Health in Laos

Public health

Health and health care in Laos were poor in the early 1990s. Although diets are not grossly inadequate, chronic moderate vitamin and protein deficiencies are common, particularly among upland ethnic groups. Poor sanitation and the prevalence of several tropical diseases further eroded the health of the population. Western medical care is available in few locations, and the quality and experience of practitioners are, for the most part, marginal, a situation that has not improved much since the 1950s.Ireson, W. Randall. "Public Health". [http://lcweb2.loc.gov/frd/cs/latoc.html "A country study: Laos"] (Andrea Matles Savada, editor). Library of Congress Federal Research Division (July 1994). PD-notice]

The life expectancy at birth for men and women in Laos was estimated in 1988 at forty-nine years, the same as in Cambodia but at least ten years lower than in any other Southeast Asian nation. High child and infant mortality rates strongly affected this figure, with the Ministry of Public Health estimating the infant mortality rate at 109 per 1,000 and the under-five mortality rate at 170 per 1,000 in 1988. The United Nations Children's Fund (UNICEF--see Glossary) believed these figures underestimated the true mortality rate but still represented decreases from comparable rates in 1960. Regional differences were great. Whereas the infant mortality rate for Vientiane was about 50 per 1,000, in some remote rural areas it was estimated to be as high as 350 per 1,000 live births; that is, 35 percent of all children died before the age of one.

Children's deaths are primarily due to communicable diseases, with malaria, acute respiratory infections, and diarrhea the main causes of mortality as well as morbidity. Vaccination against childhood diseases was expanding, but in 1989 Vientiane's municipal authorities still were unable to vaccinate more than 50 percent of targeted children. Other provinces have much lower rates of immunization. Malaria is widespread among both adults and children, with the parasite Plasmodium falciparum involved in 80 to 90 percent of the cases.

In the first malaria eradication program between 1956-60, DDT was sprayed over much of the country. Since 1975 the government has steadily increased its activities to eradicate malaria. The Ministry of Public Health operates provincial stations to monitor and combat malaria through diagnosis and treatment. Prevention measures involve chemical prophylaxis to high-risk groups, elimination of mosquito breeding sites, and promotion of individual protection. The campaign has had some success: the ministry reported a decline in the infected population from 26 percent to 15 percent between 1975 and 1990.

As of 1993, diarrheal diseases were also common, with regular outbreaks occurring annually at the beginning of the rainy season when drinking water is contaminated by human and animal wastes washing down hillsides. Only a few rural households have pit or water-seal toilets, and people commonly relieve themselves in the brush or forested areas surrounding each village. For children in these villages, many of whom are chronically undernourished, acute or chronic diarrhea is life-threatening because it results in dehydration and can precipitate severe malnutrition.

Although nutrition appears to be marginal in the general population, health surveys are of varying quality. Some data indicate that stunting--low height for age--in the under-five population ranged from 2 to 35 percent, while wasting--low weight for height--probably does not exceed 10 percent of the under-five population. These figures reflect village diets based predominantly on rice, with vegetables as a common accompaniment and animal protein--fish, chicken, and wild foods--eaten irregularly. Children aged six months to two years--the weaning period--are particularly susceptible to undernutrition. The nutritional status of adults is related closely to what is being grown on the family farm, as well as to dietary habits. For example, fresh vegetables and fruits are not highly valued and therefore are not consumed in adequate amounts. As a result, it is likely that vitamin A, iron, and calcium deficiencies are common in all parts of the country.

HIV/AIDS

Permissive attitudes of Laotian men toward sex and prostitution facilitated the transmission of human immunodeficiency virus (HIV) during the 1980s and 1990s, making HIV infection and acquired immune deficiency syndrome (AIDS) a growing concern. In 1992 a focused sample of about 7,600 urban residents identified one AIDS case and fourteen persons who tested HIV positive. No other statistics were available as of mid-1994.Ireson, W. Randall. "Acquired Immune Deficiency Syndrome". [http://lcweb2.loc.gov/frd/cs/latoc.html "A country study: Laos"] (Andrea Matles Savada, editor). Library of Congress Federal Research Division (July 1994). PD-notice]

The government convened a conference on AIDS in 1992, which noted the potential for a rapid spread of HIV in the population. Participants at the conference agreed that the spread of AIDS in Laos was inevitable, and, in fact, would likely be through young men who migrated to towns and then returned to their villages, as well as through women who entered the sex trades because of economic necessity. The numbers of HIV-positive people could increase to more than 10,000 within the next few years, although these numbers would likely not expand at the same rate as in Thailand--even though Thai men demonstrate similar attitudes toward sex and prostitution--because Laos's national policies forbid open prostitution. Through the early 1990s, Laos avoided widespread prostitution such as that found in neighboring countries, but it is likely to increase, as is the temporary migration of Laotian women to neighboring countries to work in the sex industry. Other possible routes of HIV infection include users of injectable illicit drugs and medical injections using unsanitary syringes. Should AIDS spread significantly in Laos, it will not only have a devastating effect on rural labor and the national economy, but will put impossible stress on the health care system. As the best means of preventing an epidemic, the conference report emphasized education in all sectors of the population through a variety of methods, including the media.

Health Infrastructure

Despite government promises that the urban-oriented health system inherited from the RLG would be expanded to support rural primary health care and preventative programs, little money had been allocated to the health sector as of 1993. According to figures from 1988, less than 5 percent of the total government budget was targeted for health, with the result that the Ministry of Public Health was unable to establish a management and planning system to facilitate the changes envisioned. UNICEF considered the effort to construct a primary health care system to have failed entirely.Ireson, W. Randall. "Health Infrastructure". [http://lcweb2.loc.gov/frd/cs/latoc.html "A country study: Laos"] (Andrea Matles Savada, editor). Library of Congress Federal Research Division (July 1994). PD-notice]

Official statistics identified hospitals in fifteen of the sixteen provinces, plus several in Vientiane, and clinics in 110 districts and more than 1,000 tasseng (subdistricts--see Glossary). In reality, most subdistrict clinics are unstaffed, unequipped, and unsupplied, and in 1989 only twenty of the district clinics actually provided services. The physical condition of the facilities is poor, with clean water and latrines unavailable at most health posts, and electricity unavailable at 85 percent of district clinics, rendering vaccine storage impossible. Drugs and equipment stored in the central warehouses are seldom distributed to outlying provinces, and in most situations, patients had to purchase Western pharmaceuticals from private pharmacies that imported stock from Thailand or Vietnam.

The number of health care personnel has been increasing since 1975, and in 1990 the ministry reported 1,095 physicians, 3,313 medical assistants, and 8,143 nurses. Most personnel are concentrated in the Vientiane area, where the population per physician ratio (1,400 to one) is more than ten times higher than in the provinces. In 1989 the national ratio was 2.6 physicians per 10,000 persons.

Training medical personnel at all levels emphasizes theory at the expense of practical skills and relies on curricula similar to those used prior to 1975. International foreign aid donors supported plans for a school of public health, and texts were written and published in Lao. As of 1990, however, the school did not exist, because of delays in approval of its structure and difficulties in finding trainers with the appropriate background.

Rural and provincial health personnel work under conditions similar to their counterparts in education: salaries are low and seldom paid on time, necessary equipment and supplies are unavailable, and superiors offer little supervision or encouragement. In these circumstances, morale is low, job attendance sporadic, and most health care ineffectual. In general, the population has little confidence in the health care sector, although some village medics and a few district or provincial hospitals are respected by their communities.

Use of traditional medical practitioners remains important in urban as well as rural locations. Healers who know how to use medicinal plants are often consulted for common illnesses. The Institute of Traditional Medicine of the Ministry of Public Health formulated and marketed a number of preparations from medicinal plants. Spirit healers are also important for many groups, in some cases using medicinal plants but often relying on rituals to identify a disease and effect a cure. Many Laotians found no contradiction in consulting both spirit curers and Western-trained medical personnel.

In the absence of a widespread system of health workers, local shops selling drugs became an important source of medicines and offered advice on prescriptions. However, these pharmacies are unregulated and their owners unlicensed. As a consequence, misprescription is common, both of inappropriate drugs and incorrect dosages. In rural areas, vendors commonly make up small packets of drugs--typically including an antibiotic, several vitamins, and a fever suppressant--and sell them as single-dose cures for a variety of ailments.

References