Fieldwork in Sop On, Khammouane Province of Lao PDR

The Khammouane Province is located in the middle of Lao PDR and has a total area of approx 16,135 square kilometers. The total population of this province is about 330,000 and Thakhek is the provincial capital, and it borders to Thailand across the Mekong River in the west and Vietnam in the east. This province has a fertile land suitable for agriculture. Most of its population are farmers and comprising some minority groups of Phuan, Phoutai, Tahoy, Katang and Kri.

The Khammouane Province has nine districts, of which I visited Nakai and Gnommalath, housing each a district hospital. The difference in standards, equipment, economical situation, and even in medical practice, differs a lot between hospitals found on the district level from the larger and relatively better equipped provincial ones, like in Thakhek. The lowest level of the official Lao health system will be found in Community Health Centres in the rural areas, where “traditional medicin”, healers and Tradition Birth Attendants without any formal education, can be incorporated into the health system in order to make a difference.

It should be mentioned that Lao PDR is one of the poorest countries in Southeast Asia. The consequences of an injury or illness may be worse in a low-income country than in a high-income country, since the healthcare system in many low-income countries relies heavily on “out-of-pocket” financing, meaning that the person seeking medical attention pays the costs himself. This type of unsubsidised financing may be devastating for a family living on a low income and facing medical expenditures. Either one seeks medical attention and pay the relatively high costs, or do not seek costly healthcare and risk one’s health and income for the family.

An injury or illness could easily make a person an economical liability for the family in many low-income countries. Seeking medical attention in low-income countries may also make a person owe a debt for medical expenditures. The financial barrier that faces poor people may hinder medical access and continuation of treatment in many low-income countries. In a sense, this could also affect the country’s workforce, productivity and economical growth. In a high-income country taxation or insurance policies can subsidise medical expenditures.

During the Karolinska Institute’s Global Health Course in Lao PDR, I visited the district hospitals in Nakai and Gnommalath besides the Provincial hospital in Thakhek. Fieldwork in the village of Sop On was performed as a thorough review of families in the village and its Community Health Centre. The fieldwork I and two medical students performed in Sop On, included interviewing a family about their situation concerning: water & sanitation, food, shelter, healthcare and security. All photos are from that interview on 4 January 2012, picturing their living conditions.

On the first photo, I’ve pictured the fairly newly built house of the family I and two medical students interviewed. Sop On is a resettled village due to a newly built dam, and all the houses are better than in the old village, funded of course by the company building the dam.

The second photo shows the me to the left, the husband and his wife, and the interpreter in red, while interviewing them. Photo number three pictures the sleeping quarters of the house, the mosquito net that’s used by night, is clearly seen here. Malaria and Dengue fever are easily prevented with mosquito net and mosquito repellents.

On the fourth photo, the living room is pictured. This family had a TV set and also a DVD-player, most probably funded by the company that built the dam! The house got a tin roof and was not wind proof, but it was still better than the old one. The sanitation facilities was also funded by the company that built the dam.

The last photo shows the kitchen of the household, that’s hardly wind or water proof, and without all of the equipment and comfort found in a kitchen in a high-income country.