The death of British lawyer Simone White, 28, and five other tourists as a result of a suspected mass poisoning in Laos has rightly cast a spotlight on the serious methanol problem with which poorer parts of Southeast Asia are grappling. But that shouldn’t be allowed to obscure what was almost certainly another critical factor in this tragedy: the absolutely abysmal condition of the Laotian healthcare system.
Laos has been stagnating for almost half a century
Those unfamiliar with the country might have wondered why almost all the tourists who were poisoned with tainted alcohol were flown or driven to neighbouring Thailand, delaying urgent treatment by hours, despite falling sick just a couple of hours north of the Laotian capital of Vientiane. Anyone who’s been, however, will just be glad they got out.
Between 2008 and 2009, I worked in Laos on behalf of the United Nations. Whilst there, I was told to avoid the local hospitals like my life depended on it – even in the capital, which in many countries will host at least a few good facilities for the government and NGO class.
Not in Laos. I was advised to seek treatment abroad for not just serious conditions, but even relatively mundane procedures, such as an endoscopy for a stomach complaint.
For anybody who grew up in a developed economy, it ought to be at least a little unsettling to be a whole country away from adequate healthcare. At best, it means great inconvenience and prolonged discomfort and distress if you fall ill. At worst, a delay of several hours can be the difference between life or death.
Southeast Asia is a very dynamic region which has seen huge growth in recent decades. Neighbouring Thailand boasts world-class health facilities. So how did Laos manage to fall so far behind?
The Laotian government has to shoulder most of the blame. For Laos – formally the Lao People’s Democratic Republic – is one of the world’s last remaining communist countries. Unlike Vietnam, which combines one-party rule and an aesthetic commitment to socialism with a pragmatic approach to the economy, the Lao People’s Revolutionary Party (LPRP) really means it.
LPRP rule combines self-destructive economic policies with the ruthless suppression of dissent and vicious persecution of ethnic minorities such as the Hmong, with grimly predictable results. There is no organised opposition, independent civil society, or free media.
The Politburo’s main objectives are enshrined in Laos’s constitution: preserving the “people’s democratic regime” and creating “conditions to move towards socialism”; in other words, preserving the rule of the Party, at any cost.
Laos has been stagnating for almost half a century since the revolutionaries overthrew the royalist government in 1975. Most Laotians still live in rural areas, 80 per cent of whom rely on farming to survive. According to the Heritage Foundation, Laos ranks at 142 out of 184 countries for economic freedom and is one of the least free in the Asia-Pacific region.
Unsurprisingly, firms are reluctant to enter Laos and do business, discouraging the creation of jobs and economic development. It has the worst foreign direct investment record of any country in the region aside from Burma, a nation gripped by full-blown civil war.
Meanwhile, the UN Development Programme’s Human Development Report ranked Laos 139 out of 193 countries, citing poor per capita income, schooling and life expectancy. Despite progress in recent years, Lao PDR still has the highest under-five child mortality rate in Southeast Asia, 46 per 1,000 live births, according to the Lao Social Indicator Survey.
The Laotian government is looking for scapegoats
It was therefore no surprise to learn that, 15 years after I left, Laos still has not one decent hospital at which Simone and the others could have been treated effectively; one French NGO, Comité de Coopération avec Laos (CCL), claimed to have observed no real improvement in the health sector in Laos in the 25 years it had operated there.
A bracingly honest assessment, perhaps – but also a damning indictment of Western development policy. As you might expect, the full alphabet soup of international agencies and NGOs are operating in Laos, and huge sums of foreign money have poured in over the decades.
The country – and thus, the regime, for the government makes no distinction between them – are dependent upon the billions of dollars in aid that flow into Laos. As aid sceptics such as Dambisa Moyo (author of Dead Aid) would predict, corruption is rife, with millions lost in backhanders and bribes on key projects (which, in any event, fail to materialise).
British policymakers ought also to note how the LPRP’s insistence on NHS-style healthcare have played a major role in the challenges facing modern Laotians seeking decent treatment.
There’s an endless cycle of grand reform plans that go nowhere, accompanied by endemic reports of old and ill-maintained facilities and equipment. Patients also complain of rude staff and poor treatment – but with a state-imposed monopoly in place, can do nothing about it.
That isn’t (at least entirely) the fault of the medical staff. Laotians qualify for universal healthcare (in theory) with a trivial insurance premium of 100,000 kip (about £9), while a single major operation can cost hundreds of times that, crippling hospitals’ finances.
Vientiane’s insistence on the monopoly model also means that the government is a serious bottleneck to not just much-needed reform and cash, but also basic administration such as ordering new machines.
Healthcare administrators are clear that greater independence would let them improve performance, whilst allowing greater co-payments and private providers could bring urgently needed capital into the system.
For the Politburo, however, the purity of the socialist model is what matters most, whatever the outcomes for patients.
If any good is to come from the death of Simone and the others, it can only come from holding to account those responsible – not just for their falling sick, but for the terrible conditions in which they fell sick, and which may well have turned a survivable emergency into a death sentence.
The Laotian government is looking for scapegoats. But Sir Keir Starmer and David Lammy must be clear that it was Vientiane’s policies that played a critical role in the death of a British citizen – and embark on a fundamental review of how aid money is propping up a failing regime.
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