A Public Health Stranger in the Land of Medical Care
Saturday, August 21, 2010
The greatest asset in Laos is the people. According to our hosts at the Lotus Villas Guest House in Luang Prabang, a town on the Mekong River in north central Laos, the Lao people are what helped them decide to move from their native Australia to make Laos their home.
Laos is also one of the poorest countries in the world with a average annual income of about $1800 a year. Life expectancy is about 60, though “healthy” life expectancy is about 47. Infant mortality is high at about 75 deaths per 1000 live births and the people spend about $85 per year on health care. There is not much health care available.
Luang Prabang is a designated World Heritage City by UNESCO and was the old capital of Laos until the mid 1500s. There are dozens of wats (Buddhist temples) filled with monks. Each morning at about 5:30am, they walk through the streets and are offered alms of different foods mostly sticky rice, which is their daily diet. They proceed single file opening their baskets for food. All is quiet except for calm drumming and the occasional click of a tourist’s camera. As we offered alms, we sat either on chairs or mats. We were expected to serve from below their height. Their simple life made ours seem far overburdened.
One morning, we went to an orphanage supported by Andrew Brown, one of the owners of the guest house. Deak Kum Pa Orphanage houses over 500 children, though only 80 were there at the time (during the summer months children are often sent back to spend time in their villages). We asked Andrew where the children came from and why they were orphaned. He said that life expectancy is very low in the villages partly because there is no infrastructure and no health care. So a parent who falls ill from pneumonia or develops a bacterial infection that could be easily treated with health care, will often die instead.
Andrew is very culturally aware about his engagement with the orphanage. He knows that the directors are suspicious of a white foreigner offering help to young children. They are concerned about exploitation and pedophilia. So Andrew always go there with someone else and recently he hired a Lao woman to go with him and assist in organizing activities. We observed an English class that happened to be discussing using helmets on bikes and scooters, a subject about which I have research and personal experience. When asked, I was happy to tell a short story about how my helmet saved my head once.
Their kitchen is basic. The small concrete cooking space is fired with wood scraps. They were cooking chicken and green bean stir-fry in the largest wok I have ever seen. We were offered at taste and it was good and spicy.
The orphanage is a substantial campus with numerous buildings and many needs: food and supplies, art and recreation activities, and teachers, lots of teachers. The orphanage is officially run by the government, but it is held together by locals who either work or volunteer their time there, like Andrew. I will try to develop their situation into a class project for my International Health Class this fall.
When we read news stories or blogs like this that inform us about the plight of the less privileged, we feel sympathy or something stronger and may be compelled to contribute. When I see the situation on the ground and go to an orphanage or any site where help is needed, there is a compelling difference. It is in front of me, present for my eyes and ears to capture.
At one level, I feel like a wayward tourist, taking in the poor as my object and acting as a “helicopter” helper: handout some toothpaste and soap, drop a few dollars, and go back to my air-conditioned suite at the guest house. When I observe, hear, and participate, however, I am also aware of what I’m doing and I know that steps must be taken no matter how small. Bigger steps will follow.