How Vietnamese govt. mobilized to beat SARS

Fred Feldman ffeldman at bellatlantic.net
Wed May 7 06:39:21 MDT 2003


I found this a very interesting article.  The open, unembarrassed way the
Vietnamese government combatted SARS is remindful of the open way the Cuban
government has fought to contain the AIDS virus.  And it appears contrary to
the response of the governments in China and North Korea to both AIDS and
SARS.  (I believe North Korea still denies having any AIDS cases.  What do
you think are the odds?)

I think this instance shows how Vietnamese society, for all its poverty and
problems, is still marked positively by the thirty-plus years of national
liberation war that ended in a socialist revolution. This was perhaps the
most sustained mass mobilization of hundreds of thousands and millions of
people in the history of the world.

This incident highlights the fact that the close ties between Vietnamese and
Cuban governments are based on more than the fact that they fought together
in the good old days.
Fred Feldman

How Vietnam Halted SARS
By SETH MYDANS


ANOI, Vietnam, May 5 - Doctors and nurses clustered around the bed of Nguyen
Thi Men when she emerged in mid-March from a nine-day coma, urging her to
stay alive.

"Breathe, breathe," they said. "Keep trying. Your husband and your children
are waiting for you."

She heard them and she tried, although she felt as if she were drowning, she
said in an interview this weekend at her home.

"I saw a lot of doctors looking at me and it really raised my spirits," she
said. "So many people looking after me. I was very touched."

What she did not yet know was that they had gathered to view a miracle. She
was the only survivor from among the six most critically ill patients
infected when SARS broke out in the Hanoi French Hospital more than two
months ago.

Her survival became a hopeful symbol for Vietnam, which on April 28 was
declared by the World Health Organization to be the first nation to contain
and eliminate the disease. Vietnam earned that distinction by going 20
straight days without a new case after recording 63 infections, including
the six critical cases. Five people had died.

"Vietnam has been able to show the world that there is hope that SARS can be
contained," said Pascale Brudon, the World Health Organization
representative for Vietnam.

The country's success was not a miracle, said Aileen Plant, who led the
fight against SARS in Vietnam for the World Health Organization. "This was
real, old-fashioned infectious disease containment," she said. "It all comes
back to the same thing, which is stopping infected people from infecting
other people."

After a crucial meeting on March 9 with members of the World Health
Organization, the government decided to fight the outbreak openly and
aggressively, Ms. Plant said. A task force was formed, information gathering
was centralized and virtually the whole government was mobilized to deal
with the infection and its consequences.

"It was the speed, the leadership, the transparency, the flexibility, the
intensity with which they educated people what to do," she said. "It all
sounds a lot easier than it is."

Vietnam's luck was that the disease had entered the country through just one
infected person, an American who brought it from abroad. The Vietnamese
capitalized on this luck by moving fast to confine the outbreak to the
hospital.

That patient, Johnny Chen, a 50-year-old businessman, came to Hanoi in late
February after a stay at the Metropole Hotel in Hong Kong, where many of the
early cases were contracted.

He fell ill and was taken to the privately run Hanoi French Hospital. He was
later evacuated to Hong Kong, where he died. His illness was first
identified as a new and unknown disease by a World Health Organization
doctor, Carlo Urbani, 46, who later died of SARS himself.

At the urging of Dr. Urbani and his colleagues, Vietnam closed the hospital
to new patients and visitors on March 11. Most of the hospital's staff
remained inside, some falling ill, others watching their colleagues sicken
and die.

"The net effect probably was that they gave SARS to each other and not to
the outside world," Ms. Plant said.

Ms. Men, 46, is a pediatric nurse at the hospital, but she often helped out
in other wards. It is impossible to know exactly how she was infected, but
on the evening of March 1, she said, she spent some time in the room of Mr.
Chen, who was critically ill.

In the following days she began to suffer headaches, fever, diarrhea and
exhaustion. "It was strange," she said. "A strange, overpowering tiredness."

When she checked herself into the hospital, two other nurses had already
fallen ill, but, she said, "it never entered our heads that we could die."

They were friends in nearby beds and they joked, they gossiped, they sang
and they left their rooms to wash their hair. But they grew sicker. One
nurse, Nguyen Thi Luong, who would be the first to die, was put on a
respirator in the next room. Ms. Men could hear it, "Beep-beep, beep-beep."

As the hospital's doctors and nurses were falling ill, the government was
coming to grips with the crisis.

It formed a steering committee, led by the health minister, that reported
directly to Prime Minister Phan Van Khai and involved the departments of
transportation, customs, finance, education and the interior as well as
medical experts.

Provincial officials were ordered to file daily 4 p.m. updates. They were
told to isolate patients and send them to two designated hospitals in Hanoi.
Two suburban hospitals were prepared as isolation centers in case they were
needed.

Health workers traced and monitored hundreds of people who had interacted
with workers or patients at the hospital, including one "very friendly" man,
the father of a patient, who had more than 120 close business and social
contacts.

Each of these people was visited every day, said Huang Thuy Long, a steering
committee member who heads the National Institute for Hygienics and
Epidemiology.

An immigration screening system was set up, soon to be bolstered by seven
$50,000 infrared machines at airports and border crossings to detect people
with high temperatures, Mr. Huang said. Hundreds of electronic thermometers
are being bought for use by immigration agents.

He said 2,000 Vietnamese students studying in China would be isolated for 10
days whenever they returned.

Health experts say there are sure to be more cases of SARS as travelers pass
in and out of Vietnam.
The challenge for the government will be to identify and isolate them
quickly, as it has now learned to do, before another epidemic is touched
off.

The Hanoi French Hospital, in which the outbreak was contained, has
transferred the last of its patients to another hospital and is being
thoroughly disinfected.

The walls are being repainted, the carpets are being changed and medical
equipment is being steam cleaned.

Ms. Men desperately wants to go back to work when the hospital reopens, but
it is not certain that she can.

She is still weak and short of breath, and her right leg, immobile during
her coma, is painful and has lost some of its function.

When she emerged from the coma six weeks ago, she said: "I couldn't even
recognize my own body. It wouldn't do anything I wanted it to. It seemed to
belong to someone else."

There was pain everywhere, as if she were being tortured.

"The doctor told me, `Now everything depends on you,' " she said. " `You
have to try hard to breathe.' "

Before he removed the tube that had been forcing oxygen into her lungs
through an incision in her throat, she practiced breathing, in and out, as
if the training wheels were being taken off her bicycle.

"I felt that I was drowning," she said, "like somebody was pushing me under
water."

Her doctors stood over her, the only colleague they had managed to save.
"Keep going, otherwise all our work will be wasted," she said they told her.
"That made me stronger. That made me feel that I was living for other
people."

At home with her husband, she has two small daughters to raise. She also has
two grown sons. At work she has newborns to care for.

"I want to go back and see my friends and start my life again," she said. "I
like my work. It's a happy job." A few days ago, one month after she was
discharged, a doctor checked her lungs and found severe scarring. He could
not tell her how well she would heal or how long it might take.

At the end of the interview, as her 7-year-old daughter jumped rope outside,
Ms. Men limped to a dresser to fetch a certificate from a long-distance
race.

It will not be enough for her to walk again, she said. Ms. Men is a
competitive runner.






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