(Mai Chau village)

Blogging after Myanmar is a tough act to follow; yet life continues to be interesting in Vietnam. Three days after returning from the Tet holiday, I flew to Ho Chi Minh City for a week-long surveillance conference, which brought together over 80 surveillance officers and technical experts from 19 countries in order to share updates and best practices as they pertain to the conduct and use of HIV/AIDS surveillance data.

(The rice fields of Mai Chau)

Again, I marveled over the stark contrasts between the HIV epidemic in Africa compared to Asia. Unlike the generalized epidemic in most African nations, Asia has a concentrated epidemic primarily driven by injection drug users (IDU), commercial sex workers (CSW) and men having sex with men (MSM). Therefore, surveillance methodologies delved into the strengths and weaknesses of different approaches to reach these ‘Most-At-Risk Populations’.

(Mai Chau)

The issues are more complex than one would imagine. How does one enumerate the size of the MSM population? Are there other populations that should be considered ‘most at risk’, i.e., prisoners, mobile populations, etc? How should HIV incidence, or the rate of new infection in a population over time, be estimated? What are the new surveillance priorities in terms of pediatric surveillance, mortality surveillance, case surveillance and using program data for surveillance?

(Woman making coal bricks)

Answers to these questions and more were discussed in great detail throughout the course of the week. I felt honored to be part of such an impressive group, yet the real beauty stemmed from its diversity. The Asia region includes countries such as Afghanistan, Pakistan, Uzbekistan (and Central Asia), China, India, Papua New Guinea, Malaysia, Cambodia, Laos, and Thailand. Each country brings a wealth of information to the table; their experiences and lessons learned help inform best practices and allows countries to avoid some of the surveillance pitfalls.

(shucking snails)

After the conference, several of us decided to go on the ‘city tour’ in order to see Saigon/Ho Chi Minh City. The first stop was the Reunification Palace, the home and workplace of the President of South Vietnam during the Vietnam War. This building is most notable for its symbolic role in the fall of Saigon in April 1975, when the North Vietnamese tanks crashed through its gates.

(Reunification Palace with my friends from Afghanistan)

Next we went to the War Remnants Museum, which primarily contains exhibits relating to the American phase of the Vietnam War. The exhibits ranged from reproducing the ‘tiger cages’ in which the South Vietnamese Government housed political prisoners, to graphically describing torture techniques, to atrocities such as the My Lai massacre (mass murder by the US Army of approximately 500 unarmed civilians, including victims that were sexually abused, beaten, tortured, and even mutilated).

(Tiger Cages)

Yet the images that still haunt me depict the effects of Agent Orange and other chemical defoliant sprays. From 1962 to 1971, over one hundred million liters of toxic chemicals were sprayed throughout the country, directly affecting approximately 4.8 million Vietnamese, resulting in 400,000 deaths and disabilities, and 500,000 children born with birth defects.

(Montage of images that were displayed at the Remnants of War Museum)

In fact, we have people in our USAID office working on Agent Orange Remediation Programs. In early 2009, the Government of Vietnam, the U.S. Government, and other donors reached a consensus on a clean-up approach to address dioxin contamination. The approach’s first phase involves removal and containment of dioxin contaminated soil and sediment in secure landfills to eliminate any further human and environmental exposure. The second phase will focus on the longer-term goal of dioxin destruction, which requires more testing before a final remedy can be selected.

Why haven’t we learned from our past? We’ve created generations of deformities and broken homes, with people still experiencing the effects of Agent Orange today. And now Depleted Uranium is being used in Iraq, Afghanistan, etc., and we have no idea to what extent this radioactive material will wreak havoc on this part of the world for decades to come. As an environmentalist at heart, it worries me that we are so shortsighted as to the true costs of using Depleted Uranium. So many innocent lives are afflicted by war; if only we could redirect those human and financial resources towards alleviating poverty the world would be a much safer place.

Alas, I’m now back in Hanoi recovering from surgery! One of my back molars became severely abscessed due to a failed root canal/crown. I can honestly say, I have never, in my entire life, experienced such excruciating pain! After a week of intense antibiotics and pain killers, the doctor was finally able to perform the surgery, which included the use of a bone graft (via a cadaver) and membrane from a cow’s Achilles tendon. Needless to say, my jaw is still sore! I’ll return in two weeks to remove the sutures but will need to wait six months to see if the implant/bone graft worked prior to replacing the crown. Ah, the joys of surgery overseas!

(Buying goods in Mai Chau village)

Finally, one of my dear friends from Malawi is currently in town on TDY! It’s been great catching up with Emily and reminiscing about days gone by. As much as I love my new job, I definitely miss my friends from Lilongwe!

(Emily and Amy in Hanoi)

Sending much love to all,
Amy