Do I Choose to Stay or Leave? A Diagnosed Mother and a Daughter with an Opportunity
It is Wednesday night and I am in Portland Oregon, attending NCORE, the national conference on Race and Equity. This space focuses on sustaining institutional changes so that racial and ethnic communities can achieve educational access and their definition of success by including culturally diverse and equitable frameworks. This wasn’t the space just for my own education, but the opportunity to invoke community advocacy in myself, and learn the necessary skills to achieve equity in all capacities, whether that is health, education, policy, and more.
Then the world hits me, with a message telling me that my mother is going into surgery. Being the worried daughter, I departed Thursday evening to be present at her surgery. 1:30 pm her surgery starts, and by 8:00 pm she is released into her hospital bed. The doctor informs me that they removed a pelvic mass from her system, and surprisingly found tumor underneath. The tumor was initially found in the ovaries; however, the source was located in the transverse colon, indicating that my mother was diagnosed with stage 4 colon cancer. Before I alarm you, stage 4 colon cancer looks very different depending on the circumstances. By definition, stage 4 means that the tumor has spread beyond the colon and has metastasized to different regions of her body, such as the ovaries [1]. With that information, treatment, chemotherapy, surgeries, and follow up procedures will vary.
It was no surprise to my family that my mother would be diagnosed with cancer so early in her life. Don’t get me wrong, I cried for several hours when I heard the news, but looking at our family history, cancer seems to be hereditary. My grandmother passed from stomach cancer, my aunt passed from breast cancer, my uncle is being treated for colon cancer in Vietnam, and my uncle at the age of 25 passed from sarcoma cancer. I want to extend this narrative to a possible historical trauma, that has physically become embedded in my family’s genetics, and my own future lineage.
Before I go into the historical context of the Vietnam war, the spraying of deadly chemical herbicides known as Agent Orange, and the outcome of hereditary cancer that could possibly be in my bloodstream, I should introduce my big decision. For years, I have been building upon my research skills, for weeks I applied to various prestigious summer programs, and in a few days I had to decide if I should stay with my mom during her recovery and first round of chemotherapy, or leave to Harvard University for 6 weeks to participate in the FACETS research program (Fostering Advancement & Careers through Enrichment Training in Science).
I battled with my core Vietnamese values: prosperity through education or the power of family. Growing up, hard work and education were synonymous to my family’s definition of success. “Con cố gắng đi học nhé” (try to go to school), “Con cố gắng sẽ thành công” (work hard so you can then prosper), many sentences started with “cố gắng” (keep working) because that was our formula to the end goal of success. For a long time, I assumed the stereotypical track of careers, income levels, and status was what my parents pressured me to be, but instead it was always about family and the generations to come. Utilizing education as an outlet for the abundance of opportunities I can pursue in America and creating a foundational safety net for future generations was based on an entire populations’ circumstances. The outcome of having to seek refuge from a war that not only caused destruction, but detrimental trauma to those who had to forcefully leave the place that holds their homes, families, traditions, and stories. By uprooting their culture, they could only hold on to the values that would someday provide truth to their future children.
That is why my parents encourage me to go, they tell me to “cố gắng đi học nhé” (focus on school), because at the end of the day, they never wanted to be an obstacle towards my goals. However, my family runs deep in the sacrifices we have made for one another. As of September 2018, my extended family immigrated to America. 5 families, 19 individuals, 15 years of waiting, and my father’s joy after knowing that 20 years of his hard work, to focus on his career during holidays, summers, and weekends, approximately 90 hours a week, was to give his siblings and their families freedom. He was one of the few who escaped on the boat and safely entered a refugee camp before his departure to America. He laid the foundation by choosing to leave family, so he can later sponsor them in the future, to better their lives.
At first, I thought my uneasiness to pursue my summer program was based on selfishness, being an opportunist, and not knowing when to slow down. How can I weigh an opportunity over my mother’s life? But as I see the big picture, I hope that the skills I cultivate at this summer program will prepare me for my future work of translating public health research into effective policies, programs, and initiatives that will improve population health. That given this opportunity, I want to extend my identity, background, and research interests to underserved populations who are facing difficulties in understanding their health inequities and do not have services in place to promote healthy lifestyles. In a growing complex field, I want to learn the necessary skills to approach health issues with an adept attitude towards organizational change.
So, let’s go back to the historical trauma of the Vietnam war and its lasting health impacts. Initially I wonder, what are the root causes that provoked the U.S. to go to war with Vietnam? It could go as far back as 1940, when President Truman authorized financial support for the French war in Indochina resulting in the French to colonize Vietnam, it could be in the 1950s when the Geneva Accords divided the country into North and South where President Eisenhower provided aid for the U.S. to establish a non-communist southern region. The policy making was catered towards this idea that the U.S. will “pay any price, bear any burden” to support capitalism by countering communist pursuits. Then when the war escalated, the 3 pillars of these root causes were revealed: communism, the Cold War, and credibility [5].
When the U.S. meant “pay any price, bear any burden”, they went as far as releasing 20 million gallons of various herbicides such as Agent Orange, which is a contained deadly chemical dioxin, all over Vietnam, Cambodia, and Laos. They simply wanted to eliminate forest cover and crops from North Vietnam, but instead caused serious health impacts, including cancer, severe psychological and neurological problems, and birth defects. 2 million people are now suffering from cancer and other illnesses associated with the exposure of agent orange [2]. However, what if the mere exposure not only causes birth defects but hereditary genetic modifications that will increase your family’s likelihood of cancer?
In 2015, Dr. Eskander created the first report linking Lynch syndrome to Vietnamese-American kindred. Lynch syndrome, also identified as non-polyposis colorectal cancer (HNPCC), is an inherited cancer disorder associated with certain genes (mismatch-repair genes) to create a mutation that is associated with a predisposition to various cancers. The identification of an MSH2 mutation is prevalent in the Vietnamese community and acknowledges that physicians and patients should be aware of this unrecognized concern. Moving forward, local and state-based hospital databases should increase efforts to detect familial cancer trends in the Vietnamese population and develop culturally sensitive community outreach to increase awareness of prevention methods, such as cancer screening, appropriate cancer counseling, and in-depth education [3].
When I speak upon prevention methods, the ideas and my motivation for public health jolts me back to reality. Back to the fact, that not only do I recognize the methods that can be implemented in the future, but the injustice that my community endured based on root causes associated with white supremacy and the values of the United States. In 2004, Vietnamese citizens filed a lawsuit against more than 30 chemical companies which sought billions of dollars to remediate the health damages done by Agent Orange. They deemed the poisonous effect as a violation of international law and believed that the government should provide reparations. By 2005, the federal judge in Brooklyn, New York, dismissed the suit and rejected the final appeal in 2008. As of 2008, there has been no justice for the Vietnamese community concerning the exposure of Agent Orange from the war [2].
The author of Scorched Earth: Legacies of Chemical Warfare in Vietnam, Fred A. Wilcox, revealed that, “the U.S. government refuses to compensate Vietnamese victims of chemical warfare because they do not want to admit their involvement in committing war crimes in Vietnam. This would cause lawsuits to increase, costing the government billions of dollars.” However, their involvement in these war crimes stem from the context of Vietnam decolonization after obtaining independence from Europe’s former colonial empires, leaving the U.S., the Soviet Union, and China drawn to recruit potential allies. Vietnam became the proving grounds for each country to make their mark internationally. As the U.S. aided South Vietnam, China and the Soviet Union aided the North. It was not always a battle between North and South Vietnam, but a battle to dictate which power country had credibility during the Cold War. That the U.S. could prove that by containing communism, supporting non-communist governments, and implementing democracy building, was credible [5].
“Vietnam represents the cornerstone of the Free World in Southeast Asia”, the ideology that informed foreign policy to institute this idea of liberation in all countries [5]. Yet, the freedom my people witnessed has been poisoned with trans-generational trauma, disruptions of long-lasting culture, and constant arising health issues that have been minimally researched. In 2002, Dr. Le observed population‐based data from the Surveillance, Epidemiology and End Results program, California Cancer Registry and International Agency for Research on Cancer, to compare incidence cancer rates within the Vietnamese population in the United States and those living in Ha Noi, Vietnam. The findings revealed stomach, liver, lung and cervical cancers, were elevated for U.S. Vietnamese populations compared to residents from Vietnam and even exceeded corresponding rates for whites [4]. 17 years, since this data has been updated, and all the more motivation to pursue the skills to collect the current and changing generational numbers.
In the FACETS program, I will focus on the range and applicability of public health by engaging in extensive research projects. My designated mentor specializes in environmental health and the relation to mental health, specifically how environmental factors affect the nervous system and epidemiology of neurologic disorders. Their work focuses on exploring how toxicants (e.g., lead, manganese, and air pollution) affect cognitive function and psychiatric symptoms, autism spectrum disorder (ASD); and the development of amyotrophic lateral sclerosis (ALS). They have conducted research within large cohorts, for example analyzing risk factors for ALS mortality using the American Cancer Society’s Cancer Prevention Study II cohort, with a size of over 1 million people. So, what if I build upon the skills I learned in this program, to say, uncover the effects of agent orange on hereditary cancer syndromes in the United States and Vietnam post war?
The link to my mother’s diagnosis and the historical implications of lynch syndrome in Vietnam should not be overlooked. The acts committed by the United States and the refusal to provide reparations is unacceptable, and I am unable to let them take away my earned opportunities because of their American “values”. If I choose to stand on the side of justice, to push for a future lawsuit against the chemical warfare, to collect relevant data informing current cancer rates, and to not let their involvement in the war affect my future goals of achieving equity, then I know what my decision should be. Even based on my family’s dynamic and role, I, being the oldest and the daughter, must uphold certain gender norms that have been rooted in my community. However, I am not the caretaker, cooker, or cleaner, but I’ve always been the advocator, researcher, and learner.
At the end of the day, I don’t want to leave feeling regret, but be strengthened by my determination to achieve. To not have the guilt weigh me down, but to utilize my mother’s decision to allow me to go, so that I can best support her by taking care of myself. Not only am I enhancing my education, but I am choosing to elevate my preparation for graduate studies because “I am my ancestors wildest dream”. I am the product of their sacrifices and must push against a system that wants my community to dissolve its essence and assimilate. I must push by displaying the compassion, trauma, and healing, to reveal our truth and obtain the justice that is ours to claim. And for that, I will call, pray, and speak with my mother every day, even if we are thousands of miles apart. To hear her joyful words and expressions as I inform her about my educational pursuits at Harvard University.
References
[1] Dixon, Suzanne. “Learn How to Deal With Stage 4 Colon Cancer.” Verywell Health, Verywell Health, 20 Mar. 2019, www.verywellhealth.com/dealing-with-stage-4-colon-cancer-796545.
[2] Editors, History.com. “Agent Orange.” History.com, A&E Television Networks, 2 Aug. 2011, www.history.com/topics/vietnam-war/agent-orange-1.
[3] Eskander, R. N., Lynch, H. T., Brown, S. M., Wagman, L. D., & Tewari, K. S. (2015). Novel MSH2 Mutation in the First Report of a Vietnamese-American Kindred with Lynch Syndrome. Gynecologic oncology reports, 12, 31–33. doi:10.1016/j.gore.2015.02.003
[4] Le, G.M., Gomez, S.L., Clarke, C.A., Glaser, S.L. (2002). Cancer incidence patterns among Vietnamese in the United States and Ha Noi, Vietnam. Int J Cancer. 102(4):412–7. 10.1002/ijc.10725
[5] Stur, Heather. “Why the United States Went to War in Vietnam.” Foreign Policy Research Institute, 25 Mar. 2017, www.fpri.org/article/2017/04/united-states-went-war-vietnam/
