Laos: What Would You Do If UXO Accident Happens in Your Village?

In Laos, U.S. Forces dropped as many as two million tons of bombs during both the Vietnam War and the civil war in the 1960’s and 1970’s. Reportedly, approximately 30% of them have remained in Laos as unexploded ordnance (UXOs) that continue to cause accidents and deaths even today. Xieng Khuang Province located in the north of the country in particular is an accident-prone area. According to statistics from National regulatory Authority for UXO/Mine Action Sector in Lao PDR, in 2012, 31 persons are injured in this province alone, accounting for 55% of all the victims in Laos.
Below is a report from Noriko ANDO, who has been engaged in operations in Xieng Khuang Province.

A Nearby “VHV” is Better than a Far-off Hospital
The medical standard in Laos is not very high. In Xieng Khuang Province, one of the worst affected areas by UXOs, each district has only one hospital that is able to provide decent medical treatment for victims of UXOs. There are only four ambulances available in the whole province. To make matters worse, most of the roads are unpaved which prevents ambulances from reaching hospitals during the rainy season. Delayed medical treatment has resulted in higher numbers of UXO-related deaths as well as victims who sustain life-altering bodily injury. Some victims do not even have a   choice but to give up going to hospitals because of their inability to cover their medical fees.

“I would like to share what I have learned with villagers,” said Ms. Syvai, a VHV in Phounven Village with Noriko ANDO on the right.

Since 2010, AAR Japan has been providing training of first-aid techniques to both VHVs (note1) and nurses at health centers (HCNs) (note 2) so that they can speedily cope with the UXO-related injured on the spot in villages far away from hospitals. The training includes how to resuscitate, how to stop bleeding, how to treat  fracture and how to transport the injured to hospitals. We have also urged them to recognize the significance of mental care for victims after treatment at hospitals. So far, 385 VHV of 207 villages and 68 HCNs of 25 health centers  have participated in the training. Furthermore, together with VHV of 74 most accident  prone villages, we have provided workshop on the prevention of accidents and on first-aid techniques, in which roughly 3,500 persons have taken part up to now.

Note1: Each village has one or two VHVs, who are appointed by the village leader. They are engaged in simple medical service such as prescription of medicine. This is an honorary position. It is the villagers’ confidence in and the high level of motivation of the volunteers that have been key to running this system.
Note2: This is a provisional medical office which is always stationed by a doctor or a nurse but is not equipped with medical instruments fully enough. They provide diagnosis, treatment and prescription of medicine to patients with minor ailments such as a cold and diarrhea as well as minor injuries.

Stopping the Bleeding by Using Herbs and Urine
People Still Try to Treat Injuries through traditional methods
Many of the victims of accidents caused by UXOs who are transported to hospitals suffer excessive bleeding due to the damage sustained during the blast. It is essential to stop bleeding as promptly and effectively as possible. However, many people in villages still believe that the use of herbs and urine in the treatment of the injuries is effective in stopping hemorrhaging. Both the use of various herbs and urine causes infection, complicating the healing process and increasing medical treatment expenses. Furthermore, improper use of a tourniquet to constrict the bleeding can result in unnecessary complications like nerve damage and loss of limb. Therefore, during the first-aid techniques sessions, we have been teaching the proper way to stop bleeding through hands-on practice with the use of bandages for head and arm injuries.

Noriko ANDO (in the center) revisited Mee Village ,where AAR Japan provided training in the past, to see Ms. Vankham , a VHV (on the left) to make sure that she is still able to apply dressings on the injury properly

Focusing Our Thoughts on the Next Challenge
After the training, many participants said, “I have instantly found what I learned to be very helpful to us.” However, memories of participants fade as time goes by, and so we revisit the villages after the training to check whether they are still able to apply the techniques properly as well as to give them  a review  when necessary.
Besides the job of helping villagers, the VHVs are expected to pass what they learned on to other villagers. However, on our revisits after one year, we found some VHVs unable to carry out the awareness raising activities for  villagers. They say, “With only one VHV, it is difficult to provide enough opportunities for transmitting the knowledge and techniques to  villagers.” For the future, AAR will continue to tackle this problem in collaboration with HCNs in charge of these villages.

In the future, AAR Japan would like to continue  assistance so that not only will more villagers be able to acquire proper first aid techniques but to minimize damage caused by UXOs.

 “I’m now confident in myself after the training,” said Ms. Nead (27), a nurse at Phonekham Health Center in Kham District.

On AAR’s revisit one year after the training, Ms. Nead reviewed resuscitation techniques with illustrated cards.
“After my participation in the training provided by AAR, I became able to spread the knowledge and techniques to villagers confidently. Before attending the training, I was unsure whether or not my knowledge was sufficient enough.
In my village, there still exist many people who try to stop bleeding by using herbs on the injury. Some time ago, there was a case in which, upon the arrival at a hospital, herbs were pressed into the victims wound which led to an infection and resulted in an even longer healing time.
I have been extremely busy doing quite a lot of jobs, but have been delighted to be able to help villagers. I will review the knowledge and techniques that I learned in the training so as to keep them always fresh in my mind.”

Noriko ANDO, AAR Japan Xieng Khuang Office
After working at a university hospital as a nurse for 10 years, ANDO joined Japan Overseas Cooperation Volunteers (JOCV) to work in Laos for two years. After coming back to Japan, ANDO continued to work as a nurse for a while before joining AAR Japan in April 2012. “I am glad that through my activities, I am able to payback the kindness to the people of Xieng Khuang Province, who assisted me a lot when I was there as JOCV.” Originally from Gifu Prefecture.