Epidemic Politics in Contemporary Vietnam: Public Health and the State 9780755636174, 9780755636204, 9780755636198

Citation preview

Epidemic Politics in Contemporary Vietnam

ii

Epidemic Politics in Contemporary Vietnam Public Health and the State Martha Lincoln

BLOOMSBURY ACADEMIC Bloomsbury Publishing Plc 50 Bedford Square, London, WC1B 3DP, UK 1385 Broadway, New York, NY 10018, USA 29 Earlsfort Terrace, Dublin 2, Ireland BLOOMSBURY, BLOOMSBURY ACADEMIC and the Diana logo are trademarks of Bloomsbury Publishing Plc First published in Great Britain 2022 Copyright © Martha Lincoln, 2022 Martha Lincoln has asserted her right under the Copyright, Designs and Patents Act, 1988, to be identified as Author of this work. For legal purposes the Acknowledgments on pp. viii–x constitute an extension of this copyright page. Cover image © Linh Pham/Getty Images All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage or retrieval system, without prior permission in writing from the publishers. Bloomsbury Publishing Plc does not have any control over, or responsibility for, any third-party websites referred to or in this book. All internet addresses given in this book were correct at the time of going to press. The author and publisher regret any inconvenience caused if addresses have changed or sites have ceased to exist, but can accept no responsibility for any such changes. A catalogue record for this book is available from the British Library. Library of Congress Cataloging-in-Publication Data Names: Lincoln, Martha (Medical and Cultural Anthropologist), author. Title: Epidemic politics in contemporary Vietnam : public health and the state / Martha Lincoln. Description: New York : Bloomsbury Academic, an imprint of Bloomsbury Publishing, 2021. | Includes bibliographical references and index. Identifiers: LCCN 2021010171 (print) | LCCN 2021010172 (ebook) | ISBN 9780755636174 (hardback) | ISBN 9780755636181 (epub) | ISBN 9780755636198 (pdf) | ISBN 9780755636204 (ebook other) Subjects: LCSH: Epidemics–Political aspects–Vietnam. | Epidemics–Economic aspects–Vietnam. | Epidemics–Social aspects–Vietnam. Classification: LCC RA650.7.V54 L56 2021 (print) | LCC RA650.7.V54 (ebook) | DDC 614.409597–dc23 LC record available at https://lccn.loc.gov/2021010171 LC ebook record available at https://lccn.loc.gov/2021010172 ISBN: HB: 978-0-7556-3617-4 ePDF: 978-0-7556-3619-8 eBook: 978-0-7556-3618-1 Typeset by Integra Software Services Pvt. Ltd. To find out more about our authors and books visit www.bloomsbury.com and sign up for our newsletters.

To my family Chim có tổ, người có tông

vi

Contents Acknowledgments Note on Text

viii xi

Introduction 1 1 Medicine and Disease in North Việt Nam: Doctoring the Body Politic 27 2 Water and Sanitation in Transition 55 3 Risky (Small) Business: Constructing a Disease of the Market 79 4 Sacrificial Beasts: Disease Risk at the Species Boundary 103 5 Statistics and Their Discontents 121 Conclusion: In the Republic of Health 151 Notes Bibliography Index

166 172 204

Acknowledgments This book owes a great deal to colleagues, friends, and mentors as well as the institutions that have supported my research. In Việt Nam, I am very grateful to the faculty and students of Hà Nội School of Public Health for hosting me as a visiting researcher from 2009 to 2010. Special appreciation to Dean Lê Vũ Anh and to PGS/TS Lê Thị Thanh Hương and her colleagues in the Environmental Health Department—public health movers and shakers TS Lê Thị Hương, TS Trần Thị Tuyết Hạnh and TS Nguyễn Việt Hùng as well as their wonderful young colleagues Phung Xuân Sơn, Đỗ Phúc Huyền, Trần Thị Thu Thuỷ, Trương Thanh Thuý, Nguyễn Nhung, and Trần Khánh Long. Xin chân thành cảm ơn. I deeply appreciate the Institute of International Education-Fulbright for supporting my fieldwork in Hà Nội and also thank the hardworking Việt Nam Fulbright country office—Dr. Trần X. Thảo, Đỗ Thu Hương, Đỗ Thị Ngọc Hà, and Vũ Thị Dịu—for their support and assistance. A Dissertation Proposal Development Fellowship from the Social Science Research Council enabled a research visit to Việt Nam in 2008, and a grant from the Foreign Language Area Studies program supported my participation in the Southeast Asian Summer Study Institute at the University of WisconsinMadison in 2009, where I’m particularly indebted to thầy Bắc Hoài Trần. Many grateful thanks to my other wonderful Vietnamese teachers too—the erudite and funny TS Nguyễn Thế Dương, dear friend and honorary sister em Nguyễn Phương Thảo in Hà Nội, and cô Đinh Thị Hồng of UW-Madison who let me join her class from California via Skype. During the process of data collection in Hà Nội, I was helped immeasurably by the contributions of hardworking research assistants Trần Thủy Bình, Nguyễn Mai Lan, Trinh Linh, Minh Hằng, Nguyễn Phương Thảo, and Sam Hằng Trần; thanks also to Nguyễn Thanh Mai for her expert assistance with transcription. I owe a great intellectual debt to my interview respondents for their time, hospitality, and sharing of information. And warm thanks to Nguyễn Cẩm Thúy for sharing her home with me in Hà Nội and to Phong and Huệ Nguyễn, who also welcomed me as a guest. The Vietnamese Studies community has been a source of great scholarly generosity and inspiration, and over the years many anthropologists, health

Acknowledgments

ix

researchers, and other disciplinary specialists on Việt Nam have collegially shared time, insights, and other contributions to this study. They include Larry Ashmun, Stephen Baker, Sarah Bales, Trude Bennett, John Berlow (rest in peace), Nadja Charaby, Amy Dao, Ginger Davis, James Delaney, Dương Lê Quyên, Claire Edington, Masahiko Ehara, Diane Fox, Tine Gammeltoft, Sarah Grant, Thảo Griffiths, Erik Harms, Jane Hughes, Michael Iademarco, Mike Ives, Tim Karis, Lynn Kwiatkowski, Danielle L’Abbé, the late Judith Ladinsky, Lê Văn Tấn, Ann Marie Leshkowich, Kevin Li, Trinh Luu, Shaun Malarney, Nina McCoy, Natalie and Nhu Miller, Jason Morris-Jung, Seth Mydans, Nghiêm Kim Hoa, Dat Manh Nguyen, Lilly Nguyen, Nguyễn Văn Hạnh, Pauline Oosterhoff, Melissa Pashigian, Natalie Porter, Thilde Rheinländer, Stephane Rousseau, Christina Schwenkel, Virginia Shih, Merav Shohet, Jack Sidnell, Philip Taylor, C. Michele Thompson, Trần Tuấn, Van Tran, Rogier Van Doorn, Nhung Walsh, Rob Whitehurst, Pamela Wright, and Peter Zinoman. At CUNY Graduate Center, warmest thanks to my dissertation committee members Murphy Halliburton and Karen Strassler, to my advisor Victoria Sanford for her years of support and friendship, to Louise Lennihan, and to Ellen deRiso. I continue to experience true collective effervescence with a CUNY cohort including Sophie and Carwil Bjork-James, Risa Cromer, Daisy Deomampo, Saygun Gökariksel, Erin Martineau, Andrea Morrell, Josh Moses, Christine Pinnock, Michael Polson, Ted Powers, Maria Radeva, Jeremy Rayner, Jonathan Stillo, and Karen Williams. Thanks also to interdisciplinary friends, colleagues, and collaborators—Rob Contin, Emilio Dirlikov, the one and only Đoàn Hồng Nhung, Penny Edwards, Oliver Meeker, Branwyn Poleykett, Eugene Richardson, Lorenzo Servitje, Priscilla Wald, and Lee Worden. I’m also extremely grateful to the Center for Southeast Asian Studies at the University of California, Berkeley for hosting me as a visiting researcher from 2011 to 2012, and the Center for Advanced Study in the Behavioral Sciences at Stanford University for hosting me as a visiting scholar from 2012 to 2013. A postdoctoral position at the Prevention Research Center/UC Berkeley School of Public Health funded by a grant from the National Institutes of Health (NIAAA Training grant T32-AA014125) helped me complete this project, as did the support of Genevieve Ames, Joel Grube, and Roland Moore. I appreciate my colleagues at San Francisco State University’s Department of Anthropology and give particular thanks to Dawn-Elissa Fischer, Sahar Khoury, Meredith Reifschneider, and Cindy Wilczak. Thanks also to Martha Kenney, Laura Mamo, and the members of the Science, Technology, and Society Hub. Finally,

x

Acknowledgments

I am very much in the debt of Olivia Dellow, Sophie Campbell and colleagues at I.B. Tauris, and Viswasirasini Govindarajan at Integra for their stewardship of this project, and would also like to thank two anonymous reviewers for their perceptive comments. There would be no book without the inspiration and love my family has provided—my parents Bruce and Louise, my twin sister Rebecca and her husband Jay, my nieces Hanna and Ida, my bà nội Geraldine. My husband Jaime Omar Yassin shares with me, in sickness and in health, a “fiefdom of our own.” And I’ll always owe a debt to my ancestors—especially, but not only, Frank and Reba, Bill, Charles and Martha, and Elsie and Bob. While this study would not be the same without the contributions of the people named above, any errors are my responsibility.

Note on Text Since the seventeenth century, Vietnamese is written in a romanized alphabet called quốc ngữ, “national language.” Quốc ngữ features five tone markers that shift the inflection of a marked syllable and a series of diacritics that modify the pronunciation of vowels. When quoting Vietnamese text, including place names, I reproduce these diacritical marks. Vietnamese names are written with the surname first, the middle name second, and the given name last. The references section uses this format where possible. Because some Vietnamese surnames are very common, I identify Vietnamese authors in most in-text citations by full names. Quotes from Hanoian interview respondents cite pseudonyms and fictive kin terms that index a speaker’s gender and respective age, for example, Em (younger brother or sister), Chị (elder sister), Anh (elder brother), Cô (aunt or “miss”), Chú (younger uncle), Bác (older aunt or older uncle), Bà (grandmother), and Ông (grandfather).

xii

Introduction

An epidemic intensifies certain behavior patterns, but those patterns, instead of being aberrations, betray deeply rooted and continuing social imbalances. — Roderick McGrew, “The First Cholera Epidemic and Social History” (1960, 71) An epidemic has a sort of historical individuality, hence the need to employ a complex method of observation when dealing with it.—Michel Foucault, “The Birth of the Clinic” (1994, 25) Lan and I were speaking with Bác Thanh and Bác Tuyết, a couple in their seventies who offered us green tea and kindly called us “child” (cháu) and “miss” (cô). It was a very hot August day, and they had turned on a fan to cool their oneroom concrete house in an eastern district of Hà Nội near a bend of the Đuống River. Bác Thanh was born in 1936 in Văn Lâm district of Hưng Yên province, east of Hà Nội. His parents were farmers; he worked alongside them and studied without a teacher because, he explained, under French colonial rule there was no formal schooling available for poor children—only for “the children of the canton chiefs.” As a boy, Bác Thanh earned money by finding work when and where he could, carrying a flag or beating a drum in funeral processions. “When I was small like this,” he said, indicating the height of a teenager, “I wandered around the city looking for work. My family was poor, so I had to.” From 1960 to 1990, Bác Thanh had worked six days a week making wood products in the Cầu Đuống factory, founded in 1959 as a “friendship” enterprise of the Vietnamese and Czech governments. (Today the plant produces the ubiquitous Watersilk tissues and Comfy toilet paper.) At age fifty-four, Bác Thanh had received permission to retire early owing to poor health: during the Second Indochina War,1 he worked twelve-hour graveyard shifts, and in the daytime went to shelter in “hedges and bushes” (bờ bụi), escaping American bombing raids with other Hanoians. Rhetorically, he asked, “How could my health be any good at all?”

2

Epidemic Politics in Contemporary Vietnam

Bác Tuyết, aged seventy-four, had worked as a seamstress prior to retiring. She and Bác Thanh had lived in their thirty-square-meter home since 1959, raising their three daughters and three sons. Because of the destruction of the war, the state hadn’t enforced the family planning policy that encouraged families to “stop at two children” (Gammeltoft 1999, 68). To my eye, the couple appeared poorer than the average low-income household in Hà Nội. Over a series of months, we had visited many families across the city and thus developed an approximate—to be fair, extremely approximate—understanding of how deprivation manifested in people’s lives and living situations. Bác Thanh and Bác Tuyết owned just a few of the material possessions that I, like state agencies, attempted to use as a rough proxy for socioeconomic status: a bicycle, though no motorbike and certainly no car; a “table” telephone and a refrigerator, but not a computer or a mobile phone. They drew their drinking water from a drilled well in the yard that was shared with a number of other neighboring families and just laughed when I asked if they filtered the water. Bác Tuyết told us she had used river water to cook in the “old days” (ngày xưa), so the well was a big improvement. As the couple’s account of raising six children and cooking with river water suggested, they had long experience of what would be considered poverty in today’s Hà Nội—though in previous decades their circumstances might have appeared less exceptional by comparison. Beginning in the 1990s, Việt Nam’s economy entered a period of sustained, rapid growth, but the influence of national economic trends on the family’s overall standard of living could not have been called significant. Local authorities had not even recognized Bác Thanh and Bác Tuyết as an officially poor family until the previous year because their three sons still lived at home; the authorities saw the children as a source of income. The family’s recategorization as poor had actually represented a good turn for the household, as an official designation of poverty can qualify a family for support from the state. But Bác Thanh and Bác Tuyết disagreed a bit about what this had actually meant in practice. ML Do you receive any support from the local authorities? Bác Thanh They gave us that fan [pointing to the electric fan on the wall]. Bác Tuyết The grandchildren went to school for free. Bác Thanh No, just reduced [tuition]. They probably discounted it about thirty or forty percent. I’m not really clear. Then last year it was so hot, so they gave us the fan, they gave us a bag of stuff for the Lunar New Year (hàng Tết) and that was it. No money. Bác Tuyết There was money, each kid got 100,000 (Vietnamese đồng, approximately five US dollars).2

Introduction

3

As of the previous year, Bác Thanh had received special health insurance for low-income families, apparently for the first time. However, it didn’t cover his wife, who commented: If I were to go to the hospital I’d be afraid. Uncle (Bác trai, i.e., her husband) was a factory worker, so he has more of a policy (chế độ), but I don’t have one, and so I’m afraid. I don’t dare get sick. That is, I’m afraid of being sick and not having the money to go to the hospital.

Her husband added, “Hospital fees have gone up by ten. Before, if you went to be treated it would cost 3,000 ($0.14); now it’s more than 30,000 ($1.40). The money for a bed is from 40,000 ($1.85) to 65,000 ($3), just to stay one night in a state hospital.” Bác Thanh knew the rates because he had a motorbike accident four months ago, and his injured heel turned septic and required surgery. His hospital stay had lasted fifteen days and cost the family between 4 and 5 million VNĐ ($184–$230), an unbelievable sum. The bill hadn’t included the cost of medicine, the 500,000 VNĐ ($23) paid on the side as an “incentive” (bồi dưỡng) to the surgeon, or the several tens of thousands paid informally each time Bác Thanh needed help from a nurse. The couple’s sons and daughters had helped put together the money, but it had taken Bác Thanh a long time to walk again. Then the previous year Bác Thanh had also suffered an infection of cholera, a bacterial infection that causes acute vomiting and diarrhea. He remembered having eaten beef phở and drunk ice water at a street restaurant in the neighborhood and believed that was what had sickened him. “I was sick for a day and a night, so in the end, I couldn’t stay home.” Bác Thanh recovered after treatment in the hospital with antibiotics—the standard of care set by the Ministry of Health (Ministry of Health of Việt Nam 2007a, 80).

Tracing the Social Life of Cholera Amid the couple’s broader account of navigating systems for securing state assistance and receiving health care in late-socialist Việt Nam, Bác Thanh’s story of cholera infection caught my attention. Though my respondent described his sickness somewhat nonchalantly, cholera is a potentially fatal disease. Historical accounts of cholera—which has inflicted sickness and death worldwide in a series of at least seven pandemics over two hundred years—depict it as a uniquely symbolically charged diagnosis, associated with social upheaval, rupture, and

4

Epidemic Politics in Contemporary Vietnam

a sense of nature coming out of balance. In precolonial Việt Nam, cholera was known to be caused by “soldiers in a malevolent spirit army” called Quan Ôn (Malarney 2012, 109), and during epidemics, the royal court, members of the mandarin class, and the general population offered effigies to propitiate the spirits or organized processions to drive them away (Dyt 2015; Marr 1987, 40). During the movement for independence, Vietnamese nationalists worked to introduce scientific accounts of disease transmission into public consciousness, framing disease control as an avenue to liberation. Cholera in Việt Nam today retains significant symbolic and political associations, perhaps particularly for members of older generations who witnessed epidemics firsthand. All experiences of epidemic disease transmission have the effect of revealing reality anew. However, different pathogens reveal different aspects of reality, and cholera’s manifestation in pandemic form over a hundred and fifty years has given that pathogen countless opportunities to expose respective social truths across continents. Cholera is ultimately also a disease whose meaning is conjugated by its broad global sweep. As the historiography of cholera epidemics in Europe and North America suggests, the mass spread of a deadly and mysterious disease brings hidden aspects of collective consciousness into perspective, making commonly held anxieties, suspicions, desires, and style of thought available for analysis. In the nineteenth century, cholera’s appearance in multiple world regions coincided with “an era of acute social tensions” in Europe (Snowden 2020, 235), contributing to an atmosphere of political ferment and uncertainty; cholera occasioned fears, rumors, and even riots targeting medical authorities (Gilbert 2008). In his analysis of an outbreak of cholera in Hamburg in 1892, the historian Richard Evans finds “the workings of state and society, the structures of social inequality, the variety of values and beliefs, the physical contours of everyday life … were all thrown into sharp and detailed relief ” (Evans 1987, ix). And in his classic work on nineteenth-century cholera outbreaks in the United States, Charles Rosenberg brackets cholera as “a sampling device, a way of gaining access to particular configurations of demographic and economic circumstances, ideas, and institutional relationships” (Rosenberg 1992, 118). In the nineteenth century, cholera’s revelatory quality was caused in part by the social shock it delivered. The swift transit of this disease through populations was at least as unnerving as the symptoms of cholera itself, especially given the lack of consensus on cholera’s nature and causes and the inability of any medical system to reliably stabilize patients or reverse the course of illness. Cholera symptoms appear without warning, striking a person as if they had

Introduction

5

been, as one nineteenth-century New Yorker put it, “knocked down by an axe” (Rosenberg 1987, 3). During cholera epidemics in China’s Zhejiang Province in 1821 and 1822, people “died like sheep (…) dropping down in the streets without a struggle” (The Chinese Repository 1843, 488). The symptomatology of the disease—violent vomiting and diarrhea, which caused death from profound dehydration in as little as four to six hours (Kavic et al. 1999, 399)— inspired horror, shame, and dread. Reducing a healthy individual to a bluish, dehydrated body, one of cholera’s prevailing cultural meanings was the radical de-individuation of its victims: “[T]he kind of fatality that, in retrospect, has simplified a complex self, reducing it to sick environment” (Sontag 2001, 37). In Europe and North America, cholera was associated with poverty, sin, and the disenfranchised classes; to die of cholera “was to die in suspicious circumstances” (Rosenberg 1987, 42). However, cholera did not spare professionals, aristocrats, or royalty: G.W.F. Hegel died of cholera in 1831, Pyotr Ilyich Tchaikovsky died of cholera in 1893 (or was said to), and France’s King Charles X succumbed likewise in 1836. During this period, cholera was at the center of a significant scientific controversy on the causality of infectious diseases in general. While multiple accounts of the transmission of cholera circulated in the nineteenth century,3 the major contending perspectives were anticontagionism, which asserted that cholera was caused by exposure to noxious airs and places, and contagionism, which posited that cholera and other diseases were actively transmitted between infected and healthy persons via the action of a disease particle or animal agent whose existence remained speculative. Scientists of the anticontagionist camp understood cholera—along with other epidemic diseases, including especially smallpox and yellow fever—to be caused by foul smells and noxious emanations known as miasma. Continuous with a historically established humoral perspective on the cause and nature of disease, many nineteenth-century Europeans understood stagnant water and insalubrious places to threaten health via the action of “bad airs.” This theory posited that “once inhaled, the causative agent acted upon the blood to disrupt the body’s internal balance, resulting in fever and other symptoms of each epidemic disease” (VintenJohansen et al. 2003, 172). Belief in miasmas underwrote major sanitary reforms to urban environments, including the Haussmannization of Paris in the 1850s that cleared slum neighborhoods and built a network of boulevards to open the city to cleansing “light and air” (Snowden 2010). During this period, cholera also revolutionized French techniques for the creation and use of detailed social statistics and gave impetus to the creation of medical institutions, yielding

6

Epidemic Politics in Contemporary Vietnam

“the beginnings of an invigorated, ‘modern’ set of welfare practices” (Rabinow 1995, 30–1). Despite its ultimate scientific repudiation, anticontagionism was associated with progressive perspectives and social policies—while the inability of nineteenth-century medical doctors to explain or treat cholera fundamentally threatened the legitimacy of their profession, as Owen Whooley (2013) has argued. Ultimately, however, biomedical hegemony was shored up as evidence accumulated to support a contagionist explanation of cholera. In 1848, surgeon John Snow advanced the microbial paradigm with the hypothesis that a water-borne disease agent caused a series of cholera outbreaks in London’s Soho district. Louis Pasteur’s formulation of the germ theory of disease in the 1860s continued to add evidence to the contagionist perspective, and in 1884, microbiologist Robert Koch published findings4 demonstrating that cholera was caused by the microorganism Vibrio cholerae O1. The disease has since been understood as an intestinal infection caused by certain serogroups of a gramnegative toxigenic bacterium that appears under magnification as a curved rod with a single polar flagellum (Nguyen Binh Minh et al. 2009). Cholera infection occurs after consuming water or food contaminated by Vibrio cholerae: if the infectious dose contains enough bacteria to survive the effect of digestive acids, they colonize the lining of the small intestine and release an enterotoxin whose clinical symptoms resemble those of poisoning.

A World-Making Disease Alongside the immense amount of death cholera has inflicted worldwide since the early nineteenth century, the disease has informed political and social relations, shaped the trajectory of scientific research, and compelled significant changes to the built environment. As this history suggests, cholera has long been a “world-making disease,” shaping social “norms and forms” (Rabinow 1995) in unexpected ways. But less academically, cholera is a pathogen that inflicts debilitating illness via its opportunistic relationship to poverty and settings that lack sanitary infrastructure. As the World Health Organization wrote in 2018, “To put it bluntly, cholera spreads when people have no choice but to eat food or drink water that contains feces” (Neumann 2020). Anthropologists Marilyn Nations and Cristina Monte identify “poverty, low earning power, female illiteracy, sexism, lack of basic sanitation and clean water supplies” (1996, 1007) among the material inputs to cholera, and in their monograph on a cholera

Introduction

7

outbreak that tore through indigenous communities in Venezuela in the 1990s, Briggs and Mantini-Briggs tie the epidemic to “the inequality that lies at the heart of the modernist project” (2004, xvi). Despite our increasingly sophisticated scientific understanding of the cholera pathogen and its associations, cholera has yet to be eradicated. In fact, it is still not totally clear what cholera is. In recent decades, as historian of science Christopher Hamlin writes, Vibrio cholerae has “turned out (like other microbes) to be a repository for varying bits of rogue DNA, which together express toxicity under certain conditions. While we know vastly more about it, the general entity ‘cholera’ is less fixed than at any time since 1830” (Hamlin 2009, 16). Inputs to any given case of cholera operate at disparate geographic scales, from the microscopic to the atmospheric—making it challenging to disambiguate the causes of cholera (c.f. Eisenberg et al. 2013). In any given cholera outbreak, there may be no straightforward answer to questions such as: Who is to blame—governments, experts, the private sector, or the population? What matters more to disease prevention, individual hygiene or public sanitation? Food safety or climate? Microbes or poverty? Even the ontology of the cholera pathogen itself is unstable. A new cholera biotype was identified in 1897 at a medical station in the Sinai Peninsula (Echenberg 2011, 6). Called El Tor, the new strain was implicated in a seventh pandemic that began in Indonesia, lasting from 1961 to 1975. Most recently, an outbreak of cholera in Bangladesh and India spread to Latin America in 1991 and inaugurated what some scientists have described as an eighth pandemic (Reidl and Close 2002), spreading from Peru to Ecuador, Colombia, Chile, Brazil, and Venezuela (Stewart-Tull 2001, 586). In 1991, a record 596,689 cases of cholera were reported from sixty countries with a case fatality rate of 3.2 percent (Gleick et al. 2006, 290). The following decade witnessed an “unprecedented increase in the global burden of cholera” (Collins 2003). Cholera has continued to represent a significant source of morbidity and mortality worldwide, reported in recent years in all world regions and causing thousands of deaths in outbreaks in Zimbabwe (2008), Haiti (2010), the Democratic Republic of the Congo (ongoing since 2017), Somalia (ongoing since 2017), and Yemen (2020). Where cholera was once concentrated in Asia, the burden of disease has shifted to Africa, where over 90 percent of cases are now found (Reyburn et al. 2011). Physician Jane Zuckerman and co-authors assert that globally, cholera is “at least as prevalent now as it was fifty years ago” (Zuckerman et al. 2007, 522) and is unlikely to ever be eradicated. Accordingly, the designation of cholera as a “classic disease of the nineteenth century”

8

Epidemic Politics in Contemporary Vietnam

(Rosenberg 1987)—while not inaccurate—may not be the most helpful heuristic for conceptualizing the realities of cholera epidemiology in the present and the future. Indeed, historian Myron Echenberg cautions that given the cholera pathogen’s evident symbiosis with globalization and climate change, cholera “may soon become the quintessential twenty-first century disease” (Echenberg 2011, 12). As the above discussion suggests, scientific authorities have advanced shifting perspectives on the nature of cholera and its causation over the last two centuries—ultimately coming to recognize cholera as a shifting thing itself. Yet the pathogen has long been stably imagined as an epochal disease that indexes the living standard, or even civilizational level, of affected individuals and populations. I take a slightly different view of cholera’s relationship to poverty and time. Though the relationship of cholera risk to poverty is indisputable, I suggest that mainstream epidemiological accounts fall short of their explanatory power by failing to theorize poverty in more processual terms—essentially treating poverty as a static, simple variable instead of as the outcome of processes of exploitation. In this way, they may also fall back into a conservative account of cholera as related to temporal categories of “underdevelopment” or “backwardness”—misrecognizing a twenty-first-century disease as a nineteenth-century one, as above. By contrast, I suggest that the pathogen reveals historically prior experiences of dispossession, such that cholera is also likely to be found in association with the externalities of “development,” “progress,” and “modernization.” In this work, which treats a series of cholera outbreaks in post-marketreform urban Việt Nam, I follow the methodological precedent of treating cholera as a “sampling device”—a way to see more deeply into the shifting social, economic, political, and cultural arrangements that inform public health. The book’s chapters individually address the systemic inputs to cholera and the response to its appearance. I argue that though these experiences were startling and occasioned surprise and even shock in the national capital, they appear less surprising in consideration of cholera’s relationship to economic volatility, mass population movements, and infrastructural weaknesses—disavowed but constitutive features of contemporary urban society in Việt Nam.

Anomalous Outbreaks This brings us back to the case of cholera suffered by Bác Thanh, a seventyfour-year-old Hanoian and former factory cadre (cán bộ). The cholera epidemic that found its way to him began quietly, as infectious disease outbreaks often

Introduction

9

do, preceded by events elsewhere in the city. In late October 2007, a rice farmer in his seventies had arrived at Hà Nội’s Bạch Mai Hospital with acute diarrhea and vomiting: symptoms worse than those of ordinary food poisoning. Under the microscope, stool samples showed “darting motility”: the movement pattern characteristic of cholera vibrios. These samples were sent to the National Institutes for Hygiene and Epidemiology (NIHE), where analysis confirmed a diagnosis of cholera (Tran Minh Nhu Nguyen et al. 2008, 2–3). In Việt Nam, cholera is categorized as a Class A infectious disease, mandating the notification of the nearest People’s Committees, specialized health agencies, or health establishments. An epidemiological investigation team was therefore dispatched to the patient’s home village. From interviewing the patient’s family, the team learned that he had attended two weddings and a funeral within the last two days. At such events, large amounts of food and drink are typically prepared in advance and then consumed in common. No food remained to be sampled, but the outbreak investigation team collected samples of environmental water and fecal samples from the family; these did not detect any other infections. It seemed that no one who had shared a meal with the patient became ill. The rice farmer’s family had poured the patient’s vomitus into a nearby pond, and as a precaution, the health services disinfected the pond with 700 kilos of chlorine (Nam Nguyên 2007). Three days after the farmer had reported to hospital, another patient with severe acute watery diarrhea was admitted to hospital; no link between the infections could be established. In the next few weeks, more and more patients with the same symptoms began to appear in hospitals and clinics in North Việt Nam. By early November, over 100 cases of cholera had been laboratory-confirmed, but the state had still not declared an epidemic (BBC Vietnam 2007). By mid-November, disease had spread across fourteen provinces and caused at least 1,880 cases of what the Ministry of Health called “acute diarrhea” (tiêu chảy cấp)—of which 240 cases were confirmed as cholera (World Health Organization 2008). The total number of clinical, or symptomatic, cases exceeded annual cholera case counts reported in Việt Nam over the past decade. Reports of the total numbers of cholera infections in North Việt Nam varied between sources, but the fullest public accounting of the burden of disease throughout the region stated that the Fall 2007 outbreak, from October to December, caused 675 cases of cholera in Hà Nội (Trần Như Dương et al. 2010, 6). This was followed by three more waves of infection. These caused 58 cases in Hà Nội between December 2007 and February 2008; 1,365 cases from March to November 2008; and 528 cases in Spring 2009 (Trần Như Dương et al. 2010, 6)—a total of 2,626 reported cases. Overall, 8,064 cases of cholera

10

Epidemic Politics in Contemporary Vietnam

were reported in cities and provinces of North Việt Nam from 2007 to 2009. Of these, “649 had a positive stool culture for Vibrio cholera sero group O1 (biotype El Tor, serotype Ogawa)” (Tran Nhu Duong 2008)—but because not all symptomatic cases were tested for the presence of Vibrio cholerae, the total percentage of cases attributable to cholera is unknown.

Sensitive Research With the rich literature on the history of cholera in mind, I was intrigued by the social and political questions presented by cholera outbreaks in contemporary Việt Nam. Given the country’s history of successful disease control under socialism and its newly appreciating national economy after market transition, there should have been—on paper—no cholera there. It was particularly noteworthy that cases were reported in the capital city, whose built environments projected the nation’s rapid economic appreciation, integration with global markets, and increasing attractiveness to foreign investors. At the outset of research, I saw the outbreaks as a unique opportunity to understand how Việt Nam’s changing political economy has influenced public health outcomes, social determinants of health, and state approaches to infectious disease control. While there is a fascinating story to be told about the changing situation of public health and health care provision in Việt Nam’s rural communities, my focus is on these issues in Hà Nội—where the effects of accelerating urbanization, marketization, and shifts in public culture shape the social and environmental pathways of infectious disease and the ways disease is understood and explained. Việt Nam’s health system under socialism, like that of Cuba, has historically received international praise and also drawn controversy for reporting public health outcomes that appeared to significantly outperform national economic indicators. In prior decades, Việt Nam’s public health metrics and progress in controlling infectious disease have signaled the promise of primary health care not for only poor countries but for revolutionary and postcolonial settings. Among other accomplishments, cholera was reported to be eradicated in Việt Nam shortly after independence from colonial rule. The legal framework of the Government of Việt Nam has historically included ambitious provisions establishing state responsibility for public welfare as part of the social contract and has often put forward rhetoric implying that the health of the nation and the health of the population are, if not the same thing, then mutually entailing. Article 3 of the current Constitution, ratified in 2013, commits:

Introduction

11

The State shall guarantee and promote the People’s right to mastery; recognize, respect, protect and guarantee human rights and citizens’ rights; and pursue the goal of a prosperous people and a strong, democratic, equitable and civilized country, in which all people enjoy an abundant, free and happy life and are given conditions for their comprehensive development. (Việt Nam News 2014)

However, these aspirational promises can be hard to spot in practice, both in the contemporary Vietnamese health care system and elsewhere in society. The environmental challenges, health system limitations, and lack of economic security I will describe in the chapters ahead suggest the state is providing less than what is necessary for the nation’s people to secure “comprehensive development.” Cholera, a disease associated with poverty and compromised infrastructure, suggested the unacknowledged costs of a rapid market transition widely characterized as a success and an example for other “transitional” countries. Studying the epidemiology and cultural meanings ascribed to cholera in the national capital would permit insight into these unexpected associations. Or so I believed. My early enthusiasm about this case study distracted me from the political limitations on research regarding sensitive (nhạy cảm) topics in Việt Nam, especially when studies are led by foreign investigators. As I attempted to realize the promise of this intriguing topic, I found that conversations with scientists, medical professionals, and researchers had a strange tendency to go in circles. No hospital data on cholera patients could be made available to me, and epidemiological data on the outbreaks could not be released from the National Institute of Infectious and Tropical Diseases either—mostly, as a staffer informed me, owing to concerns about “politics and tourism.” One district health official, after granting me permission to collect data from local households, added a caveat: “Remember, science is science, and politics is politics.” And I received numerous emails turning down requests, such as the following: I asked my friends about your question. It is very difficult for you to have data on cholera patients (almost impossible). There are some reasons; the most important reason is relative to tourism and politics. My friends suggest [that you do research] about hepatitis or dengue, maybe that would be possible. (personal communication, January 15, 2010)

As these comments suggested, cholera was right on the margin of what is considered “scientific”—and thus politically acceptable—and what is considered “political” and therefore inappropriate. Despite Việt Nam’s sometimes restrictive research environment, fewer restrictions have been

12

Epidemic Politics in Contemporary Vietnam

placed on foreign anthropologists whose studies are perceived to be on topics “directly related to socioeconomic development (e.g. ecology, economy, and health),” as Hy Van Luong has observed (2006, 373). Researchers studying politically sensitive issues in Việt Nam—state expropriation of land, the national controversy over bauxite mining, “street children,” and the activities of dissidents, for example—have encountered overt and disconcerting forms of censorship and state harassment. I never experienced anything similar. Most of the rejections I received were polite non-answer answers, consistent with a local etiquette of allowing people to save face. But it did become apparent that I was pursuing a topic that was in ways off limits. In response to one emailed request for information on the legal framework for infectious disease management, one health officer advised, “In fact, [my] office has no documents on this topic and I talked with my boss, a professor on cholera as I mentioned to you before. He refused to meet you because cholera is a sensitive topic and he doesn’t want to talk with foreigners about that without permission of Government” (personal communication, July 6, 2010). As this remark suggests, the Vietnamese government, often described as a “Party-state” for its closely entangled relationship with the Communist Party of Việt Nam, exercises significant political and legal authority over the organization and function of the public health sector. However, while the state (or Party-state) is sometimes characterized as authoritarian or totalitarian, anthropological and other accounts of Vietnamese society have drawn attention to the limitations of this descriptor. In practice, as researchers across diverse domains have shown (c.f. Kerkvliet et al. 2003, MacLean 2013), the state has evidenced only partial and limited capacity to enforce its own directives. Not only does its practice frequently diverge from policy, but the state has also historically made concessions to the appeals of non-state actors, setting and implementing policy in “dialogic” fashion (Kerkvliet 2003). Too, insofar as the national process of economic liberalization has entailed deregulation and private ownership, Việt Nam’s post-socialist state no longer acts as the nation’s (nominal) sole authority—though neither, as some scholars argue, is Việt Nam’s society or economy now best described as straightforwardly “neoliberal.”5 In sum, the Vietnamese state is “no clearly bounded entity able to rule and implement” (Priwitzer 2012, 138) and its still quite significant powers fall short of all-encompassing. In the health sector, the state’s ambitions to govern to the level of the locality during the socialist period entailed the creation of a health system that was once described as a “vast pyramid” (Pham Ngoc Thach 1965, 9). While this

Introduction

13

infrastructure is still in place, the process of market reform has changed its appearance and function, as I discuss later in this book. Since liberalization, the state has relaxed its formerly tight hold on health matters: allowing private medical practices to operate, deregulating the pharmaceutical industry (Nguyen Thi Kim Chuc and Tomson 1999), and permitting international nongovernmental organizations (INGOs) to establish programs and services that support public health, as I discuss in Chapter 5. The state’s approach to public health communications has also shifted from a more traditionally coercive strategy of mass-mediated didactic messaging to a more neoliberal approach in which the public is educated, “empowered,” and encouraged to make healthconscious choices (c.f. Porter 2019). Thus, the appearance of cholera and the impetus to respond to it opened space for debates about what aspects of public health are, or are not, the business of the state. While the state’s effort to keep politics out of health challenged my early attempts to retrieve even very basic information on the cholera outbreaks in North Việt Nam, these field experiences also underscored why these events were such a rich subject for anthropological research. Cholera’s political, cultural, and social significance in Việt Nam is as intriguing as its biological and epidemiological dimensions, and indeed these domains cannot be neatly separated. Furthermore, as I will argue, cholera revealed some of the most confounding facets of Việt Nam’s transition from socialism—an encompassing reordering of society that has entailed resonant consequences for the way people live, the risks to which they are exposed, and the safety net that is supposed to protect their health. In the chapters that follow, I examine the series of cholera outbreaks that occurred in Hà Nội and other provinces in North Việt Nam. The outbreaks prompted a great deal of public discourse, debate, and engagement. Specifically because it was challenging to explain, the reemergence of cholera in this setting was an opportunity to explore the worldviews that diverse actors drew on in making sense of anomalous events. I focus on how laypersons and professionals explained and responded to the cholera, and also inquire into the material factors that likely contributed to the outbreaks, directly and indirectly. During my fieldwork, interviews with “experts,” colleagues, and ordinary people helped me gain insight into the local significance of cholera and the different models of causality, or “geographies of blame” (Farmer 1996), that explained it. Many accounts of cholera that I recorded, both lay and “official,” deviated from a biomedical or bioscientific idiom and took on additional significance referencing society, politics, culture, and morality. And the ethnographic

14

Epidemic Politics in Contemporary Vietnam

accounts I present—whose implications go beyond cholera to issues of poverty, health, and public welfare—shed light on the aspects of the de facto social contract of the post-transition period, showing where lived experience deviates from the state’s political promises to Vietnamese citizens.

Study Methods Cholera’s political sensitivity required me to adopt an approach to data collection that could circumvent administrative obstacles. For example, it was impossible to access an official list of individuals who had been affected directly by cholera infection, so purposive sampling of cholera patients was hence also impossible. It was also difficult to establish the geographic distribution of cholera cases at the district or ward level in Hà Nội, preventing me from making a “cholera map” à la John Snow in 1850s Soho. I decided to interview a comparatively large sample of lower-income city residents, hoping that it might include some cholera patients by chance, and framed a study emphasizing the relatively innocuous topics of food safety, water and sanitation, and family health. My semi-structured, open-ended interview instrument included questions about occupation and income, household access to food and water, family health, medical care, and perceptions regarding the cause of diarrheal disease—topics less liable to seem uncomfortably “political.” I stuck to these questions in interviewing, developing a dimensional sense of how poverty, urban environments, and the health care system interact in the lives of city residents. Despite my cautious approach to research, it took months of requests to be permitted to conduct interviews with city residents (“regular people”—người dân or người bình dân). With the help of staff at Hà Nội School of Public Health (HSPH), where I had my research affiliation, I accomplished this via a series of meetings with public health authorities, beginning at city-level offices and working down the administrative hierarchy to district-level health centers and ward health stations. I received ethical approval from the Institutional Review Board at HSPH and also from the Preventive Medicine Centers (Trung Tâm Y tế Dự phòng) of four district-level health authorities. Subsequently I purposively selected four of Hà Nội’s twelve urban districts (quận) for data collection, choosing two districts where higher rates of cholera had been reported in the 2007 outbreak (Hai Bà Trưng and Hoàng Mai districts) and two reporting lower rates of cholera (Hoàn Kiếm and Long Biên districts). Six wards (phường) per district were selected randomly; in each ward, five respondents whose names

Introduction

15

were on ward lists of officially poor and near-poor households (hộ gia đình nghèo, cận nghèo) and who otherwise matched the study enrollment criteria6 were selected randomly by health station staff. From February to August 2010, I carried out semi-structured ethnographic interviews with low-income families in their homes in twenty-four wards of Hà Nội, arriving at ward health stations (trạm y tế phường/xã) in the morning and spending the day speaking with respondents in the neighborhood. A health station staffer who could get free of her other duties would accompany me and a research assistant to peoples’ homes (however, health workers did not observe our conversations). Interview participants provided informed consent and permission to tape-record; subsequently, recordings were transcribed and interview content was translated for thematic analysis. In keeping with local conventions for research, respondents received a small sum of money (50,000 VNĐ, approximately $2.25) to thank them for their time, as did commune health station workers for “guiding” us (hướng dẫn) and the administrators of the systems where I received permission to work. Of the 118 interview respondents, 73 percent were female (86 women) and 27 percent were male (32 men); individuals were aged twenty-nine to ninetytwo, with a median age of fifty-one. Interviewing during the hours of work and school skewed the sample toward an older demographic; my sample also contained many unemployed, self-employed, and retired individuals; some respondents continued working through the interview. Conversations were facilitated by research assistants, young Hanoians who assisted with translation and culture brokering; many of my respondents had not interacted frequently with foreigners or foreign researchers, if at all, and I anticipated it would have been uncomfortable if I had arrived unaccompanied. I also conducted interviews with dozens of Vietnamese and foreign individuals whose professional experience positioned them to provide information about the cholera outbreaks, the organization of the national health system, disease control, and related matters of policy or public record. These respondents included government workers from the level of the neighborhood to the Ministry of Health, health care facilities, university departments, NGOs, and bilateral and multilateral aid and lending organizations with ties to North America, Western Europe, Australia, New Zealand, and the Association of Southeast Asian Nations (ASEAN). I further met with journalists and academic researchers—mostly foreign, but also some Vietnamese. These conversations allowed me to develop insight into how Vietnamese and foreign officials understood, explained, and managed matters of public health and infectious disease.

16

Epidemic Politics in Contemporary Vietnam

In Hà Nội Formerly a quiet (yên tĩnh) town whose traffic mostly consisted of bicycles, Hà Nội is becoming a global city—a status marked by the presence of transnational corporations, projects funded by foreign aid and investment, regional and international tourism, and the offices of NGOs based in Europe, Asia, and North  America. Hà Nội’s extremely heterogeneous architecture includes dynastic-era “tube houses,” pagodas, museums, French colonial villas, works of socialist brutalism, a cathedral built by the French, and a growing number of sleek modern skyscrapers. In the early years of the economic boom, anthropologist David Craig described the city’s ambiance as it was newly animated by commercial imperatives: [T]he city was in its first flush of commodity capitalism: people were changing the dull greens and grays of military and worker clothing for brighter colors and sharper cuts; big, new, illuminated plastic signs hung on house and shop fronts; street barrows with primary colored plasticwares were being pushed in slow motion down the middle of the street (…) Neighbors might suddenly open a karaoke pub in their front room, or decide to add another floor or two to their house, beginning work unannounced at five o’clock in the morning with a sledgehammer on a shared wall. (Craig 2002, 17)

Today, this passage feels both prescient and nostalgic, as it has since turned out that Hà Nội’s process of creative destruction was only getting started. Liberalization has spelled enormous changes for the city’s built and social environment, with new wealth manifesting in the motorbikes and private cars supplanting the calm bicycle traffic of yesteryear (Truitt 2008), an astonishing range of types of commercial activity in the city, and the burgeoning of globalized culture—with shopping malls, international fast-food chains, American movies in cinemas, and, as of 2017, a McDonald’s franchise. As these indications suggest, Việt Nam’s economic transformation is, for some, presenting new opportunities for transnational contact and exchange, for new experiences of consumption, and for the fashioning of middle-class distinction. Meetings with the officers of INGOs and government departments inadvertently illuminated the growing disparities between wealthy, wellconnected individuals and ordinary working-class people in Hà Nội—in some situations shedding light on what I have elsewhere described as “medical stratification” or inegalitarianism in patterns of access to health care facilities

Introduction

17

(Lincoln 2014). Typically, the headquarters of foreign NGOs in Việt Nam are found in comparatively new buildings and wealthy neighborhoods, and feature air conditioning, fast internet, and international staff. The typical medical research facility funded by multilateral donors is housed in a newly built building with up-to-date labs and pleasant décor—and was, in one case, steps away from some of the most overcrowded and uncomfortable hospital waiting areas I have ever seen. These luxurious settings stand in sharp contrast to state medical facilities— the district health offices that direct public health activities, which are typically unglamorous if functional, and the ward health stations where poor people are encouraged to receive primary health care. These latter, though designed to provide the residents of every neighborhood with medical services, face compressed budgets even as their financing has turned to a fee-for-services model. And of course, the homes of NGO workers and the foreign staffers of bilateral agencies—big and air-conditioned villas in the expatriate-friendly part of town—pose an imponderable contrast to the extremely simple, even spartan homes of poor Hanoians that we were permitted to visit in the course of this research. The accommodations of poor and near-poor Hanoians feel remote from these spaces of past and present luxury and leisure. I interviewed families who  lived in socialist-era collective apartment buildings (nhà tập thể, chung  cư), in small unluxurious apartments built into warrenlike alleys (ngõ, ngách) on the inside face of city blocks, and in narrow houses that opened directly into busy roads and markets. While housing stock and living accommodations vary greatly across Hà Nội, most of these homes were rental properties as small as twelve square meters, or one-quarter the footprint of the average Vietnamese house (Minot and Baulch 2004, 239–40); one elderly lady in a Soviet-era apartment cheerfully noted, “The house is so small (bé lắm), there’s barely room for a bed.” Homes sometimes lacked a kitchen or a bathroom or both, and virtually never had any form of climate control besides an electric fan. It is difficult to document deprivation without objectifying it in a problematic way. With that said, as a middle-class American, I found it humbling to be a guest in the small and simple concrete and tile rooms that were home to members of multigenerational families, to see the evidence of their accomplishments displayed in photographs and certificates, and to hear them speak about their lives. It was a privilege to speak with workingclass Hanoians, whose stories are excluded from much of the national and

18

Epidemic Politics in Contemporary Vietnam

international discourse about Vietnamese society today, and to learn about Việt Nam from their perspectives. At the time of my data collection Việt Nam was experiencing one of the most intense urban transitions in the world, with cities and towns projected to increase from one-third to one-half of the country’s population within twentyfive years (L’Abbé 2010, 5); Hà Nội was one of the centers of this phenomenon. Hà Nội’s population began growing substantially in the early 1990s, increasing at an annual rate of approximately 3 percent (L’Abbé 2010, 6). During my field research in 2009 and 2010, Hà Nội had some 6.5 million inhabitants; as of 2019, the city’s population was just above 8 million.7 While increasing economic opportunities in cities, urbanization has concentrated some of the most challenging characteristics of post-reform Vietnamese society, including the rise in intra-urban disparities which is accompanied by an increasing polarization of income (…), rising unemployment rates, an increase in environmental pollution (…), crime rates, prostitution and corruption as well as the emergence of slum-like settlements as a consequence of the growing pressure to migrate from rural areas. (Waibel 2004, 31)

My friends in Hà Nội, many of whom had migrated to the capital for work or education, described the city as a place where quality of life and economic opportunities surpassed those available in surrounding rural provinces, where life could be sad (buồn) and boring (chán). With its increasingly cosmopolitan ambiance, Hà Nội certainly proffers opportunities—or at least the proximity to opportunity. The capital has also long been described as a place where inequity is concentrated and amplified: “[A]verage incomes are well above the national average. Most of the recent increases, however, are accruing to a small group of nouveau riche, with most of the capital’s growing population, particularly the poor households, being left with expenditure levels which are very similar to those in rural areas” (Drakakis-Smith and Kilgour 2001, 232). In the center of the city, businesses and residences are sited tightly side by side, with traffic, work, commerce, light industry, and the activities of daily living mixed together. Traffic is the main contributor to the municipality’s air pollution levels, which exceed those of any other Southeast Asian city (Ngo Tho Hung 2010). In many parts of the city there is little green space to be found, as formerly open land has been paved over (Drakakis-Smith and Kilgour 2001, 227). Coming from New York City at the time of my fieldwork, I was familiar with crowds and traffic but still frequently overwhelmed by the

Introduction

19

extraordinary population density, commercial activity, and constant coming and going in the neighborhoods of Hà Nội.

Renovation This background contributed to the sense of cognitive dissonance prompted by the arrival of cholera: what made these outbreaks seem so anomalous was not only Việt Nam’s history of successful disease eradication, but its muchtouted decades-long economic boom. Formerly among the absolutely poorest countries in the world, Việt Nam was approaching middle-income-country status when I began fieldwork in 2009. This was the result of an extremely rapid and consequential economic transformation called đổi mới, or “renovation.” In the immediate postwar period, Việt Nam’s national economy, damaged by a brutal all-fronts conflict, was progressively enervated by “the end of Chinese aid, a significant reduction in Soviet and East European aid, and (…) a US-led trade embargo” (Hy Van Luong 2003, 3); food shortages and declining living conditions were reported throughout the reunified country (Banister 1985, 3). Beginning in the late 1970s, party leaders permitted new forms of economic decentralization in response. In the mid-1980s, as the economy continued to struggle, Việt Nam embarked on formal economic reforms that disestablished many features of the centrally planned economy, creating a “market economy with socialist orientation” (kinh tế thị trường định hướng xã hội chủ nghĩa). Vietnamese leadership aggressively pursued trade liberalization agreements and integration with global markets as well as promoting internal deregulation, boosting the performance of the national economy: in the 1990s and early 2000s, Việt Nam’s GDP growth rates were among the very fastest in the world. At the time of my fieldwork, Prime Minister Nguyễn Tấn Dũng had presided over a “hyper-liberal turn” for several years and was in the process of “transform[ing] Vietnam into a magnet for foreign investors” (Masina and Cerimele 2018, 11). In January 2007, Việt Nam gained admission to the World Trade Organization: a high-water mark in the pursuit of integration with global markets, capping decades of bullish economic performance. In September, with the nation’s foreign direct investment, economic growth, and tourist arrivals at record rates, the Vietnamese Ministry of Sports, Culture, and Tourism placed a spot on CNN, portraying the country as an “attractive destination with diversified and abundant cultural aspects and tourism products.” This was part of a national branding campaign featuring the slogan “Vietnam: The Hidden Charm.”

20

Epidemic Politics in Contemporary Vietnam

As the state promoted Việt Nam as a newly dynamic—yet timelessly appealing—destination for Western leisure travel and investment, a disease associated with poverty, war, and natural disasters was breaking out in the national capital. Given the country’s model macroeconomic performance, the appearance of a disease associated with infrastructural collapse caused shock, belying the nation’s history of improvements to public health and its apparent exit from poverty. The outbreaks raised questions that media and policymakers struggled to explain. What social, environmental, political, economic, and behavioral dynamics were disclosed by the spread of cholera? How do people— particularly poor people—live in present-day urban Việt Nam, and what factors in everyday life expose them to disease? In Hà Nội, the arrival of cholera was dissonant with the greater economic context of increasing opportunity and wealth; it also failed to conform to established epidemiological form. I was told that cholera was unexpected in October, given its tendency to appear during the rainy season. Furthermore, cholera outbreaks in Việt Nam were, I was told, typically spatially concentrated, limited to rural areas, and traceable to a single place or event, such as a shared ceremonial meal (ăn cỗ). In 2007, cholera cases were scattered across Hà Nội with no obvious point source, and infection appeared to be spreading from the city into surrounding provinces—a troubling and counterintuitive trend that was actively suppressed in official reports. In terms of Việt Nam’s general public health indicators, the outbreaks were even more unlikely: in 2005, an Asian Development Bank report had stated that the Red River Delta, where the outbreaks began, had the “epidemiological profile of a middle-income country” (Bloom et al. 2005, 1). Cholera had been reported intermittently in the Central Highlands in the 1990s, but not in other parts of the country (Kelly-Hope et al. 2008). It was not considered an endemic disease. In attempting to make sense of these events, I approach Hà Nội’s cholera outbreak from the perspective of critical medical anthropology—a research tradition oriented to the political economic analysis of health and medical concerns. This analytic approach is particularly well suited for assessing the vicissitudes of health and economy in a setting experiencing rapid systemic change. In the 1990s, as the logic of structural adjustment and austerity spread throughout the Global South, critical medical anthropologists strenuously refuted claims associating neoliberal reforms with improved health outcomes and pointed out the deleterious effects of these policy changes on public health (c.f. Kim et al. 2000). Research from diverse world regions drew attention to the ways that economic liberalization had underwritten new forms of unwellness.

Introduction

21

Studies from the pan-regional post-socialist world have illuminated the relationship between health and political economy in particularly important ways, in part because they reveal health to be strongly conditioned by the disruptive remaking of social and economic systems. As anthropologist of Russia Michelle Rivkin-Fish has argued, research on “health after socialism” can help “explain the trajectories and trials of life (and death) in former socialist contexts by revealing how daily life is embedded in shifting formations of citizenship, practices of distinguishing public and private, and changing notions of personhood” (2011, 8). This has taken on a degree of urgency in the years since the collapse of the Soviet Union, as anthropologists have resolved in disturbing detail how economic “shock therapy” has compromised health and welfare in socialist-bloc countries transitioning to market economies. Craig Janes and Oyuntsetseg Chuluundorj (2004) have pointed to Mongolia’s “free markets and dead mothers,” Erin Koch (2013) has investigated “free market tuberculosis” in post-socialist Georgia, and Jonathan Stillo (2015) has studied tuberculosis among the self-described “losers of socialism” in Romania. Gábor Scheiring et al. have taken stock of the “wounds of post-socialism” evident in elevated mortality rates in post-socialist Hungary, advising “No critical analysis of postsocialism can be complete without assessing the human costs of economic transformation” (Scheiring et al. 2018, 24). The present work addresses đổi mới’s human costs in Việt Nam, whose national health outcomes have generally not paralleled the trend of precipitous decline observed in other formerly socialist settings. This is in part because the country’s “cautious and pragmatic attitude shaped a reform process fundamentally different from the so-called transitions of Eastern Europe and former Soviet states” (Masina and Cerimele 2018, 6). Nonetheless, the “wounds of post-socialism” in Việt Nam are important to attend to, and the case study I treat in this book represents an unusually visible expression of the weak spots in the post-reform social contract. As in other socialist settings, the Vietnamese state has historically shored up its legitimacy with “calls for the development of a more effective, broad-based, and equitable health system” (London 2008, 116), and the eradication of epidemic disease played an important part of this project. The cholera outbreaks I address came as a material and symbolic rebuke to Việt Nam’s contemporary political economy—a socialist polity whose national economy has been growing for decades at ferocious, globally competitive rates. The emergence, spread, and recurrence of cholera in North Việt Nam, including in the national capital, threatened to give voice to some of the nation’s systemic wounds—upstream contributors to disease such as weak urban

22

Epidemic Politics in Contemporary Vietnam

infrastructure, hidden poverty, and disinvestment in primary health care. Problems in infrastructure, public utilities, and socioeconomic arrangements are common factors in cholera outbreaks worldwide: environmental factors, infrastructural weaknesses, poverty, and the degradation of national health systems also informed cholera outbreaks in Zimbabwe in 2008 and in postearthquake Haiti in 2010, among others. In Việt Nam, the cholera outbreaks should have prompted calls for major reforms to municipal infrastructure and the state’s system for public health communications—not to mention furtherreaching calls for greater socioeconomic equity and investment in public welfare. However, these likely inputs to the cholera outbreaks in North Việt Nam, which should have been front and center for local and international health experts, were all but absent from news media and scientific reports about the epidemics. Instead of pursuing questions about systemic contributors to contagion, journalists and researchers focused elsewhere. The most widely circulated accounts of cholera’s causes in Hà Nội emphasized scandal, even conspiracy: relating stories of unsafe food products, the carelessness of food workers and vendors, and the deficient behaviors of customers and consumers, media about cholera contributing to uncertainty surrounding the true causes of disease and the best ways of staving it off. As I will suggest, this tendency in media coverage led to the development of intricate, arguably unlikely hypotheses that posited quite improbable and bespoke transmission chains and avoided mentioning the role of large-scale inputs to the propagation of an enteric pathogen. In these ways, the most widely circulated and influential accounts of cholera reflected the political and economic priorities of the state.

Significant Ghosts While I argue that cholera in contemporary Hà Nội cannot be understood absent the larger cultural and political economic context of Việt Nam’s post-transition period, I do not couch this account completely in the positivist tradition of critical medical anthropology; the evidentiary basis is not quite robust enough to allow this. As noted, cholera was very politically sensitive, and its sensitivity made for a challenging case study. In the absence of fully descriptive data, I draw inspiration from the research of anthropologist Diane Niblack Fox on the afterlife of defoliant agents that the US military sprayed on Vietnamese landscapes during the Second Indochina War. These large-scale intentional exposures to persistent organic pollutants left behind essentially unresolvable questions regarding the

Introduction

23

impacts of toxins on natural environments and human health. Fox describes Agent Orange as “one significant ghost” of the war, where cultural meanings are made in the absence of scientific knowledge, and as “an intersection” (2003, 81) where contesting claims and perspectives coalesce, making sense of experience and creating meaning. Fox’s work sets intellectual precedent for research on phenomena that exceed “the limits of what is currently known by science” (Fox 2003, 81). Along similar lines, I position cholera in Hà Nội as a phenomenon that cannot be fully explained via scientific representations, especially given the political obstacles to fully documenting its epidemiology, untangling its causes, or resolving its significance. And in similar fashion to Fox, in this work I have treated cholera as an intersection in which meanings drawn from historic experience, society and politics, moral imaginaries, and scientific expertise all collide. My account thus uses historical, ethnographic, and public health sources to elucidate the significance of cholera in present-day Việt Nam. In data collection and analysis, I rely on qualitative, interpretively oriented methodologies. In sum, this book uses the experience of cholera in Hà Nội to develop a critical assessment of the material conditions of Việt Nam’s market transition, and to sketch an ethnographic account of the cultural politics of health and disease in the hybrid political economy of the present day. Following in the tradition of the medical anthropological and critical historical study of infectious disease, I suggest that the cholera outbreaks revealed social, cultural, and material factors that would otherwise remain undisclosed and outside of collective consciousness—and that these dynamics can be read when an outbreak brings them to the surface. Individual chapters present background to the outbreaks, establishing how social, cultural, political, and economic factors shaped cholera risk and responses to its manifestation. Chapter One, “Medicine and Disease in North Việt Nam: Doctoring the Body Politic,” historicizes cholera in Việt Nam and the rise of a national health service  to combat infectious disease. I demonstrate how the political and economic conditions of Việt Nam’s colonial period exacerbated the spread of cholera—suggesting how medicine came to represent a vital resource, ideologically and materially, to advance the cause of anticolonial resistance during the revolutionary and socialist periods. I trace the evolution of medicine in the Democratic Republic of Việt Nam, establishing how a local cultural politics of medicine attributed contagious disease to foreign occupation, mobilized the masses in a national culture of patriotic health, and imagined health workers as “new people” of socialism, casting doctors in a family-like

24

Epidemic Politics in Contemporary Vietnam

role as the parents and kinfolk of the masses. This background illuminates the cultural significance of cholera in the present day: in contemporary Việt Nam, cholera is perceived as an atavistic disease associated with underdevelopment and oppressive foreign influence—but this perspective may actually cause misrecognition of risk factors and undermine the most effective responses to an outbreak. I close this chapter by describing the predicaments in health and welfare that some of my study respondents faced, showing how transition has undone some of the most fundamental achievements of the socialist health care system and social contract. In Chapter Two, “Water and Sanitation in Transition,” I examine one of the most significant and overlooked risk factors in the spread of cholera: contaminated water. Despite national precedent for enteric illness associated with water and sanitation problems, Vietnamese officials and media reports barely mentioned water in their accounts of the cholera outbreaks, focusing on other causes instead. In the history of water management in North Việt Nam, channeling water has long represented an important source of political legitimacy, but in recent decades Việt Nam has pivoted to overseas development assistance to maintain its water and sanitary infrastructure; Hà Nội’s water and sanitation capacity has also been challenged by rapid urbanization associated with the nation’s long economic boom. I draw on interview data that establish how Hanoians work around the absence of a centralized urban infrastructure for water and sanitation, pointing to the de facto privatization of home water and sanitation solutions as a potentially significant but occluded factor in the spread of disease. Chapter Three, “Risky (Small) Business: Constructing a Disease of the Market,” shifts focus to address the “outbreak narratives” that were most commonly repeated to explain the cholera epidemics, despite their probable lack of accuracy. These accounts, presented in Vietnamese and international media as well as by professionals and laypeople, attributed the spread of cholera to economically marginal actors, especially unlicensed food vendors. Positioning this cultural belief in the broad context of Việt Nam’s political economic transition, I contend that these accounts gave voice to the anxieties of a period of economic upheaval, rapid economic stratification, and massive rural-to-urban migration. Textually commenting on risky foodstuffs and risky eating habits, these narratives subtextually underscored the uncertain, unpredictable nature of consumption under capitalism. As I argue, the staying power of this perspective suggests an interesting shift in a local politics of blame. Where cholera was formerly imagined as an outcome of poverty inflicted by colonialism, cholera is

Introduction

25

still imagined critically—as a product of the free market and its unruliness—yet the role of larger economic actors in spreading contagion has remained largely invisible. Anxieties about consumption also found locally particular voice in accounts that attributed cholera contagion to Việt Nam’s flourishing but stigmatized dog meat trade. Eating dog meat is a practice that symbolizes both nostalgically regarded vernacular cultural practices and dispositions perceived as antithetical to a modern and cosmopolitan habitus; both state and media accounts claimed an association between eating dog meat and cholera risk. Chapter Four, “Sacrificial Beasts: Disease Risk at the Species Boundary,” investigates the belief that cholera was caused by pathogens originating with nonhuman animals and explores the symbolic significance of these accounts. As I suggest, dogs occupy a liminal position in Vietnamese society that raises cultural anxieties about their proximity to humans. This version of cholera’s etiology sheds light on how the outbreaks were explained as a form of contagion with interspecies uncanniness: a form of non-anthropocentric illness causing the boundary between humans and animals to become blurred. In Chapter Five, “Statistics and Their Discontents,” I present the perspectives of skeptical scientists and bloggers who critiqued the epidemiological accounts of the Vietnamese state during the cholera outbreaks. I contextualize these in a broader discussion of the statistical foundations that underpin perceptions of the socialist reforms that are held to have improved public health outcomes in the Democratic Republic of Việt Nam. As Chapter One suggests, epidemiological and demographic statistics have historically served as an important ideological resource for the Vietnamese state in constructing a compelling narrative of progress in public health. Yet numerous critics of state science, many of whom were scientists themselves, suggested—both in public and in private—that the cholera statistics were manipulations, serving both to conceal inconvenient realities and to protect the image of the health authorities. I bring these perspectives into conversation with Ken MacLean’s construct of “the government of mistrust” in Việt Nam, in which bureaucracy tacitly functions as an opportunity structure for its participants; I suggest how this ethos introduces particular contradictions into the domain of public health. The book’s Conclusion reflects on how the novel coronavirus pandemic that began in 2019 shows Việt Nam’s disease control capacity in a different light. As the first cases of the highly contagious respiratory infection were diagnosed in Hồ Chí Minh City, Việt Nam took swift preemptive measures to contain the SARSCoV-2 virus—emerging as a global leader in infectious disease surveillance

26

Epidemic Politics in Contemporary Vietnam

and prevention as well as in health communication to the public. Ironically, the missteps of the Vietnamese state in controlling cholera—politically motivated undercounting of disease, nontransparent public communication, economic protectionism, and blaming victims—were prominently visible in the efforts of the US government to respond to the spread of Covid-19. As these experiences suggest, Việt Nam’s national capacity in disease control is remarkable, but this capacity was not reflected in the country’s response to cholera—a disease associated with some of the most stigmatized and disavowed parts of Vietnamese national history. I suggest that this disparity in experiences of epidemic response is primarily due to an economic calculus. While cholera was apparently perceived as a disease that could be lived with and contained, even as it debilitated members of vulnerable populations, SARS-CoV-2 was assessed to pose an existential threat to the national economy tout court. Việt Nam’s program of Covid-19 eradication evidenced what feminist scholar Michelle Murphy (2017) has called “the economization of life”: an encompassing econometric calculation of what lives are worth living, and what value can be derived from life.

1

Medicine and Disease in North Việt Nam: Doctoring the Body Politic

Everyone in society, from the social worker to the leader (chủ tịch), from the worker to the director, from the employee to the minister, from the military private to the field marshal, passes through a doctor’s caring hands. A doctor witnesses every human life—from the heartbeat in the mother’s belly to the cry that greets life to one’s last breath. Medicine is a special mission that requires the doctor to be close to every person. This great difficulty is also the most admirable thing about medicine.—Lê Hùng Lâm, “Lectures on Social Medicine and Health Organization” (1991, 17) When French Catholic missionaries brought medical technologies and equipment to Tonkin in the seventeenth century, they did not find the “health care vacuum” (Au 2011, 4) they might have expected—nor did their biomedical offerings garner the interest of elites or generate great popular appeal. This was at least in part because the traditional Chinese and Vietnamese materia medica in regular use offered superior curative results (Marr 1987, 42). Indeed, the Portuguese missionary Alexandre de Rhodes, who developed the romanized graphic system for Vietnamese called quốc ngữ, was “impressed with the medical practice he saw in Vietnam in 1627” (Craig 2002, 41)—perhaps because European medicine of the period relied on leeches to treat fevers, smoke fumigation against plague, and the “King’s Touch” to cure tuberculosis (Haycock 2001). As late as the 1830s, with only quinine and a few other effective remedies, European medicine boasted only “slender therapeutic means” (Marcovich 1988, 115): “French ignorance of tropical pathologies, in addition to the prevalence of serious epidemic and endemic diseases (…) made it difficult for the first colonial physicians to do more than erect a cordon sanitaire to protect the ‘whites’ from local fevers” (Monnais 2006, 42). By contrast, a richly pluralistic field of medical knowledge and practice was well established in Vietnamese society long prior to the arrival of Europeans

28

Epidemic Politics in Contemporary Vietnam

(Thompson 2012). During the premodern period, the indigenous development of medical practices, as well as the exchange of knowledge, practices, and materia medica with China, established the foundations of formalized medical systems that continue to be practiced in contemporary Việt Nam. These two major medical traditions were described as thuốc Bắc (“Northern medicine,” or Traditional Chinese Medicine) and thuốc Nam (“Southern medicine,” or Traditional Vietnamese Medicine). Western biomedicine never supplanted these preexisting bodies of medical knowledge and practice, which received official recognition as part of the nation’s medical patrimony during the socialist period and retain a significant market share in health seeking practices to this day. Rather, biomedicine was “indigenized, Vietnamized, and pluralized by colonial encounters” (Monnais 2019, 255), becoming appropriated into local pharmacopoeia and therapeutic repertoires. Traditional Vietnamese physicians “were open to contact with western doctors and to adding western techniques to their repertoire of medical treatments” (Thompson 2003, 117). As the usefulness of French medicine improved over their period of influence in Indochina, the colons introduced biomedical techniques and technologies via the establishment of training institutions, research facilities, and hospitals; they also developed new medical resources in dedicated research institutes, including via clinical trials involving local populations and via the introduction of pharmaceuticals (Monnais 2006; 2019). In a “chronically underfunded and thinly spread” colonial health system with “at least two tiers” (Monnais 2019, 255), French biomedicine was most materially useful to the European population and, secondarily, to Vietnamese elites. It reached the general population in the form of measures such as disease surveillance and mass compulsory vaccination. Enforced by the army and the police, these initiatives at times caused moral outrage and resistance in the communities they targeted. Literature on the history of medicine in Việt Nam, perhaps particularly in the colonial period, thus raises a disquieting contrast between a richly complex genealogy of cross-pollination in medical traditions and the fact of medical treatment’s inaccessibility for a large part of the population. This is particularly troublesome because the institutions of colonialism functioned in tight symbiosis with infectious disease, propagating and accelerating its transmission. In this chapter, I provide a history of cholera epidemiology in Việt Nam from the nineteenth century, suggesting the close association of this disease with the political and economic arrangements of colonial rule. I demonstrate how cholera assumed symbolic significance and how the provision of medical care came to represent a vital ideological resource for the cause of anti-colonial resistance during the revolutionary and socialist periods. During the socialist period, state

Medicine and Disease in North Việt Nam

29

discourse described health workers as the honorary family members of their patients, representing their care for individual bodies in terms of the state’s care for the body politic. Amid these initiatives to modernize medicine in a nationalist idiom, cholera came to be seen as the antithesis of modernity—a perspective that may, despite its great intuitive appeal, oversimplify cholera’s epidemiological dynamics. I close the chapter by discussing how market transition has affected the lives and health status of poor Hanoians and suggesting how this process has introduced embodied forms of inequality in a still nominally socialist nation, creating ideological conundrums as well as new forms of ill health.

Two Hundred Years of Cholera All of Southeast Asia has historically been “liable to cholera epidemics of a highly explosive nature” (Swaroop and Pollitzer 1955, 335), but accounts of the history of cholera in Việt Nam are somewhat limited and challenging to interpret. In the early precolonial period, between the years 196 and 180 BC, according to historian Keith Taylor, “a cholera epidemic ravaged the army of Han China’s Empress Lü, who had sent forces against Zhao Tuo’s kingdom of Namyueh (Nam Việt)” (Taylor 1983, 24). In his account of Vietnamese history, former colonial officer Oscar Chapuis cited an episode of cholera in the thirteenth century, when Mongol troops in Bắc Giang province suffered disease alongside a tactical defeat by military commander Trần Hưng Đạo; he also notes a cholera outbreak in 1774 (Chapuis 1995, 84, 137). However, these accounts of precolonial epidemics may be anachronisms. It’s unclear what disease is referenced by early accounts of “cholera” in the territory known today as Việt Nam; conceivably, these outbreaks were caused by a different enteric pathogen. Many scholars believe that true cholera did not appear outside South Asia until the first recorded pandemic, which began in 1817. From the nineteenth century, history is less ambiguous: definitively, cholera reached Southeast Asia during the first pandemic, and the disease represented a serious burden in Việt Nam thereafter. In 1821, amid an outbreak that stretched north from Hà Tĩnh province (Dyt 2015, 36), 20 percent of the names were removed from the lists of mandarins; on this basis, political scientist Samuel Popkin suggests the first cholera pandemic in Việt Nam may have killed millions (1979, 113). Mortality during the second pandemic (1829–1851) was also very high: in 1849, 600,000 died throughout Việt Nam (Popkin 1979, xvi), and military physician O’Neill Barrett claims that an epidemic the following year caused 2 million cases of cholera, a figure that the Vietnamese Ministry of Health also reports (Barrett 1982, 17; Ministry of Health, 2007a, 12).

30

Epidemic Politics in Contemporary Vietnam

French colonial rule in Việt Nam lasted from 1885 to 1945 but was preceded by military presence beginning in 1860, when France dispatched armies to protect missionary interests in what would become Indochina. In the early 1860s, the French won control over a large area of southern Việt Nam, which they subsequently called Cochinchina. In 1863 conquest continued to Cambodia; in the 1880s, central Việt Nam (“Annam”) and North Việt Nam (“Tonkin”) also came under French control. Laos followed in 1893. The Union of Indochina, declared in 1887 and ultimately comprising five countries, was administered by a governor-general. One unintended outcome of French colonial rule in Southeast Asia was the creation of infrastructure and institutions that abetted the circulation of infectious disease. The colonial encounter drew new populations into contact with Vietnamese communities, exacerbated economic pressures on households, and introduced new forms of mass transportation. These new social, political, and economic arrangements introduced novel risks for disease transmission and amplified existing ones: inequity, crowding, famine, and squalor. Cholera was among the most significant disease burdens of the colonial period, initially affecting both French and “native” populations in commensurable ways. It represented the leading cause of deaths in Vietnamese hospitals (Guénel 2004, 1). It broke out in cities as well as in the countryside, in association with regional pandemics, and following disturbances in the political, economic, and social order. During conquest, cholera followed troop movements; latterly, outbreaks were associated with other institutions of colonial rule: prisons, work camps, military conscription, urban slums, and urbanization more generally. Anglophone publications of the period reference the “Tonquin cholera” much like the term “Asiatic cholera,” as if the term described a unique strain of disease, but this retrospectively appears exaggerated. In 1884, the French city of Toulon experienced an outbreak of cholera that was, as one journal speculated, transmitted by an auction of the clothes and possessions of soldiers who had died of cholera in Tonkin and Cochinchina—where, the author wrote, “[C]holera always exists more or less” (Ohio State Eclectic Medical Association 1884, 389). In Anglophone sources, the “Tonquin cholera” was described as imported into Europe by the French (New York Medical Journal 1887, 589). However, historian Michael Vann argues that French troops were the “likely vectors” (Vann 1999, 342) bringing cholera to Tonkin, not vice versa. In 1888, an outbreak of cholera in Hà Nội province claimed the lives of 1,800 Vietnamese people in just a few weeks.1 In 1896 the New York Times warned that famine in Tonkin, caused by the prior year’s drought, could precipitate further cholera outbreaks, writing: “Last year the rainfall was so meager that this year’s harvest is a failure, and, as the Annamites [sic] are improvident, living

Medicine and Disease in North Việt Nam

31

from hand to mouth, the distress is now very great. The parents are selling their children for a few cents, and pillage is rife.” The victim-blaming quality of this American report aside, an association between cholera and rural poverty in North Việt Nam appears entirely credible.2 The French colonial administration levied rents and taxes at rates multiple times higher than those of the Nguyễn dynasty, leaving the rural population without cash or food reserves in case of crop failure or natural disaster (Ngô Vĩnh Long 1991, 68). As the French dismantled institutions for collective landholding and famine insurance, peasants in Tonkin and Annam became increasingly vulnerable to the impact of natural disasters. Mass expropriation of land reduced communal fields that had functioned as a hedge against poverty and famine under dynastic rule; high rents and taxes levied by the French meant “pervasive misery” for the peasantry (Kolko 1985, 15).3 These policies compounded the impact of natural disasters and crop failures in the Vietnamese countryside, leading to subsistence crises (Dyt 2015) that in turn drove urbanization in colonial Tonkin. The “commercialization of agriculture, coupled with the pressures of rural overpopulation,” made “urban centers … magnets for huge swells of displaced people” (Edington 2019) and generated opportunities for the transmission of infectious disease. Hà Nội, the capital of the Indochinese Union, was said to suffer “perpetual” health crises. Colonial physician Le Roy des Barres describes serial outbreaks of cholera during and after conquest and pacification: Epidemic manifestations of cholera are relatively frequent in Hanoi. However, they manifest a certain tendency to space themselves out, which seems related to the progressive improvement of individual and urban hygienic conditions. Before 1926, we know of epidemics in 1885–1886–1887–1888–1895–1896–1903–1904– 1910–1915–1916. In 1919, [there was] a small epidemic of 72 cases, another in 1920 with 137 cases and another in 1921 which struck down 93 people. (des Barres 1927, 295)

In 1908, a cholera epidemic in Huế affected half the city’s population, with a case fatality rate of 70 percent (Barrett 1982, 17). By 1910, another cholera epidemic broke out in Hà Nội (Vann 1999, 344). A total of 872 cases were recorded between April 15 and July 1, of which 720 died: a case fatality rate of 82 percent. Only 20 of the 872 were European (Vann 1999, 345). A survival rate of approximately 85 percent was recorded for European cholera patients, indicating that the advantages enjoyed by the French colonial population had important ramifications for life chances. By the end of the epidemic, 15,473 deaths were recorded; the true toll may have been closer to 20,000 (Vann 1999, 345).

32

Epidemic Politics in Contemporary Vietnam

Cholera also traversed colonial prisons in the late nineteenth and early twentieth centuries, where “high rates of death and disease (…) were doubtless owing to a combination of poor food, inadequate sanitation, unresponsive medical services, overcrowding, and overwork” (Zinoman 2001, 96). Hà Nội Civil Prison had to be evacuated in 1888 and again in 1890 amid cholera epidemics; between May and June 1904, cholera killed thirty prisoners there. In his 1939 memoir Prison Verse, the nationalist Huỳnh Thúc Kháng, who served a thirteen-year sentence for political activity on the prison archipelago Poulo Condore from 1908 to 1921, describes a 1909 cholera outbreak that killed three of his cellmates (Zinoman 2001, 95). During a subsistence crisis in 1915, cholera swept through work camps where impoverished Vietnamese were interned (Nguyen-Marshall 2005, 244–5; Nguyen-Marshall 2008, 37). French interventions into the natural environment also abetted the circulation of infectious disease. Clearing of forests, the construction of railroads, increased sea trade, cash cropping, and urbanization all served to drive the transmission of disease. As the colonial economy expanded, a new epidemiological situation arose (…). The rapid growth of urban centres, especially in the delta region, and European methods of building, often carried out hastily and without consideration, brought about serious sanitary problems. In particular, a series of diseases linked to water supply, and tuberculosis, became increasingly frequent. (Marcovich 1988, 112)

By the First World War, when France was conscripting Indochinese men to the European front, cholera represented the “most troublesome” disease for the colonial authorities (Au 2011, 46). Although tuberculosis, plague, and syphilis also occurred regularly, “unlike other debilitating health problems that also drew complaints for the metropole, the threat of cholera was significant enough that the ministry was willing to turn back entire steamers contaminated with the disease” (Au 2011, 46). In view of these risks, the French took early measures to protect Europeans in Indochina from disease. As early as the 1890s, the “construction of hospitals and improved sanitation facilities” had begun to relieve French troops of the “ravages of disease, particularly cholera” while the Vietnamese population suffered the brunt of outbreaks (Munholland 1981, 646). Cholera continued to recur through the 1920s and 1930s despite the colonial administration’s periodic imposition of quarantines and mass vaccination. Historian Laurence Monnais notes that between 1926 and 1930, over 66,000

Medicine and Disease in North Việt Nam

33

cases of cholera were notified in Indochina, inflicting a mortality rate of over 80 percent (Monnais 2019, 57). In 1937, an outbreak of cholera in Hải Phòng and Móng Cái caused over 20,000 infections and some 15,000 fatalities (Ministry of Health of Việt Nam 2007a, 12–13). The epidemic lasted thirteen months, primarily affecting northern Annam and Tonkin, and especially Thanh Hóa province in Annam and Hà Đông province southwest of Hà Nội. The report of the General Inspection of Hygiene in Indochina showed a case rate of 2.6 cases and 1.4 deaths per thousand populations in Tonkin, and a slightly higher death rate of 2 deaths per thousand in Annam (Genevray 1939, 1027). In these very significant outbreaks, disease incidence was understood to be associated with poverty: [I]n his study of the epidemic, Genevray made a significant comment. As he stated, “It was above all a disease of destitution, that for the most part struck the most disinherited class of the population. With only rare exceptions, there were no great centers of the epidemic, but a very large number of isolated cases and small centers of the epidemic in villages. Water appears to have played no role in its propagation, which was done through interhuman contact.” (Malarney 2007, 50)

Despite the aggressive response of the colonial health authorities, the disease found its niche among the “poorest and most vulnerable sections of Tonkin society, such as the laborers, petty market sellers, rickshaw pullers, or especially beggars” (Malarney 2007, 51). Sick and destitute people coming into the city in search of care collapsed and died on the roadside. Colonial authorities cordoned the city neighborhoods believed to be particularly likely to spread disease and imposed mass vaccination (Marr 1987, 47). Health disparities entrenched by colonial rule played out brutally in French favor: from 1930 to 1940, “only two Europeans contracted cholera and none died, while there were over 28,000 reported cases among the Indochinese, of which almost 75 percent died” (Malarney 2007, 46).

French Medical Racism In the background of these events was a colonial encounter in which French administrators and settler colonists perceived Indochina and its populations as both uncivilized and dangerous. Like their eighteenth- and nineteenth-century European counterparts, who imagined Africa as “a continent inimical to

34

Epidemic Politics in Contemporary Vietnam

civilized existence” (Comaroff 1993, 312), the French characterized Indochina as insalubrious and potentially deadly. Missionaries, administrators, and troops were unfamiliar with endemic diseases such as malaria and lacked medical resources to respond to cholera, leprosy, smallpox, and plague. As resident French colons and their families settled in the region, they developed a cultural preoccupation with health, illness, and death: “With the perpetually busy hospital and the rapidly expanding graveyard as reminders of white mortality, pessimism, fatalism, and depression darkened the white experience in the city” (Vann 2005, 96). As Laurence Monnais (2019) has shown in her work on the “colonial life” of pharmaceuticals in Việt Nam, French medical officials retained a skeptical, pejorative outlook on the medical practices and health status of the “Annamese” population, whom they regarded as indifferent and irrational consumers of biomedical therapies. Still further, public advisories disseminated by the colonial medical services consistently emphasized the risks of contact with Vietnamese people, warnings against disease contagion, opium use, and the sexual temptations of Vietnamese women (and men); the latter issue underscored French perceptions of Indochina as an environment of enervating decadence (Proschan 2002). Extended stay in the region was understood to threaten Europeans with physical, mental, and moral degeneracy and décivilisation.4 French colonial humor reflected these anxieties about deracination, infectious disease, and the risk of death (Vann 2009). By the early twentieth century, the aims of the medical service in Indochina were, according to medical inspector Gabriel-Henri Clavel, “the battle against disease, the physical improvement of the Annamite race [sic], and, at the same time, the economic development of the country” (Marcovich 1988; Ovesen and Trankell 2010, 30). Clavel envisioned a health sector that could “propagate notions of hygiene, incessantly fight against diseases, and lower the appalling mortality caused by ignorance and prejudice”; colonial medicine’s perhaps overriding ambition was to create “governable subjects” (Trankell and Ovesen 2004, 97). However, cholera control in colonial Indochina set the stage for conflict between the French medical authorities and Vietnamese communities in Hà Nội. Hanoians were alienated by measures such as the registration of deaths, autopsies, vaccination campaigns, and the confiscation of possessions and corpses from affected families. Offended by such intrusions into the private family events of illness, death, and burial, Vietnamese families concealed their dead from the French authorities, sometimes burying them in secret (Vann 1999, 335–6).

Medicine and Disease in North Việt Nam

35

While infectious disease outbreaks generated a pretext for biomedical surveillance and control by colonial administration, they also showcased the contradictions of French-imposed modernization. Cholera and other epidemic diseases were reminders that the mission civilisatrice, through exploitation and impoverishment, caused “backwards” (lạc hậu) living conditions throughout the population. In 1903 the French imposed a quarantine to control an outbreak of bubonic plague in Hà Nội, interning both healthy people along with the sick in the capital’s Temple of Literature (Văn Miếu). An anonymous letter about the episode, addressed to the governor’s court (Toà Đốc lý Hà Nội), lamented that the internment showed that the French perceived the Vietnamese “as dogs or pigs” (Malarney 2004, 31). In tandem with resource extraction, taxation, and political repression, such violently imposed “modernization” supported the nationalist perception that, as novelist Hoàng Đạo wrote, “Western civilization is only a thin coat of whitewash over a decaying wall” (Ngô Vĩnh Long 1991, 76). During the colonial period, “insufficient health care combined with poor public health practices resulted in very high rates of morbidity and mortality in both adults and children, even when compared to other developing nations” during the colonial period (Ladinsky and Levine 1985, 257–8). The mid1940s were marked by recurring crop failures, famine, epidemics of cholera, hemorrhagic fever, malaria (Thompson 2003, 138), high prevalence of parasitic infections, and extreme economic hardship imposed by war and the dwindling capacity of the colonial state. In this period, infectious disease, particularly cholera and malaria, was rampant among even the most privileged Vietnamese communities. As late as 1944, one study found that in many villages up to 90 percent of the inhabitants suffered from tuberculosis, malaria, and trachoma—malaria and trachoma being the most common. Nationwide, the 1944 study estimated that about 5 million of Vietnam’s 20 million suffered from malaria and could work at only 50 per cent efficiency. (…) According to the Vietnamese doctor who studied in 1944, 790 out of 908 persons examined in Khuong Ha (a village outside Hanoi) had trachoma, and 316 were partially blind. These results came from a total population of only 1,000 persons and in one of the richest and cleanest villages in Tonkin, one in which all the streets and yards were paved and most of the houses were clean, tall, well ventilated, and built of bricks. (Ngô Vĩnh Long 1991, 76)

Prior to independence—as this history of uncontrolled epidemics might suggest—Vietnamese nationalists associated cholera epidemics with the

36

Epidemic Politics in Contemporary Vietnam

“feudalism” of the dynastic period and with the underdevelopment perpetrated by French colonial rule. Đặng Quân Sơn, the head of health and social relief activities in the City Administration of Hà Nội in the late 1950s (Đỗ Thị Thanh Loan 2007, 51), expressed this in a publication about “patriotic hygiene,” writing, “For thousands of years our people lived under the feudal yoke and for nearly one hundred under the French colonial regime, they were heavily oppressed politically and devastatingly oppressed economically, thus they were impregnated with many unhygienic and unscientific habits” (quoted in Malarney 2012, 111). Cholera, like other highly prevalent infectious diseases, was seen as a symbol of unfreedom, associated with an enforced ignorance of the biological causes of disease. A 1937 proposal for the creation of a society to promote literacy, which declined significantly under French colonial rule, claimed that “illiteracy was as dangerous as cholera” because it could “retard people intellectually or even lead to the extermination of an entire nationality” (Marr 1984, 178). In 1944 and 1945, a series of typhoons combined with the administrative failures of the French and Japanese5 to precipitate mass famine (NguyenMarshall 2005, 237): “Even millet, potatoes, and rice bran were exhausted; potato leaves, banana roots, grasses, and the bark of trees remained” (Scott 1976, 2). This disaster claimed the lives of between 1 and 2 million out of a population of 10 million6—decimating the countryside, engendering outbreaks of typhus and cholera, and laying the groundwork for the August Revolution (Thompson 2003, 136, 139). One of my interview respondents in Hà Nội, an elderly gentleman living in a downtown district with his wife, described eating surrogate foods during the famine and cholera outbreak in that period: I remember 1945; the cholera was uncontrolled, terrible. People were hungry, so they ate anything they could catch hold of, contracted cholera, and died.—Trần Xuân Sơn, 82 years old, Hoàn Kiếm district, Hàng Gai ward, August 24, 2010.

During the famine, more than 1,580 bodies were abandoned in the streets of Hà Nội (Vann 1999, 328), suggesting a situation of near-total social collapse. Dignified burial is a critically important rite in Vietnamese society owing in part to the role that ancestors play in the lives of the living; a “bad death” (chết đường, literally death in the street) is abhorred (Kwon 2013, 20). The nationalist Việt Minh7 forces stepped into the political and moral vacuum that remained in the wake of these serial disasters, encouraging the population to ransack rice warehouses and refuse to pay taxes. Following Japanese surrender in August 1945 and the internment of the Vichy regime, the

Medicine and Disease in North Việt Nam

37

Việt Minh consolidated power. On September 2, 1945, Hồ Chí Minh acceded to declare the independence of the Democratic Republic of Việt Nam (DRV). By 1946, Việt Nam was at war with its former colonial ruler.

Health and Disease in the Socialist Period (1945–1975) French colonization had introduced Western biomedical resources while stifling the nation’s immediate prospects for medical capacity after independence. For the most part, the health system in colonial Indochina was staffed by French doctors and served French patients, offering few curative resources for Vietnamese patients and even less in the way of medical education to Vietnamese medical students. Doctor-to-patient ratios recorded in the period of the founding of the DRV vary somewhat, but sources indicate that the Vietnamese population was very underserved, especially in rural areas. Professor of surgery Hoàng Đình Cầu wrote that in 1945, Việt Nam’s northern and southern provinces were reported to have “51 physicians, 152 assistant physicians, twenty-one pharmacists, … [and] 1,227 nurses” (Hoang Dinh Cau 1965, 37) to serve a population of approximately 23 million (Thompson 2003, 122). This would have meant each Western-trained physician served a population of almost half a million.8 During the revolutionary period (1945–1965), the newly established DRV mobilized to increase the medical capacity of the newly independent nation, but infectious disease remained a significant burden for civilians as well as military populations. Therefore, the DRV moved quickly to establish a health care system staffed principally by workers providing basic services—primary health care and preventive health education—at the grassroots level. When anti-colonial war broke out in 1946, large portions of the medical infrastructure of the DRV moved into the jungle: medical personnel, pharmaceutical production, and all training and research institutions—including the College of Medicine and Pharmacy and the Microbiology Institute of the Health Ministry (McMichael 1976, 18–19). Jungle hospitals were established to treat military and civilian casualties and physicians provided care in these improvised field settings through the Second Indochina War. Combat photographer Võ Anh Khánh documented the dramatic circumstances of wartime health care provision; today, his extraordinary image of a surgical theater in a jungle, with the medical team working up to their knees in water, is displayed in Vietnamese museums alongside the kits that field medics carried into combat.

38

Epidemic Politics in Contemporary Vietnam

During the same period, the nascent health apparatus of the DRV prioritized the fight to eradicate cholera and smallpox, developing vaccines in the evacuated microbiology institutes. The DRV claimed impressive gains in suppressing these diseases, achievements that were allegedly sustained up until reunification in 1975. This would have taken a comprehensive effort given the challenges posed by war. Although the circumstances of the First Indochina War were, to put it mildly, “not conducive to demographic data collection” (Hirschman 1994, 393), estimates indicate that at least half a million Vietnamese civilians and soldiers were killed and one million wounded (Hirschman, Preston, and Vu Manh Loi 1995, 783) from 1946 to 1954. French losses were estimated at 92,000 (Lomperis 1996, 96). Hồ Chí Minh had anticipated these disparate sacrifices when he told the French in 1946: “You can kill ten of my men for every one of yours, yet even at those odds, you will lose and I will win.” (The actual casualties subsequently recorded were almost as devastating—five Vietnamese combatants died and ten were wounded for every French death.) Upon the victory of the DRV against the French in 1954, a centrally directed, state-financed health care system established to—as Minister of Health Nguyễn Văn Hưởng described—“liquidate as rapidly as possible the aftermath of colonialism and war” (1970, 9). As Minister of Health Phạm Ngọc Thạch wrote, the concerns in national public health during the interwar period (1954 to 1965) remained dire: Millions of people suffered from malaria and trachoma, hundreds of thousands from tuberculosis, venereal diseases and leprosy, while practically the entire population was infested with intestinal parasites. And intestinal infections of all kinds were rampant. (Pham Ngoc Thach 1965, 4)

Medical services would play an important part in developing the legitimacy of the newly established state, which rapidly established a public health system, developed a national network of commune health stations, and implemented a campaign to vaccinate against communicable diseases. The national health system prioritized grassroots-level local provision of effective resources for disease prevention, establishing a foundation of commune-level primary health care9 delivery. Preventive medicine was seen as the “principal task of Vietnamese medicine” (Nguyen Van Huong 1970, 9). In the interwar period, the DRV claimed to extend health services to a large percentage of rural communes and to implement a national program of universal primary health care, with emphasis on the improvement of sanitation and vaccination campaigns in rural areas (London 2008, 16–17). Preventive health and basic health services were

Medicine and Disease in North Việt Nam

39

dispensed at neighborhood-level commune health centers in rural and urban areas (Bryant 1998; Hoang 1965); curative services were delivered through state hospitals administered at the district, provincial, and central government levels. The DRV’s program of preventive medicine included public education, the improvement of hygienic and sanitary conditions, the extension of primary health care services to the grassroots level, and the implementation of mass vaccination campaigns. Health cadres (cán bộ y tế) in rural districts worked in close contact with communities, leading mobilizations and directing participation in preventive health campaigns (Malhotra 1999, 13). Health education was carried out via campaigns providing simple principles for maintaining health, like the “three cleans” (ba sạch): clean food, water, and living conditions; and the “three exterminations” (ba diệt): kill rats, flies, and mosquitoes. Beginning in the 1950s, germ theory was emphasized in public health education as part of state efforts to help rural populations “to transcend the stigmatized backwardness in which Vietnam was mired” and become “disciplined, clean, healthy citizens who were ready and able to (…) move into the bright socialist future” (Malarney 2012, 111). In some villages, people were encouraged to look at waterborne parasites magnified under microscopes in order to appreciate the dangers of drinking “raw” or untreated water (Hickey 1964, 118). Following the tendency for revolutionary communications to address the mostly illiterate peasantry in popular oral forms such as “poems, songs, stories, and aphorisms,” the population was encouraged to learn easily recited slogans (khẩu hiệu) about health (Marr 1984, 187; also see Hurle 2009).10 One commonly repeated khẩu hiệu was “Hygiene is patriotism” (vệ sinh là yêu nước) (Leow 2014); another was “Germs cause disease” (vi trùng sinh bệnh). Another saying, “Eat cooked food and drink boiled water” (ăn chin, uống sôi), dates at least to the 1950s (Malarney 2012, 113) and remains current in Việt Nam to this day. One poem that circulated in the late 1940s began with the lines: What are you carrying in your bag, Mr. Fly? I bet it’s loaded with dangerous illnesses See, here’s some cholera and some TB, And there are some inflamed eyes and sore throats. (Marr 1984, 188)

On the basis of these efforts at popular education and mobilization, the DRV claimed impressive progress in controlling vaccine-preventable diseases. Cholera was said to be eradicated in North Việt Nam as early as 1957, according to a former minister of health (Pham Ngoc Thach 1965, 29); smallpox was said to be eradicated between 1957 and 1958; infantile polio was allegedly

40

Epidemic Politics in Contemporary Vietnam

eliminated by 1961 (Nguyen Van Huong 1970, 11); and substantial progress was claimed in malaria control in the early 1960s. The DRV was untouched by the cholera epidemic of 1961, which affected most of South and Southeast Asia “from India to Indonesia, from the Philippines to Hongkong, including South Vietnam” (McMichael 1976, 46). By the mid-1960s, official sources reported that the national health care system had extended services to almost the entire population. While North Việt Nam was said to remain virtually free of cholera in this period, the number of cases in South Việt Nam increased from a few hundred in 1963 to more than twenty thousand by 1965, the result of war’s erosion of living conditions (Carter 2008, 208).11 American bombing and the establishment of “free fire” zones in South Việt Nam created an enormous population of internally displaced people, setting the stage for disease epidemics in refugee camps and urban slums. In 1964, the arrival of the seventh pandemic of cholera, caused by the V. cholerae O1 El Tor biotype, colluded with conditions of war to cause an outbreak in South Việt Nam, with 15,000 reported cases of cholera and 700 deaths (Barrett 1982, 18). One physician reported that “the destruction of villages, the uncontrolled movement of groups of people and the squalid conditions in the camps have broken the natural barriers to the spread of disease” (Carter 2008, 208–9). Between the failing network of civilian hospitals, the utter scarcity of doctors or any other health care personnel, and the limited offerings of the US military, during the Second Indochina War, “There existed no health care system as such for the whole of southern Vietnam” (Carter 2008, 208). The region recorded a “rising incidence of TB, intestinal parasite infestations, leprosy, and malaria as major causes of morbidity, along with marked increases in the incidence of cholera, plague, and human rabies” (Allukian and Atwood 2008, 318). Smallpox was endemic, with a mortality rate rising to 92 percent in some areas (McMichael 1976, 152). Tuberculosis affected 10 percent of the civilian population (Poffenbarger 1971). In the mid-1960s, a Cuban doctor serving in a hamlet clinic reported, “I have seen things I would not believe” (Gellhorn 1994, 235), and a Congressional investigation in 1966 concluded that “[a]lmost every disease known to man is present” in the region (Carter 2008, 209).

Love the Patient Given the situation of public health in the DRV, training health personnel was a critical early priority in the postrevolutionary period, with thousands of health

Medicine and Disease in North Việt Nam

41

cadres trained annually by the mid-1950s (Szolontai 2005, 407). The country’s ambitious program to deliver health care on a mass scale—to doctor the body politic—was a pressing material necessity. It was also an artifact of the moral status that Hồ Chí Minh invested in the health sector and the interest he took in the development of health cadres, who were meant to cultivate personal virtues as part of their political work (Fitzgerald 2005, xi; Thompson 2003, 138). Hồ described the health system’s orientation, including the conduct of health cadres, as egalitarian and marked by the expression of quasi-familial solidarity. In a frequently quoted letter to the 1955 Conference of Health Cadres, Hồ wrote: Love (thương yêu) the patient—The patient entrusts their life to you. The government entrusts to you the work of curing illness and preserving the health of your fellow countrymen (đồng bào). That is a very glorious duty. Therefore, the cadre needs to love and look after the patient as solicitously as if they were his or her blood relations and see their pain as if it were one’s own suffering. “A good doctor is like a mother” (lương y như từ mẫu)—that saying is very correct. (Ministry of Health of Việt Nam 1995, 27–8)

As this suggests, medical education was moral education: doctors were to transmit the values of the Party and state directly to the populace. In providing health care, clinicians addressed not only their patients’ physical bodies but also their moral selves, inculcating them with revolutionary values. Health care providers were thus important intermediaries of what anthropologist of Romania Katherine Verdery (1996, 63) has called “socialist paternalism”—a “quasi-familial dependency” between the state and its citizen-children. To this end, medical curricula in the DRV emphasized the moral and ideological preparation of health care workers alongside their acquisition of technical skills. A nurse serving in the National Front for the Liberation of South Việt Nam, or Việt Cộng, described her medical education: The program of study consisted of many subjects and politics was first: Whom did the revolution’s first-aid men and nurses serve? To which social classes did they render service? The answer was that they served the workers and farmers because they belonged to the poor class. Under the feudal regime, only the rich could receive medical treatment or send their children to school to get a medical doctor’s degree, and they, in turn, would only serve the rich for benefits. The revolution’s medics received no salary—be they first aid men, nurses, assistant physicians, or physicians—they were to serve the people with the smallest cost

42

Epidemic Politics in Contemporary Vietnam to them. They were to alleviate the people’s suffering caused by disease. This was our political training. Of course, our political training was longer and what I just told you was only part of it. (Hawk 2002, 43)

State sources represented prerevolutionary health professionals as aristocrats unwilling to serve common people, or “quack” practitioners who peddled ineffective religious cures (McMichael 1976, 165). The socialist doctor—a “new person” (c.f. Lynteris 2013) enthusiastically serving the people—was figured as personifying a radical break from the medical practitioners of the dynastic and colonial periods. Despite the feminized, familial idiom often deployed to characterize health work, civilian public health initiatives in North Việt Nam during the First and Second Indochina Wars also assumed a military register. Publications of the period compared commune health workers to combatants, emphasizing the threat that medical capacity posed to adversaries and the military advantage it offered to those receiving care. As then-Minister of Health Phạm Ngọc Thạch wrote, “The village sanitary cadre is like the local partisan who in the beginning defended his village with a lance or a bamboo pike then little by little learnt to handle a rifle, to attack a patrol, then to capture small military posts” (1965, 9). State accounts celebrated medical workers for their versatility—altruistically donating their own blood to patients undergoing surgery (Vu Can 1972, 88) and shooting at American planes during air raids (Do Huu The 1970, 112). Declassified captured documents and interrogation records collected by the US military provide a partial impression of North Việt Nam’s well-trained medical workforce. Outlining practices in medical education and training, describing the capacity of care centers, and even detailing the internal organization of hospitals, these archival materials provide a sense of the impressive infrastructure for biomedical curative care in North Việt Nam. For example, one confidential intelligence report authored by the Department of Defense in 1969 provides a detailed account of the capacities and operations of Lào Cai’s provincial hospital near the Chinese border. According to details obtained from an interrogation, the civilian facility treated up to 250 patients; it boasted sixteen departments, a surgical room, and an X-ray machine. The staff prescribed pharmaceuticals from Russia, East Germany, China, and North Việt Nam. Tuberculosis was the most commonly diagnosed complaint, and multiple drugs were used to combat it alongside other infectious diseases, including dysentery, malaria, and cholera (Captured Documents 1968). The details of these reports suggest

Medicine and Disease in North Việt Nam

43

the resourcefulness of Vietnamese medical workers; they also reveal the US military’s appreciation of the strategic significance of Vietnamese medical capacity to popular morale and the outcome of the war. Hồ Chí Minh’s admonitions for health workers to “unify” and to serve their patients “like a loving mother” (1955) signified the importance of medical institutions and medical workers in the project of inspiring public trust in the Communist Party. Notably, the two tropes of “doctor as mother” and “doctor as soldier” imagine health workers in an interesting role respective to the masses (nhân dân): both as feminized members of the national family and as masculine paramilitaries. This dualistic representation of physicians as loving mothers or sisters and as patriotic fighters is evident, for example, in the celebrated diary of combat physician Đặng Thùy Trâm, a young Hanoian M.D. killed in action in Quảng Ngãi province in 1970. Since the publication of her diary in 2005, Dr. Trâm has achieved an iconic status in Việt Nam—in part because of her heterodox perspective on the Vietnamese Communist Party and her valor in war, but also because of her tender solidarity with the soldiers whom she treated. As her diary attests, Dr. Trâm protected her patients selflessly, feared for their safety, and loved them. I have a physician’s responsibilities and should maintain some degree of objectivity, but I cannot keep my professional compassion for my patients from becoming affection. I know that in their moments of illness, my patients come to love and depend on me. Even though we haven’t met before, something ties them to me and makes them feel very close to me. They call me chị hai [elder sister] and refer to themselves as ‘younger brother’ even though they are older than me. (…) In these perilous days, they give me joy and comfort. (Dang Thuy Tram 2005, 20)

Public Health in the Time of “Socialization” Đặng Thùy Trâm’s selflessness, empathy, and high ideals have inspired contemporary Vietnamese readers perhaps not only because they reinforce a master narrative regarding the socialist state’s commitment to care for the body politic, but also because they stand in sharp contrast to some pessimistic trends that have been documented in the post-transition Vietnamese health care system, including the ubiquitous expectation that patients in public care facilities will make informal payments to their caregivers in exchange for

44

Epidemic Politics in Contemporary Vietnam

competent and responsive treatment. Liberalization has entailed a suite of retrogressive effects on some aspects of Việt Nam’s public health situation, which had previously been lauded by international observers as an example of what primary health care could achieve. Since at least the mid-1990s, researchers in Việt Nam have observed health disparities and other unintended outcomes increasing in association with the nation’s macroeconomic growth and the liberalization of its health system (c.f. Bryant 1998; London 2008; Luong 2003; Malhotra 1999; Nguyen and Popkin 2003; Vasavakul 2009; Witter 1996; Wolffers 1995). Many “mainstream accounts of Vietnam’s development have focused on the undeniable benefits of economic growth” (London 2004, 127), and in the health sector, these gains are indeed significant. In the years immediately following reunification, curative medicine in Việt Nam deteriorated owing to “debility in the health services” (Banister 1985, 17) and to systemic shortages of basic medical materials like catgut and antibiotics (Marshall 1982, 13); these systemic weaknesses have become a thing of the past. The Vietnamese population has steadily experienced improved life expectancies since đổi mới, declining rates of infant mortality, and progress in immunization coverage (Haub and Phuong Thi Thu Huong 2003). However, these progress reports often overlook important compromises introduced by transition. Following market reform, the system of statesubsidized household provisioning ended and government support for education, health services, and other entitlements was significantly reduced. This was part of a national policy reorientation toward “socialization” (xã hội hoá)—a term that somewhat counterintuitively denotes the transfer of responsibility for formerly publicly funded services to individuals and families (c.f. London 2011, 81; Minh T.N. Nguyen 2018). In the wake, some epidemiological developments suggest the emergence of new forms of embodied disparity, with poorer populations more likely to experience health problems and less able to receive high-quality care. Over the post-reform period, Việt Nam’s national epidemiological data show an increasing burden of cancer and other chronic diseases (Hinh and Minh 2013; Stalford 2019); increasing prevalence and geographic distribution of dengue fever, including in urban settings like Hà Nội (Do Thi Thanh Toan et al. 2013); rising rates of HIV/AIDS, notably among women (Lindan et al. 1997; Thu Anh Nguyen et al. 2008); and the resurgence of tuberculosis, including in multidrug-resistant forms (McNeil 2016). Much as the Chinese system public health became enervated in the post-Mao years, “overshadowed by an economic development

Medicine and Disease in North Việt Nam

45

agenda that left little room for mundane concerns like measles and diarrhea” (Mason 2016, 3), Việt Nam’s historic commitments to public health have threatened to founder amid rising national prosperity. In response to sweeping transformations in the financing and organization of the health sector, local ideologies of health are also changing. Public health was formerly guaranteed by the state and constructed as a right of citizenship. In recent years, sensibilities about the significance of health have changed significantly. As my interviews with city residents suggested, Hanoians in the post-reform period have a tendency to understand health as their own responsibility—a finding that paralleled, perhaps, an observation by Michelle Rivkin-Fish from the former Soviet Union, where respondents showed a tendency to dismiss “the state and the public sphere as viable sources of social protection and justice” (Rivkin-Fish 2005, 4). More material changes—increasing commodification and pharmaceuticalization of health (Nga Thuy Thi Do et al. 2014), the appreciating popularity of private health care, an “increase in readily available health and body care commodities” (Pashigian 2012, 535), and the rise of an urban gym and fitness culture (Leshkowich 2008)—suggest the suasive power of a vision of health as a property of private and self-responsible bodies, a commodity, and the counterpart of economic well-being. On several occasions during fieldwork, I was surprised to encounter multilevel marketing schemes for nutritional supplements—the American brand Herbalife is popular, as were “miracle” gấc fruit compounds available through multilevel marketing—suggesting the currency of increasingly globalized, commodified, individualized, and privatized notions of medicine and health. These trends suggest that health is increasingly envisioned as a middle-class achievement and as the result of careful private stewardship and investment; it is less often publicly constructed as a revolutionary project to be achieved collectively, as in the past (though this perspective was certainly manifest in the experience of combatting epidemics like SARS and Covid-19, as I will discuss in the Conclusion). As part of this reorientation of health care priorities, fees for services in the health care system were introduced in 1989 and private health care provision was legalized. Universal free health care ended: today, only children under six are entitled to receive free care. As the state health sector transitioned, a cost recovery system was instituted such that the right to receive care at the public expense has largely been replaced by the obligation to pay. In 2001, fifteen years into market transition, the World Bank reported that “a single visit to a public hospital takes up 22 percent of all nonfood expenditure for a year for a typical person in the lowest [economic] quintile” (World Bank and Vietnamese

46

Epidemic Politics in Contemporary Vietnam

Ministry of Health 2001, 149). Even studies that emphasized the macrosocial benefits of economic growth conceded that reform was contributing to stratified health outcomes: The majority of the population has benefited economically from the recent changes as agricultural production and prices have increased and new opportunities for business and trading opened up. However, this has increased income disparities in what had been a remarkably egalitarian society. At the same time, safety nets, subsidies and free services have disappeared, and the costs of goods such as health care have increased. Thus, access to health care is increasingly dictated by income, which in turn relates to geographical position, skills, and access to labour, capital, land and power. (Witter 1996, 160)

This sea change in health financing has coincided with diminishing state investment in health across the board. In 1984, before the initiation of market reforms, the Government of Việt Nam expended 11 percent of the national budget on health (Ladinsky 1987, 1105); by 2003, this figure had dropped to 4.21 percent (WHO 2003, 368). Writing more recently, medical anthropologist Alfred Montoya found that “only about 25 percent of health spending in Vietnam comes from the public sector, [with] the government allocating less than 1 percent of GDP to current health services” (Montoya 2013, 39). This shift in expenditure represents a vast transfer of the direct costs of health onto the population, which took place so swiftly in Vietnam’s transition that “[b]y the early 1990s, 80 percent of all health expenditure was estimated to be out-ofpocket. (…) [I]n the span of a few years, the principles governing payment for health care in Vietnam almost fully inverted” (London 2008, 115). This new de facto imperative to pay for health care out of pocket has had extremely significant material results for poor Vietnamese individuals and families. In the absence of state entitlements and with new emphasis on fees for services, “socialization” policy has entrenched a system in which illness, accidents, and disability can incur catastrophic expenses, posing a significant risk of precariousness to low-income families. Since the early 2000s, researchers have documented the unique burden of medical expenses upon the finances of poor households in North Việt Nam. A 2002 study of poor rural households found that families expended a very high average of 16.8 percent of their income for health care, despite reporting less sickness than wealthier families—presumably because they have “‘less time’ to be sick and tend to ignore illness if they possibly can” (Segall et al. 2002, 499).

Medicine and Disease in North Việt Nam

47

Diarrheal illness, though sometimes conceptualized as common, mild, or readily treatable, poses significant out-of-pocket costs to low-income Vietnamese families. One study examined the relative financial impact of treating diarrheal illness in poor families, finding “expenditure on health care for episodes of diarrhea during the previous month was equivalent to 63 percent and 75 percent of average monthly non-food expenditure for poor and near-poor households respectively” (McIntyre et al. 2007, 697). As another study showed, health care costs prevent some Vietnamese families from seeking care for diarrheal illness, no matter how severe. Individuals in the poorest quintile were found 33 percent more likely than those in the wealthiest quintile to suffer from diarrheal disease, and “those in the poor group were almost three times as likely not to seek any care as those in the rich group” (Luong et al. 2007, 577). One-third of the lowincome respondents stated that lack of money was the main reason for going untreated when suffering illness (Luong et al. 2007, 577). Deferring care for diarrheal illness may, in some cases, lead to hospitalization, whose costs are even more prohibitive for poor families. A 2015 study by Hoang Van Minh et al. confirmed that a treatment episode of foodborne diarrheal disease in Việt Nam requiring hospitalization incurs an average cost of $106.90; the individual poverty line was $1.61 per day (World Bank 2012, 15), meaning one hospitalization could consume more than two months of income for a lowincome patient. As this disparity between costs and resources suggests, accessing simple curative services is prohibitively expensive for many poor individuals, though they are at increased risk of contracting diarrheal disease. Furthermore, and perhaps more disturbingly, these studies suggest that enteric illness, once recognized as a national priority for universal eradication, now represents an opportunity for profit by medical facilities. Despite the tendency of poor families to self-treat illness (Witter 1996), “in the face of family illness, the poor stretch their resources to obtain health care and put their household economies under strain (…) To meet costs, poor households regularly had to sell assets (…) and/or borrow money and (…) reduce essential consumption and/or withdraw children from school” (Segall et al. 2002, 502–3). In my 2010 interviews with poor Hanoian families, who are typically described as being more financially secure than poor rural families, I also heard many reports of selling assets, borrowing money, and reducing consumption. Đỗ Thị Yến, a fifty-five-year-old woman whom we interviewed with her elderly mother in their pleasant but chilly house in Hoàng Mai district, was a farmer descended from farmers; as she explained, “[b]ecause the family’s

48

Epidemic Politics in Contemporary Vietnam

situation is poor, we couldn’t ask (xin) to be factory workers.” Her mother, Bà Phượng, had broken her hand recently in a fall and needed operations on her eyes. Her father had had a traffic accident that led to a stroke, which required a surgery costing 30 million VNĐ (approximately $1,500 US). Bà Phượng, commented, “Many times out on the street, not like everyone else, I feel very sorry for myself because they have enough to eat and enough to spend, but I’m poor and don’t have anything, I have to run after every meal.” As Cô Yến stated, “These last few years, my house has been endlessly exhausted (kiệt quệ vô cùng). (…) I can’t do anything about it; I can’t eat any less. So much money has gone into medicine, that’s why we’re poor like this” (Interview, Hoàng Mai district, Đại Kim ward, March 1, 2010). Many of the families I interviewed reported recent experience of serious and costly health problems, ranging from noncommunicable illnesses such as cancer and diabetes to infectious diseases such as dengue fever and tuberculosis. In the course of interviews with families, I met many individuals who were physically disabled or chronically ill, or who were caring for ill or disabled family members; this included ten households who reported having a relative with a serious mental illness like autism (bị tự kỷ) or schizophrenia (bị tâm thần phân liệt).12 These families struggled to provide for sick relatives, with few strategies of recourse except to assume responsibility for caregiving wherever possible. Adults in the family, especially mothers, were often also caring for children or elderly parents or parents-in-law. Given the limited availability of state entitlements, long-term illness and disability made the home provision of medical and other care physically, financially, and emotionally difficult. If a family member was ill enough to be hospitalized, relatives usually continued to provide most of their care, sleeping on the floor or on a foldout chair in crowded hospital wards to cook meals, wash clothes, and help with medical procedures. One woman, a stay-at-home mom (nội trợ) married to a motorbike taxi driver, described tending her two children during their long inpatient treatment at Thanh Nhàn Hospital for dengue fever. ML When your children went to the hospital, how long were they there? Cô Lý Close to twenty days. ML During that time, who took care of them? Cô Lý I and my husband with the older child ran back and forth bringing them food; I was taking care of one and my husband taking care of the other.—Phan Thị Lý, fifty-one years old, Hoàng Mai district, Tương Mai ward, March 7, 2010.

Medicine and Disease in North Việt Nam

49

Socialization has had similarly drastic effects on the institutions prioritized by Việt Nam’s health care system. Under socialism, the national public health system was originally envisioned as an encompassing system in which grassroots-level preventive care provision served as the foundation for universal services. Commune health centers were financed by the agricultural collectives where they operated. Within just a few years after the beginning of đổi mới, commune health centers lost their major source of funding as agricultural collectives closed, coming to receive only a small fraction of the national health budget (Malhotra 1999, 15; Quan Xuan Dinh 1999). Once the front line of public health, commune health stations have since relied mainly “on revenues from (largely unregulated) user fees for drugs and services” (Smithson 1993, iii). By the early 1990s, 80 percent of national health expenditure was out-of-pocket (London 2008, 115). This national pivot in health care priorities and financing was plainly visible in the commune health stations (trạm y tế) I visited across Hà Nội. While new construction boomed across the city, and while private clinics and hospitals offered extremely cosmopolitan medical experiences, commune health stations remained unglamorous outposts of state-run public health—simply appointed, often a little dingy or dim, and sometimes lacking basic supplies like soap or toilet paper. Their staff typically included one or more nurses (y tá) a pharmacist or prescription clerk (dược sĩ, dược tá), a nutritionist (diều dưỡng) or midwife (nữ hộ sinh), and sometimes a specialist in traditional medicine (y học cổ truyền)—but not necessarily a doctor (bác sĩ). The mostly female health cadres nevertheless were busy, because there were so many preventive programs to implement in communities. But while individuals in the catchment area of a commune health station would once have received diverse services there, even the poorest families I interviewed said that they avoided those facilities—visiting only occasionally and for very basic services like childhood immunizations or blood pressure checks. As a result, the exam rooms and waiting areas of health stations often sat empty. The sapping of resources at lower levels of the health system, abetted by deregulation, has translated into overcrowding at higher levels of the health care system. Whereas access to health facilities was previously administered by the subsidy system, ability to pay is now the only condition for seeking hospital care or specialist services, a practice referred to as “transferring up” (chuyển lên). Almost 50 percent of patients treated at central hospitals in Viet Nam self-refer from other provinces, owing in part to a perception that central hospitals offer superior services (Nguyen, Suong Thi Thao et al. 2018). A neurologist I met

50

Epidemic Politics in Contemporary Vietnam

at Bạch Mai hospital—a prestigious national-level facility—told me he was accustomed to sixty-hour work weeks and sleeping in his office. As he wearily noted, caseloads were high in every department: “There are sometimes four or five patients in a bed.” Ngô Văn Hiệp, a forty-three-year-old freelance barber, told me that he and his wife had slept on the floor underneath their thirteenyear-old son’s bed when they were caring for him during his long hospital stay (Interview, Long Biên district, Ngọc Lâm ward, August 5, 2010). Although poor patients are liable to avoid health services when possible, they also “transfer up” when they can. The six individuals in my sample who reported a cholera infection all stated that they had seen a private doctor or self-referred to a hospital for treatment; given the severity of their symptoms, they avoided facilities at lower administrative levels, which they perceived as inferior. However, it is conceivable that some affected individuals would have chosen to seek no services at all and to self-treat their symptoms, contributing to the undercounting of disease. Nguyễn Thị Vân, a forty-two-year-old mother and self-employed tea vendor, suggested how these costs of health care—even for relatively easily treated conditions—might translate into “irrational” use of over-the-counter medicine and home self-diagnosis and treatment. If I go get a little thing checked it costs a million, two million. Where am I going to get that? If I cough and get it checked, they take 500,000 from me, a million. They contrive (bày vẽ) this thing and that, they check this and check that. If I didn’t have health insurance, I wouldn’t dare to go. Where’s the money [for that]? I’m just [working] at home. If I buy a little thing of medicine for myself it’s 4,000, the cost of a bunch of vegetables.—Nguyễn Thị Vân, Hoàn Kiếm district, Hàng Buồm ward, August 27, 2010.

Households under Stress My interviews with poor and near-poor households, originally intended to get a sense of the scope of cholera prevalence in Hà Nội, revealed the challenges that poor urban families currently face in their everyday lives. These were, in many cases, dismaying, with frequent reports of incapacitating injuries, catastrophic medical expenses, and menial work to try to make ends meet. As economist Quan-Hoang Vuong has put it, the de facto imperative for families in the posttransition period is “Be rich or don’t be sick” (Vuong 2015). Or, in the words of Ngô Thị Tuyết, a forty-six-year-old woman who had retired from factory work and informal vending owing to the disabling effects of extrapulmonary

Medicine and Disease in North Việt Nam

51

tuberculosis: “Every time I’m sick, we’re bankrupt” (Interview, Hoàng Mai district, Mai Động ward, March 5, 2010). From this perspective, “socialization” appeared to present a very bitter and unjust experience of transition: with an increasingly opulent city as backdrop, many individuals I met were, with extremely limited assistance from the state, struggling to ensure the health and welfare of their families. Some of the homes I visited were in Hà Nội’s Old Quarter, the city’s most touristed district, and it was disorienting to hear stories of economic frustration and health challenges in tiny apartments abutting new restaurants, bars, and boutiques. In particular, the experiences of working-class and precarious mothers contradicted cheerful state messages and corporate representations of Vietnamese women as the heads of happy, healthy households. On more than one occasion, women started crying when a research assistant and I posed a question that I thought would be straightforward, such as “What do you do for work?” (Ngô Thị Tuyết, quoted above, cried when we asked “Is this your house?”) One woman I met in a neighborhood in the southern part of the city had a seventeen-year-old daughter who was comatose from advanced stages of Japanese encephalitis,13 which had begun in infancy. While Minh Hằng and I interviewed Bác Thơm, her daughter rested on a mat on the floor with her eyes closed, chewing a plastic plate. Her fingers and feet appeared twisted. As we were talking, she began to jerk around on the mat: a petit mal seizure. Her parents did not get up. “It happens every day,” her mother explained wearily. Bác Thơm and her husband Bác Hoàng were also suffering from illness. She had retired from construction work after an injury and had recently been diagnosed with diabetes; her husband had come back from the Second Indochina War with symptoms that they suspected were related to Agent Orange exposure. Their combined pensions were well above the official poverty line, and as such they were not considered officially poor—but the cost of their daughter’s ongoing medical care, which they paid out of pocket, meant they feared running out of money. Bác Thơm I’ve sold flowers for nearly twenty years, I retired and had to work informally (làm thêm) to live, with the child like this, how can we have enough to eat? Every bout of illness (trận ốm) can be 500,000 (approximately twenty-five USD) for the medicine. And just the last day her sickness took all of 160,000. ML Is selling flowers enough to take care of her? Bác Thơm Of course I still have to sell, he’s at home with a pension. I have to sell to make more than 800,000 a month. It’s a million [a month]

52

Epidemic Politics in Contemporary Vietnam to take care of her. That’s for her to eat. From selling flowers, I get 20,000 or 30,000 a day; that with the pension, we have to try to give her enough to eat.—Nguyễn Thị Xuân Thơm, fifty-six years old, Hoàng Mai district, Định Công ward, February 1, 2010.

Bà Đinh Thị Tràng, a seventy-seven-year-old woman living in central Hà Nội, lived with her two adult sons, neither of whom was able to work. When she was younger, she had worked for an agricultural collective until retirement and then sold duck eggs for extra money, but a recent surgery had left her dependent on her adult daughter’s salary from sweeping the street. One of her sons suffered from nerves (bị tâm thần, a commonly cited if nonspecific ailment that many families reported); the other was “very weak,” she said, but without health insurance, he had not been able to visit a physician and receive a diagnosis. The son with nerves had suffered from psychological trauma that had gone undiagnosed and untreated despite contact with health care providers. Bà Tràng said her son was depressed (bị trầm cảm): several consecutive setbacks in work and finances had left him “stupefied” (ngầy ngơ), only able to mumble a few words. Neighbors speculated he had been possessed by a ghost (bị ma nhập, bị ma làm). Bà Tràng had sought the advice of fortune tellers (thầy bói) instead of a doctor because her son, having lost his job with the state, had no health insurance. Ultimately, however, she took him to the hospital. The doctors said that if we had taken him there immediately then they would still be able to treat him. But having lost a few years, then he was not suffering from nerves, but repression (bị ức chế). He was repressed, so it changed into depression. I don’t know that disease, but I went to pray about it, and nevertheless the disease got stronger every day and so the family just has to suffer it. The doctor just said that if you had money and property, I could send him to someplace pleasant, then he’d forget it and have relief (khuây khỏa). But how would my family have money to send him to play (đi chơi)? I still don’t have enough to eat, much less to send my son to play. I’m just resigned to it (đành chịu thế thôi).—Đinh Thị Tràng, Hoàn Kiếm district, Hàng Gai ward, August 24, 2010.

With two sick sons, the family was left with one wage-earner, Bà Tràng’s adult daughter—who had her own family to support. It was hard to imagine how a family of three was surviving on part of a street sweeper’s salary plus an allowance from the state of 200,000 VNĐ (ten USD) a month in recognition of their status as an officially poor family. There was a grim feeling in their small house, whose crumbling concrete walls were decorated with a few religious

Medicine and Disease in North Việt Nam

53

books on a rack and a poster for an anti-scarring cream. Bà Tràng’s son lay in bed quietly while she showed us the medicine that had been prescribed to him. ML Do you give him any medicine? Bà Tràng Medicine that the ward provides, the state provides. ML What kind of medicine? Bà Tràng Depression medicine, this one. ML Just this, vitamins? Is there anything else? Bà Tràng That’s all. Research assistant This is “brain tonic” (thuốc bổ não). Probably it doesn’t have much effect? Bà Tràng I don’t know, they just provide this and that’s all.

We usually closed the interview by asking respondents what they hoped for their children, a question I originally believed would serve as a positive way to end a conversation. This time it left us sitting uneasily. She said, “They’re old now, and they can’t do anything. I don’t know what to do either.”

Conclusion As these ethnographic vignettes suggest, the national economic gains of market transition have not delivered on the promise of encompassing, even paternalistic health care that was envisioned under socialism. The withdrawal of social service provision, including formerly free and universal health care, makes the lives of poor Vietnamese families full of difficult choices. Ill health is a major source of financial problems and, essentially, vice versa. My conversations with Hanoians squared uncomfortably with the image that Việt Nam is currently working to project—a dynamic society offering all citizens equality of opportunity and the benefits of national economic growth. While the erstwhile ambitions to doctor the body politic and fight disease as if it were war are still part of public consciousness, as shown by national responses to SARS, avian flu, and the Covid-19 pandemic, macro-structural shifts in the health care system— the removal of resources from primary health care, the privatization of health, and the pharmaceuticalization of health—have informed a new and troubling common sense in which health is the achievement of private individuals, not a civil right or a public good. As I will discuss in the next chapter, economically vulnerable populations in post-transition Việt Nam must also contend with the externalities of the country’s economic boom, which has generated an array of environmental risks that also impact health.

54

2

Water and Sanitation in Transition

Đời cha ăn mặn, đời con khát nước. (The fathers ate salt, so the children are thirsty)—Vietnamese proverb Cholera is often described as a waterborne disease: a pathogen that originates in feces and is transmitted by ingestion (Encyclopedia of Environmental Health 2011). This characterization has its origins in an episode in nineteenthcentury England when—as has become canonical in epidemiology textbooks— the Victorian physician John Snow correctly inferred that a cesspool below a communal water pump was responsible for causing some 600 deaths in London’s Soho neighborhood over a ten-day period (Tulchinsky 2018). Famously, Snow created a map of cholera fatalities and found that they were arrayed a short distance around a “much-frequented” pump on Broad Street. As a parish committee investigating the outbreak later learned, prior to the outbreak, a mother who lived near the Broad Street pump had washed her sick infant’s soiled diapers in a pail and poured the dirty water into a drain nearby (Johnson 2006, 178). Further inspection found that sanitary architecture of the neighborhood was improperly constructed: the brickwork of the pump well lining had decayed, such that the well “showed signs of a steady percolation of waste from the cesspool” (Vachon 2005). At the same time that these experiences were building a case that cholera was transmitted by fecal contamination of drinking water, the local Board of Guardians continued to perceive cholera as a disease spread by atmosphere; quicklime was scattered in the streets to hold down infectious miasma. One resident of Broad Street took note of the proximity between the sewer line and the many cholera infections in the neighborhood. Their letter published in the Times inquired about the possibility that the construction of a new sewer had “most injuriously disturbed the soil, saturated with the remains of persons deposited here during the great plague of London (…) [Is it not possible, therefore, that] a deadly miasmatic atmosphere has been for some months arising through the

56

Epidemic Politics in Contemporary Vietnam

gully holes connected with the sewer?” (Vinten-Johansen 2020, 170–1). In this model, the author proposed that earth contaminated by corpses interred in the seventeenth century during an epidemic of bubonic plague had been reactivated by moisture, creating infectious vapors to enter the atmosphere—a model of causality that does not lack logical reasoning and is also endorsed, coincidentally, by some Vietnamese laypeople in their accounts of the transmission of leprosy (Le Hoang Ngoc Yen 2020). Over the second half of the nineteenth century, the progressive scientific ratification of contagionist perspectives put to rest the belief that environments contribute to cholera epidemiology. However, the germ theory of disease also informs disease control agendas that address environmental factors and infrastructure: as the World Health Organization has asserted, “Cholera can only be reliably prevented by ensuring that all populations have access to adequate excreta disposal systems and safe drinking-water” (WHO 1992, 9), meaning sanitary engineering is ultimately among the most important inputs to cholera control. And further, more recent research has continued to shift and complicate scientific understandings about the relationship between environments and the cholera pathogen.

Reframing Cholera In the late 1970s, oceanographer and microbiologist Rita Colwell began research on an unsettled question in the biology of cholera: “Where does Vibrio cholerae hide between epidemics?” (Colwell and McGrayne 2020, 79). Suspecting from pilot studies that saltwater would offer a hospitable reservoir, Colwell ultimately discovered viable cholera vibrio populations in the waters of the Chesapeake Bay (Colwell et al. 1977), substantiating a hypothesis that other scientists had in fact derided. Colwell’s subsequent research established that the cholera pathogen can survive over long periods in marine environments, coexisting in commensal association with microscopic zooplankton called copepods by attaching to their exterior surfaces or by lodging in their gut. Furthermore, cholera bacteria are robustly adapted to changing environmental conditions, able to reduce their size, and assume a dormant state when conditions are unfavorable for growth and reproduction—when their environment is too cold or too saline, for example, or when the surrounding waters do not contain sufficient nutrients. When hydrological and climatic circumstances enable phytoplankton and zooplankton colonies to bloom, providing increased nutrition to the vibrios, cholera bacteria

Water and Sanitation in Transition

57

come out of dormancy. Studies have shown that under some conditions, cholera outbreaks in human populations are associated with the appearance of algal blooms. Colwell’s research revolutionized cholera science, which until that point had maintained that cholera was transmitted by direct contact with the microbe, spread by infected individuals. As a result of Colwell’s insight, cholera scientists have essentially developed a unified-field theory of the pathogen, understanding it to be both, as it were, particle and wave: both an infectious microorganism and an environmentally driven disease. Cholera can be sustained in a freestanding environmental reservoir for lengthy periods and in widely varying climatic and hydrological conditions. By framing aquatic environments and climate dynamics as important contributing factors to the cyclic pattern of cholera outbreaks, these findings in ways revive the discredited anticontagionist perspective. Research beginning in the early 2000s suggested that cholera could be conceptualized as a “climate-sensitive” disease, finding its epidemiology to be associated with seasonal trends in cholera-endemic areas: “the coasts surrounding the Bay of Bengal, both Bangladesh and the Indian subcontinent, and coastal Latin America” (Lipp et al. 2002, 761). Cholera epidemiology suggests “strong seasonality” that has, as Reyburn and coauthors note, been observed for centuries; studying disease trends in Zanzibar, the authors observed that a “one-degree C increase in temperature at four months’ lag resulted in a two-fold increase of cholera cases, and an increase of 200 mm of rainfall at two months’ lag resulted in a 1.6-fold increase of cholera cases” (Reyburn et al. 2011, 862).

Diarrheal Disease in Việt Nam While Việt Nam is understood to be highly vulnerable to health risks associated with global climate change, particularly infectious disease risks (Tran Thi Tuyet Hanh et al. 2018), much of the research on cholera and other diarrheal disease in Việt Nam to date has focused on local water quality, handwashing practices, and exposure to raw sewage in agricultural settings. Although the prevalence of diarrheal illness has declined since 1990, it remains a significant source of disability and loss of life (Tran Thi Tuyet Hanh et al. 2018), as attested by an extensive literature. A 2008 technical report on handwashing found that “[Diarrheal] diseases (…) have not reduced in recent years, suggesting a need to improve both hygiene and the water supply in Vietnam” (Cogswell and Le Thi Thu Anh 2008, 7).

58

Epidemic Politics in Contemporary Vietnam

Between 2005 and 2011, the average annual total case count of diarrhea in Việt Nam, including nonhospitalized cases, was one and a half million (Kotsila 2014, 1). A more recent report by the same author found this figure has remained relatively stable despite national improvements to the water and sanitation sectors (Kotsila 2017). Pathogens contributing to diarrheal disease epidemiology in areas of Hà Nội where untreated wastewater is used in agriculture include rotavirus, Entamaoeba histolytica, Shigella, and E. coli (Bui Thi Thu Hien et al. 2007); a study of diarrheal disease in children near the Red River identified Campylobacter, Shigella, and E. coli as the most common causes of illness (Isenbarger et al. 2001). However, “unlike malaria or HIV, the control of diarrhea does not constitute a clear priority in today’s Vietnam” (Kotsila 2017, 95). At the time of my fieldwork, waterborne diseases remained “widespread” in Việt Nam, with over 250,000 cases of diarrhea registered at hospitals annually (USAID 2010, 116). A 2008 report found that “[d]iarrhea-caused diseases and acute respiratory infections have not reduced in recent years, suggesting a need to improve both hygiene and the water supply in Vietnam” (Cogswell and Le Thi Thu Anh 2008, 7). Publications that have attended to the role of larger environmental and climatic factors in influencing cholera epidemiology have suggested that environmental shifts are responsible for increased cholera incidence in Vietnamese cities. In a 2008 study, Emch and colleagues drew on a small dataset to find that increased rain, river height, and river discharge are associated with the increased likelihood of a cholera outbreak in the coastal city of Nha Trang, while increasing sea surface temperature has “a highly significant effect” on the probability of a cholera outbreak in Huế, which “is separated from the ocean by several kilometers of estuary” (Emch et al. 2008, 824). In northern Việt Nam, a study of diarrhea incidence in communities along the Red River by Isenbarger and colleagues suggested that seasonal patterns of elevated diarrhea risk in the wet rainy season may be attributed to “the impact of flooding on the spread of fecal waste into drinking water supplies” (Isenbarger et al. 2001, 235), suggesting a model for diarrheal disease risk that connects climatic trends, sanitation systems, and patterns of individual exposure. Taken together, these findings suggest that environment is a source of important inputs to cholera incidence, but that these associations show significant variation between sites. Given a robust literature by foreign and Vietnamese authors documenting enteric illness occurring in association with water and sanitation problems over recent decades in Việt Nam, it would have been reasonable to expect that the cholera outbreaks would inspire inquiry and debate regarding water and

Water and Sanitation in Transition

59

sanitation quality in Hà Nội. Evidently, there was awareness of the possible role of urban water in spreading disease, because disease control efforts did include environmental interventions. Media reported that urban lakes, suspected of constituting an infectious reservoir, were dredged and dosed with Cloramin-B (chlorine). And many study respondents had seen city workers spraying bodies of water with chemicals and putting chemicals into home water tanks. However, despite these efforts, official comments and media reports on Hà Nội’s cholera outbreaks hardly mentioned water at all; the few news articles that did describe the disease as potentially waterborne appeared in foreign publications. Virtually no one addressed the role that environmental factors might have played in propagating the spread of cholera; during my field research, this possibility was literally only whispered about. As I discuss in Chapter 3, the state’s focus was transmission via food—though food that causes cholera infection would be highly likely to have been originally contaminated by water. A Vietnamese epidemiologist working for the United States Agency for International Development (USAID) told me that the head of the National Institute of Hygiene and Epidemiology had considered the possibility that the Red River was the original cholera reservoir, but this idea was never presented in print. As another Vietnamese scientist suggested to me, the prospect of a waterborne cholera epidemic was simply too politically challenging for the state to countenance. As I suggested in Chapter 1, cholera in Việt Nam has historically been imbued with political and ideological meanings regarding modernity, development, socialism, and science, and its historic association with the “backwardness” of the dynastic period and the colonial period has made cholera prevention an important part of modernity and the construction of the “medical nation.” Controlling water in Việt Nam has long represented a source of cultural and political power; it is a resource for governance and governmentality. Therefore, it seemed politically unacceptable for media or other prominent voices to associate cholera incidence with faulty water and sanitary infrastructure. As a representative of a European health NGO suggested to me, “Hà Nội considers itself a modern city with things that a ‘modern’ city has, and cholera is not something a modern city has.” In this chapter, I provide a history of how water has informed politics and how politics has in turn shaped the circulation of water in North Việt Nam, suggesting the broader symbolic significance of water resources in the present day. I follow this history with ethnographic accounts of how poor individuals and families in contemporary Hà Nội source and make use of water in their everyday lives,

60

Epidemic Politics in Contemporary Vietnam

suggesting that these experiences reveal significant limits in the infrastructural ambitions and capacities of the contemporary state. Where in previous eras the state attempted to control water supply and provision, in recent years a large share of Việt Nam’s water and sanitation infrastructure have been funded by overseas development assistance (ODA); the sector is thus shaped by a partial retreat of the state. In Hà Nội, the devolution of water provision to extremely local levels and the wide reliance on individual solutions like wells have the potential to introduce risks to the population—including the risk of waterborne disease.

Water in Việt Nam: A Hydrogenealogy An ample supply of fresh water and arable lowlands furnished the historic conditions for humans to settle in North Việt Nam’s Red River Delta, the cradle of the Vietnamese civilization. The Red River’s headlands are in the mountains of China’s Yunnan province; the river crosses the China-Việt Nam border in Lào Cai province and threads through the northwestern provinces before breaking into branches at Việt Trì in Phú Thọ province to form the deltaic plain. It’s 150 kilometers from Việt Trì to the delta’s coastal edge on the South China Sea; at the coast, the delta is 130 kilometers across. All told, the wedge-shaped delta covers 14,300 square kilometers; its highest elevations lie just 3 meters above sea level (Luu et al., 2010). The Red River Delta’s oldest strata date to the early Pleistocene epoch or before; remote sensing has revealed that shifting global sea levels contributed to the establishment of its morphology and the layering of sedimentary deposits over millennia (Mathers and Zalasiewicz 1999). Archaeological evidence suggests an early Neolithic period in northern Việt Nam, dated to c. 5000 to 3000 BCE (Nishimura 2005, 102), with settlement patterns throughout the delta corresponding to the availability of usable land. Present-day Hà Nội was inhabited later than other parts of the Red River Delta because marine or brackish water covered the area in the early Neolithic (Nishimura 2005, 103). The region’s saturation with waterways and the infusion of nutrients into the soil via deposits of alluvium and sediment have supported highly productive wet-rice agriculture, begun in the region by the late third or early second millennium BCE (Long 2011, 129). Wet-rice cultivation was the foundation for population settlements in the region of proto-Việt Nam. Cultivating rice required labor in the construction and maintenance of an irrigation infrastructure, and the naturally high carrying capacity of the region supported population growth in turn. Natural and cultural

Water and Sanitation in Transition

61

conditions have thus contributed to the Red River Delta becoming one of the most densely populated areas in the world.1 Like the riverine civilization (Biggs 2012, 9) of the Mekong Delta in Việt Nam’s South, the Red River Delta is often called a “rice basket”; as a downstream riparian country, the nation’s economy is oriented around the productive capacity of its northerly and southerly river deltas. The shape of modern Việt Nam is sometimes described as resembling “two rice baskets on a carrying pole.” Water’s critical role in the founding of North Vietnamese centers of power is also visible in the words for “nation” and “state”: đất nước (nation) means “land/water”; nhà nước (state) is “water/house.” These terms emphasize how a polity is constituted by its hydrological resources as well as by its territory and population. Indeed, water’s dynamic presence—in ocean tides, rivers, floods, and paddies—has been foundational in the formation and development of the North Vietnamese state over centuries. Some historians have conceptualized North Vietnamese civilization as the juncture of an inland riverine mode of production with connections to the region via maritime trade; Whitmore (2006) has argued for a complication of this model by making an analytic distinction between the upriver and the downriver coastal subareas of the Red River Delta. Other scholars have used the concept of a “hydraulic civilization” (Wittfogel 1956) to characterize Vietnam, emphasizing that the control and channeling of water resources “required substantial and centralised works of water control, which was, in turn, reflected in political power and societal leadership” (Feyen et al. 2009). Along similar lines, historian Momoki Shirō argues that the construction of infrastructure to manage floods not only expressed, but consolidated, political authority. As Momoki argues, in the Đại Việt period during the thirteenth to fifteenth centuries, the Trần dynasty reinvigorated its political authority via “the building and subsequent overseeing of a series of large-scale public works— among them the construction of floodplain embankments on the Red River Delta”—a move that helped establish a system of “Chinese-style bureaucracy and territorial administration” and subsequently secured the dynasty’s hold on power (1998, 19).2 Water surrounds the city of Hà Nội, which was founded in a bend of the Red River just over a thousand years ago as the capital of the Lý dynasty (1009– 1225). Beginning with the royal citadel, the city grew up as a market town in the confluence of the Tô Lịch River. The area where Hà Nội was founded is threaded with rivers—the Nhuệ, Tô Lịch, Lừ, and Sét are the city’s main waterways— and dotted with over a hundred ponds and lakes. An apocryphal story recounts Emperor Lý Thai Tổ’s fifteenth-century encounter with a mysterious turtle at

62

Epidemic Politics in Contemporary Vietnam

Turtle Lake (Hồ Gươm) in central Hà Nội. After defeating a Chinese invasion with a magical sword bestowed on him by the gods, the Emperor was boating. A giant turtle approached his boat and snatched the sword, diving underwater to return the weapon to its divine source. Hồ Gươm became known as the Lake of the Restored Sword (Hồ Hoàn Kiếm). This lacustrine legend, naturalizing the Emperor’s power and legitimacy vis-à-vis Chinese opponents, the Vietnamese nation, magical creatures, and the gods, rivals Arthurian myth for expressiveness in political symbolism. Originally named Thăng Long (Ascending Dragon), the city was renamed Hà Nội, meaning River’s Interior, by Emperor Minh Mạng in 1831. The settlement of Thăng Long, like other delta communities, was premised on a balance between the benefits (food) and risks (flood) of a naturally abundant water supply and annual inundation. Agriculture and aquaculture formed the economic basis for the population to grow; given the land’s low elevation with respect to the Red River, a “net-like series of dykes was constructed all over the lowlands to protect the agricultural land from floodwaters and to allow dry season irrigation” (Nishimura 2005, 99). The construction of dikes in the region of the royal capital began approximately contemporaneously with the founding of Thăng Long (Phong 2015, 32). Waterworks were also an early part of the city’s establishment: in 2012, archaeologists excavating the royal citadel found a large hydraulic system dating to the Lý dynasty; paved with red bricks and lined with wooden poles, the structure may have been a waterway, a drainage system, a water supply system, or a well. As historian David Biggs has shown in his account of “nation-building and nature” in South Việt Nam’s Mekong Delta (2012), the management and ordering of water resources are time-honored venues for cultural and political struggles in Việt Nam. Furthermore, the control of atmospheric water represented a source of political legitimacy for the Nguyễn court; as Kathryn Dyt (2015) has shown, “Environment events were intimately linked to the power and legitimacy of the monarch” (Dyt 2015, 3) and hence emperors routinely commissioned rituals “calling for wind and rain (cầu đảo)” during droughts. Something similar took place in colonial Hà Nội, when beginning in the late nineteenth century, French interventions reshaped the city’s network of bodies of water “for health and aesthetic reasons,” as historian William Logan writes  (2000, 72). The French believed that the lack of a natural drainage system for Hoàn Kiếm Lake and the Tô Lịch river resulted in “stagnant pools of wastewater left lying everywhere” during the dry season. The southern part of the city was marked by “interconnecting swamps” and “a series of marshes and

Water and Sanitation in Transition

63

ponds” that the French saw as insalubrious (Logan 2000, 73). Hà Nội’s colonial administrators severed Hoàn Kiếm Lake from the Tô Lịch River and Trúc Bạch Lake by infilling swamps and ponds throughout the city with sand taken from the Red River, and the French also removed the dwellings that fronted Hoàn Kiếm Lake—once an extensive settlement of poor city residents. By 1902, the lake’s banks were empty of all structures besides Báo Ân pagoda, a library, and the properties of a wealthy French trader (Logan 2000, 75–6). During this period, the French also moved to construct shallow wells, water channels, water treatment plants, and pumping stations to serve a population of 20,000 in the urban core. The oldest parts of the water distribution network were completed in 1894 (Wnukowska 2004, 23). Sewer infrastructure covered approximately 1,000 hectares in the city’s center, while the rest of the city relied on open drains. Following the anticolonial First Indochina War, Hà Nội was left with the legacies of French-constructed water and sanitation infrastructure, designed to meet the needs of a population of 90,000. In the Democratic Republic of Việt Nam, water supply companies were established to meet water demand for domestic use and production activities in urban areas and industrial zones.  Between 1955 and 1965, two water treatment plants were constructed in Hà Nội and the city’s water production capacity increased; however, the materials and equipment imported from the Soviet Union and China that made up the bulk of these expansions were of low quality, as hydrologist Trinh Xuan Lai (2007) has suggested. During the Second Indochina War, few resources were allocated to urban water and sanitation; after the war’s end, the supply system was renovated, increasing the city’s capacity for water production (Wnukowska 2004, 23). Aid from the United Nations contributed to the rehabilitation of Hà Nội’s water supply at a time when material improvement was otherwise hindered by the embargoed postwar economy. A Water Master Plan was developed in the mid1980s, based on “data and documents compiled by Russian experts during the 70s and 80s” (FINNIDA 1993). Subsequently, the plan was updated by the Finnish International Development Agency between 1985 and 1997. By 2000, Finnish aid to Hà Nội’s water and sanitation system had been largely replaced by support from the World Bank, the Asian Development Bank, and the Japanese Overseas Economic Co-operation Fund (Wnukowska 2004, 19). Japanese investors took a leading role in improving Hà Nội’s water infrastructure after Finnish-Vietnamese cooperation ended. As this account of technical and planning assistance in Việt Nam’s water and sanitation infrastructure suggests, overseas development assistance (ODA) has

64

Epidemic Politics in Contemporary Vietnam

long represented the greater share of investment into these sectors and remains an important source of fiscal inflow in the post-reform period. From 1990 to 2004, some $14 billion in ODA was disbursed to Vietnamese wat/san projects and infrastructure (Wnukowska 2004, 35). From 2001 to 2011, an estimated 10.2 percent of the Government of Việt Nam’s expenditure was water-related (not including a series of massive investments in hydroelectric power plants). Fifteen percent of this spending was directed to basic drinking water supply and sanitation, and 12.7 percent to large systems for water and sanitation. The average annual government investment on all water-related infrastructure and programs was $114 million, while average annual ODA disbursements represented some $240 million—more than twice as much as state expenditure (Food and Agriculture Organization 2013, 1). Large systems for water supply and sanitation received the largest share of ODA allocation: 33.5 percent of all ODA from 2002 to 2011.

Water Pressure For at least the past two decades, increasingly unsustainable urbanization has pushed Hà Nội’s water and sanitary infrastructure to its limits. International researchers and NGO reports on city systems for water provision and management of wastewater have expressed concern over systemic adequacy and sustainability since the early 1990s. Vietnamese media in recent years have also documented urban water pollution and challenges in sanitation management, problems that can be readily observed throughout Hà Nội. Less visible, but equally pressing, are patterns of water sourcing and rates of use, topics that have raised concern for Vietnamese and foreign analysts. In Hà Nội, most of the municipal water supply is drawn from groundwater, a source that has been exploited for domestic and industrial use for over a century (Nguyen and Nguyen 2002, 1). The rate of groundwater abstraction has begun to overreach the carrying capacity of the water table; this contributes directly to increasing the pollution levels of the two main aquifers that supply the city (Montangero et al. 2007, 56), as intensive pumping “causes lowering of the groundwater table creating a cone of depression and a large hydraulic gradient” (Nguyen and Nguyen 2002, 3). Overexploitation of these aquifers not only reduces the city’s slowly replenishing natural resources, it also amplifies groundwater pollution by “intrud[ing] contaminants into the aquifers” (Fjorth

Water and Sanitation in Transition

65

and Nguyen 1993). Land subsidence also causes groundwater to become more susceptible to pollution from surface water and the surrounding soil. Although 97 percent of Việt Nam’s urban residents have access to improved water (Cogswell and Le Thi Anh Thu 2008, 8), meaning water that has been treated at least somewhat, less than 10 percent of urban water is centrally treated (Asian Development Bank 2015, 2). The city’s water concern does not provide potable water, and no one drinks tap water without boiling it. International visitors are warned against using tap water to brush their teeth, and most of the middle-class Hanoian homes I visited used plastic dispensers of “sanitary” (đảm bảo vệ sinh) water for drinking and meal preparation. However, many city residents still use water supplied by private wells: a water source that is not regulated or tested. Private household wells, like urban public water supplies have increasingly been found to be contaminated with geogenic arsenic (Winkel et al. 2011). In 2013, a major aquifer supplying Hà Nội was found to have absorbed arsenic—apparently, overpumping by private wells had caused the aquifer to pull water from a contaminated aquifer a mile away (McNeil 2013). Other pollutants found at high levels in Hà Nội groundwater include nitrogen ammonia and fecal coliform (Montangero et al. 2007, 56; Nguyen and Nguyen 2002, 5). The increasing degree of pollution in Hà Nội groundwater required a new government policy for the use of surface water; municipal drinking water will be increasingly drawn from the Red River (Hubert Jenny, personal communication, May 17, 2010). In the Democratic Republic of Việt Nam, the state encouraged the construction of secure wells in rural areas—which were, similar to sanitary latrines, perceived as a “means of revolutionary commitment” as well as a means of improving public health (Malarney 2012, 121). Wells, once uncommon, are now an extremely common source of household water, even for urban families. However, because some wells draw groundwater from water table levels that are particularly subject to contamination through leaching from septic tanks, water drawn from home wells may be a source of health risk. Spot tests have shown drilled wells in Hà Nội to be universally contaminated with organic pollutants beyond the permitted standard (Trinh Xuan Lai 2007, 9). In the early 1990s, an article claimed that throughout Hà Nội, “the low coverage of the sewerage system, unfavorable topographical conditions and overloaded hydraulic capacity of sewers […] have resulted in frequent flooding, and unmanaged filling of open water spaces has reduced the regulation storage for flood control” (Hjorth and Nguyen 1993, 460); this remained the case during my fieldwork, when heavy

66

Epidemic Politics in Contemporary Vietnam

rains would occasionally overwhelm the urban drainage infrastructure and leave major streets knee-deep in floodwater.

Wastewater and Sanitation While investment into the water supply by both bilateral agencies and the Government of Việt Nam has been relatively robust, the waste side of water and sanitation in Hà Nội has been neglected (Wnukowska 2004, 27). Some 65 percent of Hanoians are estimated to have access to sewerage services (Nguyen Viet Anh et al. 2005, 6).3 This rate surpasses rates found in rural areas, but the system’s capacity to reduce the environmental burden of waste is conscribed. As a water and sanitation advisor pointed out to me, the question, from the perspective of understanding potential exposure to waterborne disease, is, “What happens to it afterwards?” For the most part, nothing happens to black water and solid waste in Hà Nội, as far as treatment is concerned. There is no centralized treatment of wastewater in the capital. To date, no sewage treatment plants have been constructed in Hà Nội; the city’s two pilot plants have the capacity to treat only 1 percent of urban wastewater. Two-thirds of the municipal sewer system were constructed before 1954 (Hjorth and Ngyuen 1993, 458); the current system is “old and in disrepair,” with “its hydraulic capacity (…) significantly impeded by solid wastes” (Nguyen Viet Anh et al. 2005, 14). With very little exception, wastewater is directly discharged into city lakes, ponds, and rivers. This means that “most of the outfalls from the sewer system are seen as point pollution sources to the lakes and rivers in Hanoi both under dry and wet weather conditions. Point sources [from the sewer system] (…) were one of the largest potential sources of human faecal contamination” (Quan et al. 2010, 47). Hà Nội’s limited sewer capacity essentially requires individuals to seek sanitation options which, while rational and necessary at the household level,  collectively contribute to environmental degradation and public health problems when they are practiced widely across the city. As white papers, news reports, and policy documents emphasize, waterways throughout Việt Nam are increasingly threatened by pollution. A 2008 article in Việt Nam News reported “that river systems and their surrounding basins all across the country [have become] polluted at alarming levels,” according to an official at the Environmental Protection Department. A woman who lived along the Nhuệ river in Hà Tây province, southwest of Hà Nội, was quoted in the article

Water and Sanitation in Transition

67

saying, “In the past, the river was full of fish and shrimp, and it was so clean that the villagers could even cook with its water. But this is gone now. The river has become terribly dirty. My family has drilled three wells, but all the water we find is polluted by the nearby river.” In Hà Nội, runoff of wastewater and mostly untreated industrial wastewater finds its way to the Tô Lịch, the Kim Ngưu (Golden Buffalo), the Lừ, and Sét rivers, the city’s primary water drainage paths (Việt Nam News 2008); since at least the early 2000s, these waterways have been described as “open sewers” (DiGregorio et al. 2003, 183). Refuse chokes the banks of Trúc Bạch Lake, where fish die-offs have become common. The Tô Lịch River, once a cherished symbol of the pastoral, runs black in places and reeks of anaerobic processes; a recent B.A. thesis in Applied Engineering called it a “dead” river (Minh Hoang Nguyen 2018); as of May 2020, an ambitious project funded by the Japanese government is underway to redirect untreated sewage to treatment plants instead of into the Tô Lịch and other of the capital’s rivers (VietnamNet 2020). In 2010, one of my interview respondents who lived near the river’s southern section told us how unpleasant it was: The Tô Lịch used to run near here; now it has pooled. It has become polluted because people bring trash down there and dump it. Now it’s a lot better, but it’s still an area of low-lying land (vùng đất trũng), so stagnant water from the city floods down here whenever it rains. So there are frequently contagious diseases here in this area; there is a high risk of disease. Last year there was cholera, not in this area but in some neighborhoods below here; some people had cholera.—Lê Thị Minh Tâm, fifty-seven years old, Hoàng Mai district, Yên Sở ward, March 12, 2010.

Two health stations in Hoàng Mai fronted the Kim Ngưu river, an urban waterway so thoroughly polluted that the stagnant water was black. An elderly man commented on the river’s oppressive atmosphere in an interview in Mai Động ward, where he lived with his chronically ill wife, their daughter, and her two children in a narrow two-room house fronting a heavily trafficked road. ML Around this area is there anyplace that is polluted? Ông Quang There’s that sewer out there. If you go in there there’s the edge of the sewer canal there, that’s a branch of the Kim Ngưu river there. ML Is that place always like that? Ông Quang It’s always like that, it flows all year. The water flows from the village out to the river Kim Ngưu, when it’s coming up to summer it really smells. ML Does that stream affect the health of everyone in this area?

68

Epidemic Politics in Contemporary Vietnam Ông Quang Of course it does, from here to there is around 500 meters but in summer the wind blows, then that atmosphere [comes here]; everyone underneath this sky is breathing polluted air.—Đỗ Văn Quang, 80 years old, Hoàng Mai district, Mai Động ward, March 5, 2010.

More remote wards in Hoàng Mai district, rather than benefitting from the ostensibly healthier rural surroundings, also experienced environmental stress associated with development and urbanization. As the below interview excerpt with Anh Trung showed, some of the piped water in the area was municipally dispensed while other users relied on a local water station or their own wells. Anh Trung also noted how infilling of ponds, a common phenomenon in semirural and urbanizing areas of Việt Nam, had contributed to environmental pollution. Finally, he remarked on the presence of temporary renters—ruralto-urban migrants—whose substandard housing put them and the surrounding community at risk for infectious disease. We were sitting on low plastic stools in the alley that led up to the small buildings and courtyard where he, his wife, and his parents all lived; the tape is filled with background noise from vehicles passing in the street just a few feet away. ML Is there anyplace in this area that’s polluted? Anh Trung Generally now, in this period, it’s half country and half city; it’s developing, so it’s pretty polluted. ML What kind of pollution? Anh Trung Several things, like water for daily activities (sinh hoạt). Running water isn’t as “guaranteed” (i.e. hygienic) as clean water because the water that is supplied for the people here is water from the wells that people bore themselves, they make their own tiny little water pumps, so it’s not guaranteed as clean water from the factory. There is an area on this side where they use clean water from Hà Nội and it’s better, but the area on this side they still use water from the “mini station” (trạm mi ni). There are some people in the area who bid on contracts, so probably the issue of treatment [of water] is not as good as Hà Nội’s. ML Apart from water is there anything else? Anh Trung There’s a lot, but in Việt Nam we have to accept it, because that’s the general situation. My house is here; when they give advice from the Ministry of Health about prevention during one period or another during the year, then naturally I have to protect myself. I use some things [that they suggest], but [I also

Water and Sanitation in Transition

69

apply some] health advice that I believe to be good. ML  Before, when this area still didn’t belong to Hà Nội, was it also polluted, was it more open? Anh Trung In the old days it was less [polluted] because there were many lakes and ponds, now the native people just a little less than one half of the people here, and the rest are people who are renting, then they’re here year-round, and only go back to their home town a few days at Tết. So the area has people renting with conveniences that aren’t like our house has (tiện nghi không được như nhà mình) and the hygiene is poor, many times there is a disease outbreak of some sort that begins there first, then spreads around. There are a lot of renters here. ML The places where people are renting usually get what diseases? Anh Trung For example in a year they often warn that there are two outbreaks, cholera and dengue fever like last year. Afterwards then it spreads to the people’s houses, if anyone doesn’t hear the warnings and doesn’t individually prevent those diseases then they’ll be infected.—Phạm Vũ Trung, 38 years old, Hoàng Mai district, Thịnh Liệt ward, March 3, 2010.

Gaps in the provision of water and sanitation open a space to think about Việt Nam’s complex transition from socialist provisioning regimes to the uncertain, ungoverned “public-private” regime of social goods. On the first day of interviews with city residents, I met the mother of a thirteen-month-old baby in the twenty-two-square-meter home that she shared with her husband, her husband’s parents, and the family of her sister-in-law. We were in Hoàng Mai district: not one of the city’s most central neighborhoods, but still well within its limits. The health cadre from Định Công’s ward health station had led me down a series of dusty lanes to introduce me to the family. It was midday and the house was quiet but felt tense. As Chị Phương explained, her husband was suffering from a relapsed case of tuberculosis. Before the baby came, she had worked at Đông Xuân market selling clothes; now, she said, “I’m just home with the baby (ở nhà bế cháu thôi).” Between serious illness, lack of income, and crowding, the family was struggling to meet the everyday needs of its members. From her discussion of sourcing safe drinking water—a substance that is sometimes posited as a right in national and international policy framing documents—it was evident that accessing water was difficult at best. Chị Phương My household uses rainwater for drinking. We built a tank to catch it. Whenever we don’t have rainwater, we bring up well

70

Epidemic Politics in Contemporary Vietnam water and filter it for cooking. Of course, in the hot season we don’t have well water, so we often lack water. Running water is more convenient, eating and drinking is cleaner. ML  How do you make sure that the water you use for eating and drinking is clean? Chị Phương If we had running water, then I would just have a big tank on top of the house so we could collect water, then bring it down for cooking. But how could we? If I were to dream, that’s how I’d dream (Ước thì ước như thế). We’re still using well water and a little rainwater.—Nguyễn Thị Phương, forty years old, Hoàng Mai district, Định Công ward, February 1, 2010.

Chị Phương’s situation was continuous with broader features of the posttransition situation: the partial withdrawal of the state, the opening up of gaps, the unsatisfied dreams that accompany “relative” poverty, and a new sense of less status for poor families. And while the cost of water and water delivery improvements was prohibitive for Chị Phương’s family, these rates are considered low by international lenders—who wanted to see Vietnam’s Ministry of Finance raise water tariff rates significantly and much more frequently, as specialists at the Asian Development Bank explained to me. Some ADB loans to individual Vietnamese cities were, in fact, conditional on tariff increases. When I mentioned to these experts that I had met families who felt the price of water was too high, they cited affordability studies that had identified no issues with the expense. As the discussion of Chị Phương in Hoàng Mai district suggests, urban residents faced the retreat of the state in the water, sanitation, and waste disposal sectors and shored up their everyday needs for these core resources with improvised workarounds. At the household level, these include practices such as drilling a well for one’s home to draw water for drinking, cooking, and washing. Similarly, most of the poor and near-poor families I interviewed used a septic tank instead of having a connection to a municipal sewer system. In a more extreme case, Cô Nguyễn Ngọc Thiến, fifty, who lived in Long Biên district east of the Red River, described how infilling of lakes in the district made for floods when it rained. The bác tổ trưởng (the elected head of the sub-ward) has met us out on the main street and led us down to meet Nguyễn Ngọc Thiến, fifty, whose husband is sick. Her house is very spare, not even a calendar on the wall. Essentially, the room is a concrete box with one window and a bed. She sells food from a stall for a living.

Water and Sanitation in Transition

71

She says “Every time it rains, the house floods with water (Nhà cô mà cứ mưa một trận là ngập). I just have to push the bed up and block the door. This area is low. Before there were lakes here but now people have filled them in, so there’s no place for the water to flow. … Some houses over there have money so they’ve been able to raise the foundations, but I haven’t been able to yet, so every time it floods I have to clean the house.” (Field notes, Ngọc Lâm ward, August 5, 2010)

While her more monied neighbors had raised the foundations of their homes, Cô Thiến could only afford to block the door when it rained. In case of a heavy rain, of course, rags in the doorframe would supply the barest of stopgaps. Chú Đại, a forty-nine-year-old man who worked as an informal repairer of bicycles and motorbikes, told us that he had slept on his own motorbike when his home flooded in October 2007; one could easily see the mark that the floodwaters had left on the painted concrete wall. Bà Phượng, whose story is presented in Chapter 1, also told us that her house was easily inundated in storms: “Before it was so rickety (nhà vách rách nát). We started building it more in 1995, but the house was still so badly done. Now it’s been built for a long time, but the rainwater comes in.” Other stopgap measures for securing water and sanitation include the home treatment of drinking water by boiling it or filtering it; sunning it on the roof in plastic bottles or purifying it with an ozone treatment system. One woman, a widowed farmer, went to fetch small amounts of water from her mother-in-law when her household faced water shortages. Sourcing safe drinking water was a major undertaking for some families. Bùi Thị Thanh Trang, a thirty-three-yearold single mother and construction worker (thợ xây) whose husband had left her for another woman many years ago, told us: “The kids don’t drink ‘raw’ water (nước lã), they always have to drink boiled water. If we don’t have boiled water then I go to my mother-in-law, where she has a water filter, to take a pitcher and bring home in order to be safe” (Interview, Hoàng Mai district, Đại Kim ward, March 1, 2010). In Hà Nội, most households install septic tanks for treating black water instead of connecting to the municipal sewer system, which has extremely limited coverage. This is a very common arrangement for urban household  sanitation—as a senior officer at the Asian Development Bank told me, “Hà Nội is all septic tanks.” Neighborhoods where many households have elected to use septic tanks and wells may face potential risks of water supply contamination. Sub-adequate construction or maintenance of

72

Epidemic Politics in Contemporary Vietnam

either a septic tank or a well, or both, could entail fecal contamination of a household’s well water in situ. The high prevalence of septic tanks across the city, plus a low rate of desludging, threatens to contaminate groundwater and private wells. At least 90 percent of Hanoian households use septic tanks, and of these, 95 percent did not desludge the tanks regularly; in fact, almost 90 percent had never been desludged (Harada et al. 2007, 331). This may at least partly be a result of the lack of any national laws governing the collection and treatment of septage in Việt Nam (USAID 2010, 119). But it is also because in houses, septic tanks are often constructed under tile floors. To desludge a septic tank requires breaking the portion of the floor above the tank. If the house is not new, residents may not remember where the tank is, requiring the entire floor to be broken up (Collignon et al. 2011, 33), making an already unpleasant and costly process even more difficult. Owing to these difficulties, household septic tanks are infrequently desludged, emptied, and cleaned. Less regular desludging may limit a septic tank’s capacity for anaerobic digestion, as well as “increasing the level of suspended solids and untreated sewage in effluent” (USAID 2010:4). In turn, this means an increased chance for sludge to seep and leach into aquifers or well water. The weaknesses of Hà Nội’s sanitation and drainage capacity were apparent in October 2008, when a heavy storm inundated northern Việt Nam and southern China, with up to a meter of rainfall recorded in Hà Nội. Samples of lake water and road runoff taken during the storm were found to contain high levels of total coliform and E. coli, suggesting that flooding in a city relying on septic tanks could entail widespread exposure to waterborne contaminants. Though diluted with a huge amount of rainwater, pathogenic pollution level was still considerable in inundated water. It was suggested that when inundation occurs, more pollution sources emerge such as from solid waste that had not been collected on the roads or from leaking septic tank systems. This information indicated the potential of human health risk to Hà Nội residents when exposed to flooding water. (Quan et al. 2010, 53)

Some of my respondents in Hà Nội mentioned the floods, which had killed sixteen city residents and caused significant damage to homes. During that flood, Cô Thiến in Long Biên district told me, she had floodwater in her house for a week and so had all her neighbors.

Water and Sanitation in Transition

73

Hydrologies of Market Transition During the socialist period, the Vietnamese state’s representations portrayed a highly ambitious vision for social progress and provisioning: as one poster for a national literacy campaign claimed, efforts would proceed until “the last illiterate person” had been lettered. Since market reform, the maximal ambit once claimed by the state has been replaced by a much more partial regime of surveillance and intervention, a dynamic of state retreat that marks other formerly socialist places as well. In her research on Bulgaria’s declining public health system, anthropologist Elizabeth Dunn (2008, 255) identifies areas that have fallen off the map of governmentality as “stateless spaces … first created by the implosion of the Soviet system.” Of course, during Việt Nam’s socialist era, behaviors and regimes outside state control also proliferated; it might well be the case that Chị Phương’s family never had running water provided by the local authorities and instead found workarounds to meet their everyday needs for clean water, operating in a modest and practical fashion to find livable solutions for their families. While it is common in Việt Nam to seek such pragmatic solutions to problems, collecting rainwater is not nearly as politically confrontational as other forms of creative provisioning (tax resistance, refusing state land appropriations, theft, corruption, and black-market dealings). Material needs have often motivated the private, family-centric appropriative practices called “fence-breaking” (c.f. Kervliet 2011). However, the patchiness of the state’s water and sanitation infrastructure in post-transition Việt Nam represents a deeper crack in the social contract. Although the provision of clean water and reliable sanitation to the population was never total, the socialist regime historically intended to achieve it; in the present day, with national economic growth permitting the completion of many equally ambitious commitments, the continuing absence of water and sanitation provision reveals a legacy of disinvestment in critical urban infrastructure. The suspension of optimistic promises also reveals the profit orientation of the post-reform state’s priorities. While some of the policy literature makes a value-neutral assessment of how “financial constraints in the water sector” have deferred construction of a much-needed new sewerage and drainage system for Hà Nội (c.f. Wnukowska 2004, 24), other foreign analysts attribute a more cynical intention to these shortcomings. In the late 1990s, environmental economist Charles Perrings speculated that the Government

74

Epidemic Politics in Contemporary Vietnam

of Việt Nam had made water and sanitation a low priority as part of a strategy to attract bilateral aid: The World Bank conjectures that one reason that public investment in water infrastructure and preventive health care is such a low priority at the moment is that the government hopes to expand the existing water supply programme funded by UNICEF using aid from other donors. While a strategy of diverting public resources to areas less attractive to donors might well maximize aid income, it clearly does involve public health risks. (Perrings 1998, 64)

A German technical advisor to the national water sector who spoke with me in Hà Nội echoed this perception, stating that the Government of Việt Nam lacked the political will to invest in wastewater in particular—a sector that, neither glamorous nor offering economic opportunity, is funded entirely by international donors. As he commented, “Local governments aren’t really interested. Bridges, buildings—there’s more money in the game. But you’ll never be rich and famous in the wastewater sector.”

Water and Sanitation Workarounds Supplanting or replacing a state-funded and state-supervised system for centralized water treatment and sanitation, Hanoians’ everyday practices around water and sanitation are characterized by their small scale and redundancy. While often necessary, these informal and decentralized attempts to secure basic household necessities may perversely expose families and communities to health risks. The demographic and economic pressures of the post-transition period— urbanization, deregulation, and privatization—have translated into a form of urban development that, while featuring a landscape of new office buildings, malls, and residential towers, has mostly failed to invest in the less glamorous work of installing and maintaining adequate water and sewer systems. A water/sanitation infrastructure composed of vulnerable units operating in parallel is precarious and challenging to govern. While the pattern of privatized escapes from a dysfunctional system does not resemble what is classically considered a “tragedy of the commons,” I suggest that the mass replication of these individual interventions across a densely populated city may have similar effects for water and sanitary resources. The proliferation of water and sanitation workarounds in an urban setting creates abundant

Water and Sanitation in Transition

75

opportunities for systemic vulnerability to risk and has a multiplicative environmental impact on surface water and groundwater resources. In the context of rapid urbanization, economic disparities, and a diminished role for state-funded preventive health, the decentralization of water and sanitation systems is a concerning input to waterborne disease epidemiology. In conversation with technical experts at the Asian Development Bank, I speculated that a dispersed system of leaking septic tanks is a potential source of serial cholera outbreaks that appeared across the city with no common point source. This seemed like a live possibility given that toxigenic Vibrio cholerae can survive in “an estuarine environment and other brackish waters” (Faruque et al. 1998, 1308); further, they are also “capable of persisting for upward of three weeks in well water, given the right local conditions” (Sawchuk 2010, 97). Upon reviewing an article about groundwater pollution in Hà Nội (Nguyen and Nguyen 2002) and the findings of Harada et al. (2008) on septage in Hà Nội, an ADB anthropologist agreed with me that the research pointed to “a reasonably high probability that poor septage is one of the main reasons behind the growing groundwater contamination in Hà Nội (in terms of high levels of faecal coliform in the city’s two aquifers)” and concluded, “This, in turn, could be responsible for the cholera outbreaks” (Nitish Jha, personal communication, May 18, 2010). In another conversation, an officer at the Centers for Disease Control suggested that the cholera outbreaks in Hà Nội “started out as in a first-world country, i.e. they were spread by food—and then it got into the water system, as in a thirdworld country. That’s why it was hard to control” (personal communication, October 13, 2009). Although one might question the distinction between “first-world” and “third-world” epidemic transmission, there is support for at least the former claim in a set of findings made public, albeit quietly, by Việt Nam’s National Institute of Hygiene and Epidemiology. The authors concluded that water had represented not the original source of the outbreaks but that it “play[ed] an important role after day fifteen” of all four cholera outbreaks from 2007–2010 (Trần Như Dương et al. 2010). By representing Việt Nam as having a foot in both “first” and “third” world epidemiologies, the CDC officer’s explanation of cholera outbreaks suggested how Việt Nam’s status as a transitional country is frequently perceived, both in terms of its economic development and the nation’s public health. As the national economy has grown in the post-reform period, health economists and epidemiologists have suggested that the country occupies a dual or intermediate position with respect to its public health outcomes. This perspective is supported by the reality that Việt Nam remains affected by some of the health burdens

76

Epidemic Politics in Contemporary Vietnam

characteristic of a poor country—infectious diseases such as tuberculosis are increasingly prevalent. At the same time, Vietnamese citizens, particularly wealthier groups, are increasingly vulnerable to chronic diseases such as cancer and cardiovascular illness. In a sense, this view of Việt Nam’s developmental profile collapses market reform and a presumed epidemiological transition into one unified transition. However, this formulation overlooks aspects of the nation’s political economic and historical trajectory that fit less well in a schema of simultaneous “first” and “third” world status. By positioning Việt Nam in a traditional teleology of “development” organized by GDP indicators, accounts of the country’s epidemiological transition elide Việt Nam’s seventy-five years of belonging to the socialist “second world.” Since the fall of the Berlin Wall, the idea of a “second world” has largely gone by the wayside, such that “first world” and “third world” became euphemisms for wealthy countries and poor countries rather than collectively referencing capitalist nations and nonaligned countries. Việt Nam does not fit neatly into this political economic schema of “worlds”; it belongs to all three of them. Still nominally a second-world (socialist) country, Việt Nam’s first-world (capitalist) free market coexists with levels of economic development associated with the “third” world. Thus, the construct of epidemiological transition—a teleological model informed by Western history—may not fit neatly on the Vietnamese case, nor offer the most illuminating explanation of the shifts that Việt Nam’s public health sector has experienced since economic liberalization. The transition from socialism to Việt Nam’s current political economic order—a “market economy with socialist orientation”—is very unlike the transformation that an epidemiological transition presumes, in which a poor country becomes wealthier and its public health profile shifts.4 Accordingly, a number of Vietnamese bloggers—mostly pseudonymous authors with backgrounds in biology, epidemiology, or medicine—combined their critique of the state’s outbreak management with political commentary.5 In 2007, after the Ministry of Health had put forward the hypothesis that shrimp paste was responsible for the outbreak, Vietnamese-Australian scientist and blogger Nguyễn Văn Tuấn claimed that “the Ministry of Health was too strong-handed (quá mạnh tay) with shrimp paste, and neglected one different and important risk factor: the water source.” In July 2010, another Vietnamese blogger criticized the absence of state efforts to test and treat potentially contaminated water in Hà Nội, writing:

Water and Sanitation in Transition

77

The single most pressing and necessary action is that you have to test the immediate water source in all the provinces and cities affected by cholera. Up to this point, I haven’t yet seen a single publication of test results regarding the hygienic situation of all the tap water used for everyday purposes in Hà Nội. The more important thing is to struggle to impute the blame for shrimp paste and dog meat, lá mơ herb … and the many other different “culprits” that people can think of. (…) [T]he principal culprit is the source of drinking water, and not a food product that has been thoroughly cooked (bất cứ thực phẩm đã nấu chín nào khác). (Nikonian 2010)

Conclusion The physical control of water—and its improvement for safe use—represent a source of power and legitimacy in Việt Nam, as elsewhere in the world. While the socialist state has long cautioned the population against consuming unimproved or “raw” water (nước lã), as historian Shaun Malarney notes (Malarney 2012, 117– 18), the cholera outbreaks in and around Hà Nội were almost never discussed in terms of exposure to unsafe water. Instead, as the next chapter will find, cholera risk was imagined in terms of the consumption of unsafe food. This perspective was widely shared by the public; in almost 120 interviews with city residents, I only met a few individuals who criticized the injunctions against allegedly unsafe food products. One was Chị Nhung, a thoughtful and opinionated woman who scoffed at the ban on dog meat with confidence, stating: People cook dog meat thoroughly so it can’t cause cholera, but some houses use water that’s not sanitary. … [W]ater is more important than eating dog meat. Dog meat is cooked thoroughly so many times, so it can’t spread from that, just raw shrimp paste can. Cooking will certainly kill any cholera.—Phạm Hồng Nhung, female, 40 years old, Hoàng Mai district, Định Công ward, 1 February 2010.

78

3

Risky (Small) Business: Constructing a Disease of the Market

Each cholera story created a dramatis personae, a series of events, and a set of causal inferences, casting some parties as heroes who acted wisely and courageously, others as villains (…), and still others as pathetic bystanders not smart enough to get out of the way.—Charles Briggs and Clara Mantini-Briggs (2004, 7) The experience of disease virtually always compels discourse. Over the last three decades, an important branch of social scientific and humanities scholarship has developed in recognition of the analytic opportunities afforded by “illness narratives” (Kleinman 1988), essentially positing that the form, content, and circulation of these texts can be studied critically. In an essay written in the early years of what would become the HIV/AIDS pandemic, historian Charles Rosenberg argued that “a true epidemic is an event, not a trend” and, consequently, that outbreaks of infectious disease are social experiences that unfold develop in a predictable series of phases that can be compared to the acts of a play. Emphasizing “the apparently inevitable juxtaposition of suffering and death with a search for meaning,” Rosenberg contends that epidemics also furnish an occasion for collective reflection and rationalization, the consolidation of ideological hegemony, and “retrospective moral judgment” (1989, 9). In this work, Rosenberg built on his account of North American cholera outbreaks in the nineteenth century—work that remains seminal in the humanistic study of infectious disease and its social life. As medical humanities scholar Dóra Vargha writes, the analytic framework of The Cholera Years “has provided a springboard for understanding a wide variety of epidemics and societies through time, going beyond the discipline of history” (Vargha 2020). A version of this chapter was published as “Tainted Commons, Public Health: The Politico-Moral Significance of Cholera in Vietnam” in 2014 in Medical Anthropology Quarterly (doi 10.1111/ maq.12069).

80

Epidemic Politics in Contemporary Vietnam

Rosenberg’s dramaturgical framing of epidemics has also drawn critique, in part for its implication that an outbreak is a temporally bounded event. The usefulness of this heuristic was brought into question anew with the advent of the Covid-19 pandemic, prompting Richard Keller to point to “just how limiting this particular model is as a tool for thinking about the pandemic”; in the same forum, historian Julie Livingston suggests that scholars attend to “the prehistory and long aftermath [rather] than the discrete event” (Langstaff 2020). But Rosenberg nonetheless offers a powerful model of the relationship between disease events and narratological elements. While his schema de-emphasizes how epidemics furnish a venue for the expression of preexisting social conflicts and contests, “What Is an Epidemic?” established important methodological precedent by attending to the formal features of the social response to an epidemic event and enabling comparison between disease events. Written twenty years after Charles Rosenberg’s essay “What Is an Epidemic?”, Priscilla Wald’s monograph Contagious follows a similar methodological tack. Opening with a reflection on the experience of Severe Acute Respiratory Syndrome (SARS), a highly virulent respiratory virus, Wald turns to examine the patterned stories that circulated in media to account for the emergence of the new infection. Pointing to the stock characters, tropes, and anxieties that circulated in news coverage of SARS as well as other well-publicized outbreaks beginning with the HIV/AIDS pandemic, Wald argues that contemporary accounts of infectious disease—in fiction, film, scientific publications, and news media—tend to share certain narratological features, so much so that these stories about emerging disease cohere as one singular, somewhat formulaic story. While the particulars of this story change from outbreak to outbreak, its core holds constant between tellings. Wald calls this ur-story the “outbreak narrative” and likens it to myth, suggesting stories about disease in contemporary society have a comparable role to the stories of gods and monsters told in antiquity. Outbreak narratives do ideological work in their accounts of disease emergence, functioning much like parables about modernity, progress, “development,” and the risks of social contact and commerce in a globalized world. Wald argues, for example, that outbreak narratives reflect a widely shared preoccupation regarding the scale of a pandemic, which draws microorganisms into the path of global travel, exchange, and circulation. As Wald writes, these stories disclose “a fascination not just with the novelty and danger of the microbes but also with the changing social formations of a shrinking world” (2008, 2). Attending to the meta-features of outbreak narratives allows a fuller understanding of the cultural byproducts that epidemics generate. During modern epidemics, mass mediation strongly conditions how publics come to

Constructing a Disease of the Market

81

understand the meaning of the pathogen, risk of infection, proper prevention, and state power, among other concerns. In Wald’s work, the focus is turned to media accounts of disease outbreaks that are produced in the Global North and specifically in the United States. As her analysis emphasizes, stories of disease that address a cosmopolitan readership comment on the risks posed by globalization in the form of cross-border travel and commerce, with special anxiety regarding the potential dangers of an interdependent global economy. These tend to reproduce themes of American exceptionalism, Eurocentrism, and the advance of science; they also typically produce quite uniform accounts of disease emergence from Asia, Latin America, and Africa, ethnocentrically emphasizing the presumed health risks posed by “traditional” societies, “less developed” places, and “customary” practices. However, mass-mediated “outbreak narratives” are produced in the Global South as well, and studying local outbreak narratives is perhaps of particular analytic interest in a site like Việt Nam, where commonly shared perspectives and values are undergoing rapid change. Outbreaks, and the stories told about them, can clarify and crystallize collective sensibilities that are in the process of being reconstituted. In this chapter, following the methodological precedents set by Rosenberg and Wald—while acknowledging the limitations of this approach—I present and assess the local outbreak narratives that Vietnamese health officials, laypeople, and media used to describe and explain how cholera spread through the capital city. The content of these stories points to widely held anxieties about how Việt Nam’s transition—from a command economy that directly provisioned households with staple foods via a subsidy system to a deregulated market economy—has reshaped the experience of everyday life. During the cholera outbreaks, laypeople as well as media represented consumer practices as the most important sources of infection, with food purchasing, food preparation, and eating and drinking all called into question. These stories also touched on unresolved questions regarding gender norms, class relations, moral imaginaries, commercial practices, and everyday habitus in the rapidly transforming national capital.

Consuming Risk In the early months of the outbreak, official and lay accounts of cholera had scrambled to account for cholera’s source and transmission pathway. In keeping with the second phase of an epidemic that Rosenberg describes—

82

Epidemic Politics in Contemporary Vietnam

“managing randomness”—this entailed the exploration of many different potential inputs to disease in official communications and news media. These possible causes included food from market stalls, discharge of waste on railroad lines, polluted surface water and drainage ditches, and vegetables grown in fields of raw sewage.1 But the state’s outbreak narratives quickly focused on risky food, and media for the most part followed suit. By spring 2008, the Ministry of Health had shifted its focus to food products as the source of cholera risk and named foods including blood pudding (tiết canh), pork intestine (lòng lợn), raw vegetables, fermented pork roll (nem chua), ice, fruit, dog meat (thịt chó), and shrimp paste (mắm tôm, a salty condiment served alongside a variety of dishes in north Vietnamese cuisine) as potential causes of disease. One online news source ran an image of a group of women and children eating on the sidewalk, confidently captioned “Street food: The source of cholera” (Yume.vn 2010). Advisories encouraged residents to avoid a growing list of foods. Part of this messaging was continuous with long-standing perceptions of “backwards” (lạc hậu) culinary and personal practices believed to be risky or unsafe. In a wartime account of the health of rural peasants during the colonial period, the director of the National Institute for Hygiene and Epidemiology wrote, “People drank unboiled water, took tainted foods, liked to eat fermented foods, raw vegetables, raw meat (nem), raw fish (goi), never used soap, toothpaste, and towels; their hair and clothes were full of lice” (Hoang Thuy Nguyen 1972, 97–8). Contemporary messages about cholera bore a clear resemblance to these historic anxieties, expressing fear of practices held over from a purportedly less modern era. Too, these messages were reminiscent of the state campaign launched in the early 1990s against drug use and prostitution, among other “social evils” (tệ nạn xã hội) alleged to be associated with the transmission of HIV/AIDS (Phinney 2008). But setting a yet broader background to these public health advisories was an emerging public discourse regarding risks tied specifically to merchandise of “unclear origin” (không rõ nguồn gốc). As policy reports and news articles on food safety often reported, adulteration of food was increasingly prevalent in domestic food production as well as in the supply chains of imported foods, and state capacity was inadequate to surveil food production, whether it took place in rural provinces or on city streets. During my fieldwork, news articles about uncanny commodities proliferated, with particular anxiety regarding superficially attractive products that were chemically contaminated or adultered

Constructing a Disease of the Market

83

to attract the unsuspecting buyer. Thảo, my Vietnamese teacher, knew I found those stories intriguing and saved them from the papers for me. One article described how dried squid—a popular snack—was bleached white to appear more attractive to the buyer. Another found that bulk candy was sold years after its sell-by date. Other reports suggested that some of the apples imported from China were abnormally large and long-lasting because of the use of dangerous chemical fertilizers, pesticides, and preservatives—a story that became a scandal in 2012 (c.f. Figuié et al. 2019, 152). Another article alleged that street food was fried in grease that was used over and over until it became carcinogenic, and yet another suggested that the chemicals in Styrofoam containers could leach into take-out food and cause cancer. A scientist at the National Institute for Hygiene and Epidemiology commented to me along similar lines, averring that imported Chinese food products were affordable but untrustworthy: “Chicken, you see, duck, and pig—it’s very cheap. The Chinese have chemicals to keep food looking good. Fruit, too. After you cut it, fifteen minutes and it gets rotten after being exposed to the air. Vietnamese food is safer because we don’t have high tech” (personal communication, October 9, 2009). Media about food—groceries as well as prepared foods, staples as well as snacks—thus tended to make a fatalistic appraisal of the conundrums of modern urban life, in which frequent contact with strangers and exposure to profitmotivated behavior force the average consumer into making irrational choices owing to a dearth of information. Many Hanoians, especially women, but also men, seemed to maintain a mental list of “safe” and “unsafe” types of food. For example, one NGO worker described the rules she followed: She always brought her lunch to work and avoided purchasing food outside (ở ngoài), where it’s “dirty.” Some things were okay to eat “outside,” like hot pot (lẩu), but never snails (ốc); she said raw vegetables were okay to eat in South Việt Nam, but not North Việt Nam, where she said the fields were more likely to have been treated with human waste. One news article published shopping advice from an “expert,” attempting to shore up the uncertainties of going to market. Professor Trần Đáng, Head of the Bureau of Food Safety and Hygiene, shared advice recapitulating many of the practices for selecting and preparing food safely that Hanoians described to me: buying from trusted vendors, soaking vegetables in saltwater to kill bacteria, peeling fruit, and boiling drinking water. Suggesting that the customer leverage every bit of information they can discern from a shopping expedition, he emphasized the necessity of scrutinizing produce before buying:

84

Epidemic Politics in Contemporary Vietnam Faced with the latent risk of bringing polluted (ô nhiễm) vegetables home, be an intelligent consumer to protect yourself and your family. According to your own experience and your family’s, only buy from familiar vendors (người bán hàng quen). You must know how to test: to choose fresh vegetables and fruits you need to pay attention to their exterior form: is it full; is the skin intact; is it banged or crushed; scratched or scuffed; eaten into or overripe at the stem? (TinTucOnline 2008)

As Professor Đáng’s point about the need for attention to the “exterior form” of foods suggests, consumer suspicion is a running theme in media about food production and consumption. News articles about food safety and “lifestyle” (cuộc sống) issues more broadly often emphasized that in a field of potentially dangerous or counterfeit merchandise, consumers had to struggle to determine what was authentic and safe. In an example of the paranoid tenor that had crept into this discourse, the article quoted above reminded the reader that even “clean” vegetables (i.e. vegetables purchased at a supermarket) might not actually be clean at all. Another article, titled “Food Poisoning … out of Ignorance,” quoted a Hanoian woman’s account of a food purchasing catch-22, framing it as a typical consumer’s dilemma: Fresh pork meat, people say it’s been soaked in borax (ướp hàn the). I worry that eating fatty pork, lots of people will have heart problems, blood pressure problems—but if I buy lean meat, then I hear that lots of types of pig are given some kind of chemical to eat that makes them more lean. So just by looking, how are we supposed to tell? Bà Thơm said that her son, who works for a foreign company (…) tells her “Mum, don’t care so much about money—if you see something clean and safe, then buy it.” But how can I be sure that something is safe, that it’s clean? Was this pig fed with chemicals? Is this chicken a Vietnamese chicken or a culled Chinese chicken (gà Trung Quốc thải loại)?—Bà Nguyễn Thị Thơm, Giảng Võ ward, Ba Đình district. (Tuệ Khanh 2009)

Alongside such portrayals of hapless customers and anonymous consumer products, media also drew attention to the allegedly unscrupulous practices of food producers and vendors. The article quoted above was illustrated by photographs of women shopping at the small informal markets that are common in neighborhoods throughout the city. One of these, depicting a woman receiving a bag of vegetables from a vendor, ran the caption “Just closing one’s eyes and believing what the vendor says.” Such stories suggested how

Constructing a Disease of the Market

85

increasingly, consumer transactions in Việt Nam are experienced as a source of disadvantage and uncertainty—especially for middle-class purchasers who are concerned about the health risks of adulterated food. Taken together, these stories point to several evolving concerns in Vietnamese society. First, they reveal the remaking of public health as a byproduct of private health behaviors. Where the Vietnamese state once portrayed public health as a collective civic accomplishment, increasingly it is described as the province of technical experts but, more importantly, “intelligent consumers” who, having been “liberat[ed] to negotiate authenticity of products” (Pashigian 2012, 534), manage the inherent dangers of consumption by exercising responsibility, knowledge, and good judgment. In these accounts, the role of state agencies in securing the food supply is barely described. The consistent media emphasis on consumer judgment and choice concords with anthropologist Natalie Porter’s account of a broader shift in Vietnam’s health governance: “from governing self-responsible citizens in the Communist era to governing self-responsible consumers in the marketsocialist era” (2019, 26). Secondly, the sheer number of these stories, and the anxious moral indignation they inspired, indexed the inadequacy of the state’s regulatory apparatus in the market reform era and suggested how risks are transferred to consumers by market mechanisms that are widely portrayed as open to pollution, corruption, and the abuses of the profit motive. However, these critiques did not translate into calls for more robust state protections but instead emphasized the culpability and risky behaviors of both petty traders and consumers themselves. These narratives of undisciplined commercialism and consumption underscored a broader ambivalence about market institutions and their relationship to social welfare in an era of loosely governed capitalism. As the following discussion suggests, these problems of free markets assume moral, political, and cultural dimensions and meanings through their association with the culturally charged topics of food, health, and disease.

Food from Outside Beginning in the 1950s, the Democratic Republic of Việt Nam established the beginnings of a system in which citizens, as the clients of state redistribution, were provisioned with most of the necessities of life. During the “subsidy period”  (thời bao cấp, 1975–1986), the state attempted to monopolize the

86

Epidemic Politics in Contemporary Vietnam

distribution of household necessities to a population facing severe deprivation. In this system citizens, “classified by their occupations and needs, were allotted goods to buy at fixed prices” (Kerkvliet 2011, 88). Initially, rice and cloth were rationed; later, the system included other types of goods, and citizens required tickets and coupons as well as cash to purchase from government shops (Kerkvliet 2011, 88). The “stamp regime,” whose privations are remembered as causing hardship for average people (MacLean 2008), is now memorialized quasi-nostalgically in the form of several subsidy period-themed restaurants in Hà Nội that recreate the ambiance of the era, with vintage décor and retro menu selections. As the great cultural distance between these museum-like reenactment restaurants and the provisioning and culinary practices of present-day Hà Nội might suggest, Việt Nam’s foodways have shifted profoundly as a result of market transition over the past forty years: The food sector in Vietnam is undergoing sweeping changes: end of shortages, development of an agri-food sector, and supermarket distribution. These changes come about through the impact of the combined forces of rapid economic liberalization, urbanization, improved living standard of the people, and the transformation of social and cultural norms. Households are seeing a diversification of the products consumed and changes in consumption practices: their own production of food decreases both in urban and rural contexts. (Figuié et al. 2019, 40)

The broad contours of these changes are expressed in the profusion of street food, which has, since economic liberalization, become a fixture of cityscapes in Việt Nam. During my fieldwork in 2009 and 2010, prepared food products were ubiquitous throughout town, with a wide variety of items prepared and sold by unlicensed small traders—from plastic bags of jackfruit sections to fully cooked meals. Foreigners receive a lot of advice about avoiding street food (thức ăn đường phố) and I took pleasure in proving my cultural bona fides by buying various forms of the dessert food chè, pomelos from a woman who often passed the gate of my residence block’s courtyard, little fried sweets on the street, street-prepared bún bò Huế near the university with department colleagues, and phở gà and phở khô with friends at tiny plastic tables on the sidewalk. I occasionally rolled the dice by ordering drinks that are perceived by some as unsafe, including iced tea (trà đá) and sugarcane juice (nước mía). All very normal and typical: scenes of informal food preparation and consumption are often celebrated as a picturesque aspect of the city’s

Constructing a Disease of the Market

87

traditional culture, and the hard-working vendors themselves have been interpreted as evidence of Việt Nam’s entrepreneurial energy and economic dynamism. During the cholera epidemics, however, official advisories and media reports began to work energetically to portray the city’s informal food sector as an uncivilized and even sinister institution, ascribing risk to the everyday practices and pleasures of the city. Despite a lack of solid evidence, Vietnamese and foreign news articles attributed the cholera outbreaks to street food consumption, with photo stories revealing the allegedly hidden (but actually, quite unconcealed and unsurprising) practices of food workers that were held to be backward and even potentially—as one headline suggested—“harmful to human life” (VnMedia 2009b). That particular article included over a dozen photographs depicting everyday scenes of city life in a developing country, where large blocks of ice are cut into ice cubes with hand tools on a sidewalk, for example. Between their hidden camera-style images and scolding text, these tabloid reports were, more or less, articulated along the lines of didactic state media, portraying health problems as the inevitable outcome of unscrupulous individual behavior and lack of education. Journalists accused vendors of “concealing cholera” (coi thường bệnh tả) (Thanh Niên 2010); another article asserted, “[S]ubjective (chủ quan) habits and psychology have kept many people from losing their taste for eating along the side of the road” (VnMedia 2009a, 1). As time and the outbreaks progressed, media reports began to assign more blame to consumers, whose lack of awareness of official advisories was alleged to lead to bad choices and risky behaviors. Whether the result of media messages or otherwise, suspicion about street food was common in Hà Nội. In my interviews, the question “Do you know what caused the cholera at the end of 2007?” often prompted people to name street food (thức ăn đường phố)—including dog meat and shrimp paste, “raw” foods (raw leafy greens and the popular dish tiết canh, made of raw duck’s blood), ready-to-eat foods purchased on the street, and “careless eating and drinking” practices generally (ăn uống lung tung/linh tinh/bừa bãi). The following explanation by one respondent—an elderly gentleman living with his wife in the city center—was characteristic: ML How do you and your family prevent cholera? Ông Nghĩa We prevent it like they [health officials] require us to, not eating shrimp paste or blood pudding or pork intestine, not eating raw things. We keep away from those foods and don’t eat improperly. Before, the family still ate noodles with shrimp

88

Epidemic Politics in Contemporary Vietnam paste and dog meat, but from the time they propagandized (tuyên truyền), the family doesn’t eat it anymore.—Trần Văn Nghĩa, seventy-three years old, Hoàn Kiếm district, Hàng Gai ward, August 24, 2010.

On its face, the claim that individual street food vendors could be responsible for hundreds and ultimately thousands of cases of cholera across numerous provinces seemed improbable. This would have meant that vendors themselves—a heterogeneous group of unrelated people who worked all over the city—were transmitting disease to their customers directly via unsafe food or unsafe food handling practices; they were perhaps also, themselves, infected. However, I found that my skepticism about this theory was not widely shared. Interviews with laypeople regarding cholera frequently elicited commentary about street food and small traders, much as media and state reports had. Comments typically characterized street food vendors as unscrupulous. For example, thirty-three-year-old Chị Thanh, an assistant at a construction site (phụ xây, not an uncommon occupation for working-class women), told us that vendors washed raw vegetables haphazardly (ào ào). Cô Oanh, fiftyone, who was working as a cleaner for a company when we interviewed her, suggested that vendors actively attempted to deceive customers. When I asked, “Do you ever eat street food?” she replied, “Never, I feel that people (i.e. vendors) pull the wool over your eyes (bảo khuất mắt trông coi). I’m afraid that it is stale, or dirty, so I don’t dare to buy it, I just buy fresh things to bring home.”2 While most accounts of unsafe food products identified raw vegetables and certain meat products as risky, some people saw additional types of food as unsafe. One woman surprised me by describing the possible risks of new rice, a popular dessert. The most unsanitary is new rice (cốm) … If you were to see you would never dare eat outside in the street. … But the people who make it have to sprinkle it with water so it’ll be heavy. They mix it with some dye to make it up into a patty so they can go and sell it. In hot windy weather like this, they make the cốm lighter, and they’ll flood it with water, and you don’t know the source of water that they carry and where it came from.—Đỗ Thị Yên, fifty-five years old, Hoàng Mai district, Đại Kim ward, 1 March 2010.

Forty-five-year-old Lê Thị Hạnh, who had, with her family, suffered cholera infection a few years prior after eating contaminated beef, echoed these anxious, distrustful sentiments. She said: “Everything I buy I bring home and cook, but I’m still so scared. Don’t think I’d dare eat anything outside (…) Environmental

Constructing a Disease of the Market

89

hygiene in Việt Nam is frightening, it’s terrible. Completely dark with dust and dirt. You wash the rice and black dust comes off it, that’s coal dust. It causes premature death (chết non).”3 Beyond the reports of daily newspapers, which drew content from press releases published by the Ministry of Health, hygiene information and supplies were disseminated in urban neighborhoods via long-established methods of  “propaganda” (tuyên truyền). As the men and women I interviewed noted, food safety messages had reached them via loudspeaker (loa), radio, television, newspapers, and fliers; during the months when the cholera outbreak was active in Hà Nội, their neighborhoods had been saturated with public health messages. Unlike the average North American neighborhood, which functions in the absence of formal state administrative structures, Vietnamese city neighborhoods are organized for the dissemination of information and directives to residents. The state apparatus at the neighborhood level can be as simple as a chalkboard notifying parents of vaccine schedules for children or as a block leader (tổ trưởng) going door to door to share information. These systems were mobilized during the cholera outbreaks, with hygiene and food safety advisories read over neighborhood loudspeakers and on the radio and disseminated in flyers and inperson visits by health workers. It seemed from my respondents’ retrospective accounts that the majority of these state messages about cholera prevention had focused on food. One of the most commonly repeated messages (khẩu hiệu) must have been “Eat cooked food, drink boiled water” (ăn chín, uống sôi), because almost half of the sample of respondents spoke this phrase when I asked how they prevented foodborne illness at home.4 In over 100 conversations, when I asked city residents, “Is street food as safe as food prepared at home?” men and women often replied rhetorically, “How could it be as safe?” then proceeded to explain how foods exposed to the environment—where there was heat, wind, insects, and a polluting atmosphere—were especially risky. Dozens of respondents also said, “Don’t eat shrimp paste and don’t eat dog meat” when I asked them to discuss food safety in general or cholera prevention in particular. Chị Nguyễn Thị Duyên, forty-five, of Hoàng Mai district, Yên Sở ward, made me laugh when she said, “The ward loudspeaker talks about dog meat all day, and the TV talks all day too … That Tuyết from the ward health station (rồi phường cái Tuyết). Shouting (reo réo) on the loudspeaker all day.” Though media and state messages suggested an ambiance of general risk, public communications also reported that Hà Nội’s cholera patients had poor and working-class backgrounds. However, it was never clear that this claim was

90

Epidemic Politics in Contemporary Vietnam

premised on data, and during fieldwork I heard of at least a few exceptions to this association. For example, in September 2007, a chef at a five-star hotel—and thus, assumedly, a nonpoor individual—was reported to have tested positive for cholera (Dân Trí 2007b; VietNamNet Bridge 2007). I was also told confidentially of a patient who was treated for cholera in 2010 by a private provider who did not report the diagnosis, meaning it was not included in official case counts. While it might have been reasonable to suppose that poorer individuals would be more at risk of infection, the socioeconomic makeup of the thousands of cholera patients remained scientifically nebulous—in part because the data about patients were so scanty. However, even with more and better data it would have been difficult to say for sure whether cholera had, in fact, affected mostly poor communities in Hà Nội. As I learned from field research, “poverty” is not at all easy to define in Việt Nam, particularly given a backdrop of rapid urbanization and socioeconomic change, and so the alleged association of cholera with poverty would require some qualification in order to be meaningful. While I never saw any public challenge to media claims that cholera was caused by poverty and by the careless preparation and consumption of street food, the association appeared less strong to me as I progressed through interviews with lowerincome Hanoian families. Street food was an unaffordable luxury for many of my interview respondents, who explained they never purchased it at all. The two respondents quoted below were not substantially poorer than my other low-income respondents, and, like many others, described preparing all or almost all of their meals at home. It seemed ultimately that the association between street food and cholera risk rested on a misunderstanding of local economic realities, given that my respondents and others in their approximate socioeconomic position—saw street food as not a symbol of poverty, but of relative wealth. ML  Does your family often eat prepared food cooked outside, like cơm bình dân (“common people’s food”)? Chị Diệp No, we don’t have the economic conditions (điều kiện), so we only cook at home.—Lưu Thị Bình Điệp, thirty-six years old, Long Biên district, Gia Thụy ward, July 29, 2010. [I eat street food] only rarely because I go to market and bring things home to cook, whereas I buy street food very rarely and don’t eat it out much either. My circumstances don’t permit it.—Bùi Thị Minh Hằng, forty-six years old, Hoàn Kiếm district, Hàng Bạc ward, August 19, 2010.

Constructing a Disease of the Market

91

Alternative Health and Alternative Disease As elsewhere in the world, laypeople in Hà Nội often explained disease transmission to me in ways that are concordant with non-biomedical models of disease causation (c.f. Martin 1994). But people also sometimes cited bacteria (vi  khuẩn) or viruses (vi rút) in association with other unseen things—often specifically corner-cutting in food preparation—as a potential source of risk for ready-made meals purchased from small eateries (cơm bình dân). Chị Nhung’s account, below, named multiple forms of risk to consumers: dust, chemicals, contaminated surfaces, bacteria, improper food safety practices, and person-toperson transmission. You can’t know if you see it with your eye, you can’t follow how they make it from the beginning, so even if you see it with your eyes you can’t tell if it’s safe or unsafe at all. If the street is dusty, and there are chemicals, then I don’t dare (không dám) to be certain about the bowl and chopsticks they use. If, for example, people who have that disease eat the food, and the people wash the bowl and the chopsticks less carefully than I would, then I can’t possibly see the bacteria. That disease spreads from one person to another, so I think that it’s not clean, the best is not to eat food on the street.—Phạm Hồng Nhung, forty years old, Hoàng Mai district, Định Công ward, February 1, 2010.

Another woman, a stay-at-home mom who vended drinks informally in the historic center of Hà Nội, suggested that cholera was caused by all of these factors at once—bodily imbalance, improper consumption, and irresponsible food preparation. ML Do you know what habits can lead to cholera infection? Cô Vân Men often eat blood pudding and drink alcohol. Beer and alcohol cause a lot of heat. Right? Beer and spirits out at a street restaurant (quán), eating improperly (bậy bạ). Out at a street restaurant, the food they make isn’t clean and fresh. They buy it cheap and sell it dear, so it’s easy to get sick.—Nguyễn Thị Vân, forty-eight years old, Hoàn Kiếm district, Hàng Buồm ward, August 27, 2010.

These accounts of cholera posit a complex association of intersecting risk factors—including a humoral model of disease causation, as Cô Vân’s comments about the risk of drinking beer and spirits suggest. Hanoians commonly cite changing weather and atmosphere (trái nắng trở trời, trái gió trở trời) as risk factors for illness; both traditional Chinese and Vietnamese medicine understand temperature shifts and noxious winds (trúng giớ) to be pathogenic (c.f. Craig

92

Epidemic Politics in Contemporary Vietnam

2002). Similarly, food products that cause imbalances of “cold” or “heat” in the body are known to create health problems. Street food is sold outdoors, where it is subject to fluctuating climates; in this paradigm of disease causation, street food consumption can be seen as a source of humoral imbalance. I speculate that the association of cholera with the informal sector might have gained traction because it tapped into these common sense and widely held models of disease causation, particularly those that have to do with environment. However, another theme in Cô Vân’s commentary stands out: the term bậy bạ (improper, nonsensical). She perceived purchasing certain types of foods from certain kinds of vendors as erratic, a judgment shared by other Hanoians who described buying snacks or cooked food on the street as individualistic, irrational, or “subjective.” By contrast, meals prepared and eaten at home were characterized as a source of safe and healthy nutrition. This suggests an interestingly spatialized perception of disease risk: as respondents explained to me how to prevent cholera, or listed its causes, they relied on social geographies to explain safety and danger. Food purchased and eaten outside (ở ngoài) was dangerous; cooking and eating food at home was considered safe. Food purchased from a familiar trader (mua ở người quen) is safe; food sold by a stranger is not. Eating meals at home (ở nhà) is normative; eating out for fun (ăn chơi, đi nhậu) is risky. In this way, social networks and social geographies are understood as making food safe (đảm bảo): food safety is imagined as proceeding from established relationships with familiar food vendors and, even more significantly, the institutions of family and home. Public health communications and lay expectations about food safety and hygiene thus emphasize not only orderly food preparation, but also wellordered families whose members fulfill expectations for their age, gender, and relationships to others. These rules for “safe” food use rest on schemata such as outside versus inside, public versus private, domestic versus commercial, and— especially in media reports—Vietnamese versus foreign, implicitly supporting a vision of food safety and public health as bound within normative relations of kinship, gender, class, and nationality. This model of family-based health resonates with ideals of the “civilized family” (gia đình văn minh)5 and the “happy family” (gia đình hạnh phúc), constructs that have been extensively promulgated by the state in the post-transition period (c.f. Pettus 2003; Rydstrøm 2017). As Melissa Pashigian has noted, despite Vietnamese women’s high rate of participation in work outside the home, “care for the family is still highly vested in women” (Pashigian 2002, 139). Public communications about health are almost always implicitly addressed to women; the Ministry of Health’s

Constructing a Disease of the Market

93

website Health and Lifestyle, for example, is targeted to middle-class women, with features about beauty, exercise, cooking, sex, and childcare. Although the “civilized family” is the locus of public health, women are the implicit target audience for these communications. An article featured in VnMedia during the outbreaks began with the claim “To guarantee her own and her family’s health, every housewife should be a wise consumer!” (Tuệ Khanh 2009). Leveraging these perceptions about gender, food, and health responsibility to commercial advantage, Vietnamese food manufacturers and supermarkets frequently advertise products as “hygienic” (đảm bảo vệ sinh)—justifying higher prices than meat, fish, bread, rice, and produce sold on the street and at informal markets.6

Street Food and Women As the interviews and news articles I have quoted above suggest, the cholera epidemics exposed a deep public distrust of street vendors—who are typically poor female rural-to-urban migrants making a living by occupying public space without a license (Lincoln 2009). Stories linking cholera to street vendors represented informal workers as what Briggs and Mantini-Briggs, in their analysis of the Venezuelan cholera outbreaks of the early 1990s, term “unsanitary subjects”: people who are “intrinsically linked to (…) premodern or ‘marginal’ characteristics—poverty, criminality, ignorance, illiteracy, (…) filth” (Briggs and Mantini-Briggs 2004, 33). The association of cholera with migrants, widely assumed but never proven, further served to conflate rural places and rural people with filth and ignorance and to represent groups from the countryside as out of place in the city. These disparaging representations are continuous with historic portrayals of independent petty traders in Việt Nam over the course of several successive political economic orders. Traders have been stigmatized since before the socialist period. As anthropologist Ann Marie Leshkowich has shown, under socialism, these women were represented as a “pariah capitalist class” whose activities “dramatized state failures to provide for citizens’ material needs” (2005, 187). In the post-liberalization period, traders have been imagined as a source of disorder and a reminder of a less modern, less “civilized” national economy. What is novel about the representations of traders in the cholera outbreak narratives, however, is the figuring of rural women as posing not just a moral or political threat, but also a risk to public health. Street vendors were described as personifying some of

94

Epidemic Politics in Contemporary Vietnam

the most negative attributes of the post-đổi mới public sphere: contamination, deregulation, and the corrosion of traditional forms of order. Some city residents described rural-to-urban migrants as the principal source of unsafe food, as Cô Lý, a stay-at-home mom, commented: “Even when they say [street food] is safe, I think it’s not safe. (…) Generally, the kids working there (các cháu phụ) have come up from the country, they don’t make things clean like I do.”— Phan Thị Lý, fiftyone years old, Hoàng Mai district, Tương Mai ward, March 7, 2010. The cultural logic of blaming street vendors for cholera comes into focus when placed in the context of market transition and the influence of desocialization on gender relations in Việt Nam. Following the retreat of the state from its historic prioritization of preventive health care, the burden of securing public health has come to depend more on women in their capacity as mothers and wives. While the work of social reproduction was also feminized during the socialist period, in the post-reform era, health is increasingly envisioned as a property of private families with the material security to dedicate female labor to the maintenance of middle-class living standards. Street vendors in Hà Nội—poor and uneducated rural women—confound this expectation. Considered a source of moral and material disorder, they are also easily imagined as a threat to public health.

Cholera and “Civilization” As the above discussion suggests, foodborne illness and risks related to consumption are “good to think with” in Việt Nam, generating complex and sometimes contradictory views about the source of disease, the responsibility of securing health, and the nature of risk itself. Although it was never quite proven that food constituted the most important source of cholera risk during the outbreaks in Hà Nội, Hanoians almost universally described cholera as a disease caused by food and also by food systems, commercial practices, and urban environments. In this way, foodborne illness was constructed as something deeply related to broader issues of economic development, the built environment, and modernity itself. The late- or post-socialist world seems vulnerable to the development of new or revanchist moral schemata around health and deservingness. For example, in the former Soviet Union, an influential discourse developed around the idea of kul’turnost’ or “culturedness”—a form of symbolic capital encompassing an individual’s education, good judgment, manners, and morally correct behavior.7 Observing health policy reforms in Russia in the 1990s and early

Constructing a Disease of the Market

95

2000s, anthropologist Michele Rivkin-Fish was disturbed to hear health workers making judgments about patients’ respective levels of kul’turnost’ in ways that “symbolically authorized the privileges of the emerging middle class” (2009, 79)—claiming, for example, that patients who didn’t pay for more luxurious care didn’t care about their health. Rivkin-Fish struggled to understand how, in the perspectives of these health professionals and in post-socialist Russia more broadly, “growing social inequities could be understood as societal progress, a moral form of development” (2009, 80). As Rivkin-Fish argues, socialism’s nominally egalitarian social order had given way to a “contemporary embrace of inequality and stratified consumption” that was normalized by revanchist appeals to the historic discrimination that the “intelligentsia” and other cultural elites faced under communism. Something comparable is taking shape in post-transition Việt Nam, where the term “civilization” (văn minh) is frequently repeated alongside other broad temporal categories “to rank social or cultural differences” (Taylor 2001, 11). Such use of the term văn minh tacitly argues that historically later periods feature more “civilized” conduct, while earlier periods—of “feudalism” and perhaps also of socialism—can be seen as less “civilized.” Rather than describing civilizations, plural, văn minh signifies “modern” (rational, individualist, “developed,” urban, and cosmopolitan) social forms. As the following passage suggests, industrialization and urbanization are often regarded as evidence of civilization and development, while practices or images of the “undeveloped” past connote stigma: People frequently referred to their condition, to society, customs and ideas, variously as “progressive” (tien bo), “developed” (phat trien), “civilised” or “modern” (van minh/hien dai) or, alternatively, as “backward” (lac hau), “undeveloped” (chua phat trien) or “traditional” (truyen thong). Ubiquitous billboards erected by the state displayed images of electrification, factories and vast orderly rural fields ploughed by tractors as exemplifying “civilisation/ modernity” (van minh), and they caricatured as “uncivilised” (khong van minh) and “backward”, phenomena such as gambling, superstition, drinking and large families. (Taylor 2001, 11)

Although Vietnamese intellectuals of the 1920s and 1930s frequently invoked “civilization” to connote national strength and independence (Nguyen-Marshall 2008, 58), in recent years the term is invoked most in struggles over norms of class positionality and personal conduct. For example, in a district of Hồ

96

Epidemic Politics in Contemporary Vietnam

Chí Minh City, anthropologist Erik Harms documented the disappearance of traditional sidewalk cafes, which offered fluid intermixing between public and private spaces. Harms connects this transformation to other civic policies organized around the concept of “urban civilization” (văn minh đô thị), while noting “neither the use of civilization (văn minh) to mobilize the population nor assertions of urban order to control them are particularly new” (Harms 2009, 184). Understanding “civilization” as a code word, Harms argues that struggles over public “order” are proxies for struggles over the regularization of property rights and the state’s work to advantage Việt Nam’s owning classes. Appealing to “civilization” as both aim and justification, imperatives to reshape space are visible in myriad forms in Việt Nam: the prohibition of informal traders from public streets (Leshkowich 2005; Lincoln 2009); the replacement of informal markets (chợ cóc8) by large built markets (Geertman 2010)9; “white clearings” (giải tỏa trắng) to sweep prostitutes and other social undesirables from public spaces (Nguyễn-võ Thu-hương 2008, 122); urban police disestablishing informal retail operations, confiscating merchandise, and levying fines; and the state’s exercise of eminent domain to remove people from their villages and land. In keeping with Harms’s reading of the meaning of “civilization,” the common denominator in these exercises of spatial power is hierarchies based on property relations. Anthropologist Christina Schwenkel has also linked the discourse of “civilization” to the Vietnamese state’s imperative to create privileged forms of spatial order by sweeping out “unmanaged” populations and practices: The circulating logics of self-discipline and responsibility that inform neoliberal projects of urban renewal are not entirely new in Vietnam. State socialist discourses of civilization (văn minh) — civilized cities (thành phố văn minh) and civilized streets (đuờng phố văn minh), for example — have also been employed in conjunction with policies that aim to “clean up” urban areas and rid them of unmanaged, mobile bodies, in this case largely poor, rural-to-urban migrants in the informal economy. As Leshkowich has argued, female petty traders, in particular, whose mode of survival in late socialism signifies an irrational, “backward subsistence economy,” have been targeted by government decrees that aim to restore urban order and “implant modernity through rational economic development.” (Schwenkel 2012, 461)

While the concept of văn minh has consistently connoted macrosocial issues of modernity, industrial development, urbanization, and “progress,” it has also come into use as commentary on individual personal comportment. This

Constructing a Disease of the Market

97

is a relatively new aspect of the word’s meaning—or, rather, one that was set aside during the socialist period. As historian Mark Bradley suggests, during the colonial period, nationalist thinkers understood “civilization” to imply individual  transformation: “[M]uch of Vietnamese radical thought—inflected by the redemptive, egalitarian, and transcendent yearnings (…) that were embedded in some forms of civilizational discourse—aimed to shift sensibilities about the behavior and obligations of individuals toward themselves and to society at large” (Bradley 2004, 67). The turn to collectivism in the socialist period “rendered these civilizational visions of the self moot in Vietnam until recently” (Bradley 2004, 67). In the socialist period, “civilization” described macrosocial accomplishments, not personal morality or expressions of “culturedness.” In Việt Nam’s post-transition period, văn minh is often framed in terms of individual moral autonomy and as a property of persons. As socioeconomic disparity increases, class distinctions have become increasingly fine-grained; the term “civilization” is now frequently used to connote the habitus of the urban middle and professional classes, while critiques of “backwardness” appear to stigmatize and target social groups with less wealth and social power, especially the rural poor. In this way, the term văn minh can, like kul’turnost’, serve as “a weapon of power and exclusion” (Rivkin-Fish 2005, 12). Its use belies practices of intrasocial discrimination, highlighting distinctions in socioeconomic status, “culturedness,” education, and alignment with the norms and values of Kinh (ethnic majority) culture. Illustrating a common stereotype, a public-service announcement that played before the feature in Hà Nội cinemas showed a male patron in rustic clothes squatting on a theater seat in sandals, talking on a cell phone, and smoking a cigarette as a reminder to the audience: “Let’s be civilized while watching the film.” This message suggested that rural and ethnic minority people are not only “uncivilized,” but in some ways exist beyond the cultural pale of modern Vietnameseness. As the complex associations of the term văn minh suggest, “civilization” draws together ideas of individual “culturedness”—evidenced in personal habits and behaviors—with perceptions of social “advancement,” “development,” “modernity,” and “progress,” ideas that are often carried out in the clearing, cleaning, and gentrification of urban environments. This helps explain why ubiquitous practices like vending food or eating food on the street are so symbolically charged; they fit into a schema of civilization and backwardness, purity and danger. Public and official accounts constructed cholera as a symbol of anti-civilization: evidence that a person or group lacked the comportment, morals, or personal habits that qualify them for inclusion in public life.

98

Epidemic Politics in Contemporary Vietnam

Tainted Commons, Public Health This sense of cholera as opposite to civilization was legible in the way people explained the disease in association with the outdoors, or with unknown people. “Civilization” describes orderly spaces and behaviors, as the examples described above suggest. In their explanations of the cholera outbreaks, Hanoian laypersons frequently suggested that outdoor environments, public settings, and transactions with strangers inevitably posed invisible, ungovernable risks to health. These accounts evoke an imaginary that I call the “tainted commons”—a shared space in which resources, institutions, and relations once stabilized by the state or by widely shared interpersonal norms are undone by the logic of profit. In this pessimistic view, commercial transactions that take place in public venues or with unknown individuals are seen as inherently risky. Instances of a “tainted commons” are found across societies, not only transitional settings; scandals and moral panics over product contamination, for example, are common worldwide. But the image of a tainted commons has particular significance in a market-socialist nation, giving voice to suspicions and anxieties about the marketplace as the primary agent for the redistribution of consumable goods. Accounts of cholera’s circulation through informal commerce, via prepared food sold on the street, thus can be read as expressing a nostalgic view of the mores, norms, and gender roles of a prior era. According to these models of disease causation, the public was safer when products could be purchased from “familiar” vendors, women could manage households and prepare meals in the home, and consumption was practiced in a fashion that was perceived as orderly and predictable. In this way, discourse about cholera was used to reinscribe hierarchies of class and gender that predate the transitional period—but it also reflected cultural perspectives on health, more newly emergent in Vietnam, that could be described as neoliberal. Particularly, the individualization of questions of risk and responsibility for disease prevention, and the privileging of the private family as a site for health promotion, signaled the departure from a socialist vision of public health as a social good produced by collective practices. Thus, the nostalgic wish for more traditional lifestyle amid modernization was not a complete endorsement of socialist values as such. Ultimately, anxiety over food as a vector of disease was legible as critiquing the free market’s promotion of anonymizing exchange, profit motivation, and self-interest. But it also suggested new social hierarchies casting rural populations and workingclass women in a very negative light. Outbreak narratives explaining cholera revealed a broader shift in official public culture, which formerly upheld rural

Constructing a Disease of the Market

99

people, the working class, and female proletarians as valorized vanguard groups whose contributions to society were seminal and indispensable. Accounts of cholera located responsibility for disease in the habitus of these same groups— working-class women, the poor, and rural-to-urban migrants. A mistrust of collectives, the public sphere, and socially marginalized groups was thus apparent in narratives casting cholera risk and public health in terms of “civilization” or “uncivilization.” These stories made the epidemics ideologically continuous with a recent history of struggles over urban space, private property, and the concept of citizenship—but went farther by positing outliers to “civilization” as actually pathogenic. The most commonly repeated outbreak narratives thus scapegoated unregulated publics, illicit forms of commerce, and undisciplined consumption in the name of public health. These changes in the political economy of blame indicate how the “public” is newly figured in state messages: not in terms of the masses (người dân or người bình dân), but as a body politic composed of middle-class “hygienic citizens” (Briggs and Mantini-Briggs 2004, 33). Thus, public health messages functioned more accurately as reminders about private health and its production via the good judgment and careful decisions of individuals and households. Cholera—once understood as a symbol of political and economic oppression—was reframed as a disease spread by poor rural individuals and middle-class people who indulged in habits and pastimes that violate classed and gendered expectations for public behavior. In this model of society, groups who are politically powerless but economically agentive are easily targeted as out of step with “civilization.” Furthermore, inasmuch as food and consumption stand in for class identification, geography, gender, and political affiliation, pathologizing foods produced and sold by migrant workers made a symbolically potent statement about the new socioeconomic order of post-transition Việt Nam. Connecting cholera to deficient “culture” or bad “habits” further allowed the state to disavow responsibility for the “irrational” behaviors of unsanitary subjects like rural-to-urban migrants, street vendors, and middle-class consumers taking a moment to enjoy prepared food on the street.

Conclusion In a recent study of state diarrheal disease prevention programs in the Mekong Delta, political ecologist Panagiota Kotsila describes a trend of “disease individualization, stigmatization and moralization” (Kotsila 2017, 101) in state

100

Epidemic Politics in Contemporary Vietnam

efforts to educate the public about diarrheal disease. Her findings offer an important clue about the Vietnamese state’s weak response to cholera: as she shows, both official perceptions and state discourse couched the prevention of enteric disease in general as the responsibility of individuals. Kotsila notes the “common portrayal of those vulnerable to disease as ignorant, dirty or indifferent towards state advice” and suggests that in this framing, disease comes to be read as “an indicator of social misbehavior against ‘culture’” (Kotsila 2017, 100). Kotsila’s finding parallels my discussion of the politico-moral meanings ascribed to cholera and its representation as a form of anti-civilization, suggesting the profound stigma attached to all forms of diarrheal illness in Việt Nam. Finally, Kotsila notes that the moralization of diarrheal illness had a chilling effect on her conversations with respondents: “[A]voiding such conversations didn’t indicate a feeling of aversion or disgust towards the disease and causation, but a particular hesitance or denial of talking about these things in relation to themselves or their families” (Kotsila 2017, 101). This transformation in the social and political meaning of diarrheal disease takes place in the broader context of the state’s significant retreat from its erstwhile ambitions to underwrite a comprehensive program of primary health care for all citizens. Việt Nam’s transition away from universal provision of free care has, in conjunction with other changes associated with liberalization, supported a view of health as individual dysfunction. As a result, a mass disease event is necessarily seen as the mass dysfunction of unscrupulous, uneducated, or dangerous individuals whose class or other characteristics somehow impair their sanitary citizenship. In some ways then, it is perhaps inevitable that a significant part of the public would share this view, seeing cholera as a disease of disturbed social norms, social relations, and social environments. Although these stories about the spread of disease ultimately blame victims, they also gave many of my respondents an opportunity to distance themselves from the risky behaviors and identities that were officially described as pathogenic. To close, I draw a parallel to the 2008 cholera outbreaks in Zimbabwe, which African studies scholar and medical doctor Simukai Chigudu has interpreted in a recent work. Describing the public response to a threatened epidemic in Harare in 2016, Chigudu quotes the Minister of the Environment Oppah Muchinguri-Kashiri who claimed at a press conference that “Zimbabweans are living dangerously” and “Zimbabwe has become one of the dirtiest countries in Southern African” (2020, 35). Pointing to the infrastructure of the colonial period, held over in contemporary Harare’s built environment, Chigudu

Constructing a Disease of the Market

101

notes:  “Hers is a narrative of irresponsible citizenship and individual blame that belies the extended, multi-scalar political-economic factors that produce cholera epidemics” (2020, 36). In the months and years following the appearance of cholera in Hà Nội—like Harare, a colonial capital whose sanitary infrastructure reflected the original priorities of a colonial administration—the outbreak narratives produced by Vietnamese health officials, media, and laypeople imagined risk in quite similar fashion. Obscuring the role of upstream inputs—historical, infrastructural, and environmental factors that would require complex interventions—these stories imagined the spaces of the modern city and the influx of populations from rural areas as dangerous. Despite being extremely common in Hà Nội, certain kinds of consumption and exchange—particularly those involving unlicensed, informal traders and merchants—were imagined to threaten both health and morality. To a certain extent, these stories gave voice to broader anxieties about the uncertainty of markets and commercial exchanges with strangers. But by naming petty capitalists as the primary source of risk, these accounts misrecognized Việt Nam’s tragedy of the commons and failed to recognize how privatization, deregulation, and other consequences of “development” have affected institutions and resources that secure collective health. It is particularly troubling that the discourse on cholera and the public sphere were marked by the idea of “civilization”—a term that is increasingly used to denote late-capitalist arrangements in public space and private behavior. As this chapter has suggested, the construct reveals some significant ironies of the post-transition period. The political economic arrangements of “civilized” postsocialist Việt Nam inevitably create “uncivilized” externalities in the form of enclosure, crowding, pollution, disease risk, and new forms of socioeconomic exclusion.

102

4

Sacrificial Beasts: Disease Risk at the Species Boundary

Who should eat whom, and who should cohabit?—Donna Haraway (2008, 6) In a Spring 2010 meeting at the Ministry of Health, a highly placed officer informed me that cross-border dog trafficking was at the root of the cholera epidemics in North Việt Nam. Elsewhere in Southeast Asia, he said, dogs were raised in unsanitary conditions, and traffickers brought them to Việt Nam where they were sold for meat. The government was unable to police the border effectively and so the situation was more or less intractable. The officer borrowed my notebook to illustrate. Drawing Việt Nam, Thailand, Laos, and Cambodia in quick schematics, he added a set of arrows across Việt Nam’s western edge to indicate an influx of illicit dogs. I was surprised by his account, in part because it sounded like a conspiracy theory and in part because of some basic facts in the back of my mind. For one, there are no known animal reservoirs for cholera besides plankton and shellfish (Sack 1973; Sack et al. 2004, 224). Too, humans are the only known host for cholera vibrios (Kavic et al. 1999, 393). Finally, dogs and other mammals do not incubate the pathogen and have not proven to be a vector for cholera contagion. Given this, I didn’t really know what to make of the official’s story. But as my interviews with public health experts continued, I came to realize this association had been accepted as a thoroughly explanatory account of the outbreaks. A group of staffers at the infectious disease division of a major hospital also endorsed the dog meat story enthusiastically. I was surprised by this, and I was also surprised when the country office director of the World Health Organization (WHO)—an American epidemiologist—presented the same dog meat claim, expressing impatience when I suggested that there might be problems with this account. During the same meeting, another WHO staffer added a new detail. He suggested that the epidemiological curve of the cholera

104

Epidemic Politics in Contemporary Vietnam

outbreak clearly revealed the Vietnamese cultural preference for eating dog meat at the end of the lunar month. The country office director urged me to have a look at the daily progression of cholera case counts to see this curious trend for myself, but then regretted she could not share the relevant epidemiological data with me. I was ultimately able to source the data describing the cholera outbreaks in Hà Nội and surrounding provinces in Fall 2007, and I followed up on the WHO’s suggestion, too. Although the case counts did rise and fall over a period of active reporting of infections, the pattern of disease incidence did not appear associated with the dates of the lunar calendar. The end of the eighth lunar month—when more Hanoians were thought to have been consuming allegedly contaminated dog meat—fell on October 11. The first case of cholera was reported on October 24, as detailed in the Introduction; the index case did not report consuming dog meat. Case counts peaked on November 2, with 216 cases reported. Cholera infection has a short incubation period. The median incubation period of toxigenic cholera is 1.4 days; in 95 percent of patients, symptoms appear after infection in not more than 4.4 days (Azman et al. 2013). Therefore, exposure to V. cholerae in the second week of October could not have caused infections that did not manifest until early November. It therefore appeared—at least to me—that the sine wave of reported cholera cases represented a normal epidemic curve, not the epiphenomenon of a lunar cycle. In 2008, cholera recurred in the second half of the fifth lunar month, starting June 3, and persisted through the rest of the year. Incidence was so low and variable that any association with the lunar calendar would be challenging to confirm. But these were just conclusions I worked out on a scratch pad, while the story about dog meat and the lunar calendar was out in the world attracting notice. It would prove to have curiously strong staying power, and its circulation was not just by word of mouth. The purported association of dog meat with disease— which added a dimension of cultural or sociological scandal—took on a life of its own in the news. The account appeared in print frequently during the periods of active contagion and was reported by major national newspapers, including Thanh Niên, Tuổi Trẻ, and Sài Gòn Giải Phóng and the Englishlanguage VietnamNet and Việt Nam News. It also appeared on the US financial news website Bloomberg.com and in the United Nations publication IRIN News. Jean-Marc Olivé, the WHO’s representative in Việt Nam, made a statement that “[e]ating dog meat or other food from outlets that serve it is linked to a twenty-fold increase in the risk of developing the severe acute watery diarrhea commonly caused by the cholera bacterium” (Bennett and Nguyen 2008).

Disease Risk at the Species Boundary

105

Later in the outbreaks, the dog meat story moved from news media to peerreviewed scientific publications, with reports on the link between cholera and dog meat consumption appearing in the Vietnamese journal Preventive Medicine (Trần Như Dương et al. 2010), The Open Infectious Disease Journal (Tuan Cuong Ngo et al. 2011), and PLoS Neglected Tropical Diseases (Dang Duc Anh et al. 2011). Some of these included a complex accounting of how bacteria could survive in a cooked food product. A Japanese bacteriologist provided me with a series of illustrated reports that suggested that dogs raised for meat were force-fed quantities of probably polluted water prior to slaughter, a technique designed to increase their weight and therefore their price; this model of causality was later published in The Open Infectious Diseases Journal (Tuan Cuong Ngo et al. 2011). Researchers determined that the surfaces, equipment, and dogs at a dog slaughterhouse in Thanh Hóa province were contaminated with cholera bacteria—though these findings represented only a tenuous relationship between local contamination and the broader outbreaks (Rabbani and Greenough 1999, 3). One Vietnamese sociologist conjectured that dogs might become passive carriers of cholera by eating human feces (personal communication, December 13, 2009)—an idea that one scientist dismissed as “stupid” when I ran it by her—but nonetheless an evocative one, made further curious by the additional point. As Dr. Khánh (pseudonym) noted, “In the old days, people didn’t get cholera because they didn’t have the means to eat it. In the subsidy period, people had just a little bit of meat. Now, with the ‘consumer boom,’ people change their way of life and they eat anything—and the dogs also eat each other.” Alongside sharing disease prevention messages with city residents in affected neighborhoods, the city’s health authorities ordered inspectors to inspect and close dog meat restaurants and dog slaughterhouses. Street restaurants were inspected and closed, and in 2008, street food vending was sharply curtailed in both major cities, with vendors barred from downtown areas of Hà Nội and all informal trade in fresh food prohibited in Hồ Chí Minh City. As one blogger wrote in a spirited defense of dog meat and a refutation of public policies that had been adopted in the wake of the outbreaks: “After the order forbidding dog, there were people who ironically said that the way of preventing disease in the capital is: Wherever you touch, ban it. Whatever you touch, ban it. Just forbid, forbid” (Dân Luận 2010). Efforts to rationalize the role of dog meat in causing multiple cholera epidemics led to further scientifically questionable conclusions. For example, some accounts of the cholera deviated from blaming dog food to blame mắm

106

Epidemic Politics in Contemporary Vietnam

tôm, a strongly flavored condiment made of fermented shrimp and typically consumed alongside dog meat. A published analysis to disambiguate the respective roles played by dog meat, shrimp paste, and raw vegetables in causing cholera demonstrated that despite the fact that 95 percent of cholera patients had eaten shrimp paste, the product did not have a strong association with cholera (Tran Minh Nhu Nguyen et al. 2008, 16). Nonetheless, early in the epidemics, Minister of Health Nguyễn Quốc Triệu requested the public to “temporarily stop eating shrimp paste until the epidemic is over” (Dân Trí 2007a). The Ministry of Health’s Decision 4233 (2007b) also requested the health services to issue warnings about shrimp paste. Chị Nguyễn Thị Duyên, quoted in Chapter 3, described what she’d learned from these advisories: Chị Duyên Generally speaking, if you eat unhygienically you’ll get diarrhea. I heard the radio say that during an episode of diarrhea then you shouldn’t eat some things like raw vegetables; anything you eat you should boil thoroughly before you dare to eat them (ăn gì phải đun kỹ mới dám ăn). Then pig intestine, blood pudding, dog meat, and shrimp paste you should never dare to eat, so your family will never get diarrhea. ML Why does your family avoid eating rice porridge with intestine (cháo lòng), blood pudding, dog meat, and shrimp paste? Chị Duyên Because I heard that those foods aren’t clean (không sạch sẽ). If you eat raw things that aren’t hygienic, flies swarm over it and that causes diseases. Hằng But people cook dog meat? Chị Duyên It’s not because of dog meat but shrimp paste. Hằng But shrimp paste is salted, so how can it still be [dangerous]? Chị Duyên I don’t know (chẳng biết được), I hear the radio say that; people hear it and are scared. For some months after, I haven’t dared to touch it.

The commonsense appeal of this account was strong. Because it is prepared and served raw, many Vietnamese people consider shrimp paste unsanitary. However, it seems unlikely that mắm tôm could have played a significant role in disease transmission. As the head of one health NGO informed me, shrimp paste is 15 to 30 percent salt; as she added with amusement, “No self-respecting Vibrio cholerae would ever live in mắm tôm!” My scientist friend Dr. Xuân, who appears in Chapter 5, told me that one of her colleagues had actually attempted to culture V. cholerae in shrimp paste—but the findings were null and never got published.

Disease Risk at the Species Boundary

107

If microbiology and epidemiology could not resolve these questions about cholera etiology, we might at least explain the explanation. In Việt Nam, dogs are very symbolically significant, quasi-anthropomorphic social actors; eating their meat indexes social distinctions around gender, socioeconomic class, religion, politics, and geographic region. In this chapter, I unpack the story of cholera outbreaks caused by dog meat, explaining why this account took on so much commonsense explanatory power, persuading diverse audiences of its correctness.

Zoonosis Cholera is not a disease spread by animals—or at least, it is not commonly thought of as such. As described in Chapter 1, the organisms that cause cholera infection live in marine environments in association with microscopic zooplankton. Favorable conditions cause the vibrios to multiply, potentially leading to disease outbreaks in nearby human populations. Nevertheless, the story of dog meat causing cholera outbreaks in North Việt Nam constructed cholera in an interesting way—as a quasi-zoonotic disease. Zoonotic diseases are defined by the WHO as “diseases and infections which are naturally transmitted between vertebrate animals and man” (Palmer et al. 2011, ix). As anthropologists Keck and Lynteris note, though “the definition of zoonosis has been unstable since its first articulation in the second half of the nineteenth century” (2018, 2), vectorborne illnesses such as malaria are typically excluded from the category. In recent decades, the emergence of novel zoonotic diseases has inspired concern in public health and global health; these include hantavirus (whose original animal reservoir was mice), SARS (civet cats), Middle Eastern Respiratory Syndrome (camels), Nipah virus (bats), and H5N1 influenza (wild birds and domesticated poultry). It also includes more familiar diseases like anthrax (spread by herbivores, particularly cattle) and bubonic plague (carried by flea-infested gerbils). The influenza pandemic of 1918 probably originated in wild waterfowl (Taubenberger 2006), and the SARSCoV-2 pandemic is also believed to have animal origins. Zoonoses represent an increasingly important source of global morbidity and mortality among humans. As an Institute of Medicine report has noted, their role in human disease emergence “cannot be overstated” (1992). Epidemiological surveillance trends suggest that over recent decades, the “incidence and frequency of epidemic transmission of zoonotic diseases,” both known and new,

108

Epidemic Politics in Contemporary Vietnam

has grown rapidly (Wilcox and Gubler 2005, 263). Zoonoses now account for some 60 percent of emerging infectious disease events; of these, 71.8 percent are caused by pathogens “with a wildlife origin” (Jones et al. 2008, 990). The possibility of contagion spread by animals has long gripped public imagination powerfully, just as animals—wild and domesticated—have long been “good to think with.” In Victorian England, as historian Harriet Ritvo has shown, social struggles over domestic hierarchies, colonialism, and the national social order were visible in discourse about animals. For example, an epidemic of rabies in the 1870s was attributed to the dogs of the poor and foreign, though the hunting dogs of the upper class were more probably the source (Ritvo 1989). As literary critic Claire McKechnie suggests, the clinical features of rabies in this period also inspired the authors of Gothic works such as Dracula and The Hound of the Baskervilles: rabies symptoms compelled rumination on “the bodily pain of infection, the biting trope, and human-animal transformation” (McKechnie 2013, 115). In more recent years, zoonoses have provided fodder for a number of bestselling popular science titles (c.f. Garrett 1994; Quammen 2012; Quammen 2015; Wasik and Murphy 2013), numerous mass-market novels, and a string of disease-themed horror films. Here, the horror inheres in the transformation of a domestic or otherwise familiar creature from companion to vector, engendering the uncanny feeling of a call coming from inside the house. Continuous with an image of species encroachment, the metaphor of “spillover” further evokes an excess of liquid animality, overflowing one species to spread into another. This construction establishes zoonosis as pollution in the classic sense of “matter out of place” (Douglas 2005, 44). As anthropologists Frédéric Keck and Christos Lynteris noted in a recent essay, the specter of a widespread zoonotic pandemic has “become the platform of massive scientific, political, and economic investment” (Keck and Lynteris 2018, 3) over recent years, in part because of the specific anxieties around animal agency it raised. Insofar as the widely circulated narrative of a coming zoonotic plague figured animal bodies as the reservoir of crippling mass illness, it “reconfigured animals as agents of humanity’s future return to ‘the stone age’” (Keck and Lynteris 2018, 3). There is more to zoonotic uncanniness than simply the figure of the agentive animal intruding on the human social order, however. Zoonosis also registers the porosity of humans to other forms of life, registering that we are partially commensurable with other beings. Infection spread by animals both offers a radical shift of human self-perception and raises anxieties about human blurring and morphing. In a 1996 work on the use of animal genomes in the

Disease Risk at the Species Boundary

109

practice of “the new genetics,” sociologist Paul Rabinow invoked the poet Arthur Rimbaud’s gnomic claim that “the man of the future will be full (chargé) of animals” (Rabinow 1996, 92). This now appears, in retrospect, to be a very optimistic assessment of the future molecular relationships between animals and “men.” The man of the future, more likely, will be chargé d’animaux owing to pandemics of zoonotic disease—that is, if predictions about emerging interspecies pathogens come true. Attaching contagion to an animal can be a way of explaining disease and containing it—if only cognitively. An animal handle seems somehow to make an unfamiliar emerging disease—which otherwise has an alienating, unexplained quality—domestic by association. Medical anthropologists Charles Briggs and Mark Nichter have suggested that individual diseases have varying types of “biocommunicability,” a phenomenon they describe in terms of the “production, circulation, and reception of knowledge [that] forms part of (bio)medicalized domains” (Briggs and Nichter 2009, 194). Zoonotic diseases often take on an extra dimension of biocommunicability by their association with an animal. This is seen, for example, in media describing recent emerging disease outbreaks where the pathogen in question is understood to be zoonotic. When zoonotic infections have emerged in non-Western countries in recent years, they have frequently been represented with xenophobic or racist images of the affected population, with the emergence of a novel pathogen explained in terms of alleged cultural behaviors that include animals. This occurred during the early years of the HIV/AIDS epidemic, when scientific as well as popular accounts of the origins of the retrovirus cited green African monkeys as the original source of disease. These animal associations appeared in mainstream media narratives and also in scientific accounts: discussion of species-jumping simian retroviruses connected the dots with racist representations of taboo sexual practices, voodoo, and cannibalism in Africa and Haiti (c.f. Farmer 1996). Similar stereotypes were recycled to explain the 2014 Ebola outbreak in West Africa (Farmer 2020). Both scientific and media accounts of “bushmeat”—a term defined by the Centers for Disease Control as “meat that comes from wild animals captured in developing regions of the world such as Africa” (CDC 2014)—represented a devastating public health crisis in terms of pejorative and voyeuristic accounts of African cultural life. Such stories uncritically advanced a racist vision that conflated Africans with primates and pathology. As anthropologist Jared Jones (2011) has suggested, the attribution of Ebola’s transmission to “traditional practices” and “cultural beliefs” also contributed to

110

Epidemic Politics in Contemporary Vietnam

an acute misrecognition of the most important drivers of Ebola transmission, which were found to be social contact and the health care system itself. The emergence of novel coronavirus in 2019, attributed in media to a bat reservoir or a pangolin at a “wet market,” has been similarly appropriated in ethnocentric fashion to depict Chinese culture as barbaric and grotesque. These events suggest how the idea of zoonosis is so compellingly common sense, and also how it can be problematic. Racist and xenophobic accounts of zoonotic disease emergence allow preexisting prejudices to be expressed indirectly, often with a significant degree of plausible deniability. Essentially, to make a disease zoonotic is to anthropomorphize it. It is very difficult to anthropomorphize microbes, but it is easy enough to anthropomorphize animals. Calling a disease zoonotic also offers a convenient, apparently scientific way of displacing the disavowed qualities of animals and nature onto people and cultures that are perceived as inferior in some way. In this way, zoonotic diseases—or racist representations of zoonosis—naturalize the suffering that accompanies the spread of infection and exceptionalize its presence in a nonWestern setting—as if disease could not, and will not, spread to other human populations elsewhere in the world. As feminist scholar Mel Chen writes in her book Animacies, “When many axes of human difference collide, the stakes heighten; if the animal figure mediates many of these axes, then it becomes a condensed and explosive discursive site” (2013, 100). As this suggests, the association of disease with an animal hypostatizes presumed cultural differences, making them seem natural, commonsensical, and extremely socially consequential. In ways, calling a disease zoonotic is to scapegoat an animal—but inevitably it is to scapegoat certain humans too: humans who get—and are implicitly described as being—too close to animals. The association of cholera in Hà Nội with dog meat—its depiction as a quasi-zoonosis—was a particularly successful form of scapegoating because it made sense in two ways to two different audiences. Like the attribution of Ebola to “bushmeat” consumption, accounts of dog meat as zoonotic vector were persuasive because they expressed a preexisting sociological imaginary. For audiences outside Việt Nam, the story ratified preexisting racist tropes about East Asian culinary practices, which are often described in ethnocentric and xenophobic ways as grotesque and inclusive of animals that are not considered food animals in the West. For local audiences, the story affirmed the normative perception that eating dog meat—while a valorized part of male cultural repertoires and a symbol of appropriate political inclinations—nevertheless has unsavory associations and symbolizes forms of masculine recreation that are

Disease Risk at the Species Boundary

111

transgressive, anti-family, and even antisocial. In the below discussion, I will further develop the cultural significance of dog meat consumption in Việt Nam. But first, a word about dogs.

The Social Life of Animals Before addressing the cultural meanings surrounding dog meat and its consumption, I turn to a discussion of the place of dogs and other animals in Vietnamese society. I develop these comments relative to a growing interdisciplinary interest in theorizing the relationships between humans and other animals. In anthropology, these expansions of purview have introduced species diversity to an intensely anthropocentric field, allowing novel topical and methodological forays like the ethnography of viruses (Lowe 2010) and considerations of “bird flu biopower” (Porter 2013). Such projects have dislodged anthropology from its tendency to privilege human beings and neglect our entanglements with other species. Drawing on his field experiences of the communicative and pragmatic connections that draw dogs and humans in Amazonia into shared experiential worlds, Eduardo Kohn (2007) has proposed new anthropological agendas by calling for a more flexible and encompassing “anthropology of life.” Animals constitute a rich part of Việt Nam’s cultural landscape. As elsewhere, they are not simply a source of economic value or food security: animals also index class aspirations, aesthetic sensibilities, and idealized notions of cultural and natural forces as well as human vices (Richard Quang-Anh Tran 2020). The image of a boy riding a buffalo in a rice field is a quintessential icon of the rural idyll, but animals are also very present in everyday city life. Here and there chickens dwell on sidewalks, sometimes in basketry coops and sometimes free. “Wet markets” sell all types of living creatures, and with the growth of the middle class, pet stores in Hà Nội and Hồ Chí Minh City have become more common. The keeping of songbirds is an increasingly popular practice associated with neoConfucian repertoires of masculine self-cultivation (Avieli 2007); throughout the city, birds sing in cages under shopfront awnings and apartment balconies. Religio-spiritual representations of animals in Việt Nam also make up a poetic imaginary where animal agencies become part of human social life. The lunar calendar, which is an increasingly significant part of popular culture in post-transition Việt Nam, assigns twelve animals to each year of a twelve-year cycle. Everyone has a birth year animal and I was impressed by how much my

112

Epidemic Politics in Contemporary Vietnam

friends seemed to know about the respective significances of the different animal signs. Furthermore, disciplining one’s relation to animals is an important part of Buddhist principles in Việt Nam: injunctions against killing animals require abstention from eating meat on the first and fifteenth days of the lunar month. The ritualized humane treatment of animals is understood to help accrue merit— as when individuals release fish or birds (phóng sinh) at the Lunar New Year. Animals are frequently represented in vernacular scenes of country life. Traditional Đông Hồ wood-block prints, with titles like “The Rat’s Wedding” (Đám cưới Chuột) and “The Schoolmaster Toad” (Thầy đồ Cóc), depict animals satirically in the roles of humans. Classical Vietnamese sources, drawing on Chinese mythology, speak of four holy beasts (Tứ Linh or Tứ Thánh Thú): the dragon, unicorn, tortoise, and the phoenix. In a more homely vernacular, a nineteenth-century poem (Lúc Sục Tranh Công) relates a farmyard quarrel between the “six sacrificial beasts” (lúc sục hy sanh), the dog, horse, goat, buffalo, chicken, and pig, each of which insisted that they were the most useful to humanity. The dog claims that his merits are recognized specially, such that even a dead dog may be of service and receive honor in the afterlife. The goods and chattels I protect on earth – in death I’ll guard that bridge to the Dark World. I’ll help the virtuous ones escape from hell – the mean and wicked I shall not let pass! Mindful of past and future services, The lord will bury me with money and rice. (Nguyễn Ngọc Huy and Huỳnh Sanh Thông 1981)

Dogs’ actions in the service of humans are indeed recognized in Vietnamese culture, in part because dogs are more workers than they are pets. Most of their work is as guardians of property and homes. In a very detailed M.A. thesis in English linguistics, comparing Vietnamese and English proverbs containing the word “dog,” Đào Thanh Tú noted how dogs are perceived as spiritual protectors as well as worldly guardians: In daily life of Vietnamese people, two animals considered two of their close and important ones are buffalo and dog. Buffalo helps to produce food, dog helps to protect homes. In spiritual life, dog is also used to protect against evils, therefore, stone dogs are built much in northern Vietnam, mainly standing in front of village gates, communal house doors, tombs, home terraces or gates. (…) Due to containing supernatural power, the stone dog is called Nghê (lion’s whelp). (Đào Thanh Tú 2007, 28)

Disease Risk at the Species Boundary

113

These services by canines notwithstanding, all but the most middle-class dogs tend to remain on the fringes of society in Việt Nam. Dogs occupy an ambiguous social position—as Đào Thanh Tú’s thesis further suggests, they are described in everyday figures of speech as having some of the more disavowed tendencies of humans themselves. The author takes note of dozens of phrases and proverbs referencing dogs as liminal figures external to human sociality. These include the saying “as ignorant as a dog” (ngu như chó) and the phrase “a dog with scabies” (chó ghẻ) to reference someone who is hated and disgraced. An aggressive person is described as a rabid dog that bites (chó dại cắn càn). The term “hunting dog” (chó săn) is used to mean “spy” or “reactionary lackey” and the delightful expression “a dog dancing on the altar” (chó nhảy bàn độc) describes someone talentless who holds a high social position. The semantic valences surrounding the dog in Vietnamese are mostly negative—though there are also proverbs with positive connotations, such as “a yawning dog catches flies” (chó ngáp phải ruồi), which describes a sudden turn of good luck. As this suggests, dogs are uncomfortable reminders of bad human qualities, though they are also sometimes figures of more positive identification. Essayist Hữu Ngọc comments on a Buddhist teaching that canine embodiment is a karmic punishment (Hữu Ngọc 2008, 1040)—a view that suggests a porous ontological boundary between humans and dogs (albeit a boundary mediated by cycles of reincarnation). If bad humans—in this life, or the previous one—are conceived of as dogs, perhaps dogs are just bad humans, and a reminder of human foibles. One folk saying suggests it is “better to marry a dog from your village than a distinguished man from far away” (Hữu Ngọc 2008, 463)—a claim suggesting the familiarity of dogs, while unpleasant, has some redeeming qualities. This ambivalence about dogs runs strongly parallel to public attitudes in Victorian England, where “If the dog was loved, it was also despised and feared” (McKechnie 2013, 116). Vietnamese dogs are both tolerated in the social fold and regarded with disdain. As Nir Avieli notes in his account of dog meat culture in Hội An, none of his friends who had pet dogs bought them dog food or allowed them in the house, though they were sad when their dogs got injured or lost. Of the dog-owning families I knew in Hà Nội, there was not a great deal of dog-walking and certainly no dog obedience classes, agility training (Haraway 2008) dog grooming, or dog accessories (although one Hanoian lapdog I know did have some cute dog clothes to wear). One afternoon on a trip in the Mekong Delta I watched a beige and brown dog, skinny and dark-faced, browse the floor at a cơm bình dân (“common people’s food”) establishment. It resembled other semi-domesticated country dogs, with

114

Epidemic Politics in Contemporary Vietnam

a thick coat, thin limbs, and a furry tail. Huy, a friend from Hà Nội, glanced over as the dog licked the concrete noisily. As we finished our meal and reached for toothpicks, the dog tipped over a waste bin and crawled in to browse for scraps. “Amazing,” Huy said, shaking his head at the scavenger’s resourcefulness. Huy was an observant person and liked commenting on passing sights. No one else seemed to notice.

On Dog Meat On the other side of the human-dog sociality continuum, there is the production and consumption of dog meat. Dog meat (thịt chó) is a luxury food in Việt Nam. It is served cooked, accompanied by side dishes—shrimp paste (mắm tôm) and an aromatic fresh herb called lá mơ (Paederia foetida). No statistics document the scope of dog meat production and consumption in Việt Nam, and no legislation sets industry standards, so the assertion that using dogs for meat in North Việt Nam is a popular practice is not documented by any statistics. However, it is commonly claimed by both Vietnamese and foreign sources that dog meat consumption is a practice that is culturally particular to the country’s northern provinces; elsewhere in the country it is less common and regarded with less acceptance, in part because eating dog meat is associated with Communist cadres and support for the Hà Nội regime (Avieli 2011). In his work on modernity in Vietnamese society, the anthropologist Philip Taylor discusses a satiric story of the đổi mới era that landed author Trần Huy Quang in trouble for its irreverent depiction of Hồ Chí Minh. In The Prophecy Fulfilled (1993), the story of Hồ Chí Minh’s journey overseas to discover the principles of communism is retold in a comic, ridiculous fashion, contrasting a lofty tone of transcendence with a depiction of everyday village surroundings that include a dog meat restaurant. In the passage below, the protagonist Hinh reads a set of “nonsense directions” from a scripture: “Thou shalt go to the South along a road flanked on one side by trees and on the other side by water, until at the end of the road there shall be a tavern selling draft beer and dog meat. Thou shalt not peer into this place of indulgence, but rather continue on slowly. (…) Upon continuing, thou shalt come upon a newspaper kiosk and thus turn left, finding before thee a small flower garden. (…) Hinh embraced the scripture to his chest and hiccupped with emotion. ‘My God, this magical talisman, this oracle.’” (Taylor 2001, 66–7)

Disease Risk at the Species Boundary

115

As this parody suggests, dog meat symbolizes a somewhat seedy aspect of quotidian social realities; its class associations are decidedly mixed. The literatus Hữu Ngọc writes “‘thinking’ folks in general do not eat [dog meat],” implying its association with downward mobility (Hữu Ngọc 2008, 357). Dog meat is mostly eaten in specialized restaurants like the one in The Prophecy Fulfilled; other eating establishments typically do not list dog meat on the menu. While I never saw dog meat in a Vietnamese supermarket, it is possible to buy a butchered dog in some outdoor city markets. Journalists and NGOs critical of the dog meat trade frequently present photographs of these market scenes— which are, for the dog lover, indeed very difficult to regard. However, dog meat culture evokes a certain kind of romanticized national belonging, an association implied by the frequency with which new acquaintances—always older men— liked to ask me if I “knew how” to eat dog meat. This conversational gambit always struck me as a nod to my status as an “honorary man” (Carsten 2014, 208) and a polite way of asking whether I appreciated an aspect of traditional Vietnamese culture that does not much appeal to foreigners. This was an important question—if asked in jest—because consuming or refusing dog meat may index a diner’s gender, region, political leanings, religious beliefs, and relationship to Việt Nam and the Vietnamese Communist Party. Although some Vietnamese people qualify eating dog meat as a form of disorderly eating, eating dog meat in Việt Nam is a strongly socially structured practice, signifying multiple identifications. Dog meat is considered a “hot” food (c.f. Craig 2002; Rydstrøm 2004, 83–4), and its consumption is therefore generally reserved for men, who eat dog meat primarily in recreational contexts in the public sphere. Literature on the cultural dimensions of dog meat eating is limited, but a query posted to the Vietnamese Studies Group listserv prompted an outpouring of observations and stories, with foreign and Vietnamese researchers weighing in on dog meat’s meanings for the eater.1 from my experience it is a very “manly” thing to do. Men eat it while drinking and “nhau.”2 I’ve also heard that it is supposed to have a high degree of testosterone as to help boost masculinity. I don’t know if women regularly engage in eating it at all. (Khai Thu Nguyen, personal communication, November 30, 2009) Between 2006 and 2008 I participated in three different drinking groups of working-class, middle-, and upper-class men. I did not see dog meat served in the upscale restaurants where my wealthy male informants socialized and drank. The men most of whom have eaten dog meat before do think dog meat as meat of class, particularly at their fancy drinking establishments. By this, I do

116

Epidemic Politics in Contemporary Vietnam

not mean that rich people do not eat dogmeat if they have a preference for it but they would have to consume it at other venues. In fact the eating establishments where dog meat is served are mostly called “quan” rather than “nha hang.”3 (Binh Ngo, personal communication, December 2, 2010) I heard from the Viet truck drivers that they avoid eating Thịt chó [dog meat] and tiết canh vịt [duck blood] before long trips, as it can bring bad luck. While many people in the North eat dog, it seems like Southerners don’t eat it much, and you are right that for a Buddhist, eating a dog is really a sin. (Dinh Lu Giang, personal communication, December 2, 2010)

As these reflections indicate, dog meat consumption is a slightly taboo topic that inspires a range of moods—morbid curiosity, pleasure, and black humor. But despite its status as a somewhat socially marginal practice, dog meat eating in North Việt Nam has apparently been very common since at least the late 1980s (Hữu Ngọc 2008, 354). In Hà Nội, dog meat restaurants are concentrated on Nhật Tân and Nghi Tàm streets; the former is sometimes jokingly referred to as the “Unified Dog Meat Enterprises of Nhật Tân” (xí nghiệp liên hiệp thịt chó Nhật Tân). It’s also common to see roadside dog (and cat) restaurants in other provinces. While many Vietnamese people refrain from eating dog meat on moral or aesthetic grounds, enthusiasts describe its flavor as uniquely, even addictingly, savory. A university colleague of mine happily remembered the occasions during the subsidy period when he would make a special preparation of dog intestine as a treat for their fellow starving university students, using aromatic herbs and garlic for a flavor unrivaled by any dish. “You have to eat it while you’re living,” he explained, quoting a verse of folk song (ca dao) “because you don’t know if they have dog meat in Hell.”4 Dog meat eating also appears to index a felt Vietnameseness, which references the pleasures of the body and sociability more than the ethics of sacrifice and hierarchy that inform the construction of the state’s patriotic ethos. At the same time, archaeologist Vũ Thế Long described the enjoyment of dog meat to me in terms of the phrase quốc hồn quốc túy, or “national spirit” (personal communication, December 8, 2010). The food is sometimes called by nicknames—thịt cây, cây còn, and mộc tồn—that function both as euphemisms and as terms of endearment.5 Dr. Long followed up with me by sharing a personal essay—a paean, actually—arguing that the practice of dog meat consumption in Việt Nam was as old as dog companionship itself. No one knows how long Vietnamese people have eaten dog meat, but owing to my archaeological research, I can provide very strong evidence: at the very

Disease Risk at the Species Boundary

117

least, from the time of the Hùng Kings [Hùng Vương, c. 2879–258 BCE]. Along with bánh chưng and bánh dây6 eaten in the major festivals, our people have eaten dog meat (mộc tồn). Have you seen the image of a dog scampering in the carved images on the Đông Sơn7 bronze drums? Have you seen the image of a dog hunting deer on the Đông Sơn bronze axes? (…) After excavating layers of soil in the Hoa Lộc, Phùng Nguyên, Đồng Đầu, and Gò Mun cultural layers … I saw skulls that had been broken to eat the brains and dog bones that had been broken to suck the marrow out. Perhaps the sentence “As delicious as dog brains” also existed three or four thousand years ago. (Vũ Thế Long, personal communication, December 8, 2009)

But not everyone sees dogs as fair game, as an interesting story from Binh Ngo suggested. Ngo grew up in the Mekong Delta, where dog meat was not considered widely acceptable: I remember growing up in Rach Gia witnessing many cadres from the North eat dog meat. Many people believe that dogs do not eat their own species and dog can detect dogmeat eaters from non-dog eaters and chase after them. I don’t know how much of this belief is fact but I experienced it first-hand. In the early 1980s the principal of the high school where my father taught gave my father a bowl of “cho xao lan” [a kind of dog curry]. (…) My mother did not want to eat it, so she asked me to give the dish to our two dogs. They sniffed and walked away uninterested. Our dogs also gave the principal a hard barking and chasing (unusual behavior for them) every time he had to pass by our house to get to his school. (Binh Ngo, personal communication, December 1, 2009)

This story is intriguing for its attribution of supernatural sensitivity to dogs themselves—another reason to avoid eating them as meat. Indeed, for the religious, eating dog meat is regarded as especially unethical; as Dinh Lu Giang stated in the quote above, “for a Buddhist, it would be a real sin.” In a short story by the darkly comic đổi mới writer Nguyễn Huy Thiệp, a mandarin eats dog meat en route to offering prayers at the pagoda—a gesture that reveals his corrupt character (Nguyen Huy Thiep 1992, 70). Dog meat has also taken on some additional unsavory associations in past years owing to the lack of regulations in its production. While Việt Nam’s huge poultry industry is becoming increasingly commercialized and industrialized (Porter 2019), the dog meat supply chain remains in the shadows. Many people believe that kidnapped family pets provide dog meat served by restaurants, and foreign and domestic press in recent years has reported lurid stories about black market dog meat, dog thieves, and trafficking. As news sources suggest,

118

Epidemic Politics in Contemporary Vietnam

the going rate for dogs is high enough to motivate theft, while the fine levied for a dognapping conviction is so negligible that some dog owners take justice into their own hands when a thief is caught instead of seeking the support of courts and the police. Violence around dog theft and its extrajudicial control has been reported throughout the country over the past twenty years. In 2014, two suspects were murdered by as many as seventy villagers in Quảng Trị province; the same year, four dog thieves were convicted of murder of three of their pursuers in Hồ Chí Minh City. Nir Avieli was told “at least a dozen times that dogs of my acquaintances or their neighbors had been stolen” (2011, 65) during his fieldwork in Hội An in 2004 and 2005, and witnessed the aftermath of dog thieves being beaten and having their motorcycles burned. Popular moral indignation around dog thieving is a plot point in the dramatic film Wood Cutters (Những người thợ xẻ, 2000), in which a dog meat restaurateur is burned out of his house when he is discovered to be stealing his neighbors’ pet dogs.

Masculinity, Class, and Cholera Given the discrepant ideas of class that were encoded in cholera outbreak narratives, it was somewhat clear from news stories who was believed to be at risk. Broadly, cholera was attributed to poor communities with limited access to sanitation, and to rural-to-urban migrants selling potentially unsafe merchandise. However, the popular and frequent attribution of cholera to dog meat consumption also suggested that more middle-class men were at risk. One article, sarcastically titled “Eat, Play, and Forget Cholera!” (Tổ Quốc 2011), depicted cholera victims as responsible for their own misfortune. The phrase “eat and play” (ăn chơi) in Vietnamese refers to a hedonistic, even debauched sensibility. Calling behavior ăn chơi references the immoderate pursuit of pleasure; it translates loosely as “playboyesque.” While ăn chơi may be used to describe literal eating, it suggests eating for pleasure, not nutrition. Nir Avieli’s extensive observations of dog meat restaurants in Hội An describe an ambiance of high prices, alcohol, and service by “beer girls” (gái bia). As this suggests, dog meat consumption in Việt Nam is widely perceived as a hedonistic, male-dominated, primarily middle-class behavior, which is, as one sociologist suggested to me, also homosocial activity that often precedes visits to commercial sex workers. And indeed the Tổ Quốc article blaming “eating and playing” figured cholera almost as if it were a sexually transmitted disease. Like others published in the period of intermittent cholera infection,

Disease Risk at the Species Boundary

119

the news story constructed cholera as caused by decadent behaviors by mostly male middle-class urbanites outside the context of acceptable forms of sociality. This model does leave some questions. The association of cholera with dog meat consumption, rural-to-urban migrants, and groups described as poor appears discrepant on its face. But the logic of this model is, essentially, that certain types of bodies are understood as risky and at risk when they leave their assigned social roles: rural women traveling to the city to sell merchandise, middle-class men outside of their roles as family members. However, poor communities are assumed to be potentially pathological no matter what they do—and represent, owing to their poverty, a different kind of “matter out of place” in post-transition urban Việt Nam. In sum, the association of cholera with vended food, the informal sector, and recreational eating made the disease signify disorderly sociality and the assumed backward tendencies of poor and working-class people.

Conclusion In I Contain Multitudes, a book about research on the microbiome—that is, the constellation of commensal microorganisms that live on and in every living being—the science writer Ed Yong argues: “All zoology is really ecology. We cannot fully understand the lives of animals without understanding our microbes and our symbioses with them” (2016, 5). I would suggest that the reverse is also true: We cannot understand the lives of microbes without understanding our animals and our symbioses with them. As anthropologist Heather Paxson has argued, “neglect of the microbe … continues to distort our anthropological view of the social world” (2008, 18–19). Microbes were evidently quite neglected in the popular story of cholera and dog meat in Hà Nội. But what these accounts lacked in scientific clarity and specificity, they made up for with the cultural, moral, social, and political significance that surrounds the production and consumption of dog meat in Việt Nam. The interpolation of the figure of the dog (a half-civilized and very anthropomorphic social being) into the discourse regarding cholera (an atavistic disease of premodernity) illuminated broader struggles over backwardness and civilization, socialism and capitalism, market and state. In a way, the dog story domesticated cholera, increasing its biocommunicability by presenting a readily grasped—if probably incorrect—explanation.

120

Epidemic Politics in Contemporary Vietnam

Associating dog meat with cholera further resonated with a fear that imperatives of commercialism and expediency, when insufficiently contained, permit objectionable forms of cruelty and danger. These fears are prominent in public culture of the post-reform period. Finally, the anthropomorphic perception of dogs in Việt Nam situates them as liminal beings, with a status positioned somewhere between humans and animals. In this way, dogs are figures of a hybridity as internally contradictory as the nation’s “market economy with socialist characteristics.” Dangerous and friendly, family members and food, dogs serve as a particularly potent symbol of the anxieties, compromises, risks, and affinities of Vietnam’s post-reform period.

5

Statistics and Their Discontents

Dr. Xuân, a life scientist whom I’ve come to know through a mutual friend, invites me to visit her lab in a research institution in Hà Nội. A sticker on the aluminum door of her section reads “Biohazard 2,” indicating the presence of bacteria and viruses that cause mild disease in humans—but inside, the ambiance feels biosecure in a quite domestic way. A few young lab assistants are working together at a bench and my friend invites me to slide past them and join her for tea at a wicker table in the corner. In her lab coat and slippers with a row of big formaldehyde bottles to her back, Dr. Xuân almost looks like she’s relaxing at home. We share a plastic cup of yogurt and sweet black rice, talking about family and friends before getting around to science and politics. As we chat, the lab workers step around us to use equipment and head out to the balcony to take phone calls. Cold air and the sound of traffic seep through the French windows from the street below. The lab is a plain room equipped with computer monitors on benches and an assortment of lab machines; the counters are full of trays, pipettes, and printouts. The paint is a little dingy and the fluorescent lights are dull. Dr. Xuân’s cheerfully incisive commentary seems to brighten the surroundings. Today she’s talking about corruption, a subject that often causes people to lower their voices—but because she’s speaking English, Dr. Xuân doesn’t alter her volume at all. Describing how unfair practices in realms from grants administration to hiring and promotion have infected her colleagues, even those she had imagined as beyond reproach, she quotes a proverb: “Near ink it’s black, near the light it’s bright” (Gần mực thì đen, gần đèn thì sáng). It means that our character is influenced by our surroundings, for good or for ill. “When you die, you are ash,” Dr. Xuân continues, in a philosophical mood. “When you realize this, you are free, you don’t go chasing after money. You just need enough to live, and that is it.” On other occasions when we’ve spoken, I’ve been surprised by Dr. Xuân’s open criticism of the inky areas of her research institution. With a note of

122

Epidemic Politics in Contemporary Vietnam

bitterness, she told me on another occasion that the facility is a shell of its former self, increasingly full of “dead labs.” She said the leadership was greedy, and the director—notorious for his vanity and fancy car—surrounded himself with “kneeling people.” It was impossible for anyone good to do any work here, Dr. Xuân said. She contrasted the research being carried out at her institute to studies she had carried out with international colleagues, which she saw as meeting a higher scientific standard. And though cholera was not Dr. Xuân’s research specialization, she followed the outbreaks closely and related details of their mismanagement to me with a certain grim enthusiasm. Once she said, “They tried to hide it, but they were very careless. The data are everywhere, but people shrivel up like a snail if you ask for them.” My friend’s colleague Dr. Thảo, an expert on enteric disease, stops by the lab to chat. He also agrees to lend me a copy of a recent doctoral thesis on cholera and we head over to his office to pick it up. On the way down the corridor, I inquire about a forthcoming journal issue on the outbreaks. A number of other scientists have alluded to this publication in their emails putting off my requests for information, so I’m impatient to read the articles. At the mention of this, though, Dr. Thảo gives me a bit of an amused look. “Sometimes there is something funny with those reports,” he says. He indicates a bulletin board covered with articles from the institute’s in-house journal, one of which was about cholera risk factors. Laughing as he leafs through the pages, he told me that the numbers are “probably all wrong. The methodology is not good … Maybe I will use it as an example for students,” he adds, implying that the publications were case studies in mistakes.

Legibility and “Papereality” The political scientist James Scott has famously argued that technologies of abstraction such as maps, censuses, and statistics, are “indispensable to statecraft” (Scott 1998, 77): The functionary of any large organization “sees” the human activity that is of interest to him largely through the simplified approximations of documents and statistics: tax proceeds, lists of taxpayers, land records, average incomes, unemployment numbers, mortality rates, trade and productivity figures, the total number of cases of cholera in a certain district. (Scott 1998, 76–7)

Statistics and Their Discontents

123

Armed with these simplifying representations, modern states and state-like actors are empowered to govern. Scott’s analysis emphasizes the importance of accurate documentation—in the form of correct statistics and properly scaled maps, for example—in creating “legibility,” which in turn enables states to exercise governmental power. While Scott acknowledges that the data derived from such “state simplifications” are, “to varying degrees, riddled with inaccuracies, omissions, faulty aggregations, fraud, negligence, political distortion, and so on” (Scott 1998, 80), erroneous data and misleading documentation do not form a major focus of his analysis, which centrally posits that, normatively, accurate typifications facilitate efficient governance. An interesting literature nuances Scott’s insight into the use of abstractions in governance, suggesting how the production and use of specifically false or manipulated “simplifications” can give rise to alternative types of social power. Attuned to the reality that actors in bureaucratic systems may falsify data to gain advantages or avoid disadvantages, this scholarship subverts expectations that the purpose of quantified representations of reality is solely to report the truth. While Scott imagines the state’s will to knowledge as creating the foundation for governmental power and legitimacy, other scholars have pointed out how the power of quantification can be misappropriated and subverted. In an essay on the social practices enabled by “false numbers,” for example, sociologist Martha Lampland makes the suggestive claim that “[n] umbers are instruments, not simply transparent signs. (…) The point is to analyze what numbers are doing, and hence what they mean” (Lampland 2010, 383). Historian Arunabh Ghosh, who has written on the use of statistics in the People’s Republic of China, notes that “[s]tatistics are rarely about numbers and their truth claims” (Ghosh 2020, 1). In socialist states, statistics and other forms of quantification have played central roles in the apparatus of social and economic management. In these settings, “what numbers are doing” is typically a great deal of ideological heavy lifting, alongside whatever utilitarian purpose is assigned to practices of statistical management. Under socialist systems, statistical methods and knowledge were often imbued with authority because they have been perceived as continuous with the scientific ambitions and modernist, even futurist, ethos of Marxism.1 In Việt Nam’s socialist period, continuous with the spirit of scientization (khoa học hoá) that began as early as the 1930s (Ninh 2005, 33), “numbers, audits, and quotas” were central to the management of industrial and agricultural collectives (Kerkvliet 1993, Montoya 2013). The 1970s and 1980s further saw

124

Epidemic Politics in Contemporary Vietnam

a “renewed interest in science, technology, and quantification” and efforts to “improve national agricultural and industrial output through the application of science, technology, and applied research” (Montoya 2013, 45). However, despite this enthusiasm about the use of statistics in the scientific management of many domains of society, the use of numbers has remained subject to irregularities in Việt Nam. The country’s centrally directed economy and the ordering of an administrative hierarchy have historically provided opportunities, even incentives, for irregularity in the creation and circulation of statistics (thông kế). While statistics have formed a key piece of state authority and legitimacy during Việt Nam’s socialist and transitional periods, as earlier chapters have suggested, data collection and reporting have also furnished venues for power struggles and the pursuit of individual ends. In his monograph The Government of Mistrust, anthropologist Ken MacLean examines these struggles in Vietnamese society, arguing that quantification and data reporting practices have at times functioned as an opportunity structure for individuals to pursue their own interests via the creative management of information. As MacLean argues, lower-ranking officials in Việt Nam’s tightly vertical administrative hierarchies deploy information as a means of protecting themselves against pressures from higher levels of the system: “Cadres at all levels of the bureaucracy (…) learned to withhold data at some moments and to overstate them at others if they wished to meet their quotas, acquire more personnel and equipment, garner larger budgets, receive promotions, and so on—practices collectively known as ‘chasing after results’” (MacLean 2013,18). Anthropologist Peter Chaudhry documents something similar in his ethnographic research on poverty counting, a highly politicized process in which “Both lower- and higher-level officials are (…) engaged in a process of (mis)representing statistics in particular ways to suit their needs” (Chaudhry 2016, 217). This research sheds light on how the exercise of “weapons of the weak” (Scott 1985)—or, in this case, weapons of the bureaucrats—can ultimately compromise the state’s ability to create a totalizing vision of reality. Political scientist David Dery has called the end result of withholding or overstating numbers “papereality”—“a particular form of representation that takes precedence over the things and events represented” (Dery 1998, 677). In these accounts, the actions of many relatively less powerful actors, distributed across time and space, aggregate into a cloud of unknowing—a cloud that nonetheless appears in the form of definite and specific figures, metrics, and statistics. In this way, the system for measuring social realities inadvertently, and often cryptically, creates

Statistics and Their Discontents

125

representations that appear to be “known knowns,” or things we are aware of or understand—but are, in reality, more like “unknown unknowns”—things we are neither aware of nor understand. However, where this literature emphasizes how self-interested reporting creates ignorance, other factors can also cloud the vision of the state, and the state itself may also be served by the production and circulation of measures that do not completely describe reality. For example, in her examination of the Ukranian state’s response to population health problems following the nuclear disaster at Chernobyl, Adriana Petryna offers a subversive insight into state unknowing. Exploring how official responses to the accident created ignorance—by designating medical results as state secrets, for example— Petryna argues that Ukrainian “state power is as concerned with making bodies and behaviors ever more predictable and knowable as it is with creating—both intentionally and inadvertently—spaces of nonknowledge and unpredictability” (2003, 13). While some of the gaps in knowledge about radiation’s health effects were unintentionally caused by “the unraveling of the Soviet system” (2003, xv), Petryna also found that Ukraine’s post-Soviet government actively perpetuated these lacunae in knowledge. Scientific and bureaucratic ignorance was useful, in part, because it helped save costs: by certifying only a small fraction of the population as disabled by the effects of radiation, the state was able to limit its provision of costly entitlements to “sufferers.” A parallel dynamic is likely at play in Việt Nam, which has, like Ukraine, retreated from its historic commitments to universalism and crafted new policy to reduce expenditure on public health. The Vietnamese state might be, in ways, disincentivized to document disease exhaustively given the limits to state financial capacity. However, unlike Ukraine, Việt Nam retained the administrative hierarchies of socialism; these have tended, as discussed above, to encourage the manipulation of data. The arrangements of Việt Nam’s hybrid political economy thus place novel pressure on public health: market socialism exposes the population to new forms of risk, including environmental risks to health, while requiring individuals to become increasingly financially responsible for their health and welfare. At the same time, the state’s capacity to document health problems may be deployed selectively, particularly in cases of public health concerns that might threaten prospects for economic growth and integration with regional and global markets. A market-socialist system may therefore be particularly vulnerable to encompassing forms of “papereality,” because actors at multiple bureaucratic levels—including the top levels of decision-making and policy—may be structurally encouraged to manipulate numbers.

126

Epidemic Politics in Contemporary Vietnam

What the Numbers Will Be The problems that Dr. Xuân and Dr. Thảo identified in the state’s scientific account of cholera—miscounting, undercounting, and statistical manipulation in the epidemiology of infectious disease—are not unique to Việt Nam; they are ubiquitous. However, in local settings, these practices are shaped by specific contextual pressures and systemic weaknesses. In Việt Nam, part of this phenomenon is the result of historic limitations in state capacity for statistical data collection; in other instances, our ignorance about epidemiological realities has been constructed more actively (Smithson 2008, 209). As I suggested in Chapter 1, epidemiological and demographic statistics have historically served as an important ideological resource for the Vietnamese state to construct a compelling narrative of progress in public health and nation building, adding an immediately corporeal dimension to accounts of economic and social development. During the cholera outbreaks, Vietnamese critics of state science—many of whom were themselves scientists—asserted that the state’s epidemiological statistics were manipulations, serving to conceal inconvenient realities and protect the image of the health authorities. In this chapter, I present the complications that attend health data in Việt Nam and attempt to reconcile the difficulties that these problems pose. Most assessments of public health in Việt Nam tell a version of the following story: the health infrastructure established by the Vietnamese state under socialism accomplished enormous gains in public health, with significant reductions in many formerly prevalent causes of lost health and life. This is certainly the consensus of most of the scholarly literature published in English on public health in the Socialist Republic of Việt Nam. However, these assertions generally rely on state-reported statistics—which are, in turn, used, cited, and also praised quite uncritically (c.f. Pollack 2020). Upon scrutiny, however, the numbers that represent population health, disease epidemiology, poverty, and other vital statistics can appear questionable, mushy, and of indeterminate provenance, even as they recur throughout the literature. The following discussion explores the meanings and uses of uncertain numbers and “unknown unknowns” in research on Việt Nam. During fieldwork I was frequently made aware that foreign scholars and aid workers also questioned the accuracy and utility of contemporary data sets collected by Vietnamese state agencies. For example, I knew an American cultural anthropologist who had long experience in Việt Nam; in the 1980s, she

Statistics and Their Discontents

127

had helped with the collection of a foreign-sponsored commune-level health survey. She informed me that health statistics from the 1960s and 1970s were unreliable, given the operating assumptions of Vietnamese statisticians during the period—who seemed, she said, to be recording epidemiological data “that they thought would appear right.” Then an American development worker, who had also worked in Việt Nam for many years, commented to me that “[b]etween 1993 and 2003, Vietnam reported that it had cut poverty by half, but this involved the backwards reworking of baseline data—retrospectively raising the 1993 rate” (personal communication, July 26, 2010). A policy expert with decades of experience in the health sector acknowledged to me that Việt Nam’s data were, “for a country that’s headed towards middle-income level, just really bad. Awful.” One foreign researcher stated simply, “Government statistics aren’t worth the paper they’re published on.” On their face, these comments were reminiscent of casually ethnocentric statements that I often heard expatriates, including health and humanitarian aid agency staffers, make about Việt Nam and its administrative culture. For example, I had heard foreign public health professionals complain that the Vietnamese health sector held over “Soviet” qualities that created inefficiency— bureaucracy, proceduralism, factionalism, favoritism, and information “siloing” and “stovepiping.” Given this, it might have been possible to write off these critiques as the politically colored perspectives of outsiders. But I also heard similar comments about state statistics from Vietnamese researchers whose opinions I respected. On multiple occasions scientists and health policy experts commented to me that the state’s epidemiological data—from the socialist period to the present—could not be accepted at face value. For example, a scientist who had worked at the National Institute of Hygiene and Epidemiology since the mid-1970s opined that there might be no way at all of clarifying the epidemiological records from the socialist period. “There probably is no such thing,” he said when I asked about the reliability of statistical records from the decades in question, and added: “Even today, they may be made up.” Later, he sent me an email: I spoke with a colleague who is a professor of around 70 years old about statistics in the 1940s–1970s. He said that the concept of statistics at that time was very vague (mơ hồ) and all the statistics only incrementally represent (chỉ mang tính công đơn) cases or events, etc. So if you want to research that concept in that period, it didn’t exist at all. (personal communication, July 24, 2015)

128

Epidemic Politics in Contemporary Vietnam

Another researcher told me that at some point before the introduction of computerized databases, NIHE had run out of space for its collection of statistical records and so destroyed its physical archives. As a result, he said, only province-level data remained, as records collected at lower administrative levels had all been disposed of. I could not independently confirm the report of destroyed records, but I was more inclined to accept the possibility after a visit to the library of Hà Nội Medical University, the nation’s premier medical training institution. As of Summer 2015, the library had deaccessioned some of its older materials, such that catalogued items from the late 1970s and early 1980s, once held in a closed-stack system, were no longer available in any form. A librarian presented me with a volume from 1991 with an apology that it was “rather old.” Vietnamese researchers also suggested to me that despite the nation’s economic liberalization and its increased openness to outside agencies, a command-economy ethos continued to inform the collection of epidemiological data by state agencies. One friend with experience in policy work described how officials finessed reports: “Say the quota for the number of traffic fatalities per month is fifty, but there are actually sixty cases one month. There will be consequences if they say it was sixty. So, they will report fifty and save the extra ten for later, reporting them in a month where they can fit.” An observation in my field notes suggested a similar small-scale manipulation of case counts. A friend emailed to tell me, “I’ve recently started working with a woman at NIITD [the National Institute of Infectious and Tropical Diseases] who told me that right now there are seventy confirmed cholera cases in her hospital” (personal communication, July 2010). The same day, the daily newspaper Tuổi Trẻ published the following: According to Mr. Nguyễn Hồng Hà, the vice director of National Institute of [Infectious and] Tropical Diseases, the number of acute diarrhea patients hospitalized has risen in recent days. Counting from June 28 to July 7, there were 135 patients with diarrhea hospitalized; the first round of tests had fortyfive cases testing positive with cholera. (Tuổi Trẻ 2010)

On another occasion, a Vietnamese colleague laughed as he handed me a copy of the new edition of the national infectious disease yearbook, explaining in English that some of the numbers were “bullshit.” He pointed out that the numbers for communicable diseases were generally much the same from year to year and added, “They decide in advance what the numbers will be.”

Statistics and Their Discontents

129

Taken together, these accounts suggest a wide range of problems in the evidentiary basis of public health in Việt Nam—from technical limitations to destruction of records; from pressure to confirm narratives of progress to unfamiliarity with statistical methods and procedures. While it is beyond the scope of this chapter to untangle and disambiguate these specific inputs into the statistical representations that ultimately are accepted as fact, it is important to note the forces that bear on statistics and their production in Việt Nam, particularly in the period following market transition. In the background is the fact that the nation’s health system and health outcomes have been intensely politicized—held either to reveal the remarkable achievements of a low-income socialist country or to represent the systemic failures of a totalitarian regime.

Local Bits of Lore As the adage goes, the plural of “anecdote” is not “data”—and thus these unsystematically collected comments by individual scientists and public health professionals cannot be used to craft a complete account of the limits of epidemiological statistics in Việt Nam. In one sense, these anecdotes represent faulty data about data that are differently faulty. It is likely untrue, for example, that all the epidemiological data recorded by the Ministry of Health are concocted or have no relationship to reality. However, widespread skepticism among Việt Nam’s health professionals about the accuracy of national epidemiological data sets indicates at a bare minimum that state-generated statistics have broadly failed to appear persuasive and have become, at least in some professional circles, an object of suspicion. When I began research on the outbreaks, I hypothesized that cholera had appeared in connection with new socioeconomic disparities that were generated and exacerbated by market transition, yet remained hidden in aggregate macroeconomic metrics such as gross domestic product. This expectation of a conclusive Q.E.D. was slowly replaced by a more nuanced perspective—in part because my interlocutors in health agencies shared so much critique about the meaning and reliability of statistics. Too, it was impossible to conclusively establish the precise prevalence of cholera or to demonstrate its association with poorer populations or geographic areas, given the desire of state agencies to protect that information. Nonetheless, it is still possible to make clear claims about the meaning of cholera and the factors that contributed to its spread. I ultimately

130

Epidemic Politics in Contemporary Vietnam

appreciated that while epidemiological statistics might not offer a perfectly transparent window on reality, the critical study of statistical representations could offer an important means of understanding the politics of health. In an article reflecting on the fraught situation of epidemiological statistics on the HIV/AIDS pandemic in Việt Nam, medical anthropologist Alfred Montoya acknowledges that weak data and weak data systems pose serious methodological challenges for health researchers in that nation, writing that “as in many places, biological and behavioral surveillance data are virtually always incomplete and contestable, even as such data has become an essential driver of funding and programming” (Montoya 2013, 35). This poses a conundrum: though these data are not entirely reliable, health policymakers and advocates depend on them. By way of resolution, Montoya concludes that “[o]perating effectively requires being plugged into the loose ‘community’ of HIV/AIDS prevention and control and being ‘in the know,’ privy to local bits of lore, as much as it does mastery of the technical aspects of analysis and intervention” (Montoya 2013, 53). Essentially, Montoya argues that anthropological research, or research with an anthropological bent, offers the best possible means of bringing into focus a descriptive, accurate, and nuanced picture of the situation of Vietnamese health—given that official statistics are overdetermined by multiple competing interests and often fail to present an accurate picture of social and epidemiological realities. Unraveling the story of cholera epidemiology and statistics in Việt Nam, this chapter responds to Montoya’s call for “mastery of the technical aspects of analysis” and for accounts that draw on “local bits of lore.”

Discrepant Statistics In review, to define a disease event as an “epidemic” requires comparing the incidence of cases to the historic baseline prevalence of the disease in a population. Counterintuitively, this can mean that a disease event, however apparently sudden and surprising, may not qualify as an epidemic. As I worked to keep track of the cholera case counts in the news and official sources and to document the history of cholera in Việt Nam, it appeared progressively less likely that a single comprehensive account of cholera epidemiology could be constructed. Normatively, cholera surveillance data in Việt Nam have, at least since the 1990s if not longer, been aggregated from reports collected at the district

Statistics and Their Discontents

131

level: “[H]ealth centers collect surveillance data from each commune and report them monthly to 1 of 61 Provincial Preventive Medicine Centers, which then report the data to one of four regional Pasteur Institutes under the direction of the NIHE” (Dalsgaard et al. 1999). As Dalsgaard et al. further note, the reports of district centers often rely on clinical definition, without culture of specimens. However, there are other ways that inaccuracy creeps into statistical accounts of the local incidence and prevalence of cholera, as both my field experience and review of the relevant literature suggest. No single published source documents annual cholera case counts and fatalities across all provinces of Việt Nam over the twentieth century; a unified account can only be arrived at by piecing together disparate sources, some of which contradict each other. If Việt Nam’s baseline epidemiological data were not completely trustworthy, it would mean—among other things—that it might be difficult to establish whether a disease event constitutes an epidemic or not. During the first wave of the cholera outbreaks, one blogger—Hồ Chí Minh City-based medical doctor Phan Xuân Trung—argued exactly that. Cholera was not actually all that anomalous in Việt Nam, he suggested, and thus no one should be surprised by its return. Following the statements of all the high-ranking national health officials closely, we could only shake our heads. Not only because they speak in a way that’s hard to understand, but they also make us doubt that they have a thorough grasp of the information. (…) Specifically, like the statement in Dân Trí, in which Dr. Nguyễn Huy Nga, Director of the Department of Preventive Health, stated “We cannot believe that a type of epidemic which usually only happens in backwards (lạc hậu) places could occur right in the midst of the capital city, Hà Nội.” I’m extremely surprised that the director is surprised! Cholera has existed in our country for a long time, and has been written down on white paper with black ink since the nineteenth century. At the present time, every year in our country the number of cholera [cases] may rise and fall, but the average is around 1750 people; in that number there are around twenty percent from the northern provinces and Hà Nội. These numbers are very clear in all scientific articles (…) So how can he be surprised? (Phan Xuân Trung 2007)

Dr. Trung’s argument—implying a long history of endemic cholera—put forward an interesting reversal of the generally accepted association between cholera and “backwards” conditions, presenting Hà Nội’s apparently anomalous outbreaks as, instead, predictable and continuous with historically established precedent.2 In this view, the more recent outbreaks I discuss in this book barely satisfied the

132

Epidemic Politics in Contemporary Vietnam

definition of an epidemic; with this claim Dr. Trung implied that by dint of its historic failure to control disease, Việt Nam had never been modern. But Dr. Trung’s analysis also failed to take into account one important piece of the puzzle. If cholera epidemiology over Việt Nam’s history had mostly gone unmeasured, then it would also be highly likely that the outbreaks were similarly undercounted. Contextual factors suggest the likelihood that the true burden of disease caused by the cholera outbreaks of 2007–2010 was incompletely documented: underreporting of cholera is common not only in Asia (Zuckerman et al. 2007) but throughout the world: Mead et al. (1999) recommend multiplying case numbers by two as a means of estimating disease prevalence more accurately. Furthermore, foodborne infections are both poorly documented and highly prevalent in Việt Nam; medical doctor Punnee Pittisuttithum argues “foodborne illnesses have been considered to be the most widespread public health problem and the second leading cause of illnesses and mortality, even though they have been highly underreported” (Pittisuttithum 2007, 726, emphasis added). Beyond these broad tendencies, policy decisions actively contributed to undercounting of disease during the cholera outbreaks. As mentioned previously, the Ministry of Health used the terms “acute diarrhea” (tiêu chảy cấp) and “dangerous acute diarrhea” (tiêu chảy cấp nguy hiểm) to describe clinical, or symptomatic, cases of cholera; official ministry announcements and recommendations omitted the term “cholera” completely (c.f. Ministry of Health of Việt Nam 2007a, 86–8). These practices ran counter to the protocols of the World Health Organization (WHO), which state that a cholera epidemic may be declared after just one case of cholera has been confirmed—after which point “it is not necessary to make a distinction between suspected and confirmed cases; all should be reported as cholera” (World Health Organization 1992, 5). Vietnamese law makes the same provision: Decision 4233 states, “A cholera epidemic can be confirmed when at least one case of cholera has been confirmed” (Ministry of Health of Việt Nam 2007b). But as one health official stated to a skeptical journalist, “Don’t worry about the name” (Nam Nguyên 2007). The Ministry of Health continued to distinguish between laboratory-confirmed cases and symptomatic cases of cholera long after the confirmation of the index case, minimizing case counts, and also continued to describe the outbreak as “acute diarrhea” to mitigate public concern. Further contributing to undercounting, it’s possible that some infected individuals purchased over-the-counter antibiotics to treat their symptoms and thus never entered health facilities for treatment; poor families in Việt Nam are more likely to self-treat diarrheal illness, regardless

Statistics and Their Discontents

133

of symptom severity (Lương et al. 2007), and antibiotics are widely used and can be purchased without a prescription. My data collection found a prevalence of cholera diagnoses that far exceeded the reported rate of cholera morbidity. The officially notified per capita rate of cholera infections over 2007–2009 in Hà Nội—as expanded to include rural districts in 20083—was 0.0004 percent, or four cases for every ten thousand people. In my non-statistically significant sample of 118, a total of 6 respondents, or 5 percent of the sample, reported having a cholera infection during the 2007–2009 outbreaks: a respondent’s child in Hoàng Mai district, a thirty-eight-year-old woman in Hai Bà Trưng district, a seventy-four-year-old man and a forty-five-year-old woman in Long Biên district, and one man and one woman in Hoàn Kiếm district, both aged forty-four at time of interview. While this is a non-generalizable finding given my study’s lack of statistical power, the unexpectedly high case rate I identified in a small sample suggests that the prevalence of cholera might have exceeded the statistics published in media and official reports, perhaps by a substantial multiplier. As this suggests— and as Dr. Trung’s critique underscores—to rely on official epidemiological statistics necessarily yields a limited and potentially misleading understanding of the possible scope of cholera infection. The true prevalence of cholera, though unknown, seems potentially to have exceeded reported case counts.

Behind the Façade When I attempted to construct a table aggregating cholera case counts in Việt Nam over the twentieth century, I found that reports varied between sources by dozens and sometimes hundreds of cases. From the colonial period to the present day, Việt Nam’s health and welfare statistics are marked by significant indeterminacies. Statistical documentation of disease trends and other indicators of public health begins in the 1880s during the French colonial period, but these data are not highly reliable. Even raw population counts in colonial Indochina are acknowledged to be “of very poor quality” (Hirschman 1994, 393), and French records of disease morbidity and mortality in the Vietnamese population were likely undercounted, given the limits to colonial governmentality and the resistance of Vietnamese populations to intrusive measures like the registration of deaths. During the revolutionary period, despite the Democratic Republic of Việt Nam’s (DRV) improved medical capacity and the expansion of a vital registration

134

Epidemic Politics in Contemporary Vietnam

system (Bryant 1998, 236), the exact prevalence of disease in the population was unknown. From 1945 to 1954, wartime conditions posed significant challenges to any regular collection of statistical data in Việt Nam and though some figures exist, how well state statistics represented lived experience remains unknown. However, accounts that privilege the state’s successes in building a health system—which frequently cite statistics in disease reduction to support claims about the ingenuity and dedication of the medical corps—may perhaps benefit from more critical treatment. The consequences of the First Indochina War were devastating for civilians as well as combatants. As historian Christopher Goscha writes, “Death had many faces” (2011, my translation); illness “sowed great burdens of death” across the country, and disease was “the worst enemy of the guerrilla” until at least 1950. Land reforms in North Việt Nam achieved only part of their goals to increase popular well-being. The medical infrastructure serving the Vietnamese population in this period also remained rudimentary and inadequately staffed; Goscha describes the university and medical schools in Hà Nội as “a heterogeneous collection of thatched houses.” Historian Philippe Papin expands on Goscha’s argument that during the period of revolution and war, “eloquent statistics” gave the appearance of substance to a threadbare Vietnamese state: We cannot be sure of really knowing what existed behind the façade. We see ministries, offices, departments of public health, public servants and cadres, a whole network of administration, police and military, a pyramid of skillfully boxed authorities; but the further we strain our neck to see, the more we get the impression that there is not much behind the façade. (Papin 2012, 29)

Although critical histories such as these have improved the view of outsiders into the material situation of Vietnamese communities in the twentieth century, it remains challenging to peer behind the façade—which is now replicated, sometimes inadvertently, in the historiography of Vietnamese public health. The frequently repeated and, in ways, unlikely narrative of the state’s continuous achievements in public health can be nuanced by critical research drawing on primary documents, as in the work of anthropologist Ken MacLean. Citing Ministry of Labor archives that suggest the limitations to public health capacity in the DRV, MacLean complicates the triumphalist story of socialist public health. As mentioned in Chapter 1, by the mid-1960s, official sources reported that the national health care system had extended services to almost the entire population. However, ministry archives reveal that in the early 1960s,

Statistics and Their Discontents

135

between 12 and 14 percent of the population on agricultural cooperatives in North Việt Nam was ill at any given time “due to unsanitary food conditions” (MacLean 2013, 103). Following the land reforms in North Việt Nam, the “Three Cleans” campaign apparently failed to secure its intended goal of maintaining a healthy and productive workforce: cooperative members were falling ill at such a high rate that, according to Ministry experts, their absence from work would ultimately bankrupt the cooperatives (MacLean 2013, 105). Although the story of Việt Nam’s improved public health outcomes under socialism and during war is frequently repeated, independent accounts substantiating this narrative are few—in part because the country was largely inaccessible to outsiders between the August Revolution in 1945 and the normalization of relations with the United States in 1993. First-hand accounts of  wartime conditions include the reports of scientists and other scholars who were allowed into the Socialist Republic of Việt Nam during the Second Indochina War as members of academic, scientific, or political delegations; their reports provide suggestive but limited glimpses of the country’s public health. British scientists who participated in a wartime delegation to Hà Nội commented: “The health statistics of North Vietnam, if related to those of the surrounding countries, stand out like a bright light in an epidemiologically dark world” (Rose and Rose 1971, 135). Botanist Arthur Galston and biologist Ethan Signer, visiting Hà Nội in 1971, also cite statistics that were shared with them by the Director of Hospitals of the Ministry of Health, telling a familiar story of dramatic disease reduction after the end of colonial rule (Galston and Signer 1971, 382). More cautiously, molecular biologist Mark Ptashne, who also visited Hà Nội with a scientific delegation, wrote, “The North Vietnamese claim to have essentially eliminated the major diseases which ravage the peoples of Asia (…). I cannot verify these claims, but the general health of the people of North Vietnam contrasts sharply with that of the residents of Vientiane or Saigon” (Ptashne 1971, 22). (By contrast the critic Susan Sontag, who participated in a delegation to the SRV in 1968, took uneasy note of the official preoccupation with statistics in her essay “Trip to Hanoi” [Sontag 1969].) Descriptive statistics on disease in this period tend to repeat from source to source. In a 2007 article, medical doctor Myron Allukian and American studies scholar Paul Atwood claimed that as early as 1973, even before the conclusion of hostilities, cholera was controlled in North Việt Nam along with plague, smallpox, malaria, and sexually transmitted infections—a remarkable accomplishment amid war, the authors note (Allukian and Atwood 2008, 328). Demographer Judith Banister quotes SRV statistics stating that “the incidence

136

Epidemic Politics in Contemporary Vietnam

of contagious diseases during 1978–80 indicate[d] that cholera, plague, typhoid fever, diphtheria, measles, whooping cough, and polio were well contained by 1980” (Banister 1985, 97). The first WHO representative in Hà Nội approvingly remarked that “the whole of Vietnam can be considered as one well-designed [primary health care] project” (Allman 1993, 324). Even the World Bank praised Việt Nam’s improvement of social welfare indices during the postwar period (Allukian and Atwood 2008, 325). However, some of these optimistic appraisals are still difficult to take at face value. In a rare dissent, sociologist Charles Hirschman and collaborators question how Việt Nam’s stated rates of mortality reduction in the 1960s and 1970s could have been achieved in wartime in a “very poor country that lack[ed] modern medical technology and medicines” (Hirschman et al. 1995, 787). Hirschman et al. are right to wonder about this, and the same question could be posed relative to public health reports from the 1980s, when—as noted in Chapter 1—the health system faced serious shortages of basic supplies. State capacity for data collection—even the most basic vital statistics—was thoroughly compromised by war. Both the death toll of the Second Indochina War and the war’s impact on surviving populations remain uncertain, with questions enduring about the long-term health effects of combat exposure and herbicide spraying (Fox 2003; Hirschman et al. 1995; Teerawichitchainan and Korinek 2012). In the postwar period, a far-reaching trade and diplomatic embargo stifled the domestic economy and pressured international agencies like the International Monetary Fund and the Asian Development Bank to refrain from providing support to Việt Nam (Fallows 1991). The immediately postwar period was marked, probably nationally, by very serious food shortages and shortages of medicine as a result of embargo and disrupted production. The country suffered from abysmal levels of poverty; a cholera epidemic occurred immediately after reunification. In 1979, the first nationally representative census was collected, allowing a more comprehensive accounting of the welfare of the public (Banens 1999, 2), but it included only partial reports from the south (Banister 1985, 13). Demographer Judith Banister assessed morbidity and mortality data from the early 1980s as “overly optimistic” and warned against “uncritical acceptance” of the reported death rate in particular (Banister 1985, 18). Seven years into market transition, Banister further suggested “evidence is inconclusive regarding whether health and mortality conditions in Vietnam today are improving, stagnating, or even deteriorating” (Banister 1993, xii).

Statistics and Their Discontents

137

Scholarship on Việt Nam’s health sector in the postcolonial period has, of necessity, relied on data that—while documenting significant successes in disease eradication, mortality reduction, and other public health outcomes— can only be described as weakly triangulated. On the basis of state-reported statistics, outside analysis has frequently assumed that national population health measures were indeed improved significantly under socialism and then retrospectively nominated social factors that could have been responsible for these outcomes—such as collective landholding, the improvement of sanitation and education levels, mass mobilizations, state-sponsored transfer of food to deficit regions, and the empowerment of women (Bryant 1998, 247–8; Malhotra 1999, 13). These post hoc analyses presume the statistical reports of the Vietnamese state to be accurate. But given that basic demographic data in Việt Nam were only collected irregularly from the 1930s to the 1970s (Banens 1999, 2) and that no national population census was conducted until 1979, population and epidemiological trends during this period remain “to a large extent unknown” (Barbieri et al. 1996, 211). The lack of a unified version of epidemiological reality makes it difficult to assess whether the cholera outbreaks that began in 2007 were indeed an anomaly—a radical break with public health achievements of the post-transition period—or whether cholera had lurked endemically in the region for years, benefiting opportunistically from factors found in the natural environment, in built environments, and in the country’s political economic arrangements. If it were the case that cholera had been essentially endemic in Việt Nam over the twentieth century, the socialist period would retrospectively appear a less triumphant success, perhaps calling into question the national narrative of broad disease eradication. It would suggest—like Dr. Trung stated in his blog post about the history of cholera written “in black ink”—that cholera found a niche despite mass public health mobilization, just as it had amid a national economic boom.

Insufficient Data Imprecision continues to crop up in literature on cholera in Việt Nam, even in very recent publications. In an article that appeared in Vaccine in 2020, Lopez et al. wrote that “Vietnam reported 51 and 3 confirmed cholera cases in 2011, with no subsequent reported cases” (Lopez et al. 2020, A18). The same year, in a discussion of the global epidemiology of cholera published in the same journal,

138

Epidemic Politics in Contemporary Vietnam

Deen et al. wrote, “Vietnam has reported no cases of cholera since 2012” (2020, A34). Just a little difference: no cases since 2011 versus no cases since 2012. This minor discrepancy is the tip of an iceberg of problems in the statistical documentation of cholera in Vietnamese history. For example, in an article on the history of cholera in Việt Nam, microbiologist Anders Dalsgaard and his Vietnamese collaborators N.V. Tam and P.D. Cam noted the lack of context for the epidemiological trends they observed and also speculated in passing about a more general tendency for cholera data to be undercounted: No data were available to explain the low number of cases reported to NIHE in 1989, 1990, and 1991 from some regions of the country. In spite of the defects of the current system for health data collection, an increase in the reported cholera cases seems to have occurred in recent years (…) The reason(s) for this increase is unknown. (Dalsgaard et al. 1997, 70)

It remains challenging to establish how errors work their way into more recent reports of cholera in Việt Nam. For example, in 2008, the country office of the WHO published a “cholera country profile” providing an overview of the 2007 and 2008 outbreaks in the northern provinces and establishing the historic background of the prevalence of cholera in Việt Nam. In all, the WHO report provided a strongly positive impression of Việt Nam’s efforts to control cholera, especially during the postwar period. Drawing on figures from the WHO Global Health Atlas (personal communication, Dr. Tamano Matsui, August 10, 2010), the statistics published in this report diverged significantly from data that appear elsewhere, showing case counts in the single and low double digits from 1950 to 1963 and few cases from 1970 to the early 1990s, with one significant outbreak from 1964 to 1969. Notably, the report also claimed that “Vietnam became a French colony in 1951” and that the Second Indochina War lasted from 1959 to 1975 (1965–1975 are the most commonly cited dates). The WHO report’s graph of historic cholera counts contained other questionable claims. Its report of few cases throughout the 1950s is a puzzling contrast to the claim by Minister of Health Phạm Ngọc Thạch that intestinal infections were “rampant” in the interwar period. The WHO data seem to further understate the scope of cholera in the post-reunification period, with WHO Global Health Atlas figures citing approximately 1,000 cases in 1976, 32 cases in 1977, and 2 in 1978. These case numbers describe—or are intended to describe—an outbreak that took place in the coastal city of Hải Phòng and in Quảng Ninh province, associated with a “massive repatriation” of individuals

Statistics and Their Discontents

139

who had fled across the seventeenth parallel in 1954 after the Geneva Conference (Dang Nguyen Anh et al. 2005, 288). By contrast, one international NGO, also citing Ministry of Health figures, states that national cholera prevalence in 1976 reached 43.4 per 100,000 populations (Föreningen Levande Framtid 2006, 5). If this datum is even close to accurate, it would indicate an astonishing burden of disease—far greater than the WHO’s count; this high rate of infection is conceivably in keeping with the context of the extremely challenging postwar situation. After the close of hostilities, Việt Nam was one of the absolutely poorest countries in the world (Glewwe et al. 2004, 1), suggesting the potential for waterborne disease to travel rapidly in association with limited sanitation and food insecurity. Evidence for a significant post-reunification outbreak of cholera is also provided by a rigorously researched article, “Cholera in Vietnam: Changes in Genotypes and Emergence of Class I Integrons Containing Aminoglycoside Resistance Gene Cassettes in Vibrio cholerae O1 Strains Isolated from 1979 to 1996” by Dalsgaard and collaborators (1999). Where the WHO’s graph suggests that not more than roughly 15,000 cases of cholera were reported over this period, Dalsgaard et al. show that after 1976, high cholera case counts persisted for years in Việt Nam: between 1979 and 1996, the country reported a total of 56,050 reported cases of cholera and 1,272 deaths (Dalsgaard et al. 1999; Thuong V. Nguyen et al. 2017). Historian David Marr has written that in the years following reunification, both “cholera and plague refuse[d] to be eliminated” (Marr 1988, 26). These accounts are consistent with other qualitative accounts of the immediate postwar period and early 1980s, which describe rampant poverty, limited health sector capacity, and high prevalence of infectious disease. These discrepancies not only generate confusion for scholarship; they raise questions about the WHO’s use of statistics in presenting a particular vision of Vietnamese public health to the broader global health community. Although the WHO “transmits cholera data as reported by national authorities” (WHO 2020c), the WHO data diverge widely from the reports of other sources, including Vietnamese state sources themselves—leading to questions about the multiple interests that take form in contradictory statistical accounts. The creation and circulation of competing epidemiological realities appear to be ongoing. In 2020, a WHO chart documenting cholera counts in Việt Nam from 2002 to the present indicated that “3.00” cases of cholera were reported in 2011 (without any indication of a per-population metric) and represented annual case counts in the outbreak years of 2007 to 2010 as “0, 0, 0, 0” (WHO 2020d). The reasons for these inaccuracies are unclear.

140

Epidemic Politics in Contemporary Vietnam

“So Many Careless Things” Dr. Thảo and Dr. Xuân were not the only ones casting a critical eye on state science. For example, they both enjoyed reading a weblog by a Vietnamese expatriate scientist whose gloves-off accounting of the cholera outbreaks offered a refreshing response to what they perceived as the misdirection and prevarication of official reports. From time to time, Dr. Xuân laughed with me over what Dr. Nguyễn Văn Tuấn published on his homemade website, modestly titled “tuan’s blog”—opinionated commentary with titles like “Water Is More Important than Shrimp Paste” (2007a) and “Shrimp Paste Is Innocent!” (2008a). Dr. Tuấn disavowed any interest in the political significance of the cholera outbreaks in an email exchange with me, insisting he was “completely uninterested in the connection between cholera and politics,” but the diction of his articles suggested that it was impossible to keep politics out of his critique. Particularly, he made use of legal terminology, arguing that shrimp paste was “innocent” (vô tội) and employing terms such as “convict” (kết tội), “culprit” (thủ phạm), and “damages” (thiệt hại) (Nguyễn Văn Tuấn 2007a, 2008a). In a setting where bloggers were facing prosecution on charges including subversion and propaganda against the state (Thayer 2009), these critiques resonated with other issues in national politics. In all, Tuấn’s writing set forward blunt challenges to official claims, underscoring how statistics and epidemiology were being used to obscure information that might be both beneficial to public health and politically compromising. In a blog post addressed to the head of the Food and Safety Bureau, he wrote, “[A] high-level health [leader] stating so many careless things (nhiều điều quá sơ sài) is rather remarkable. To plan your policy without relying on scientific evidence is absurd and dangerous” (Nguyễn Văn Tuấn 2008a). Tuấn’s articles also critiqued the flaws in the state’s outbreak investigation and the reporting of the epidemic in state media—pointing out, for example, that the Ministry of Health persistently conflated the concepts of risk factor (yêu tố nguy cơ) and cause (nguyên nhân), making the correlation of shrimp paste and dog meat consumption with cholera appear to be a causal relationship. This epidemiological fallacy obscured the possibility that food prepared with contaminated water was the cause of infection. Furthermore, the lack of a control group in epidemiological reports from the Fall 2007 outbreak, Tuấn argued, made the ministry’s conclusions regarding cholera risk factors meaningless. Dr. Tuấn was joined in critique of state statistics and disease response by Dr. Phan Xuân Trung, the general practitioner and blogger who had alleged

Statistics and Their Discontents

141

that cholera “has existed in our country for a long time.” In a blog post titled “Language in the Time of Cholera,” Dr. Trung critiqued the Ministry of Health for failing to assume leadership in the outbreaks, deferring its responsibility to mass media and propaganda agencies, and issuing unclear information regarding disease prevention (Phan Xuân Trung 2007). On another occasion, Dr. Trung published a political cartoon lampooning the health services’ conflation of correlation with causation. In the first panel, a politician exclaimed to a flustered physician, “Strongly forbid all the citizenry from brushing their teeth! Destroy toothpaste! Confiscate toothpaste!” In the second panel, he explains: “Because 100 percent of diarrhea patients used toothpaste to brush their teeth before becoming sick!” (Phan Xuân Trung 2008). Another observer of the 2007 cholera outbreak argued that what circulated publicly about the cholera outbreaks was “science lacking information, and information lacking science” (Nguyễn Đình Nguyên 2007). Although their critiques focused primarily on failures in domestic health policy, these three scientists were also attuned to the failure of international nongovernmental organizations to respond to the cholera outbreaks. In Spring 2008, Dr. Jean-Marc Olivé—the country representative of the WHO—issued a statement recapitulating the Ministry of Health’s improbable claims about dog meat, as described in Chapter 4. Olivé stated that “[e]ating dog meat or other food from outlets that serve it is linked to a 20-fold increase in the risk of developing the severe acute watery diarrhea commonly caused by the cholera bacterium” (Bennett and Nguyen 2008). It is curious that in his statement, Olivé recapitulated the state’s misdirection by suggesting that infection by the cholera bacterium and the symptoms that it caused were not one and the same. Dr. Tuấn and collaborators Phan Xuân Trung and Nguyễn Đình Nguyên responded to this statement with an open letter addressed to Olivé and the head of NIHE; in part, their letter read: 1. In your comment to Bloomberg.com, you state that dog meat is linked to a 20-fold increase in the risk of cholera. We would like to know where this figure comes from. We specifically would like to know how many individuals were studied, what pathogens were tested in dog meat (and other meats or vegetables), and what was the magnitude of association (i.e., odds ratio and confidence interval) between these potential risk factors and cholera. 2. Moreover, as we understand from the popular media, 194 samples of shrimp sauce have been tested for V. cholerae and all were negative for the bacterium. We are therefore curious to find out the basis for the following statement: “Contaminated shrimp sauce caused at least 157 cholera cases in November and December.”

142

Epidemic Politics in Contemporary Vietnam

3. We are also concerned about your interpretation of data. Because the unpublished study was designed as a case-control investigation, it is not possible to make any inference on the cause-and-effect relationship between any of the risk factors examined and cholera risk. However, the terms “cause” and “link” have been reported in various media outlets, and this has unfortunately generated considerable confusion in the public. (…) We consider that the Vietnamese public is entitled to be informed of important information of the current cholera outbreak. However, it is equally important that the public is not misinformed as is likely to occur in the absence of published comprehensive evidence. We are sure you understand that in medical research the real news is the scientific evidence, not the public claim. (Nguyễn Văn Tuấn 2008b)

In his response, Olivé eluded the scientists’ challenge, stating that NIHE had conducted the investigations and that interested parties should therefore contact NIHE (Nguyễn Văn Tuấn 2008b). Tuấn expressed frustration at the nonresponse, but it could not have come as a great surprise. Although the WHO had carried out diverse activities in outbreak response—providing technical and logistic support to the Vietnamese Ministry of Health, carrying out a case control study with the US Centers for Disease Control, and providing rapid diagnostic tests (WHO 2008)—its officials were reluctant to put forth their own analysis.

An Evening at the Embassy One evening during my fieldwork, my Fulbright cohort was invited to a reception at the US Embassy in Hà Nội—the kind of swanky, elaborately catered occasion that inspired uncomfortable cognitive dissonance with its contrast to my everyday surroundings of unheated apartment, shared university office with lots of hardworking colleagues and students coming and going, and fieldwork with low-income families. To boot, I found myself chatting with the ambassador himself, making small talk and fielding questions about my research. Ambassador Michalak graciously commented that my topic sounded interesting and requested that I share my findings down the line, then moved on to greet the other guests. I took note of his failure to comment more substantively and

Statistics and Their Discontents

143

wondered what the US Embassy knew about my research topic. In 2010, the trove of diplomatic cables released by Wikileaks included a document that spoke to that issue. It appeared that Ambassador Michalak had been thoroughly briefed on the inter-agency debates over the second wave of cholera and its management. UNCLAS SECTION 01 OF 03 HANOI 000588 SENSITIVE SIPDIS E.O. 12958: N/A TAGS: TBIO AMED AMGT CASC EAGR PINR VM SUBJECT: MOST RECENT CHOLERA OUTBREAK RECEDES Officials report that Vietnam’s most recent outbreak of severe acute diarrhea is winding down. Though the Government of Vietnam (GVN) again responded promptly and effectively, victims from northern provinces that traveled to other parts of the country infected other people, demonstrating the ease with which a cholera outbreak could spread and spin out of control. (…) As in the past, questions remain about how to refer to this outbreak. JeanMarc Olive, WHO Country Representative, reluctantly agreed with the GVN to use the title “acute diarrhea epidemic partly sourced from cholera” to describe the initial outbreak. Though the Ministry of Health readily acknowledged the large number of cholera victims, the Prime Minister’s office directed the MOH to generally refer to “severe acute diarrhea” and only use the term cholera for specific cases that had tested positive for the bacteria. While this label may pass the smell test, some local media have raised questions as to whether this title will cause Vietnamese citizens to change their risky behaviors. Vice Minister of Health Trinh Quan Huan defended use of the name and stated that referring to the outbreak as “cholera” would not cause people to improve sanitation practices. After all, Vietnamese knew they should not eat sick chickens, but many still do and many men continue to have unprotected sex despite well-publicized warnings that they should use condoms. However, according to a recent survey by an online newspaper, many Vietnamese were not concerned by the epidemic because they thought it was just another diarrhea outbreak. In private discussions with the GVN, CDC and WHO experts noted that most of the people with acute watery diarrhea have cholera and that it makes public health sense to label this event as such. Fortunately, clinicians in

144

Epidemic Politics in Contemporary Vietnam

Vietnamese hospitals and clinics treat every case of acute watery diarrhea as cholera. (Michalak 2008)

The cable contained a number of surprises, permitting a look behind a carefully measured and indeed diplomatic façade. As noted, it revealed the Embassy’s granular awareness of struggles over the proper descriptor for the cholera outbreak, which were—as the Ambassador acknowledged—contributing to a diminished statistical awareness of the burden of disease. Further the cable suggests a circumscribed role for international, and perhaps particularly American, agencies attempting to influence outcomes in the Vietnamese health sector. Michalak’s cable further implies a significant shift in state priorities around public health. This is revealed in the skepticism of the Vice Minister of Health regarding the possible positive impact of public communications about health promotion and disease risk. Where the Vietnamese state once, as earlier chapters have described, prided itself on its comprehensive extension of preventive health care and services to the population, particularly emphasizing popular mobilizations based on health education and information, this cable reveals a changed tack in the management of cholera—from education to obfuscation. In continuing to refer to cholera as “acute diarrhea,” the Ministry of Health essentially retreated from its former emphasis on education and accepted the inevitability of future infections, while relying on clinicians to diagnose and treat patients correctly and effectively. Given that Vietnamese hospitals treated “acute diarrhea” as if it were cholera, fatalities were for the most part avoided. However, as Michelle Murphy has written in her assessment of the invention of oral rehydration therapy, this approach to disease management “moved the prevention of death away from water and sanitation management to dispersements of inexpensive emergency medicines administered near the brink of death … prevent[ing] mortality, not morbidity” (Murphy 2017, 100– 1). In refusing to develop systemic interventions to prevent cholera or even identify it as such, deferring disease management to hospital clinicians, the Vietnamese state was essentially doing likewise—albeit for a slightly higher cost per patient. Where the state had formerly identified the elimination of reservoirs of cholera in the population as a major public health priority, its insistent use of a misnomer for cholera revealed an agenda rebalanced toward preventing poor public relations, not preventing infections. But lastly, and most significant of all, this cable suggests that the production of “papereality” in cholera statistics was not, on this occasion, the byproduct of

Statistics and Their Discontents

145

low-level bureaucrats protecting reputations or maintaining appearances. It was ordered at the highest levels of the Vietnamese government, with the awareness and “reluctant” compliance of two major global health stakeholders, the WHO and the US Centers for Disease Control.

NGOs in Việt Nam As global health and humanitarian aid organizations have come to occupy an increasingly significant share of public health work in low-income nations, anthropologists have critically noted their limitations: their pursuit of a narrow and depoliticized mandate, their provision of temporary fixes, and their inattention to the role of structural disparities in creating ill health (c.f. Farmer 2005). Some critical assessments of nongovernmental intervention to provide assistance to the survivors of disaster are deeply bleak in their implication that the administration of crisis relief inevitably fails to recognize civil, social, or human rights frameworks (Redfield 2013). In formerly socialist countries, the activities of international aid agencies suggest a sea change in the geopolitical terms of humanitarian assistance—as a former president of Médecins sans Frontières observed, the demise of socialist bloc was arguably the instigating force in a global “renaissance of nongovernmental humanitarianism” that began in the 1990s (Fassin 2007, 509). At face value, postwar Việt Nam would appear susceptible to the NGOification of its health and human services sectors, given enduring economic challenges, epidemiological concerns—particularly in South Việt Nam after reunification—and its reliance on foreign aid. Indeed, though much of Việt Nam’s foreign aid in the revolutionary period came from COMECON countries,4 the government of Việt Nam has authorized support of the health sector by agencies outside the socialist bloc since at least the 1960s, even when such activity was curtailed in other sectors. The Dutch NGO Medical Committee Netherlands Việt Nam began working in North Việt Nam in the 1960s, and the Britishbased Medical Aid Committee for Việt Nam was established at the beginning of the Second Indochina War to support “the countryside of South Vietnam within the administration of the National Liberation Front” (British Medical Journal 1966, xxiv). In the 1970s, the newly founded French relief organization Médecins sans Frontières also supported war theaters in Việt Nam—albeit with missions “haphazard in organization, largely symbolic in impact, full of

146

Epidemic Politics in Contemporary Vietnam

romantic panache, and entirely temporary in duration” (Redfield 2005, 333). Development aid was also used in South Việt Nam both before and during the Second Indochina War as a tactic of soft-power counterinsurgency. Historian of medicine Randall Packard notes the use of mosquito control programs there as a means of “winning hearts and minds” (Packard 2016, 113), and historian Jessica Elkind (2016) has documented the strategic granting of US civilian aid as a tactic of anti-communist nation-building in South Việt Nam, with interventions made in sectors from agricultural development to refugee resettlement, education, and public health. Following the end of the Second Indochina War, the first foreign nongovernmental organization to receive official permission to work in Việt Nam was the Thailand-based Population Development International (Lux and Straussman 2003, 176), which founded its Hà Nội office in 1983 in collaboration with Vietnamese NGOs and the Ministry of Health.5 Other INGO activity in the late 1980s and early 1990s focused on humanitarian assistance and relief (Payne 2003). Following the advent of market reforms in 1986 and the normalization of relations with the United States in 1993, the number of foreign nongovernmental organizations operating in Việt Nam began to increase from a handful of groups. By 1994, there were some 200 INGOs working in Việt Nam; by 2002, more than 500 INGOs were making annual disbursements of $85M (Payne 2003). During this period, INGO priorities shifted toward longer-term projects and programs focused on “poverty eradication, sustainable development and capacity building (…) as well as microfinance, environment, gender, and advocacy” (Payne 2003). Presently, there are upwards of 800 INGOs working in Việt Nam. The WHO has been active in reunified Việt Nam since 1980 (Government of the Socialist Republic of Vietnam and The United Nations in Viet Nam 2012, 67). The stated mission of the WHO Representative Office there “is to respond to requests from the host country to support policy-making for sustainable health development (…). This includes providing guidance, building up local relationships to implement technical cooperation, making standards and agreements, and ensuring that public health measures are coordinated and in place during crises” (WHO 2020a). During the cholera outbreaks, the WHO provided technical and logistical support to the Ministry of Health. However, WHO officials, perhaps lacking a mandate, were clearly reluctant to assume an independent role in analysis and commentary. United States support for the health sector in reunified Việt Nam began in 1995 after the normalization of relations. As a health official at the US CDC told me,

Statistics and Their Discontents

147

The US Embassy started up here in 1995; for historic and political reasons, it was difficult to find things that the Vietnamese government wanted to work on. Health was politically acceptable, though it was very difficult to work here, owing to the lack of development. Currently, seventy-five percent of all US government investment in Việt Nam is in health development and disability work. (personal communication, October 13, 2009)

Per Ambassador Michalak’s cable, while the US CDC was also aware of the problems with Việt Nam’s approach to cholera response and reporting, these criticisms were never aired publicly. As this suggests, the United States and the US-led international community have pursued diplomatic relations with Việt Nam via participation in the health sector—but not with a free hand. Việt Nam places much tighter restrictions on NGO activities than other countries in the Global South have tended to. The INGO sector in Việt Nam is governed by several state bodies: the Committee for Foreign NGO Affairs (COMINGO), a body of the Ministry of Foreign Affairs; the Vietnam Union of Friendship Organizations (VUFO), a body of the Fatherland Front; and the People’s Aid Co-ordinating Committee (PACCOM), the “specialized and functional body” of VUFO and the government’s liaison office for INGOs (Payne 2003). Although foreign organizations like the World Bank and the UNDP have successfully sought to promote civil society organizations in recent years (Thayer 2009, 6), INGOs still operate under the close supervision of state agencies. The role of international funding in the national health sector increased significantly when Việt Nam was selected as a “focus” country for the USbased President’s Emergency Plan for AIDS Relief (PEPFAR) in 2004. Donor support for HIV/AIDS activities had already begun to reshape the country’s funding landscape, as Le Minh Giang and Nguyen Thi Mai Huong write: “By 2003, (…) HIV/AIDS funding from international donors had surpassed funding from the central government, and the increase in international funding was disproportionately higher than the increase in government investment” (2004, 283). On the basis of this influence, the international donor community has led challenges to the state’s HIV/AIDS policy, strategy, and public communications— for example, by discouraging the state campaign to associate HIV risk with socalled social evils like drug use and prostitution (Le Minh Giang and Nguyen Thi Mai Huong 2004, 290–1). Other observers have found that the arrival of PEPFAR funds and pressures to expend them have distorted the HIV/AIDS agenda in Việt Nam (Turnbull 2006, 1).

148

Epidemic Politics in Contemporary Vietnam

Despite the significant share of health expenditure contributed by international nongovernmental organizations and bilateral aid agencies, the Vietnamese state has retained strong ownership over the direction of the health sector, refusing to let it become a “republic of NGOs” (Farmer 2011, 4). In the health sector as well as elsewhere, the state has successfully “dictat[ed] the terms of global integration” (Porter 2019, 14), avoiding clientelistic relations with international agencies and preserving significant independence and autonomy. Indeed, as the US Ambassador’s cable about cholera suggested, the requirement for foreign organizations to maintain a posture of neutrality in Việt Nam can bend leadership toward a politics of nonintervention.

Conclusion While this discussion might suggest a state whose orientation toward public health is one of negligence, informed by a cynical desire to limit accountability for less positive outcomes, this does not accurately describe Việt Nam. Rather, Việt Nam’s optic of governance—its strategy for “seeing like a state”—is selective, capable of sharp resolution in some areas alongside inadvertent or even intentional fuzziness in others. Where the socialist state formerly endorsed an ambition of total epidemiological surveillance, Việt Nam now sees public health specifically like a market-socialist state, with selective recognition of some phenomena and selective inattention toward others. Just as socialization (xã hội hoá) has largely shifted the locus of control and responsibility for health onto individuals themselves, the state’s ambitions for documenting health statistically have also changed. While the administrative priorities, hierarchies, and practices of socialism endure, the imperatives of the market have assumed new importance in defining what “health” and “disease” mean, and how they should be managed. Why was cholera so politically threatening in post-transition “market-socialist” Việt Nam that the state hesitated to identify the disease by its correct name or to count cases as international and national health agencies require? And why were international health organizations apparently complicit in the production of “papereality” about this disease? As I have suggested, Vietnamese history as well as the state’s political economic priorities directly informed its strategies in epidemic response and disease control. Cholera was widely perceived as an atavistic disease, anomalous and unexpected in a modern country such as Việt Nam and incompatible with the level of development held to be uniform in the national capital.

Statistics and Their Discontents

149

But beyond this, cholera threatened the project of national integration into global markets, in part for its immediate effects and in part because of the stigma of underdevelopment that this particular disease carried. When I asked Vietnamese and foreign colleagues in public health why cholera was so sensitive, they tended to mention the state’s desire to protect sectors such as seafood exports and tourism, both important economic interests: by itself, tourism accounted for approximately 5 percent of the nation’s entire GDP through the 2000s. By way of precedent, Việt Nam had also experienced heavy economic losses after outbreaks of SARS in 2003 and avian influenza in 2003–2004. SARS inflicted losses estimated at over US $220 million, or 1.1 percent of the nation’s economic growth, compounded by 120,750 lost jobs (Curley and Thomas 2004, 23). Avian influenza affected the Vietnamese national economy more seriously than any other in Asia, causing an estimated 0.3 to 1.8 percent of lost GDP. The nation’s direct losses to poultry flocks were also the highest among the affected countries (McLeod et al. n.d., 2). But by contrast, cholera was widely regarded as a disease of backwardness, poverty, and deficient culture; the state wished to minimize any public association with such a disease. In an analysis of national responses to the outbreak of avian influenza in three Southeast Asian countries, political scientist Tuong Vu describes the experience of H5N1 in Việt Nam as essentially undemocratic, with the state working to protect the tourism sector and appearing to disregard groups who might be harmed by the delayed announcement of an outbreak. As Vu notes, “Government officials were not concerned about how an early announcement and quarantine would help millions of farmers, suggesting the latter’s lack of representation in the system” (Vu 2011, 14). The state’ s response to cholera went similarly, with the Ministry of Health announcing the outbreak long after the confirmation of the first case of cholera. One respondent in a ministry office suggested to me that this was because the population would be prone to panic if cholera was announced. As she stated, “the government is very prudent when announcing an epidemic” (personal communication, July 26, 2010). But it seemed more likely that a different calculus was at work. A timely and transparent report of a cholera outbreak with accurate statistical accounting would have threatened not only these favored economic sectors and interests, but would also have cast doubt on the legitimizing narrative of heroic progress central to the image and selfunderstanding of the Vietnamese state. Cholera was not just an epidemiological aberration, but a contradiction of the state’s “hyper-liberal” prowess—one that threatened to call the political system’s legitimacy into question.

150

Epidemic Politics in Contemporary Vietnam

However, state measures in prevention and treatment made it possible to manage the effects of cholera while undercounting cases and misrepresenting their cause. While the Ministry of Health played down the systemic factors contributing to disease risk, blamed individuals, and misleadingly termed cholera “acute diarrhea,” it simultaneously invested in quite comprehensive prevention efforts—from immunizing city residents to chlorinating lakes. Clinical management of cases was also effective, as Ambassador Michalak’s diplomatic cable suggested. Essentially, state protocols in epidemic response and public health communication generated a form of market-socialist papereality in which it was both unnecessary and undesirable to track cholera epidemiology with complete accuracy. As the next chapter will suggest, however, the more recent history of the Covid-19 pandemic in Việt Nam reveals another side of national public health. The Vietnamese state’s capacity in disease surveillance, case counting, educating the public, and stopping disease transmission proved to be significantly greater than the experience of cholera epidemics would have suggested. This disparity in state response to recent outbreaks presses home questions about the cultural significance of disease in a transitional country—questions to which I will now turn.

Conclusion In the Republic of Health

As this book has shown, the cholera outbreaks in Hà Nội and surrounding provinces that lasted from 2007 to 2010 gave voice to some of the significant ghosts  of Việt Nam’s post-transition period. Recurring waves of infection revealed the Vietnamese state’s priorities in public health, new risks to health under market socialism, the cultural meanings of infectious disease, and the consequences of those meanings. These events, conflicting with the image of an ascendant Asian tiger economy, underscored the state’s troubling approach to public-health governmentality: less than full transparency in official communications, less than total integrity of epidemiological datasets, and less than perfect security of water and sanitation systems in Việt Nam’s booming capital. In the background of these anomalous outbreaks were concerning largescale transformations. Where public health was once upheld as the core of the Vietnamese social contract and a site for the development of socialist scientific modernity, state health services have come to be popularly regarded with suspicion and anxiety. Việt Nam’s transition has also placed pressure on social reproduction, with institutions originally intended to support collective welfare becoming increasingly fragmented and privatized. In sum, the experience of cholera pointed to the “ironies of freedom” (Nguyễn-võ 2008) at the heart of Vietnamese public health. However, over the months while I was finishing this book—February through October 2020—the global emergence of the novel coronavirus pandemic compelled a second look at Việt Nam’s public health system and its capacities. From its earliest moves to control the pandemic, the Vietnamese state hardly resembled the government that had insisted on using misnomers for a pathogen, undercounted infections, and attributed disease to the personal habits of members of marginalized social groups. Implementing a comprehensive

152

Epidemic Politics in Contemporary Vietnam

portfolio of evidence-based measures for outbreak management, Việt Nam brought three successive waves of infections to a halt and reported morbidity and mortality data that could only be envied elsewhere in the world. In this chapter, I reflect on how the Covid-19 pandemic—at the time of this writing, an ongoing global emergency—reveals another side of public health in Việt Nam and complicates the story of epidemic response that my previous chapters have told.

SARS-CoV-2, a “Coming Plague” As is now canon, a highly infectious and virulent novel coronavirus of zoonotic origin, later named SARS-CoV-2 by the International Committee on the Taxonomy of Viruses (WHO 2020b), emerged and begun spreading in the Chinese provincial capital of Wuhan in late 2019. On December 30, a vaguely worded news article, machine-translated into English and mentioning cases of an unknown pneumonia, appeared in ProMED-mail—a notification system that provides early warnings about emerging disease. As was later reported, the first symptomatic patient had been identified in mid-November, and in an ambiance of growing anxiety, more patients with similar symptoms were hospitalized. By December 20, sixty confirmed cases of the new disease had been reported (Davidson 2020). On the last day of 2019, the Wuhan Municipal Health Commission finally announced that “scientists were studying an unknown type of ‘viral pneumonia’ that had infected twenty-seven people” (Hessler 2020). These reports resonated with mass-cultural representations of epidemics that have long warned popular audiences of a “coming plague” (Garrett 1994) or “monster at our door” (Davis 2005). The anticipated specter of a novel pathogen of pandemic proportions has captivated and unsettled the public for decades. Works in the disease-horror genre have frequently imagined Asia as a future “hot spot” of an epochal disease event, depicting Asian populations and places in pessimistic, even dystopian fashion. And accordingly, early US media accounts of the novel coronavirus were hit pieces—portraying the Chinese government as duplicitous and corrupt (c.f. Buckley and Myers 2020; Fisher 2020; Kristof 2020), attributing the emergence and spread of the virus to “wet markets,” (c.f. Myers 2020) and downplaying the possibility that contagion could affect other world regions. In this way, media audiences were primed to anticipate the next plot points of an “outbreak narrative”: a hunt for the source of contagion, the

Conclusion: In the Republic of Health

153

development of new medical technologies, and the application of Western scientific and military power. The virus at the center of this story has indeed turned out to closely resemble the plagues that decades’ worth of popular cultural texts had foretold. A fasttraveling respiratory virus, readily spread via asymptomatic carriers, SARSCoV-2 caused tens of millions of infections and at least a million deaths within a year of its emergence. In some recovered patients, Covid-19 also inflicts symptoms of chronic illness and cognitive disability—a syndrome termed “long Covid” that remains poorly understood and difficult to treat. But despite being described by right-wing North American elites as the “‘Wuhan virus,’ ‘Chinese virus,’ and the ‘Kung Flu’” (Reny and Barretto 2020), SARS-CoV-2 was not a Chinese virus, and its story would not end with a US-led campaign of disease suppression. Instead, the novel coronavirus was efficiently controlled across East and Southeast Asia in early 2020, while making deep viral inroads in the wealthy liberal democracies that had been assessed as the countries best prepared to respond to a pandemic (c.f. Lincoln 2020; Mishra 2020).

First Cases From Wuhan, which is in South China, it is a short trip across the Vietnamese border: just 1,450 miles to Hồ Chí Minh City and less than a thousand miles to Hà Nội. Vietnamese Ministry of Health officials, deeply alarmed by early reports of the new virus, publicized the news from Wuhan on the MOH website on December 25 (Hong Kong Nguyen and Tung Manh Ho 2020, 2)—six days before the Wuhan Municipal Health Commission’s public announcement about the mysterious pathogen (Hessler 2020; Wee and Wang 2020). In the first week of January, border security measures were stepped up and Vietnamese intelligence agents reportedly launched cyberattacks against the Chinese Ministry of Emergency Management and the provincial government of Wuhan to “glean information about the virus” (Pham and Bennett 2020). On January 20, a Chinese medical official acknowledged that the virus could indeed be spread via human-to-human transmission (Hessler 2020), but this likely did not come as a surprise to the Vietnamese Ministry of Health. Việt Nam’s first cases of Covid-19 appeared just days before the celebration of the Lunar New Year—the biggest and most festive national holiday and an inconvenient time to introduce stringent new disease control measures. On January 22, a sixty-five-year-old Chinese man and his twenty-seven-year-old

154

Epidemic Politics in Contemporary Vietnam

son, a resident in Long An province, arrived at the emergency department of Chợ Rẫy, Hồ Chí Minh City’s largest general hospital. The father, who had recently traveled from Wuhan to visit his son, was suffering from low-grade fever and exhaustion and the young man was experiencing vomiting and diarrhea; tests confirmed both patients to be suffering the symptoms of Covid-19 (L.T. Phan et al. 2020). The father and son were isolated and treated; as they recovered, health authorities identified and isolated the close contacts the family had encountered during holiday travels in Hà Nội, Nha Trang and Hồ Chí Minh City (L.T. Phan et al. 2020). In northern Việt Nam, another Covid-19 case was separately confirmed in the city of Thanh Hóa: a twenty-five-year-old woman who had returned from an extended business trip to Wuhan had referred to hospital on January 23 with “coughing, sneezing, fever, and chest pain.” After she was found to be infected with Covid-19, twenty-one of her contacts were identified and isolated (Le Van Cuong et al. 2020). With these two episodes, the Vietnamese front of the pandemic was underway.

To Win a Hundred Battles Along with the United States—where the first case of Covid-19 was identified on January 20, according to an internal report by the Centers for Disease Control (Washington Post 2020)—Việt Nam was one of the first countries outside China to identify imported cases and human-to-human transmission of Covid-19 (Pham Quang Thai et al. 2020). Expectations for Việt Nam’s pandemic response were low: observers noted the country’s “challenging regulatory environment” (Nguyen and Malesky 2020) as a potential impediment to coordinating a program of disease control. Other situational factors seemed to stack the odds in favor of the virus: Việt Nam shares a long and porous border with China; the national population is nearly 100 million; and the country’s resources are typically described as limited. However, Việt Nam was far better prepared than outsiders assumed. Upon the confirmation of these first cases inside Vietnamese borders, the Ministry of Health put the country on a war footing, knowing SARS-CoV-2 to be a fastmoving, cryptically spreading virus with documented potential to overwhelm health systems. As well, the past was prologue: as the first country to have successfully contained SARS in 2003, Việt Nam had a playbook to draw on, with proven measures including lockdowns, quarantines (Fahlman 2019), and, in health care settings, “complete isolation of patients and implementation of

Conclusion: In the Republic of Health

155

nosocomial infection control from an early stage of epidemic” (Ohara 2004). Beginning in late January, with case numbers that were apparently regarded in other national settings as epidemiologically insignificant or not requiring urgent response, the government of Việt Nam formed a national steering committee to direct pandemic response and implemented a series of intensifying measures to exclude new cases, preempt the spread of disease through the population, and communicate effectively to the public (Pham Quang Thai et al. 2020). In the moment, these decisions appeared precipitous; in hindsight, they appeared prescient—particularly by contrast to the delayed decisions and confused communication of governments and health agencies elsewhere in the world. Flights to and from Wuhan were cancelled on January 24 (Nguyen Minh Duc et al. 2020, 3). Arrivals from China, Macau, and Hong Kong were banned on February 1 (Pham and Murray 2020). On February 3, with eight cases reported, the government closed schools and universities nationwide and deferred the National High School Examination (Pham and Murray 2020). By the first week in February, a test kit for Covid-19 had been developed by a private company, Viet A Corp (Công ty Cổ phần Công nghệ Việt Á), in collaboration with Vietnam Military Medical University (Sen Nguyen 2020b; Tran Chung Chau et al. 2020); in addition, three other rapid diagnostic tests were developed domestically in spring (Pollack et al. 2020). This early innovation paid immediate dividends. A second wave of cases appeared in March, including an outbreak of sixteen cases among nurses and food service staff at Hà Nội’s Bạch Mai hospital (Boudreau and Nguyen 2020). The hospital was locked down and some 30,000 individuals were tracked down and rapid-tested for Covid-19 within two to three days (Nguyen and Malesky 2020; Rogier van Doorn, personal communication, July 21, 2020; Viet-Phuong La et al. 2020). From mid-March, Việt Nam’s test positivity rate, or ratio of confirmed cases to tests, was the lowest in the world (Pollack et al. 2020), indicating that Covid-19 cases were being found and isolated more efficiently there than in any other national setting.1 Contact tracing of early cases in Hồ Chí Minh City and Thanh Hóa was implemented “well before these measures were advised by WHO” (Pham Quang Thai et al. 2020, 4), and over the course of the pandemic, Việt Nam continued to practice “rapid, granular” contact tracing to stay ahead of the virus (Tatarski 2020).2 Basing contact tracing and quarantine protocols on “epidemiology, not on symptomatology” (Rogier van Doorn, personal communication, July 21, 2020), health officials identified the contacts of infected individuals and quarantined them in government facilities, regardless of their symptomatic status. While most contact-tracing programs stopped at identifying the close

156

Epidemic Politics in Contemporary Vietnam

contacts of infected individuals, Việt Nam’s “third-degree contact tracing” also identified the contacts of contacts,3 who were asked to self-quarantine at home for fourteen days—again, regardless of whether they seemed to be ill (Pham Quang Thai et al. 2020, 10; Sen Nguyen 2020b, 43). Military sites, health centers, and hotels were converted into dedicated quarantine facilities; as of May 1, some 70,000 individuals had been quarantined in state-hosted sites while twice that number had self-quarantined at home or in hotels (Pham Quang Thai et al. 2020, 10). All individuals in quarantine, whether at home or in government accommodations, were supplied with food at no cost (Kai Nguyen 2020; Tran Chung Chau et al. 2020). In April, continued “aggressive mass testing,” along with a national policy of social distancing (cách ly xã hội), brought the second wave of cases under control (Khanh Vu et al. 2020). From April 1 until April 22,4 the nation remained effectively under lockdown, with residents only permitted to make essential outings (Ha Van Nhu et al. 2020; Xuan Quynh Nguyen and Nguyen Dieu Tu Uyen 2020). Businesses were closed, travel between cities was restricted (Klingler-Vidra and Ba-Linh Tran 2020), and public gatherings of more than two people were prohibited (Pham Quang Thai et al. 2020, 6). Community transmission was apparently halted by the middle of the month (Pham Quang Thai et al. 2020, 4) and by month’s end, social life returned much to normal, with schools and universities reopening in early May. In the course of the second wave of cases, which was treated as a national emergency of the highest concern, Việt Nam had still recorded only 270 new infections. No further cases occurred until a third wave of imported cases developed in the coastal city of Đà Nẵng in late July. (By contrast, on July 25—as reports of new Covid-19 infections ended Việt Nam’s 100-day period without community transmission—the United States reported 73,500 new cases [New York Times 2020].) From the reports of these first cases, the Vietnamese state communicated the realities of the pandemic to the public over multiple channels—from announcements on war-era neighborhood loudspeakers to text messages and posts on popular social media and messaging apps. Timely, “accurate and credible” communication by the state helped to win public compliance with escalating measures for disease control (Hong Kong Nguyen and Tung Manh Ho 2020, 1), delivering “a message of hope and order” (Nguyen-Thu 2020, 3). Where other nations issued tentative, contradictory, and partial information regarding the risks of the new virus and the best practices for preventing it, Việt Nam’s Ministry of Health rolled out simple, clear, and easily remembered recommendations. This approach resonated with the country’s historic experience of mass public communication and education about the risks of

Conclusion: In the Republic of Health

157

communicable disease, as discussed in Chapter 1. Slogans like “Fight disease like the enemy” (Chống dịch như chống giặc) and “To stay at home is patriotic” (Ở nhà là yêu nước) framed the pandemic as a war and addressed the Vietnamese public as if they were, alongside health workers, on the front lines of fighting disease (AFP News Agency 2020; Humphrey 2020a). Public communications by the state recapitulated these images, with the prime minister commending health workers as “soldiers in white blouse” and invoking the saying “Trăm trận, trăm địch”—“Fight a hundred battles, win a hundred battles.” City streets were plastered with bright, stylized socialist-realist posters publicizing prevention: handwashing, mask wearing, and social distancing. In February, the National Institute of Occupational and Environmental Health produced a pandemic-themed cartoon accompanied by a catchy song: Ghen Cô Vy (Jealous Coronavirus), which encouraged handwashing, social distancing, and not touching one’s face. Slipping into international media circulation, the song drew praise from comedian John Oliver, Billboard magazine, and the United Nations. Just days after the country’s first Covid-19 infections were notified, Prime Minister Nguyễn Xuân Phúc stated “Vietnam accepts economic losses to protect the lives and health of people” (Hutt 2020). However, the state did not merely accept losses, but also extended significant social and financial support to Covid-19 patients and the general public. Covid-19 testing was free for suspected cases and close contacts of cases; hospital care was also provided at the state’s expense (Ha-Linh Quach and Ngoc-Anh Hoang 2020). To assist the general population, many of whom lost income as a result of the closure of businesses and the slowing of key sectors of the economy, the nation bankrolled a 62 trillion đồng relief package extending support to households and businesses (Buckley 2021). Private donors funded innovative forms of social assistance—no-cost “rice ATMs” in Hà Nội, Hồ Chí Minh City, Huế, and Đà Nẵng (Lee 2020); “mask ATMs” dispensing free antiviral fabric masks in Hồ Chí Minh City (Tran and Klingler-Vidra 2020), and “zero đồng stores” providing basic goods in cities including Hà Nội, Hải Dương, Bắc Ninh, and Huế (Urbanist Hanoi 2020). These measures were depicted in news media in terms of pandemic communitas and camaraderie, showcasing the prosocial ingenuity of the nation. Proactive and meticulous case identification coupled with high-quality clinical care held fatalities to zero over the first six months of the pandemic. Although Việt Nam lost its first patient to Covid-19 at the end of July, fatalities only increased slowly, never spiking. As of October 2020, nine months after Việt Nam’s first cases were found, the country had recorded only thirty-five fatalities—an infection fatality rate of 3 percent and a per capita death rate that,

158

Epidemic Politics in Contemporary Vietnam

at less than one death per one million population, is one of the four lowest in the world (Sharma 2020). Over three waves of infection, Việt Nam recorded a total of just over a thousand cases; in early September, the pandemic seemed to stall out, with no further community transmission occurring. As this discussion suggests, Việt Nam mounted a highly integrated, coordinated, and multi-faceted pandemic response that went far beyond the expectations of the international community for a lower-middle-income country and well exceeded the demonstrated capacities of many wealthier nations. This harmonized program of pandemic control is what the Trump administration might have had in mind when aspirationally describing an “all-of-government” response. Indeed, Việt Nam coordinated an all-ofsociety response that combined multiple overlapping non-pharmaceutical interventions, with each layer of protection reducing the chances that the virus would gain a foothold (c.f. Lai et al. 2020). The nation’s confidence was manifest in its rather pointed gestures of health diplomacy—the provision of humanitarian aid to countries struggling with the pandemic, including the United States, and an offer by Vietnamese doctors to consult with the care team of British Prime Minister Boris Johnson during his hospitalization for Covid-19 (Nguyen Quy 2020; Quach 2020). In August 2020, I spoke with Dr. Lê Văn Tấn—a molecular epidemiologist and the head of the Emerging Infections Group at Oxford University Clinical Research Unit central offices in Hồ Chí Minh City—about his perspectives on Việt Nam’s experience. Dr. Tấn, who had been working around the clock with his team on diagnostic testing for Covid-19 as well as on his established research program in pathogen discovery, joined me by Skype from his home office; the white board behind him was covered with recently erased calculations. When I asked him to account for the nation’s superior pandemic response, which was regarded by many as a surprise, he replied: I am not very surprised, Martha, actually. We’ve been facing many emerging infections over the last decade, more than any country in Europe or America. We had the SARS coronavirus in 2003. We had avian influenza, H5N1, in 2004 and 2005. We had H5N1 in 2009. Then we have hand, foot, and mouth disease every year. Then we have COVID-19 … [laughing] It’s almost our “normal.” (…) I must say, we’ve been trained to deal with this kind of stuff. I’m not surprised with the success of Việt Nam. (…) We’ve been dealing with many emerging infections. (…) The whole country is paying attention. People take it seriously. When a challenge hits us, we respond. (interview August 12, 2020)

Conclusion: In the Republic of Health

159

Zero (0) Fatalities In settings where the pandemic had freely spread through the population to fortify a viral redoubt, Việt Nam’s outcomes seemed utopian, even fantastical. Accordingly, perhaps, some parts of the international community perceived the country’s successes with suspicion. Most prominently, the American economist Steven Hanke alleged in June that Việt Nam was a “rotten apple of #coronavirus data,” misunderstanding the data point of zero fatalities as signifying that no data had been reported to international health agencies. A group of public health professionals was so angered by this claim that they published an open letter to demand that Hanke retract his tweet and formally apologize; the letter attracted hundreds of signatories (Rotten Apple Media 2020). In media reports and social media, rumors percolated that Việt Nam’s report of no deaths and few cases was the product of state oversights or cover-ups. As my discussion in Chapter 5 demonstrated, epidemiological data in Việt Nam have been historically subject to political forces that compromise their accuracy. However, in the case of the coronavirus pandemic the state’s data were evaluated as remarkably trustworthy, the result of recent improvements to reporting systems (Pollack et al. 2020) and of an apparent consensus that concealing cases in the short term would only lead to the runaway spread of disease. The state’s remarkable epidemiological outcomes were consistently appraised by experts, both internationally and inside Việt Nam, as reliable. Kidong Park, head of the WHO, stated there was “no indication of any outbreaks beyond what had been reported by the government” (Khanh Vu et al. 2020). Calls to funeral homes in Hà Nội found no unexpected increase in funerals (Khanh Vu et al. 2020). In July 2020 I asked microbiologist Rogier van Doorn, head of the Oxford University Clinical Research Unit in Hà Nội, about these allegations of hidden cases and cooked books. He confirmed that they were untrue: “Unless there is a massive conspiracy going on, which I don’t think there is. We are based at the two reference hospitals for infectious diseases. So if there was a case in Việt Nam, it would be at our hospital. We would know. And we don’t. We have not heard of any cases” (interview July 21, 2020). The state’s highly transparent reporting of fatalities beginning shortly after this conversation seemed to cement the fact that no excess cases or deaths had been covered up.

160

Epidemic Politics in Contemporary Vietnam

Mandating Public Health Other published critiques of Việt Nam’s response to the novel coronavirus addressed the state’s methods for tracing and quarantining individuals— methods that were effective in part because they were intrusive and prioritized public health above individual privacy, liberty, or choice. Beyond the national social distancing policy enacted in April, individual neighborhoods and even entire villages were selectively cordoned off and locked down after the appearance of cases. During periods of lockdown or self-quarantine, ward police and neighborhood officials went door to door to confirm that residents were in their homes and to inquire about travel histories and any hospital visits (Hayton and Tro Ly Ngheo 2020). Patient travel history was broadcast in print news and online to warn the public of potential exposures to ill individuals. In an early and highly publicized cluster of cases associated with a popular bar in Hồ Chí Minh City, health officials even used video surveillance footage to identify exposed individuals, test them for Covid-19, and place infected persons in quarantine (Quach 2020). In at least one case, information about individual patients was leaked, resulting in their harassment and public shaming (Max 2020). As part of its program of informing the public about the pandemic, the state also enforced existing legislation on the dissemination of “false, untruthful, distorted, or slanderous” information on social media to restrict the spread of inaccurate information about the coronavirus (Phuong Nguyen and Pearson 2020); by May 2020, over a hundred people faced fines for violations of the “fake news” statute (Hayton and Tro Ly Ngheo 2020). Dr. Nguyễn Văn Tuấn, whose blog had critiqued the state’s response to cholera (see Chapter 2 and Chapter 5), described these policies as “draconian” and asserted, “Those measures cannot be used in a democratic society” (Quach 2020). Journalist Bill Hayton and a pseudonymous Vietnamese collaborator went further in an article for Foreign Policy, claiming that the state’s disease control measures “were born as tools of Communist Party control and have now been repurposed in the service of health protection” (2020). However, such criticisms seemed to miss the mark—in part because the state’s preëmptive measures enjoyed widespread public support. Bluezone, the government’s contact-tracing app, was met with “unusually eager public acceptance” and downloaded over 20 million times (Dien Nguyen An Luong 2020). An April study of Covid-19 knowledge, attitudes, and practices found widespread awareness and acceptance of disease prevention measures in the general population (Ha Van Nhu et al. 2020). More broadly, domestic and

Conclusion: In the Republic of Health

161

international media reports have suggested that Việt Nam’s Covid-19 response inspired public trust, confidence, and pride. Although scholars have long noted that public health measures and disease emergencies can function as a Trojan horse for new forms of discipline and surveillance, it seemed that these concerns about privacy rights in Việt Nam’s disease control protocols had a manufactured quality—particularly given that even long-standing critics of the state expressed so little criticism of these measures. These complaints also rang hollow given that over the same period, pandemicstricken Western liberal democracies were very hard pressed to protect the fundamental rights of their citizens to safety, health, and even life itself. From the United States, the current world leader in Covid-19 cases and deaths (NEJM 2020), it has been impossible not to view the pandemic as a litmus test of governmental capacity, with the United States lagging far behind almost every other nation in the world. While Việt Nam was developing street-side disinfection chambers, repatriating citizens from overseas, and flattening the curve of new cases, Americans were panic-shopping, struggling to access coronavirus tests, and receiving false reassurances from the highest levels of government—all in an ambiance of dread, uncertainty and improvisation. In the United States, face masks became the symbol of a broader culture war; in Việt Nam, policy mandated mask-wearing in public and secured total or near-total compliance. In American news media, editorials compared the experience of Covid-19 to the humiliating defeats of the Second Indochina War—yet failed to note that Việt Nam was again outperforming the United States on a front widely described as a war. As labor and development scholar Joe Buckley wrote in a retrospective on the first waves of the pandemic, “Vietnam’s success in combatting the virus cannot therefore be attributed to state repression or economic centralization. Its swift-footed response was well within the means of richer liberal-democratic nations, had they summoned the political will” (Buckley 2021). In its failures, the pandemic response of the US federal government and state health agencies strongly paralleled the missteps I have described in Việt Nam’s experience with cholera, with policy stumbles including the politically motivated undercounting of disease, non-transparent and contradictory public communications, victim-blaming, and economic protectionism at the expense of public health. The desire to project a strong, healthy polity and minimize public awareness of risk critically hampered disease control efforts in the United States. Still further, an insistence on personal and economic liberties was consistently allowed to take precedence above evidence-based measures to promote public health and limit the spread of the virus.

162

Epidemic Politics in Contemporary Vietnam

If my critique of Việt Nam’s response to cholera suggests the way a market economy corrodes systems for securing public health, this was illustrated in Technicolor by the debacle of coronavirus response in the United States. In view of what the Covid-19 pandemic revealed about public health in the United States, his book was originally supposed to conclude with two reflections: one on the admirably far-sighted efforts of the Vietnamese state in managing Covid-19 and another on the hypocrisy of Western journalists who nitpicked the details of Việt Nam’s world-class pandemic response while their own countries drowned in disease.

In the Republic of Health However, two events in Vietnamese jurisprudence also coincided with the pandemic, each of which was impossible to overlook. The first began in the early hours of January 9, when thousands of police officers cordoned off Đồng Tâm village—the site of a long-running land dispute—and entered it by force, dispersing tear gas, beating villagers, and killing eighty-four-year-old village leader Lê Đình Kình. In the violent encounter that ensued, three police officers died in circumstances that remain uncertain. Twenty-nine civilians from Đồng Tâm subsequently faced charges in their deaths. When the case went to trial in September amid critique from human rights groups, twenty-two of the defendants were found guilty; the village leader’s two sons were sentenced to death, another defendant was sentenced to life in prison, and the remaining defendants were given prison terms for obstruction of officials. In early October, journalist and pro-democracy activist Phạm Đoan Trang— who had worked to publicize the case of Đồng Tâm village as well as many other human rights causes in Việt Nam—was arrested in Hồ Chí Minh City on charges related to producing propaganda against the state—apparently, the many articles and books she had authored, as well as the works she had helped publish as a cofounder of Liberal Publishing House (Nhà Xuất bản Tự do). In 2015 I had met Trang in Hà Nội and found her remarkable: generous and full of humor despite having endured years of state harassment and surveillance. I was dismayed to see news of her arrest hit Twitter, then Reuters and The Guardian. As these reports revealed, Trang had been taken in by security forces at 11:30 PM on October 6, just hours after the government had concluded its annual human rights dialogue with the United States. Her charges threatened a prison term of up to twenty years, and national law would permit her to be detained for months before going

Conclusion: In the Republic of Health

163

to trial (Trinh Huu Long 2020), as Trang must have known—she had recently published a work titled A Handbook for Families of Prisoners. Political scientist Carlyle Thayer predicted more arrests would follow as the thirteenth National Party Congress approached (Humphrey 2020b). This coda to Việt Nam’s victory against Covid-19 thus suggests a sinister dimension in the state’s politics of life. The Đồng Tâm case and Trang’s arrest and detention pressed home a troubling dichotomy between securing the biological life of the population and exposing political enemies to harassment, physical violence, and even death. Where journalists like Bill Hayton leveled a rights-based critique at Việt Nam’s pandemic response, such concerns appeared to be a reach—in part because disease control measures have prompted so little domestic criticism to date. The public, grateful to have their lives and livelihoods secured, appeared willing to limit their personal freedoms temporarily in service of that goal, and to place their trust in official directives. Furthermore, as the Đồng Tâm trials and Trang’s detention suggested, the state actually did not need the pretext of public health to target political enemies, surveil private citizens, or exercise punitive and far-reaching forms of social control. Neither did the state’s open and accurate communications about disease risk—which inspired public feelings of trust and even patriotism— contain a promise of increased civic freedoms or of reshaped state-society relations. Despite the nation’s collective triumphs in responding to Covid-19, one author argued, “[T]he sense of social hope and informational transparency briefly experienced during the pandemic period is unlikely to be linked with any improvement in political reformation” (Giang Nguyen-Thu 2020, 2). Essentially, the public commitments of the pandemic response began and ended with the state’s guarantee of physical survival. This politics of willed existence sits uncomfortably with the experiences that Vietnamese dissidents have confronted over the last decade. In the conclusion to her samizdat work Politics of a Police State, Trang described the effects of ten years of police harassment on her life and work. First arrested in 2009 for protesting bauxite mining in the Central provinces of Việt Nam, she has faced escalating harassment and intimidation in her work as a journalist covering national politics, losing access to sources and ultimately being dismissed from her position as a reporter at VietNamNet. In June 2018, a plainclothes police officer injured Trang’s knee at a demonstration, permanently disabling her. In August, she sustained a concussion in a police assault and had to be hospitalized. Following the confiscation of her residence registration card, Trang was unable to rent an apartment legally or even safely stay at a temporary accommodation;

164

Epidemic Politics in Contemporary Vietnam

she has stayed at forty-two different houses since 2017, including hotels and construction sites (Phạm Đoan Trang 2019, 149). Her account of state intrusion and hostile treatment alludes to a disturbingly carceral dimension of the country’s life politics—one in which life and the desire to live can be weaponized. Being an independent journalist and author under a totalitarian regime means you may be arrested and questioned, even assaulted any time without any protection, unable to travel inside your country, not to mention travel abroad. (…) [Y]ou can hardly die, because they do not mean to kill you. But you simply cannot live normally as other people do or as you used to. (Phạm Đoan Trang 2019, 149)

The Economization of Health Not long after Trang’s arrest, investor and fund manager Ruchir Sharma appraised the post-pandemic gains of Việt Nam’s high-performing economy in an editorial for the New York Times, writing that the nation was “making autocratic capitalism work unusually well, through open economic policies and sound financial management” (2020). Absent of any anxiety about surveillance or state overreach, this characterization inadvertently captured the technocratic calculus underwriting the life politics of Việt Nam’s goldstandard pandemic response. Sharma’s commentary implied that effective public health measures were not simply a humanitarian gesture. Indeed, Việt Nam’s pandemic successes do not suggest a future utopia of universal public health, but rather a republic in which populations will be compelled to health in the service of economic utility. I had originally believed that Việt Nam’s response to cholera could be explained in terms of the symbolic significance of the disease: cholera’s historic associations with underdevelopment seemed to have prevented an open acknowledgment of the epidemics. However, Việt Nam’s swift management of the coronavirus pandemic suggested another dimension of decision-making in disease control. Cholera was perhaps perceived as a disease that could be lived with and contained—an endemic disease, essentially, or a series of recurring micro-epidemics—even as it debilitated members of vulnerable populations. By contrast, SARS-CoV-2—an airborne virus with a long incubation period, readily communicated through normal social interactions, was understood as a pathogen capable of derailing the nation’s economic future if it was not swiftly contained. As such, Việt Nam’s program of Covid-19 eradication was based on what feminist scholar Michelle Murphy (2017)

Conclusion: In the Republic of Health

165

has called “the economization of life”: an encompassing econometric calculation establishing what life is worth living, and what value can be derived from life. The nation’s comprehensive and well-coordinated pandemic response strategy is perhaps best understood as an expression of the economization of individual and public health—on the ground, a more sophisticated approach to a pandemic than the forms of neoliberal abandonment currently practiced in the United States and Western Europe, but not a less calculated one. Where the political economy of public health in the United States has left citizens to contend with the risk of infection on their own, Việt Nam’s strategy in fact mandated a healthy population. Việt Nam’s Covid-19 response expropriated health decisions from individuals and the public, assimilating individual healths directly into the health of the body politic. This is the opposite move to the neoliberalizing tendency I critiqued in the national response to cholera, in which “public health” was reimagined as a byproduct of the good judgment and healthconscious behavior of private individuals. In Việt Nam’s response to Covid-19, private decision-making was all but obviated by the society-wide enforcement of uniform health protocols. While the country’s outcomes were commendable through the first year of the pandemic, particularly by contrast to the humiliating performances of the United States and the UK, they also suggest that health has been defined not exactly as a human right, but as a macroeconomic good. Public health— or, at minimum, freedom from a potentially deadly airborne pathogen—has constituted an important part of a national business model whose features include increased economic integration with global markets, a highly educated and disciplined but low-paid workforce, and the net effects of thirty years of economic expansion. Indeed, as a partial result of its recent successes in controlling Covid-19, Việt Nam’s economy is now the fastest-growing in the world (Buckley 2021). As the country’s leadership consolidates these political, economic, and epidemiological victories, the experience and meaning of life, health, and disease in Việt Nam will continue to be subject to redefinition.

Notes Introduction 1

2 3

4

5

6

The Second Indochina War, called the Anti-US Resistance War for National Salvation (Kháng chiến chống Mỹ Cứu nước, 1965–1975) in North Việt Nam, is known as the Vietnam War in the United States. In 2009 and 2010 the currency exchange rate was approximately 21,700 Việt Nam đồng (VNĐ) to one US dollar. These included “The Fermentation Theory,” “The Excrementitious-Poison Theory,” a “Kiehl’s Theory” (which posited cholera as a “contagion first formed in the human organism itself ”), “Johnson’s Blood-poison Theory,” “Theory of Ilisch— Decomposing Dejections,” “Bryden’s Monsoon Theory,” “The Ozone Theories,” “The Organic-Dust Theory of Von Gietl,” parasitic theories, theories implicating a fungus (Wendt 1885, 119–25), and others—including the hypothesis that cholera could be caused by eating certain fruits (Coclanis 2008, 174) or by a fit of rage (Hamlin 2009, 27). Although the German physician is credited with the 1883 discovery of V. cholera and its role as the causative agent of cholera (Faruque et al. 1998, 1302), Florentine scientist Filippo Pacini had published “Microscopical Observations and Pathological Deductions on Cholera” in 1854, describing the comma-shaped bacillus he discovered in a histological examination of a cholera victim’s intestinal mucosa and articulating its relationship to the disease. While Koch was apparently unaware of this publication, his work recapitulated Pacini’s findings, also arguing that cholera was a contagious disease and that “kommabazillen” were its contagious agent. Koch’s kommabazillen were later renamed V. cholerae in honor of Pacini’s earlier work (Kavic et al. 1999, 397). As Christina Schwenkel and Ann Marie Leshkowich have suggested, the country’s “socialist and neoliberal regimes and processes are neither totalizing nor distinct” (2012, 380); Bekkevold et al. characterize Việt Nam, like the “socialist market economies” of China and Laos, as “far too statist for the neoliberals and too liberal in economic terms for the developmental state proponents” (2021). Enrollment criteria required that respondents be over age eighteen, male or female, a member of a household that was recognized as poor or near poor, and willing to provide informed consent. Residence registration in the ward was not a criterion, but my respondent sample consisted mainly of individuals with KT1 status— permanent residents of the ward where they were registered. This meant that my

Notes

7

167

sample did not include many recently relocated rural-to-urban migrants, a “floating population” in Vietnamese cities that is typically young, informally employed, and low income. In this way, my research design inadvertently excluded an important “hard-to-reach” group likely to be precarious and to face more negative health outcomes. This rapid growth mostly consisted of “rural migrants from surrounding provinces, with natural growth playing only a minor role in the population increase” (L’Abbé 2010, 6).

Chapter 1 1

2

3

4

Colonial-era deaths among the Vietnamese population were likely undercounted given both that “many people did not inform the mandarinate when a family member died of an epidemic disease” (Malarney 2004, 28) and that statistical surveillance was in its infancy. For example, in 1895–1896, an epidemic in Hưng Hóa near Hà Nội followed a drought that sparked the loss of three harvests and a famine; in Hưng Hóa’s vicariate, bishop Paul-Marie Ramond recorded that 10 percent of the population had succumbed (Michaud 2004, 301). While land tax, for example, under the Nguyễn dynasty was only some 3–6 percent of a peasant’s average yield, the land tax under the French went up to 20 percent of a harvest, forcing small landholders to sell their land in years of poor harvests (Ngô Vĩnh Long 1991, 68). Unique pathologies believed to affect French residing in Indochina were catalogued in medical discourses of the period. L’anémie coloniale referenced the general malaise that affected whites in tropical colonies; distance from civilization and proximity to the colonized allegedly caused neurasthenia; and a psychological malady akin to depression or culture shock was termed le cafard: “a sort of misanthropy” understood to be physiological (Stoler 1989, 646; Vann 1999, 313). French medical knowledge of the period posited whites in colonial territories as [A] distinct and degenerate social type, with specific psychological and even physical characteristics. Some of that difference was attributed to the debilitating results of climate and social milieu, ‘such that after a certain time, he [the colonial] has become both physically and morally a completely different man’ (Stoler 1989, 646).

5

These had included the categorical neglect of any famine prevention and public relief systems during food shortages, and the conversion of paddy to jute and other “war-machine crops,” and the occupation forces’ appropriation of the already scanty crop in 1943 (Scott 1976, 1).

168 6

7 8

9

10

11

12

13

Notes Hirschman, Preston, and Vu Manh Loi indicate the famine’s death toll ranged from 400,000 to 2 million deaths in the Red River Delta during the winter of 1944–45 (1993, 783); Nguyen-Marshall cites the latter figure (Van Nguyen-Marshall 2005, 237). An anti-colonial coalition formed in the early 1940s. Other sources cite other figures. Wilfred Burchett wrote that “at the time of the August revolution, there were 147 doctors trained in western medicine for the whole of Vietnam, one for each 150,000” (1957, 214); Galston and Signer cite 47 doctors, one for every 180,000 of the population (1971, 382). Primary health care, a model for health promulgated by the Alma-Ata Declaration of 1978, prioritizes preventive health measures and ancillary health promotion activities such as health education and the improvement of sanitation. Historian David Marr cites, for example, a poem titled “Germs Cause Cholera Very Quickly,” which was recited to him by a woman “who learned it while living in a Viet Minh liberated zone in the late 1940s” (Marr 1984, 187). World Health Organization data indicate that 20,186 cases and 872 deaths were reported (WHO 2008, 1). This epidemic was caused by the more virulent strain of cholera, V. cholerae O1 El Tor biotype, which emerged globally in 1961 to inaugurate the seventh cholera pandemic. These conditions were sometimes glossed by family members as having an “abnormal brain” (đầu óc không bình thường) or “suffering from nerves” (bị thần kinh). Japanese encephalitis, common in North Việt Nam, is a vaccine-preventable mosquito-borne illness. Vaccination is usually administered to children aged one to five.

Chapter 2 1 2

3

The delta’s average population density is 1,160 inhabitants per square kilometer, four times higher than across the rest of Việt Nam (Luu et al. 2010). Similar historical dynamics can also be explored in South Việt Nam, where Simon Benedikter (2014) has described North Việt Nam’s hydraulic engineering and administration of water resources in the Mekong Delta as a “hydrocracy” and David Biggs (2012) has influentially shown the significance of environmental history in the Mekong Delta in the history of Vietnamese efforts in nation-building. Ninety-four percent of Việt Nam does not have central sanitation (personal communication, Hubert Jenny, May 17, 2010); eighty-eight percent of city residents “have sustainable access to improved sanitation” (Cogswell and Le Thi Anh Thu 2008, 7).

Notes 4 5

169

For a critique of the inapplicability of an epidemiological transition model to postmarket-reform China, see Cook and Dummer (2004). These authors were somewhat unusual for bringing public health and epidemiological questions into the sphere of contentious politics, which has, over the past decade, focused on more immediately material issues—such as environmental policy and natural resource use, land rights, labor issues, corruption among politicians and civil servants, and diplomatic and economic relations with China (c.f. Kerkvliet 2019). Though some public grievances have addressed corruption among state health care workers and overcrowding of public health facilities, in general discourse is less strongly attuned to health and medical issues as a domain where political struggles are reflected.

Chapter 3 1

2 3 4

5

6

7 8 9

Although the practice has been banned, many farmers in North Việt Nam use human waste or blackwater to fertilize crops and irrigate agricultural fields (Jensen et al. 2010; Phuc Pham-Duc et al. 2014). Both Chị Nguyễn Thị Thanh and Cô Trần Kim Oanh lived in Hoàng Mai district, Đại Kim ward, and were interviewed March 1, 2010. Interview, Long Biên district, Ngọc Lâm ward, August 5, 2010. In a content analysis study of official materials educating the public about diarrheal disease in the Mekong Delta, Kotsila found that 80 percent of the documents contained the phrase “eat cooked food, drink boiled water” but less frequently mentioned handwashing with soap, controlling flies, or keeping toilets functional and clean (Kotsila 2017, 97). “Civilized family” is an official category recognized by local authorities; in some households that I visited, an official People’s Committee certificate conferring the honor was displayed in a frame on the wall. Foreign firms have also capitalized on the health concerns and germ consciousness of middle-class families. A brand of toilet cleaner owned by Unilever used cartoon monsters labeled “cholera,” “jaundice,” and “vomiting” in its advertisements in Việt Nam (giaoduc.net.vn 2012). For related commentary on the trope of “civilization” in post-reform urban China, see Anagnost (1997) and Farquhar and Zhang (2005). Literally “toad markets,” so called for their ability to disband quickly and evade police (Maruyama and Le Viet Trung 2010, 3). As Maruyama and Le note, “the Vietnamese government attempts to control and eliminate informal sector activities and elements, such as peddlers, street-side cooked-food outlets, and spontaneous fresh produce markets” (Maruyama and Le

170

Notes Viet Trung 2010, 1). These efforts at civic discipline in public spaces are ongoing, with proposals issued in 2020 to restrict vending, shoe polishing services, and street performances in the vicinity of Hà Nội’s heavily touristed Hoàn Kiếm Lake (Tuổi Trẻ 2020).

Chapter 4 1 2 3 4 5

6 7

This thread is archived at http://www.lib.washington.edu/SouthEast Asia/vsg/ elist_2009/Dog%20Meat.html. Nhậu is a leisure activity consisting of hanging out in all-male company over snack food and alcoholic drinks. Quán references a more informal, often outdoor, eating establishment; nhà hàng connotes a sit-down restaurant. The original verse: “Sống ở trên đời biết miếng dồi chó/Chết xuống âm phủ biết có hay không?” Thịt cây, “fox meat,” is a euphemism for dog meat (Avieli 2011). Còn cây is a play on the term thịt cây, formed by swapping the words and substituting “còn” (remaining) for “con” (animal), which has been substituted for “thịt” (meat). This form of word play in Vietnamese is called nói lái and is somewhat similar to Cockney rhyming slang in its substitution of nonsense words or phonically similar words to create a new word or phrase. The phrase mộc tồn is a further play on the phrase cây còn: mộc is the Sino-Vietnamese word for cây, “wood”; tồn is the Sino-Vietnamese for còn. Traditional types of rice cake. Đông Sơn bronze materials, archaeological evidence of the Bronze Age civilization in present-day Việt Nam, are a symbol of national cultural patrimony.

Chapter 5 1

2

Though statistics have often been central to the management and planning efforts of socialist states, this does not hold true universally through time. In his study of the rise of statistics in the People’s Republic of China, Xin Liu shows that socioeconomic statistics had, up to the 1980s, been “labeled a bourgeois pseudoscience and abandoned by the Maoist government” (Liu 2009, 17), only to be rehabilitated later as a valorized and institutionalized part of state governance. This was, in its way, also a statement of creative epidemiology, exaggerating the reported annual case counts at least somewhat. Other authors have argued that cholera is endemic in South Việt Nam, but not in the North (Pittisuttithum 2003, 726).

Notes 3

4

5

171

In 2008, Hà Nội was administratively expanded to include new districts that had previously not been part of the city; the expanded population of “Hà Nội II,” inclusive of these areas, was 6,232,940 (https://en.wikipedia.org/wiki/Hanoi; https://dantri.com.vn/Sukien/Hon-90-dai-bieu-Quoc-hoi-tan-thanh-mo-rong-Haoi/2008/5/234655.vip). From the August Revolution to the end of US embargo, the majority of the foreign assistance Việt Nam received came from the USSR and other socialistbloc countries. The Indochinese Communist Party received medical supplies from China from the late 1940s (Aso 2017, 155); assistance in the form of “food and basic consumer goods” continued through at least 1975, “so much so that Vietnamese in the North scarcely realized how dependent they had become on China” (Stowe 2004, 69–70). The United States-based Program for Appropriate Technology in Health (PATH) claims to have worked in Việt Nam since 1980 (PATH 2021)—though it is unclear whether the organization had formal recognition to operate in what would have been a very early moment for INGO presence.

Conclusion 1

2

3 4

By October 2020, the number of tests performed per infection in the United States lagged behind rates measured in Kazakhstan, Zimbabwe, and Ethiopia, as an article by the editors of the New England Journal of Medicine pointed out (NEJM 2020). Detailed chronology of national disease control measures instituted during the first hundred days of Việt Nam’s Covid-19 response can be found in Pham Quang Thai et al. (2020) and in Ha-Linh Quach and Ngoc-Anh Hoang (2020). The contacts of contacts of contacts of infected individuals (referred to as ‘F3’) were also identified and asked to remain in home quarantine for 14 days. In heavily affected areas, including Hà Nội, lockdown lasted until April 30 (Nguyen and Malesky 2020).

Bibliography AFP News Agency. 2020. “VIDEO: Vietnamese artists are wielding their paintbrushes in the country’s fight against the coronavirus, designing propaganda posters that have popped up across Hanoi.” April 29. https://twitter.com/AFP/ status/1255455538621681667. Allman, James. 1993. “Primary Health Care in Vietnam.” In Reaching Health for All, edited by Jon Rohde, Meera Chatterjee, and David Morley, 324–41. New Delhi: Oxford University Press India. Allukian, Myron and Paul L. Atwood. 2008. “The Vietnam War.” In War and Public Health, edited by Barry S. Levy and Victor W. Sidel, 313–35. Oxford: Oxford University Press. Anagnost, Ann. 1997. National Past-Times: Narrative, Representation, and Power in Modern China. Durham, NC: Duke University Press. Asian Development Bank. 2015. “Urban Sanitation Issues in Viet Nam.” Manila: Asian Development Bank. https://www.adb.org/sites/default/files/publication/175000/ urban-sanitation-issues-vie.pdf, accessed September 22, 2020. Aso, Michitake. 2017. “Learning to Heal the People: Socialist Medicine and Education in Vietnam, 1945–54.” In Translating the Body: Medical Education in Southeast Asia, edited by Hans Pols, C. Michele Thompson, and John Harley Warner, 146–72. Singapore: NUS Press. Au, Sokhieng. 2011. Mixed Medicines: Health and Culture in French Colonial Cambodia. Chicago: University of Chicago Press. Avieli, Nir. 2007. “Dog-meat, Orchids, Music and Song-Birds: The Politics of Vietnamese Masculinity.” The International Conference on Vietnamese Anthropology. Binh Chau, Vietnam. Invited Presentation. Avieli, Nir. 2011. “Dog Meat Politics in a Vietnamese Town.” Ethnology 50, no. 1: 59–78. Azman, Andrew, Kara Rudolph, Derek Cummings, and Justin Lessler. 2013. “The Incubation Period of Cholera: A Systematic Review.” The Journal of Infection 66, no. 5: 432–8. DOI: https://doi.org/10.1016/j.jinf.2012.11.013. Banens, Maks. 1999. “Vietnam: A Reconstruction of Its 20th Century Population History.” Asian Historical Statistics COE Project, Hitotsubashi University, Tokyo. https://hal.archives-ouvertes.fr/hal-00369251/document. Banister, Judith. 1985. The Population of Vietnam. Washington, DC: US Bureau of the Census. Banister, Judith. 1993. Vietnam Population Demographics and Prospects. Berkeley: Institute of East Asian Studies.

Bibliography

173

Barbieri, Magali, James Allman, Pham Bich San, and Nguyen Minh Thang. 1996. “Demographic Trends in Vietnam.” Population: An English Selection 8: 209–34. Barrett, O’Neill. 1982. “Setting.” In Internal Medicine in Vietnam: Volume II, edited by Andre Ognibene and O’Neill Barrett, 3–19. Washington, DC: Office of the Surgeon General and United States Army Center of Military History. Barua, Diman and William B. Greenough. 1992. Cholera. New York: Plenum Publishing Corporation. BBC Vietnam. 2007. “Chúng tôi chưa công bố dịch tả” [We Still Haven’t Announced Cholera]. http://www.bbc.co.uk/vietnamese/vietnam/story/2007/11/071108_ nocholeraannouncement.shtml, accessed January 22, 2013. Bekkevold, Jo Inge, Arve Hansen, and Kristen Nordhaug. 2021. “The Socialist Market Economy in China, Vietnam and Laos: A Development Model to Embrace?” Development Economics. January 21. https://developingeconomics.org/2021/01/11/ the-socialist-market-economy-in-china-vietnam-and-laos-a-development-modelto-embrace/. Benedikter, Simon. 2014. The Vietnamese Hydrocracy and the Mekong Delta: Water Resources Development from State Socialism to Bureaucratic Capitalism. Berlin: LIT Verlag. Bennett, S. and V. Nguyen. 2008. “Dog Meat May Be Spreading Vietnam’s Cholera Outbreak.” http://www.bloomberg.com/apps/news?pid=20601087&sid=aUCkC1SvB rK4&refer=home, accessed August 3, 2008. Biggs, David. 2012. Quagmire: Nation-Building and Nature in the Mekong Delta. Seattle: University of Washington Press. Bloom, E., A. Jain, L. Nazarbekova, Asian Development Bank, and Asian Development Bank Board of Directors. 2005. “Report and Recommendation of the President to the Board of Directors on a Proposed Loan and Asian Development Fund Grant to the Socialist Republic of Viet Nam for the Preventive Health System Support Project.” Manila, Philippines: Asian Development Bank. Boudreau, John and Xuan Quynh Nguyen. 2020. “Hanoi’s Largest Hospital Locked Down on Virus Outbreak Fears.” Bloomberg. March 28. https://www.bloomberg. com/news/articles/2020-03-28/hanoi-s-largest-hospital-locked-down-on-virusoutbreak-fears. Bradley, Mark Philip. 2004. “Becoming Van Minh: Civilizational Discourse and Visions of the Self in Twentieth-Century Vietnam.” Journal of World History 15, no. 1: 65–83. Briggs, Charles and Clara Mantini-Briggs. 2004. Stories in the Time of Cholera: Racial Profiling during a Medical Nightmare. Oakland, CA: University of California Press. Briggs, Charles and Mark Nichter. 2009. “Biocommunicability and the Biopolitics of Pandemic Threats.” Medical Anthropology 28, no. 3: 189–98. British Medical Journal. 1966. “Medical Aid to Vietnam.” British Medical Journal 2, no. 5514: xxiv. Bryant, John. 1998. “Communism, Poverty, and Demographic Change in North Vietnam.” Population and Development Review 24, no. 2: 235–69.

174

Bibliography

Buckley, Chris and Steven Lee Myers. 2020. “As New Coronavirus Spread, China’s Old Habits Delayed Fight.” New York Times. February 1. https://www.nytimes. com/2020/02/01/world/asia/china-coronavirus.html?searchResultPosition=30. Buckley, Joe. 2021. “Vietnam’s Pandemic.” New Left Review. January 22. Electronic document,https://newleftreview.org/sidecar/posts/vietnams-pandemic, accessed January 22, 2021. Bui Thi Thu Hien, Do Thuy Trang, Flemming Scheutz, Phung Dac Cam, Kåre Mølbak, and Anders Dalsgaard 2007. “Diarrhoeagenic Escherichia coli and Other Causes of Childhood Diarrhoea: A Case-Control Study in Children Living in a WastewaterUse Area in Hanoi, Vietnam.” Journal of Medical Microbiology 56, no. 8. DOI: https:// doi.org/10.1099/jmm.0.47093-0. Burchett, Wilfred. 1957. North of the Seventeenth Parallel. Hà Nội: Red River Publishing House. Captured Documents (CDEC): Unknown Interrogation Source, Log Number 022969-69, 09/ 17/1968, CTZ 1, Thura Thien Province, 1969/02/22, Reel 0491, Vietnam Archive Collection, Vietnam Center and Sam Johnson Vietnam Archive, Texas Tech University, https://www.vietnam.ttu.edu/virtualarchive/items. php?item=F034604910087, accessed August 7, 2020. Carsten, Janet. 2014. “Kinship.” In Critical Terms for the Study of Gender, edited by Catharine R. Stimpson and Gilbert Herdt, 207–31. Chicago: University of Chicago Press. Carter, James M. 2008. Inventing Vietnam: The United States and State Building, 1954–1968. Cambridge: Cambridge University Press. Centers for Disease Control. 2014. “Facts about Bushmeat and Ebola.” Electronic document, http://www.cdc.gov/vhf/ebola/pdf/bushmeat-and-ebola.pdf, accessed 27 January 2015. Channel News Asia. 2008. “Vietnam Cholera Contagion Spurs Cleanliness Crusade.” http://www.channelnewsasia.com/stories/afp_asiapacific/view/341463/1/.html, accessed October 3, 2008. Chapuis, Oscar. 1995. A History of Vietnam: From Hong Bang to Tu Duc. Westport, CT: Greenwood Press. Chaudhry, Peter. 2016. “The Struggle to Be Poor in Vietnam’s Northern Borderlands: Political Metis and Biopower in the Local State Arena.” In Connected and Disconnected in Viet Nam: Remaking Social Relations in a Post-Socialist Nation, edited by Philip Taylor, 203–39. Canberra, Australia: ANU Press. Chen, Mel. 2013. Animacies: Biopolitics, Racial Mattering, and Queer Affect. Raleigh, NC: Duke University Press. Chigudu, Simukai. 2020. The Political Life of an Epidemic: Cholera, Crisis, and Citizenship in Zimbabwe. Cambridge: Cambridge University Press. Coclanis, Peter. 2008. “Scholarly Note: Cholera in Nineteenth-Century Burma.” Southeast Review of Asian Studies 30: 166–76.

Bibliography

175

Cogswell, Lynne and Le Thi Anh Thu. 2008. “Enabling Environment Assessment and Baseline for Scaling Up Handwashing Programs: Vietnam.” Electronic document, http://www.wsp.org/wsp/sites/wsp.org/files/publications/EEHW_Vietnam.pdf, accessed July 9, 2009. World Bank Water and Sanitation Program. Collignon, Bernard, Sixto Requena, Tran Van Thinh and Nguyen Thi Than Hang. 2011. “Sanitation Management for Urban Areas in Vietnam: Final Report.” Washington, DC: World Bank; AusAID; Hydroconseil; PEMConsult. Collins, Andrew. 2003. “Vulnerability to Coastal Cholera Ecology.” Social Science and Medicine 57: 1397–407. Colwell, R., J. Kaper, and S.W. Joseph. 1977. “Vibrio cholerae, Vibrio parahaemolyticus, and Other Vibrios: Occurrence and Distribution in Chesapeake Bay.” Science 198, no. 4315: 394–6. Colwell, Rita and Sharon McGrayne. 2020. A Lab of One’s Own: One Woman’s Personal Journey through Sexism in Science. New York: Simon & Schuster. Comaroff, Jean. 1993. “The Diseased Heart of Africa: Medicine, Colonialism, and the Black Body.” In Knowledge, Power and Practice: The Anthropology of Medicine and Everyday Life, edited by Shirley Lindenbaum and Margaret Lock, 305–29. Berkeley, CA: University of California Press. Cook, Ian G. and Trevor J.B. Dummer. 2004. “Changing Health in China: Re-evaluating the Epidemiological Transition Model.” Health Policy 67, no. 3: 329–43. DOI: 10.1016/j.healthpol.2003.07.005. Craig, David. 2002. Familiar Medicine: Everyday Health Knowledge and Practice in Vietnam. Honolulu: University of Hawaii Press. Curley, Melissa and Nicholas Thomas. 2004. “Human Security and Public Health in Southeast Asia: The SARS Outbreak.” Australian Journal of International Affairs 58, no. 1: 17–32. Dalsgaard, Anders. 2001. “Health Aspects of the Reuse of Wastewater in Agriculture and Aquaculture in Vietnam.” In Wastewater Reuse in Agriculture in Vietnam: Water Management, Environment and Human Health Aspects: Proceedings of a Workshop Held in Hanoi, Vietnam. IWMI Working Paper 30, edited by Liqa Raschid-Sally, Wim van der Hoek, and Mala Ranawaka, 26–8. Colombo, Sri Lanka: International Water Management Institute. Dalsgaard, A., N.V. Tam, and P.D. Cam. 1997. “Cholera in Vietnam.” The Southeast Asian Journal of Tropical Medicine and Public Health 28, no. 1: 69–72. Dalsgaard, A., N. Forslund, V. Tam, D. X. Vinh, and P. D. Cam. 1999. “Cholera in Vietnam: Changes in Genotypes and Emergence of Class I Integrons Containing Aminoglycoside Resistance Gene Cassettes in Vibrio Cholerae O1 Strains Isolated from 1979 to 1996.” Journal of Clinical Microbiology 37: 734–41. Dân Luận. 2010. “Đào Tuấn: Khuynh hướng Chó Tả” [Dog Cholera Trend, by Đào Tuấn]. Electronic document, http://danluan.org/tin-tuc/20100715/dao-tuankhuynh-huong-cho-ta, accessed September 15, 2012.

176

Bibliography

Dân Trí. 2007a. “Đôi lời với … mắm tôm” [A Couple of Words about Shrimp Paste]. Electronic document, http://dantri.com.vn/c202/s202-210420/doi-loi-voi-mamtom.htm, accessed August 22, 2012. Dân Trí. 2007b. “Đầu bếp Khách sạn, Nhà hàng Mặc Tiêu chảy cấp” [Two Chefs at a Hotel and Restaurant Contract Cholera]. http://www.baomoi.com/2-dau-bepkhach-san-nha-hang-mac-tieu-chay-cap/84/1146641.epi, accessed January 14, 2013. Dang, Duc Anh, A.L. Lopez, D.T. Vu Thiem, S.L. Grahek, N.D. Tran, J.K. Park, H.J. Kwon, M. Favorov, T.H. Nguyen, and J.D. Clemens. 2011. “Use of Oral Cholera Vaccines in an Outbreak in Vietnam: A Case Control Study.” PLoS Neglected Tropical Diseases 5: e1006. Dang Nguyen Anh, Cecilia Tacoli, and Hoang Xuan Thanh. 2005. “Migration in Vietnam: Current Trends, Patterns and Their Policy Implications.” In Migration and Development: Pro-Poor Policy Choices, edited by Tasneem Siddiqui, 283–332. Dhaka: The University Press Limited. Dang Thuy Tram. 2007. Last Night I Dreamed of Peace: The Diary of Dang Thuy Tram. New York: Three Rivers Press. Đào Thanh Tú. “Idiomatic Expressions Containing the Word ‘Dog’ in English and Vietnamese.” M.A. thesis, Vietnam National University. http://citeseerx.ist.psu.edu/ viewdoc/download;jsessionid=E39B394EF346C278E367732ECECF6809?doi=10.1.1 .457.6716&rep=rep1&type=pdf. Davidson, Helen. 2020. “First Covid-19 Case Happened in November, China Government Records Show—Report.” The Guardian. March 13. Electronic document, https://www.theguardian.com/world/2020/mar/13/first-covid-19case-happened-innovember-china-government-records-show-report, accessed September 19, 2020. Davis, Mike. 2005. The Monster at Our Door: The Global Threat of Avian Flu. New York: The New Press. Deen, Jacqueline, Martin A. Mengel, and John D. Clemens. 2020. “Epidemiology of Cholera.” Vaccine 38, Suppl. 1: A31–A40. Degeling, Chris and Ian Kerridge. 2013. “Hendra in the News: Public Policy Meets Public Morality in Times of Zoonotic Uncertainty.” Social Science & Medicine 82: 156–63. Dery, David. 1998. “‘Papereality’ and Learning in Bureaucratic Organizations.” Administration & Society 29, no. 6: 677–89. des Barres, Le Roy. 1927. “Rapport sur L’epidémie de Choléra à Hanoï, en 1926–1927” [Report on the Cholera Epidemic in Hanoi in 1926–1927]. Bulletin de la Société Médico-chirurgical de l’Indochine [Bulletin of the Medical-Surgical Society of Indochina] 7: 295–305. Dien Nguyen An Luong. 2020. “Vietnam’s Virus-Tracing App Treads Grey Line between Safety, Privacy.” South China Morning Post, August 24. Electronic document, https:// www.scmp.com/week-asia/opinion/article/3098566/vietnams-coronavirus-appbluezone-treads-grey-line-between-safety, accessed September 1, 2020.

Bibliography

177

DiGregorio, Michael, A. Terry Rambo, and Masayuki Yanagisawa. 2003. “Clean, Green, and Beautiful: Environment and Development under the Renovation Economy.” In Postwar Vietnam: Dynamics of a Tranforming Society, edited by Hy V. Luong, 171–200. Lanham, MD: Rowman & Littlefield. Do Huu The. 1970. “The Creation of a National Pharmaceutical Industry.” Vietnamese Studies 25: 101–28. Đỗ Thị Thanh Loan. 2007. “Đảng bộ Hà Nội lãnh đạo xây dựng hệ thống tổ chức chính quyền từ 1954 đến 1965” [Hanoi Party Committee Building the Administrative Government System from 1954 to 1965.] M.A. thesis, Vietnam National University. https://repository.vnu.edu.vn/bitstream/VNU_123/16592/5/V_L2_01046_Noi_ dung.pdf. Do Thi Thanh Toan, Wenbiao Hu, Pham Quang Thai, Luu Ngoc Hoat, Pamela Wright, and Pim Martens. 2013. “Hot Spot Detection and Spatiotemporal Dispersion of Dengue Fever in Hanoi, Vietnam.” Global Health Action 6. DOI: 10.3402/gha. v6i0.18632. Douglas, Mary. 2005. Purity and Danger: An Analysis of Concepts of Pollution and Taboo. London: Routledge Classics. Drakakis-Smith, David and Andrea Kilgour. 2001. “Sustainable Urbanisation and Environmental Issues in Vietnam.” In Living with Environmental Change: Social Vulnerability, Adaptation, and Resilience in Vietnam, edited by W. Neil Adger, P. Mick Kelly, and Nguyen Huu Ninh, 213–33. New York: Routledge. Drummond, Lisa. 2000. “Street Scenes: Practices of Public and Private Space in Urban Vietnam.” Urban Studies 37, no. 12: 2377–91. Dunn, Elizabeth. 2004. Privatizing Poland: Baby Food, Big Business, and the Remaking of Labor. Ithaca, NY: Cornell University Press. Dunn, Elizabeth. 2008. “Postsocialist Spores: Disease, Bodies, and the State in the Republic of Georgia.” American Ethnologist 35, no. 2: 243–58. Dyt, Kathryn. 2015. “‘Calling for Wind and Rain’: Rituals, Environment, Emotion, and Governance in Nguyễn Vietnam, 1802–1883.” Journal of Vietnamese Studies 10, no. 2: 1–42. Echenberg, Myron. 2011. Africa in the Time of Cholera: A History of Pandemics from 1817 to the Present. Cambridge: Cambridge University Press. Edington, Claire. 2019. Beyond the Asylum: Mental Illness in French Colonial Vietnam. Ithaca: Cornell University Press. Eisenberg, M.C., S.L. Robinson, and J.H. Tien. 2013. “Identifiability and Estimation of Multiple Transmission Pathways in Cholera and Waterborne Disease.” Journal of Theoretical Biology 324: 84–102. Elkind, Jessica. 2016. Aid under Fire: Nation Building and the Vietnam War. Lexington: University of Kentucky Press. Emch, Michael, Caryl Feldacker, Mohammad Yunus, Peter Kim Streatfield, Vu Dinh Thiem, Do Gia Canh, and Mohammad Ali. 2008. “Local Environmental

178

Bibliography

Predictors of Cholera in Bangladesh and Vietnam.” The American Journal of Tropical Medicine and Hygiene 78, no. 5: 823–32. Encyclopedia of Environmental Health, s.v. 2011. “Waterborne Disease,” accessed August 12, 2020, https://www.sciencedirect.com/topics/earth-and-planetarysciences/waterborne-disease. Evans, Richard J. 1987. Death in Hamburg: Society and Politics in the Cholera Years. New York: Penguin. Fahlman, Miles J. 2019. “The Anthropology of SARS and the Leveraging of Cultural Logics in Vietnam.” M.A. thesis, University of Sasketchewan. https:// harvest-test.usask.ca/bitstream/handle/10388/11977/FAHLMAN-THESIS-2019. pdf?sequence=1. Fallows, James. 1991. “Shut Out: The U.S. Embargo Does Not Prevent Other Countries from Doing Business There, but It Does Prevent the Country from Rebuilding Itself.” The Atlantic 267, no. 3: 42. https://www.theatlantic.com/past/docs/issues/91mar/ shut.htm, accessed August 22, 2020. Farmer, Paul. 1996. AIDS and Accusation: Haiti and the Geography of Blame. Oakland, CA: University of California Press. Farmer, Paul. 2005. Pathologies of Power: Health, Human Rights, and the New War on the Poor. Oakland, CA: University of California Press. Farmer, Paul. 2011. Haiti after the Earthquake. New York: PublicAffairs. Farmer, Paul. 2020. Fevers, Feuds, and Diamonds: Ebola and the Ravages of History. New York: Farrar, Straus, & Giroux. Farquhar, Judith and Qicheng Zhang. 2005. “Biopolitical Beijing: Pleasure, Sovereignty, and Self-Cultivation in China’s Capital.” Cultural Anthropology 20, no. 3: 303–27. Faruque, Shah M., M. John Albert, and John J. Mekalanos. 1998. “Epidemiology, Genetics, and Ecology of Toxigenic Vibrio cholerae.” Microbiology and Molecular Biology Review 62, no. 4: 1301–14. Fassin, Didier. 2007. “Humanitarianism as a Politics of Life.” Public Culture 19, no. 3: 499–520. Feyen, Jan, Matthew Neville, and Kelly Shannon, eds. 2009. Water and Urban Development Paradigms: Towards an Integration of Engineering, Design and Management Approaches. Boca Raton, FL: CRC Press. Figuié, Muriel, Paule Moustier, Nicolas Bricas, and Nguyen Thi Tan Loc. 2019. “Trust and Food Modernity in Vietnam.” In Food Anxiety in Globalising Vietnam, edited by Judith Ehlert and Nora Katharine Faltmann, 139–66. New York: Palgrave Macmillan. FINNIDA. 1993. “Water Master Plan of Hanoi City for the Period 1993–2010: Final Report.” Hanoi: Hanoi’s People’s Committee and Finnish International Development Agency (FINNIDA). Fisher, Max. 2020. “Coronavirus Exposes Core Flaws, and Few Strengths, in China’s Governance.” New York Times. January 27. https://www.nytimes.com/2020/01/25/ world/asia/coronavirus-crisis-china-response.html?searchResultPosition=35. Fitzgerald, Frances. 2005. Introduction. In Last Night I Dreamed of Peace: The Diary of Dang Thuy Tram, v–xix. New York: Three Rivers Press.

Bibliography

179

Food and Agriculture Organization. 2013. “UN-Water Country Brief.” Electronic document, http://www.unwater.org/WaterCountryBriefs.html, accessed August 10, 2015. Föreningen Levande Framtid [Living Future Society]. 2006. Long-Term Consequences of the Vietnam War: Public Health. Electronic document, http://www.nnn.se/ environ/health.pdf, accessed September 22, 2020. Foucault, Michel. 1994. The Birth of the Clinic: An Archaeology of Medical Perception. New York: Vintage. Fox, Diane Niblack. 2003. “Chemical Politics and the Hazards of Modern Warfare: Agent Orange.” In Synthetic Planet: Chemical Politics and the Hazards of Modern Life, edited by Monica Casper, 73–90. Princeton, NJ: Routledge. Galston, Arthur and Ethan Signer. 1971. “Education and Science in North Vietnam.” Science 174, no. 4007: 379–85. Gammeltoft, Tine. 1999. Women’s Bodies, Women's Worries: Health and Family Planning in a Vietnamese Rural Commune. Surrey, United Kingdom: Curzon Press. Garrett, Laurie. 1994. The Coming Plague: Newly Emerging Diseases in a World Out of Balance. New York: Penguin Books. Geertman, Stephanie. 2010. “Urban Development Trends in Hanoi and Impact on Ways of Life, Public Health and Happiness: Liveability from a Health Perspective.” Paper presented at Hanoi Millennium – City Past and Future conference, Hanoi, October 12–13, 2010. Gellhorn, Martha. 1994. The Face of War. New York: Atlantic Monthly Press. Genevray, J. 1939. Le Cholera en Indochine en 1937–1938 [Cholera in Indochina in 1937–1938]. Extrait au Bulletin mensuel de l’Office International d’Hygiene Publique [Extract from the Monthly Bulletin of the International Office of Public Hygiene] 31, no. 6: 1024–7. Ghosh, Arunabh. 2020. Making It Count: Statistics and Statecraft in the Early People’s Republic of China. Princeton, NJ: Princeton University Press. Giaoduc.net.vn. 2012. “GS Nguyễn Lân Dũng: Quảng cáo nước tẩy rửa Vim thiếu tính khoa học” [Dr. Nguyễn Lân Dũng: Advertising for Vim Washing Liquid is Unscientific]. Electronic document, http://giaoduc.net.vn/Ban-doc/GS-NguyenLan-Dung-Quang-cao-nuoc-tay-rua-Vim-thieu-tinh-khoa-hoc/216689.gd, accessed December 2, 2013. Gilbert, Pamela K. 2008. Cholera and Nation: Doctoring the Social Body in Victorian England. Albany, NY: SUNY Press. Gleick, Peter H., Heather Cooley, David Katz et al. 2006. The World's Water 2006–2007: The Biennial Report on Freshwater Resources. Washington, DC: Island Press. Glewwe, Paul. 2004. “An Overview of Economic Growth and Household Welfare in Vietnam in the 1990s.” In Economic Growth, Poverty, and Household Welfare in Vietnam, edited by Paul Glewwe, Nisha Agrawal, and David Dollar, 1–26. Washington, DC: World Bank. Goscha, Christopher. 2011. Vietnam: Un État né de la Guerre. Paris: Armand Colin. [Kindle edition].

180

Bibliography

Government of the Socialist Republic of Vietnam and the United Nations in Viet Nam. 2012. One Plan 2012–2016. Electronic document, https://apps.who.int/iris/ bitstream/handle/10665/206609/one_un_vnm_2012-2016_eng.pdf;jsessionid=A821 F2B9E79B69E394F9738CA7E1747C?sequence=1, accessed September 29, 2020. Gray, Michael. 1999. “Creating Civil Society?: The Emergence of NGOs in Vietnam.” Development and Change 30, no. 4: 693–713. Guénel, Annick. 2004. “Malaria, Colonial Economics and Migrations in Vietnam.” Paper presented at the 4th Conference of the European Association of Southeast Asian Studies, Paris, September 1–4, 2004. Electronic document, http://hal.inria.fr/ docs/00/13/69/81/PDF/Malaria1.pdf, accessed May 10, 2011. Hamlin, Christopher. 2009. Cholera: The Biography. New York: Oxford University Press. Harada, Hidenori, Matsuda Tomonari, Nguyen The Dong, Nguyen Thi Kim Thai, and Saburo Matsui. 2007. “Septic Tanks Need Urgent Improvement for Management of Urban Sanitation in Hanoi, Vietnam.” Annual Report of FY 2007, the Core University Program between Japan Society for the Promotion of Science (JSPS) and Vietnamese Academy of Science and Technology (VAST). Osaka, Japan, pp. 331–42. Haraway, Donna. 2008. When Species Meet. Minneapolis: University of Minnesota Press. Harms, Erik. 2009. “Vietnam’s Civilizing Process and the Retreat from the Street: A Turtle's Eye View from Ho Chi Minh City.” City and Society 21, no. 2: 182–206. DOI: https://doi.org/10.1111/j.1548-744X.2009.01021.x. Haub, Carl and Phuong Thi Thu Huong. 2003. An Overview of Population and Development in Vietnam. Electronic document, https://www.prb.org/ anoverviewofpopulationanddevelopmentinvietnam/, accessed March 13, 2020. Haughton, Dominique, Jonathan Haughton, and Nguyen Phong, eds. 2001. Living Standards during an Economic Boom. Hanoi: Statistical Publishing House. Hawk, Alan. 2002. “Jungle Medicine, Treating VC Wounded.” Vietnam 15, no. 1: 42–8. Haycock, David. 2001. “Health in the 17th Century.” Electronic document, http://www. nmm.ac.uk/places/queens-house/fact-files/health-in-the-17th-century, accessed May 20, 2011. Hayton, Bill and Tro Ly Ngheo. 2020. “Vietnam’s Coronavirus Success Is Built on Repression.” Foreign Policy. May 12. Electronic document, https://foreignpolicy. com/2020/05/12/vietnam-coronavirus-pandemic-success-repression/, accessed September 2, 2020. Hessler, Peter. 2020. “Nine Days in Wuhan, the Ground Zero of the Coronavirus Pandemic.” The New Yorker. October 12. Electronic document, https://www. newyorker.com/magazine/2020/10/12/nine-days-in-wuhan-the-ground-zero-of-thecoronavirus-pandemic, accessed October 12, 2020. Hickey, Gerald C. 1964. Village in Vietnam. New Haven, CT: Yale University Press. Hinh, Nguyen Duc and Hoang Van Minh. 2013. “Public Health in Vietnam: Scientific Evidence for Policy Changes and Interventions.” Global Health Action 6: DOI: 10.3402/gha.v6i0. 20672.

Bibliography

181

Hirschman, Charles. 1994. “Population and Society in Twentieth-Century Southeast Asia.” Journal of Southeast Asian Studies 25, no. 2: 381–416. Hirschman, Charles, Samuel Preston, and Vu Manh Loi. 1995. “Vietnamese Casualties during the American War: A New Estimate.” Population and Development Review 21, no. 4: 783–812. Hjorth, Peder and Nguyen Thi Dan. 1993. “Environmentally Sound Urban Water Management in Developing Countries: A Case Study of Hanoi.” International Journal of Water Resources Development 9, no. 4: 453–64. Hồ Chí Minh. 1955. “Thư Hồ Chủ Tịch Gửi hội nghị cán bộ y tế đầu năm 1955” [Letter sent by Leader Ho to the Conference of Health Cadres at the Beginning of 1955]. Electronic document, http://vnthuquan.net/diendan/tm.aspx?m=90505, accessed March 18, 2011. Hoàng Đạo. 1991. “Mud and Stagnant Water.” In Before the Revolution: The Vietnamese Peasants under the French, edited by Ngô Vĩnh Long, 205–18. New York: Columbia University Press. Hoang Dinh Cau. 1965. “The Training of Medical and Health Workers in the Democratic Republic of Vietnam.” In Health Organization in the DRV, 37–66. Hanoi: Vietnamese Studies. Hoang Thuy Nguyen. 1972. “Preventive Medicine in the DRVN: Problems and Achievements.” Vietnamese Studies 34: 87–114. Hoang, Van Minh, Tuan Anh Tran, Anh Duc Ha, and Viet Hung Nguyen. 2015. “Cost of Hospitalization for Foodborne Diarrhea: A Case Study from Vietnam.” Journal of Korean Medical Science 30, Suppl 2: S178–S182. DOI: 10.3346/jkms.2015.30.S2.S178. Huard, Lucian. 1887. La Guerre du Tonkin [The War of Tonkin]. Paris, s.n. Humphrey, Chris. 2020a. “‘In a War, We Draw’: Vietnam’s Artists Join Fight against Covid-19.”The Guardian, April 8. Electronic document, https://www.theguardian. com/global-development/2020/apr/09/in-a-war-we-draw-vietnams-artists-joinfight-against-covid-19, accessed October 1, 2020. Humphrey, Chris. 2020b. “Vietnam Arrests Prominent Journalist as State Cracks Down on Free Speech Online.” The Guardian, October 7. Electronic document, https://www.theguardian.com/global-development/2020/oct/08/vietnam-arrestsprominent-journalist-as-state-cracks-down-on-free-speech-online, accessed October 7, 2020. Hurle, Robert J. 2009. Propaganda and the People: An Examination of Persuasion in the Struggle for Independence in Viet Nam to 1954. Mauritius: Lambert Academic Publishing. Hutt, David. 2020. “Vietnam Walls off Viral China at Its Peril.” Asia Times. January 30. Electronic document, https://asiatimes.com/2020/01/vietnam-walls-off-viral-chinaat-its-peril/, accessed October 1, 2020. Hữu Ngọc. 2008. Wandering through Vietnamese Culture. Hà Nội: Thế Giới Publishers. Institute of Medicine. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington: National Academy Press.

182

Bibliography

Isenbarger, D.W., B.T. Hien, H.T. Ha, T.T. Ha, L. Bodhidatta, L.W. Pang, and P.D. Cam. 2001. “Prospective Study of the Incidence of Diarrhoea and Prevalence of Bacterial Pathogens in a Cohort of Vietnamese Children along the Red River.” Epidemiology and Infection 127, no. 2: 229–36. Janes, Craig and Oyuntsetseg Chuluundorj. 2004. “Free Markets and Dead Mothers: The Social Ecology of Maternal Mortality in Post-Socialist Mongolia.” Medical Anthropology Quarterly 18, no. 2: 230–57. Jensen, P.K.M., P.D. Phuc, and L.G.K. West. 2010. “How Do We Sell the Hygiene Message? With Dollars, Dong or Excreta?” Environmental Health 9, no. 27. DOI: 10.1186/1476-069X-9-27. Johnson, Steven. 2006. The Ghost Map: The Story of London’s Most Terrifying Epidemic— and How It Changed Science, Cities, and the Modern World. New York: Riverhead Books. Jones, Kate, Nikkita Patel, Marc Levy, Adam Storeygard, Deborah Balk, John Gittleman, and Peter Daszak. 2008. “Global Trends in Emerging Infectious Diseases.” Nature 451: 990–4. Jones, Jared. 2011. “Ebola, Emerging: The Limitations of Culturalist Discourses in Epidemiology.” The Journal of Global Health 1, no. 1: 1–5. Kavic, Stephen, Eric J. Frehmb, and Alan S. Segal. 1999. “Case Studies in Cholera: Lessons in Medical History and Science.” Yale Journal of Biology and Medicine 72: 393–408. Keck, Frédérick and Christos Lynteris. 2018. “Zoonosis: Prospects and Challenges for Medical Anthropology.” Medicine Anthropology Theory 5, no. 3: 1–14. Kelly-Hope, Louise, Wladimir J. Alonso, Vu Dinh Thiem, Do Gia Canh, Dang Duc Anh, Hyejon Lee, and Mark A. Miller. 2008. “Temporal Trends and Climatic Factors Associated with Bacterial Enteric Diseases in Vietnam, 1991–2001.” Environmental Health Perspectives 116, no. 1: 7–12. Kerkvliet, Benjamin. 1993. “Claiming the Land: Take-overs by Villagers in the Philippines with Comparisons to Indonesia, Peru, Portugal, and Russia.” The Journal of Peasant Studies 20, no. 3: 459–93. Kerkvliet, Benjamin. 2003. “Authorities and the People: An Analysis of State-Society Relations in Vietnam.” In Postwar Vietnam: Dynamics of a Transforming Society, edited by Hy V. Luong, 27–54. Singapore: Institute of Southeast Asian Studies. Kerkvliet, Benjamin. 2019. Speaking Out in Vietnam: Public Political Criticism in a Communist Party-Ruled Nation. Ithaca, NY: Cornell University Press. Kerkvliet, Ben, Russel Heng, and David Koh, eds. 2003. Getting Organized in Vietnam: Moving in and around the Socialist State. Singapore: Institute of Southeast Asian Studies. Kerkvliet, Melinda Tria. 2011. “The Food Problem in Hanoi during the Subsidy Period: How Workers Coped.” South East Asia Research 19, no. 1: 83–106. Khanh Vu, Phong Nguyen, and James Pearson. 2020. “After Aggressive Mass Testing, Vietnam Says It Contains Coronavirus Outbreak.” Reuters. April 20. Electronic

Bibliography

183

document, https://www.reuters.com/article/us-health-coronavirus-vietnam-fightinsi/after-aggressive-mass-testing-vietnam-says-it-contains-coronavirus-outbreakidUSKBN22B34H, accessed July 21, 2020. Kim, Jim Yong, Joyce V. Millen, Alec Irwin, and John Gershman, eds. 2000. Dying for Growth: Global Inequality and the Health of the Poor. Monroe, ME: Common Courage Press. Kleinman, Arthur. 1988. The Illness Narratives: Suffering, Healing, and the Human Condition. New York: Basic Books. Klingler-Vidra, Robyn and Ba-Linh Tran. 2020. “Vietnam Has Reported No Coronavirus Deaths—How?” The Conversation. April 21. Electronic document, https://theconversation.com/vietnam-has-reported-no-coronavirus-deathshow-136646, accessed September 29, 2020. Koch, Erin. 2013. Free Market Tuberculosis: Managing Epidemics in Post-Soviet Georgia. Nashville, TN: Vanderbilt University Press. Kohn, Eduardo. 2007. “How Dogs Dream: Amazonian Natures and the Politics of Transspecies Engagement.” American Ethnologist 34, no. 1: 3–24. Kolko, Gabriel. 1985. Anatomy of a War: Vietnam, the United States, and the Modern Historical Experience. New York: Pantheon. Kotsila, Panagiota. 2014. The Socio-Political and Cultural Determinants of Diarrheal Disease in the Mekong Delta: From Discourse to Incidence. Berlin: LIT Verlag. Kotsila, Panagiota. 2017. “Health Dispossessions and the Moralization of Disease: The Case of Diarrhea in the Mekong Delta, Vietnam.” Journal of Political Ecology 24: 87–109. Kristof, Nicholas. 2020. “Coronavirus Spreads, and the World Pays for China’s Dictatorship.”New York Times. January 29. Electronic document, https:// www.nytimes.com/2020/01/29/opinion/coronavirus-china-government. html?searchResultPosition=6, accessed September 1, 2020. Kwon, Heonik. 2013. Ghosts of War in Vietnam. New York: Cambridge University Press. Ladinsky, Judith. 1987. “The Influence of Traditional Medicine in Shaping Medical Care Practices Today.” Social Science and Medicine 25, no. 10: 1105–10. Ladinsky, Judith and Ruth E. Levine. 1985. “The Organization of Health Services in Vietnam.” Journal of Public Health Policy 6, no. 2: 255–68. Lai, Shengjie, Nick W. Ruktanonchai, Liangcai Zhou, Olivia Prosper, Wei Luo, Jessica R. Floyd, Amy Wesolowski, Mauricio Santillana, Chi Zhang, Xiangjun Du, Hongjie Yu, and Andrew J. Tatum. 2020. “Effect of Non-Pharmaceutical Interventions to Contain COVID-19 in China.” Nature 585: 410–13. https://www.nature.com/articles/s41586020-2293-x. Lampland, Martha. 2010. “False Numbers as Formalizing Practices.” Social Studies of Science 40, no. 3: 377–404. Langstaff, Alex. 2020. “Pandemic Narratives and the Historian.” Los Angeles Review of Books. May 18. https://lareviewofbooks.org/article/pandemic-narratives-and-thehistorian/.

184

Bibliography

Le Hoang Ngoc Yen. 2020. “Leprosy, Impurity, and Stigma in Vietnam.” Medicine Anthropology Theory 7, no. 2: 175–86. Lê Hùng Lâm. 1991. Bài giảng Y học Xã hội và Tổ chức Y tế [Lectures on Social Medicine and Health Organization]. Hà Nội: Hà Nội Medical University. Le Minh Giang and Nguyen Thi Mai Huong. 2004. “From Family Planning to HIV/ AIDS in Vietnam: Shifting Priorities, Remaining Gaps.” In SexPolitics: Reports from the Front Lines, edited by Richard Parker, Rosalind Petchesky, and Robert Sember. Rio de Janeiro: Sexuality Policy Watch. Le Van Cuong, Hoang Thi Nam Giang, Le Khac Linh, Jaffer Shah, Le Van Sy, Trinh Huu Hung et al. 2020. “The First Vietnamese Case of COVID-19 Acquired from China.” Lancet 20, no. 4: 408–9. DOI: https://doi.org/10.1016/S1473-3099(20)30111-0. Lee, Alicia. 2020. “‘Rice ATMs’ Provide Free Rice for People Out of Work in Vietnam Due to the Coronavirus Crisis.” CNN. April 13. Electronic document, https:// edition.cnn.com/2020/04/13/world/coronavirus-vietnam-rice-atm-trnd/index.html, accessed September 15, 2020. Leow, Rachel. 2014. “Healing the Nation: Politics, Medicine and Analogies of Health in Southeast Asia.” In Histories of Health in Southeast Asia: Perspectives on the Long Twentieth Century, edited by Tim Harper and Sunil S. Amrith, 202–9. Bloomington: Indiana University Press. Leshkowich, Ann Marie. 2005. “Feminine Disorder: State Campaigns against Street Traders in Socialist and Late Socialist Viet Nam.” In Le Viêt Nam au Féminin: Viet Nam: Women’s Realities, edited by Gisèle Bousquet and Nora Taylor, 187–207. Paris: Les Indes Savantes. Leshkowich, Ann Marie. 2008. “Working Out Culture: Gender, Body, and Commodification in a Ho Chi Minh City Health Club.” Urban Anthropology 37, no. 1: 49–87. Lincoln, Martha. 2009. “Report from the Field: Street Vendors and the Informal Sector in Hanoi.” Dialectical Anthropology 32, no. 3: 261–5. Lincoln, Martha. 2014. “Medical Stratification in Vietnam.” Medicine Anthropology Theory 1, no. 1: 21–33. Lincoln, Martha. 2020. “A Special Self-Image Is No Defence against COVID-19.” Nature 585: 325. Electronic document, https://www.nature.com/articles/d41586-020025968?utm_source=twt_nnc&utm_medium=social&utm_campaign=naturenews, accessed September 23, 2020. Lindan C.P., T.X. Lieu, L.T. Giang, V.D. Lap, N.V. Thuc, T. Thinh, P. Lurie, and J.S. Mandel. 1997. “Rising HIV Infection Rates in Ho Chi Minh City Herald Emerging AIDS Epidemic in Vietnam.” AIDS 11, Suppl. 1: S5-13. PMID: 9376101. Lindenbaum, Shirley. 2001. “Kuru, Prions, and Human Affairs: Thinking about Epidemics.” Annual Review of Anthropology 30: 363–85. Lipp, Erin K., Anwar Huq, and Rita R. Colwell. 2002. “Effects of Global Climate on Infectious Disease: The Cholera Model.” Clinical Microbiology Reviews 15, no. 4: 757–70.

Bibliography

185

Liu, Xin. 2009. The Mirage of China: Anti-Humanism, Narcissism, and the Corporeality of the Contemporary World. New York: Berghahn Books. Logan, William S. 2000. Hanoi: Biography of a City. Seattle: University of Washington Press. Lomperis, Timothy J. 1996. From People’s War to People’s Rule: Insurgency, Intervention, and the Lessons of Vietnam. Chapel Hill, NC: University of North Carolina Press. London, Jonathan. 2004. “Rethinking Vietnam’s Mass Education and Health Systems.” In Rethinking Vietnam, edited by Duncan McCargo, 127–42. London: Routledge. London, Jonathan. 2008. “Reasserting the State in Viet Nam: Health Care and the Logics of Market-Leninism.” Policy and Society 27: 115–28. London, Jonathan. 2011. “Historical Welfare Regimes and Education in Vietnam.” In Education in Vietnam, edited by Jonathan London, 57–103. New York: Cambridge University Press. Long, S. Le. 2011. “‘Colonial’ and ‘Postcolonial’ Views of Vietnam’s Pre-history.” Sojourn: Journal of Social Issues in Southeast Asia 26, no. 1: 128–48. Lopez, Anna Lena, Shanta Dutta, Firdausi Qadri, Ly Sovann, Basu Dev Pandey, Wan Mansor Bin Hamzah, Iqbal Memon, Sopon Iamsirithaworn, Duc Anh Dang, Fahima Chowdhury, Seng Heng, Suman Kanungo, Vittal Mogasale, Ashraf Sultan, and Michelle Ylade. 2020. “Cholera in Selected Countries in Asia.” Vaccine 38, Supplement 1: A18-A24. DOI: https://doi.org/10.1016/j.vaccine.2019.07.035. Lowe, Celia. 2010. “Viral Clouds: Becoming H5N1 in Indonesia.” Cultural Anthropology 25, no. 4: 625–49. Luong, Duong Huy, Shenglan Tang, Tuohong Zhang, and Margaret Whitehead. 2007. “Vietnam during Economic Transition: A Tracer Study of Health Service Access and Affordability.” International Journal of Health Services 37, no. 3: 573–88. Luong, Hy V. 2003. “Wealth, Power, and Inequality: Global Market, the State, and Local Sociocultural Dynamics.” In Postwar Vietnam: Dynamics of a Transforming Society, edited by Hy V. Luong, 81–106. Lanham, MD: Rowman & Littlefield. Luong, Hy V. 2006. “Structure, Practice, and History: Contemporary Anthropological Research on Vietnam.” Journal of Vietnamese Studies 1, no. 1–2: 371–410. Luu, Thi Nguyet Minh, Josette Garnier, Gilles Billen, Didier Orange, Julien Némery, Thi Phuong Quynh Le, Hong Thai Tran, and Lan Anh Le. 2010. “Hydrological Regime and Water Budget of the Red River Delta (Northern Vietnam).” Journal of Asian Earth Sciences 37, no. 3: 219–28. Lux, Steven J. and Jeffrey D. Straussman. 2003. “Searching for Balance: Vietnamese NGOs Operating in a State-Led Civil Society.” Public Administration and Development 24: 173–81. Lynteris, Christos. 2013. The Spirit of Selflessness in Maoist China: Socialist Medicine and the New Man. New York: Palgrave Macmillan. MacLean, Ken. 2008. “The Rehabilitation of an Uncomfortable Past: Everyday Life in Vietnam during the Subsidy Period (1975–1986).” History and Anthropology 19, no. 3: 281–303.

186

Bibliography

MacLean, Ken. 2013. The Government of Mistrust: Illegibility and Bureaucratic Power in Socialist Vietnam. Madison, WI: University of Wisconsin Press. Malarney, Shaun King. 2004. “Văn Miếu Hà Nội và bệnh dịch hạch năm 1903” [Hanoi’s Temple of Literature and Bubonic Plague in 1903]. Xưa và Nay 215: 28–31. Malarney, Shaun King. 2007. “Health and Structural Violence in Colonial Indochina.” The Journal of Social Science 61: 27–56. Malarney, Shaun King. 2012. “Germ Theory, Hygiene, and Transcendence of ‘Backwardness’ in Revolutionary Vietnam (1954–1960).” In Southern Medicine for Southern People: Vietnamese Medicine in the Making, edited by Laurence Monnais, Michele Thompson, and Ayo Wahlberg, 107–32. Newcastle Upon Tyne: Cambridge Scholars Press. Malhotra, Kamal. 1999. “Basic Health Services for Vulnerable Families in Vietnam— Should User Fees Be the Way Forward?” Paper prepared for the International Save the Children Alliance and UNICEF, Hanoi, April 1999. Marcovich, Anne. 1988. “French Colonial Medicine and Colonial Rule: Algeria and Indochina.” In Disease, Medicine, and Empire: Perspectives on Western Medicine and the History of Western Expansion, edited by Roy Macleod and Milton Lewis, 103–17. New York: Routledge. Marr, David. 1984. Vietnamese Tradition on Trial 1920–1945. Oakland, CA: University of California Press. Marr, David. 1987. “Vietnamese Attitudes Regarding Illness and Healing.” The Vietnam Forum 10: 26–50. Marr, David. 1988. “Tertiary Education, Research, and the Information Sciences in Vietnam.” In Postwar Vietnam: Dilemmas in Socialist Development, edited by David G. Marr and Christine Pelzer White, 15–44. Ithaca, NY: Cornell Southeast Asia Program. Marshall, Alex. 1982. “Visit to Commune Clinic Tells Much about Rural Life.” The Asia Record, p. 13. March issue. Martin, Emily. 1994. Flexible Bodies: Tracking Immunity in American Culture from the Days of Polio to the Age of AIDS. Boston: Beacon Press. Maruyama, Masayoshi and Le Viet Trung. 2010. “The Nature of Informal Food Bazaars: Empirical Results for Urban Hanoi, Vietnam.” Journal of Retailing and Consumer Services 17, no. 1: 1–9. Masina, Pietro and Michela Cerimele. 2018. “Patterns of Industrialisation and the State of Industrial Labour in Post-WTO-Accession Vietnam.” European Journal of East Asian Studies 17, no. 2: 1–36. DOI: 10.1163/15700615-01700200. Mason, Katherine. 2016. Infectious Change: Reinventing Chinese Public Health after an Epidemic. Stanford, CA: Stanford University Press. Mathers, Steve and Jan Zalasiewicz. 1999. “Holocene Sedimentary Architecture of the Red River Delta, Vietnam.” Journal of Coastal Research 15, no. 2: 314–25. Max, D.T. 2020. “The Public-Shaming Pandemic.” The New Yorker. September 21. Electronic document, https://www.newyorker.com/magazine/2020/09/28/thepublic-shaming-pandemic, accessed October 1, 2020.

Bibliography

187

McGrew, Roderick. 1960. “The First Cholera Epidemic and Social History.” Bulletin of the History of Medicine 34: 61–73. McIntyre, Di, Margaret Whitehead, Lucy Gilson, Göran Dahlgren, and Shenglan Tang. 2007. “Equity Impacts of Neoliberal Reforms: What Should the Policy Responses Be?” International Journal of Health Services 37, no. 4: 693–709. McKechnie, Claire Charlotte. 2013. “Man’s Best Fiend: Evolution, Rabies, and the Gothic Dog.” Nineteenth Century Prose 40, no. 2: 115–40. McLeod, Anni, Nancy Morgan, Adam Prakash, Jan Hinrichs. n.d. “Economic and Social Impacts of Avian Influenza.” Electronic resource, http://www.fao.org/avianflu/ documents/Economic-and-social-impacts-of-avian-influenza-Geneva.pdf, accessed August 15, 2015. McMichael, Joan K., ed. 1976. Health in the Third World: Studies from Vietnam. Nottingham, England: Bertrand Russell Peace Foundation. McNeil, Donald. 2013. “Arsenic Contamination Threatens Water in Hanoi.” New York Times. September 23. https://nyti.ms/1fvdGdW. McNeil, Donald. 2016. “Vietnam’s Battle with Tuberculosis.” New York Times. March 16. https://nyti.ms/22Vkh9q. Mead, Paul S., Laurence Slutsker, Vance Dietz, Linda F. McCaig, Joseph S. Bresee, Craig Shapiro, Patricia M. Griffin, and Robert V. Tauxe. 1999. “Food-Related Illness and Death in the United States.” Emerging Infectious Diseases 5, no. 5: 607–25. Michalak, Michael. 2008. “Most Recent Cholera Outbreak Recedes.” Diplomatic cable, May 8. Electronic document, https://wikileaks.org/cable/2008/05/08HANOI588. html, accessed March 1, 2020. Michaud, Jean. 2004. “French Missionary Expansion in Colonial Upper Tonkin.” Journal of Southeast Asian Studies 35, no. 2: 287–310. Ministry of Health of Việt Nam. 1995. Sơ lược Lịch sử Y tế Việt Nam [Brief History of Vietnamese Health]. Hà Nội: Nhà Xuất bản Chính trị Quốc Gia [National Political Publishing House]. Ministry of Health of Việt Nam. 2007a. Cẩm nang: Triển khai Công tác Phòng chống Bệnh Tả [Handbook for Implementation of Disease Prevention]. Hà Nội: Phú Thịnh Publishing Company. Ministry of Health of Việt Nam. 2007b. “Quyết Định Số 4233 về Việc Ban hành ‘Quy trình Xử lý Dịch tả’” [Decision 4233 Regarding the Promulgation of “Process for Treating Cholera”]. Electronic document, http://thuvienphapluat.vn/archive/ Quyet-dinh/Quyet-dinh-4233-QD-BYT-Quy-trinh-xu-ly-dich-ta-vb57527t17.aspx, accessed April 11, 2012. Minot, Nicholas and Bob Baulch. 2004. “The Spatial Distribution of Poverty in Vietnam and the Potential for Targeting.” In Economic Growth, Poverty, and Household Welfare in Vietnam, edited by Paul Glewwe, Nisha Agrawal, and David Dollar, 229–72. Washington, DC: World Bank. Mishra, Pankaj. 2020. “Flailing States.” London Review of Books 42, no. 4. Electronic document, https://www.lrb.co.uk/the-paper/v42/n14/pankaj-mishra/flailing-states, accessed August 13, 2020.

188

Bibliography

Momoki, Shirō. 1998. “Dai Viet and the South China Sea Trade: From the 10th to the 15th Century.” Crossroads: An Interdisciplinary Journal of Southeast Asian Studies 12, no. 1: 1–34. Monnais, Laurence. 2006. “Preventive Medicine and ‘Mission Civilisatrice’: Uses of the BCG Vaccine in French Colonial Vietnam between the Two World Wars.” IJAPS 1, no. 2: 40–66. Monnais, Laurence. 2019. The Colonial Life of Pharmaceuticals: Medicine and Modernity in Vietnam. Cambridge: Cambridge University Press. Monnais, Laurence, Michele Thompson, and Ayo Wahlberg, eds. 2012. Southern Medicine for Southern People: Vietnamese Medicine in the Making. Newcastle Upon Tyne: Cambridge Scholars Press. Montangero, A., C. Le, V.A. Nguyen, D.T. Vu, T.N. Pham, and H. Belevi. 2007. “Optimising Water and Phosphorus Management in the Urban Environmental Sanitation System of Hanoi, Vietnam.” Science of the Total Environment 384, no. 1–3: 55–66. Montoya, Alfred. 2013. “How to Argue with a Computer: HIV/AIDS, Numbers, and the Form of the Future in Contemporary Vietnam.” East Asian Science, Technology, and Society 7, no. 1: 35–67. Munholland, Kim J. 1981. “‘Collaboration Strategy’ and the French Pacification of Tonkin, 1885–1897.” The Historical Journal 24, no. 3: 629–50. Murphy, Michelle. 2017. The Economization of Life. Raleigh, NC: Duke University Press. Myers, Steven Lee. 2020. “China’s Omnivorous Markets Are in the Eye of a Lethal Outbreak Once Again.” New York Times. January 28. Electronic document, https:// www.nytimes.com/2020/01/25/world/asia/china-markets-coronavirus-sars. html?searchResultPosition=14, accessed August 31, 2020. Nam Nguyên. 2007. “Vì sao Việt Nam gọi dịch tả là dịch tiêu chảy cấp?” [Why Does Việt Nam Call Cholera Acute Diarrhea?]. Radio Free Asia. November 10. http://www.rfa.org/vietnamese/in_depth/VnpressreviewAcuteDiarrhea_ NNguyen-20071110.html, accessed January 13, 2013. Nations, Marilyn K. and Cristina G. Monte. 1996. “‘I’m Not Dog, No!’: Cries of Resistance against Cholera Control Campaigns.” Social Science and Medicine 43, no. 6: 1007–24. Neumann, Ann. 2020. “Unnatural Disasters: On the Pandemics We Make for Ourselves.” The Baffler 52: 11–21. New England Journal of Medicine. 2020. “Dying in a Leadership Vacuum.” October 8. DOI: 10.1056/NEJMe2029812. New York Medical Journal. 1887. “Miscellany.” New York Medical Journal 46: 589. New York Times. 1887. “Cholera Again in Tonquin; Alarming News Held Back by the French.” June 12. Electronic document, http://query.nytimes.com/mem/archive-free/ pdf?res=F1071FF93C5413738DDDAB0994DE405B8784F0D3, accessed July 20, 2011. New York Times. 2020. “U.S. Coronavirus Cases Soar as 18 States Set Single-Day Records This Week.” July 25. https://nyti.ms/2BzKWpO.

Bibliography

189

Nga Do TT, Chuc NT, Hoa NP et al. 2014. “Antibiotic Sales in Rural and Urban Pharmacies in Northern Vietnam: An Observational Study.” BMC Pharmacology and Toxicology 15, no. 6. DOI: 10.1186/2050-6511-15-6. Ngo, T. C., D. T. Nguyen, H. H. Tran, T. H. Le, H. T. Nguyen, T. T. Diep, T. P. L. Nguyen, B. M. Nguyen, N. D. Tran, Yamashiro, K. Morita, T. H. Nguyen, and M. Ehara. 2011. “Imported Dogs as Possible Vehicles of Vibrio Cholerae O1 Causing Cholera Outbreaks in Northern Vietnam.” The Open Infectious Diseases Journal 5: 127–34. Ngo Tho Hung. 2010. Urban Air Quality Modelling and Management in Hanoi, Vietnam. Ph.D. dissertation. National Environmental Research Institute, Aarhus University, Denmark. https://forskning.ruc.dk/en/publications/urban-air-qualitymodelling-and-management-in-hanoi-vietnam. Ngô Vĩnh Long. 1991. Before the Revolution: The Vietnamese Peasants under the French. New York: Columbia University Press. Nguyen, Binh Minh, Je Hee Lee, Ngo Tuan Cuong, Seon Young Choi, Nguyen Tran Hien, Dang Duc Anh, Hye Ri Lee, M. Ansaruzzaman, Hubert P. Endtz, Jongsik Chun, Anna Lena Lopez, Cecil Czerkinsky, John D. Clemens, and Dong Wook Kim. 2009. “Cholera Outbreaks Caused by an Altered Vibrio cholerae O1 El Tor Biotype Strain Producing Classical Cholera Toxin B in Vietnam in 2007 to 2008.” Journal of Clinical Microbiology 47, no. 5: 1568–71. Nguyễn Đình Nguyên. 2007. “Khoa học thiếu thông tin và thông tin thiếu khoa học” [Science Lacking Information and Information Lacking Science]. Electronic document, http://vietsciences.free.fr/timhieu/khoahoc/ykhoa/ khoahocthieuthongtin.htm, accessed April 20, 2012. Nguyen, Hong Kong and Tung Manh Ho. 2020. “Vietnam’s COVID-19 Strategy: Mobilizing Public Compliance via Accurate and Credible Communications.” ISEAS 2020, no. 69. Electronic document, https://www.iseas.edu.sg/wp-content/ uploads/2020/05/ISEAS_Perspective_2020_69.pdf, accessed September 10, 2020. Nguyen Huy Thiep. 1992. The General Retires. Singapore: Oxford University Press. Nguyen, Kai. 2020. “Quarantined in Vietnam: Scenes from Inside a Center for Returning Citizens.” NPR. April 6. Electronic document, https://www.npr.org/ sections/pictureshow/2020/04/06/823963731/quarantined-in-vietnam-scenes-frominside-a-center-for-returning-citizens, accessed August 15, 2020. Nguyen Minh Duc, Hoang Duc Ha, Tran Anh Tuan, Mai Tan Lien Bang, Pham Hong Duc, and Pham Minh Thong. 2020. “From First COVID-19 Case to Current Outbreak: A Vietnamese Report.” Electronic Journal of General Medicine 17, no. 4: em208. Nguyen, Minh Hang. “The To Lich River: A Research Studies.” M.A. thesis. HAMK University of Applied Sciences. https://www.theseus.fi/bitstream/ handle/10024/154126/To%20Lich%20River.pdf?sequence=1&isAllowed=y. Nguyen, Minh T.N. 2018. “Vietnam’s ‘Socialization’ Policy and the Moral Subject in a Privatizing Economy.” Economy and Society 47, no. 4: 627–47. Nguyen, Minh Thang and Barry Popkin. 2003. “Child Malnutrition in Vietnam and Its Transition in an Era of Economic Growth.” Journal of Human Nutrition and Dietetics 16, no. 4: 233–44.

190

Bibliography

Nguyễn Ngọc Huy and Huỳnh Sanh Thông. 1981. The Quarrel of the Six Beasts. New Haven: Yale Southeast Asia Studies. Nguyen, Phuong and James Pearson. 2020. “Vietnam Introduces ‘Fake News’ Fines for Coronavirus Misinformation.” Reuters. April 14. Electronic document, https://www. reuters.com/article/us-health-coronavirus-vietnam-security/vietnam-introducesfake-news-fines-for-coronavirus-misinformation-idUSKCN21X0EB, accessed August 10, 2020. Nguyen Quy. 2020. “Vietnam Donates $50,000 to WHO for Covid-19 Fight.” VnExpress. April 25. Electronic document, https://e.vnexpress.net/news/news/vietnam-donates50-000-to-who-for-covid-19-fight-4089975.html, accessed August 18, 2020. Nguyen, Sen. 2020a. “Coronavirus Miracle? Vietnam Says All Its Infected Patients Cured.” Al Jazeera. February 29. Electronic document, https://www.aljazeera.com/ news/2020/2/29/coronavirus-miracle-vietnam-says-all-its-infected-patients-cured, accessed July 15, 2020. Nguyen, Sen. 2020b. “Vietnam’s Pandemic Success Is a Lesson for the World.” Global Asia 15, no. 3: 42–9. Electronic document, https://www.globalasia.org/v15no3/ cover/vietnams-pandemic-success-is-a-lesson-for-the-world_sen-nguyen, accessed October 15, 2020. Nguyen, Suong Thi Thao et al. 2018. “Waiting Time in the Outpatient Clinic at a National Hospital in Vietnam.” Nagoya Journal of Medical Science 80, no. 2: 227–39. DOI: 10.18999/nagjms.80.2.227. Nguyen Thi Kim Chuc and Göran Tomson. 1999. “‘Doi Moi’ and Private Pharmacies: A Case Study on Dispensing and Financial Issues in Hanoi, Vietnam.” European Journal of Clinical Pharmacology 55, 325–32. Nguyen, Thu Anh, Pauline Oosterhoff, Anita Hardon, Hien Nguyen Tran, Roel A. Coutino, and Pamela Wright. 2008. “A Hidden HIV Epidemic among Women in Vietnam.” BMC Public Health 8, no. 37. DOI: https://doi.org/10.1186/1471-24588-37. Nguyen, Thuong V., Quang D. Pham, Quoc K. Do, Tai T. Diep, Hung C. Phan, Thang V. Ho, Hong T. Do, Lan T. Phan, and Huu N. Tran. 2017. “Cholera Returns to Southern Vietnam in an Outbreak Associated with Consuming Unsafe Water through Iced Tea: A Matched Case-Control Study.” PLoS Neglected Tropical Diseases 11, no. 4: e0005490. DOI: 10.1371/journal.pntd.0005490. Nguyen, Trang (Mae) and Edmund Malesky. 2020. “Reopening Vietnam: How the Country’s Improving Governance Helped It Weather the COVID-19 Pandemic.” Brookings. May 20. https://www.brookings.edu/blog/order-from-chaos/2020/05/20/ reopening-vietnam-how-the-countrys-improving-governance-helped-it-weatherthe-covid-19-pandemic/, accessed July 7, 2020. Nguyen Van Dan and Nguyen Thi Dzung. 2002. “Groundwater Pollution in the Hanoi Area, Vietnam.” Electronic document, https://publications.iwmi.org/pdf/H033493. pdf, accessed 14 May 2010. Nguyen Van Huong. 1970. “Twenty-Five Years of Health Activities in the DRVN.” Vietnamese Studies 25: 7–20.

Bibliography

191

Nguyễn Văn Tuấn. 2007a. “Dịch tả: Nước quan trọng hơn mắm tôm” [Cholera: Water Is More Important than Shrimp Paste]. Electronic document, http://tuanvannguyen. blogspot.com/2007/11/dch-t-nc-quan-trng-hn-mm-tm.html, accessed November 19, 2008. Nguyễn Văn Tuấn. 2007b. “Mắm tôm và chuyện xin lỗi” [Shrimp Paste and the Matter of an Apology]. Electronic document, http://www.tuoitre.com.vn/Tianyon/Index.asp x?ArticleID=234362&ChannelID= 118, accessed January 5, 2010. Nguyễn Văn Tuấn. 2008a. “Mắm tôm vô tội!” [Shrimp Paste Is Innocent!]. Electronic document, http://tuanvannguyen.blogspot.com/2008/04/mm-tm-v-ti_8662.html. accessed January 5, 2010. Nguyễn Văn Tuấn. 2008b. “Thảo luận với Dr. Olivé” [Discussion with Dr. Olivé]. Electronic document, http://tuanvannguyen.blogspot.com/2008/04/tho-lun-vi-droliv.html, accessed January 5, 2010. Nguyen Viet Anh, Pham Thuy Nga, Tran Hieu Nhue, and Antoine Morel. 2005. “Decentralised Wastewater Management in Vietnam—A Hanoi Case Study.” Department for International Development. Paper presented at the Water Environmental Federation (WEF) International Conference: Technology. August 28–31, 2005, San Francisco. Nguyen, Xuan Quynh and Nguyen Dieu Tu Uyen. 2020. “Vietnam Orders 15-day Nationwide Isolation from April 1.” Bloomberg. March 30. Electronic document, https://www.bloomberg.com/news/articles/2020-03-31/vietnam-orders-15-daynationwide-isolation-from-april-1, accessed September 14, 2020. Nguyen-Marshall, Van. 2005. “The Moral Economy of Colonialism: Subsistence and Famine Relief in French Indo-China, 1906–1917.” The International History Review 27, no. 2: 237–58. Nguyen-Marshall, Van. 2008. In Search of Moral Authority: The Discourse on Poverty, Poor Relief, and Charity in French Colonial Vietnam. New York: Peter Lang. Nguyen-Thu, Giang. 2020. “From Wartime Loudspeakers to Digital Networks: Communist Persuasion and Pandemic Politics in Vietnam.” Media International Australia 177, no. 1: 144–8. DOI: https://doi.org/10.1177/1329878X20953226. Nguyễn-võ Thu-hương. 2008. The Ironies of Freedom: Sex, Culture, and Neoliberal Governance in Vietnam. Seattle: University of Washington Press. Nhân Dân. 2008. “72 More Cases Tested Positive to Cholera.” Electronic resource, http://www.nhandan.com.vn/english/life/220808/life_72.htm, accessed August 28, 2008. Ninh, Kim Ngoc Bao. 2005. A World Transformed: The Politics of Culture in Revolutionary Vietnam, 1945–1965. Ann Arbor: University of Michigan Press. Nikonian. 2010. “Lại nói chuyện chó và thịt chó” [Talking about Dogs and Dog Meat Again]. Electronic document, http://www.drnikonian.com/2010/07/l%E1%BA%A1inoi-chuy%E1%BB%87n-th%E1%BB%8Bt-cho/#comments, accessed August 21, 2012. Nishimura, Masanari. 2005. “Settlement Patterns on the Red River Plain from the Late Prehistoric Period to the 10th Century AD.” Bulletin of the Indo-Pacific Prehistory Association 25, no. 3: 99–107.

192

Bibliography

Ohara, Hiroshi. 2004. “Experience and Review of SARS Control in Vietnam and China.” Tropical Medicine and Health 32: 235–40. Ohio State Eclectic Medical Association, Worthington College (Ohio). 1884. “The Cholera at Toulon.” Eclectic Medical Journal 44: 389–90. Ovesen, Jan and Ing-Britt Trankell. 2010. Cambodians and Their Doctors: A Medical Anthropology of Colonial and Postcolonial Cambodia. Copenhagen: NIAS Press. Packard, Randall. 2016. A History of Global Health: Interventions into the Lives of Other Peoples. Baltimore, MD: Johns Hopkins University Press. Palmer, Stephen R., Lord Soulsby, Paul R. Torgerson, and David W.G. Brown. 2011. Zoonoses: Biology, Clinical Practice, and Public Health Control. London: Oxford University Press. Papin, Philippe. 2012. “Review of Christopher Goscha. Vietnam: Un État né de la Guerre 1945–1954.” H-Diplo Roundtable Review, edited by Thomas Maddux and Diane Labrosse, 24–32. Electronic document, http://www.h-net.org/~diplo/roundtables/ PDF/Roundtable-XIV-1.pdf, accessed August 19, 2013. Pashigian, Melissa. 2002. “Conceiving the Happy Family: Infertility and Marital Politics in Northern Vietnam.” In Infertility around the Globe: New Thinking on Childlessness, Gender and Reproductive Technologies, edited by Marcia Inhorn and Frank van Balen, 134–51. Oakland, CA: University of California Press. Pashigian, Melissa. 2012. “Counting One’s Way onto the Global Stage: Enumeration, Accountability, and Reproductive Success in Vietnam.” Positions: East Asia Cultures Critique 20, no. 2: 529–58. PATH. 2021. “Vietnam.” https://www.path.org/where-we-work/vietnam/, accessed December 18, 2021. Paxson, Heather. 2008. “Post-Pasteurian Cultures: The Microbiopolitics of Raw-Milk Cheese in the United States.” Cultural Anthropology 23, no. 1: 15–47. Payne, David. 2003. “The VUFO-NGO Resource Centre: 10 Years of Partnership between Vietnam and International NGOs.” Electronic document, http://www. ngocentre.org.vn/content/our-history, accessed August 20, 2015. Perrings, Charles. 1998. “Investment in People and the Reform Process.” In Economic Reform in Vietnam, edited by Keith Griffin, 57–76. New York: St. Martin’s Press. Petryna, Adriana. 2003. Life Exposed: Biological Citizens after Chernobyl. Princeton, NJ: Princeton University Press. Pettus, Ashley. 2003. Between Sacrifice and Desire: National Identity and the Governing of Femininity in Vietnam. New York: Routledge. Pham, Bac and Bennett Murray. 2020. “Behind Vietnam’s COVID-19 Response.” The Diplomat. May 14. https://thediplomat.com/2020/05/behind-vietnams-covid-19response-deep-distrust-of-china/, accessed September 30, 2020. Phạm Đoan Trang. 2019. Politics of a Police State. Hà Nội: Luật Khoa Tạp Chí [Legal Initiative for Vietnam], NXB Tu Do, Giay Vun, Green Trees. Electronic document, https://the88project.org/wp-content/uploads/2019/08/POLITICS-OF-A-POLICESTATE-2208-BAN-EBOOK.pdf, accessed October 10, 2020.

Bibliography

193

Phạm Đoan Trang and Will Nguyễn. 2020. “Báo Cáo Đồng Tâm/Dong Tam Report.” Our Vietnam. Electronic document, https://drive.google.com/file/d/1 lyghZgxJomcZM8CPTd2nWlhnRKz9paZQ/edit?fbclid=IwAR01Ki1gW7kC_ nKFdVZF_6ey1Xg4I55agXLnZXabfkoo_TDc6SXI5JqltFo, accessed October 10, 2020. Pham Ngoc Thach. 1965. “Interview.” Vietnamese Studies 6, no. 2: 3–21. Pham Quang Thai, Maia A Rabaa, Duong Huy Luong, Dang Quang Tan, Tran Dai Quang, Ha-Linh Quach, Ngoc-Anh Hoang Thi, Phung Cong Dinh, Ngu Duy Nghia, Tran Anh Tu, La Ngoc Quang, Tran My Phuc, Vinh Chau, Nguyen Cong Khanh, Dang Duc Anh, Tran Nhu Duong, Guy Thwaites, H. Rogier Van Doorn, Marc Choisy, and OUCRU COVID-19 Research Group. 2020. “The First 100 days of SARS-CoV-2 Control in Vietnam.” (medRxiv preprint) DOI: https://doi.org/10.1101 /2020.05.12.20099242. Phan L.T., T.V. Nguyen, Q.C. Luong, T.V. Nguyen, H.T. Nguyen, H.Q. Le et al. 2020. “Importation and Human-to-Human Transmission of a Novel Coronavirus in Vietnam.” New England Journal of Medicine 382, no. 9: 872–4. DOI: https://doi. org/10.1056/NEJMc2001272. Phan Xuân Trung. 2007. “Ngôn ngữ thời bệnh tả” [Language in the Time of Cholera]. Electronic document, http://www.ykhoa.net/thoisu/dichta/ngonnguthoibenhta.htm, accessed August 21, 2012. Phan Xuân Trung. 2008. “Trang chuyên đề bệnh tả” [Page on the Subject of Cholera]. Electronic document, http://www.ykhoa.net/thoisu/dichta/chuyendebenhta.htm, accessed August 10, 2012. Phinney, Harriet. 2008. “‘Rice Is Essential, but Tiresome; You Should Get Some Noodles’: Doi Moi and the Political Economy of Men’s Extramarital Sexual Relations and Marital HIV Risk in Hanoi, Vietnam.” American Journal of Public Health 98, no. 4: 650–60. Phong, L.H. 2015. “The Relationship between Rivers and Cities: Influences of Urbanization on the Riverine Zones—A Study of Red River Zones in Hanoi, Vietnam.” In Sustainable Development and Planning VII, edited by Ö. Özçevik, C.A. Brebbia, and S.M. Şener, 27–44. Southampton, UK: WIT Press. Phuc Pham-Duc, Hung Viet Nguyen, Jan Hattendorf, Phung Dac Cam, Christian Zurbrügg, and Peter Odermatt. 2014. “Diarrhoeal Diseases among Adult Population in an Agricultural Community, Hanam Province, Vietnam, with High Wastewater and Excreta Re-Use.” BMC Public Health 14: 978. DOI: 10.1186/1471-2458-14-978. Pittisuttithum, Punnee. 2007. “Foodborne Illness in Southeast Asia.” In International Handbook of Foodborne Pathogens, edited by Marianne Miliotis and Jeffrey W. Bier, 711–32. New York: Marcel Dekker, Inc. Poffenbarger, Phillip. 1971. “Physicians in South Vietnam – Controversies and Needs.” New England Journal of Medicine 284: 1065–71. Pollack, Todd, Guy Thwaites, Maia Rabaa, Marc Choisy, Rogier van Doorn, Duong Huy Luong, Dang Quang Tan, Tran Dai Quang, Phung Cong Dinh, Ngu Duy Nghia, Tran

194

Bibliography

Anh Tu, La Ngoc Quang, Nguyen Cong Khanh, Dang Duc Anh, Tran Nhu Duong, Sang Minh Le, and Pham Quang Thai. 2020. “Emerging COVID-19 Success Story: Vietnam’s Commitment to Containment.” Exemplars in Global Health. June 30. https://ourworldindata.org/covid-exemplar-vietnam. Popkin, Samuel. 1979. The Rational Peasant: The Political Economy of Rural Society in Vietnam. Oakland, CA: University of California Press. Porter, Natalie. 2013. “Bird Flu Biopower: Strategies for Multispecies Coexistence in Việt Nam.” American Ethnologist 40, no. 1: 132–48. Porter, Natalie. 2019. Viral Economies: Bird Flu Experiments in Vietnam. Chicago: University of Chicago Press. Priwitzer, Kerstin. 2012. The Vietnamese Health Care System in Change: A Policy Network Anaysis of a Southeast Asian Welfare Regime. Singapore: Institute of Southeast Asian Studies. ProMED-mail. Undiagnosed Pneumonia—China (Hubei): Request for Information. ProMED-mail 2020; 30 Dec: 20191230.6864153. Electronic document, https:// promedmail.org/promed-post/?id=6864153. Accessed October 8, 2020. Proschan, Frank. 2002. “‘Syphilis, Opiomania, and Pederasty’: Colonial Constructions of Vietnamese (and French) Social Diseases.” Journal of the History of Sexuality 11, no. 4: 610–36. Ptashne, Mark. 1971. “A Scientific Visit to Hanoi.” Science for the People 3, no. 3: 19–23. Quach, Georgina. 2020. “Vietnam’s Coronavirus Death Toll Is Zero. The Cost? Total Surveillance.” Medium OneZero. May 29. Electronic document, https://onezero. medium.com/vietnams-coronavirus-death-toll-is-zero-the-cost-total-surveillance1cf3d0c6172b, accessed August 19, 2020. Quach, Ha-Linh, and Ngoc-Anh Hoang. 2020. “COVID-19 in Vietnam: A Lesson of Pre-Preparation.” Journal of Clinical Virology 127. DOI: https://doi.org/10.1016/j. jcv.2020. 104379. Quammen, David. 2012. Spillover: Animal Infections and the Next Human Pandemic. New York: W.W. Norton. Quammen, David. 2015. The Chimp and the River: How AIDS Emerged from an African Forest. New York: W.W. Norton. Quan, P.V., H. Furumai, F. Kurisu, and I. Kasuga. 2010. “Pathogenic Pollution of Surface Water under Dry and Wet Weather Condition in Hanoi Downtown.” In Southeast Asian Water Environment 4, edited by Kensuke Fukushi, 47–54. London: IWA Publishing. Quan Xuan Dinh. 1999. “The State and the Social Sector in Vietnam: Reforms and Challenges for Vietnam.” ASEAN Economic Bulletin 16, no. 3: 373–93. Rabbani, G.H. and W.B. Greenough III. 1999. “Food as a Vehicle of Transmission of Cholera.” Journal of Diarrhoeal Diseases Research 17, no. 1: 1–9. Rabinow, Paul. 1995. French Modern: Norms and Forms of the Social Environment. Cambridge, MA: MIT Press. Rabinow, Paul. 1996. Essays on the Anthropology of Reason. Princeton, NJ: Princeton University Press.

Bibliography

195

Redfield, Peter. 2005. “Doctors, Borders, and Life in Crisis.” Cultural Anthropology 20, no. 3: 328–61. Redfield, Peter. 2013. Life in Crisis: The Ethical Journey of Doctors without Borders. Oakland, CA: University of California Press. Reidl, J. and K.E. Close. 2002. “Vibrio Cholerae and Cholera: Out of the Water and into the Host.” FEMS Microbiology Reviews 26, no. 2: 125–39. Reny, Tyler T. and Matt A. Barretto. 2020. “Xenophobia in the Time of Pandemic: Othering, Anti-Asian Attitudes, and COVID-19.” Politics, Groups, & Identities. DOI: https://doi.org/10.1080/21565503.2020.1769693. Reuters. 2020. “Vietnam Detains Activist Hours after Human Rights Meeting with U.S.” Reuters. October 6. Electronic document, https://www.reuters.com/article/usvietnam-security/vietnam-detains-activist-hours-after-human-rights-meeting-withu-s-idUSKBN26S0RT, accessed October 6, 2020. Reyburn, Rita, Deok Ryun Kim, Michael Emch, Ahmed Khatib, Lorenz von Seidlein, and Mohammed Ali. 2011. “Climate Variability and the Outbreaks of Cholera in Zanzibar, East Africa: A Time Series Analysis.” The American Journal of Tropical Medicine and Hygiene 84, no. 6: 862–9. Ritvo, Harriet. 1989. The Animal Estate: The English and Other Creatures in the Victorian Age. Cambridge, MA: Harvard University Press. Rivkin-Fish, Michele. 2005. Women’s Health in Post-Soviet Russia: The Politics of Intervention. Bloomington: Indiana University Press. Rivkin-Fish, Michele. 2009. “Tracing Landscapes of the Past in Class Subjectivity: Practices of Memory and Distinction in Marketizing Russia.” American Ethnologist 36, no. 1: 79–95. Rivkin-Fish, Michele. 2011. “Health, Gender, and Care Work: Productive Sites for Thinking Anthropologically about the Aftermaths of Socialism.” Anthropology of East Europe Review 29, no. 1: 8–15. Rose, Steven and Hilary Rose. 1971. “Science in North Vietnam.” The New Scientist 49, no. 735: 134–6. Rosenberg, Charles. 1987. The Cholera Years: The United States in 1832, 1849 and 1866. Chicago: University of Chicago Press. Rosenberg, Charles. 1989. “What Is an Epidemic? AIDS in Historical Perspective.” Daedalus 118, no. 2: 1–17. Rosenberg, Charles. 1992. Explaining Epidemics and Other Studies in the History of Medicine. Cambridge: Cambridge University Press. Rotten Apple Media. 2020. “Vietnam Not Covid-19 ‘Rotten Apple’: 285 Sign Open Letter to Johns Hopkins University.” Medium. June 16. Electronic document, https://medium. com/@vietnamnotcovid19rottenapple/vietnam-not-covid-19-rotten-apple-285-signopen-letter-to-johns-hopkins-university-9ffb551b85d7, accessed June 25, 2020. Rydstrøm, Helle. 2004. “Female and Male ‘Characters’: Images of Identification and Self-Identification for Rural Vietnamese Children and Adolescents.” In Gender Practices in Contemporary Vietnam, edited by Lisa Barbara Welch Drummond and Helle Rydstrøm, 74–95. Singapore: Singapore University Press.

196

Bibliography

Rydstrøm, Helle. 2017. “A Zone of Exception: Gendered Violences of Family ‘Happiness’ in Vietnam.” Gender, Place & Culture 24, no. 7: 1051–70. Sack, David, R. Bradley Sack, G. Balakrish Nair, and A.K. Siddique. 2004. “Cholera.” Lancet 363: 223–33. Sack, R. Bradley. 1973. “A Search for Canine Carriers of Vibrio.” The Journal of Infectious Diseases 127, no. 6: 709–12. Sawchuk, Lawrence A. 2010. “Deconstructing an Epidemic: Cholera in Gibraltar.” In Plagues and Epidemics: Infected Spaces Past and Present, edited by Ann Herring and Alan C. Swedlund, 95–118. New York: Berg Publishers. Scheiring, Gábor, Darja Irdam, and Lawrence King. 2018. “The Wounds of Postsocialism: A Systematic Review of the Social Determinants of Mortality in Hungary.” Journal of Contemporary Central and Eastern Europe 26, no. 1: 1–31. DOI: 10.1080/25739638.2017. 1401285. Schwenkel, Christina. 2012. “Civilizing the City: Socialist Ruins and Urban Renewal in Central Vietnam.” Positions: Asia Critique 20, no. 2: 437–70. Scott, James. 1976. The Moral Economy of the Peasant: Rebellion and Subsistence in Southeast Asia. New Haven: Yale University Press. Scott, James. 1985. Weapons of the Weak: Everyday Forms of Peasant Resistance. New Haven: Yale University Press. Scott, James. 1998. Seeing Like a State: How Certain Schemes to Improve the Human Condition Have Failed. New Haven: Yale University Press. Segall, M., G. Tipping, H. Lucas, T.V. Dung, N.T. Tam, D.X. Vinh, and D.I. Huong. 2002. “Economic Transition Should Come with a Health Warning: The Case of Vietnam.” Journal of Epidemiology and Community Health 56: 497–505. Sharma, Ruchir. 2020. “Is Vietnam the Next ‘Asian Miracle’?” New York Times. October 13. https://nyti.ms/313C5pL. Smithson, Michael J. 2008. “Social Theories of Ignorance.” In Agnatology: The Making and Unmaking of Ignorance, edited by Robert Proctor and Londa Schiebinger, 209–29. Palo Alto: Stanford University Press. Smithson, Paul. 1993. “Health Financing and Sustainability in Vietnam.” The Save the Children Fund (UK). Hanoi, Vietnam. Snowden, Frank. 2010. Naples in the Time of Cholera 1884–1911. Cambridge: Cambridge University Press. Snowden, Frank. 2020. Epidemics and Society from the Black Death to the Present. New Haven, CT: Yale University Press. Sontag, Susan. 1969. “Trip to Hanoi.” Esquire, December 1969: 130–41, 286–91. Sontag, Susan. 2001. Illness as Metaphor and AIDS and Its Metaphors. New York: Picador. Stalford, Maria. 2019. “Connecting Rural Patients with Urban Hospitals across the Cancer Care Continuum: A View from Vietnam on a Global Problem.” In Negotiating Structural Vulnerability in Cancer Control, edited by Julie Armin, Nancy J. Burke, and Laura Eichelberger, 117–40. Santa Fe, New Mexico: SAR Press.

Bibliography

197

Stewart-Tull, D.E.S. 2001. “Vaba, Haiza, Kholera, Foklune, or Cholera: In Any Language Still the Disease of Seven Pandemics.” Journal of Applied Microbiology 91, no. 4: 580–91. Stillo, Jonathan. 2015. “‘We Are the Losers of Socialism!’: Tuberculosis, the Limits of Bio-citizenship and the Future of Care in Romania.” Anthropological Journal of European Cultures 24, no. 1: 132–40. DOI: https://doi.org/10.3167/ajec.2015.240110. Stoler, Anne. 1989. “Making Empire Respectable: The Politics of Race and Sexual Morality in 20th-Century Colonial Cultures.” American Ethnologist 16, no. 4: 634–60. Stowe, Judy. 2004. “Money and Mobilisation: The Difficulties of Building an Economy in Times of War.” In Naissance d’un État-Parti: Le Viêt Nam depuis 1945 [The Birth of a Party-State: Vietnam since 1945], edited by Christopher Goscha and Benoît de Tréglodé, 61–71. Paris: Les Indes Savantes. Swaroop, Satya and Robert Pollitzer. 1955. “Cholera Studies: World Incidence.” Bulletin of the World Health Organization 12: 311–58. Swyngedouw, Erik. 2004. Social Power and the Urbanization of Water: Flows of Power. New York: Oxford University Press. Szolontai, Balazs. 2005. “Political and Economic Crisis in North Vietnam, 1955–6.” Cold War History 5, no. 4: 395–426. Taubenberger, Jeffery K. 2006. “The Origin and Virulence of the 1918 ‘Spanish’ Influenza Virus.” Proceedings of the American Philosophical Society 150, no. 1: 86–112. Tatarski, Michael. 2020. “New research from Vietnamese experts on VNA flight 54 from London to Hanoi on March 2, in which one passenger transmitted COVID-19 to 15 other people on the plane. Also highlights the rapid, granular contact tracing that served the country so well.” Twitter. September 21. https://twitter.com/miketatarski/ status/1308283099877236736, accessed September 21. Taylor, Keith. 1983. The Birth of Vietnam. Oakland, CA: University of California Press. Taylor, Philip. 2001. Fragments of the Present: Searching for Modernity in Vietnam’s South. Honolulu: University of Hawai’i Press. Teerawichitchainan, Bussarawan and Kim Korinek. 2012. “The Long-Term Impact of War on Health and Wellbeing in Northern Vietnam: Some Glimpses from a Recent Survey.” Social Science & Medicine 74, no. 12: 1995–2004. Thanh Niên. 2010. “Hàng rong coi thường bệnh tả” [Vendors Hide Cholera]. April 14. Electronic document, http://www.thanhnien.com.vn/News/ Pages/201016/20100414092412.aspx, accessed May 1, 2010. Thayer, Carlyle. 2009. “Vietnam and the Challenge of Political Civil Society.” Contemporary Southeast Asia 31, no. 1: 1–27. The Chinese Repository. 1843. The Chinese Repository XII. Canton: Proprietors, 1832–51. Thomas, Mandy. 2001. “Public Spaces, Public Disgraces: Crowds and the State in Contemporary Vietnam.” Sojourn: Journal of Social Issues in Southeast Asia 16, no. 2: 306–30.

198

Bibliography

Thomazi, Auguste. 1934. Conquête de l’Indochine [Conquest of Indochina]. Paris: Payot. Thompson, C. Michele. 2003. “Medicine, Nationalism, and Revolution in Vietnam: The Roots of a Medical Collaboration to 1945.” East Asian Science, Technology, and Medicine 21: 114–48. Thompson, C. Michele. 2012. “Setting the Stage: Ancient Medical History of the Geographic Space That Is Now Vietnam.” In Southern Medicine for Southern People: Vietnamese Medicine in the Making, edited by Laurence Monnais, Michele Thompson, and Ayo Wahlberg, 21–60. Newcastle Upon Tyne: Cambridge Scholars Press. Thompson, C. Michele. 2015. Vietnamese Traditional Medicine: A Social History. Singapore: National University of Singapore Press. TinTucOnline. 2008. “Sống chung với rau ‘bẩn’” [Living with “Dirty” Vegetables]. Electronic document, http://www.tin247.com/song_chung_voi_rau_ban-10-45390. html, accessed March 15, 2012. Tổ Quốc. 2011.“Ăn, chơi quên…dịch tả!” [Eat, Play, and Forget Cholera!]. Electronic document, http://www.baomoi.com/An-choi-quen-dich-ta--0105/82/1589588.epi, accessed March 29, 2012. Tran, Ba-Linh and Robyn Klingler-Vidra. 2020. “Good News Stories from Vietnam’s Second Wave—Involving Dragon Fruit Burgers and Mask ATMs.” The Conversation. September 17. Electronic document, https://theconversation.com/good-newsstories-from-vietnams-second-wave-involving-dragon-fruit-burgers-and-maskatms-145940, accessed September 17, 2020. Tran Chung Chau, Michael DiGregorio, and Nicola Nixon. 2020. “Vietnam: A Covid-19 Success Story.” DevPolicy Blog. May 18. Electronic document, https://devpolicy.org/ vietnam-20200518-2/, accessed October 1, 2020. Tran Minh Nhu Nguyen, Alden Henderson, and Dana Schneider. 2008. “Vietnam Field Epidemiology Training Program: An Outbreak of Cholera in Northern Vietnam, 2007–2008.” Presented at the Global Scientific Conference of TEPHINET, Kuala Lumpur, Malaysia, November 2008. Tran Nhu Duong. 2008. “Re-emergence of Cholera in Northern Vietnam.” Paper presented at the annual TEPHINET (Training Programs in Epidemiology and Public Health Interventions Network) Global Scientific Conference, Kuala Lumpur, Malaysia, November 2. Trần Như Dương, Nguyễn Trần Hiền, Nguyễn Thị Thu Yến, Nguyễn Bình Minh, Phạm Thị Cẩm Hà, and Nguyễn Quang Minh. 2009. “Yêu Tố Nguy Cơ Mắc Bệnh Tả Tại Một Số Tỉnh Miền Bắc Việt Nam, 2008” [Risk Factors for Cholera Infection in Northern Vietnamese Provinces, 2008]. Tạp chí Y học dự phòng [Journal of Preventive Medicine] 5, no. 104: 41–9. Trần Như Dương, Ngô Huy Tú, Nguyễn Minh Sơn, Hoàng Văn Tân, and Nguyễn Trần Hiển. 2010. “Mô Tả Một Số Đặc điểm Dịch tễ học Bệnh tả Miền Bắc Việt Nam Năm 2007–2009” [Describing Some Epidemiological Characteristics of Cholera in North Việt Nam, 2007–2009]. Tạp chí Y học dự phòng [Journal of Preventive Medicine] 20, no. 3: 3–10.

Bibliography

199

Tran, Richard Quang-Anh. 2020. “Sex in the City: The Descent from Human to Animal in Two Vietnamese Classics of Urban Reportage.” International Quarterly for Asian Studies 51, no. 1–2: 171–92. https://doi.org/10.11588/iqas.2020.1-2.10751. Tran Thi Tuyet Hanh, Le Thi Thanh Huong, Nguyen Thi Lien Huong, Tran Nu Quy Linh, Nguyen Huu Quyen, Nguyen Thi Trang Nhung, Kirstie Ebi, Nguyen Dinh Cuong, Ha Van Nhu, Tran Mai Kien, Simon Hales, Do Manh Cuong, Nguyen Thi Thi Tho, Luu Quoc Toan, Nguyen Ngoc Bich, and Hoang Van Minh. 2018. “Vietnam Climate Change and Health Vulnerability and Adaptation Assessment, 2018.” Environmental Health Insights 14. DOI: https://doi. org/10.1177/1178630220924658. Trankell, Ing-Britt and Jan Ovesen. 2004. “French Colonial Medicine in Cambodia: Reflections of Governmentality.” Anthropology and Medicine 11, no. 1: 91–105. Trinh Huu Long. 2020. “Legal Briefing on Democracy Activist Pham Thi Doan Trang’s Arrest.” The Vietnamese. October 9. Electronic document, https://www. thevietnamese.org/2020/10/legal-briefing-on-democracy-activist-pham-doantrangs-arrest/, accessed October 12, 2020. Trịnh Thị Ngọc. 2009. “Nhận xét đặc điểm dịch tễ học bệnh tả (Vibrio cholerae) tại khoa truyền nhiễm - Bệnh Viện Bạch Mai” [Commentary on the Epidemiological Characteristics of Cholera in the Infectious Disease Ward of Bach Mai Hospital]. Tạp chí Y học dự phòng [Journal of Preventive Medicine] 4, no. 103: 50–4. Trinh Xuan Lai. 2007. “Vietnam Water Sector Review.” Electronic document, http:// www.vnwatersectorreview.com/files/Water_supply_and_sannitation_EN.pdf, accessed May 1, 2012. Truitt, Allison. 2008. “On the Back of a Motorbike: Middle-Class Mobility in Ho Chi Minh City, Vietnam.” American Ethnologist 35, no. 1: 3–19. Tuệ Khanh. 2009. “Ngộ độc hàng loạt … vì không thông thái” [Serial Food Poisoning … Out of Ignorance]. VnMedia. April 22. Electronic document, http://www6. vnmedia.vn/newsdetail.asp?NewsId=162187&Catid=23, accessed July 7, 2010. Tulchinsky, Theodore H. 2018. “John Snow, Cholera, the Broad Street Pump; Waterborne Diseases Then and Now.” Case Studies in Public Health: 77–99. DOI: 10.1016/B978-0-12-804571-8.00017-2. Tuổi Trẻ. 2010. “Ngăn dịch tả từ xa” [Stopping Cholera from Afar]. July 6. Electronic document, http://tuoitre.vn/Chinh-tri-xa-hoi/Song-khoe/388517/Ngan-dich-ta-tuxa.html, accessed September 8, 2015. Tuổi Trẻ. 2010. “Bệnh tả xuất hiện tại bốn địa phương” [Cholera Appears in Four Localities]. Electronic document, http://tuoitre.vn/Chinh-tri-xa-hoi/Songkhoe/388895/Benh-ta-xuat-hien-tai-bon-dia-phuong.html, accessed July 19, 2010. Tuổi Trẻ. 2020. “Hanoi Requests Proper Dressing, Language at Hoan Kiem Lake: Draft Regulations.” Tuổi Trẻ, September 27. Electronic document, https://tuoitrenews.vn/ news/society/20200927/hanoi-requests-proper-dressing-language-at-hoan-kiemlake-draft-regulations/56962.html, accessed September 29, 2020. Turnbull, Wendy. 2006. “Uncharted Waters: The Impact of U.S. Policy in Vietnam.” Washington, DC: Population Action International.

200

Bibliography

Urbanist Hanoi. 2020. “Inside Hanoi’s ‘Zero Dong’ Supermarket for People Affected by Covid-19 Pandemic.” Urbanist Hanoi. April 16. Electronic document, https:// urbanisthanoi.com/hanoi-news/16495-inside-hanoi-s-zero-dong-supermarket-forpeople-affected-by-covid-19-pandemic, accessed August 28, 2020. USAID. 2010. “A Rapid Assessment of Septage Management in Asia: Policies and Practies in India, Indonesia, Malaysia, the Philippines, Sri Lanka, Thailand, and Vietnam.” Electronic document, http://pdf.usaid.gov/pdf_docs/PNADS118.pdf, accessed March 17, 2012. Vachon, David. 2005. “Father of Modern Epidemiology—Part Two.” https://www. ph.ucla.edu/epi/snow/fatherofepidemiology_part2.html, accessed September 1, 2020. Van Nhu, Ha, Tran Thi Tuyet-Hanh, Nguyen Thi Anh Van, Tran Nu Quy Linh, and Truong Quang Tien. 2020. “Knowledge, Attitudes, and Practices of the Vietnamese as Key Factors in Controlling COVID-19.” Journal of Community Health 45: 12631269. DOI: https://doi.org/10.1007/s10900-020-00919-4 Vann, Michael. 1999. White City on the Red River: Race, Power, and Culture in French Colonial Hanoi, 1872–1954. Ph.D. dissertation. Department of History, University of California, Santa Cruz. https://www.google.com/books/edition/White_City_on_ the_Red_River/APrHPgAACAAJ?hl=en. Vann, Michael. 2005. “Of Le Cafard and Other Tropical Threats: Disease and White Colonial Culture in Indochina.” In France and “Indochina”: Cultural Representations, edited by Kathryn Robson and Jennifer Yee, 95–106. Lanham, MD: Lexington Books. Vann, Michael. 2009. "Caricaturing ‘The Colonial Good Life’ in French Indochina." European Comic Art 2: 83–108. Vargha, Dóra. 2020. “Epidemic Years: A Third Look.” Isis 111, no. 4: 791–4. Vasavakul, Thaveepoorn. 2009. “Corruption in the Health Sector: Management of Service Delivery and Impact on Poverty Reduction in Vietnam.” Policy Discussion Paper at the 6th Anti-Corruption Dialogue in Vietnam, Hanoi. Verdery, Katherine. 1996. What Was Socialism, and What Comes Next? Princeton, NJ: Princeton University Press. Viet-Phuong La, Thanh-Hang Pham, Manh-Toan Ho, Minh-Hoang Nguyen, KhanhLinh P. Nguyen, Thu-Trang Vuong, Hong-Kong T. Nguyen, Trung Tran Quy Khuc, Manh-Tung Ho, and Quan-Hoang Vuong. 2020. “Policy Response: Social Media and Science Journalism for the Sustainability of the Public Health System Amid the COVID-19 Outbreak: The Vietnam Lessons.” Sustainability 12, no. 7. DOI: https:// doi.org/10.3390/su12072931. VietnamNet. 2020. “Hanoi Employs New Technology to Clean Up To Lich River.” Electronic document, https://vietnamnet.vn/en/sci-tech-environment/hanoiemploys-new-technology-to-clean-up-to-lich-river-642643.html, accessed August 12, 2020. VietnamNet Bridge. 2007. “Cholera Infects Two More Provinces.” Electronic document, http://english.vietnamnet.vn/social/2007/11/753922/, accessed July 9, 2010.

Bibliography

201

Việt Nam News. 2008. “Poisoned Rivers Menace Public Health.” Việt Nam News. July 13. Electronic document, https://vietnamnews.vn/sunday/features/178444/ poisoned-rivers-menace-public-health.html, accessed July 24, 2020. Việt Nam News. 2014. “The Constitution of the Socialist Republic of Viet Nam.” January 15. Electronic document, https://vietnamnews.vn/politics-laws/250222/ the-constitution-of-the-socialist-republic-of-viet-nam.html, accessed January 20, 2021. Vinten-Johansen, Peter. 2020. Investigating Cholera in Broad Street: A History in Documents. Tonawanda, NY: Broadview Press. Vinten-Johanson, Peter, Howard Brody, et al. 2003. Cholera, Chloroform, and the Science of Medicine: A Life of John Snow. Oxford: Oxford University Press. VnMedia. 2009a. “Ăn uống mất vệ sinh tiếp tay cho dịch bệnh” [Eating and Drinking Unhygienically Abets Infectious Diseases]. Electronic document, http://www6.vnmedia.vn/newsdetail.asp?NewsId=162690&Catid=23, accessed July 7, 2010. VnMedia. 2009b. “Thức ăn đường phố: Nguy hại tới tính mạng của con người” [Street food: Harmful to Human Life]. April 25. Electronic document, http:// www6.vnmedia.vn/newsdetail.asp?NewsId=162526&CatId=23, accessed August 12, 2009. Vu Can. 1972. “On the Medical Front in Ha Tinh Province.” Vietnamese Studies 34: 67–100. Vu, Tuong. 2011. “Epidemics as Politics with Case Studies from Malaysia, Thailand, and Vietnam.” Global Health Governance 4, no. 2: 1–22. Vương Đức, dir. 1999. Những người thợ xẻ [Wood Cutters]. 85 min. Cinéma Public Films. Paris. Vuong, Quan-Hoang. 2015. “Be Rich or Don’t Be Sick: Estimating Vietnamese Patients’ Risk of Falling into Destitution.” Springerplus 4: 529. DOI: 10.1186/s40064-0151279-x. Vuong, Quan-Hoang, Ha Nguyen, and Thu-Trang Vuong. 2017. “Health Insurance Thresholds and Policy Implications: A Vietnamese Medical Survey in 2015.” Biomedical Research 28, no. 6: 2432–8. Waibel, Michael. 2004. “The Ancient Quarter of Hanoi—A Reflection of Urban Transition Processes.” ASIEN 92: 30–48. Wald, Priscilla. 2008. Contagious: Culture, Carriers, and the Outbreak Narrative. Raleigh, NC: Duke University Press. Washington Post. 2020. “CDC Internal Report Confirms First Positive Coronavirus Case.” April 3. Electronic document, https://www.washingtonpost.com/context/cdcinternal-report-confirms-first-positive-coronavirus-case/c43ab93a-075b-4466-91c5bb7467ba0b49/, accessed October 3, 2020. Wasik, Bill and Monica Murphy. 2013. Rabid: A Cultural History of the World’s Most Diabolical Virus. New York: Penguin. Wee, Sui-Lee and Vivian Wang. 2020. “China Grapples with Mystery Pneumonia-Like Illness.” New York Times. January 6. Electronic document, https://www.nytimes.

202

Bibliography

com/2020/01/06/world/asia/china-SARS-pneumonialike.html, accessed October 2, 2020. Wendt, Edmund Charles. 1885. Treatise on Asiatic Cholera. New York: W. Wood and Company. Whitmore, John K. 2006. “The Rise of the Coast: Trade, State and Culture in Early Ðại Việt.” Journal of Southeast Asian Studies 37, no. 1: 103–22. Whooley, Owen. 2013. Knowledge in the Time of Cholera: The Struggle over American Medicine in the Nineteenth Century. Chicago: University of Chicago Press. Wilcox, Bruce and Duane Gubler. 2005. “Disease Ecology and the Global Emergence of Zoonotic Pathogens.” Environmental Health and Preventive Medicine 10: 263–72. Winkel, Lenny, Pham Thi Kim Trang, Vi Mai Lan, Caroline Stengel, Manouchehr Amini, Nguyen Thi Ha, Pham Hung Viet, and Michael Berg. 2011. “Arsenic Pollution of Groundwater in Vietnam Exacerbated by Deep Aquifer Exploitation for More Than a Century.” PNAS 108, no. 4: 1246–51. Witter, Sophie. 1996. “‘Doi Moi’ and Health: The Effect of Economic Reforms on the Health System in Vietnam.” International Journal of Health Planning and Management 11: 159–72. Wittfogel, Karl. 1956. Oriental Despotism: A Comparative Study of Total Power. New York: Random House. Wnukowska, K. 2004. “Management of Urban Water Resources in Hanoi, Vietnam.” Master’s Thesis. Division of Land and Water Resources Engineering, Royal Institute of Technology, Stockholm, Sweden. Wolffers, Ian. 1995. “The Role of Pharmaceuticals in the Privatization Process in Vietnam’s Health-Care System.” Social Science and Medicine 41, no. 9: 1325–32. World Bank. 2012. Well Begun, Not Yet Done: Vietnam’s Remarkable Progress on Poverty Reduction and the Emerging Challenges. Hanoi: World Bank in Vietnam. World Bank and Vietnamese Ministry of Health. 2001. “Vietnam. Growing Healthy: A Review of Vietnam’s Health Sector.” Hanoi: The World Bank. World Health Organization (WHO). 1992. “WHO Guidance on Formulation of National Policy on the Control of Cholera.” Electronic document, http://www.who. int/topics/cholera/publications/WHO_CDD_SER_92_16/en/index.html, accessed May 15, 2011. World Health Organization (WHO). 2003. “Demographics, Gender, and Poverty: Country Health Information Profiles, 2003 Revision, Ministry of Health and WHO/Western Pacific Region.” Electronic document, http://www.wpro.who.int/ countries/2005/vtn/, accessed January 11, 2013. World Health Organization (WHO). 2008. “Cholera Country Profile: Vietnam.” Electronic document, www.who.int/cholera/countries/VietNamCountryProfile2008. pdf, accessed October 9, 2008.

Bibliography

203

World Health Organization (WHO). 2020a. “About WHO in Vietnam.” Electronic document, http://mobile.wpro.who.int/vietnam/about/en/, accessed September 29, 2020. World Health Organization (WHO). 2020b. “Naming the Coronavirus Disease (COVID-19) and the Virus That Causes It.” Electronic document, https://www.who. int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/naming-thecoronavirus-disease-(covid-2019)-and-the-virus-that-causes-it, accessed September 29, 2020. World Health Organization (WHO). 2020c. “Number of Reported Cases of Cholera.” Electronic document, https://www.who.int/data/gho/indicator-metadata-registry/ imr-details/42, accessed September 29, 2020. World Health Organization (WHO). 2020d. “Viet Nam Statistics Summary (2002– present).” Electronic document, https://apps.who.int/gho/data/node.country. country-VNM, accessed September 29, 2020. Yong, Ed. 2016. I Contain Multitudes: The Microbes within Us and a Grander View of Life. New York: HarperCollins. Yume.vn. 2010. “Để không bị dịch tả trong vùng dịch” [In Order Not to Be Infected with Cholera in an Outbreak Region]. Electronic document, http://yume.vn/ news/cate/subcate/de-khong-bidich-ta-trong-vung-dich.35A61F36.html, accessed October 6, 2012. Zakaria, Fareed. 2020. “What Sets Apart Countries That Successfully Handled the Pandemic? Failure.” Washington Post. September 17. Electronic document, https:// www.washingtonpost.com/opinions/american-exceptionalism-has-become-ahazard-to-our-health/2020/09/17/9521a060-f921-11ea-be57-d00bb9bc632d_story. html, accessed September 17, 2020. Zinoman, Peter. 2001. The Colonial Bastille: A History of Imprisonment in Vietnam, 1862–1940. Oakland, CA: University of California Press. Zuckerman, Jane N., Lars Rombo, and Alain Fisch. 2007. “The True Burden and Risk of Cholera: Implications for Prevention and Control.” Lancet Infectious Diseases 7, no. 8: 521–30.

Index Locators followed by “n.” indicate endnotes “acute diarrhea” 9, 128, 132, 143–4, 150 Allukian, Myron 135 Alma-Ata Declaration (1978) 168 n.9 American exceptionalism 81 animals, social life of 108, 111 Buddhist principles 112 dogs 112–14 humans and 25, 109, 111–13, 120 religio-spiritual representations 111 vernacular scenes 112 anthrax 107 anti-civilization 97, 100 antibiotics 3, 44, 132–3 sold over the counter 132–3 Asian Development Bank (ADB) 20, 63, 70–1, 75, 136 Asian tiger economy 151 “Asiatic cholera” 30 Atwood, Paul 135 August Revolution 36, 135, 168 n.8, 171 n.5 avian influenza 53, 107, 111, 149, 158 Avieli, Nir 113, 118 “backward subsistence economy” 96 Bangladesh, cholera outbreaks 7 Banister, Judith 135–6 Barrett, O’Neill 29 Bekkevold, Jo Inge 166 n.5 Benedikter, Simon 168 n.2 Biggs, David, “nation-building and nature” 62, 168 n.2 biocommunicability 109, 119 “Biohazard 2” 121 bloggers 25, 76, 105, 131, 140 Bluezone (contact tracing app) 160 Bradley, Mark 97 Briggs, Charles and Clara Mantini-Briggs 7, 79, 93, 109 bubonic plague 35, 56, 107 Buckley, Joe 161

Bulgaria, declining public health system 73 Burchett, Wilfred 168 n.8 bureaucracy 25, 61, 124, 127 “bushmeat” 109–10 cadres 8, 39, 41–2, 49, 69, 114, 117, 124, 134 Cam, P.D. 138 capitalism 16, 24, 76, 85, 119, 164 Chapuis, Oscar 29 Charles X, King 5 “chasing after results” 124 Chaudhry, Peter 124 Chen, Mel, Animacies 110 Chigudu, Simukai 100 China 60, 166 n.5 cholera 5 Covid-19 153–4 public health system 44 statistics 123, 170 n.1 Traditional Chinese Medicine 27, 91 Chinese Ministry of Emergency Management 153 cholera 55, 81, 132, 170 n.2 anomalous outbreaks 8–10, 131, 137, 148 as antithesis of modernity 28 Bác Thanh (case example) 1–3, 8 and biomedical hegemony 6 and civilization 94–7 as Class A infectious disease 9 “concealing cholera” 87 cultural significance 24 epidemic manifestations 31 history of 4, 28–9, 130–2, 137–8 and “ironies of freedom” 151 management 143–4 masculinity, class, and 118–19 outbreaks in Africa 7, 22, 100

Index outbreaks in Europe 4–5, 30 outbreaks in Hà Nội 9–10, 13–19, 20, 22–3, 30, 59, 75, 77, 89, 94, 104, 133, 151 outbreaks in Haiti 7, 22 outbreaks in India 7 outbreaks in Latin America 7 outbreaks in North America 4–5, 79 outbreaks in North Việt Nam 9–10, 13, 21–2, 24, 30–1, 39, 103, 107 outbreaks in Yemen 7 pathogen, ontology of 4, 6–8, 56 perceptions of 25, 92, 100 political sensitivity of 10–14, 140–5, 148–50 post-reunification period and 138–9 prevention 59, 89, 150 reframing 56–7 science 11, 56–7, 126 social life of 3–6 socioeconomic disparities and 129 source and transmission of 81–2 study methods 14–15 as symbol of oppression 24, 99 symptomatology of 5, 9, 104 two hundred years of 29–33 “world-making disease” 6–8 Chuluundorj, Oyuntsetseg 21 civilization (văn minh) 98–9, 101, 119, 169 n.7 cholera and 94–7 “civilized family” (gia đình văn minh) 92–3, 169 n.5 Clavel, Gabriel-Henri 34 climate change 8, 57 “climate-sensitive” disease 57 colonial Việt Nam 10, 23, 28–9, 34, 133, 167 n.1. See also French colonization Colwell, Rita 56–7 commerce 18, 80–1, 98–9 Committee for Foreign NGO Affairs (COMINGO) 147 commune health stations 15, 38–9, 49 “concealing cholera” 87 Conference of Health Cadres (1955) 41 conspiracy theory 103 consumers 22, 34, 81 dilemma in food purchasing 84 “intelligent consumers” 85 risks 85, 91

205

corruption 18, 73, 85, 121, 169 n.5 Council for Mutual Economic Assistance (COMECON) 145 Covid-19 (coronavirus) 25–6, 45, 80, 107, 110, 150–3 “all-of-government” response 158 contact tracing 155–6 control measures 161, 171 n.2 eradication program 26, 164 fatalities 157–8 first cases of 153–4 human-to-human transmission 153–4 lockdown 156 “long Covid” 153 mandating public health 160–2 pathogen 152, 158 policy failures 161 prevention measures 157, 160 “republic of health” and 162–4 risks of 156–7 second wave of cases 156 social and financial support 157 test kit for 155 testing 156 “viral pneumonia” 152 zero fatalities 159 Craig, David 16 Dalsgaard, Anders 131, 138–9 Đặng Thùy Trâm 43 Đặng Quân Sơn 36 “dangerous acute diarrhea” 132 Đào Thanh Tú 112–13 décivilisation 34 Deen, Jacqueline 138 Democratic Republic of the Congo, cholera outbreaks 7 Democratic Republic of Việt Nam (DRV) 37, 85 evolution of medicine 23 health care workers 41 medical capacity 37–8, 133–4 preventive medicine program 39 public health outcomes 25 secure wells, construction 65 water supply companies 63 dengue fever 44, 48, 69 deregulation 12, 19, 49, 74, 94, 101 Dery, David 124 des Barres, Le Roy 31

206

Index

diarrheal disease 14, 47, 57–60 educating public about 99–100, 169 n.4 pathogens 58 risk 58 self-treatment 132 Dinh Lu Giang 117 disease causation 6, 8, 36, 40, 82, 91–2, 94, 98, 100, 132 disease prevention 7, 37–9, 59, 89, 98–100, 105, 130, 141, 150, 156–7, 160 disease transmission 4–5, 30–2, 56, 81, 82, 88, 91, 106–7, 109–10, 150 “first-world” and “third-world” 75–6 via food 59 disease treatment 28, 47–8, 50 doctors 28, 35, 37, 40, 50, 52, 158 moral significance of 23–4, 41–3, 53 trained in Western medicine 37, 168 n.8 dog meat 25, 77, 82, 87, 89, 103–4, 170 n.5 causes cholera 105–7, 110, 119–20, 141 culture in Hội An 113 meanings for eater 115–16 nicknames 116, 170 n.5 production and consumption 104–5, 111, 114–19, 140 restaurants 105, 114–16 supply chain 117 trade 115 traditional Vietnamese culture 115 dogs 25, 35, 103, 105, 107–8, 117–18 ambiguous social position of 113 anthropomorphic perception of 120 humans and 111–13 as spiritual protectors/worldly guardians 112 thieves 118 đổi mới (market reform) 13, 19–22, 44, 46, 49, 73, 76, 85, 114, 117, 146, 171 n.4. See also economic liberalization; market transition Dracula 108 Dunn, Elizabeth 73 Dyt, Kathryn 62 “Eat, Play, and Forget Cholera!” 118 “eat and play” (ăn chơi) 118 Echenberg, Myron 8

economic development/growth 34, 44, 73, 75–6, 94, 96, 149, 165 benefits of 44, 46, 53 economic transformation 16 and integration 125, 165 economic liberalization 12–13, 20, 76, 86, 128. See also đổi mới (market reform); market transition economic losses 149, 157 economic “shock therapy” 21 economization of health 164–5 economy 2, 10, 12, 19–21, 26, 32, 61, 75, 81, 124, 136, 149, 157, 164–5 Elkind, Jessica 146 Emch, Michael 58 Environmental Protection Department 66 epidemics 1, 29, 31, 45, 56, 59, 93, 99–101, 109, 130, 132–3, 136, 150, 167 n.2, 168 n.11. See also specific epidemics disease transmission 4–5, 75, 107 history of uncontrolled 35–6 “managing randomness” 82 mass-cultural representations 152 epidemiological data (morbidity/mortality data) 5, 7, 29, 31–3, 35, 55, 107, 131–3, 136–7, 152, 157 and demographic statistics 4, 25, 38, 126 epidemiology 8, 11, 20, 23, 28, 56–7, 75, 126, 131–2, 137, 170 n.2 environmental shifts and 58 epidemiological trends 44 Eurocentrism 81 Europe, cholera outbreaks 4–5, 31 Evans, Richard 4 families 44 food safety and hygiene in 92 French colonization and 34 health insurance for 3 hospital costs for 3 low-income 2–3, 15, 46–7, 142 recategorization of 2 and self-treatment of illness 47–8, 132–3 serious and costly health problems of 48 standard of living 2 under stress 50–3 famine 30–1, 36, 167 n.5, 168 n.6 “fence-breaking” practices 73

Index feudalism 36, 95 Finnish International Development Agency (FINNIDA) 63 First Indochina War 38, 42, 63, 134 floods case of 70–2 management 61–2, 65 risks 62 food 9, 14, 31, 141, 170 n.2 adulteration 82, 85 consumption of unsafe 77 disease transmission via 59 markets 82 media about 82–5, 88 “from outside” 85–90 preparation 81, 86, 91–2 production 82, 84 purchasing and consumer’s dilemma 84–5 raw 77, 82–3, 87–8 restaurants 3, 86, 91, 105, 115–18 risky 24, 81–91 security 111 street food 3, 82–3, 86–8, 90, 92–4, 98–9, 105 surrogate 36 vendors 22, 24, 83–4, 87–8, 92–4, 98, 105, 119 Food and Safety Bureau 140 foodborne illnesses 89, 94, 132 “Food Poisoning … out of Ignorance” 84 food safety 7, 14, 82, 84, 89, 91–2 Foreign Policy 160 Foucault, Michel, The Birth of the Clinic 1 Fox, Diane Niblack 22 Agent Orange 23 France (French) biomedicine 28 cholera outbreak (Toulon) 30 colons 28, 34 land tax 167 n.3 medical racism 33–7 modernization 35 free markets 25, 76, 85, 98 French colonization 1, 29–31, 37. See also colonial Việt Nam literacy, promoting 36 “pervasive misery” of 31 public health indicators 133 public health interventions 33–5 water distribution network 62–3

207

Galston, Arthur 135, 168 n.8 gender 92–3, 98, 146 effects of “socialization” policy on 94 General Inspection of Hygiene (Indochina) 33 Geneva Conference 139 “geographies of blame” 13 germ theory 6, 39, 56 Ghen Cô Vy (Jealous Coronavirus) 157 Ghosh, Arunabh 123 Goscha, Christopher 134 Government of Việt Nam (GVN) 10, 46, 143, 145, 155. See also Socialist Republic of Việt Nam expenditure, wat/san projects 64 water and sanitation 66, 73–4 groundwater abstraction 64 Haiti, cholera outbreaks 7, 22 Hamburg, cholera outbreaks 4 Hamlin, Christopher 7 Hanke, Steven 159 Hà Nội 131, 146, 154, 171 n.3 capital and population 18–19 cholera outbreaks 9–10, 13–19, 20, 22–3, 30, 59, 75, 77, 89, 94, 104, 133, 151 consumption and exchange 101 critical medical anthropology 20, 22 devolution of water provision 60 economic frustration and health challenges 51–3 French interventions 62–3 groundwater pollution 64–5, 75 heterogeneous architecture 16 liberalization 16 lockdown 171 n.4 medical stratification 16–17 municipal sewer system 66, 71 nouveau riche 18 poor, accommodations 17 scientific delegation 135 settlement of Thăng Long 62 subsidy period-themed restaurants 86 university and medical schools 134 untreated wastewater 58 urbanization 18, 24, 64 wastewater 66–7 water and sanitation capacity 24, 58–9, 63, 66, 72, 76–7

208 water treatment plants 63 waterworks 62 wells in 65 Hà Nội School of Public Health (HSPH) 14 hantavirus 107 “happy family” (gia đình hạnh phúc) 92 Harada, Hidenori 75 Haraway, Donna 103 “hard-to-reach” group 167 n.6 “harmful to human life” 87 Harms, Erik 96 Haussmannization of Paris 5 Hayton, Bill 160, 163 health and disease, alternative 91–3 health and disease, socialist period (1945–1975) anti-colonial resistance 28 doctor-to-patient ratios 37 DRV 37–8 medical services 38 revolutionary communications 39 sanitation and vaccination 38–9 “three cleans” 39 Health and Lifestyle (website) 93 health care system 10–11, 24, 53, 110, 134, 136 under colonial rule 35, 37 post-đổi mới 21–2 under socialism 37–8, 43, 45, 49 health care workers 23, 28, 95, 159 capacities and operations 42–3 as combatants 42 corruption 169 n.5 Hồ Chí Minh’s admonitions for 43 medical education 41–2 national epidemiological data 129 during pandemic 157 prerevolutionary relations 42 Hegel, G.W.F. 5 Hirschman, Charles 136, 168 n.6 HIV/AIDS 44, 79–80, 82, 109 donors and funding 147 epidemiological statistics 130 prevention and control 130 Hồ Chí Minh 38, 41 admonitions for health workers 43 Love the patient, letter 41 The Prophecy Fulfilled 114 Hồ Chí Minh City 105, 155, 157

Index Hoàng Đạo 35 Hoàng Đình Cầu 37 Hoang Van Minh 47 hospitals 28, 30, 32, 37, 42, 103, 144, 154–5, 159 cosmopolitan medical experiences 49 cost 3, 50 Covid-19 cases 155 during Second Indochina War 40 “transferring up,” practice 49–50 treatment 48, 50, 144 The Hound of the Baskervilles 108 households. See families humanitarian assistance and relief 145–6, 158, 167 n.5, 171 n.4 “hunting dog” 113 Hữu Ngọc 113, 115 Huỳnh Thúc Kháng, Prison Verse 32 “hydraulic civilization” 61 hygiene 34, 36, 39, 57–8, 69, 89, 92–3 “hygienic citizens” 99 illness narratives 79 India, cholera outbreaks 7 Indochinese Communist Party 171 n.5 industrialization and urbanization 95 infectious disease 15, 23, 30, 34–5, 42, 48, 76, 79–80, 103, 108, 126, 159. See also specific infectious diseases cholera (see cholera) control 10, 15, 25–6, 34, 40, 130, 135, 138 Covid-19 (see Covid-19 (coronavirus)) HIV/AIDS 44, 79–80, 82, 109, 130, 147 malaria 34–5, 38, 40, 42, 107, 135 risk 30, 34, 47, 57, 60, 68, 156–7 Severe Acute Respiratory Syndrome (SARS) 45, 53, 80, 107, 149, 154 tuberculosis 21, 27, 32, 35, 38, 40, 42, 44, 48, 51, 69, 76 informal food sector 86–7. See also food Institute of Medicine 107 International Committee on the Taxonomy of Viruses 152 international funding (health sector) 147 International Monetary Fund (IMF) 136 international non-governmental organizations. See non-governmental organizations (NGOs) Isenbarger, D.W. 58

Index Janes, Craig 21 Japanese Overseas Economic Cooperation Fund 63 Johnson, Boris 158 Jones, Jared 109 Keck, Frédéric 107–8 Keller, Richard 80 Kinh (ethnic majority) culture 97 Koch, Erin, “free market tuberculosis” 21 Koch, Robert 6 Kohn, Eduardo, “anthropology of life” 111 Kotsila, Panagiota 99–100, 169 n.4 kul’turnost’ (culturedness) 94–5, 97 lá mơ (Paederia foetida) 77, 114 Lampland, Martha 123 land subsidence 65 land tax 167 n.3 l’anémie coloniale 167 n.4 Latin America, cholera outbreaks 7 le cafard 167 n.4 Lê Hùng Lâm 27 Le Minh Giang 147 Lê Văn Tấn 158 Le Viet Trung 169 n.9 Leshkowich, Ann Marie 96, 166 n.5 “pariah capitalist class” 93 Livingston, Julie 80 Logan, William 62 Long, Vũ Thế 116 Lopez, Anna Lena 137 lunar calendar 104, 111 Luong, Hy Van 12 Lý Thai Tổ, Emperor 61–2 Lynteris, Christos 107–8 MacLean, Ken, The Government of Mistrust 25, 124, 134 malaria 34–5, 38, 40, 42, 107, 135 Malarney, Shaun 77 market economy 81 corrodes public health systems 162 “with socialist orientation” 19, 76, 120 market reform. See đổi mới (market reform) market transition 10–11, 23, 28–9, 45, 53, 81, 94, 129, 136. See also đổi mới (market reform); economic liberalization

209

foodways 86 hydrologies of 73–4 Marr, David 139 “Germs Cause Cholera Very Quickly” 168 n.10 Maruyama, Masayoshi 169 n.9 Marxism 123 masculinity 43, 110–11, 118–19 mass disease event 100 mass vaccination. See vaccination Matsui, Tamano 138 McGrew, Roderick, The First Cholera Epidemic and Social History 1 McKechnie, Claire 108 Mead, Paul S. 132 Médecins sans Frontières (MSF) 145 media 20, 22, 24–5, 59, 64, 80–2, 88–90, 109, 152, 157, 159–61 about food 83–4, 87 newspapers 104 urban water pollution 64 Vietnamese vs. foreign 92 Medical Aid Committee for Việt Nam 145 Medical Committee Netherlands Việt Nam 145 “medical nation” 59 medicine 23, 27, 44, 50, 144. See also pharmaceuticals biomedicine 27–8, 34–5, 37 cost 3, 48, 50–1 cultural politics of 23 history of 28 medical knowledge and practice 27–8, 167 n.4 preventive 38–9 shortages of 136 Traditional Chinese Medicine 27, 91 Traditional Vietnamese Medicine 27, 91 Mekong Delta (South Việt Nam) diarrheal disease prevention programs 99–100, 169 n.4 as “hydrocracy” 168 n.2 “nation-building and nature” 62 riverine civilization 61 mental illness 48 miasma 5, 55 Michalak, Michael 142–4, 147, 150 Middle Eastern Respiratory Syndrome (MERS) 107

210

Index

migration 18, 24, 68, 93–4, 96, 99, 118–19, 167 n.6 Ministry of Health 3, 15, 29, 41, 76, 82, 89, 103, 129, 140–3, 146, 149, 153–4, 156, 171 n.4 “acute diarrhea” 9, 132, 144, 150 Decision 4233 106, 132 Health and Lifestyle, website 93 national cholera prevalence statistics 139 Ministry of Labor 134 mission civilisatrice 35 modernization 6, 8, 28, 35, 98 Momoki Shirō 61 Monnais, Laurence 32 “colonial life of pharmaceuticals” 34 Monte, Cristina 6 Montoya, Alfred 46, 130 morbidity and mortality. See epidemiological data (morbidity/ mortality) Muchinguri-Kashiri, Oppah 100 Murphy, Michelle oral rehydration therapy 144 “the economization of life” 26, 164–5 National Front for the Liberation of South Việt Nam. See Việt Cộng National Institute for Hygiene and Epidemiology (NIHE) 9, 59, 75, 82–3, 127–8, 131, 138, 142 National Institute of Infectious and Tropical Diseases (NIITD) 11, 128 National Institute of Occupational and Environmental Health 157 Nations, Marilyn 6 New England Journal of Medicine 171 n.1 New York Times 30, 164 Ngo, Binh 117 Nguyễn Đình Nguyên 141 Nguyễn Hồng Hà 128 Nguyễn Huy Nga 131 Nguyễn Huy Thiệp 117 Nguyễn Quốc Triệu 106 Nguyễn Tấn Dũng 19 Nguyen Thi Mai Huong 147 Nguyễn Văn Hưởng 38 Nguyễn Văn Tuấn 76, 140, 160 “tuan’s blog” 140, 142 Nguyễn Xuân Phúc 157

nhậu 115, 170 n.2 Nichter, Mark 109 Nipah virus 107 nói lái 170 n.5 non-governmental organizations (NGOs) 13, 15–17, 59, 106, 139, 141, 146, 148, 171 n.4 in Việt Nam 145–8 North Việt Nam 23, 166 n.1, 168 n.13, 169 n.1 agricultural cooperatives in 135 cholera outbreaks in 9–10, 13, 21–2, 24, 30–1, 39, 103, 107 dog meat in 114, 116 early Neolithic period in 60 land reforms in 134–5 poor households in 46 public health initiatives in 42 Red River Delta 20, 58–63, 168 n.6 water in 59 Olivé, Jean-Marc 141–3 The Open Infectious Disease Journal 105 oral rehydration therapy 144 “outbreak narratives” 24, 80–2, 93, 98–9, 101, 118, 152 outbreaks. See epidemics overseas development assistance (ODA) 60, 63–4 Oxford University Clinical Research Unit (OUCRU) 158–9 Pacini, Filippo 166 n.4 Packard, Randall 146 “papereality” 144, 148 legibility and 122–5 market-socialist 150 Papin, Philippe 134 Park, Kidong 159 Pashigian, Melissa 92 Pasteur, Louis 6 Pasteur Institutes 131 pathogens 4, 6–8, 25, 29, 55–6, 108, 141, 151–2, 158, 164 misnomers for 151 patients 4, 9, 11, 14, 28, 31, 37, 42–3, 49–50, 89–90, 95, 104, 106, 128, 141, 152, 154, 157, 160 “patriotic hygiene” 36 Paxson, Heather 119

Index People’s Aid Co-ordinating Committee (PACCOM) 147 Perrings, Charles 73 Petryna, Adriana 125 Phạm Đoan Trang 162–4 A Handbook for Families of Prisoners 163 Politics of a Police State 163 Phạm Ngọc Thạch 38, 42, 138 Phan Xuân Trung 133, 140–2 history of endemic cholera 131–2, 137 “Language in the Time of Cholera” 141 political cartoon 141 pharmaceuticals 28, 42, 45, 53 antibiotics 3, 44, 132–3 “colonial life” 34 cost 3, 49–50 regulation 13 self-treatment 47, 50 plague 27, 32, 34, 40, 135–6, 139, 153 PLoS Neglected Tropical Diseases 105 political and economic oppression 24, 99 politics and tourism 11 politics of health 23, 130 Popkin, Samuel 29 population 4, 8, 10, 37, 46, 152, 154, 168 n.1, 168 n.8 on agricultural cooperatives 135 cholera epidemic 31–2, 57, 139 Covid-19 pandemic 157–8 “floating population” 167 n.6 French colonization 30, 133 growth 60, 62 Hà Nội 18, 171 n.3 health measures 137 new social hierarchies 98 risks 60, 125 water distribution network 63 Population Development International 146, 171 n.4 Porter, Natalie 85 poverty 2, 8, 11, 24, 33, 70, 90, 124, 127, 136, 139, 149 rural poverty 30–1, 46–7, 94, 99 urban poverty 18, 20, 50, 119 President’s Emergency Plan for AIDS Relief (PEPFAR) 147 Preston, Samuel 168 n.6 Preventive Medicine 105

211

primary health care 10, 17, 37, 44, 100, 136, 168 n.9 commune-level 38 removal of resources 53 private health care 13, 45, 49–50, 90 privatization 53, 74, 101 Program for Appropriate Technology in Health (PATH) 171 n.6 Provincial Preventive Medicine Centers 131 Ptashne, Mark 135 public health 65, 85, 93, 107, 125, 139–40, 145, 148, 151–2, 165 after đổi mới 20, 22 assessments of 126 under colonial rule 28, 35–6, 133 communications 13, 22, 92, 150 crisis 109 and epidemiological questions 169 n.5 financing and 45–6, 49 governmentality 151 historiography 134 interwar period (1954 to 1965) 38 liberalization 44, 76 mandating 160–2 outcomes 10, 25, 75, 135, 137 policy 20, 125 post-transition period 137 problems in evidentiary basis 129 reorientation 45 during Second Indochina War 1, 42, 135–6 under socialism 10, 43–50, 126, 135, 137 state priorities in 144, 151 subsidy system and 49 “tainted commons” 98–9 Quan Ôn 4 quarantines 32, 35, 149, 154–6, 160, 171 n.3 “quasi-zoonotic disease” 107, 110 quốc ngữ 27 rabies 40, 108 Rabinow, Paul 109 Ramond, Paul-Marie 167 n.2 Red River Delta (North Việt Nam) 20, 58–63, 168 n.6 renovation. See đổi mới (market reform)

212 “republic of health” 162–4 Reyburn, Rita 57 Rhodes, Alexandre de 27 Rimbaud, Arthur 109 risks/risk factors 24, 76, 80, 91, 119, 122, 125, 140–2, 156, 163 consumers and 85, 91 consuming and 81–5 of Covid-19 156–7 floods 62 foodborne illness and 91, 94 infectious disease 57, 68, 147 market mechanisms 85 population 60, 125 ready-made meals 91 water supply contamination 71 Ritvo, Harriet 108 Rivkin-Fish, Michele 45, 95 health after socialism 21 Rosenberg, Charles 4, 79, 81 disease events and narratological elements 80 framing of epidemics 79–80 “managing randomness” 82 “What Is an Epidemic?” 80 rural-to-urban migration. See migration Russia, health policy reforms in 94–5 sanitation 14, 24, 38, 118, 137, 139, 143, 151, 168 n.9 bilateral aid 74 decentralization 75 management 64, 144 sanitary infrastructure 6, 24, 59–60, 63–4, 73–4, 101 sewage treatment 66–7, 73 urban water and 63 wastewater and 66–72 workarounds 74–7 SARS CoV-2 virus. See Covid-19 (coronavirus) Scheiring, Gábor, “wounds of postsocialism” 21 scholarship 79, 123, 137, 139 Schwenkel, Christina 96, 166 n.5 scientists 5, 7, 11, 25, 56–7, 105–6, 121–2, 126–7, 129, 135, 140–1, 152 Scott, James 122–3 accurate documentation 123 technologies of abstraction 122

Index Second Indochina War 1, 22, 37, 40, 42, 51, 63, 135–6, 138, 145–6, 161, 166 n.1 septic tanks 65, 70–2, 75 “severe acute diarrhea” 143 Severe Acute Respiratory Syndrome (SARS) 45, 53, 80, 107, 149, 154 Sharma, Ruchir 164 shopping advice 83–4 shrimp paste (mắm tôm) 76–7, 82, 87–9, 105–6, 114, 140 Signer, Ethan 135, 168 n.8 smallpox 5, 38–40, 135 Snow, John 6, 14, 55 “social evils” (tệ nạn xa hội) 82, 147 socialism 76, 93, 95–6, 119, 126, 137, 148 administrative hierarchies of 125 disease control 10 health after 21 health care system under 37–8, 43, 45, 49, 126 “losers of ” 21 market 125, 151 public health under 10, 43–50, 135, 137 socialist market economies 166 n.5 “socialist paternalism” 41 socialist reforms 25 Socialist Republic of Việt Nam 135 capacity in disease control 26 cholera in (see cholera) Covid-19 pandemic in (see Covid-19 (coronavirus)) development 44, 75–6, 101, 148 foreign aid 145 French colonial rule in 29–31, 133 issues in 12 macroeconomic performance 20 political economy 10, 21, 23, 76, 125 public health 126 Second Indochina War 135 social welfare, improvement 136 water 57, 60–4 “socialization” policy (xã hội hoá) 44, 46, 148 public health under “socialization” policy 43–50 Somalia, cholera outbreaks 7 South Việt Nam 83, 170 n.2 after reunification 145 development aid 146 “free fire” zones 40

Index historical dynamics 168 n.2 Mekong Delta (see Mekong Delta (South Việt Nam)) “stamp regime” 86. See also subsidy period; subsidy system state power, Ukranian 125 statistics (health statistics) 5, 25, 126–7 “behind the façade” 133–7 discrepant 130–2 insufficient data 137–9 legibility and “papereality” 122–5 “local bits of lore” 129–30 small-scale manipulation 128 uncertain numbers 126 Stillo, Jonathan, “losers of socialism” 21 street vendors. See food subsidy period 85–6, 105, 116 subsidy system 49, 81 “tainted commons” 98–9 Tam, N.V. 138 Taylor, Keith 29 Taylor, Philip 114 Tchaikovsky, Pyotr Ilyich 5 Dr. Thảo 122, 126, 140 Thayer, Carlyle 163 “Three Cleans” campaign 135 thuốc Bắc (Traditional Chinese Medicine) 27, 91 thuốc Nam (Traditional Vietnamese Medicine) 27, 91 “toad markets” 169 n.8 “Tonquin cholera” 30 tourism 11, 16, 19–20, 149 trachoma 35, 38 trade embargo 19 “tragedy of the commons” 74, 101 Trần Đáng 83–4 Trần Hưng Đạo 29 Trần Huy Quang, The Prophecy Fulfilled 114–15 Trinh Quan Huan 143 Trinh Xuan Lai 63 tuberculosis 21, 27, 32, 35, 38, 40, 42, 44, 48, 51, 69, 76 Tuổi Trẻ 128 “Unified Dog Meat Enterprises of Nhật Tân” 116 Unilever 169 n.6

213

Union of Indochina 30–1 United States Agency for International Development (USAID) 59 United States Embassy 142–5, 147 United States of America cholera outbreaks 4–5 Covid-19 154, 156, 161–2 neoliberal abandonment in 165 normalization of relations with 135, 146, 171 n.4 support for Vietnamese health sector 146 universal free health care 45, 53 “unsanitary subjects” 93, 99 urban civilization (văn minh đô thị) 96 urban environments 5, 14, 94, 97 urbanization 10, 18, 24, 30–2, 64, 68, 74–5, 86, 90, 95–6 US Centers for Disease Control 75, 109, 142, 145–7, 154 vaccination 28, 32–3, 38–9, 168 n.13 van Doorn, Rogier 159 Vann, Michael 30 Vargha, Dóra, The Cholera Years 79 vectorborne illnesses 107 Verdery, Katherine 41. See also “socialist paternalism” Vibrio cholerae 6–7, 10, 56, 75, 104, 106, 166 n.4 Vibrio cholerae O1 6–7, 10, 40, 139, 168 n.11 Viet A Corp 155 Việt Cộng 41 Việt Minh 36–7, 168 n.10 Việt Nam colonial Việt Nam (see colonial Việt Nam) Democratic Republic of Việt Nam (DRV) (see Democratic Republic of Việt Nam (DRV)) North Việt Nam (see North Việt Nam) Socialist Republic of Việt Nam (see Socialist Republic of Việt Nam) South Việt Nam (see South Việt Nam) Vietnam: The Hidden Charm (slogan) 19 Vietnamese Communist Party 12, 43, 115 Việt Nam News 66, 104 Vietnam Union of Friendship Organizations (VUFO) 147 Vietnam War. See Second Indochina War

214 VnMedia 93 Võ Anh Khánh 37 Vu, Tuong 149 Vu Manh Loi 168 n.6 Vuong, Quan-Hoang 50 Wald, Priscilla Contagious 80 outbreak narratives 80–1 wastewater 74 in agriculture 58 and sanitation 66–72 water provision and management 64 water 14, 33, 39, 59, 88, 151, 168 n.2. See also sanitation bilateral aid 74 Chị Phương (case example) 69–70, 73 decentralization 75 de facto privatization of 24 drinking water 2, 39, 55–6, 58, 64–5, 69, 71, 77 financial constraints 73 groundwater 64–5, 72, 75 hydrogenealogy 60–4 management, history 24 pressure 64–6 urban water infrastructure 24, 59–60, 63–4, 73–4 wastewater 58, 64, 66–72, 74 water treatment 63, 74 workarounds 74–7 Water Master Plan 63 West Africa, Ebola outbreak 109–10 “wet markets” 110–11, 152

Index wet-rice cultivation 60 Whitmore, John K. 61 Whooley, Owen 6 Wikileaks 143 women 83 empowerment 137 HIV/AIDS 44 street food and 93–4 working-class 88, 98–9 Wood Cutters 118 World Bank 45, 63, 74, 136, 147 World Health Organization (WHO) 6, 19, 56, 103–4, 107, 132, 136, 142, 145–6, 168 n.11 “cholera country profile” 138 Global Health Atlas 138 graph of historic cholera epidemiology 138–9 zoonotic diseases 107 Wuhan Municipal Health Commission 152–3 Xin Liu 170 n.1 Dr. Xuân 106, 121, 126, 140 research specialization 121–2 yellow fever 5 Yemen, cholera outbreaks 7 Yong, Ed, I Contain Multitudes 119 Zhao Tuo 29 Zimbabwe, cholera outbreaks 7, 22, 100 zoonosis 107–11 Zuckerman, Jane 7

215

216

217

218

219

220