|Once Ebola arrives, it will spread incredibly fast.— Photo vov.vn
by Lady Borton
At some point, Ebola will arrive in Viet Nam as an uninvited guest.
Once Ebola arrives, it will spread incredibly fast.
Because of Vietnamese culture.
Let me give some background.
In February 2003, Viet Nam was the first country to address the SARS (Severe Acute Respiratory Syndrome) epidemic. SARS had begun in southern China, spread to Hong Kong, and then from Hong Kong to Viet Nam by way of a single visitor arriving in Ha Noi. He was hospitalised at the French Hospital, the premier foreign hospital in northern Viet Nam. The French Hospital, the WHO office in Ha Noi, Bach Mai (one of Ha Noi's premier Vietnamese hospitals), and the Vietnamese Public Health System responded with exemplary speed.
Despite these efforts, we lost the Hong Kong visitor to SARS. We lost the head of WHO in Viet Nam to SARS. We lost an esteemed French-Vietnamese doctor returning to his homeland for the first time to SARS. Those two international health workers were treated in the French Hospital. Several of the Vietnamese health-care workers who had treated the Hong Kong visitor also caught SARS, but they survived. The Vietnamese were all treated at Bach Mai Hospital.
Why did they survive? My thesis is that Bach Mai had an open-air ventilation system, instead of a closed system of air-conditioning. By devastating coincidence, the French Hospital's closed system used a temperature particularly appropriate for further propagation of the SARS virus.
But we must understand this: The SARS epidemic in Viet Nam would have been devastating had the initial case been a Vietnamese person.
In Viet Nam, when someone is sick, the patient's friends and family all come to visit, bringing oranges and condensed milk and warmth, support, friendship, and love. Had the initialSARS case been a Vietnamese person, the spread of the virus would have been phenomenal?
Despite precautions, all SARS cases in Viet Nam were health-care workers, except one.
SARS jumped from the French Hospital to Ninh Binh, which is a hundred kilometers south of Ha Noi. A senior provincial leader caught the virus at the French Hospital while visiting his daughter, who was recuperating from an appendectomy. I heard about this "jump" very early, before the news was public, because I happened to have supper at the house of a medical worker.
Within hours, the airwaves bristled with announcements searching for anyone who had visited the Ninh Binh provincial leader, whose name, position, and home address were announced.
Public health workers rounded up everyone who'd had any contact with the new patient.
The French Hospital was quarantined, controlling the spread. An electrician from Hai Duong Province east of Ha Noi had been working in the French Hospital. No one at the hospital knew his name. Vietnamese public health workers went to every district in Hai Duong Province until they found the "unnamed" electrician. He was quarantined along with his family until health officials could determine that everyone was safe.
Effective public health initiatives contained the SARS virus in Viet Nam. Other cities—Toronto comes to mind—were not as attentive.
Over the years, I have shared that analysis about SARS with anyone in the medical community who would listen. No one has challenged this analysis.
What about Ebola?
Ebola is insidious. We now have several cases in the United States involving medical personnel, who were wearing full protective gear (but not sufficiently protective) yet caught the Ebola virus. The slightest contact with the Ebola virus brings gruesome results. A person with the earliest Ebola symptoms (fever, aches, sore throat), which are like the symptoms of a head cold or flu, can be unintentionally spreading the disease before it is diagnosed.
Ebola will spread fast in Viet Nam unless we address several behaviors:
1. Visiting the ill: The wonderfully warm Vietnamese custom of visiting the ill now becomes dangerous. Sitting on our sick friend's bed, picking up nearby objects, hugging, kissing the patient's cheek, holding our friend's hand—all these behaviors can become life-threatening in the Season of Ebola and also be of concern for other viruses. We would do well to address that wonderfully warm custom of visiting the ill.
2. Greetings: Shaking hands and kissing a friend's cheek can become dangerous. When we were addressing SARS, I asked cultural researcher Huu Ngoc about greetings. He pointed out that shaking hands and kissing a friend's cheek are Western customs. The traditional Vietnamese greeting is a slight bow, with the hands clasped together in front of the chest.
We could prevent transmission of illness by returning to the traditional Vietnamese bow.
3. Chopsticks: Here's terror. Ebola is carried by bodily fluids. Saliva is a bodily fluid.
Think about how we eat in Viet Nam. Using chopsticks, we dip the "eating end" into a common serving dish, then into our mouths (into our saliva), then into the serving dish.
Suppose I am carrying the Ebola virus, but don't yet know it. Suppose I have organised friends to come for lunch. I'm not feeling so hot, but I don't really feel sick. I gargle for my sore throat and take aspirin, which controls my slight fever, but of course aspirin does NOT stop Ebola. My friends and I eat from the same serving dishes. Like everyone else, I am using the eating end of my chopsticks (with my Ebola-active saliva on them) to dip into the serving dishes. Even worse, as a gracious host, again using my chopsticks' eating end with my Ebola-active saliva, I drop morsels into the rice bowls of my guests.
With my chopsticks, I unintentionally spread the Ebola virus from my saliva not just to the commonly used serving dishes but even into each guest's rice bowl.
Then my guests go home, taking the Ebola virus to their families.
What to do?
We can return to "Viet Minh chopsticks."
"Viet Minh" refers to the movement established in 1941 by the Communist Party under the leadership of Ho Chi Minh, founder of the modern Vietnamese state, to widen the revolution and include patriots who were not communists. Ho Chi Minh was a great public health advocate. I do not know whether "Viet Minh chopsticks" originated with President Ho, but I've heard many of the Vietnamese who were activists in the 1940s say that when they were in the mountains, they learned to use one end of their chopsticks for eating and the other end for serving. At that time, these Vietnamese were adept at rotating chopsticks with one hand.
In prevention, should we use "Viet Minh chopsticks"?
We need to keep talking about Ebola (and in general about viruses like Ebola and SARS) and change our behavior before we have a problem. We foreigners need to pitch in to support the Vietnamese public health system to educate through radio, TV, the internet, and newspapers.
We need to do the prevention now, before uninvited Ebola arrives.
Prevention is cheap compared with the financial costs (to say nothing of the emotional trauma) of treating one case of Ebola or one case of a virus like SARS.
Of course, whenever we have a cold, the flu, or other possibly contagious symptoms, we should stay home and avoid other people through work and travel. Ebola is not the last epidemic.
With globalised travel, we will have other outbreaks of new, uninvited guests.
We have all seen the wrenching tragedy unfolding in countries of western Africa and now spotting in Europe and the United States. We need to draw upon our compassion, our health-care resources, and our fund-raising to help those whom Ebola has besieged.
We need to look within the different cultures in our various communities and countries to define the cultural behaviors that are dangerous in the Season of Ebola and other uninvited guests. For example, do Chinese, Japanese, and Koreans also use only one end of their chopsticks, or do they eat with one end and serve with the other end?
We don't have Ebola in Asia.
We would do well to change behaviors now to stop this and other uninvited guests, as Viet Nam did with SARS. Waiting for Ebola to arrive before acting is too late. — VNS
* Biography: Lady Borton has received four honorary degrees for her work on all sides during and after the American War in Viet Nam. She brought to Viet Nam and disseminated the first foreign materials about HIV/AIDS. She conceived the intervention model for Agent Orange/Dioxin after the 10-80 Committee (Viet Nam)/Hatfield Consultants (Canada) first identified "hot spots" of residual wartime dioxin in A Luoi District west of Hue. Lady organised the first visit by Westerners to the Da Nang site of Agent Orange/Dioxin, which she had seen during the war.