Life Stories from Southern Laos

By Barbara Crossete

The weathered face of Nouhak, a poor farmer in southern Laos , was creased with worry and a terrible foreboding. As he waited outside a primitive laboratory in a small district hospital in the village of Lao Ngam , Nouhak tenderly cradled his feverish eight-year-old daughter, Phonesay, and tried to shield her with a threadbare grain sack from the fiercely hot sun.

Nouhak, 36, was once the father of eight childen. His oldest son, a teenager, had left their rice fields and coffee grove for employment opportunities across the border in Thailand .

The rest of the childen had all died, one by one, from malaria. Phonesay was his last child and now she too had a fever that he feared signaled the worst. Her twin was already dead. In the small shabby lab a dismal room with stained walls, a rusted sink, a few tables and chairs, and a worn bed technicians were testing her blood.

Phonesay's mother Phai, 36, is Nouhak's second wife. He left his first wife because he had no children, he said. Phai stayed at home six kilometres away, while Nouhak used the family bicycle to bring Phonesay to the lab. Other patients had walked to the spartan hospital that day, or were brought on carts pulled by the small tractors, not much bigger than lawn mowers, that farmers trudge behind as they prepare rice fields for planting. Only patients with money to spare could afford to ride in a motorised rickshaw.

The battering that life has dealt Nouhak and Phai, who belong the Oi ethnic minority, is a story repeated in many remote villages in Laos , a landlocked country in Southeast Asia . Eighty percent of the five million people in Laos live in rural areas, many in villages that are impossible or very difficult to reach even by a dirt track. In some regions, particularly the hilly north, the percentage of people living in poverty -- defined by the government as a composite measure of inadequate food, shelter and clothing and the lack of money to pay for health care or education -- reaches 75 percent. Half the people in Saravan province, where Lao Ngam is located, are below the bare-minimum poverty line.

Everything bad comes together in lives like these. Without family planning, couples have an unsupportable number of children. Large families have a harder time escaping poverty and often suffer perpetual malnutrition. There is often no time or money to improve life – to buy mosquito nets, for example, for protection against malaria. Health suffers, not only because of malarial mosquitoes but also because of contaminated water and scant sanitation. Schools, where there are any, are under-equipped and under-staffed, and many families simply can not afford to buy the clothes, books and writing materials so pupils must provide for themselves. Illiteracy or very low levels of education put information out of the reach of many, for whom radio and television are distant luxuries. Look in any direction and there is a hurdle.

Without reproductive health care that covers all a woman's needs, from contraception and ante-natal care to safe delivery under skilled supervision, many women suffer and die young. The national maternal mortality rate in Laos is estimated by the government at about 530 deaths for every 100,000 live births (Lao Reproductive Health Survey 2000).

In Saravan province, where Nouhak and Phai live, maternal mortality stands at about 700 deaths per 100,000 live births (an average of the southern region including Saravan), according to the Lao government's own figures. In neighbouring Vietnam , the rate is 95 per 100,000; in Singapore it is 9 and in the United States , 7. Reproductive health care makes all the difference.

Most births in Laos take place at home without experienced midwives or medical attendants. Many of the mothers are girls still in their teens, the most dangerous age for childbirth. No one can estimate how many deaths may go unrecorded.

At the outpatient corner of the district hospital in Lao Ngam, a young mother named Kien said that the month-old baby she held in her arms was her fifth child, and she was just 22 years old. Not far away, in a dingy ward, another young mother, too weak or ill to eat even the scraps of food she had brought in a rumpled plastic bag, stared with expressionless eyes as Ketkeo Soudachan, a Lao physician whom the United Nations Population Fund (UNFPA) recently hired to work in the province, talked to her kindly about family planning and urged her to seek help. She was 24, suffering from a fever and had not had a normal menstrual period for thee months. With three children, the youngest three months old, she thought she might be pregnant again.

Weakened by early and repeated pregnancies, nutritionally deficient, bereft of information and accustomed to accepting that children just keep coming year after year, many Lao women like this suffer needlessly. Traditions can add to their burden.

In the ethnic Lao village of Naphang Noi , about 15 miles from Saravan town, the provincial capital, a 74-year-old woman named Long said that much had improved in health care in her lifetime but the rituals of birth were no kinder to women than they had been decades ago. Throwing a towel she carried over a rafter above a shaded platform on which we sat to talk, Long demonstrated how a woman in labour is expected to suspend herself from a roof beam while giving birth, an exhausting and painful practice. Watching her, I thought of a maternity hospital I had visited in Brazil , where women are encouraged to deliver a baby in whatever position they feel most comfortable -- lying down, sitting, squatting or even standing with the support of two cheerful nurses.

Long, who attributed her unusually long life to more access to medicine in old age, nevertheless wanted to emphasize how crippling the cost of that care can be for the poor, and how farmers often have to chose between life at the cost of destitution and debt, or death to keep the family's meager property intact. When her husband, Pheuak, was diagnosed with kidney stones six years ago, the doctor told them Pheuak needed an operation.

“We had no money,” she said. “The doctor asked if I wanted him to live 15 days without the operation or 20 years with the operation,” she said. “We had to sell our only buffalo.” The buffalo is a Lao farmer's most important capital investment, because it is used to plough the life-sustaining rice fields and do other farm work. Peuak is now in good health but he and Long are essentially penniless. Somehow, they now have to find a way to borrow or rent a buffalo to work their farm plot. There is no alternative but starvation in this village, where extreme poverty is measured in the inability to grow enough rice to feed a family until the next harvest.