Doctors remain rare in Vietnam's drug detention centers

By Lam Le   December 17, 2016 | 02:00 am GMT+7

How a dearth of doctors has helped fuel disease and discontent at Vietnam's drug detention centers.

>> Part 1: Vietnam's drug rehab riots: what went wrong 

In mid October, a group of 50 men arrived at the Xuan Loc Center for Labor and Social Education in Dong Nai Province.

They had drug problems that the state wanted to fix, but new laws required that they be interviewed, medically examined and brought before a district-level judge before treatment under a two year detention could begin.

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Tran Ngoc Dung. Photo by VnExpress/Phuoc Tuan

On the night of October 23 in the facility, 26-year old Tran Ngoc Dung asked the staff for a sedative to help him sleep. They refused to give him one, pointing out that they weren't on the clock.

So Dung smashed a light bulb and began waving the broken pieces at the staff.

Dung and other new arrivals then took up sticks and fire extinguishers and led a riot that inspired 500 long-stay inmates to rush into the National Highway, just an hour north of Ho Chi Minh City.

Labor Minister Dao Ngoc Dung later told reporters: “They thought going to court meant they were guilty [of a crime], so they became afraid.”

But two weeks later, 166 detainees at Xuan Loc staged another escape.

A squad of hundreds of policemen had the situation under control by the end of the day, but that did nothing to calm the remaining detainees. The following morning, they took to the roofs and climbed over the walls in a protest that took the police 90 minutes to curb.

“We have a home, a family, why do you call us homeless?” shouted one inmate standing on the roof. “Just come and see how we live here.”

When Minister Dung visited the same day, another inmate told him: “We want better medical treatment so we can go home early.”

Detainees at the Xuan Loc Center in Dong Nai during the protest on November 7, 2016. Photo by VnExpress/Phuoc Tuan

Detainees at the Xuan Loc Center in Dong Nai during the protest on November 7, 2016. Photo by VnExpress/Phuoc Tuan

Treating a disease without doctors

The 06 Center opened in 2009 with a designed capacity of 800 patients, the same year the World Health Organization (WHO) estimated that 1-30 percent of confined addicts attempt to escape, depending on the center.

Where drug addicts detained at the Dong Nai center sleep. Photo by VnExpress/Phuoc Tuan

Where drug addicts detained at the Dong Nai center sleep. Photo by VnExpress/Phuoc Tuan

At the moment, the center's patients are confined to just one square meter of personal space -- the government recommends a minimum of 2.5.

Most of the centers created to house Vietnam’s most hardened addicts are over-burdened with people who fell through the cracks -- repeat drug offenders, homeless addicts and rehab drop-outs.

Some operate at 30-40 percent over capacity, Labor Minister Dao Ngoc Dung told the press after the escape.

Only centers in big cities like Hanoi, Ho Chi Minh City, Hai Phong and Quang Ninh are in relatively good condition.

According to the WHO, many facilities lack a single doctor and instead are staffed by a mix of government officials, managers or social workers who survive on a meager monthly salary of just VND2 million ($88). Most hold “a negative opinion” of drug users.

Low pay makes it hard for these facilities to recruit and retain staff.

In Ho Chi Minh City, where conditions are relatively “good”, detention centers have reported a staffing shortfall of 200 people, according to the director of the municipal labor department, Le Minh Tan.

At the Dong Nai center, 10 medical officers including one doctor operate alongside 100 staff and 44 guards.

Moving on to 'multi-purpose centers'

On World Aids Day (December 1), the director of  the central Department of Social Vices Prevention, Nguyen Xuan Lap, delivered a bold message at a conference in Hanoi: “Vietnam is on track towards eliminating 06 Centers”.

Lap reported there are just 10 compulsory drug detention centers left in the country; the rest have been transformed into so-called “multi-purpose centers”.

Officials at the labor ministry did not respond to several inquiries about the current population of compulsory drug centers, so it remains unclear whether the recent high-profile breakouts occurred at 06 or multi-purpose centers.

Last year, however, the country reported its 06 Centers housed 18,727 drug detainees out of the estimated 220,000 registered drug users. Assuming that population hasn’t significantly changed, one could argue multi-purpose centers are simply 06 Centers that offer add-on services.

The “add-ons” include voluntary addiction treatment, social centers to house drug users awaiting their court hearings, opioid replacement therapy and community-based treatment.

The Department of Social Vices Prevention, which falls under the auspices of the labor ministry, remains in charge of these centers which are now nominally tasked with treating what has been recognized as a disease.

Perhaps for this reason, Ho Van Lac, the vice director of Dong Nai's labor department, called for drug addiction to be overseen by the Ministry of Health during a recent conference on social evils in Ho Chi Minh City.

The status quo is particularly troubling when it comes to treating HIV/AIDS in these facilities.

“There is a lack of consensus between the Ministry of Health and the labor ministry as to how this health activity should be effectively implemented,” the WHO found in 2009. “The Ministry of Health seems to be reluctant to assume responsibility for [HIV] treatment delivery in the centers, while [the labor ministry] has no institutional capacity to deliver them itself.”

Availability and capacity of health professionals

Six years ago, the government estimated that between a fifth and half of compulsory drug detainees were HIV positive.

In its national AIDS prevention strategy, the government admitted that many drug detainees suffered from full-blown AIDS or had died from the disease.

Researchers from the WHO found that even when anti-retroviral drugs were available, “staff members lack the capacity to administer the treatment”.

The agency also found that the centers largely lacked condoms even though sex occurred in them frequently.

“Many have no treatment to deal with withdrawal symptoms and medical care is very limited,” the report concluded. “However, in rare occasions, some centers do use a collection of analgesics, sedatives and other pharmacological means, as well as non-traditional means, to assist drug users to cope with withdrawal symptoms.”

In the Dong Nai center, for example, drug users were being treated simply with seduxen, a widely available sleeping pill.

Meanwhile, the use of methamphetamines is on the rise and Vietnam lacks a treatment strategy, according to Nguyen Xuan Lap of the Department of Social Vices Prevention.

“Most of the recent escapees were actually addicted to methamphetamine,” Lap said.

So far, legislation has focused almost exclusively on methadone, a heroin substitute, to treat drug addiction.

This is a mistake, according to Dr. Hoang Van Ke, the chairman of Hai Phong’s Union of Science and Technology Association.

At an HIV/AIDS conference in Hanoi, Dr. Ke reported a growing trend of people dropping out of methadone programs or continuing to use illicit drugs during treatment that lacked a therapy and counseling component.

Dr. Ke warned that such omissions not only reduce the effectiveness of the methadone program but “put patients at risk of having to return to drug detention centers".

Protesters at the center in Dong Nai are being brought back by the police. Photo by VnExpress/Phuoc Tuan

Protesters at the center in Dong Nai were brought back by police. Photo by VnExpress/Phuoc Tuan

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