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Presentation for workshop in Vinh city, June 25 2004 Tine Gammeltoft |
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Dear Participants, I feel very happy and honoured to be here today. Our ENRECA project has now had activities in Nghe An for two years, but today is my first chance to visit Vinh and to meet all of you who are involved in the project – so it is a great pleasure for me to be here today. In my presentation today I will first say a few words about Stage I and II of the project’s research in Quynh Luu district, and then go on to say something about the activities we are planning in the last year of the first phase of the project. I hope you will all have comments and suggestions for us, both to the research that has already been carried out, and also to the research that we are planning to conduct in the coming year. First: in the first stage of the project, we did two things. We carried out exploratory anthropological field research in the summer of 2002, now two years ago – a team of more than twenty researchers came to Quynh Luu to spend three weeks to talk to people there about reproductive health. Even though the time for fieldwork was short, the researchers brought with them home a lot of interesting results. After that, later the same summer, another group of researchers carried out a baseline survey which also focused on a number of reproductive health issues. The main results of both of these two first studies are presented in the new publication “An Introduction to Social Anthropology....”. We have brought a number of copies with us today, and we hope that you will read the book and let us know what you think. The book provides insights into antropological research methods, but it also provides some basic insights into gender and reproductive health issues in Nghe An. This initial research pointed to a number of issues where the researchers – through talking to local people – found that more research is needed:
2) In relation to the use of health services, we found that more research attention needs to be devoted to quality of care issues. In particular, we found that feelings of shyness (“ngai”) was an important factor in determining whether people use services or not and to which extent they are satisfied with services. The stage I research pointed out that more research is needed to find out what people mean when they talk about shyness – the term seems to cover a range of different issues, including economic issues, perceptions of the body, and perceptions of morality. The stage I research also showed that Catholic people tend to feel shy more often than non-Catholic people when using health services, and that the service utilization among Catholics is much lower than among non-Catholics.
This was very briefly about what we found in the first stage of research, conducted over the summer of 2002. After that, two groups of researchers were formed – a group of junior researchers and a group of senior researchers. The junior researchers focused their research on the differences between Catholics and non-Catholics in relation to pregnancy, delivery and childcare. They have done fieldwork two times, in the summer of 2003 and in spring this year, and they are now working on an article on the research – in a few minutes (Chi) will present on behalf of the junior researchers. The senior researchers are today represented by Nguyen Thi Thanh Huong. The senior researchers have done or are currently doing research on a number of issues. Huong’s research is on one of the topics on the silent RH agenda: elderly and sexuality. Two other researchers have focused on quality of care issues: Tran Quang Lam did research on the quality of antenatal care; and Le Thi Thanh Xuan did research on quality of care in relation to abortion services, comparing menstrual regulation and abortion. Xuan is still in the process of working on her data, so you will hear more about her research at the next workshop. Since Lam is now in Bangkok to pursue further studies, he could not be here with us today, but we will distribute a written short report from his fieldwork that those of you who are interested can pick up. Finally, two other members of the senior research group, Nguyen Thu Nam and Trinh Van Thang, will conduct a study that commences in October this year, focusing on gender and on sexual violence within marriage. Again, this is one of the topics on the silent RH agenda which we often do not hear much about, but where more research-based knowledge is needed. In addition to the groups of junior and senior researchers, two young Vietnamese researchers, Nguyen Dinh Anh and Nguyen Thi Hiep have also conducted fieldwork in Quynh Luu as part of their studies to obtain a Master’s degree in international health at the University of Copenhagen. Hiep’s research focused on breastfeeding, while Dinh Anh’s research focused on adolescents and how adolescents may learn about sexual/reproductive health issues through the mass media. Hiep and Dinh Anh have just submitted their MA theses in Denmark this week, so next time we meet here in Vinh I hope they will be able to present their findings to you. Both of their fieldworks in Quynh Luu were very successful, and they very much appreciated all the help and support they received from local people and authorities. Finally, we have also had two young Danish researchers working in Quynh Luu, Hanne and Line. I have promised them to convey their deepest thanks and appreciation to you. They felt very warmly welcomed in Quynh Luu and they are still hoping to have the chance to come back again in the near future. At the moment, they are both working on their Master’s thesis in anthropology. After the presentations of (Chi) and Huong this morning, I will briefly present some of the research findings of Hanne and Line. So the last task for me in this presention is to tell you about our plans for the coming year. In early November this year, a Danish professor will come to Vietnam to teach a short course on anthropological research on children. As you know, even though the main focus of our research is on reproductive health, the project also covers issues related to population, family and children – and we find that in Vietnam at present, particularly child research is of great importance – and it is still a quite new field of research. This is the reason why we have invited a Danish professor with much experience in the field of child research to come to work with us in the fall. The short course will consist in four parts: an introduction, a short fieldwork, a follow-up course in January, and the writing of articles. We have not yet made detailed plans for the fieldwork at this course, but some of the researchers may come to Quynh Luu to conduct their fieldwork. We also hope that some of you from Nghe An will be able to join the course with us. Our funds for the first phase of this ENRECA project will run out next summer, so another important thing we will do in the coming year is to write an application to Danida for a phase two of the project. We very much hope that Nghe An people and authorities are still able and willing to participate in the planning as well as the implementation of the second phase of the project. The application will be written in the autumn of this year and submitted to Danida by March 1.
During the initial talks we have had in Hanoi about the second phase of the ENRECA project, it has been suggested that in this phase we should focus on equity and marginalization – as you all know, the development process in Vietnam is very well underway and living conditions are improving for most people. In this situation, it seems important to ensure that development does not become the privilige of only some sectors of society, but that everyone is included in the development process. It is therefore also important to conduct research that can help policy-makers and planners include everyone in the building of families and societies – women on an equal footing with men; people with different cultural or religious orientations; the unmarried as well as the married; the young as well as the old; rural people as well as urban people; etc. In relation to sexual and reproductive health it is particularly important to think about how we can ensure that the poor get as much access to services as the well off, and how we can include the perceptions and experiences of the poor in strategies and planning for health services. So during the last minutes of my presentation here, I would like to ask all of you for your opinions about the planning of future research: what do you think is important to focus on in the second phase, ie. the period from 2005 to 2008? We have time now for some brief comments/suggestion, and after the break there is time for more discussion. (A few minutes for discussion and ideas. Then presentation by Huong on elderly/sexuality and by junior researchers (Chi?) on service utilization among Catholics).
First from Hanne: Hanne’s research was about how mothers take care of young children’s health. She looked in particular at the use of antibiotics. In her fieldwork, she employed many different methods, including case history interviews, observations in homes and medicine shops, interviews with health staff, and focus group discussions with mothers. Hanne found that many mothers, when their children fall ill, first tried to cure them by using thuoc nam. If this does not work, they generally went to a pharmacist or medicine seller to ask advice or buy medicine, or to the health station for an examination. Mothers said that when a child was sick, they simply wanted it to recover as quickly as possible, and they therefore often gave the child medicine, and often antibiotics. They think Western medicine is highly effective, but also harmful, and therefore they try to limit the number of days that a child receives antibiotics. In many cases, therefore, mothers would stop giving the medicine when the symptoms disappeared, and this leads to inappropriate use of antibiotics. When giving antibiotics, the problems in stopping giving the medicine once symptoms disappear are: 1) that children may get too small quantities of antibiotics – even if the illness does go away, the child may fall sick again soon after 2) that antibiotic resistance may result because antibiotics are given too often and insufficiently. This means that in the future, antibiotics may not work anymore. In other words, both for individual children and for the community at large it is very harmful to give antibiotics too often and too insufficiently, as many mothers in Quynh Luu district do. Hanne also investigated where mothers get information about medicine, and she found that they got information at the place where they bought the medicine; at Young Family Club/Women’s Union/Health station meetings; through the loudspeakers or through television. They also received advice from family and neighbours. Based on her research, Hanne contends that many people need to be educated about the appropriate use of antibiotics – not only the mothers, but also the people who sell medicine, in the public and private health systems. However, Hanne also points to the problem that even if drug sellers do try to tell mothers how to use antibiotics in the right way, it is not sure that mothers follow the advice – they may think that the seller is just trying to get them to buy more medicine. So to change the situation, it may be necessary to look more critically at the market for antibiotics and the sources of information about medicine, and public awareness campaigns should be conducted to inform local people about the proper use of antibiotics. Presentation from Line: Line’s research focused on childlessness, and she explored the meanings of having children in rural Vietnam. She found that infertility is not just a medical problem, but also very much a problem that has to be understood in relation to the social system and especially the kinship system. So whereas Hanne’s research had a direct focus on medical and health systems issues, Line’s research focused more on social and psychological aspects of people’s lives. Line found that in rural Vietnam, people’s social identities tend to be determined by their place in the family. She found that women did not have a very strong position in their husbands’ families – and that this problem was aggrevated when they did not have children. The women Line talked to felt that their lives were meaningless without children, only becoming a mother would make their lives have meaning. The women were especially hoping to have a son, to be able to continue the family line; and they felt very troubled about not being able to fulfill their roles as daughter-in-law to their husband’s family. A child is seen as a link to the future – it both secures the parents in their old age, and it also continues the whole kingroup. One childless woman expressed it like this: “I am the one without soul, flying without direction”. Many of the childless couples Line met did not want to start making life plans, or for instance building a new house, before they had a child. Their life projects had stopped. When a couple could not have children, the woman might face many difficulties. First, mothers-in-law would in many cases blame the daughter-in-law for the problem – until medical exaiminations showed that it was actually the husband that had the problems. Only then did they stop blaming their daughter-in-law and start to treat her better. Second, the husband might take a second wife, get a divorce or beat their wife – not always just because he personally wanted to, but also because he was under pressure too, from his family and from tradition. In her research, Line compares her findings from Nghe An to the situation in Denmark. She finds that life and death are understood in very different ways in Denmark as compared to Vietnam. In Denmark people generally think that once you are dead, you are dead and completely away from the world of the living. For people in Denmark, the dead also live on in one’s memory – but Danish people do not think that the ancestors can influence the lives of the living in the way that Vietnamese people think. Line sums it up in this way: you can say that the past (represented by the ancestors) and the future (symbolised by the children) play a greater role in Vietnamese life than in Danish life. In Denmark it is also important to have children, but not as important as in Vietnam, Line finds. Another difference is that in Denmark childlessness is a problem of the individual couple, while Vietnam it is a problem of the entire family. Some of the people Line talked to also wondered about whether perhaps the actions and lives of their ancestors could have caused them their present trouble in life. Line concludes that in Vietnam, the future and the past are more intertwined than in Denmark, where she finds that people live lives that are more independent of each other and also more isolated from each other. In Vietnam, the close relation between the future and the past is held together by the family line – and it is this connection that is lost when a couple does not have children. In Denmark the social system is more individualistic and more concerned with life in the present, whereas the strong kinship system in Vietnam is concerned with the past and with the future, not just with the present. These two different social systems make childlessness into quite different problems in Vietnam and in Denmark, Line concludes. What then could be done to help women who suffer from childlessness? Line has the following suggestions: 1) People in the local community could try to show more compassion with women who suffer from childlessness – as it is now, these women are often met with critical remarks and condemning attitudes, and this makes their problem even worse, 2) Line’s research also points out that infertility problems are closely related to marital problems and marital violence. She therefore suggests that there should be much more IEC informing people and particularly husbands that marital violence is NOT acceptable, and that it should be easier for women to get a divorce – without being socially stigmatized due to the fact that they are divorced women, 3) Finally, Line mentions that better access to treatment of infertility is urgently needed. To receive proper treatment, couples have to travel to Benh Vien C in Hanoi – this is a long journey and too costly and infeasible for most people. As it is now, many people therefore spend a lot of time and money on treatment that does not work. So there should be better access to high quality treatment at more local service delivery points, for instance in Vinh. This was a brief presentation of the main findings of Hanne and Line. As I mentioned, they are still working on their MA theses – once they have finished their writing, I am sure you will hear more from them.
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