Ban Phakeo secondary school children walk twelve kilometers back and forth twice each day to school. Some come home for lunch; others bring lunch to school. The children take one hour to walk six kilometers. We took six hours going to the village and three hours to get back.

Dr. Bounthanh is assigned to Ban Phakeo and visits the Phakeo Village 2 to 3 times monthly to provide medical and health care to the villagers. In addition, he is responsible for 20 other villages.

We wanted to experience what it’s like to visit a remote village. We walked there with backpacks filled with bottles of daily multiple vitamins. We called it the Vitamin Walk.

Background

In 2010, Give Children A Choice embarked on a Vitamin Project to distribute daily multiple vitamins to 24,000 preschool children ages 1 to 5 years old in Xieng Khouang Province. A multivitamin distribution project was unprecedented in Laos. Give Children A Choice collaborated with the Xieng Khouang Public Health Department, who took responsibility to distribute the vitamins to 570 villages through its network of over 60 district hospital and health center doctors throughout the province. Posters and handouts were produced and distributed to the villages and schools; village leaders, teachers and parents to help them understand the benefits of taking vitamins.

Doctors, parents and teachers shared how taking the vitamins have helped the children. They were more attentive and participatory in school, performing better in school, having a bigger appetite and gaining weight, and getting sick less. Children showed physical signs of better health, where cheeks were rosier, bodies were fuller from weight gain, hair turning darker (from blond, which is a sign of malnutrition.)

Of the 9.4 million vitamin tablets that were donated by Vitamins Angels, 700,000 are left to be distributed. Very much like the 20/80 rule, the last 20% of the vitamins has taken much longer to distribute because of the difficult to reach many villages, difficulty to get the village leaders to accept the vitamins for their children, and parent illiteracy making it impossible to read the handouts. Our February trip to Phakeo Village gives a sense of the physical challenges the doctors encounter with the distribution. Yet, our partner Dr. Chanthala demonstrated her determination to give every preschool child the multiple vitamins and to make sure they take them on a regular basis.

December 2011

Last December 2011, Barbara and I visited Xieng Khouang’s Provincial Public Health Department’s Dr. Chanthala to get an update with our vitamin distribution project. We learned that she has integrated the vitamin distribution into her normal monthly meetings and processes with the provincial hospital, 8 district hospitals and 53 health clinic doctors. Vitamins are being picked up monthly by each facility’s doctors, as they continued their daily and weekly vitamin distributions to the children.

Dr. Chanthala suggested that Give Children A Choice’s staff to get first-hand knowledge and experience with the challenges and results with delivering vitamins to the 570 villages in Xieng Khouang Province. She wanted us in particular to understand the outreach challenges with the remote villages. While many villages are close to the highway and distribution is straightforward, many remote villages are only accessible by foot. She suggested that we accompany her, her staff and the doctor (responsible for Phakeo village’s medical needs) for a visit to Phakeo Village.

Barbara and I looked at each other. Without saying anything, we thought the same thing. Another adventurous challenge that will test our physical stamina.

(Deju vu flashed in our head. In China, we accompanied the Mabian County education department in Sichuan Province for a supposedly thirty-minute walk (for the local folks) to an old primary school that was structurally dangerous. It took us three hours to walk through the cold-misty, boot-sucking mud along the side of a mountain at the high, tea terrace elevations. It was a challenging and unforgettable experience. It was worth it. We replaced the old primary school. http://www.myspace.com/video/vid/29706141 )

We smiled and said to Dr. Chanthala, let’s do it. We agreed to visit the village during our February visit to Xieng Khouang.

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February 2012

It is now February 2012. Dr. Chanthala explained that she chose a remote village, that is not too far from the main road (only eight kilometers). She wanted us to experience what the doctors experience every day in distributing the vitamins (and provide medical care to the villagers). We traveled 45 minutes from the provincial capital Phonsavan by van to Thachok Village. We turned right onto a dirt road. The health department 4WD pickup was ahead of us and navigated the road to a first village two kilometers away. Our van driver told us the road was impassable with his van. We packed up and walked two kilometers to meet Dr. Chanthala in the first valley.

Walking Downhill

Those walking with us were Jen and Joe Lardner (who flew in from Connecticut USA), Lori Gilbert (an American who works in New Zealand with her husband John), Debbie, Thongchanh, Barbara and myself. Our walk gave us wonderful panoramic views of the valley ahead of us. We were in the midst of where the local villagers slash and burned the hillsides for their next season’s plantings. Most the road was downhill, so the walk was mildly taxing.

Dr. Chanthala and her staff waited for us in the shade of the Lao Loum home on stilts. I spotted children and gave out balloons to them. They immediately took them home to have their Mom tie the balloon to a long string (of rattan). The children ran around flying their balloon in the open area surrounded by homes.

Packing the Vitamins for the Six Kilometer Walk

We bought lunch for everyone. It included a large basket of sticky rice, vegetables wrapped in banana leaves, fish, pork and water. We still had room for about 100 bottles of daily multiple vitamins in our backpacks. Off we went.

The walk started on level ground through rice fields and across a bridge. Very shortly after 15 minutes, the paths became narrower and uneven. We walked across makeshift mini-bridges across water or small ravines. Some paths meant walking on narrow paths as wide as your shoes, jumping from stone to stone, up hills and down hills, across streams, and within the last kilometer, some simple flat paths. The hardest part was the navigating our ways up steep hills. Yet, breaks in the jungle fauna were beautiful panoramic views of the surrounding mountains and valleys.

Six hours later from the start, we arrived in Ban Phakeo. Homes were built on the ground and without window. The Hmong village homes were built on sloping hills. At the top of one hill were homes. At the top of another was half-primary school. (A half-school primary school has fewer than five classrooms. We’ve visited half-schools where each classroom may have children from multiple grades in a single room. We’ve seen two-room primary half-school, where one teacher is teaching both classrooms mixed with grades 1 and 2 in one classroom and grades 3, 4 and 5 in a second classroom.)

Exhausted and trying to catch our breath, we arrived at the lower part of Phakeo village. After resting (and giving some balloons away), we walked up to the upper village, which was about 80 meters away. It was only a hill, but, for us, it felt like a mountain. We met the rest of party: Jen, Joe, Lori, Debbie, Barbara and Dr. Chanthala’s staff.

Dr. Chanthala and the village doctor Dr. Bounthanh spent time with the village elder, explained to him the vitamin program and its value for the children. He agreed to support the program. We were glad, particularly because we saw some children with lightish hair, a sign of malnutrition. He dispatched the parents and their preschool children, ages 1 through 5 to come to his house. (He sent the kids who were near us. They immediately ran to the different parts of the village to spread the word. Within minutes, everyone arrived arrived.)

Dr. Chanthala and her staff, Barbara and Thongchanh sprung into action. They spoke with the children and parents to explain the importance of taking daily multiple vitamins, using the charts prepared for us by Vitamin Angels. The doctors recorded the names and ages of the children, who received vitamins on forms. The kids lined up. The village elder’s wife and daughter led each child one by one to Dr. Chanthala. With the parent standing back, each child stood quietly in line, stepped forward, confirmed their name to the doctor recording the names, then stooped down to take the vitamin from the vitamin cap. Dr. Chanthala then gave the vitamin bottle, containing 180 vitamin tablets, enough for six months.

Vitamins were distributed to about 60 children. While the sun was still above us, our watches told us that is was already 3:30 p.m. It was time to head back. We wanted to get back to the truck before dark.

Our six kilometer (3.5 mile walk) took us only 3 hours. We thought we were walking fast. (We still could not understand how the children can make this trip in an hour.) It was twilight, when we arrived.

Conclusion

Dr. Chanthala explained to us that our experience today was indicative of the challenges and efforts, that is part the day-to-day challenges of the public health department. She went further to explain that there are many villages (of the 572 in Xieng Khouang), that are more difficult to reach than Phakeo Village. The terrain is more challenging and the time to get to the villages is longer.

Dr. Bounthanh is the doctor responsible for Phakeo Village and 19 other villages, some close to the road and some very remote requiring the long walks like we took today. He was very patient with us by staying behind while we huffed and puffed our way to Phakeo Village with him. He noted that he would normally have to carry large backpacks with medical supplies, vaccinations, medicine to the village. He would visit the 20 villages 2-3 times a month with Ban Phakeo, being only one of the more remote villages amongst his 20.

We thought we were ready to jump in the truck to ride back to the main road until Dr. Bounthanh asked Barbara to help him to give an infant girl a penicillin shot. The baby had pneumonia. The doctor was attending to another patient in the meantime.

Final Thought

Yes. Dr. Chanthala did give us a better sense of the challenges she and the medical faces. Yes. Our respect for her and her colleagues and their efforts went up substantially. Hats off to what she and the many Lao doctors go through to advance the health of the Lao people.

As Barbara says, walk the walk first, then do the talk.

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