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    Sunday, April 23, 2006

    Caesarean Section Births in HCMC, Part II

    I tried to respond to the comments to my last post on caesarean sections, but the blog is acting up. My comment doesn't register on my blog, but if you click on the post comment link, it shows up in the pop-up box....strange. Especially since I haven't changed anything to my code recently.

    I wonder if it was the length of my comment.

    So, here's my response (comment) to the comments.

    "Tort Law" exists in Vietnam, but like most law in Vietnam (and I assume China) is severly dictated by the communist party. In English speak, that means they enforce what they want to enforce and make everything else far too hard to do.

    Suing someone doesn't involve the government in the USA, but in Vietnam, everything is the government. Even "private" companies are only partially private. The government holds a stake in everything. In my post, I am talking about births in Ho Chi Minh City, which almost exclusively happen at hospitals. Hospitals are government funded and ran, the doctors at hospitals are known to be members of the party--not necessarily the best doctors around.

    So, to the best of my knowledge, it is possible to sue in Vietnam (I will find out more). However, in this case, you will be suing, basically, the government. Therefore, the government makes it very expensive, impractical, and scary to try that tactic. Much easier to just get a c-section. You must remember that many Viets (most?) in HCMC make between 600k VND and 1.5 mil VND a month ($37 USD to $93 USD) and suing a doctor/hospital would cost FAR more than that. Normal people just can't do it.

    Also, interesting observation about China. I don't know if that's the reason for reticence in the actions of Vietnamese police, but it makes some sense.

    About the numbers--I was shocked too. I didn't believe the numbers until I asked other people. I'm not talking about all of Vietnam here. The 40% number is a government figure for all of Vietnam, but the 80% is my straw poll about only HCMC. I expect that most women outside HCMC have vaginal births.

    That said, even 40% is sickeningly high.

    I have, unfortunately, also heard about giving money to get adequate care. When I heard (and read) about the prevalence of c-sections in Vietnam, I couldn't understand why. I thought that maybe it's part of the Vietnamese obsession to be western, modern, like giving children formula instead of breastmilk. The theory about making money stemmed from the comments I heard people make (it kept popping up) and I included it. It's the only reason I can think of that explains why so many totally healthy women/babies were denied vaginal births/inducement AND adequate hospital time. However, I would like to get my hands on something more and explore this further...maybe someone can help??

    Finally, one of the small points I made in my post which I think is worth highlighting is the % of post-partum problems. Reasons why aside, 40% of Viet women are having c-sections and 9% of them are having serious complications afterwards. Two things jump out at me: the government study (not to be publicised) claimed only 0.16% and the independent study found 9%. That's a huge difference. I know people doctor numbers in the government to look better, but you'd think the incentive would be less if the numbers were not to be publicised. It would make the government look bad. It makes me wonder if the 40% number is doctored too.

    Second, 9% of 40% is still almost 4%. 4% of all births in Vietnam have serious complications DUE TO c-sections. Vietnam has some brave mothers.
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    1 comment:

    MGO said...

    As for law in Vietnam, now my interest is piqued and I'll have to find out more. I wonder what holds people back from suits, since there are many ways for the system to do so. Comparatively, there's not a lawyer in America who wouldn't take one of the C-section cases on a contingent fee basis (which may well be disallowed in Vietnam).

    But in focusing on the law, I don't mean to ignore the horror of the substantive aspects of your post. You're right - even taking official levels at face value - there's something shockingly amiss here (and I agree with your conclusion that it's probably due to corruption and cash).