Prehospital trauma care for traffic injuries in Vietnam: A public health ethnography.
Creators: name: Tran, Tam
Publisher: name: The Australian National University
Year: 2024

description: In October 2011, an extraordinary incident in Guangdong, China, drew worldwide attention. In a busy market street, a two-year-old toddler, wandering alone, was struck by a van. Over the next few minutes, numerous bystanders noticed but ignored the injured child. Eventually, a compassionate individual stepped in to help, but the girl tragically passed away a few days later in the hospital. This incident, while singular, echoes a global health crisis where road traffic injuries (RTIs) claim millions of lives and cause considerable disabilities. Developing countries bear a disproportionate share of this burden, grappling with inadequate healthcare systems and sociocultural complexities that make trauma system development challenging. This research presents a different perspective on prehospital trauma care in low and middle-income countries. Moving beyond the traditional quantitative biomedical focus, it explores the sociocultural dimension of RTIs, examining how cultural norms and social structures affect care and the care-seeking process. Vietnam, with its unique blend of traditional values and rapid urbanisation, presents a compelling case study. The study pivots around three key questions: (1) What does the current literature tell us about the impacts of culture on prehospital care in lower-middle-income countries? (2) How do sociocultural dynamics influence Vietnamese injured persons' prehospital care practices? (3) What roles do Vietnamese bystanders take in prehospital care, and how do sociocultural factors influence their behaviours? The current research integrates focused ethnographic insights with an in-depth analysis of existing literature on emergency medical systems in lower-middle-income countries and Vietnam to highlight the importance of culturally sensitive, community-based approaches to RTIs. The findings reveal a stark reality: most traffic-injured patients rely on informal transportation to get to hospitals. This is due to financial constraints, societal pressures, lack of awareness and distrust in the formal emergency medical services system. In addition, cultural customs and familial connections heavily influence health-seeking behaviours, with many patients delaying necessary care to obtain treatment at trusted facilities or through traditional medicine. Bystanders play critical roles in the prehospital scenario. Their actions, driven by a complex mix of sociocultural norms and personal understandings of emergency services, can both support and hinder the care process. Traditional medicine emerges as a significant component of the healthcare landscape in Vietnam and may be both beneficial and harmful. Based on these findings, the thesis proposes several policy recommendations. Promoting basic first aid training for laypeople is essential, as bystanders are often the first responders in resource-constrained settings. Legislative reforms to protect Good Samaritans may encourage more community members to assist in emergencies. The Emergency Medical Service (EMS) system's inadequacies are not only a matter of logistics but also reflect deeper issues of public perception and healthcare accessibility. Integrating traditional medical practices into the formal healthcare system can address the service gaps in rural areas and better align modern medical care with popular beliefs and traditional care, thus improving the quality of care. These recommendations seek to strengthen Vietnam's prehospital system by fostering a more culturally sensitive approach to trauma care development. It also provides a framework for improving trauma care in other developing nations, where the interplay of culture, society and healthcare presents unique possibilities and challenges.