Impressions from rural Laos
Robert G Lee MD
Department of Clinical Neurosciences
In January 2012 my wife and I spent one month in Laos as part of the University of Calgary – Laos partnership project to improve medical education and train family doctors to serve in the rural areas of Laos. The family medicine training program has been very successful and has now produced more than 100 new family doctors in Laos since its inception in 2006. Most of my time during this visit (my 16th trip to Laos since 1999) was spent in the southern city of Savannakhet (SVK), one of the provincial training sites for the family medicine (FM) program, where I worked with other colleagues from Calgary and our Lao partners to conduct the end of year evaluations for first- and second-year FM residents. I also helped the Lao teachers conduct the orientation for the new batch of residents who are just starting the program.
Since a substantial part of the FM training takes place in rural villages and district hospitals, we were interested in visiting some of these sites. For three days in late January we travelled to the eastern regions of SVK province with Dr. Phetvilay, a remarkable young woman who was one of the first graduates from the FM program and who now serves as the coordinator for family medicine training at the SVK provincial hospital.
We visited four district hospitals. Family Medicine graduates are working at three of them. Our first stop was at Phalansay, Phetvilay’s home town – about two hours east of SVK city. This is the place where dinosaur footprints and some fossils have been discovered and we learned that it was Phetvilay’s father who actually first discovered the footprints and arranged for French paleontologists to start investigating.
From there we headed farther east to Phine where we stayed overnight. There is a district hospital there which has been renovated with funding from CIDA. It is clean and well maintained with mostly single rooms and en suite toilets for the patients – something we have not seen before in Laos. The hospital director is the only doctor but he has three medical assistants working with him, one of whom has some training in anesthesia so they are able to do Caesarians and other emergency surgery. It would be an ideal place for a family medicine grad to start working.
The next day we travelled up part of the old Ho Chi Minh trail to a town called Virabouly where there is a district hospital with one of the FM grads working there. Along the road to this town we passed several Lao Teung villages, one of the ethnic minority groups in that part of Laos. We stopped at one of these villages to look around and take some photos. It was interesting to note that there seemed to be only one man in the village who spoke Lao and was able to communicate with Phetvilay. The poverty was even more obvious than what we have seen in other parts of rural Laos. We had a long discussion about this after we left and I asked Phetvilay what she would do if she were a senior government official and had a lot of money to improve the standard of living in villages like this. Without any hesitation she said she would put it into education. She said that as long as people in villages like this remain uneducated things will not change.
Our next stop was in Sephone where there is a good district hospital which has been renovated with assistance from Belgium. We met the director who took us on a tour of the hospital, and it was an impressive facility. One of the FM grads is working there but he was not around at the time of our visit.
From there we headed on to the Vietnamese border where we had lunch. This part of Laos is mostly scrub bush with no large trees – a reminder of the extensive defoliation from agent orange and other chemicals used by the Americans during the war. Along the way we had an interesting lesson from our driver on the different types of development assistance. The road from SVK city to Sephone is in terrible condition – full of potholes and broken pavement. From Sephone to the Vietnam border the road is as good as the Transcanada from Calgary to Canmore. Our driver told us that the eastern section had been built with assistance from Vietnam who sent in their own engineers who supervised the construction. The section from Sephone west to SVK city was built with assistance from Japan which gave the money to Laos and let them do it on their own – draw your own conclusions!
The following day we visited another district hospital at Songkhone, a town about 70 km south of SVK city. This is a fairly new hospital which was built about five years ago with funding from JICA (Japan). The director and one of the FM grads who works there took us on an extensive tour. This is an impressive facility – like the hospital at Sephone, they do about 50 deliveries and 20 surgical procedures a month, and have a busy out-patient clinic. Both hospitals would be very good training sites for FM residents. Phetvilay thinks that, with the family medicine program expanding to three years, that it might be a good idea to add one or two more district hospitals as training sites – I fully agree.
For more photos, please visit: http://robertlee.smugmug.com/Travel-International/Laos-Jan-2012/21034273_VZX29T#!i=1672300763&k=vMDwQPJ