RESULTS OF SURVEY AND STATISTICS OF THE GENERAL (F2) OF DIOXIN’S VICTIMS IN NAM DINH AND QUANG NAM PROVINCE AND SOME RECOMMENDATIONS

Currently, there is no nationwide census on subjects infected with Agent Orange/dioxin. However, the investigation was conducted in a number of provinces and cities across the country where there are a large number of people infected with Agent Orange or where Agent Orange residues are still of great importance. Through the results of the investigation, the State will issue policies and regimes for people infected with Agent Orange in general and policies on health and medical care for AO in particular. The investigation, survey, and statistics of the descendants (F2) of the victims are of urgent and practical concern from the provinces, cities as well as the Vietnam Association of AFFs/dioxins. The study was carried out based on the design of a questionnaire that has successfully investigated and processed statistical data in the provinces: Nam Dinh, Quang Nam, Ha Nam and Quang Tri. The article analyzes and evaluates the results achieved in 2 provinces: Nam Dinh (specifically the northern provinces) and Quang Nam (specifically the southern provinces) to serve as a basis for promulgating the support regime. society in general and health care in particular for these subjects. Basically, the results of this study can extend the same application to provinces and cities throughout the country.

1. INTRODUCTION

As early as the 70s, studies on Agent Orange/dioxin during the war in Vietnam confirmed the harmful effects of this poison not only on people who were directly exposed, but also on people who were directly exposed to it. their children, grandchildren and subsequent generations [1,2].

On April 3, 1998, the Government issued Decision No. 74/1998/QD-TTg to carry out a nationwide census for subjects exposed to CRC/dioxin during the war to determine the total number of victims. Agent Orange-contaminated patients, thereby serving as a basis for policy-making for AO/dioxin in Vietnam. This survey was carried out in two years 1998-1999 and supplemented in 2002 and 2004. Although the surveys have achieved some results, they have not yet achieved the set objectives (in terms of nature)., scale, object, time, space, reliability, criteria, approach...). Therefore, the objective requirement of a nationwide census on people who suffer the consequences of VOCs/dioxins used by the US during the war in Vietnam is very necessary and has been reaffirmed in Decision No. 651/QD/TTg dated June 1, 2012 of the Prime Minister. However, due to many different difficulties, with many reasons both in terms of subjective perception and objective conditions, this content has not been implemented yet.

While it is not yet possible to carry out a nationwide census, the in-depth survey and survey serve consulting and planning services for ministries, branches and localities according to administrative boundaries. Provincial and city governments have important, practical and feasible meanings [3]. In particular, the survey and statistical investigation of the 3rd generation who are the grandchildren of the victims has practical and high practical significance, which is the concern of the whole society. Stemming from that requirement, research, survey and investigation objectives are set to: Design a questionnaire system for subjects exposed to ACD/dioxin (F 0) and their children and grandchildren (F1, F2).

Through the actual investigation to form the process, plan for survey, investigation, handling and exploitation of statistical data on the victims of CC/dioxin in the province and city, in the immediate future, serving consulting for policy making and operation. taking care of victims, their children, grandchildren and their next generations, in the localities as well as the activities of the dioxin/dioxin community system throughout the country. The study also made requirements to ensure the practicality, objectivity, accuracy and a number of other requirements suitable to the specific conditions in the localities [4].

2. RESEARCH SUBJECTS AND METHODS

2.1. Research subjects

Being a person who was exposed to CBD/dioxin during the war from August 1961 to April 30, 1975, lived in Nam Dinh (representing the northern provinces) and Quang Nam (representing the southern provinces).

In Nam Dinh, the main survey subjects were identified as: the armed forces (soldiers, armed police, security officers, border guards), civil and political party cadres, youth volunteers, people The frontline workers at battlefields B, C, K and 10 communes in Vinh Linh district were identified as areas that were sprayed with IDCs/dioxins during the war (collectively referred to as resistance activists).

In Quang Nam, the focus of the survey was determined to be the people residing in the area with a history of exposure to VOCs/dioxins during the spraying period during the war.

The classification and screening of subjects on the basis of people whose children and grandchildren are affected by diseases and illnesses according to Decision No. 09/2008/QD-BYT of the Ministry of Health on the list of diseases, diseases, deformities and abnormalities disabilities related to exposure to toxic chemicals/dioxins dated February 20, 2008 and the Law on People with Disabilities 2010.

Some bases for assessment and classification of people with disabilities (PWDs) are specifically made according to Circular 05/2013/TT - BLDTBXH guiding the examination and assessment of diseases, illnesses, deformities and anomalies related to exposure toxic chemicals/dioxins.

2.2. Research Methods

- Recovery method: Used to classify and screen on the basis of reviewing records in departments, local mass associations.

- Methods of information collection: It is carried out by building questionnaires and organizing household surveys of target groups: exposed person (F0), exposed person (F1), exposed person\'s grandchild (F2) and the accompanying statistical tables.

- Research method longitudinal, cross-sectional description [5] classified according to figure 1.

- Data entry and processing: Using Excel 2017.

- Method of proceeding: Establishing investigation teams, directly asking and answering on the basis of training, agreeing on criteria and concepts in the investigation plan and plan, taking the district as the investigation unit (after the investigation results are available). test and learn from experience).

3. RESULTS AND DISCUSSION

The process of screening exposed subjects (F ₀₎ in the locality is conducted to review and retrospectively coordinate records between local departments, branches and social organizations directed by the Provincial People\'s Committee, the main agency maintained as the Association of Victims of Agent Orange/dioxin (Nam Dinh and Quang Nam). The results are given in Table 1.

Table 1. Results of identification of households with a history of exposure to pesticides/dioxins during the war whose grandchildren were affected (illnesses, diseases, deformities, deformities)

(Source: Research team conducting the investigation, 2020)

The results in Table 1 show that there is a significant difference in the proportion of affected grandchildren. This can explain the degree of impact of resistance participants in Nam Dinh more concentrated (participants in resistance activities) compared to the community living in the sprayed and spread areas in Quang Nam. (Further studies need to further clarify this difference) [6].

The results of the assessment and classification of the percentage of households with children with sequelae who are meritorious and ordinary people with their standard of living are shown in Table 2.

Table 2. Results of assessment and classification of the percentage of households with children with sequelae who are meritorious, common people with living standards

(Source: Research team conducting the investigation, 2020)

The results in Table 2 show that the people who need attention with children with sequelae in Nam Dinh (Northern provinces in general) are 100% contributors, while in Quang Nam (Southern provinces in general) most are civilians accounted for 62%. Living standards of these households in both regions have improved significantly, with a relatively high percentage of above-average living standards. However, in Nam Dinh, the number of poor and near-poor is higher than in Quang Nam province (not yet statistically significant).

Table 3 and Table 4 is the current status survey results exposed person F0 lost, alive and under age group.

Table 3. Current status of deceased and living exposed persons

in the locality

(Source: Research team conducting the investigation, 2020)

Table 4. Survey results of survivors by age group

(Source: Research team conducting the investigation, 2020)

^(*) Only those who are directly exposed during the war are those who have meritorious services.

The results in Tables 3 and 4 show that most of the exposed subjects who had children with sequelae in Nam Dinh were older than 65 years old, while in Quang Nam the age group under 60 and 60 - 65 years old were still worthy of treatment. account for 33.7%. This can be explained by the prolonged exposure and residual time to the years 1970 - 1975 (or longer) for the southern provinces. In particular, women make up a significant proportion of exposed subjects in Quang Nam, that is, the population in the sprayed area.

In fact, people with meritorious services outside the North were exposed mainly before 1975 and peaked in the years 1968-1972.

Table 5. Exposed persons entitled to benefits and housing

(Source: Research team conducting the investigation, 2020)

The results in Table 5 show that most of the generations of grandparents with children with sequelae in Nam Dinh have received retirement benefits and people with meritorious services, but still have difficulty in housing (77.75% in temporary houses, subsidized housing). 4). In Quang Nam, the number of ordinary people without benefits accounts for nearly 60% and the number of people living in temporary houses at level 4 accounts for over 96%. The difference in subsidy regimes and policies between the two regions is a reality. It is more difficult for people exposed to ICD/dioxin in the southern provinces.

Table 6 is a summary of some basic information about children with sequelae in Nam Dinh and Quang Nam and forms of care.

Table 6. Methods of caring for children with sequelae of ACD/dioxin.

(Source: Research team conducting the investigation, 2020)

The information in Table 6 shows that there is a significant gender imbalance in the children with sequelae, the ratio of girls to boys is 41.57%/58.43%. Regarding gender science, it is important to have more in-depth studies on the causes of this imbalance (this statistic is in contrast to the percentage of PWDs who are female, accounting for over 60% according to some studies in Vietnam). However, in terms of social and health policies, priority should be given to caring for nieces with sequelae, anti-discrimination, as well as for the niece\'s mother. As for the forms of living care, most of the children are currently living with their parents (although their parents are often the ones who suffer from sequelae and have low working ability). The children\'s ability to live on their own is 50%, the rest need the care of their relatives 24/24.

Regarding the form of intensive care and part-boarding, the rate is very low, this figure is in line with the assessments that recommend not to build too many shelters, foster care centers and separate boarding houses for EMs. The fact that the centers operate inefficiently is an objective reality. The community-based model of care for people with disabilities is an advantageous form that needs to be replicated [7].

In addition to the conclusions mentioned in the above tables, the survey also gives very useful information about the age groups of children in different areas for different subjects and the structure of diseases, disabilities, disabilities, anomalies. disability, deformity. These statistics are of a qualitative nature and have not been subject to in-depth survey of medical professionals, but are of reference value, orienting exploration for further studies, notably:

- Firstly, about age group: according to that, children under 6 years old account for 10-20%; children between 6-18 years old account for 60 - 70%; Children over 18 years old account for 15 - 25%

- Second, about sequelae (relatively positive classification by function, with photos attached to the Profile), specifically:

The number of multiple defects from the two groups above accounts for about 50% and the 4th generation (F ₃₎ is the great-grandson of the exposed subjects (F ₀₎.

* Other information:

From the documents obtained in the Questionnaire system, it is possible to synthesize with different approaches with appropriate software information about occupation, religion, education level, victim\'s aspirations, caregivers, family and maternal circumstances, disease structure of generations, number of victims in the household, statistics by district, etc. (list of general statistics tables, form of questionnaire survey questions in the attached Appendix).

From the above survey results, it is shown that FSWs/dioxins have extremely difficult circumstances, they are the poorest of the poor, so they need the joint support of the whole community. Especially these are the subjects with serious diseases that require health care. Therefore, implementing health care and improving the effectiveness of health care for this population is necessary and deserves the appropriate attention of the Party and State.

* Some proposals to implement solutions to improve the effectiveness of health care for ASWs/dioxins:

Health care in particular and social assistance in general have important implications for the lives of ethnic minorities. Implementing health care policies for these subjects is meaningful in many ways [9, p.143].

- Firstly, in terms of society and humanity. Health care for IUDs not only reflects the State\'s attitude towards IUDs - a part of the people facing difficulties and hardships in society, but also a necessary and active support measure of the State towards them. with people infected with toxic chemicals, with sequelae left by toxic chemicals. Thanks to the help of the community, CFSC is supported and helped both physically and mentally, thereby helping them to improve their health status and improve their ability to adapt to diseases.

- Second, from an economic point of view. Health care for SWs has an important meaning in ensuring the lives of SWs themselves and their children and grandchildren. From an economic point of view, health care subsidies are meant to be a means of redistributing money, wealth and services to disadvantaged members, thereby narrowing the gap. living standards, alleviating poverty. The implementation of health care based on such public finance means redistributing income towards social justice. From this perspective, health care is a means of promoting social progress.

- Third, on the legal side. Health care is the legal basis for agencies and organizations to carry out their responsibilities in ensuring the health of migrant workers so that they can enjoy the regime in accordance with the law. The elderly are also human, so they have the right to be assured of social security, including the right to be assured of health care and rehabilitation to suit the type and degree of disability. Currently, the health care policies for the CDC are not a favor, pity, beg-for-give, but a mandatory implementation [10, p.269].

* Some recommendations to improve the effectiveness of health care for ASWs/dioxins:

In Vietnam, health care protection for migrant workers is always focused and the law on social assistance in general and health care in particular for this population is constantly being improved. Specifically:

- Firstly, it is necessary to implement the regime of providing orthopedic and rehabilitation equipment for people infected with toxic chemicals when they fully meet the requirements and are determined to be contaminated with skin toxins by the competent authority. Orange. In order to do that, it is necessary to issue a document guiding the implementation of this policy so that it is simple, practical, timely, suitable to the needs of the target audience and implemented in the shortest time to avoid situations when solving problems. decide whether the subject is dead or is entitled to it but only for a short period of time. The implementation of this regime contributes to better health care for migrant workers, from which they feel more secure in life.

- Second, it is necessary to practice a concentrated feeding regime for cases of serious illnesses and diseases; illness, serious illness and inability to serve themselves and their families. It is necessary to build up special care foster care centers soon and put them in foster care centers. Only then will this subject be cared for, nursed, and treated according to the correct process and schedule.

- Third, it is necessary to implement a preferential regime in education, training, and suitable employment. The implementation of the preferential regime in education for people infected with Agent Orange or their relatives exposed to this poison is a practical work and is carried out through the regimes, policies and incentives on education. Fees, vocational training, vocational training, etc. For employment and job creation, it is required that all levels of management have their own mechanism of job creation, arrangement of their own programs and plans, and a mechanism to help and create favorable conditions. It is most favorable for the migrant workers and their biological children who are sick or seriously ill to have jobs and create jobs for themselves. Since then, rural communities have had more income, improved their lives, and improved their health.

- Fourthly, it is necessary to improve and supplement public policies and preferential policies with the motto of promoting quality in management, especially the management of medical examination and treatment and medical care for the elderly. In order to perform well, it is necessary to issue clear, simple, easy-to-understand regulations and procedures and uphold the sense of responsibility to serve the people. This is considered the success of the State\'s public policies, contributing to ensuring the interests of the State, the population community and building a developed and prosperous country.

- Fifth, perfecting the legal provisions on health care such as social insurance and health insurance for people infected with Agent Orange and their relatives by issuing a series of preferential regulations., priority in the implementation of social insurance regimes; health insurance at primary health care facilities or medical examination and treatment at higher levels. Since then, people infected with Agent Orange and their children, grandchildren and great-grandchildren will feel secure in life and confidently integrate into the community.

- Sixth, to improve the legal provisions on social assistance for these subjects, because above all they are the people with difficult and extremely difficult circumstances (based on the results of Tables 5 and 6), so it is necessary to implementing regular social assistance regimes, unscheduled social assistance and these are determined to be necessary jobs. Each period is different, the implementation of assistance will also be different, but it is necessary to be based on the reality of life and the current market economic situation to have an appropriate level of support to meet the minimum standard of living for them. and family.

Social assistance for victims of Agent Orange/dioxin is an important social security activity in modern society to help them avoid life\'s threats, overcome difficulties, and stabilize their lives. live and integrate into the community. Ensuring the right to social assistance for this subject has profound humanistic meanings. Accordingly, the misfortunes and risks in life are jointly shouldered by the whole community through public finance and the support of individuals and organizations at home and abroad. Ensuring the right to social assistance for victims of Agent Orange/dioxin helps them to be confident and aware of their own values, to solve social problems well, and to ensure the country\'s sustainable development orientation..

4. CONCLUSION

- Investigate and feasible options suitable to the actual conditions and ANCs/dioxins with children with sequelae in Nam Dinh and Quang Nam provinces have been developed.

- Successfully designed a system of tables, statistical tables and survey questionnaires for exposed subjects (F 0) and their children and grandchildren (F 1, F 2) with criteria to ensure practicality, to meet statistical requirements, to provide information that is meaningful to advise in policy formulation and implementation and health care work as well as to fight for justice for SWs/dioxins in general and their children., grandchildren, their next generation in particular.

- Successfully conducted surveys in two provinces of Nam Dinh (specific for the northern provinces) and Quang Nam (specific for the southern provinces). The results of the investigation have been highly received and used by the State management agencies and Nam Dinh and Quang Nam\'s Associations of Victims of CF/diocin abuse and put into use in formulating the province\'s action plan related to CFM. DC/dioxin of the province in the period of 2020-2025.

- The evaluation of information and documents obtained on regimes, policies, housing, care conditions, age, gender imbalance, regional differences... are very groundbreaking initial results. It is important to continue to investigate, investigate, and strengthen to distinguish between ordinary people with disabilities and people with disabilities related to exposure to CI/dioxin during war.

- Analyze the meaning of health care and propose a number of recommendations to improve regimes and policies on health care for FSWs/dioxins, thereby serving as a legal basis in the implementation of policies. priority, preferential treatment for this object.

- The results of this survey and study have been replicated in the application of the survey in the provinces and cities by the Provincial Association for Agro-Communications/dioxins (in 2020 it will be further implemented in Ha Nam and Quang Tri provinces).. While the organization of a census on the consequences for victims of CBD/dioxin is not practical and feasible, which is costly and costly to the budget, the investigation at the provincial and city administrative scale is very important. feasible, practical and effective. It is recommended that the competent authorities consider and finalize the application.

- Based on the survey results of the provinces and cities, it is hoped that there will be some contribution to the national state management agencies as a basis for reference and interest in proposals, development, and approval. policy implementation and implementation, as well as fighting for justice for Vietnamese SWs/dioxins.

Dr. Tran Ngoc Tam¹, Bachelor Pham Ngoc Kiem²,

Bachelor Nguyen Anh Ca³, MSc Nguyen Ngoc Lan 4

1) Vietnam Association of AFFs/dioxins;

2) Association of AFFs/dioxins in Nam Dinh province;

3) Association of AFFs/dioxin in Quang Nam;

4) Hanoi National University

ABSTRACT

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