From 1999 to 2000, Nguyen Thi Minh Chau and Julie Yoder worked together through the Disability Forum, an advocacy group based in Vietnam that focuses on the rights of disabled people. They individually responded to two questions posed by the Carnegie Council and we compiled their responses here.
Dialogue: Do people in your community, or in Vietnam in general, recognize that they have human rights? When poverty, environmental pollution, and pesticide contamination lead to serious health problems, do people believe their are rights being violated?
Nguyen: Vietnam has been a member of the United Nations since 1977, and it ratified the International Bill of Human Rights in 1982. For people to recognize that they have rights, they need access to relevant information and education. In my small community of health care providers, people are very much aware of human rights, but farmers and minorities in rural and remote areas know much less. Their only source of information about human rights is what they hear from their local authorities or over the loudspeaker-a medium of public education still used by the government.
Generally speaking, the Vietnamese people believe in luck and destiny. To the best of my knowledge, most people in Vietnam do not believe that health problems are human rights violations. They know that Vietnam is a poor and densely populated country, and that the government still needs time to recover from wars and other past events. Natural disasters, including floods and typhoons, are common occurrences that contribute to poverty, and people recognize that these forces are out of the government's control. The Vietnamese believe that their government is trying to give them the best life. The Ministry of Health (MOH) has been working for years in order to provide universal medical care for the poor.
Yoder: We have a mutual friend, an incredibly dynamic, educated man from central Vietnam, who was paralyzed from the waist down by a medical accident. His response was that, yes, something bad had happened, but why should he blame the doctor? It is better to move on from a bad experience than to dwell on it. Many Vietnamese continue to believe in fate-a concept that does not fit well in the language of rights. However, there does seem to be room for change. We have worked extensively with Vietnamese who have disabilities, enabling them to meet other disabled people from around the world through visits to international conferences and training seminars. When they see that others have succeeded in protecting their human rights in their own countries, many of our patients realize that they do not have to be passive and accept the destiny that they previously perceived. They develop the confidence that they too could shape a more fulfilling path for themselves and for other Vietnamese citizens with disabilities.
Dialogue: How do health care practitioners in Vietnam advocate for change? Do they make use of human rights norms, concepts, or language?
Nguyen: Most health care providers are university educated, so we are familiar with both human rights and governmental policies and regulations. If a health care provider disagrees with a policy or regulation, she is free to express her opinions to government officials either by mail or in person. In addition, whenever the government drafts a new regulation, it always consults officials from various levels as well as the people.There are offices called "Receive People" at ministries, government agencies and state hospitals all over the country. These offices are places where patients and health care providers can meet with competent government officials to share their comments and opinions about problems related to health and health care. Moreover, anyone can submit her opinions, suggestions, and complaints to the Vietnamese National Assembly, which is the highest representative organ of the people and the highest organ of state power.
Vietnam's constitution provides for this exchange of views in describing the duties of the National Assembly deputies: "The deputy to the National Assembly must maintain close ties with the electors; submit himself to their control; collect and faithfully reflect their views and aspirations for the consideration of the National Assembly and the State organs concerned; maintain regular contacts with and make reports to the electors on his own activities and the National Assembly's; answer the requests and proposals of the electors; examine, activate and keep track of the way citizens' complaints and denunciations are dealt with; and give guidance and assistance to citizens seeking to exercise their rights."
Yoder: Health care practitioners in Vietnam are often so caught up in their own fight for survival that they are neither interested in, nor able to improve, the living conditions of others. Keeping your job is often a priority, which makes genuine criticism of the government rare. Most health care practitioners are also government employees, so there is little room for distancing oneself from the state sufficiently to call for change. One difficulty is that a voice for change has to acknowledge that the present situation is not ideal. While there is a presumed acceptance of "self-criticism" in the government, the underlying reality is that a person who speaks out will either be given a warning or be removed from his position. Advocating on behalf of others is not something that is done at the expense of one's own well being, though there are the exceptional few who speak up if, for example, their households have people with disabilities or if they have a close friend with a disability.
There is little possibility of creating a collective voice powerful enough to be heard. People with disabilities have few chances to interact with others, since many stay at home alone and are never sent to school. There is also a feeling that the family should take care of its own-that a family has had some "bad luck" in having a child with a disability, and that it is their lot in life to deal with this fate as best as they can. Looking beyond the family for help is not a natural step, and demanding change is beyond the presumed capabilities of many.
In my opinion, linking inadequate health care to the violation of human rights would simply not be well understood in Vietnam. Furthermore, "human rights" is a term that is, by its very nature, considered pro-Western by Vietnamese. It is a concept that stands in opposition to government values and is thus taboo. In fact, expatriates working in Vietnam become so guarded in their speech that we avoid rights in everyday conversation. It is a tradition at the NGO Resource Centre in Vietnam for departing expatriate workers to discuss what they learned during their stay. I witnessed one of those sessions when, after her remarks, one woman said simply: "When I think of ethnic minorities in the highlands, I cannot help but to think of human rights." There was a moment of complete silence. The silence could be interpreted as shock at the public pronouncement of such a forbidden term. Or perhaps the silence meant that the group knew exactly what the term meant and why it was forbidden.