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LIÊN LẠC ĐIỀU TRỊ

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Trở Về Quê Hương

Trở về quê hương
HIV Australia | Vol. 9 No. 2 | July 2011

“Đây là bài báo của NAOMI Châu Khánh NGÔ đã đăng trên HIV Australia, Vol.9 số 2, Tháng 7 năm 2011, trình bày tóm tắt tổng quát nghiên cứu của cô về một phương pháp sử dụng quê hương cũ và văn hóa như là một hỗ trợ để cai nghiện và phục hồi. Hầu như tất cả các nghiên cứu về người Úc gốc Việt sử dụng heroin đã bày tỏ lo ngại về các hành vi nguy hiểm của họ, đặc biệt là liên quan đến những người trẻ đi du lịch Việt Nam với các lý do liên quan đến ma túy.

Họ được coi như là một "nhóm người bắc cầu” chịu trách nhiệm về khả năng vận chuyển HIV từ châu Á vào Úc và duy trì dịch bệnh viêm gan C hiện tại trong nhóm những người tiêm chích ma túy. Mặc dù các nghiên cứu đã có những phát hiện có giá trị về những rủi ro về sức khỏe của những người trẻ này, nhưng các nhà nghiên cứu đã không tập trung vào những trải nghiệm và động cơ của họ. Vì nhìn thấy chỗ trống này nên nghiên cứu tiến sĩ của tôi, tóm tắt dưới đây, nhằm mục đích cung cấp việc mô tả và sự cảm thông hiểu biết về những kinh nghiệm của người sử dụng heroin trẻ Việt Úc đã về Việt Nam để cai nghiện và phục hồi.”

Nếu muốn đọc trọn luận án tiến sĩ của cô Naomi Châu Khánh NGÔ xin vào địa chỉ: http://researchbank.rmit.edu.au/eserv/rmit:7537/Ngo.pdf

 Returning to the homeland

HIV Australia | Vol. 9 No. 2 | July 2011

NAOMI C K NGO presents an overview of her research into an approach to drug addiction employing place and culture as a driver for rehabilitation.

Almost all studies on Vietnamese-Australian heroin users have expressed concerns over their risk behaviours, particularly in relation to young people travelling to Vietnam for drug-related reasons. The latter were considered as a ‘bridge population’ in epidemiology because they were seen as liable for potentially transporting HIV from Asia into the Australian community1,2 and sustaining the current epidemic of hepatitis C among injecting drug users.3

Although these studies have produced valuable findings on the profile and health risks of these young people, they have not focused on their experiences and motivations. As a result of this knowledge gap, my PhD study, summarised below, aimed to provide a description and understanding of the experiences of young Vietnamese-Australian heroin users who travelled to Vietnam to address their heroin related issues.

Methodology

Given the focus of the study, I adopted a qualitative methodology that was influenced by a critical ethnographic approach. This was because I viewed the lives and experiences of these young people as being located within the political, economic, social and cultural context of Australian society.

The action of sending young people to Vietnam as a way of addressing their heroin related problems – an act that I refer to as the option of return – is largely a decision made by the young people’s parents, and supported and assisted by their case-workers and other professionals (‘workers’). Therefore, my research participants consisted of a range of workers (n=10), family members (n=5) and young people aged between 15 and 25 years (n=16).

Resorting to the homeland to address heroin issues in the family

Vietnamese Australian families whose children have heroin issues are not only dealing with the disruptions brought upon by the experiences of dislocation and resettlement, but they also find themselves battling with their children’s illicit drug problems. When these families turn to the Australian health system for support, they are confronted with ideologies and service models that are culturally and linguistically inappropriate and insensitive to their needs. The majority of health services are directed solely towards the individual and are based on a highly individualistic Western culture that inevitably discourages or excludes families and certain individuals from meaningful and effective access and participation.

The level of stress and hardship the young people and their families were confronted with in relation to illicit drug issues was further heightened by their limited personal resources and the absence of a supportive traditional extended family, which had disintegrated due to dislocation, migration and settlement. As a last resort, these families decided to send their children to Vietnam – a familiar society that has a familial support system, which has in the past effectively addressed the needs of the family. As one mother explains: 

‘Over here we’ve tried to detox them many times but they weren’t successful because they can ring at any time for someone to bring it [heroin] to them … That’s the problem that we had … so the family decided to send them to Vietnam. Vietnam is actually a gateway for the transport of narcotics. There’s a lot of it and I’m afraid there’s more of it than here. However, when we send them to Vietnam there are many family members who can come together to assist them. That’s the first reason. The second reason is that we can remove them from the lifestyle that they were leading … When they return to Vietnam it’s like an unfamiliar world to them.’

— 40 year-old Vietnamese-Australian mother.

Returning to a collectivist tradition

Although Vietnam is rapidly changing, it still remains largely a traditional society that is collectivist or communal in nature, where the individual is defined and directed by others. In Vietnam the family is the fundamental unit of society. The actions of family members are guided by rules, morals and virtues that are in accordance with a Confucian heritage. The traditional and common form of communication is face to face interaction, with clear lines of communication within the family that are based on filial piety. Face to face interactions and oral traditions provide most people with a sense of the past and a social context for everyday life.

Many of the young people who participated in my study successfully met their own and their families’ objectives in relation to drug detoxification and abstinence while they were in Vietnam. It appears that exposure to the traditional social, cultural and familial structures in Vietnamese society, which they lacked in Australia, helped provide most of these young people a renewed sense of identity and self respect, as well as a stronger sense of familial and social obligations and duties. This assisted them to appreciate the consequences of their actions on both their own family and the wider community, and gave them a greater appreciation for family and community.

‘The community here is more loving, like everyone talk to each other not like over there, like I don’t even know my next door neighbour … Like people [here in Vietnam] they talk more, it’s more community. Everything is close by. If you’re hungry, people bring food to your door. Over there, if you want to go somewhere you have to like hop into a car … [In Vietnam] Sometimes I can’t keep up with it. I have to follow the rules, like don’t lose the family name whatever, like I have to save face and that for the family … It’s a good thing but. [It] gives [you] something to believe in.’

— 19 year-old Vietnamese Australian young man.

In general, the option of return seems to be an effective strategy in addressing heroin issues for young Vietnamese Australians. However, the strategy also entails some risk because of the availability and affordability of heroin in Vietnam, and the lack of awareness among young people about the health risks involved in sharing injecting equipment. Furthermore, for a few young people, their experiences of Vietnam were negative because they could not identify and connect with the environment and the people around them.

Nevertheless, for the majority of the young people, the respect, support and love they received from their family and the community in which they lived in Vietnam provided them with meaningful interactions and relationships with those around them. As well as a strong sense of belonging to the family and the community, most importantly, returning to Vietnam provided these youth with a very positive and fulfilling experience that ultimately gave them a sense of confidence and optimism about their life and future.

Returning to Australia

When the young people returned to Australia, almost all were healthy and hopeful about their future. They had clear plans for themselves that included abstinence, employment and education.

However, within three months after returning to Australia, most relapsed into heroin addiction and subsequently returned to a situation where they were, again, highly at risk of dangerous heroin use and incarceration.

‘I saw a good future, but then I start using again. So that wasn’t really good. There were times I wanted to go back to studying, there were times where I wanted to go look for work, get a job, but then I started using again. There are things I want to do. I wanna just get a job, live a normal life like everyone else, be drug free. Eventually if I keep on using drugs you know, being around drugs, I’ll be left with nothing. You know what I mean? There’ll be no future.’

— 21 year-old Vietnamese Australian young man.

The factors identified as contributing to the young people’s relapse are boredom and, most importantly, returning to an environment with limited support and a state of isolation and marginalisation.

In Australia, they were part of a minority group, and for many of them their lives were characterised by socio-economic disadvantage, racism and marginalisation. Whereas in Vietnam, they were part of a majority and held the elevated status of Viet Kieu (overseas Vietnamese). Almost all of them were well cared for and most felt respected, valued and loved in Vietnam. Consequently, the conditions of their lives in Australia ultimately drew them to seek comfort with their drug using friends and in heroin.

Despite relapsing, the majority of the young people believed that they had ‘done better’ than other young people in similar situations by going to Vietnam. They found that Vietnam provided them with an environment, space and time to learn about themselves, their families and their homeland. More importantly, it provided them with the opportunity to get off heroin and start a new life. For these reasons, almost all of them recommended returning to Vietnam as an option to address young people’s heroin issues.

Recommendations

The findings of my study have provided a cultural and socio economic dimension to the discourse and debates on drug dependency and drug treatment. As a result, I have recommended that cultural and socioeconomic factors be incorporated into current understandings of heroin addiction at all times. We also need a holistic approach to ensure access and equity for all those affected by substance misuse.

To address the whole range of physiological and socio-cultural factors that cause ill-health, as well as those that sustain and create good health, I propose that we adopt the World Health Organisation’s Primary Health Care (PHC) approach – a social model of health.4

It is important not to confuse the PHC approach with primary care, which is based on a biomedical model and widely adopted by nursing and allied health. PHC is partially based on the understanding that in order for people to obtain good health, their basic needs must first be met. In practice, this translates to a whole of government approach that addresses the range of social determinants of health including income distribution, discrimination, and marginalisation based on factors such as race, gender, age, disability and so forth. Within this approach, PHC practitioners work to change the socio-economic and political structures to address the social determinants of illness in order to produce healthy people and societies.

A copy of Dr Ngo’s PhD thesis can be downloaded from http://researchbank.rmit.edu.au/eserv/rmit:7537/Ngo.pdf

References

1 Elliott, J., Mijch, A., Street, A. and Crofts, N. (2003). ‘HIV, ethnicity and travel: HIV infection in Vietnamese Australians associated with injecting drug use’, Journal of clinical virology, 26(2), 133–142.

2 Hocking, J., Higgs, P., Keenan, C., and Crofts, N. (2002). ‘HIV among injecting drug users of Indo-Chinese ethnicity in Victoria’, Medical journal of Australia, 176(4), 191–192.

3 Maher, L., Sargent, P., Higgs, P., Crofts, N., Kelsall, J. and Le, T. (2001). ‘Risk behaviours of young Indo-Chinese injecting drug users in Sydney and Melbourne’, Australian and New Zealand Journal of Public Health, 25(1), 50–54.

4 World Health Organization. (2008). The world health report 2008: primary health care – now more than ever, World Health Organization.


Dr Naomi Ngo is a Research Fellow at the Australian Research Centre in Sex, Health and Society (ARCSHS), La Trobe University. She was previously the Manager of the Multicultural Health and Support Service, a statewide service in Victoria working with migrants and refugees on issues relating to viral hepatitis and sexual health. Naomi can be contacted by telephone +61 3 9285 5175 or email This email address is being protected from spambots. You need JavaScript enabled to view it.

Khoa Học & Y Khoa

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