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.