Antibiotic Dilemmas: a multi-sited ethnography exploring community access to antibiotics in Northern Vietnam

Thesis

Antimicrobial resistance is a silent pandemic that caused nearly 4.71 million deaths in 2021 and will reach an estimated 8.22 million deaths by 2050. The World Health Organisation has warned Vietnam of the growing threat of antimicrobial resistance due to the inappropriate use of antibiotics in the healthcare system, farming, food production, and the community. Despite regulations prohibiting the over-the-counter sale of antibiotics, the phenomenon persists nationwide, leading to the inappropriate use of antibiotics in communities and contributing to the development of antibiotic resistance. To address the global threat of antibiotic resistance, this work uses an anthropological approach to examine the “blind spots” contributing to the over-the-counter supply of antibiotics in rural communities in Nam Dinh Province, from the perspectives of community women, drug sellers, and healthcare officials. Drawing on data from in-depth interviews, participant observation, and grey literature, I explore how cultural norms, medical pluralism, social relationships, everyday values, resource limitations, healthcare policies, and Vietnam’s political economy shape the use, distribution, and management of antibiotics in communities. I demonstrate the dilemmas of antibiotics in individuals’ everyday lives – while avoiding unnecessary antibiotic use was perceived as both legally and scientifically appropriate, administering the medicines in these specific contexts was driven by considerations of motherly love, care, respect, and responsibility. I highlight the influences of neoliberalism on commodifying and privatising healthcare, expanding health market competition, encouraging profits, ignoring poverty, and intensifying health inequity. Additionally, social dynamics and cultural norms embedded in everyday life present further challenges to navigate. In this complex entanglement, antibiotics became a “quick fix” for inequity, poverty, insufficient infrastructure, market competition, cultural norms and policy failures. By offering a contextual understanding of community antibiotic practices and health governance, this work seeks to inform policy-making and intervention strategies aimed at combating antimicrobial resistance.

Authors: Nguyen Thi Hong, Y

• DOI: 10.5287/ora-pz0do64bx
• Type of award: DPhil
• Level of award: Doctoral
• Awarding institution: University of Oxford
• Language: English
• Keywords: healthcare seeking behaviours; over-the-counter access; rural communities; antibiotic governance; antibiotic dilemmas; Antibiotic resistance; everyday-life values; Vietnam; neoliberalism
• Subjects: Social sciences; Medical anthropology