chemical warfare

In photos: The devastation of Agent Orange four decades after the Vietnam War

Millions of Vietnamese exposed to the chemical fell ill or developed deformities. The effects have been passed down genetically even to today’s children.

Nguyen Hoai Thuong was born in 2008 in Cu Chi District near Ho Chi Minh City in Vietnam, three decades after Vietnam’s Resistance War Against America that ended in 1975. But Hoai bears visible signs of the war. She was born without any limbs and is among numerous crippled children – all third generation victims of Agent Orange.

Agent Orange is a chemical that was used to flush North Vietnamese and Viet Cong troops out of the country’s forests. The chemical caused massive environmental damage to Vietnam’s forests and major health hazards to its population. What the world learnt later was that the effects of the chemical would linger on for decades and for generations to come.

The horrific legacy of Agent Orange has been preserved through human stories in Ho Chi Minh city’s War Remnants Museum.

Agent Orange contains dioxin, the common name of the chemical 2, 3, 7, 8-tetrachlorodibenzo-p-dioxin or TCDD. There are 75 types of dioxins, but the most dangerous of them is found in Agent Orange.

As little as 85 kg of dioxin can kill a city with population of 8 million. From 1961 to 1971, the US Army conducted 19,905 missions, spraying about 80 million litres of toxic chemicals, 61% of which was Agent Orange. It covered an area of 3.06 hectares, nearly a quarter of the total area of South Vietnam. Nearly 11% of the area was sprayed more than 10 times.

Agent Orange being sprayed during the Vietnam War. (Image: War Remnants Museum)
Agent Orange being sprayed during the Vietnam War. (Image: War Remnants Museum)

Cu Chi district, where Hoai comes from, was among the main arenas of the war in Vietnam. Using the thick forest cover, Vietnamese forces developed innovative techniques to counter the American onslaught. They made underground tunnels for movement with entry points looking like fox burrows and created holes for supply of fresh air inside. These techniques rendered it impossible for the American army to make inroads into the area and capture it. They used the next best option, spraying chemicals that burnt down forests, leaving millions of Vietnamese as collateral damage.

A bird's eye few of how Agent Orange wiped out forests. (Image: War Remnants Museum)
A bird's eye few of how Agent Orange wiped out forests. (Image: War Remnants Museum)

According to the Aspen Institute, a think tank in the United States, Agent Orange is known to cause cancers of the prostate, liver, skin and lymph. It also causes reproductive abnormalities and congenital deformities such as cleft lip, clubfoot as well as developmental disabilities. The devastating effects of Agent Orange were made known through patient histories taken through the 1980s and 1990s and were further confirmed by a 2009 report of the US Institute of Medicine. The report cited evidence of association between exposure to dioxin and five illnesses – soft-tissue sarcoma, non-Hodgkin’s lymphoma, chronic lymphocytic leukemia (including hairy-cell leukemia), Hodgkin’s disease, and chloracne.

The chemical also causes mutations of genes and chromosomes leading to birth defects and reproductive complications.

A first generation Agent Orange survivor who was exposed to the chemical as a child. (Image: War Remnants Museum)
A first generation Agent Orange survivor who was exposed to the chemical as a child. (Image: War Remnants Museum)
A second-generation Agent Orange victim born with deformities. (Image: War Remnants Museum)
A second-generation Agent Orange victim born with deformities. (Image: War Remnants Museum)

The museum

The stories of children like Hoai have been displayed in the War Remnants Museum in Ho Chi Minh City.

The three-storeyed building has one entire floor devoted to the science, data and human cost of Agent Orange. The Department of Culture of Vietnam has been following families of the victims and collecting photographs and other details of their progeny. This exercise maintains institutional memory of a devastating decade as well as documents generations of victims.

A young Hoai, probably two years old, reaches out for a flower. (Image: War Remnants Museum)
A young Hoai, probably two years old, reaches out for a flower. (Image: War Remnants Museum)

Le Thi Hoang Yen was born in 1996, blind and with a bigger than normal head. His bulging eyes with white corneas bear witness to the the tyranny of war.

Nguyen Thi Nguon, mother of two sons, works as itinerant vendor even at a very old age. She worked as nurse, along with her sons, in Ta Keo and Dong Thap during the war. She cares for two sons who developed mental illnesses.

Many children born with birth defects due to Agent Orange were also abandoned. One baby girl was left at the Tu Du Hospital in Ho Chi Minh City in year 2000. She suffered from facial skull defects which lead to bulging eyes resulting in vision problems, hearing loss and an underdeveloped upper jaw.

The stories are endless.

During the decade when the US forces sprayed the deadly weapon, 4.8 million Vietnamese were exposed to Agent Orange and over 3 million either died or developed serious medical conditions. More than 150,000 people in the second generation were born with mutations and serious diseases. The figure dropped to 35,000 in the third and 2,000 in the fourth generations.

Estimates from the Vietnamese government suggest that though the number of people affected by Agent Orange has decreased with every generation, there is still a huge number of survivors requiring help from the health system.

Entire families were affected by the transgenerational effects of Agent Orange. (Image: War Remnants Museum)
Entire families were affected by the transgenerational effects of Agent Orange. (Image: War Remnants Museum)

The Vietnamese government has worked hard to rehabilitate the victims. The government has created special infrastructure for victims of Agent Orange – special wards in hospitals and independent clinics in affected areas. The government has also mobilised international opinion against dioxins and international aid to treat victims.

Tu Du Hospital is one such place. It has a ward for children affected by Agent Orange, funded by the German government. Apart from being the chief hospital for treatment, it is also one of the leading centres of research about the chemical weapons used during the Vietnam war.

(Image: War Remnants Museum)
(Image: War Remnants Museum)

Meanwhile, as victims of Agent Orange continue to be born across Vietnam, the War Remnants Museum stands as a reminder of why the world needs to banish the use of chemical weapons.

As Akanksha Kumar, assistant professor of history at Janki Devi Memorial College, Delhi University, said, “History is not just past, it is connected to the present. Even if we don’t institutionalise history, it exists and we all live it. Documenting it in public spaces keeps the collective memory alive and helps victims in feeling solidarity.”

A painting by a child who was born with congenital deformities due to Agent Orange. (Image: War Remnants Museum)
A painting by a child who was born with congenital deformities due to Agent Orange. (Image: War Remnants Museum)

All photographs taken by Jyotsna Singh with permission from the display at the War Remnants Museum, Ho Chi Min City.

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What hospitals can do to drive entrepreneurship and enhance patient experience

Hospitals can perform better by partnering with entrepreneurs and encouraging a culture of intrapreneurship focused on customer centricity.

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Most of these tech enabled solutions have emerged as hospitals look for better ways to enhance patient experience – one of the top criteria in evaluating hospital performance. Patient experience accounts for 25% of a hospital’s Value-Based Purchasing (VBP) score as per the US government’s Centres for Medicare and Mediaid Services (CMS) programme. As a Mckinsey report says, hospitals need to break down a patient’s journey into various aspects, clinical and non-clinical, and seek ways of improving every touch point in the journey. As hospitals also need to focus on delivering quality healthcare, they are increasingly collaborating with entrepreneurs who offer such patient centric solutions or encouraging innovative intrapreneurship within the organization.

At the Hospital Leadership Summit hosted by Abbott, some of the speakers from diverse industry backgrounds brought up the role of entrepreneurship in order to deliver on patient experience.

Getting the best from collaborations

Speakers such as Dr Naresh Trehan, Chairman and Managing Director - Medanta Hospitals, and Meena Ganesh, CEO and MD - Portea Medical, who spoke at the panel discussion on “Are we fit for the world of new consumers?”, highlighted the importance of collaborating with entrepreneurs to fill the gaps in the patient experience eco system. As Dr Trehan says, “As healthcare service providers we are too steeped in our own work. So even though we may realize there are gaps in customer experience delivery, we don’t want to get distracted from our core job, which is healthcare delivery. We would rather leave the job of filling those gaps to an outsider who can do it well.”

Meena Ganesh shares a similar view when she says that entrepreneurs offer an outsider’s fresh perspective on the existing gaps in healthcare. They are therefore better equipped to offer disruptive technology solutions that put the customer right at the center. Her own venture, Portea Medical, was born out of a need in the hitherto unaddressed area of patient experience – quality home care.

There are enough examples of hospitals that have gained significantly by partnering with or investing in such ventures. For example, the Children’s Medical Centre in Dallas actively invests in tech startups to offer better care to its patients. One such startup produces sensors smaller than a grain of sand, that can be embedded in pills to alert caregivers if a medication has been taken or not. Another app delivers care givers at customers’ door step for check-ups. Providence St Joseph’s Health, that has medical centres across the U.S., has invested in a range of startups that address different patient needs – from patient feedback and wearable monitoring devices to remote video interpretation and surgical blood loss monitoring. UNC Hospital in North Carolina uses a change management platform developed by a startup in order to improve patient experience at its Emergency and Dermatology departments. The platform essentially comes with a friendly and non-intrusive way to gather patient feedback.

When intrapreneurship can lead to patient centric innovation

Hospitals can also encourage a culture of intrapreneurship within the organization. According to Meena Ganesh, this would mean building a ‘listening organization’ because as she says, listening and being open to new ideas leads to innovation. Santosh Desai, MD& CEO - Future Brands Ltd, who was also part of the panel discussion, feels that most innovations are a result of looking at “large cultural shifts, outside the frame of narrow business”. So hospitals will need to encourage enterprising professionals in the organization to observe behavior trends as part of the ideation process. Also, as Dr Ram Narain, Executive Director, Kokilaben Dhirubhai Ambani Hospital, points out, they will need to tell the employees who have the potential to drive innovative initiatives, “Do not fail, but if you fail, we still back you.” Innovative companies such as Google actively follow this practice, allowing employees to pick projects they are passionate about and work on them to deliver fresh solutions.

Realizing the need to encourage new ideas among employees to enhance patient experience, many healthcare enterprises are instituting innovative strategies. Henry Ford System, for example, began a system of rewarding great employee ideas. One internal contest was around clinical applications for wearable technology. The incentive was particularly attractive – a cash prize of $ 10,000 to the winners. Not surprisingly, the employees came up with some very innovative ideas that included: a system to record mobility of acute care patients through wearable trackers, health reminder system for elderly patients and mobile game interface with activity trackers to encourage children towards exercising. The employees admitted later that the exercise was so interesting that they would have participated in it even without a cash prize incentive.

Another example is Penn Medicine in Philadelphia which launched an ‘innovation tournament’ across the organization as part of its efforts to improve patient care. Participants worked with professors from Wharton Business School to prepare for the ideas challenge. More than 1,750 ideas were submitted by 1,400 participants, out of which 10 were selected. The focus was on getting ideas around the front end and some of the submitted ideas included:

  • Check-out management: Exclusive waiting rooms with TV, Internet and other facilities for patients waiting to be discharged so as to reduce space congestion and make their waiting time more comfortable.
  • Space for emotional privacy: An exclusive and friendly space for individuals and families to mourn the loss of dear ones in private.
  • Online patient organizer: A web based app that helps first time patients prepare better for their appointment by providing check lists for documents, medicines, etc to be carried and giving information regarding the hospital navigation, the consulting doctor etc.
  • Help for non-English speakers: Iconography cards to help non-English speaking patients express themselves and seek help in case of emergencies or other situations.

As Arlen Meyers, MD, President and CEO of the Society of Physician Entrepreneurs, says in a report, although many good ideas come from the front line, physicians must also be encouraged to think innovatively about patient experience. An academic study also builds a strong case to encourage intrapreneurship among nurses. Given they comprise a large part of the front-line staff for healthcare delivery, nurses should also be given the freedom to create and design innovative systems for improving patient experience.

According to a Harvard Business Review article quoted in a university study, employees who have the potential to be intrapreneurs, show some marked characteristics. These include a sense of ownership, perseverance, emotional intelligence and the ability to look at the big picture along with the desire, and ideas, to improve it. But trust and support of the management is essential to bringing out and taking the ideas forward.

Creating an environment conducive to innovation is the first step to bringing about innovation-driven outcomes. These were just some of the insights on healthcare management gleaned from the Hospital Leadership Summit hosted by Abbott. In over 150 countries, Abbott, which is among the top 100 global innovator companies, is working with hospitals and healthcare professionals to improve the quality of health services.

To read more content on best practices for hospital leaders, visit Abbott’s Bringing Health to Life portal here.

This article was produced on behalf of Abbott by the marketing team and not by the editorial staff.