Clear Path International was founded in 2000. It serves landmine and UXO accident survivors with social and medical services in Vietnam, Cambodia and along the Thai-Burma border. It also sends large shipments of medical equipment and surgical supplies to hospitals in mine-affected countries.
The shrapnel from the explosion perforated his intestines, broke his ribs, damaged one of his kidneys and lodged in his head. His upper body was paralyzed on the left side and he had to use a colostomy bag. Doctors in Quang Tri province had apparently decided it was too risky to reconnect his colon through surgery.
Phuc came to CPI for medical assessment at the Quang Tri General Hospital near the former Demilitarized Zone (DMZ) in central Vietnam. CPI had asked the hospital and provincial officials to identify about 100 landmine and UXO survivors as part of their first large-scale victim assistance effort.
CPI realized that the kind of physical care Phuc and many other DMZ-area survivors needed would just be the first step in their recovery. If CPI wanted to be effective at reintegrating survivors in one of the world's most heavily UXO-contaminated zones, they had to take a "holistic" approach to survivor support.
Lesson 1: Listen and Learn
Vietnamese landmine survivor, Do Thien Dang, with Clear Path's former in-country director Hugh Hosman.
On that heart-wrenching day four years ago when Phuc arrived, an effort began that has since become the most comprehensive, direct, medical and social survivor assistance program of its kind in central Vietnam. It grew and evolved along with CPI's relationship with Phuc and the other beneficiaries, now more than 1,500 in total.
With each new aid element created, CPI listens carefully to the survivors' needs, wishes and aspirations. The population of central Vietnam is largely rural like that of the rest of the country. UXO survivors are typically members of households living in poverty. A sudden traumatic injury, disability or death can pull the economic rug out from under the affected family.
CPI's first outreach to survivors starts when they learn about a new accident from authorities in one of the 10 provinces, which Clear Path oversees from its office in Dong Ha. The Vietnamese staff responds quickly with a visit to the hospital, physical needs assessment consultation with the doctors and a financial needs assessment with the family. It is tradition in Vietnam for at least one member of the patient's family to stay at the hospital.
The family is expected to pay for the meals and share in the medical cost, not to mention transportation, so CPI covers those bills immediately. In the case of death, CPI's immediate assistance comes in the form of bereavement support to cover the cost of the funeral, a socially and financially demanding event in Vietnam.
Lesson 2: UXO and Landmine Injuries are Different
Clear Path offers the same kind of assistance for post-trauma medical treatment such as corrective internal surgery, eye care or orthopedic operations. Injuries from UXO explosions tend to be more wide-ranging than typical landmine injuries involving the loss of lower limbs. Items of UXO, particularly cluster munitions, are often encountered on the surface, in the grass or hidden in the bush.
Contact with landmines comes from farming or construction accidents, when victims' hands, chest and face are closer to the ground. The shrapnel causes a variety of wounds, from intestinal injuries and upper limb loss to eye and head injuries. The same is true for injuries to children, who often play with the baseball-sized cluster bombs out of curiosity or bravado. Also, phosphorous grenades can causes severe burn injuries to many parts of the body.
Clear Path works closely with a number of specialized health care providers in the central region. The organization helps pay for post-traumatic medical treatment, working with its liaison staff in Hue and Da Nang to arrange transportation, accommodations, nutrition and treatment advocacy.
Lesson 3: Lower the Threshold
Technicians at Mea Tao Clinic's prosthetics department measure a Karen landmine amputee for a new artificial limb.
In their relation with the survivors and local government authorities, CPI found they have to be assertive when it comes to outreach and treatment. Culturally, accidents are often believed to be part of a person's preordained fate. As a result, UXO survivors tend to be poor self-advocates and society is not particularly helpful in promoting their treatment.
Add to that the logistical and financial obstacles marginalized families face, and it becomes clear that waiting for victims to ask for help isn't going to happen in a place like Vietnam. CPI learned quickly that they had to seek out the survivors in each of their communities and actively remove each roadblock—real or imagined—to their treatment, recovery and reintegration.
For example, to complement their busy staff at the office in Dong Ha, CPI set up a team of eight mobile outreach workers—most of whom are UXO survivors—in the heavily-affected district of Vinh Linh. With a grant from Adopt-A-Minefield, the workers were equipped with motos so they could easily reach the survivors.
The members of the Vinh Linh mobile team act as social workers, conducting an initial needs assessment and following up with every kind of interaction needed to ensure full implementation of each household's "family action plan." As a side benefit, the mobile team also represents an economic development activity because its members are allowed to use the mopeds to moonlight as taxi-drivers or messengers.
Lesson 4: Physical Mobility and Recovery is Just the First Step
Some UXO or landmine accident survivors make quick and full recoveries. But these are the lucky ones. Most have to live with lasting disabilities and need to adjust their gainful pursuits accordingly. Without outside support, this means a reduction in household income from the loss of productivity.
There are several ways CPI could address this problem. Ideally, the survivor has the interest and ability to engage in a vocational training program. But in Cambodia, where we have been designing and implementing such courses for landmine survivors in Kampong Cham province with our partner Cambodian Volunteers for Community Development, we were careful to offer the same benefit to other members of the survivor household.
This creates a good balance among students at our training center in Stoeung Trung on the Mekong River north of Kampong Cham City. At least one member of the survivor household is represented in the 10-month training course featuring electronics repair, small-engine repair and sewing. More than half are survivors themselves, the remainder close relatives.
Back in Vinh Linh, Vietnam, CPI was similarly flexible about which member of the survivor household participated in our pig breeding training program. They can't assume the survivor is necessarily passionate about the training offered. When the survivor is a child, their personal development priority should be their education. In that case, an older member of the family gets the training and financial assistance for the child's education is offered in the form of a scholarship that pays for books, supplies and the mandatory uniform.
Lesson 5: No Need to Reinvent the Wheel
Thanks to Hugh Hosman, CPI's expatriate country director in Vietnam, they collaborated with a number of other non-governmental organizations (NGOs) to complement their own services. Wheelchairs, not always the mobility device of first resort but appropriate in some situations, were provided to some beneficiaries by Vietnam Assistance to the Handicapped.
Former Clear Path in-country director Hugh Hosman and project coordinator Phan Thi Ai Phuong talk to landmine survivor Le Nhung at the office in Vietnam.
Several UXO survivors now have roofs over their heads because of connection to the East Meets West Foundation, which has a program called Compassion Homes, providing home construction to certain disabled groups. Soon, CPI hopes to be referring younger beneficiaries to the KidsFirst Rehabilitation Village in Dong Ha, where they can be fitted with prostheses, receive medical care and enroll in vocational training.
CPI found several NGOs with specialized services from which our survivor families could benefit. This support allows CPI to save resources and to reach out to more beneficiaries on both sides of the former DMZ. As a survivor assistance organization, they found a comfortable role in being a services advocate for their beneficiaries without taking on the full burden of funding the actual services.
At the Mae Tao Clinic in Mae Sot, CPI discovered the need to measure amputees remotely and for improved prosthetics production technology. They are addressing both needs through a partnership with Prosthetics Research Study of Seattle, which had already developed a transtibial alignment system with funding from the Center for International Rehabilitation in Chicago. They only needed a sponsor to help get over the finish line.
Lesson 6: Life is Short, Leave a Legacy
Though CPI has been blessed with ongoing private-sector donor support, it's always hard to predict how long certain assistance programs will remain sustainable. From the beginning, they made a point to include capacity building as a goal for the communities in which they work.
For the past four years, CPI has provided equipment, supplies and technical support to the Da Nang Orthopedic & Rehabilitation Center. As an organization with a near-exclusive focus on providing direct services to landmine accident survivors, strengthening trauma care and rehabilitation capacity is CPI's larger contribution to the affected communities.
Similarly, they funded tools and equipment purchases for the Ernest Burgess Mobility Clinic at the KidsFirst Rehabilitation Village. Also, they met again with the East Meets West Foundation to set up a community-based rehabilitation training center in Le Thuy, Quang Binh province. Here survivors and their family members will learn how to do physical therapy at home.
In Cambodia, the goal is to set up a destination vocational training center in Battambang province and make it self-sustaining through work-study and entrepreneurial activities that will bring in enough to pay the bills.
In Thailand, CPI's legacy comes in the form of construction of the new prosthetics fabrication shop at the Mae Tao Clinic and the creation of a new production shop for Shan amputees north of Chiang Mai.
Through the medical equipment and supplies donations program, trauma patients in mine-affected countries such as Afghanistan, Iraq, Colombia and the Philippines now get better emergency treatment and recover on better beds because of the goods we sent to their local hospitals.
Lesson 7: Avoid Creating Dependency
Ho Van Lai, 15, survived a cluster bomb accident in Quang Tri province, Vietnam. Clear Path helped Lai and his family with his long-term recovery.
In a sense, CPI leaves a lasting legacy to individuals by helping them acquire the tools to rebuild their lives. From physical treatment and recovery to peer support and financial stability, CPI has succeeded in keeping impoverished survivor families from going into a downward financial and emotional spiral from which they can't recover. However, CPI doesn't sponsor their every need. And as soon as survivor households have reached a measure of sustainable stability, they reduce or end their support. Assistance is altered about every three years. Of course, they stay in touch to make sure their recovery is on track.
Phuc, CPI's friend in Dong Ha, has almost reached this point. After the group medical assessment in 2001, they supported various medical treatments for him. First, they sent him to the operating room to have his colon reconnected at Hue General Hospital. Because one of his kidneys had been severely damaged in the accident, he developed five kidney stones in the other, so their staff followed up with assistance for that procedure at Hue Medical College. This is where their ongoing relationship with Phuc probably saved his life as he turned to CPI's office for support first. The staff responded right away and that got him to the right hospital in time. Doctors indicated his days would have been numbered.
CPI has since supported him with the construction of a new, more accessible bathroom, shower and kitchen. Through support from the East Meets West Foundation, he is a candidate for a Compassion Home. Meanwhile, Phuc is receiving physical therapy at the Quang Tri General Hospital with initial instructions from visiting CPI advisor Wolfgang Brolley.
The family's financial situation is still precarious. Phuc lives with his elderly parents, now in their sixties. His father was disabled after being in a traffic accident and only his mother generates income by collecting firewood. She earns $14 (U.S.) a month. Clear Path is still seeking a training or work opportunity for Phuc, whose overall health is greatly improved with a revived spirit to match.
Lesson 8: There is Always More to Be Done
Despite everything CPI has done for UXO survivors in central Vietnam, there is still more to be done. Peer support efforts, such as sponsorship of survivor athletes in regional special Olympics, aside, they haven't even begun to address the survivors' psychological recovery from their sudden disability.
Victim's physical recovery and financial stability go a long way in regenerating their confidence and hope in the future. But most accident survivors suffer from post-traumatic stress disorder (PTSD) and could benefit from various forms of therapy.
One of CPI's advisors, Dr. Joan Widdifield, a clinical psychologist and trauma specialist from Mill Valley, California, trained the staff in Vietnam. She partners in Cambodia and Thailand to recognize the symptoms of PTSD and be sensitive to victims when interacting with the families. In the long run, CPI would like to be able to offer a psychological treatment program for survivors.
A traditional menu of survivor assistance services includes access and advocacy for persons with disabilities, another area where CPI has not been active. On the other hand, each of their program countries have other organizations promoting the rights of the disabled.
Meanwhile, in a welcome development, more American groups are bringing resources to bear on UXO survivors in central Vietnam, including Landmine Survivors Network, PeaceTrees Vietnam and the American Red Cross. This will begin to help fill the gaps. And, special attention paid to victims of a common military legacy facilitates a different healing process—between nations at war with each other only 30 years ago.
*Photos courtesy of the author
Clear Path International
321 High School Road
Bainbridge Island, WA 98110
Tel: (206) 780-5964
Fax: (206) 780-6666