Rural health work and disease prevention

For an economically underdeveloped country to dream of generalized medical assistance, radical struggle against social diseases and at the same time.
For an economically underdeveloped country to dream of generalized medical assistance, radical struggle against social diseases and at the same time, systematic disease prevention, may seem if not utopian at least not very realistic. But this is what is being gradually achieved in the Democratic Republic of Vietnam, formerly a colony and devastated since its founding as an independent State by continual imperialist wars of aggression. It has been rendered possible by a popular medico-sanitary line, conceived in a spirit of offensive which lays stress on prophylaxis without neglecting therapeutics and which respects the national patrimony, revaluing traditional medicine to make it a complement of modern medicine.
The colonial medico-sanitary heritage was derisory. At the time of the August 1945 Revolution, Vietnam had, in the whole of its area, from north to south, and for the whole of its population of 20 million, only about 30 hospitals (47 for the whole of French Indochina, i.e. Vietnam, Laos and Cambodia) with 51 physicians, 152 assistant physicians, 21 pharmacists, 22 assistant pharmacists, 1,227 nurses and 215 midwives. There was not a single drug factory. With these poor means and an almost empty treasury, the DRVN nevertheless had to establish simultaneously two health services — a civilian one and a military one — to serve the national resistance to French aggression, which was to last until July 1954. The first foundations of modern Vietnamese medicine were laid during those years of hard trials.
The period between the two wars (1955-1964) in North Vietnam saw the socialist transformation of private capitalist industry and commerce in towns and agricultural co-operation in the countryside (1958-1960) as well as the beginning of the socialist industrialization of the country. While helping develop the economy, the new production relations, of a socialist character, laid the groundwork for an unprecedented growth of cultural and social work, particularly of education and health. Thanks to the combined efforts of the State and the people, a ubiquitous medico-sanitary network has taken shape, whose task is to carry out both treatment and prevention activities simultaneously on four echelons corresponding to those of the administrative organization: central, provincial, district and commune.
The central echelon, which gives the whole network political and technical guidance and supplies high-level cadres and means with a strategic significance, comprises, besides the Ministry of Public Health and its various departments, highly specialized treatment centres, research institutes or institutes specially in charge of the prevention of and struggle against social diseases, several drug factories and medical instrument factories, a Medical College with two branches in the provinces and a Pharmacy College.
The provincial echelon, guided by the provincial health service, is self-reliant in the main on the operational plane and is equipped with a high-capacity polyvalent hospital, several dispensaries specialized in prophylaxis and struggle against social diseases, a small drug factory making current medicines from local materials, a drugstore and a secondary school of medicine turning out secondary and subordinate cadres.
The district echelon, headed by the district health bureau, has at its disposal a medium-sized polyvalent hospital, a polyvalent dispensary in charge of all prophylactic work and the struggle against social diseases, and a drugstore; there being no State organizations at a lower level, the district health bureau constitutes the decisive link in the whole system, as it forms, together with the concerned communal bodies, a complete and autonomous rural medico-sanitary network.
Lastly, the communal echelon, led by the communal medico-sanitary committee, is provided with a popularly sponsored infirmary-maternity home, also called communal health station, and has subdivisions in the agricultural co-operatives and production brigades, which include one or several villages. This is the basic echelon, and both curative and prophylactic activities there bear a more or less marked mass character.
The whole network is reinforced by the Association of Traditional Medicine, a popular professional organization with branches in provinces, districts and even communes.
The medico-sanitary network is put under a twofold leadership: on the professional plane, it is essentially responsible to the Ministry of Health which directs and controls it through health services at all echelons, and on the politico-ideological plane, also essentially, to the corresponding Party and State levels. It could not be otherwise, for medico-sanitary work — a social work — calls for a rational mobilization of the material and human resources of the entire community. The medico-sanitary body is neither a business organization, as in a capitalist society, nor a charity organization: it functions both as a general staff for the Party and the State and as a technical framework for the popular movement in the field of health.
At present, the DRVN medico-sanitary network proper comprises 444 State-run hospitals and 595 infirmaries totaling 50,000 beds, and nearly 6,000 popularly-sponsored communal health stations with 45,000 beds. Apart from its own sections of traditional medicine which exist at all levels, it is complemented by a network constituted by practitioners of the old school and including 22 hospitals and infirmaries as well as about one hundred medico-pharmaceutical co-operatives. This does not include the 400 district polyvalent dispensaries, and the specialized dispensaries, 5 or 6 for each of the 24 provinces (not to mention Hanoi and Haiphong), these specialized dispensaries being under the technical guidance of six Institutes: Hygiene and Epidemiology; Malariology, Parasitology and Entomology; Ophthalmology; Phthisiology; Dermatology and Leprology; and Protection of Mothers and Children. To complete the picture, we should also mention the Institutes of Traditional Medicine, Materia Medica, Oto-Rhino-Laryngology and Drug and Food Control. In 1970, there was one physician for every 5,454 people and one assistant physician for every 1,093 people.
The DRVN medico-sanitary network, the line which inspires it and the methods which govern it have proved their worth in face of US aggression. In spite of the deluges of bombs not a single patient, expectant mother or wounded person has been unattended, and no epidemic has broken out.
Undoubtedly, medico-sanitary work constitutes one of the major achievements in socialist building in the DRVN. Vietnamese Studies has devoted three special issues to this question: Health Organization in the DRVN (No 6 - 1965), North Vietnamese Medicine Facing the Trial of War (unnumbered - 1967) and 25 Years of Health Work (No 25 - 1970). The present issue, Rural Health Work and Disease Prevention deals with two aspects we regard as fundamental for our socialist medicine. For a better understanding of the problems treated we reprint two articles which remain quite topical: "Health organization in Dien Chau district" (VS No 6 -1965) and "On the medical front in Ha Tinh province" (unnumbered - 1967)
According to Medical Doctor Nguyen Khac Vien
Vietnams foreign language publishing house in 1972


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