Health Care in Vietnam and Laos

	Vietnam	Laos	USA	Australia
Population	82 million	6 million	303 million	21 million
GDP (Purchasing Parity)	$2310	$1740	$44,070	$33,940
Life expectancy (M)	69	59	75	79
Life Expectancy (F)	75	61	80	84
Health Expenditure (USD)	$264	$85	$6714	$3122
% of GDP	6.6%	3.6%	15.3%	8.7%

Source:  http://www.who.int/countries - most numbers 2006

It was hard for me not to think about health care while traveling in Vietnam and Laos. Some of my fellow riders thought that these communist/socialist countries would of course provide cradle to grave health care to their populations. In fact, both Vietnam and Laos are developing nations, and as is typical of countries with relatively low GDPs, they have a primarily “out of pocket” payment system.  Both countries also have relatively little health care facility capacity, especially in rural areas.  Lonely Planet says about Northern Laos “for any serious illnesses consider flying to Bangkok” and warns that air evacuations can cost upwards of $100,000.

Our Laotian guide told us that if he or a family member were very sick, they would not seek care at a hospital, because it is just too expensive. The danger of pauperizing the family is too great.  A masseuse in Vietnam asked me, out of the blue, whether health care was “free” in a rich country like America. The ironies abound.  Vietnam (he told me) offers free care to children up to age 5. After that, city-dwellers can purchase insurance, and for others care is on an out-of-pocket basis.

During the second to the last riding day, one of the riders called forward to the two physicians to turn around.   A 6 or so year old boy had been hit by a pickup truck/taxi (we thought – although in retrospect it seems more likely to me he fell out of the back of the pickup).  An adult male had already rushed him (neck flopping – we were aghast considering the important role of neck stabilization to avoid spinal chord injury) and some of the onlookers were offering him a bit of rice whiskey (another clinical no-no, since it would make it more difficult to assess mental status). 

We examined him briefly – his brief neurologic exam was OK, he was able to move all extremities, and his abdomen was not tender.  He had a superficial scalp wound, and a nice lump on his back scalp.  We couldn’t have a verbal conversation with him, but he appeared to be answering questions appropriately.  There is relatively little traffic in Laos (compared to Vietnam) – and I’m guessing kids falling out of (or being hit by) cars is rare despite the rural villages clustered around the poorly marked roads.   We gave him some ice for the scalp bruise, and went on our way.  It’s not at all clear what we could have done if he appeared to have a ruptured spleen or a brain bleed.

Along the side of the road, most huts in Laos had an outdoor water faucet and a drain.  I believe this was the result of an NGO-government program to provide safe drinking water to the villages.  As much as I see a potentially tragic lack of access to medical care in rural Laos, it makes sense to prioritize public health needs like safe drinking water first.