The City as a Place of Care and Treatment for Cancer in Contemporary Vietnam

Abstract

In Vietnam, as in many countries around the world, the relatively small number and urban concentration of cancer treatment facilities means that each becomes a nexus of rural-urban travel routes that radiate across vast expanses. Indeed, in the two urban cancer hospitals in Southern Vietnam in which the ethnographic research for this dissertation was based, the vast majority of patients hailed from other, comparatively more rural places. Although the distances between home and hospital that such patients must travel are often conceived of primarily as obstacles to initial entry into medical care, I demonstrate that this seemingly constant variable forms not merely a static barrier to access but rather affects patients and their families in multiple, varying, and compounding ways over the course of their experiences of cancer and its treatment. While we tend to associate the concept of “rural health” with such things as village health posts and community health workers, particularly in low- and middle-income countries, rural health is in fact also made up of such things as many-months-long sojourns in big cities for radiation, or constant travel between countryside and city for chemotherapy. In this way, major urban hospitals are critical constituents of rural welfare and lifeworlds. By the same token, rural people are not merely errant users of hospitals that are more properly the preserve of urban people. Whether recognized as such or not, rural people and rural-to-urban journeys are constitutive of the very nature and functioning of urban hospitals such as these. For the patients and lay caregivers we meet in this dissertation, experiences of cancer treatment were experiences not only of the hospital environment itself, but also of sustaining themselves by becoming enmeshed with the urban landscape for weeks or months at a time. In this dissertation, I show how these patients and their loved ones drew on each other, and an array of public and private services, resources, and support, to transform the complex of hospital and city into a place they could access, inhabit, and endure, and which for them held the possibility of relief and healing.