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Objectives: Studies have revealed that a relatively high incidence of severe infection and mortality in COVID-19 patients is attributed to healthcare-associated infections (HAIs). We implemented a study in 2 field hospitals dedicated to COVID-19 treatment in Da Nang, Vietnam (July–August 2020), and Ho Chi Minh City, Vietnam (August–October 2021), to identify pathogens, risk factors, and outcomes associated with HAIs. Methods: We applied a prospective study tool to estimate HAI incidence among 1,454 patients. HAIs are diagnosed and ascertained using surveillance criteria established by the US Centers for Disease Control and Prevention. All patients hospitalized for COVID-19 for at least 2 days were enrolled in this assessment of HAI risks, pathogens, and outcomes. Results: Among 1,454 sampled patients, 391 patients had 423 HAIs (27.1%). The highest proportion occurred in ICUs, with 422 HAI patients (34.1%). Pneumonia (n = 331, 78.3%) and bloodstream infections (n = 55, 13.1%) were the most common HAIs. Multidrug-resistant (MDR) bacteria, such as Klebsiella pneumonia (27.9%) and Acinetobacter baumannii (25.3%), were the most commonly isolated organisms. Ventilators and central venous catheters were independently associated with HAIs. Regarding the mortality rates, 55% of deaths occurred in intensive care units. Patients with HAIs (70.3%) were twice as likely to die compared to patients without HAIs (38.8%). HAIs leading to septic shock caused almost triple mortality (n = 58, 90.6%) compared with non-HAI patients (n = 412, 38.8%). HAIs prolonged hospital stay: 24.7 days for patients with HAIs and 19.1 days for patients without HAIs (P < .001). Conclusions: Patients with COVID-19–related critical illnesses are at high risk of HAIs from multidrug-resistant (MDR) bacteria. HAIs prolong hospitalization, whereas HAIs with septic shock almost tripled mortality. Guidelines and procedures to prevent and control HAIs caused by MDR bacteria as well as training and monitoring on aseptic-compliant techniques during invasive clinical procedures are needed.
This chapter explores the precarious experiences of retired workers who used to work in a former state-owned enterprise. As Vietnam shifted from a planned to a market economy, the regulation of labor relations changed from the socialist social contract to a legal regime operating in line with market principles. As a result of these changes, workers in the case-study enterprise experienced less economic security and deteriorating working conditions. The chapter demonstrates how their discontents and dissatisfaction at work reveal the gap between socialist ideals of workplace justice and post-reform reality. These workers turned to informal and corrupt practices, which operate in a vague, ill-defined area of the law, to be granted early retirement and claim benefits that they perceive as deserved and just. Yet the actual benefits that workers have received fall short of their expectations and make them vulnerable to poverty and further exploitation in their old age.
Why do some people invoke the law (or resist it) as a way to solve their problems and achieve more stability in life, only to end up in another challenging and uncertain situation? This book offers an original understanding of the important, but understudied, paradoxical effects of law on the survival strategies of Vietnamese people who are caught to live and work in precarious circumstances. It demonstrates how precarity influences the way people perceive, engage with, or resist the law; yet law, at the same time, creates and reinforces such a condition. Understanding the mutually reinforcing relationship between law and precarity sheds a new light on the way law enables individuals to better their condition but ultimately makes matters worse rather than better. This book will be of interest to researchers and students of law and society, political economy, anthropology, and Asian studies.
The Conclusion summarizes and discusses the book’s three main contributions to the law and society literature. These contributions include providing a new perspective into the paradoxical effects of law on daily survival, bringing the notion of precarity into a sharper focus in studies of disadvantaged and marginalized citizens, and providing a critical view of law in regimes governed by authoritarian or dictatorial rule. The Conclusion suggests that people’s struggles against precarity and the aftereffects of their behavior are shaped by the following factors: The (mis)match between law and other sets of values and understandings of justice, legal ambiguity and the prevalence of informal processes and practices, and the regulatory and normative role of the state. The book ends with a critical review of the literature on legal precarity, and a discussion of the benefits that the sociolegal perspective will offer to the broader research agenda on global precarity.
The Introduction sets out the core puzzle of the book, its central question and argument, and the research setting. It begins with a brief story about a Vietnamese female worker’s struggle to make ends meet, and her attempt to withdraw her pension early to meet pressing family demands. The anecdote raises a striking issue about the paradoxical nature of citizens’ use of the law, or resistance to it, in their daily life: While their behaviour represents an attempt to overcome certain conditions of uncertainty and instability in work and life, their action ironically puts them in another challenging, precarious situation. This chapter introduces the notion of precarity and outlines key elements of the conceptual framework that shed light on the mutual relationship between precarity and law as developed from the author's ethnographic observations of Vietnamese low-income workers and residents.
This chapter critically engages with relevant legal consciousness literature and develops the conceptual framework of the book. It examines three accounts of law in everyday life – hegemony, alienation, and empowerment – and demonstrates their limitations in explaining the mixed, paradoxical effects of law observed through the experiences of interviewed workers and residents in Vietnam. The ethnographic approach adopted in this research foregrounds the complex nature of individuals’ life circumstances and their decision-making. The concept of precarity as applied in this book consists of three main components: Precarity as a phenomenon and result of the broader neoliberal economic structure, precarity as multifaceted and variegated individual experiences, and precarity as a ground of resistance. This chapter develops a three-pronged process that underpins the mutually reinforcing relationship between precarity and law, and identifies some of the factors that make a socialist country like Vietnam a suitable setting to explore such a relationship.
This chapter explores the decisions of low-income factory workers employed in light manufacturing industries in relation to their social insurance benefits. It discusses why many factory workers have chosen to withdraw their social insurance money early rather than accumulating the social insurance benefits to receive a pension in their retirement. The chapter shows that, as workers experience unstable work and subsist on low incomes, they have come up with tactics that exploit the law to fulfil their daily needs. These tactics allow the workers to withdraw their social insurance early in a way that complies with the letter of the law but actually undermines law's objective and authority. The justifications for their actions reveal their struggle with family needs and financial hardship, and their moral obligations to family members. This chapter analyzes the complex and multifaceted nature of workers’ legal consciousness as they face a trade-off between their needs and their legal rights.
This chapter covers issues of land and housing in peri-urban areas, which have experienced fast-paced industrial and infrastructure development. It examines the precariousness of urban dwellers, most of whom are migrants from other provinces to the city, who seek to build their own house to settle down and achieve a sense of stability in the city. There is an ongoing tension between these people’s sense of autonomy and their right to housing, and their sense of economic and political disadvantage in the land and housing markets, which are fraught with brokerage and corruption. The chapter investigates how these people engage in illegal construction activities, by building their houses on cheap, low-priced agricultural land that is not legally designated for residential purposes, to achieve stability. Yet as a result of their actions, these urban dwellers became trapped in precarious situations. Their settlement was subject to surveillance by the local authority and some people even lost their houses following government measures to crackdown on illegal construction.
This chapter provides important background on legal reform and social change in Vietnam since the economic reform of đổi mới. It examines various accounts of the role of law in shaping state and society relationships in Vietnam, covering issues such as constitutional amendments, economic governance, dispute resolution, and rights mobilization. It also draws upon some important and useful insights relating to the operations of law in daily life from the anthropology literature. It can be seen from existing literature that law has had a limited role and legitimacy in the regulation of social life, which is predominantly shaped by informal practices and morality.
A framework that brings together cultural perspectives and behavior genetics has long been needed. To be successful, however, we need sophistication in the conceptualization of culture. Here, we highlight three imperatives to this end: the need for a clear definition of cultural traits, inclusion of the role of societal power, and recognizing the distinction between traits and characteristic adaptations.