LAOSの感想

あれこれ感想をきちんとHPにまとめたいのですけれど、時間がないので、こっちにアップします。

感想文です。ちょっと読みにくいですが、すみません～

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Difficulties in global health I learned in Lao PDR

　　I didn’t know anything about Lao PDR at all before.  But I wanted to know the reality of MCH situation in developing country.  That was my biggest motivation to decide to attend when I knew the information of this Study-Tour. 
　　I am just a medical student, no experience in the field, no special knowledge about pediatrics, and this is my first participation of “Study Tour.”  So I felt anxiety a little bit, but my eager feeling to see real situation of the field exceeded only studying books in Japan.

 　Through this study-tour, I could have many precious experiences.  To visit several hospitals including different types of hospitals in Lao health system, to meet special working people in organizations like University, Health Office, WHO, UNICEF, JICA, research facilities and NGO (Mekong-Watch), to go to the field to see with my own eyes and so on.  One-week visiting is too short to study enough about health situation in Lao PDR. But Lao PDR became a “close” country for me in a short stay.

 　I was surprised or shocked with some facts I knew during Study-Tour.  For example, 90% of women give birth at home, high rate of MMR, 3800 deliveries/year at MCH hospital, 800g baby could survive without respiratory-machine, health insurance system is not working, 2 Avian-Flu cases last year (both died), lack of manpower and equipments, etc.  But if I will raise the most impressed things, I’d like to say, I have 2 points in my mind now.

 　One point is that an inequality of health service is existed between hospitals.  In one hospital, every patient has to pay any single cost like a pair of rubber gloves.  On the other hand, one hospital pays the cost in behalf of very poor patients who can’t afford.  And plus, hospitals get aid from different foreign organizations independently.  It makes a gap the quality of services and facilities among hospitals.  Then hospitals become to have own financial stance depends on their situation.  Separating roles of hospitals is important to work efficiently each other in budget & manpower limited situation, but this gap lead to inequality to access to health service for poor people. 
　　I thought I wish there were health insurance system and well- arrangement of aid from foreign countries at the time.  After visiting hospitals, I could hear that the health office people were starting the trial of health insurance system in 5 provinces and JICA had one project focused on arrangement of donor-recipient relationship about international aid.

 　In rural villages, inequality is much remarkable because of geographic factors.  I visited one health center where only 2 or 3 nurses posted there.  A nurse of that health center said most of mothers in the village gave birth there, in the simple examination room.  I heard referral system was not sufficient, some villages didn’t have road-access and not every village had health center like this village. 
　　Thinking about the main cause of mother is hemorrhage, adequate diagnosis of complications before birth and cooperation between village-district-province-central hospitals are key factors to save both mothers and children.  For that reason, well-trained health stuff, ANC and health service network system plays important roles.  I was so confused because many factors were combined each other too much to solve these situations.

 　So I could understand that providing equal health service in whole country is “really difficult” to realize, in terms of manpower (medical education), facilities, financial support and infrastructures.  I liked this word “Access to health for all” so far, because it sounds fair, and I thought it showed the respect for human-basic rights. However, I could learn that very long way existed in front of that word.  Instead of this finding, I could know that many people worked to solve these difficult situations.  JICA operates many projects in Lao PDR, also WHO has their own strategy and UNICEF also.  I cheered up with knowing many people’s efforts very much.

 　Listening to many organizations’ people talking, I keenly realize the importance of evaluating results.  This is my second impressive point.  Nam Ngn Dam story from Mekong Watch told me the relationship between economical impacts and environmental damages.  Not only Nam Ngn Dam, but also every project needs deep-consideration whether this project really contributes to the people and community both in a short term and long term. 
　　Pro. Kuroiwa taught me the risk of dumping AD syringes after vaccination.  I must always keep in mind that any good activity (I thought) may have not only good effects.  Sometimes it may have bad effects from different point of view.

 　I’d like to express very-big appreciation to Pro. Kuroiwa and other staffs of Tokyo University who coordinated this Study-Tour, many wonderful teachers who gave us lectures and introductions from various organizations, tour members who shared fun time together, and every friendly person I met in Lao PDR.

 My motivation to become a pediatrician and contribute to people of developing counties grows much bigger after return to this trip.

 I hope to meet you all in some place of the world again. 
Thank you very much!!

YUI　YAMAOKA　5th,August,2008