BACKGROUND 

The problems with dioxin and its effect to health of the communities have long been discussing during, right after the war and last until now. A number of researches have been implemented with a lot of findings. The latest one, and seems being accepted widely since it has been carried out in collaboration between an well-known research Company in Canada name Hatfield and scientists working in the specific focusing on this narrow field institution in Vietnam called committee 10-80. The approach, the methodology and the ways of collecting samples of this research have been objective and accepted by scientists worldwide through publications and presentations internationally. The results of this study have been quoted in a number of meeting aiming at how to solve problem. Based on the findings of this research, 7 hotspots have been identified with the levels of dioxin vary from as high as 2.5 to 80 time than permitted level (depending on where the sample have been taken) stipulated by a number of countries, and one could easily found out the fact that after more than 30 years of the war, people those who have been and are newly settling in the areas with high concentration of the dioxin still facing with a very high risks of being infected either thru exposing themselves directly with the water, soil where dioxin is settled and indirectly thru daily innocently eating food contaminated by the chemical toxic. Both ways of exposing are not only posing harmful impact directly to the exposed persons but the following generations. Discussions are still going on concerning to the concentrative levels of TCDD in the polluted area. However, under the public health point of view, we could not wait and see of what should be the last decision on the exact levels of TCDD settle in the water, soil and the food chain while community people is still facing day to day with threatening due to a confirmedly higher than permitted levels of dioxin in the polluted materials surrounding them. Some immediate actions should be taken using the scientific approval methods in order to reduce the risks faced by the community people right now.

Discussions with local authorities in Dong Nai have emphasized that the community has the needs to have immediate actions to protect population from having exposures with dioxin in the effected area. Local people have also indicated that for the immediate respond to the issue of exposing to dioxin, Public Health approach seems to be the most effective way to protect people living in a large area like hotpot in Dong Nai province.That explains why we, at the Vietnam Public Health Association would like to propose to The Ford Foundation our concerns and hope to be supported in this important project. As our name is clearly expressing our mission, Vietnam Public Health Association (VPHA) is a nonprofit and professional organization.

The aims of the association are:

1.     To unite its members; assist each other in improving professional knowledge; exchange experience in public health activities; respect the professional ethics; collaborate with the State agencies in administering public health activities and the professional practice of the members.

2      To provide comments and ideas to the guidelines and policies of the Party and the State on strategies for the people’s health care and protection, for the public health system as well as for the protection of the rights of people working in the field of public health.

3.     To participate in health communication and education for the people.

4.     To conduct scientific research; disseminate experience; collaborate in training; strengthen capacity in public health activities.

5.     To cooperate and exchange experience with relevant associations both nationally and internationally in accordance with the laws of the Socialist Republic of Vietnam with a view to facilitating Vietnam Public Health to integrate in the international community.

6.     To protect the rights and legitimate benefits of the members in compliance with the Statues of Vietnam Public Health Association. 

Having been founded by the end of 2002 backdroped by and based on the HSPH, the Association has been gradually become a wide network of PH all over the country, collecting and sharing information and resources for PH activities. VPHA also express its role as an advocacy organization on PH issues to the Ministry of Health and the government.  Network of VPHA has been fast developed with the strategic plan focusing on bringing academic/university people to work in selected places throughout the whole country together with practical health care network. Three districts as a whole have been selected to be the places where the academic-practical combination has been working together placed in the North, Central and South regions of the country. The works are focusing on local-based priority problems namely anti-smoking, prevention for those who use and spray pesticide in their rice fields, injury prevention, HIV/AIDS and dengue fever prevention respectively. Reports have mentioned of some successful in implementing these projects both in their direct visible impacts and in the stable development of the partnership between academic people and local PHA members. With this project being introduced in the hotspot area and focusing on the very high priority problem, which is dioxin and its impact on the community health, we can almost certain of the success of the project.   

What will the project try to accomplish?

The overall goal would be as mentioned in the title of the project, it will be the application of PH approach in reducing burden/harmful risks of the dioxin in isolated hotspots- this will be implemented as a pilot operational study, so that all information/experience will be recorded in order to expand lessons learned to other hotspots. The project will be proposed for lasting for two years in hotspot in Bien Hoa. This intervention program will be used as a pilot one for further operational activities in the other two hotspots in Da Nang and Phu Cat (Binh Dinh).  

The objectives of this project are to:

1. Find out the current situation of Improve Knowledge-Attitude-Practice of people staying in the hotspot areas toward dioxin.
2. Improve the Knowledge-Attitude-Practice of people staying in the hotspot areas toward dioxin using community participation approach
3. Build capacity of the Vietnam Public Health Association at different levels to work effectively in the issue.

1. Conduct survey to find out what would be a pattern of Knowledge-Attitude-Practice of people staying in the hotspot areas toward dioxin, using participatory approach. This means that the volunteer local people (called volunteers) will be identified and recruited and involved in the implementation of the intervention from very first step.
2. Develop suitable strategy and plan for a public health intervention program based on the results of the above survey. This will also be done with the participation of the volunteers.
3. Organize training for volunteers of what would be needed for their performance focusing on specific target groups identified from the objective number 1.
4. Make plan and get consensus of everyone involved in the intervention program of what should be implemented during the intervention period
5. Implement the project with emphasis on support supervisions provided by identified faculty of PH nearby.
6. Record all events, which have been implemented during the life of the project in order to draw the lessons for further applying to other places gradually.

How will the objectives be accomplished? 

The Dong Nai Public Health Association, in which the Bien Hoa air-port, one of the most polluted hotspot identified is located, has been established recently. It includes mainly those who have been working in the health care system so far. We would hope that after meeting with PHA for this project, the natural perception of multidisciplinary of PH will allow it to identify those who are not having medical backgrounds but enthusiastic to help community, be encouraged to join the association and this intervention program. While the possibilities of removing either the population or the toxin itself from the huge geographical area and would be difficult, the only solution that may help to prevent harmful effects and then can help improving the health of communities would be thru increasing knowledge of all people in recognizing the risk factors, and as consequences, they will automatically protect themselves by using different methods guided by public health professionals thru the activities of the PHA in the hotspot. 

Those who have been day to day exposing themselves with contaminated materials will be identified and categorized by groups based on their ways of exposing to the risks and then a tailor made intervention program will be developed for these groups so that they can be provided with very specific to their situation ways of intervention.

1. This is the process of learning together in order to identifying the most suitable solutionsfitting with any specific context and the lessons learned would be a process of how to live peacefully in the area contaminated by dioxin before any concrete activities of for example, removing all contaminated soil out of living area.

Dioxin has been widely recognized as being associated with serious diseases and malformative disabilities. The National Academic Institute of Health Sciences America has listed 12 diseases that are significantly associated with exposure to dioxin. As dioxin is extremely persistent and bio-accumulative, the risks of exposing to dioxin in contaminated areas are exiting for many years and threatening the health of several generations. Many examples and evidences have been showed in the mass-media: TV, news papers and that makes people from wherever and whatever groups recognized and tried to avoid exposing themselves to places, materials in which those toxic materials.

Being participated to this intervention program from very beginning in order to help community avoiding those worse conditions, would be a proudness of all people those who have time and energy and be accepted to be member of PHA. Moreover, these selected people will be participated and trained continuously by PH professionals; they will work effectively and make the intervention program viable. The intervention program itself will be developed based on the baseline assessment by the local people in conjunction with PH professionals at the HSPH will make it fit with the local context and easily be accepted by local government, those will latter on take the responsibility of implementing the program for the long run.

As the time is limited, besides implementing Information Education and communication activities, reinforcement, monitoring and supervisions is needed to make the outcomes of the project achievable.