Table 3 A lowland case of child diarrhoea management

Discovering the disease

One evening a 25-year old mother from a Tày lowland village discovers that her 17-month old child is slightly feverish and coughing. Without any objections from her family, she stays at home the next day to attend the child. In the morning the child starts defecating very watery and yellow-greenish stools. The mother describes the child as weak, tired, crying, thirsty, having stomach pains and only wanting breast milk.

Treatment in the home

The mother immediately initiates a range of treatments at home: To ward off the fever caused by the "cold winds hitting the child", she performs the traditional 'đánh gió' (hitting the wind); with a silver coin, an egg and some ginger mixed in a piece of cloth she strokes the head and body of the child. At the same time she gives the child a dose of a fever reducing drug, a left-over from the previous time the child was sick. Maybe the diarrhoea was caused by 'incompatible foods' she says. She therefore restricts the child's diet from such 'harmful foods': "Avoid sour and fishy things such as eggs and we didn't have any vegetable soup in 3-4 days. I didn't dare to let him eat it!". She urges the child to drink water and eat rice mixed with water, salt and minced meat. She also restricts her own diet from green vegetables, being afraid of passing any harmful substances on to the child in the breast milk. On the second day the diarrhoea stops and the mother is happy to have handled this 'light' (nhe) diarrhoea at home. Apparently this treatment was 'compatible' to the disease of the child, she says. When asked how she knew what to do, she says that she always asks her mother-in-law and other elder women in the village: "They know everything. They have been through it all". She has also noticed some campaigns during epidemics and some advice sanitation when watching TV at the neighbours. At the regular Women's Union meetings she also learned about child care and personal hygiene.

Finally, she prepares a herbal drink for the child. The old people in the village told her to do so: "The old women said that they brought up many children in the past. They all collected the herbal medicines for drinking". She finds the herbal medicines more 'compatible' for a body of a child since they are not harmful as drugs can be she says. She also finds it more practical and effective compared to drugs: "The clinic medicine is drunk just twice per day. About the herbal medicine, he can drink it anytime he's thirsty. I just let him drink whenever he asks for drinking water. I boil it and leave it in the pot". Furthermore, she can drink it herself and pass the healthy substances to the child in the breast milk - unlike any drugs given directly to the child. After four days of this combination of treatments the child recovers and the mother is proud to have successfully handled this disease of her first child.

Using drugs and government health services

But after another four days the diarrhoea begins again. This time the mother immediately goes to the CHS on her bike without involving her husband or parents-in-law. She now describes the diarrhoea as serious and therefore not treatable at home. When asked why she did not firstly consult the VHW she says: "She doesn't have medicine to provide the people. And she doesn't care about the child's diarrhoea". At the CHS she does not tell the assisting doctor about the treatment she carried out at home or what might have caused the disease. She returns home with four kinds of drugs, which she knows as: antibiotics, fever reducing drugs, digestion enzymes and ORS. Without consulting anybody, she decides to only give the fever reducing drugs and the enzymes. She finds the antibiotics 'incompatible' with a sick child's stomach. It is 'too sweet' and 'too hard' for the child which can cause even more diarrhoea. She does not know what the ORS is for and did not dare ask the CHS staff: "They are often cross with me. They think I come too often to ask for medicines", she says.