Health .1 Health facilities CAPACITY AND VULNERABILITY – NHAN BINH WARD

7. CAPACITY AND VULNERABILITY – NHAN BINH WARD

7.1 Health 7.1.1 Health facilities There is one health centre in Nhan Binh ward, which of poor quality, and lacking some functional treatment rooms for traditional medicine, gynecological and in- patients. There are 5 staff in the health centre catering with one medical staff, 2 assistants and 2 midwives. 7.1.2 Health services and programmes The health centre staff implement the national target programmes such as nutrition, family planning, vitamin A, vaccination for children. They also organize periodical health-check for the children in kindergartens. Currently, the malnutrition rate for children is 16,7 . After each storm or flood happen, the health centre is in charge of disinfecting the wells, public buildings and schools. They also organize first aid training for the health workers during the rainy season. There are two services of both western treatment as well as traditional medicine for treatment of common diseases such as flu, cough, diarrhea, wounds, menstrual regulation, plus acupuncture for headaches, backache, and paralyse. 7.1.3 Understanding on climate change related diseases Diseases for women in particular among health staff: group discussion and in-depth interviews with health staff of the centre show that health staff have limited knowledge on climate change, but much more aware of diseases related to natural disasters. According to Mr. Nguyen Dinh Chay- head of the ward Health Centre “destruction of the ozone layers caused climate change and climate change means higher temperature, irregular rains and storms, and causing a number of diseases such flu, sore eyes, diahhrea, fever, and malaria” 7.1.4 Section Health workers network There are 14 health workers for 9 sections. There are two in section 9 and 1 in section 4. These health workers are trained on first aids during the rainy season every year. 7.1.5 Experiences of coping with diseases Coping worsened by natural disasters such as storms, floods, heatwaves: In 2007 there was a malaria epidemic in the city, and there were 10 cases in Nhan Binh ward. Thanks to the early identification of the cases through the health network at section level and cooperation with Sanitation and Epidemic Prevention Department of the city, they sprayed mosquitoes and stopped the spread of the diseases. Table: Frequency of diseases in the ward and two sections Diseases Treatment Storms Floods Heatwave drought Diahrea Traditional medicine at the health centre + treatment at home x x x Cough At home and health x x x Page 54 Diseases Treatment Storms Floods Heatwave drought centre, and City hospital Flu Self treatment at home x x Sore Eye Health centre and City hospital x x x Cold Self treatment at home x x Gynecological City hospital Ward health centre x x Fever At home or ward health centre x x Uterine Fibroma Ward health centre or City hospital x x Medical and health staff of the centre highlighted that they are most busy during the rainy season, with the treatment as well as dealing with the consequences of the disasters in the areas. There are often more diseases occuring during storm with heavy rains, floods and heatwave, especially diarrhea, sore eyes, cough and fever. According to the data of the health centre, there are around 60 of the local women suffering from gynecological diseases, but there are not many periodic checking organised for women, and there is no treatment or medicine for treating for the women in the local areas for free. 7.1.6 Health and nutrition status of the poor people In general, group discussions show that unpredictable weather changes have an impact on people’s health: when it gets hotter, many sicknesses happen: high blood pressure, cold and fever, headache, dizziness and sore eyes. When there is a lot of rain, many mosquitoes are bred causing dengue fever and cholera due to the contaminated water source. Observation and group discussion with women groups in the two sections show that the disabled people, elderly, children and the poorest are often of poor health due to their own current diseases and weaknesses. The poor families especially women know about how to feed better food for the children and families, but they cannot afford a lot of good food, due to the lack of money. Poor women do not usually go to the health centre to check their health regularly. Although there are malnourished children in the ward and the two sections, the support for better conditions of the children remains very limited. However, as Nhan Binh is a vegetable growing area of 20 ha for the city, many of the local people grow a large diversity of vegetables for sale and family consumption. Discussion with women’s group Nhan Binh ward shows that women are aware of diseases, especially gynecological one, that are worsened by disasters in the local areas, yet due to being too busy with their daily life activities, and lack of money for medicine, women normally do not pay attention to treating them. Poor health of a poor woman Page 55 Ms. Nguyen Thi Kim Lien born in 1940 has no children and no occupation. She is living in a temporary house of around 20m2 with the support from local government, value at 3,000,000 dongs. There is no latrine and not any valuable furniture in the house. As told by Mrs. Lien, the house is often leaked and gets wet during storming and heavy rains, and it is very hot during the summer time. She is having asthma, high blood pressure, stomachache, and heart failure. She is worried that if there are floodsstorms, her diseases are getting worse. She only wishes to have sufficient 2 meals a day. When being sick, she often buys medicines from local drug store. She is granted healthcare card subsidized by the government, if there is serious sickness; she can visit the health centre and hospital and is provided with medicine. After floods or storms, she often receives support rice, cash from local authorities, however it is not enough as she does not have reserved rice when storms and floods occurs. After floodsstorms, she often receives support from pagoda’s charity such as rice, and vegetable, salt from neighbours. 7.1.7 Medical health insurance issues Sharing of the poor on medical services My family is an average household so we have to pay for medical insurance. I have problems with my limbs which sometimes get paralyzed. Last year, I went to the hospital for medical check up. I left home at 6am and did not arrive home till late afternoon while it is only 10km from here to the Provincial hospital in Quy Nhon city. The main reason is that too many people rush to this hospital. Before everyone with medical insurance come to the provincial hospital. Now the new regulation is that they have to come to the city hospital. I’m not sure whether to buy medical insurance in the years to come because my health is getting better. Mr. Nguy ễn Văn Bình, Section 4 Nhơn Bình Ward The hospital is 10km away. It takes a lot of time to go there and wait for the doctors. Doctors are not very keen on patients with medical insurance. Therefore, even with free medical insurance, we rarely go to hospital unless the problems are very serious, for example for surgeons. Otherwise we just buy medicines for self-treatment. group discussion in Nh ơn Bình Ward 7.1.8 Other key health concerns • Interviewed men and women complained about overloaded health services. Provincial hospitals are being overloaded with patients from many areas, consequently they have to wait long. • Overloaded provincial hospitals reflect the fact that services at districtwardcommune levels remain limited, which motivates people to come to big hospitals. According the female group in Section 9, Nh ơn Bình Ward, the ward health center provides mainly services such as vaccination for children and pregnant women, family planning IUD, medicine supply…. Regarding IUD, many women reported they got pregnant even after they’ve got IUD. Page 56 • People still have limited awareness of health only go to hospital when seriously ill, not pay attention to living environment according to the research team… • Discussions with female groups show that they still lack understanding of reproductive health. Regarding reproductive health, gender prejudices are presented quite clearly. Many women said men do not use condoms because they think pregnancy is women’s business and therefore rarely share the burden. At the ward, there is free supply for contraceptives and condoms but very few men come for them. According to the Ward Women’s Union, the rate of women infected with reproductive diseases is up to 70 of all the patients. Gender prejudices are also shown in son preference, which is the main reason for families to have many children for carrying on the family’s name and for having someone to rely on at old age. Reproductive health for women Ms Gái, Nh ơn Bình said she was not able to have an IUD insertion because of an infection. Once she got pregnant even with an IUD. When the baby was born, the IUD was on its forehead. She goes collecting snails everyday, dipping herself in contaminated water. After each storm and flood, the infection gets worse but she could not afford for a treatment. Some women said they got pregnant even after IUD insertion but could not understand why. Some said that they should not work hard after IUD insertion otherwise it will get deformed or rusty if soaked in water too often. In one case, the woman felt a backache and went for a check up but the IUD could not be seen anywhere. After some time, it was found but already broken. Because of that, she had one more baby Ms Lien’s case. Ms Men has 3 children but her parents in law do not allow her to have an IUD insertion as they want to have more Page 57 grandchildren. Neither her husband no she want to have more children but they are not practicing any modern contraception techniques. They just rely on traditional methods. She said that if she gets pregnant, she will give birth and bring the child up. Female group discussion, Section 4, Nh ơn Bình Ward 7.1.9 Capacity and Vulnerability - Health centre staff and section health network, together with health facilities with both western and traditional medicine functions are good basis for taking care of the health of the local people. The experiences of the staff and health villagers network in dealing with diseases related to natural disasters are valuable. - There are constraints such as limited understanding on climate change related diseases in the future, and limited programmes targeted children and women, as well as elderly people in the area. - Unpredictable weather changes have an impact on people’s health: when it gets hotter, many sicknesses happen: high blood pressure, cold and fever, headache, dizziness and sore eyes. When there is a lot of rain, many mosquitoes are bred causing dengue fever and cholera due to the contaminated water source. - Poor health and high percentage of women suffering from gynecology, poor reproductive health and malnourished children are considered as vulnerable to reduce their resilience to climate change. - Local people especially the poor women do not pay high attention to nutrition and their health care, due to poverty, lack of information, limited access to services.

7.2 Education