Table 2 A Highland case of child diarrhoea management

Discovering the disease

One evening when a 23-year old mother returns from field work in the hills, the children who have been attending her 12-months old baby say that the child has a 'hard belly' and hasn't defecated during the day. During the night the child defecates liquid and greenish stools thrice, cries, and develops a bellyache and slight fever. The mother describes the child as very sleepy, weak, and not wanting to eat anything except for taking breast milk.

Treatment in the home

The diarrhoea goes on for three days. During this period the parents-in-law allow the mother to remain home to attend to the child and cook for the family. When asked about the cause of the diarrhoea the mother is uncertain: "Maybe because of the weather - but I don't know [...] I thought it was maybe because the child ate something unsuitable, drank dirty water or played dirtily". She explains 'unsuitable foods' as something which 'couldn't be digested' by the child, including sweet milk or toxic forest fruits. For the first two days the mother carries the child around, all the while breastfeeding and urging the child to drink boiled water and eat some rice in the hope that the disease will cease. On the third day the parents-in-law decide to call the village 'thầy mo' (spiritualist). He explains how to cure diarrhoea "First we have to do 'bói' (fortune telling) and if there is a ghost, we can see it. Then we can do the 'mo' (warding ritual)" (Spiritualist, Red Dao). He talks in tongues and counts his fingers and says that the disease does not take a comprehensive ritual or large offerings to chase away the disturbing ghost. He chants and burns incense to contact the ghost while offering small gifts of rice, meat, and home-brewed wine. But the child keeps defecating and crying during the evening and night. The mother is now unsure of what she should do since she is "inexperienced as a mother". She has not attended village meetings where health advocacy takes place and there is no women's group in her village and she doesn't understand what is communicated on the radio and TV in Vietnamese. She places her trust in her mother-in-law who decides to prepare a bitter drink of boiled guava buds for the child. During the next five days the mother-in-law attends to the child and feeds it with the drink thrice daily, while the mother is away working in the fields. The child gradually stops defecating liquid stools and regains some strength.

Using drugs and government health services

The mother did not go to the CHS for medication, but preferred drugs from the pharmacy in town, which she perceived were of a higher quality. After another six days at home the diarrhoea resumes and the mother now perceives it as a 'serious' (nang) disease. She wants to go to the CHS, but: "I don't know how to ride a motorbike and my husband was not at home". The local custom prohibits her to sit on a motorbike with another man, and the CHS is too far away for her to walk to and she feels unable to communicate with any of the health workers at the CHS in Vietnamese. The parents-in-law decide to send her brother-in-law with the sick child to the CHS. He returns with some sachets of powder; a fever reducing drug and ORS, and written instructions on correct dosages of the medicaments in the medical notebook of the child. He was told to ask the VHW for further explanation if needed. The mother is illiterate and says that she never meets the VHW, who lives on the other side of the hill. Further, he never comes around to advice on child health she says. So she decides to give both powders the same way; two - three times a day in a teaspoon of boiled water or tea until the child stops defecating liquid stools. She is very afraid that the diarrhoea would not stop before the medicines run out, she says. But after three days of medication the child recovers and the mother is relieved that she would not have to ask her family-in-laws to take the child back to the clinic or to the district hospital, which would have been very time consuming and costly for the family.