rain the inside of the house is already damp. There is one mattress for the family, a green string hammock hangs in a corner, the only other furniture, some red plastic stools.

The circumstances of the family are as desperate as any we have seen, but despite Dũ’s very serious heart condition, and the many challenges posed by their extreme poverty, they are gracious and cheerful hosts. 

My colleague, Lê Thị Hoàng Yến has had considerable experience with cardiac interventions, and is able to offer a number of recommendations that will help facilitate the medical process. We leave having arranged for the family to travel to Danang City where Dũ will undergo preoperative tests.

The decision to provide financial assistance is made jointly by VNHIP staff and director Josh Solomon based on our site assessment, but it seems highly likely that this needy family will receive our support.

Fun and Frolics in the Ancient Capital: Annual Summer Trip to Huế for Children Living with HIV

It’s already warm at 7am as we wait in the minibus for our traveling companions – and the mid-summer day promises to be as hot as a firecracker. The occasion is the annual summer vacation for a group of children infected with the HIV virus, and their caregivers. This year, the trip, sponsored by the Viet Nam Health Improvement Project (VNHIP), will take us from Hội An to the ancient city of Huế - former capital of the Nguyến lords, a feudal dynasty which dominated much of Southern Vietnam
from the 17^th to the 19^th centuries. Our party includes VNHIP staff members Hayley Tristram, An Luu Phuoc, Nguyen Thi Thu Quynh, Le Thi Hoang Yen, Nurse Sagan Wilks, and marketing volunteer Gillian Eborn.

We are off to a slow start. There have been faulty bus connections, some of our family members have yet to arrive at the meeting point in the town of Vĩnh Đien – and our large vehicle is prohibited from entering the town precincts until 8am…..but finally, we are off. The children in our group range in age from 7 to 16. Most are accompanied by a parent, one in the care of her vivacious 80 year old grandmother. Most of the families are of very modest means, and for some, this trip represents a rare opportunity to travel beyond the boundaries of their home village.

Our path takes us North through the city of Da Nang and skirts the glorious sweep of Da Nang Bay before beginning a tortuous climb through the eastern extremity of Bach Ma national park. The highway, Đèo Hai Vân  (Ocean Cloud Pass) is a grueling series of switchbacks offering stunning views back across the bay, and, over the crest of the mountain, down into the beautiful beach landscape of the fishing and resort town of Lăng Cô. We pause at the summit for a rest stop and coffee break – 'the best coffee in Vietnam', and indeed, it is good coffee. Children and parents alike swarm the memorabilia stands, where the costume jewelry is a major attraction.

We roll in to Huế along a broad four-lane boulevard. It is close to noon, and everybody is hungry. In a tourist bus corral, promoters from a dozen small restaurants swarm the bus, but our driver has already made a recommendation – the Cóm Xuân Nhan, which advertises 'món ăn ngon' – 'delicious cuisine'. The restaurant is packed with customers, but within 10 minutes tables have been marshaled and set up on the sidewalk, and, amazingly, food begins to appear almost immediately, and is fresh and spicy. We supplement the meal with a sandwich confection made from crisp rice crackers filled with a sweet mixture containing nuts and ginger.

Our hotel is located 50 meters down a narrow alley, where we are soon installed in basic but clean rooms, and an hour is allotted for a rest before the afternoon schedule.

The party is divided into two groups for the first activity of the day: the children are to have a lesson on personal hygiene conducted by Quynh and Sagan, while the adults will have the opportunity to discuss the challenges associated with the special status of the HIV positive.

After an introductory chat with the children,and a quiz on hygiene issues, a demonstration of hand-washing technique is conducted by our nurse, Sagan. A glittery liquid soap is distributed – the glitter, transferred to any surface the children touch, is symbolic of germs. The point is quickly established, and the cleanup process in the bathroom a cheerful ruckus.

Predictably, the main topic of conversation among the adults relates to the isolation and widespread stigma resulting from fear of HIV and AIDS. Although the Vietnamese government has acted aggressively in issuing decrees prohibiting discrimination against those living with the virus, fear of casual infection stemming from a lack of understanding about the nature of the virus and modes of transmission is widespread. Often such fears combine with beliefs that all those with HIV acquired their infection through moral misconduct, and so should be avoided or excluded from society.

Lessons and discussions over, we board the bus for our first stop – The Citadel.

The history of the city of Huế for almost 400 years was virtually synonymous with the history of the Nguyễn family – one of the major families of Vietnam dating back to the end of the 14^th Century, and the days of the hero-emporer Lê Lợi. In 1558, Nguyễn Hoàng – the first of 9 'Nguyễn Lords' – prevailed in a dynastic struggle, and was given 'lordship' over the southern provinces of Vietnam. He ruled from the city of Huế, and established the dominion of the Nguyễn Lords in the southern part of the country.

In 1802 Nguyến Phúc Ánh, a descendent of the Nguyến Lords, succeeded in unifying what is now modern Vietnam – founding the Nguyến dynasty, and taking the reign name Gia Long. Construction of a capital city – the current Citadel - began in 1805. The design included four fortified enclosures contained within a massive defensive wall. The main structures were the Kinh Thanh (Capital City), for administrative buildings; Hoang Thanh (Imperial City) for Royal palaces and shrines; Tu Cam Thanh (Forbidden Purple City) for the Royal residences; and Tran Binh Dai, a bastion designed to control movement on the Perfume river which flanks the fortress.

Our children are a colorful sight, clutching balloons as we pass through the spectacular Nga Môn gate in the perimeter wall. It is brutally hot - many of the Vietnamese women in our group are covered from head to toe, with thick stockings, long-sleeved jackets, face masks, and wide floppy hats, in many cases, with only their eyes exposed. 

It's hard to know how much attention our group is paying to the presentation of our guide. Several of our number seem more interested in capturing the popular Vietnamese snapshot with a 'V for victory' sign. Our children are, for the most part, cheerful and uncomplaining – although one stylish little girl in pink sunglasses has a spectacular meltdown, and refuses to budge until her mother picks her up and carries her piggy-back for the rest of the visit.

Although many elements of the Citadel have been diminished by time, careful restorations of many significant structures evoke the grandeur of its heyday.

Our tour completed, we trudge back wearily to the bus, and return to the hotel for a freshen-up before dinner.

We gather in the early evening at a lovely restaurant with a terrace overlooking the Huong (Perfume) river. Our table extends along the parapet with a grand view across the water. The food is tasty, the beer warm – although there is plenty of ice. Gillian has volunteered her digital camera to one of our young charges, who has become an instant convert. Her free-form pictures of her companions are great fun – and are complemented by endless 'selfies'.

Bún Bò Huế is rightly famous in Vietnam. After an early checkout from our hotel, we stop at a sidewalk café where, sitting at low plastic tables, we are served bowls of this spicy beef noodle soup, iced tea, and strong, sweet, Vietnamese iced coffee. 

There is considerable excitement when one of our children tosses a shoe in the air and loses it in a tree. Fortified, and having tracked down a new pair of shoes, we set off for the tomb of Khai Đinh.

Nguyen Phúc Buu Đao was the 12^themperor of the Nguyến dynasty, becoming the nominal ruler of French occupied 'Annam' in 1916. He took the name Khai Đinh (Auger of Peace and Stability) for his reign. Although his stated agenda was to restore the prestige of the empire, his policy of close collaboration with the French colonial rulers earned him the contempt of many Vietnamese. His popularity was further diminished when he authorized a dramatic increase in taxation on the Vietnamese population, in part to pay for the palatial tomb we are visiting today.

The structure is a muddle of Vietnamese and European architectural styles. The tomb interior, a wild reflecting chamber of glass and porcelain – contains a central life-sized bronze statue of the emperor wearing an expression that might be chagrin….or melancholia. Certainly he does not seem to have been a happy fellow. Reputedly of frail and sickly disposition, he died of tuberculosis at 40.

Our colorful troupe is in sharp visual contrast to the mildewed gray concrete of the stairs and terraces as we pause for a group photograph outside the main temple.

Back on the bus we head for our final destination of the day, the Thiên Mu Pagoda (Chùa Thiên Mu). The original structure was built in 1601 on the order of Hoang Nguyễn, the first Nguyễn lord, who at the time, was governor of the city now known as Huế. The original pagoda was a simple structure, but renovations and additions over the years have greatly increased the size and grandeur of the site. The brick 'Phuoc Duyên' tower was erected in 1844, stands 21m tall, and is of octagonal shape with seven stories, each dedicated to a different Buddha incarnation. The great tower, overlooking the Perfume river, has become the unofficial symbol of the city.

The inner courtyards of the pagoda are serene and un-crowded. In a dining hall monks are chanting before their mid-day meal. A garden of bonsai trees stretches to the rear perimeter wall. In a garage off the central courtyard, a pale blue Austin Winchester automobile is parked. Mounted on a wall behind it, the famous photograph of the self-immolation of  Thích Quang Đuc, a Buddhist monk who, driven to the site in this car, burned himself to death at a busy Saigon intersection in 1963. Quang Đuc was protesting the persecution of Buddhists by the American backed South Vietnamese government led by Ngô Đình Diem.

At the foot of the pagoda, we board a brightly decorated 'Dragon' boat for a brief cruise down the Perfume River which bisects the city of Huế. According to local lore the river derives its name from the fact that it passes through forests of aromatic plants before reaching the city, bringing with it a pure and fresh aroma. In this central part of Huế, development has been restricted on the riverside, most of which is devoted to an attractive pedestrian park. We are a large group for the relatively small boat, but, reassuringly, there are sufficient life jackets for all. Our host has a captive audience in mid-river, where she presents us with a range of memorabilia for sale.

We stop for one final meal before boarding the bus for the return journey. Rather than the long haul back over the mountains, our route is through the new Hai Vân Tunnel linking Huế and Da Nang.  Opened in 2005, it is the longest tunnel in Southeast Asia.

There are high-fives and smiles as our companions disembark in Vĩnh Đien. It has been a privilege and an education to share a vacation with this lovely group of children and their parents. 

Austin Trevett