Xây dựng chính sách bảo vệ sức khoẻ cho quân nhân đóng quân tại các vùng ô nhiễm chất độc hoá học dioxin

la chi la cim chiln binh, ngudi cd cdng vdi each mang da nghi huu, con chau cua nhiing nan nhan bj anh hudng CDHH/Dioxin bi di tat, nhung chua cd mdt nghidn ciiu nao trdn ddi tugng can b

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f^NGHE VA MOI TRDX)NG

BO QUOC PHONG cue KHOA HOC, CONG NGHE VA MOI TRUING

BAO CAO TONG HOP

DE TAI DTDL.2007G/52

XAY DlTNG C H I N H SACH BAO VE SlTC KHOE CHO QUAN NHAN DONG QUAN TAI CAC VUNG 6 NHIEM C H A T DOC

HOA HOC/DIOXIN

Chu nhiem de tai: Dai ta, PGS.TS Hoang Van Luong

Cu quan chu tri: Hoc vien Quan y, Bo Quoc phdng

Ha Ndi - 2010

BANG CHtr VIET TAT

CDHILDIOXIN: Chat ddc hda hoc/Dioxin

Lieu chet 50%

DOiN VI THAM GIA NGHIEN CUtJ

1 Cue Chinh sach - Bo Qudc Phdng

2 Cue Khoa hoc Cdng nghe va Mdi trudng - Bo Qudc Phdng

3 Bo Lao Dong thucmg binh va Xa hoi

THANH VIEN THAM GIA NGHIEN ClTU

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1 TS Tran Van Minh - Cue phd Cue Chinh sach

2 Ths Tran Qudc Diing - Trudng phdng khoa hoc - Cue chinh sach

3 TS Vu Thanh Thao - Cue KJioa hoc cdng nghe va Mdi trudng

4 Tran Due Hoan Nguyen Cue phd Cue bao trg xa hoi

-BLDTB&XH

5 TS Nguyin Hai Him - BLDTB&XH

6 TS Le Nam Cung - Chii Nhiem Chinh tri - Hoc vien Quan y

7 TS Nguyen Duy Bac - Giang vien Hoc vien Quan y

8 Ths Nguyen Van Ba - Giang vien Hoc vien Quan y

9 Bs Nguyen The Tai - Hoc vien Quan y

10 Bs Dang Tien Trudng - Hgc vien Quan y

MUC LUC

• •

MdDAU 1 Chuang 1 TONG QUAN TAI LIEU 3

1 Anh hudng cua Dioxin den sue khoe cua con ngudi 3

1.1 Doc tinh cua Dioxin 3

1.2 Tac hai cua CDDC/ Dioxin tren ngudi 3

1.2.1 Tac hai ciia CDDC/Dioxin vdi sire khoe sinh san 7

1.2.2 Kha nang gay benh ciia CDDC/ Dioxin 7

1.2.3 Cac tac hai toan than va tren cac ca quan chuc nang cua ca the 10

1.2.4 CDDC/Dioxin va ung thu 10

1.2.5 Danh gia tac hai lau dai cua CDDC/Dioxin tren sue khoe eon ngudi 12

1.3 Mgt sd nghien cuu ve anh hudng cua Dioxin den sue khde con ngudi 13

2 Muc do 6 nhiem va Snh hudng CDHH/Dioxin den moi trudng d cac

viing ndng 17

3 Mot so chu trucmg va chinh sach cua Nha nude 19

5.i Tong quan vi ddi tirong chiu hau CBHH/Dioxin & Viet nam 19

3.2 Mot so chinh sdch da cd ciia Nhd nu&c vd Qudn dpi nhdm bdo ve

site khde qudn nhdn dang song viing ndng 23

3.2.1 Mdt sd che do bao dam sue khde cho quan nhan 23

3.2.2 Mdt sd che do luan chuyen can bo cho quan nhan 25

3.3 Mot so chinh sdch tra cdp cho ngn nhdn bi hdu qud CBHH/Bioxin 27

3.3.1 Quylt dinh Sd 26 /2000/QD-TTg (3/2/2000) cua Thu Tudng Chinh

phu 27 3.3.2 Nghi dinh 07/2000/ND-CP ngay 9/3/2000 cua chinh phu 29

3.3.3 Quydt dinh sd 120 /2004/QD-TTg (5/7/2004) cua Thu Tudng Chinh

phu 30 3.3.4 Quylt dinh 16/2004/QD-TTg (5/2/2004) cua thii tudng Chinh phu 32

3.3.5 Nghi dinh 54/2006/ND-CP (26/5/2004) ciia Chinh phu 32

3.3.6 Nghi dinh sd 07/2008/ND-CP (21/1/2007) ciia Chinh phu 35

3.3.7 Nghi dinh 67 /2007/ND-CP (13/4/2007) ciia Chinh phii 36

3.3.8 Nghi dinh 105/2008/ND-CP (16/9/2008) cua Chinh phii 37

3.3.9 Danh gia tdng quat ve chinh sach ddi vdi ngudi bi hau qua chat doc

hoa hoc 38

3.4 Thuc trang chl do, chinh sach cua quan nhan sdng lau dai d vimg hoa 40

hgc/Dioxin va nguyen nhan

3.4.1 Thuc trang chl dg, chinh sach ddi vdi nan nhan CDHH/dioxin noi

chung; mdi quan he vdi quan nhan dong quan lau dai d viing d nhidm chit

do hoa hgc/Dioxin 40

3.4.2 Che do, chinh sach ddi vdi quan nhan sdng lau dai d viing d nhiem

CDHH/dioxin 42

Chuong 2 DOI TUQfNG VA PHlTONG PHAP NGHIEN ClTU 49

2.1 Doi tu9Tig, dja ban va thdi gian nghien cuu 49

2.1.1 Ddi tugng nghien cuu 49

2.1.2 Cdng cu nghien cim 5 0

2.1.3 Dia ban va thdi gian nghien cuu 51

2.2 Phuong phap nghien cuu 51

2.2.1 Thiet ke nghien ciiru va each thiic thuc hien 51

2.2.2 Phuang phap nghien cuu 51

2.2.2.1 Dieu tra dich te hgc 51

2.2.2.3 Thao luan nhdm 52

2.2.2.3 Dieu tra hdi cuu 52

2.3 Noi dung nghien cuu 52

2.4 Phucmg phap phan tich va xu ly so lieu 55

2.5 Han che cua de tai 55

2.6 Van de dao due trong nghien cuu 55

Chuang 3 KET QUA VA BAN LUAN 56

TAI CAC DIEM NONG 56

1.1 Nhimg thdng tin chung ve ddi tugng 56

1.2 Thuc trang ve hudng che do, chinh sach cua quan nhan tai 3 diem

ndng 58 1.3 Thuc trang phai nhidm vdi CDHH/Dioxin cua quan nhan 59

1.4 Thuc trang bdnh tat, sue khde cua quan nhan sdng viing ndng 61

1.4.1 Tinh hmh benh tat chung qua kham bdnh 61

1.4.2 Bieu hien benh ly qua chi sd mach, huylt ap va dien tam dd 65

1.4.3 Kit qua phat hien bit thudng vl nude tieu 66

1.4.4 Nhiing rdi loan midn dich hgc cua quan nhan 66

1.4.5 Nghien cuu biln ddi vl mau 68

1.4.6 Tinh hinh bit thudng thai san va di tat bim sinh cua quan nhan,

vg/chdng quan nhan 69

PHAN II ANH HUdNG CUA CDHH/DIOXIN DEN SlTC KHOE

CON NGU'Ofl QUA SO LIEU HOI CUtJ 72

2.1 Mot so nghien ciru khdi nguon 72

2.2 Nghien cuu cua de tai Z123 73

2.3 Nghien cuu cua de tai doc lap cap Nha nude 2002-2005 85

2.3.1 Benh lidn quan vdi CDDC/Dioxin 85

2.3.2 Di dang bam sinh 85

2.3.3 Bat thudng thai san 86

2.3.4 Tac hai ciia CDDC/Dioxin qua nghien cuu benh chung tai 3 bdnh

vien quan y: 108, 103 va 175 86

2.3.5 Bien ddi cau tnic va chuc nang mdt sd gen 86

2.4 Nghien cuu cua de tai doc lap cap nha nude 87

PHAN IIL MU'C DO TON LUtJ CUA CDHH/DIOXIN TRONG MOI

TRU'OTNG 94

3.1 Nong do Dioxin trong dat tai 3 diem ndng 94

3.2 Nong do Dioxin trong mau nude va thuc pham tai 3 diem ndng 98

PHAN IV DE XUAT CAC BIEN PHAP, CHINH SACH CHO CAC

QUAN NHAN DANG SONG 6 CAC DIEM NONG 102

4.1 Bien phap tuyen truyen giao due 102

4.2 Mot so che do, chinh sach trg cap cho quan nhan dang ddng quan

tai viing 6 nhiim CDHH/Dioxin 103

4.2.1 Che do trg cap ddc hai 103

4.2.2 Che do luan chuyen can bd 114

4.2.3 Chd do hau phuang 126

4.3 Mot so bien phap bao ve sue khde, ngan ngira tiep xuc 134

4.3.1 Chl do kham sue khde dinh ky 134

4.3.2 Chl do su dung thirc pham chiic nang, tang cudng mien dich, tang thai

ddc 138 4.3.3 Cac bien phap phdng tranh phii hgp bao vd siic khoe cho quan nhan

ddng quan tai cac viing d nhidm CDHH/Dioxin 13 8

4.3.4 Chinh sach vl chl do an cho quan nhan ddng quan tai cac viing d

nhiem CDHH/Dioxm 141

4.3.5 Che do an dilu duang cho quan nhan ddng quan tai cac vimg d

nhidm CDHH/Dioxin 142

KET LUAN 143 KIEN NGHI 146 TAI LIEU THAM KHAO 147

PHVLUC

MdDAU

1 Tinh cSp thiet

Trong cugc chiln tranh xam luge Viet Nam, quan ddi My da sii dung nhieu loai chat ddc hoa hgc mdt each rgng rai lam trui la cay, diet cd, huy diet mdi trudng, sinh thai Theo sd lieu cua Bd Qudc phdng My: tir nam 1961 din nam 1971, quan ddi My da rai xudng miln Nam Viet nam khoang 72 trieu lit chat ddc hoa hgc, trong dd cd 42 tri?u lit chat da cam mang ddc td Dioxin

Tai cugc Hdi thao Qudc td lan thir II ve chat ddc hoa hgc diet cd do My sii dimg trong chien tranh Viet Nam va tac h^i lau dai ciia nd ddi vdi thien nhien va con ngudi, td chirc tai Ha Ngi tir ngay 15 din ngay 18 thang 11 nam 1993, da dua ra ket luan: Chat dgc diet cd ciia My da gay ra nhiing tac hai nhu sau:

- Huy diet thidn nhien cay cd

- Huy diet siic khoe con ngudi, gay nhidu bdnh tat nang ne

- Gay nen nhung bidn ddi ve gen di truyen qua me hoac bd, gay tai bidn

sirih san, quai thai, di dang, di tat ciia nhiing dira con sinh ra

- Gay cac benh ung thu

Lugng CDHH/Dioxm ma quan ddi My rai xudng mien Nam Viet Nam dugc dua ra khac nhau, bdi cac tac gia khac nhau, trong dd thap nhat la theo sd lieu ciia A.H.Westing - khoang 179kg, cdn theo J.Stellman la 366kg, cdn theo Fokin (Nga) thi con sd dd phai ldn den 1000kg

Chien tranh d Viet Nam da trdi qua tren ba chuc nam, nhung hau qua ciia

nd dl lai thi vin cdn rit nang nl Rieng sd ngudi la nan nhan cua CDHH/Dioxin vao tren 3 trieu ngudi, chu ydu la ngudi Viet Nam

Nhan thiic dugc tac hai ciia chat ddc hoa hgc chien tranh den siic khoe con ngudi, ngay tir sau giai phdng mien Nam cac nha khoa hgc Viet Nam da tien hanh cac nghien ciiu danh gia tac hai cua chat ddc da cam ddi vdi siic Idioe con ngudi Nam 1983, tai hdi thao qudc te lan thii nhat tai Viet Nam, Bach Qudc Tuyen da trinh biy bao cao vl hau qua di tmyen cua chit diet cd, lam trui la cay ddi vdi con ngudi Tilp theo dd, Uy ban 10/80 dudi su chi dao ciia GS Hoang Dinh Clu da tap hgp cac nha nghien ciiu trong va ngoai nganh y tl, ca quan va dan y giai quydt nhimg vin dd nghien cim d p bach nhim dua ra nhung giai phap han che tac hai ciia CDHH/Dioxin ddi vdi cac nan nhan bi nhidm CDHH/Dioxin Tuy nhien, nhimg nghien ciiu trdn ciing nhu ddi tugng ap dung

la chi la cim chiln binh, ngudi cd cdng vdi each mang da nghi huu, con chau cua nhiing nan nhan bj anh hudng CDHH/Dioxin bi di tat, nhung chua cd mdt nghidn ciiu nao trdn ddi tugng can bd sy quan sdng lau dai tai viing nong, va chua cd de tai nao chuyen sau vl xay dung chinh sach bao vd siic khoe cho quan nhan tai cac vimg d nhidm CDHH/Dioxin

Dang, Nha nude va nhan dan Viet Nam da cd nhilu cd gang, tidn hanh nhieu bidn phap khac phuc hau qua cua chidn tranh, trong dd cd viec trg giup nhung nan nhan CDHH/Dioxin va khic phuc hau qua ciia loai chat ddc hoa hgc nay ddi vdi mdi trudng bi d nhidm Tuy nhidn, do nhidu nguydn nhan, ndn cdng vide dd chua thd dat dugc kdt qua nhu mong muon Hien cd mdt thuc te la trdn nhidu vimg dat bi nhiem loai chat ddc (d nhiing miic do khac nhau), van cd ngudi dang lam an, sinh sdng va trong dd cd mgt bd phan thudc cac lire lugng vii trang nhan dan Viet Nam Vi vay, vide tidp tuc tidn hanh cac bidn phap dd nhanh chdng tra lai su trong lanh cho mdi trudng, ddng thdi ban hanh kip thdi

kien thuc te cua chiing ta hien nay

2 Muc tieu de tai:

- Ddnh gid thuc trang sue khoe ciia qudn nhdn song tai viing nong 6 nhiem b&i chdt doc hoa hoc/dioxin

- De xudt chinh sdch, bien phdp bdo ve site khoe cho qudn nhdn dang song tai viing nong

Gi&i han pham vi nghien ciru cua de tdi:

- Vung bi d nhidm bdi CDHH/Dioxm dugc lua chgn didu tra la nhiing

vimg ndng Viing ndng da dugc xac dinh va cd ten trdn ban do vd anh hudng CDHH/Dioxin Viing ndng dugc hieu la nhimg viing d nhiem tach biet vdi vimg sach, cd ndng do PCDD tren 950 ppm

- Ddi tugng nghien eiiu la quan nhan dang sdng tai vung nong vdi thdi

gian trdn 5 nam

Chuong 1 TONG QUAN TAI LIEU

1 Anh hudng cua Dioxin den sire khoe cua con ngudi:

l.I Bpc tinh cua Bioxin:

Dioxin la nhimg chit rit ddc, nhung dg ddc ciia chiing khdng gidng nhau Chit cd do dgc cao nhit la 2,3,7,8 - TCDD va 1,2,3,7,8 PeCDD Vi vay to

chirc Y td thd gidi da xac dinh he sd duang lugng ddc td ggi la WHO - TEF dh

tinh gia tri dgc tdng hgp cho ca hg PCDD, PCDF va PCB doi vdi cac ddi tugng mdi trudng, trong dd cd 2,3,7,8 - TCDD va 1,2,3,7,8 - PeCDD la nhimg chit ddc nhat cd he sd 1, va trong cac dong phan ddc ciia PCDD he so nay nhd din cho din 0,0001 ddi vdi OCDD

Dioxin cd tac dung ddc tiic thdi va lau dai, trong dd tac ddng lau dai la dang chu y nhit Lilu chdt 50 % (LD50) cua 2,3,7,8 - TCDD ddi vdi khi la 70 ppb vugt phan ldn cac chat ddc quan sir thudng trang bi ciia quan ddi cac nude nhu sarin, tabun, yperit Qua tinh toan lilu lugng tmng binh cd thd lam chit ngudi trong mdt lln tidp xiic qua dudng an udng la 0,05 - 0,07 ppm Nhung dilu quan trgng la tac ddng tich liiy va keo dai trong nhidu nam ciia dioxin d ndng do rat thap Theo quy dinh cua Td chiic Y td Thd gidi thi lilu toi da cho phep ddi vdi ngudi la 1 - 4 pg/kg ngay ddm, nghia la mdt ngudi cd can nang 50 kg trong mdt ngay ddm chi cho phep mgt lilu lugng rit nhd la 50 - 200 pg (50 - 200 phin nghui

ty gam) Dioxin dugc coi la chat ddc bac nhat vi nd gay ra tac hai d lilu rit thip, gay ra ung thu, di dang bam sinh, lam tang tac hai ciia phdng xa va chat ddc

Phai nhidm vdi Dioxin, dac biet vdi 2,3,7,8-TCDD da dugc chiing minh la nguyen nhan gay nen nhidu hau qua cd hai ddi vdi siic khoe con ngudi va ddng vat Ket qua nghien ciiu dich td hgc trdn nhung quan the bi phai nhidm cao trong cdng nghiep cho thay cd su tang nguy ca mac bdnh ung thu phdi va cac loai ung thu khac 2,3,7,8-TCDD dugc coi la chit sinh ung thu manh ddi vdi ddng vat, nhung nhiing nghidn ciiu gan day lai ggi y rang: phai nhidm vdi TCDD cd anh hudng manh nhit tdi he thdng mien dich, sinh san va he than kinh

Rat nhidu nghien ciiu dua ra cac lieu gay chet sau khi phai nhidm CDD tren ddng vat Gia tri LD50 cho mdi loai chat cimg loai khdng chi thay ddi gitta cac loai ma cdn thay ddi giiia cac chiing khac nhau

Gia tri LD50 trdn chugt cdng Sherman sau diing lilu duy nhit dudng udng 2,3,7,8 - TCDD dugc tinh toan la 22|ig/kg (due) va 45 |ag/kg (cai); va lln lugt

la 164 ^ig/kg, 297 |ag/kg, 303 |ag/kg trdn chugt cdng Fischer 344; 165 ng/kg (due) va 125 |ag/kg (cai) d chugt cdng Osborne - Mendel; 43 ^g/kg d chugt cdng Sprague - Dawley cai, va lln lugt la 60 va 100 |ag/kg d chugt Long Evans cai va due Lilu dan (gavage) 100 fig/kg gay chit 95% chugt cdng Fischer 344 due, va mgt lidu 25 }ag/kg din tdi chit 25% chugt cdng due Sprague - Dawley Hon nira, gia tri LD50 dugc thdng bao la 4,2 ^ig/kg d chdn, 115 |^g/kg d thd trang New Zealand, 175 |ig/kg d chugt lang Harley due, 0,6 ng/kg (dire) va 2,1

|.ig/kg (cai) d chugt lang Harley, va 1.157 |^g/kg hoSc 5.051 p.g/kg d chugt dit Syrian Mdt LD50 42 ngay d chugt lang Harley cai dugc xac dinh la 2,5 |ig/kg khi trdn 2,3,7,8 - TCDD trong diu thuc vat va 19 |ig/kg khi trdn 2,3,7,8 -TCDD trong methyl cellulose

Tang ty Id tii vong d chugt lang Harley khi bi phai nhidm vdi 0,03

|a,g/kg/ngay 2,3,7,8 - TCDD trong thiic an trong 11 ngay va d thd dang trong thdi

ky mang thai sau dimg 10 lidu hang ngay 1 |ig/kg trong chd do an Ngoai ra, 3 trong sd 12 khi rhesus dang mang thai chdt sau dung lidu duy nhat l|ig/kg Trong tit ca cac nghidn ciiu tren, cac ddng vat ddu chet sau phai nhidm tidm tang mdt vai ngay (gia tri trung binh thay ddi tir 9 - 43) Trong hau het cac dgng vat thi nghiem, hgi chiing suy mdn nang xuat hien nhu la ydu td chinh dan tdi tii vong

Trong cac thi nghiem thdi gian tmng han, tang tii vong d chugt cdng Osbome - Mendel phai nhidm 2,3,7,8 - TCDD trong diu bing nudi qua dng thdng da day vdi lilu 0,56 jig/kg/ngay cho tdi 13 tuin Ty Id tir vong 5% (khdng chdt trong nhdm chung) quan sat thiy d chugt cdng Sprague - Dawley phai nhidm 2,3,7,8 - TCDD bang nudi qua dng thdng da day vdi lidu xap xi 0,8

|xg/kg 2,3,7,8 - TCDD/kg/ngay trong 13 tuan; tmdng hgp chdt dau tien xay ra vao ngay thir 57 Bdn trong sd 7 chugt cdng due Sprague - Dawley diing lilu 1,6

^g/kg 2,3,7,8 - TCDD/kg/ngay bing nudi qua dng thdng da day da chdt trong mdt nghien ciru 10 tuan; thdi gian tmng binh dan ddn chdt la 53,5 ngay Tir vong tang ciing thiy d chugt lang Harley phai nhidm hang ngay trong thiic an vdi lidu 0,03 |ig/kg/ngay trong 60 ngay; 4 trong sd 10 chugt due chdt vao ngay thir 42

va 4 trong sd chugt cai chet vao ngay thii 59 Trong nghidn ciiu sir dung thiic an phai nhidm, tit ca cac chugt cdng Sprague - Dawley due dung thiic an lilu cao

nhit (3,4 |ag/kg/ngay) da chit trong vdng 4 tuin Chugt nhit C57BL/6 giam kha nang sdng sdt sau phai nhidm vdi lilu 3 |ag/kg/ngay 2,3,7,8 - TCDD, 3 ngay 1 tuin trong 25 tuin bing nudi qua dng thdng da day 5 trong sd 8 khi chdt trong vdng 2 thang sau sir dung thirc an cd chira 0,02 |xg/kg/ngay; 5 trong sd 8 khi da chdt trong vdng 9 thang sau sii dung thiic an cd chira 0,011 i^g/kg/ngay Trong tat

ca cac loai, xay ra hien tugng giam trgng lugng nhilu va mit md trudc khi chit

Ddng vat giam kha nang sdng sdt sau phai nhiem man tinh vdi CDD Phai nhiem man tinh vdi 2,3,7,8 - TCDD trong thirc an lam tang ty Id tir vong

so vdi nhdm chiing d chugt cdng Sprague - Dawley vdi lilu 0,1 |ig/kg/ngay Tang ty le tii vong d chugt nhit Swiss nhan 2,3,7,8 - TCDD qua dng thdng da day vdi lilu 1,0 |ag/kg/ngay va chugt nhit B6C3F1 vdi lilu 0,36 |ig/kg/ngay

Tu vong tang xuat hien sau khi phai nhidm cap tinh vdi cac chat CDD khac Sau dung lilu don dudng mi?ng hon hgp 1,2,3,7,8,9 - HxCDD va 1.2.3.6.7.8 - HxCDD, gia tri LD50 dugc tinh toan lln lugt la 1.800 |ig/kg va

800 |ig/kg d chugt cdng Osbome - Mendel due va cai, va lan lugt la 750|j.g/kg

va 500 |ig/kg d chugt nhit B6C3F1 due va cai Ngoai ra gia tri LD50 ciing dugc xac dinh cho nhidu chat khac trdn chugt lang (29.444 [4,g/kg ddi vdi 1,2,3 -TrCDD, 1.125 |ig/kg ddi vdi 1,2,4,7,8 - PeCDD, 3,1 |ag/kg ddi vdi 1,2,3,7,8 -PCDD,70 - 100 |ig/kg ddi vdi 1,2,3,6,7,8 - HxCDD, 6 0 - 1 0 0 |ag/kg ddi vdi 1.2.3.7.8.9 - vdi HxCDD, va 72,5 |ig/kg ddi vdi 1,2,3,4,7,8 - HxCDD) va d chugt nhit (825 ^ig/kg ddi vdi 1,2,3,4,7,8 - HxCDD va 337,5 |ig/kg vdi 1,2,3,7,8 - PCDD) sau dimg lidu dan dudng mieng bang nudi qua dng thdng trong diu an 6 chugt cdng Sprague - Dawley due, gia tri LD50 dudng mieng ddi vdi 1,2,3,4,7,8 - PCDD, 1,2,3,4,7,8 - HxCDD va 1,2,3,4,6,7,8 - HpCDD trdn lln trong diu thuc vat/acetone (95/5) lln lugt la 206, 887, 6.325 jig/kg Cac ddng phan CDD khac cd ddc tinh thip hon, vi khdng thiy tac dung trdn tii vong

d nhung lidu cao hon cac lieu gay chdt ciia 2,3,7,8 - TCDD, TrCDD, HxCDD hay PCDD Khdng thiy trudng hgp tir vong nao sau khi dung lilu don udng 1 xlO^ va 2 X 10^ {ig/kg 2,7 - DCDD lln lugt d chugt edng Sprague - Dawley va chugt Swiss Webster Ngoai ra, chugt cdng va chugt nhat sdng sdt sau dimg lidu dan d p dudng mieng lln lugt la 1 x lOSa 4 x 10^ Hg/kg OCDD

Qua cac kit qua nghidn ciiu d tren cho thiy 2,3,7,8 - TCDD la chit ddc

khoang vai (ig/kg trpng lupng co thi d cac thvc nghiem cip tinh da din din til vong cho tat c4 cac loai dvpc thir nghiem Nguoc lai, trong cac chit cimg loai duoc thil nghigm, 2,7 - DCDD va OCDD lai la chit it dpc nhit bdi vi cac ddng vat dupe thir nghiem dgu sdng sdt ngay ca khi dimg lilu rit cao (g/kg trpng lupng

CO thg) O hau hgt cac loai, hpi chung suy mdn la tac dung dpc chii ygu ciia qua trmh phai nhigm cap tinh va trung han vdi CDD Dac diim ciia hdi chiing nay la giam trpng lupng ca thg, giam md ma va cudi cimg la tit vong Trong hau hgt cac nghign cim keo dai (man tinh), nguygn nhan tut vong chua xac djtih

Ddng vat phai nhilm vdi 2,3,7,8 - TCDD theo dudng udng giam kha nang sinh san, mat qua trinh trade va sau lam td cua trimg vao nigm mac til cung, giam trpng lupng bp phan sinh dvc, giam ndng dp androgen, va thay ddi chu ky dpng due va ning tning Hien tupng mit qua trinh trudc va sau lam td cua trimg vao niem mac tu cung tang cao gap d chudt edng CRCD diing ligu 0,5 Hg/kg/ngay trpng 2 tuan trade khi giao phdi Tang tigu buy phdi thai gap d chudt edng Sprague - Dawley dimg lilu 0,125 pg/kg/ngay, d chupt nhit CF -1 dimg ligu 1,0 ng/kg/ngay, va chudt nhit NMRI dimg lilu 9 pg/kg/ngay vao cac ngay 6

- 15 ciia qua trinh mang thai, d thd su mat qua trinh sau lam td ciia tning vao nigm mac tir cung tang len d nhdm diing 0,25 pg/kg/ngay, nhung khdng thay tang d nhdm dimg 0,0 pg/kg/ngay trong cac ngay 6 - 1 5 cua qua trinh mang thai Ngoai ra, hien tupng say thai tang (10 trong sd 12 con) gap d khi sau khi dung lieu duy nhat 1 ng/kg theo ducmg udng

Dpc tinh sinh san cdn gap d chupt edng cai khdng mang thai Giam rd ret trpng lupng hudng tning, ty le trimg rvng va sd lupng tning giai phdng gap d chudt edng Sprague - Dawley cai nhan lieu duy nhat > 10 pg/kg theo dudng udng Tac dvng tren ndng do hocmpn ciing thay d chudt edng Trong vdng 24 gid sau khi dua lilu hoa chit vao, ndng dp LH va FSH tang cap cd y nghia, ndng

dp prplactin khdng thay ddi Sau khi dimg 17 (5 - estradiol, LH va FSH giam thap hem so vdi chiing

2,3,7,8 - TCDD ciing la mdt chit dpc trgn sinh san cua ddng vat due

Giam trpng lupng bpng tinh djch gap d chudt edng Sprague - Dawley sau khi

sinh san due ciing vdi su giam tetosterons va dihydrotetosterone huylt thanh (dugc so sanh vdi cap ddi chimg), dilu nay cung quan sat dugc d chugt cdng Sprague - Dawley sau khi bi diing 1 lilu 2,3,7,8 - TCDD duy nhit 12,5|ig/kg dudng udng

Trong nghidn ciiu trudng dien vdi 2,3,7,8 - TCDD cho phai nhidm 0,00064 jxg/kg/ngay trong thirc an da l^m tang ty Id say thai va gi^m kha nang sinh san d khi, cdn ndu chi dung vdi lilu 0,00012 jig/kg/ngay thi khdng thiy anh hudng ddn qua trinh sinh s ^

1.2 Tac hai cua CDHH/Dioxin tren ngudi

1.2.1 Tdc hgi ciia CBHH/Bioxin v&i sire khoe sinh sdn:

- O nam gi&i: anh hudng ldn su sinh tinh, svr di ddng cua tinh triing, hinh

lang ciia tinh trimg, ndng dQ ciia cac hormon quan trgng nhu gonadotropin, LH,

i^SH, testosteron va eac androgen khac, ca quan dap iing vdi androgen, hanh vi inh due va kha nang sinh san liic tmdng thanh Nhidm Dioxin cdn cd thi gay )at thudng tinh hoan (tinh hoan nhd), cd the dan den hgi chiing tinh triing it, /eu, hmh dang bat thudng

Ket qua phan tich dac diem tinh dich ciia mdt sd ngudi cd nguy ca phai ihidm chat da cam/dioxin tai Viet Nam, Trinh Van Bao, Trin Diic Phin, 2002

la dua ra mdt sd kdt luan sau:

* O cac ngudi Viet Nam khdng tiep xiic vdi chat ddc hoa hgc trong chien ranh (nhdm II, IV), cac chi sd ciia tinh dich dat tidu chuan miic bmh thudng

F r

heo qui udc qudc te

* 6 cac cim chidn binh ngudi Viet Nam thudc nhdm da true tidp phai ihidm vdi chit dgc hoa hgc trong chiln tranh, nay sdng d midn Bac Viet Nam, Jidi lugng tuih dich/lln xuat tinh giam, pH cua tinh dich tang so vdi qui udc [udc td, tuy nhien nhimg biln ddi nay khdng thiy cd anh hudng ddn chiic nang inh san

* Nhui chung, hiu hit cac mlu tinh dich dugc nghien ciiu ddu dat tidu huin bmh thudng theo qui udc, nhung sd ngudi cd mat do tinh triing < 20.10^ d ihdm cd phai nhidm vdi AO/Dioxin nhilu hon so vdi nhdm khdng phai nhidm

* Chi sd mat do tinh triing giam (< 20.10^) va nhit la khdng cd tinh triing

a dac didm quan sat thay d nhidu ngudi hiem mudn sinh sdng d vimg da bi rai

- d nir gi&i: Dioxin cd thd anh hudng ldn chu ky kinh, do dai va cudng do

hanh kinh, tin suit cua chu ky khdng phdng noan, ndng do cac hormon quan

trgng nhu FSH, LH, oestrogen, progesteron, hanh vi tinh due, kha nang thu thai,

kha nang mang thai du ngay

Nghidn ciru dilu tra ca ban tai xa Trach Phong huyen Thanh Phu tinh Bin

Tre va phudng 10 quan Tan Binh thanh phd Hd Chi Minh cho thiy ty Id sinh

t IS, r

con di tat bam sinh d nhdm cd nhidm chat da cam d xa Thanh Phong la 1,1% va

d phudng 10 quan Tan Binh thanh phd Hd Chi Minh la 5,4% cao ban nhdm

khdng nhilm chit da cam (0,4%) vdi p<0,05 Ty Id thai chit luu d nhdm cd

nhiem chit da cam la 0,8% va 0,34% cao hon nhdm khdng nhidm chit da cam

(0,02%) vdi p<0,01 Ty Id thai trirng d nhdm cd nhilm chit da cam la 0,73% va

3,74% cao hon nhdm khdng nhilm chit da cam (0,38%) vdi p<0,05 Ty Id sly

thai d nhdm cd nhidm chat da cam la 8,01% va 16,7% cao hon nhdm khdng

H^ F

nhidm chat da cam (3,63%) vdi p <0,05

Hoang Dinh Cau, Ld Hdng Tham (2002) nghidn ciiu thuin tap hoi ciiu

F F r

Siic khoe smh san d thd he chau cac cuu chidn binh Ha Ndi da phuc vu chidn

tmdng mien Nam va mien Bac trong thdi gian chidn tranh chdng My, hien vd

F y, F > r >

sinh sdng trong ciing nhung didu kien kinh td xa hdi nhu nhau, thuan nhat vd

cac yeu td nghidn curu, chi khac biet duy nhat bdi sir phai nhidm vdi ydu td nguy

ca la chat ddc hoa hgc trong thdi gian chien tranh cho thay:

* Tai bidn suih san da xuat hien d thd he chau cac CCB chdng My, vdi tan

suat tang cao d nhdm cd tiep xiic so vdi nhdm khdng tidp xiic, sir khac biet cd y

nghia thdng kd Say thai: RR = 9,02; CI, 3,65 - 22,26; p < 0,0001; RD =

24,8/10000; AFe = 88,9% Thai chit luu: RR = 8,56 ; CI 2,05 - 35,81; p <

0,001; RD = 9,38/10000; AFe = 88,3%

f f F F

* Di tat bam sinh ciing xuat hien d the he chau cac CCB chdng My, vdi

nhiing dac diem sau:

1) Tin suit di tat bim sinh d chau cac cuu chidn bmh phuc vu chiln

\ F t F

trudng midn Nam (nhdm cd tidp xiic) la cao hon han so vdi nhdm khdng tidp

xiic Su khac biet nay cd y nghia thdng kd vdi RR = 4,04; CI 2,15 - 7,59;

p<0,0001; RD = 21,4/10000; AFe = 75,2%

2) Do manh ciia su khac biet - nguy ca tuong ddi d thd he chau cao hon

1,8 lln so vdi nguy ca tuang ddi d Fl

3) Trong cac loai di tat bim d F2, tuang tu tinh trang nhu d Fl, mac diu

cd thd chua phat hien dugc mgt sd di tat kin dao khac, di tat he thin kinh nhu

cac dang thilu nang tri tue chilm vi tri cao nhit va tang cao hon d nhdm cuu

binh cd tidp xiic, lam ndn sir khac biet cd y nghTa thdng kd vdi p < 0,001 Tilp

ddn la di tat ngoai hinh nhu cac bidn dang tay, chan ciing tang cao hon d

nhdm cd tilp xuc vdi y nghia thdng kd vdi p < 0,05

4) O nhdm cuu chidn binh cd tidp xiic, di tat bim sinh the he chau cd gi&i

nam cao hon so vdi nG, vdi su can bang giira gidng ndi va gidng ngoai Trong

khi d cac chau CCB A, DTBS gidi nir lai cao hon, vdi sir vugt trdi d gidng ngi

5) Cd sir giam dan tan suit TBSS va DTBS d thd he chau (F2) so vdi thd

he eon (Fl), didu nay phii hgp vdi nhan dinh cua mdt sd nha khoa hgc trudc day

va sir tat giam dan tai bidn san khoa d cac thd he sau, cung nhu hgp ly vd sir

giam dan ddc td theo thdi gian ban phan huy

Dioxin cd thd tao ra nhung thuong tdn rat sdm trong thdi ky bao thai lam

F ^ F r 1

rdi loan su phat trien tidp theo ciia bao thai chii ydu theo hudng thidu san lam

cho thai phat tridn khdng hoan chinh

Mdt sd didm lam cho cac di dang bam sinh do Dioxin cd nhimg net khac

biet vdi cac di dang bam sinh do cac tac nhan khac:

Tdn sSxudt hien cao bdt thuang: trong didu kien mdi tmdng va sinh sdng

> F •*

nhu nhau d trdn mdt cdng ddng, Dioxin la tac nhan gay ra mdt sd di dang bam

F t F y

sinh cao hon sd di dang bam sinh do tat ca cac tac nhan khac khoang hai lan

Tinh da di dgng: Trdn ca thi ciia mdt tre em cd nhilu di dang phdi hgp

theo nhidu hinh thiic khac nhau

Cd thd cd mdt di dang (teo ca) lidn quan ddn nhidu bd phan khac nhau ciia

ca thd

Cd thi cd cd nhilu di dang khac nhau, mdi di dang lidn quan din mdt bd

phan ca the

Tinh gia dinh: Mdt gia dinh cd thi cd nhilu con bi di dang bim sinh theo

nhilu thd thiic khac nhau

1.2.2 Khd ndng gdy benh cua CBHH/Bioxin:

Ddn nay trdn thd gidi da cd rit nhidu cdng trinh nghidn cim vl Dioxin va

cac bdnh cd lidn quan vdi Dioxm Vidn Han lam y hgc My ciing da cdng nhan

mdt sd bdnh cd lien quan vdi Dioxin nhu sau:

Cdc benh co bans chims co lien quan chdc chdn v&i CDHH/Dioxin:

- Ung thu phan mdm {Sarcoma)

- Lymphoma non Hodgkin

- Hodgkin

- Bdnh tning ca do dor (cloracne)

Cdc benh duac coi Id co bdng chirng lien quan v&i Dioxin:

- Ung thu dudng hd hap (Respiratory cancer){ung thu thanh quan, ung

» F

thu phdi, ung ihu khi phd quan)

- Ung thu tidn liet tuyen (Prostate cancer)

- Bdnh da u tuy ac tinh {Multiple Myeloma)

F

- Bdnh gai sdng che ddi {Spina Bifida)

- Bdnh Porphyria Cutanea Tarda (bdnh rdi loan chuydn hoa

Porphyrin, dac tnmg bdi sir tang do man cam vdi anh sang, xuat hien cac ndt

phdng trdn da va cac tdn thuang khac, cd tang ham lugng porphyrin trong gan,

trong nude tilu)

F \

- Rdi loan than kinh ngoai bidn

- Bdnh dai dudng typ 2

Ngoai ra, cdn mdt sd bdnh khac hien nay tuy ngudi ta chua du chiing

CDHH/Dioxin va danh muc cac bdnh cd lidn quan den CDHH/Dioxin ddn nay

vin chua dugc cdng bd day dii

1.2.3 Cdc tdc hgi todn thdn vd tren cdc ca quan chirc ndng cua ca the:

- Rdi loan tdm thdn Idnh: Cd thd cd sir lidn quan giiia phai nhiem Dioxin

va tang ty Id rdi loan tam than kinh Tuy nhidn su khac biet cdn chua ro trdn

phuong dien thdng ke Ngoai ra, cdn cd thd cd mdt thdi gian tiim In tir khi phai

fs/ F F y

nhidm den khi khdi phat ra cac trieu chiing rdi loan tam than kinh Ngudi ta cdn

thiy, cd thd Dioxin gay ra hien tugng lao hda sdm bd nao con ngudi, lam cac tl

bao thin kinh bi pha hiiy sdm Schulte va cs (My, 1996); Liou va cs (Taiwan,

1997), Seilder va cs (CHLB Diic, 1996) da tim thiy cd sir lien he giiia phai

nhidm Dioxm va bdnh Parkinson

Rdi loan ho hdp: Thdng tin vd tac hai cua CDHH/Dioxin ldn he hd hip

cdng nghiep d Diic cho thiy ngudi bj nhidm d p 2,3,7,8-TCDD cd bilu hien

vidm phd quan va vidm thanh quan sau nhiem it ngay va vidm mang phdi xuit

huyet sau nhidm 11 thang Nhilu nghidn ciru khdng tim thiy cd sir lidn he giua

Dioxin va cac rdi loan hd hip Nhung O' Tole va cs (1996) da nghidn cim trdn

cac CCB uc va da tim thiy cac rdi loan hd hip d nhung ngudi cd phai nhidm vdi

Dioxin (RR tir 1,6 din 4,1) Nhung nghidn ciru gin day cho thiy nhilu bdnh ciia

dudng hd hap, bao gdm ca nhidm triing cap va man, hen suyen, gian phi quan,

tran dich mang phdi cd lidn quan vdi nhiem CDHH/Dioxin

F F fs, y f

- Roi loan he thong mien dich: nhidu nghidn ciru cho thay cd sir tang bdnh

nhidm trimg d cac ddi tugng cd nhiem Dioxin, RR udc tinh bing 2,8 Mdt nghidn

cim cua Ld Cao Dai, Nguyen Thj Nggc Phugng va CS cung cho thiy ty Id tir

vong ciia tre em d vimg cd bi rai chit ddc da cam cao hon d vimg khdng bi rai

- Ddi thdo du&ng: nhidu nghidn ciiu vd vin dd nay da cho kit qua trai

ngugc nhau Henriksen va cs nghidn ciiu tren cac CCB My da van chuyin chit

ddc da cam va cac chit diet cd va trui la khac tiic la nhiing ngudi bj nhidm nang

Dioxin, ed sir gia tang bdnh dai dudng cd y nghta thdng kd (RR = 1,5) so vdi

nhom chimg Tuy nhien, do ca chd bdnh sinh phiic tap, va chi khoang 50%

ngudi cd bdnh dai thao dudng la dugc chin doan ra, ndn d n cd thdm nghidn

Ciiu cd loai trir nhiing ydu td lidn quan ddn ca chd bdnh sinh dd cd thd khang

F

dinh mdi lien he nhan qua giiia Dioxin va bdnh nay

- Roi loan chuyen hoa Lipid vd Lipoprotein: mdi chi tim thay tinh trang

tang triglycerid d trong phdng thi nghiem, tuy nhidn ciing cd nghidn ciiu bac bd

F \ y

van dd nay Can cd nghidn ciiu thdm

- Benh duang tieu hoa, ke cd nhiem doe gan: Cac nghidn ciru hien tai

chua chiing minh dugc mdi lidn he nhan qua giiia Dioxin va cac bdnh dudng

tidu hda, nhung cd thd cd tang men gan d nhiing ngudi bi nhidm Dioxin Ty Id tii

vong do cac bdnh dudng tidu hda tang d ngudi da bi nhidm Dioxin 15 nam vl

tmdc (Ramlow va cs 1996)

F "\

- Roi loan tudn hodn:

F y /S,

Da sd cac dii lieu tmdc day cho rang sir phai nhidm vdi dioxin khdng gay

cac tdn thuong tim mach Nghidn ciiu trdn 226 cdng nhan phai nhidm vdi

2,3,7,8-TCDD tir 1948 ddn 1969 trong qua trinh san xuit 2,4,5-T thiy cd 52% sd

phai nhidm cd chiing ban do va ty Id dau that nguc va nhdi mau ca tim tang cao

Tuy nhign chua cd nghign ciiu khing dinh mdi lign he nhan qua giua Dioxin va cac benh nay Mdt sd nghign cim cd nhic din kha nang bj cao huylt

ap, suy tim, suy dpng mach vanh, tai biln mach mau nap d nhdm cd phai nhilm vdi CDHH/Dioxin cao hon d nhdm khdng phai nhiim

1.2.4 CDHH/Dioxin vd ung thu:

Cac nghign cim da chi ra Dioxin cd thg gay ra mpt sd Ipai ung thu sau: Ung thu dudng hd hap va phdi

Ung thu tuygngiap

Ung thu phan mgm

Ung thu he Lympho tap huylt: Lympho khdng Hodgkin, benh Hodgkin, da u hiy, bgnh bach cau

Ung thu he tigu hda nhu gan, tvy, da day,thuc quan, dai trang Ung thu tign ligt tuygn, than, tinh hoan

Ung thu nao - Ung thu vu d phu ntt

Hien nay, cac cong trinh nghign cim vg tac hai cua Dioxin vdi mdi trudng sinh thai va vdi site khog con ngudi, nghign cim ca ban vg ca chg tac dpng, vl nhihig giai phap bap ve su tac dpng cua Dipxin ddi vdi mdi tradng va con ngudi

da duoc dang trong nhigu bao cao khoa hoc trgn thg gidi Cac nghign cim nay tap chung vao nhOng hudng chinh sau day: Dj tat bam sinh va tai bign smh san; Chi sd thdng minh; Nhirng bign ddi di traygn va ung thu; Nhihig bign ddi vg mau va he men chuygn hoa; Nhttng bign doi vg he mien djch

1.2.5 Bdnh gid tdc hai lau ddi cda CDHH/Dioxin trin site khoe con ngudi:

Nghien ciru dg dua ra nhimg kgt luan vl anh hudng ciia Dioxin ddi vdi sure khog con ngudi la mpt van dg khd, nd ddi hdi nhung thigt ke nghign cim phai rat chuan xac va phai than trpng khi edng bd kgt qua

Trgn the gidi hang nam vln cd cac hdi nghj, hdi thao vg tac hai cua Dioxin tdi sire khoe con ngudi Tai Monterey thupc bang Califocnia (My) tir 13

- 17 thang 8 nam 2000 da diln ra hdi nghi vg Dioxin Tai day mdt danh mvc vl cac benh va tat cd lign quan dgn Dioxin da dupe bd xung Danh muc nay cd le phii hop vdi thue te benh ly lign quan vdi Dioxin d Viet Nam nhilu hon

Tai Hdi nghj qudc tg ve Dioxin tai Han Qudc hi ngay 9-^14 thang 9 nam

ciia Alvin L Young, ca quan nang lugng My; "Md/ tru&ng bi rdi chdt rung Id cdy

& Viet Nam vd khd ndng nhiem doc ddi v&i con nguai'' ciia Michael Nev^on, dai

hgc tdng hgp bang Oregon; "Tinh trgng sue khoe eiia ede cuu chien binh thuoc

qudn dodn hod hoe My timg tham chien & Viet Nam vd moi lien quan nong do

Dioxin trong huyit thanh" ciia Han K Kang, CDC Atlanta Cac nghidn cim diu

khang dinh CDHH/Dioxin cd anh hudng ddi vdi siic khoe con ngudi

Tuy nhidn, mdt sd nha khoa hgc My va cac nude ddng minh ciia My van

phii nhan tac hai ciia chat ddc Dioxin vdi siic khoe con ngudi: hg cho rang cac

nghidn ciiu trdn curu chiln binh iic, Han Qudc diu khdng cd sir khac biet giiia 2

nhdm cd va khdng phai nhidm (hg da khdng ndu rd rang thdi gian va phuang

thiic phai nhidm ciia cac cuu chiln binh nay nhu thi nao)

r

Mdt thuc td khach quan ma mgi ngudi phai thira nhan la cac nghidn ciiu

vd anh hudng ciia CDHH/Dioxin ddi vdi con ngudi thi khdng the co thirc dia

nao cd day dii nhan chung, vat chimg cd gia tri khoa hgc va phap ly nhu d Viet

Nam, trdn chinh con ngudi Viet Nam - nhiing ngudi bi tidp xiic lau dai nhat, cd

T > T fs, F F

thd cd nhidu ca thd trong ciing mdt pha he phai nhidm true tidp hoac gian tidp

vdi CDHH/Dioxin

1.3 Mpt so nghien ciru ve dnh hir&ng cda Bioxin den sire khde con ngirdi:

Ngay tir nhiing nam 70 ciia the ky vira qua, khi chidn tranh Viet Nam cdn

F fs/ F y

chua kdt thiic, tir thuc tidn chidn tmdng midn Nam, cac nha y hgc Viet Nam la

Tdn That Timg va Hoang Dinh Cau da quan tam nghien ciiu tac hai ciia Dioxin

ddi vdi siic khoe con ngudi Tai Hdi nghi orsay Tdn That Tung, Trinh Kim

anh da bao cao vd tinh trang dot bidn nhidm sac thd ca vd sd lugng va cau tnic

d nhiing ngudi bi nhidm chit ddc diet cay cd ciia My

Nhan thiic dugc tac hai ciia chat ddc hoa hgc chidn tranh ddn siic khoe

con ngudi, ngay tir sau giai phdng mien Nam cac nha khoa hgc Viet Nam da tidn

F F

hanh cac nghidn ciiu danh gia tac hai cua chat ddc da cam ddi vdi siic khoe con

ngudi Nam 1983, tai hdi thao qudc tl lln thii nhit tai Viet Nam, Bach Qudc

Tuyen da trinh bay bao cao vd hau qua di tmydn ciia chat diet cd, lam trui la cay

ddi vdi con ngudi Tidp theo dd, Uy ban 10/80 dudi su chi dao cua GS Hoang

Dinh c l u da tap hgp cac nha nghidn cim trong va ngoai nganh y tl, ca quan va

F F '^ ' >

dan y giai quydt nhiing van dQ nghidn ciiu cap bach nham dua ra nhiing giai

phap han chd tac hai ciia CDHH/Dioxin ddi vdi cac nan nhan bi nhidm

Trong nhiing nam qua, cac nha khoa hgc Viet Nam nhu Tdn Thit Timg, Hoang Dinh Clu, Nguydn Hung Phuc, Ld Cao Dai, Biii Dai, Nguyen Can, Nguydn Thi Nggc Phugng, Vu Trieu An, Phan Thi Phi Phi, Dao Nggc Phong, Nguydn Van Nguydn, Ld Bach Quang va nhilu ngudi khac da diu tu nhilu cdng siirc cho cac nghidn cuu va dang nhilu bai bao trong va ngoai nude vl tac hai ciia CDHH/Dioxin vdi con ngudi Vi?t Nam

Nam 1982, Nguyen Hung Phuc va Cung Binh Tmng da tiln hanh dl tai

"Nghidn ciru hau qua trdn ngudi ciia chit dgc hoa hgc do My rai d miln Nam Viet Nam va khdi thao bidn phap khic phuc" (dl tai mang ma so 52.02.05.02), ddi tugng nghien cim la ngudi bi rai true tidp chat ddc hoa hgc thudc huyen Gidng Chdm, tinh Bdn Tre, vdi cac ndi dung chinh sau:

Danh gia sir tdn luu ciia cac chat dgc hoa hgc chiln tranh d mdt sd dia

t \

didm thudc midn Nam Viet Nam

- Dieu tra xac dinh ca cau bdnh tat ciia nhiing ngudi da bi nhidm ddc true

^ F F / •

tiep do chat dgc hoa hgc chidn tranh

- Danh gia dot bidn di tmydn trdn ddng vat thuc nghiem phai nhidm vdi

- Kdt qua kham lam sang eho 1300 ngudi thay: bdnh suy nhugc thin kinh

cd ty Id cao (17,6 ± 4,70%, bdnh thilu mau (14,98%) vdi d^c didm hdng d u dudi 3 trieu, ty Id hdng cau ludi giam nhidu (cd 9,76% sd ngudi cd hdng d u ludi dudi 10.000/mm3)

- Sinh hoa: thiy sir rdi loan hoat do enzyme SGOT va SGPT, giam ham lugng albumin trdn dien di protein huylt thanh, tang y globulin, ed bidu hien thuong va giam chirc nang td bao gan

- Di tmydn va tai bidn sinh san: Didu tra 848 cap vg chdng thiy tin sd sly thai la 12,20 ± 1,44% Dilu tra 3000 tre de sdng tmdc va sau khi bi rai chit ddc thiy tmdc khi rai sd tre di tat 0,14 ± 0,08%, sau khi rai: 1,78 ± 0,35%

Nam 1998, tai hdi thao qudc gia vl tac hai ciia CDHH/Dioxin, Tmng tam

Nhiet ddi Viet Nga da edng bd mdt sd kit qua nghidn cim trdn cac cuu chiln

binh va dua ra nhiing giai phap lam han chd tdc hai cho ngudi chiu hau qua ciia

CDHHADioxin

Nhung nam 1996 - 1999, Nguydn Van Nguyen, Ld Bach Quang va CS

(Hgc vidn Quan y) da tiln hanh phin y-sinh hgc cua du an Zl vdi 8 dl tai nhanh

vd tac hai ciia Dioxin, gdm: nghidn cim dich td hgc va lam sang, nghidn ciiu su

bidn ddi he thdng mien dich, he thdng di tmyIn, he thdng sinh hoa men, he

F F F \

thdng mau va danh gia cac chi sd thdng minh va tdc do phan xa than kinh,

nghien curu tac dung ciia mdt sd thudc phuc hdi siic khoe va tang thai ddc

Kdt qua nghidn ciiu cho thiy:

Ty Id ngudi bi suy nhugc than kinh cao

- Bdnh tim mach: 17,99% (so vdi nhdm chimg 4,94%)

Bdnh da lidu: 5,78% (so vdi nhom chimg 0,52%)

- Benh thin kinh: 12,63% (nhom chimg 2,53%)

- Tan xuat vi nhan tang cao, bidu hien sir rdi loan vd sd lugng va cau

tnic nhilm sic thd Phan tich bing ky thuat PCR thay 20,4% sd mlu khdng cd

phan ling, didu dd ndi ldn cd su thay ddi cau tnic gen P53 va gen Alu (nhiing gen

nay cd lidn quan ddn ca chd kidm soat ung thu qua cac san pham protein ciia nd)

cau, tang ty Id bach cau, trong dd tang td bao lympho, giam tidu cau Ty Id

nhidm HbsAg d miic tmng binh cao (20,7%)

- Cac chi sd thdng minh va tdc do phan xa d tre em: Ty Id cac ddi

mgng tir 6-12 tudi d nhdm nghidn cim cd thdi gian phan xa cam giac thip hon

nhidu so vdi nhdm chimg Ty Id cac ddi tugng tir 6-16 tudi d nhdm nghidn ciiu

cd thdi gian phan xa cam giac van ddng cham chilm ty Id cao (24,7%) so vdi

nhdm chirng (15,66%)

- Nghidn cim tham dd mdt sd thudc cd tac dung phuc hdi siic khoe va

loai thai chit dgc khdi ca thi: Sir dung 3 loai thudc: Quercetin (chilt tir hoa

hoe), Flavonoit (chilt xuit tir vd dau xanh) va Damin (chilt xuit tir men bia)

Cac loai thudc nay la san phim ciia cac dl tai nghidn cun d p Nha nude, d p Bd

da dugc nghiem thu Cac thudc nay co tac dung giai dgc thdng qua ca chl chdng

cac gdc tu do

Dac biet da lay mau, tidn hanh phan tich ham lugng Dioxin tren 12 mlu

md md, kdt qua thu dugc cd 11 mau duong tinh vdi ham lugng Dioxin tir 10

ppt- 200ppt Day la bang chiing khach quan khoa hgc cd y nghTa giiip cho nhiing

hudng nghidn ciiu mdi

F y t F

Kdt qua didu tra di tat bam sinh trdn 10 phudng, xa cua thanh phd Bidn

Hoa cho thay:

- Ty le mic di tat bim sinh: 0,913 ± 0,018/1000 dan

- Ty Id mic di tat bim sinh: 2,19 ± 0,83/1000 tre de sdng

- Bai nao la di tat bim sinh cd ty Id cao nhat chidm 23,2%

Nam 1997-1999 Hgc vidn Quan y tilp tuc dugc giao nhidm vu nghidn ciiu

nhung tac ddng hau qua lau dai ciia chat da cam ddn siic khoe con ngudi d khu

fSi F F

vuc quanh san bay Da Nang Kdt qua nghien ciiu cho thay:

- Ty Id mic di tat bim sinh: 2,18 + 0,32/1000 dan

- Ty Id mic dj tat bim sinh: 5,38 ± 0,79/1000 tre de song

r F

- Ty Id bai nao chidm cao nhat: 34,2%

- Ham lugng men Carboxyl- Esteraza d miic do cao va cd sir gidng nhau

F t

giiia bd - con, me - con ngudi bi di tat bam sinh

- Cd sir thay ddi clu tnic gen P53 va tang ty Id ngudi cd ham lugng

proteui P53 thip va rat thap d nhdm nghidn ciiu

- Nhdm nghien cim cd ty Id mang diu In ung thu CEA va AFP cao hon

nhdm chiing

- Hgc sinh thugc nhdm nghidn ciiu cd tri nhd, phan xa thinh giac - ngdn

ngii va thi giac - van ddng kem han hgc sinh nhdm ddi chiing, giam thilu tri tue,

tri nhd, sir chii y ciia nhdm nghidn ciiu

- Dinh lugng Dioxin trong 11 mlu md ngudi thiy 3 mlu cd ham lugng

Dioxin trdn 10 ppt

Nam 1999-2000 Nguydn Van Nguydn, Ld Bach Quang va CS (Hgc vidn

Quan y) nghien ciiu anh hudng cua chit ddc da cam din sire khoe con ngudi d

san bay Phii Cat - Binh Dinh cho thay:

> t

- Ve di tat bam sinh: Nhom ngudi sinh ra sau nam 1975 tai nhiing viing

sat san bay Phu Cat cd ty Id di tat bim sinh la: 5,22 ± 0,31 tinh trdn 1000 tmdng

hgp de sdng, ty Id nay cao so vdi cac viing khdng bj rai chit ddc da cam Trong

dd cao nhit la cac dj tat vl thin kinh tmng uong chidm 30% trong tong sd 24 ddi

tugng di tat bim smb

- v l biln ddi gene P53: Nhdm doi tugng nghidn cim d Phii Cat cd bidu

hien thay ddi clu tnic gen P53 d 29,27% ddi mgng Ham lugng Protein P53

bmh thudng va bidn di trong huydt thanh ciia nhdm chiing va nhdm nghidn ciiu

ddu (+) khdng cd sir khac biet

- Ve bidn ddi sinh hoa va dau an khdi u: Nhdm ddi tugng nghidn cim cd

^ F t f f f

SU bidn ddi tang boat do he men Carboxyl - esteraza Ty Id cd cac dau an khdi u

(+) cao rd ret (22,40% cd AFP (+) va 25,41% cd CEA (+))

y F F

- Vd chi SO thdng minh: cac chi sd tri md ciia nhdm tre em hgc sinh liia

tudi 7-12 d khu vuc Phu Cat (tmdngCat Tan) thap hon so vdi trudng Ngii Hiep

(ddi chimg xa) va thap ban ca tmdng Nguydn Du - Da Ning (ddi chiing gin)

Didu tra siic khoe trdn ddi tugng cuu chidn binh thiy: Ty Id di tat bim

sinh, tai bien sinh san, ty Id bdnh lien quan d cuu chidn binh cd tiln sii tidp xiic

sdng d Phil Cat (nai la viing ndng chat ddc da cam) ty Id nay cao ban han

2 Muc do 6 nhiem va anh hudng CDHH/Dioxin den moi trudng d cac vung

Phuong tidn chu yeu dugc sii dung dd rai chat diet cd la may bay C-123 va cac

phuang tidn rai mat dit khac nhu xe ca gidi, binh phun va tau sdng May bay

t F

true thang ciing dugc sii dung dQ rai chat diet cd tai nhiing khu vuc xac dinh

nghidn ciiu gin day eua Stellman va cdng sir xem xet lai tai lieu rai chit diet cd trong chidn tranh chiing minh trdn 80 trieu lit chit diet cd da dugc quan ddi My sir dung d Viet Nam

Trong chiln dich Ranch Hand, cac phi vu tap tmng vao cac khu rimg nui cao tdi ven bidn Nhilu khu rimg da bi triet pha hoan toan Din nay rimg vin chua dugc phuc hdi, chua cd diu hieu cay rirng mgc trd lai He sinh thai rimg

Im nhiet ddi tmdc kia rit khd c6 dilu kien phuc hdi mgt each tu nhidn Chit ddc hda hda thdng qua vide buy diet toan bg tham thuc vat da lam cho chd dg dit dai thay ddi nhanh chdng, dit bd mat bi xdi mdn nia trdi, phai ning, mua, d u tnic

t 7

thd nhudng bi thay ddi theo hudng ngay mdt ngheo kiet

Sau khi bi rai chat diet cd, cay rimg bi rung la va chit Cac ddng vat an la

bi mat ngudn thirc an va nai In nip phai di chuyin di nai khac Cho din nay sau hon 30 nam sau khi rai chit diet cd, tai nhiing khu rimg rai nhilu lln nhu A Ludi, Sa Thay, Ma Da khu thuc vat, ddng vat phuc hdi bdt siic cham chap chuyin hudng theo mdt he sinh thai ngheo nan

Nhidu can cii quan sir d Viet Nam nhu Da Nang, Bidn Hda, Phii Cat cd cac kho chiia va phuang tidn sir dung cho vide rai chat da cam Tai nhiing kho chiia nay, cac vu rd ri chit diet cd da xay ra VI du nam 1970, 700 gallon chit da cam da rd ri tai can cii Bidn Hda Ngoai ra cdn cd 3 vu rd ri khac vdi lugng nhd hon ciing dugc xay ra vao thdi didm nay

/ F

Kdt qua nghien ciiu cho thay tai cac khu vuc lan can can cii quan su cii

cua My cho thay d nhidm TCDD di chuydn tir mau dat vao chudi thiic an va vao

CO thd con ngudi Dat la thanh phan phai nhidm va trd thanh ngudn d nhidm dioxin, do vay vide xac dinh didm ndng dua trdn ham lugng dioxin trong dat la hgp ly Thuc te khao sat cho thiy tai A So cd ham lugng cao TCDD trong cac

rs, t

mau thuc pham, trong mau va siia ngudi

Shecter va cdng su nam 2001 bao cao ham lugng rit cao TCDD trong 3 mlu dit tai Bidn Hda (1.2 trieu pg/g, 604000 PG/G va 10600 pg/g) Mlu bim trong hd Bidn Himg va sdng Ddng Nai gan khu vuc Bidn Hda ed gidi ban tir 0,8 pg/g din 177 pg/g

Nghien ciiu cua Uy ban 10-80 phdi hgp ciing vdi Hatfield thuc hien tu nam 2002-2005 cho thiy mirc do TCDD va TEQ phat hien dugc tai san bay Da Ning, Bien Hda va phii Cat vugt trdn miic cho phep ciia hiu hit cac tidu chuin

hoac khdi BIC My, chuang trinh giai quylt d nhidm cung nhu khao sat sau hon

phai dugc thuc hien

- Tai san bay Da Ning: gia tri tuyet ddi ciia ham lugng octa-dioxin cd gidi

ban tir 59,9pg/g din 42.100 pg/g Dung thir 2 la hepta-dioxin Ham lugng

Dioxin cao nhit dugc phat hien thiy d dia dilm 18 Ham lugng TCDD cua mlu

dit tai vi tri nay la 227 pg/g va duong lugng TEQ la 269 pg/g Vi tri 18 nim d

khu vuc thap xudi ddng chay va dugc sii dyng dl lam nai trong cay thudc nam

Dia didm 22 cd ham lugng TCDD trong mlu can bun la 130 pg/g va duong

lugng TEQ la 191 pg/g Dia dilm tai Da Ning cd nghi ngd lien quan ddn chiln

dich Ranch Hand nam d cudi bac cua can cii quan sir Nhdm nghidn ciiu cho

> 7 F

rang ham lugng TCDD cao phat hien tai dja didm 18 la hau qua cua sir tham tu

khu vuc Ranch Hand va ham lugng cao TCDD tai dia diem 22 c6 lidn quan ddn

viec rai dudi mat dat bang phuang tidn ca gidi Can bim bi d nhidm tai dia diem

22 dugc di chuyd tir khu vuc cudi phia bac ciia can cir quan sir

- Tai san bay Phii Cat: dia didm 8, 48, 50 cd duong lugng dioxin cao trong

mlu dat: 201 169 va 45,2 pg/g TCDD chilm ty Id cao trong tdng TEQ tai dia

t F ISI

didm 8, 48 va 50 Ham lugng TCDD cao nhat dugc phat hien trong mau bun tai

t t

dia didm 8 vdi ham lugng 194 pg/g, didm 48 la 164 pg/g

Ciin nhu Da Ning, miic do dioxin trong mlu dat tai Phii Cat vugt miic

eho phep quy dinh bdi nhidu nude

- Tai san bay Bidn Hda: xac dinh cso 2 viing ndng la vimg A (phia nam

can cii quan sir va hd Bidn Hung ciing vdi khu vuc lan can), viing B (gin vdi

cudi phia tay ciia dudng bang san bay)

Ham lugng dioxin cao nhit dugc phat hien trong mlu dat d dilm 89 vdi

TCDD la 392 pg/g va TEQ la 425 pg/g Ham lugng dioxui cao nhit dugc phat

bidn trong mlu bun d dilm 78 vdi TCDD la 797 pg/g va TEQ la 833 pg/g Hai

dilm nay nim each xa nhau va gin vdi can cii Bidn Hda, dilu nay cho thiy su d

nhidm cd thd lan rdng ra nhilu khu vuc khac nhau Mdt sd dia diem gan khu vuc

phia nam va hd Bien Himg ddu cd ham lugng cao dioxin trong mlu

3 Mot s6 chu truang va chinh sach cua Nha nude:

3.1 Tdng quan vi doi tuang chiu hau CBHH/Bioxin & Viet nam

F F F

Trong cudc chidn tranh xam luge nude ta do dd qudc My phat ddng

(1960-1975), Quan ddi My da tnit xudng dit nude ta 7,8 trieu tin bom, 7,5 trieu

tin dan va 75 trieu lit chit ddc hoa hgc trong dd chu ylu la chit ddc

CDHH/Dioxin, binh quan mdi ngudi dan Viet Nam luc biy gid phai ganh chiu

tren 250 kg bom, dan va khoang 1,2 lit chit ddc boa hgc CDHH/Dioxin Sd

lugng bom, dan trdn gip ban 2 lln bon dan sir dung trong chien tranh thi gidi

lan thir hai va bang siic nd ciia 700 qua bom nguydn tir ma My sii dung tha

xudng Hirosima Nhat Ban' So lugng bom, dan va chit ddc hoa hgc do My sir

dung trong chiln tranh d Viet nam da gay hau qua nang nl cho nhan dan Viet

nam, trong dd cd hang trieu ngudi tan tat va hang trieu ngudi bi hau qua chat

ddc boa hgc CDHH/Dioxin mac bdnh hilm ngheo (Fl) trong dd da cd hang

nghin ngudi da chdt va hang tram nghin ngudi sinh con di dang, di tat (F2),

tham chi khdng chi ddi con hg ma ddi chau hg (F3) ciing van bi di dang, di tat

Theo nghidn ciiu ciia cac chuydn gia Han Qudc thi cir 100 ngudi linh Han

F r

Qudc tham gia cudc chidn tranh tai Viet Nam thi cd tdi 10 ngudi (10%) bi hau

qua chat ddc hoa hgc CDHH/Dioxin do My sii dung trong chidn tranh d Viet

nam

F

Cdn theo cac chuydn gia ciia My thi ty Id linh My tham gia chidn tranh d

Viet Nam bi hau qua chit ddc hoa hgc CDHH/Dioxin tai Viet Nam khoang 7%^

F F

Ndu tir sd lieu nay ma suy luan thi ciing khdng dudi 10% ngudi dan Viet

Nam sdng trong vimg My dai chat ddc hoa hgc CDHH/Dioxin giai doan

1966-F 1966-F ^ ^ /

1975 bi hau qua chat ddc chdt ngudi nay Tir day, cd ca quan da dua ra sd lieu

trdn 2 trieu ngudi Viet nam bi hau qua chat ddc hoa hgc CDHH/Dioxin; didu

Tinh den nay, mac du chien tranh da qua di mdt phan 3 the ky nhung di

chiing ciia CDHH/Dioxin vin dl lai cho ngudi dan Viet Nam nhiing hau qua

nang nd ca vl vat chit va tinh thin, hang tram nghin tre em sinh ra bi di tat, di

dang hoac khdng cd kha nang lao ddng khi tmdng thanh; hang chuc nghin gia

dmh 3-4 lln sinh con ddu bi di tat, di dang, noi dau vd tinh than khdng bidt din

bao gd mdi ngudi ngoai

F

Cudc khao sat nan nhan bi hau qua chat ddc hoa hgc CDHH/Dioxin do

My sd dung trong chidn tranh d Viet nam (Ngudi tham gia lire lugng vii trang;

' Nguon: Uy ban dieu tra tgi ac chien tranh, BQ Lao dpng Thuong binh v^ xa hgi

Can bd dan chinh dang; Thanh nidn xung phong; Dan cdng hoa tuyln; Dan

thudng; Ddi tugng khac) va con de cua hg nam trong hai nam 1998-1999 bing

phuang phap thuc chimg (phuang phdp thue chimg & day duac xdc dfnh dua

vdo 2 yeu to , mot Id nhitng ngu&i da timg sinh sdng, hogt dong & viing bi ddi

F

chdt doe hod hoc CDHH/Dioxin, hai Id bdn thdn ho vd eon edi cua ho bi di

dgng, di tdt, bi mdc mot so edn benh hiem ngheo dd duae xae dinh Id do chdt

doc hod hoe gdy len) cua Bd Lao ddng Thuang binh va Xa hdi cho thiy cd tdi

93% xa/ phudng ciia 61 tinh/ thanh phd trong ca nude cd ngudi bi hau qua chit

ddc boa hgc CDHH/Dioxin, chi cd 7% xa/phudng (747xa/phudng), 4 huyen dao

Hoang Sa, Tmdng Sa, Ly Sdm va Cdn dao thugc 35 tinh thanh phd chua cd

ngudi bi hau qua chit ddc hoa hgc CDHH/Dioxin

Cudc didu tra ciing cho thay khoang 1,2% hd gia dinh trong ca nude cd

ngudi bi hau qua chat ddc hoa hgc va sd lugng ngudi bi hau qua chit ddc cdn

' F F t y t

sdng chidm khoang 0,5% dan sd tai thdi didm didu, sau nay ra soat bd sung thdm

' / • F F

nang tdng sd ngudi ldn khoang 0,625% dan sd; Trong sd nhiing ngudi bi hau

qua chat ddc hoa hgc thi nhiing ngudi true tidp bi hau qua (Fl), tiic la nhirng

F f f

ngudi sinh sdng, boat ddng d viing bi dai chat dgc hoa hgc CDHH/Dioxin chidm

ty Id 50,06% va nhung ngudi gian tidp bi hau qua chit ddc hoa hgc, tiic la con

hg (F2) va ddi chau (chau ndi) ciia hg (F3) chilm ty Id 49,94%

F y F F

Mdt trong nhiing van dd xa hdi biic xiic nhat ddi vdi nhdm ngudi bi hau

qua chat ddc boa hgc CDHH/Dioxin la nhiing gia dinh cd tir 2 ngudi trd len; kit

qua khao sat cho thay cd 5.415 hd gia dinh cd tu 5 ngudi trd ldn bi hau qua chit

ddc boa hgc Dioxin; 9.064 hd gia dinh cd 4 ngudi; 27.440 hd gia dinh cd 3

ngudi va 116.208 hd gia dinh cd 2 ngudi, trong dd 34.908 hd gia dinh ca hai vg

chdng bi hau qua chat ddc hoa hgc Cudc sdng ciia nhiing hd gia dinh nay

khdng chi khd khan vd vat chat ma khd khan nhieu ban, biic xiic nhidu hon la

vd mat tmh than, nhidu gia dmh phai hang gid, hang ngay ddi mat vdi nhiing

t ^

diia con di dangm di tat, thidu nang tri tue, nhidu gia dmh khdng cdn hy vgng cd

ngudi con ndi nghiep khoe manh binh thudng; nhiing udc ma gian di, binh

thudng vd nhiing dira con binh thudng, mdc mac ciing khdng trd thanh hien thuc

ddi vdi hg, dilu ma le ra hg cd nhu bao ngudi bmh thudng khac vi trdi phii cho

con ngudi

F F

Cuoc khdo sdt ndy ciing gap mgt so hgn che/tr& nggi, vi sic dung phuang

rdt l&n, so ngu&i phdt hien sau ndy hodc sd ngu&i dd bi nhiem chdt dgc hod hgc

CDHH/Dioxin nhung chua cd dieu kien kiem tra gidm dinh sire khoe, chua

khdng dinh duae eting rdt l&n; nhung vi nhu clu d p bach phai cd chinh sach trg

giup cho hg, cugc khao sat vin phai tiln hanh, mat khac nlu sir dung phuang

phap y hgc dl kilm tra sire khoe, bdnh tat vao thdi dilm luc dd thi qua tdn kem

kmh phi va ngudn lire, chua cd dilu kien lam ngay thdi dilm dd So tiln chi phi

cho giam dinh, kidm tra siic khoe du tinh vao thdi dilm dd ldn hon nhidu lan sd

tidn trg cap hang thang cho hg trong vdng 5 nam, chinh vi vay phuang phap

thuc chiing liic dd dugc coi la sir lira chgn tdi uu

Bang 1.1: Ngudi bi hau qua chat ddc boa hgc phan theo doi tugng {Vof

vu trang

38,44 44,95 41,69

Canbd dan chinh dang 3,41 2,99 3,20

Thanh nidn xung phong 1,77 2,06 1,92

Dan cdng hoa tuydn 1,95 2,40 2,17

Dan thudng

50,17 44,33 47,25

Ddi tugng khac

4,26 3,28 3,77 Kdt qua khao sat cho thay cd tdi mdt nira sd ngudi bi hau qua chat ddc

boa hgc CDHH/Dioxin la ngudi tham gia boat ddng each mang va mdt mia la

Trong sd nhiing ngudi true tidp bi hau qua chat ddc hoa hgc thi sd ngudi

la dan thudng chilm ty Id cao nhit (50,17%), sd ngudi tham gia Luc lugng vii

trang chidm ty Id 38,44%, can bg dan chinh dang, thanh nidn xung phong, dan

cdng boa myln va ddi tugng khac chilm ty Id khdng dang kd (tir 1,77 - 4,26%)

F F F

Trong sd nhiing ngudi giam tidp bi hau qua chat ddc hoa hgc thi con ciia

nhiing ngudi tham gia Luc lugng vii trang chilm ty Id cao nhit (44,95%), tidp

ddn la con dan thudng (44,33%), cac ddi tugng gian tidp cdn lai chilm ty Id rit

thip tir 2,06-3,28%

Bang 1.2: Ngudi bi hau qua chit ddc boa hgc chia theo viing (%)''

Ddng bing sdng Ciiu Long

Chung toan qudc

? 7

Ca true tidp va gian tidp

14,95 7,59 0,95 18,77 17,20 5,93 10,10 24,51

100

J

True tidp 13,86 6,52 0,81 16,98 19,08 5,78 9,77 27,17

100 Kdt qua cudc khao sat ciing cho thay Vimg Ddng bang sdng Ciiu long co

sd lugng ngudi bi hau qua chat ddc hoa hgc chilm ty Id cao nhit xip xi mdt phan tu tdng sd ngudi bi hau qua chat ddc hoa hgc CDHH/Dioxin ciia ca nude (24,51%); neu chi tinh ridng nhiing ngudi true tidp chiu hau qua chat ddc boa hgc thi ty Id nay cdn ldn hon (27,17%), tilp din la vimg bic tmng Bd (18,77%), thii ba la viing Duyen hai Nam tmng Bd (17,20), ddng bang sdng Hdng dung thir m (14,95%), Ddng Nam Bd (10,10%); cac vimg cdn lai diu dudi 10%, Viing Tay BIC la thip nhit (0,95%)

3.2 Mdt so chinh sdch dd cd cda Nhd nir&c vd Qudn ddi nhdm bdo ve sire khde qudn nhdn dang song viing ndng

3.2.1 Mgt sd ehe do bdo ddm sice khde eho qudn nhdn:

Cdng tac bao vd, cham sdc va nang cao siic khde cho quan nhan trong nhiing nam qua da dugc cac d p , cac don vi trien khai boat ddng ngay cang thanh nl nip, cd bidu qua va da dat dugc mgt sd kit qua quan trgng Chl do kham siic khde theo dinh ky cho quan nhan hang nam da dugc td chiic cd kd hoach va chit lugng ciing ngay cang tdt hon Vide dilu tri du phdng ed nhidu tiln bd ndn ciing ban ehl dugc sir phat triln va lay lan ciia bdnh tat Quan nhan

bi dm dau dugc cham sdc, didu tri ngay cang tdt Cac tmng tam didu tri ciing

/ • F timg budc dugc nang cap trang thiet bi, may mdc ky thuat cao ndn kha nang ehuln doan bdnh tat va dilu tri ciing cd hieu qua tdt Tuy nhidn, do mdi trudng sdng va chit lugng cudc sdng ciia quan nhan rat phirc tap va khdng ddng nhit giii cac vimg miln, nhit la d nhung nai cd ylu td ddc hai ldn nhung y thiic tu

phdng bdnh ca nhan ciia mdt sd quan nhan chua tdt la nhung nguydn nhan lam

anh hudng xiu ddn siic khde, ddng thdi tac ddng din ca clu bdnh tat

Thuc tl kilm tra d mdt sd don vi ca sd trgng dilm cho thiy: Cdng tac

quan ly siic khde cua quan nhan d mdt sd don vi lam chua that tdt, ty Id kham

sire khde dinh ky ed don vi cdn thuc hien chua nghiem tuc Mgt sd don vi chua

tieh cue triln khai vide tuydn tmyIn tac dung cua vide kham sire khde dinh ky

Chit lugng kham sire khde dinh ky con nhilu ban chl Tham chi mgt sd quan

nhan chua quan tam diing miic tdi y nghTa ciia vide kham chiia b^nh, cd ngudi

cdn coi thudng bdnh tat, cdn diu bdnh va khdng chip hanh nghidm chl do dilu

tri ndn da cd nhiing hau qua dang tile Bdn canh do, vide thuc hien chl do

F f

phan cap quan ly siic khde ciia quan nhan cd nai lam cdn chidu Id Co quan quan

y va can bd quan y chua thuc sir lam tdt chiic nang lam tham muu, td chu:c thuc

hien trong mdt sd boat dgng quan ly siic khde Vide thdng kd, theo ddi, bao cao

tuih hmh siic khde ciia quan nhan trong don vi minh theo phan cap cd don vi

lam chua kip thdi, cd don vi bao cao chua that nghidm tiic hoac bao cao khdng

day dii Dac bidt, chiing ta chua xay dimg hoan chinh dugc chd do kham sire

khoe dinh ky cho quan nhan ddng quan tai cac vung d nhidm chat dgc hda

hgc/dioxin Day la nhiing ban chd rat can dugc cac cap, cac ban nganh va cac

ca quan chiic nang nit kinh nghidm ciing nhu can cd giai phap khac phuc dQ

phdng va chiia bdnh cho quan nhan kip thdi trong thdi gian tdi nham bao dam

siic khde cho quan nhan ddng quan tai cac vimg d nhiem chat ddc hda hgc/

dioxin

Nhu vay, trong nhieu nam qua Dang, Nha nude va Quan ddi ta da nhan

thiie ngay cang ro hon tac hai ciia CDHH/dioxin ma quan dgi My da gay ra ddi

vdi mdi trudng va con ngudi ndi chung, ddi vdi quan nhan ddng quan tai cac

vimg d nhidm CDHH/dioxin ndi ridng Trdn ea sd dd, Dang, Nha nude va Quan

ddi ta ciing da cd mdt sd chii tmong, giai phap dd timg budc giiip dd cac ddi

F F F y

mgng bi hau qua chat ddc hda hgc cai thien nang cao ddi sdng kinh te, tmh than,

giam bdt khd khan va cd didu kien dd vuon len hda nhap cdng ddng Song,

nhiing chinh sach, chii tmang dd mdi chu ylu nham trg cap khd khan eho nhiing

ngudi da bi phai nhidm va bi bdnh do hau qua eiia chit ddc hda hgc Vin dd

ban chl tac hai va bao dam cho quan nhan ddng quan tai cac vimg bi d nhidm

f \ F t

chat ddc hda hgc/ dioxin cdn nhidu bat cap, chua cu thd, dac bidt la chua xay

dung duge chd do kham sire khde mang tinh dac thii ddi vdi nhung quan nhan

ddng quan tai cac viing bi d nhidm chit ddc hda hgc/dioxin

3.3.2 Mgt sd che do ludn chuyen cdn bg cho qudn nhdn:

*Tu tu&ng ehi dgo chung:

Chinh sach luan chuyin quan nhan ddng quan d viing bi nhidm

CDHH/dioxin phai dugc ap dung cho tit ca cac quan nhan, khdng phan bidt sy

quan, sy quan chuydn nghiep, cdng nhan vidn qudc phdng, binh sy hay cho mdt

gidi tinh cu thi nao Ddi tugng d n dugc uu tidn luan chuyin tmdc la nhiing

quan nhan da bi phai nhidm, bj phai nhiem lai; nhirng quan nhan chua bi phai

nhidm nhung thudng xuydn true tilp tilp xiic, nghiep vu chuydn mdn ludn gin

y r nt

lidn, vdi nhiing ydii td cd nguy ca phoi nhidm

Chinh sach luan chuyen quan nhan dong quan d cac vimg bi nhidm

CDHH/dioxin la thd bidn sir ddng bd, toan dien va tinh nhan dao ciia chd do xa

hdi chil nghTa trong nhiing didu kien thuc tidn cd thi ciia Dang, Nha nude va

nhan dan ta La ca sd, tao ra nidm tin, tinh cam va trach nhiem ciia toan Dang,

toan dan, toan quan ddi vdi "nhdm quan nhan dac thii" nay, trong thdi gian tai

ngu

t nt

Luan chuydn quan nhan ddng quan d cac viing bi nhiem CDHH/dioxin

phai cd chii tmong, cd bidn phap chi dao, lanh dao, cd tidu chi va cd nhiing didu

t IS, t

kien cu thd, nhung van bao dam sir chuan muc, bao dam tinh khoa hgc, kip thdi

ciia chinh sach (chd do) khi dugc xac dinh, ddi vdi tat ca mgi quan nhan Bao

dam sir dn dinh trong cac don vi, bao dam mgi boat ddng huan luyen, sin sang

chidn dau cao va edng tac hieu qua Khi td chiic luan chuydn quan nhan, mgi

boat ddng vin didn ra binh thudng d mdt quan nhan, mgt don vi cu thd Qua

* Tdc dung eiia che do ludn chuyen phii hap ddi v&i qudn nhdn ddng

qudn tgi cdc viing d nhiem chdt dgc hod hgc/Dioxin

Thuc trang hien nay vin cd mdt bd phan nhan dan dang sinh sdng, lam an,

cdng tac trdn nhiing viing dit bi nhidm ddc, trong dd cd nhiing don vi quan ddi

ddng quan lau dai tren vimg dit nhidm ddc dd Mat khac, do ydu clu vl ITnh vuc

qudc phdng - an ninh, muc tidu can phai bao vd, van can thidt cd sir dung chan

ciia nhimg don vi quan ddi trdn nhiing dia ban trgng dilm chiln luge dang bi

nhidm CDHH/dioxin

Nhiing quan nhan dang ddng quan trdn nhirng vimg dit bi nhiem ddc d n

cd siic khoe dl dl khang tmdc nhimg tac ddng ciia mdi tmdng, dd la mdt ddi hdi

khach quan va trong mdt chimg muc nao dd cdn thi hien tinh nhan van (nhan

dao) cao ca, trong vide thuc hien cdng bing xa hdi ciia chl do xa hdi chii nghTa

Trong ITnh vuc boat ddng quan sir, nudi quan, luyen quan va diing quan la ba

' ^ '^ F F y

van dd ca ban ma mgi ngudi chi huy deu phai quan tam va giai quydt Ba van de

ndu trdn ed quan he chat che vdi nhau, tac ddng lln nhau din vide hoan thanh

nhidm vu cdng tac, huin luy^n, sin sang chiln diu va chiln diu cua cac don vi

Ngoai vide xay dung chd do dai ngd quan nhan dang ddng quan tai cac

vimg bi nhiem CDHH/dioxin chimg ta cung d n nghidn cim dl dl xuit chl do

luan chuydn cho nhung quan nhan dang ddng quan tai nhimg vimg bi nhiem chit

ddc boa hgc /Dioxm dd

* Mgt sd chinh sdch ludn chuyen cdn bg hien nay:

» •» t F

- Luan chuydn do bd nhidm chirc vu mdi, chuyen ddn cdng tac d don vi

mdi, dia ban ddng quan mdi

Day la sir luan chuydn thudng xuydn ddi vdi bat ky can bd nao trong qua

trinh cdng tac tai ngii Sir luan chuydn nay tuy thudc vao qui hoach dao tao, quan

t F F

ly va sii dung can bd Bd nhidm chirc vu mdi ddi vdi can bd cac cap, cac nganh

cd chiic vu cao hon va luan chuyen nhung can bd dugc bd nhidm ddn nhiing don

vi, dia ban cdng tac mdi dugc xac dinh la mdt chinh sach chung vd su dung can

bd hien nay, khdng chi ed can bg trong quan ddi ma cdn ca nhiing can bd edng

F

chiic cac cap, cac nganh ngoai quan ddi

Luan chuyen do bd nhidm, chuyen can bg ddn cdng tac d don vi mdi, dia

ban mdi nham tao ra mdt mdi tmdng mdi dd can bd cd didu kien tich luy nhung

tiep tuc ren luyen, thir thach tren cac ITnh vuc khac ddi vdi can bd Tir boat ddng

thuc tien d cuong vi mdi, vide danh gia dire, tai, sire khoe ciia can bd ciing dugc

ehuln muc hon, day la dilu kien dl qui hoach, sii dung trong hien tai va mong

lai

9 A F

- Luan chuyen do didu ddng cdng tac ddn vi tri mdi:

Luan chuydn do dilu ddng, thuydn chuyin can bd din cdng tac d don vi

mdi, dia ban mdi do ydu d u nhidm vu Vide dilu ddng, luan chuyin can bd

thudc "nhdm" nay thudng do ca clu, td chirc, nganh ngbl, nghiep vu chuyen

mdn ddi hdi can phai cd su dilu chinh, dilu ddng hgp ly giiia cac don vi chii lire

ciing nhu don vi dia phuang, don vi thudng tryc sin sang chiln diu ciing nhu

don vi san xuat, nha may xi nghiep Ddi tugng can bg dilu dgng, dugc ap dung

ddi vdi tat ca cac can bd cd cap bac, chiic vu trong bidn chl ciia quan ddi

- Luan chuydn do di chuydn nai dong quan theo nhidm vu huan luy?n, tac

chien

Can bd thudc cac don vi ciia Bd, ciia cac quan khu, bao gdm: cac don vi

quan binh chiing, nganh trong "nhdm" don vi sin sang chiln diu; "nhdm"

chuydn mdn ky thuat; "nhdm" cac ca quan, cac hgc vidn, nha tmdng, va cac

tram, cac kho tang Nhiing dan vi nay cd thd dugc didu ddng, ca ddng ddng

quan trdn cac dia ban khac nhau, thdi gian ddng quan trdn cac dia ban ciing khac

nhau Su luan chuyen nay thudng do ydu cau ciia nhidm vu huan luyen, tac

chidn, san xuat do nhiing dac thu ridng ciia can bd nam trong nhiing don vi

thudng xuydn, hoac khdng thudng xuydn phai ca ddng, di chuydn tir vimg nay

sang vimg khac

- Luan chuydn do boat ddng d nhiing vimg cd ddc hai, nhidm ddc boa hgc/

t IS! F

Dioxin Day la sir luan chuydn do thuc tidn ddi hdi, ddi vdi can bd hoat ddng d

nhiing vimg cd ddc hai, nhidm ddc hoa hgc/Dioxin Su luan chuyen nay khdng

phu thudc vao bd nhidm ehiic vu mdi, didu ddng ddn don vi mdi, hoac do di

t y ^ ^ IS,

chuyen ea don vi theo yeu cau nhidm vu Tuy nhidn, hien nay cac khu d nhidm

CDHH/dioxin vin chua ap dung hinh thiic luan chuyen dac thii nay

3.3 Mpt sd chinh sdch tra cdp cho ngn nhdn bi hgu qud CBHH/Bioxin

3.3.1 Quyit dinh Sd 26 /2000/QD-TTg (3/2/2000) eiia Thu Tu&ng Chinh phii

Song song vdi vide phat triln he thdng chinh sach vd an sinh xa hdi bao

•\ •? 9 t F t F

gdm bao hiem tudi gia, bao hidm y te, bao hiem that nghiep va cac chinh sach

t '^

bao hiem khac (tai nan lao ddng va bdnh nghd nghiep, thai san) Dang va Nha

nude ta ciing rit quan tam ddn chinh sach uu dai xa hdi va trg giiip xa hdi trong

dd cd chinh sach ddi vdi ngudi bi hau qua CDHH/Dioxin do my sii dung trong

thdi gian chiln trang d Viet Nam Chinh nay dugc thd bidn d Quylt dinh Sd 26

/2000/QD-TTg ngay 23 thang 02 nam 2000 ciia Thu Tudng Chinh phii Vl mdt

chinh Dang, thanh nidn xung phong tham gia cdng tac, chiln diu, phuc vu chiln

diu tai cac vimg h\ My sir dung chit dgc hoa hgc trong chiln tranh Viet Nam tu

thang 8 nam 1961 din 30 thang 4 nam 1975, dang khdng hudng trg d p thuang bmh, bdnh binh, hoac ehinh sach nhu thuang binh va thudc miic do sau :

Nhdm 2: Con de cdn sdng ciia ddi tugng quy dinh tai nhdm 1 ndu trdn

thudc miic do sau :

a) Bi di dang, di tat nang, khdng cd kha nang lao ddng, khdng tu lire dugc trong sinh boat

b) Bi di dang, di tat, khdng cd kha nang lao ddng nhung cdn tu luc dugc trong smh boat

- Miic trg d p bing 100.000 ddng/ngudi/thang ddi vdi ddi tugng quy dinh

- Miic trg d p bing 84.000 ddng/ngudi/thang ddi vdi ddi tugng quy dinh tai nhdm 2 bi di dang, di tat nang, khdng cd kha nang lao ddng, khdng tu lire dugc trong sinh boat

- Mirc trg d p bing 48.000 ddng/ngudi/thang ddi vdi ddi mgng quy dinh tai nhdm 2 bi di dang, di tat, khdng cd kha nang lao ddng nhung cdn tu luc dugc trong sinh boat

Tmdng hgp cac ddi tugng neu trdn gia ylu, cd don khdng nai nuong tua,

md edi ea eha va me thi dugc xet tidp nhan nudi dudng tai cac ca sd xa hdi ciia nha nude Trg d p nudi dudng la 120 nghin ddng/ngudi/thang

Hang nam ed khoang 140 nghin ngudi dugc hudng chinh sach trg cap xa hdi theo quydt dinh 26/2000/QD-TTg

3.3.2 Nghi dinh 07/2000/ND-CP ngdy 9/3/2000 eua ehinh phu

Ddi tugng la ngudi tham gia khang chiln va con de ciia hg bi nhidm chat

Theo quy dinh ciia Nghi dinh 07/2000/ND-CP, nhiing ngudi tan tat nang (khdng phan bidt ngudn gdc gay nen tan tat), hoan canh gia dinh khd khan dugc hudng trg d p xa hdi hang thang vdi mirc phd biln la 45.000 ddng/ngudi/thang; tmdng hgp dugc nudi dudng trong cac ca sd bao trg xa hdi dugc hudng trg d p nudi duang la 120 nghin ddng mdt thang Chinh phii chiing cho ca chl dia phuong nao cd dilu kien kinh td kha hon cd thi nang mirc trg cap xa hdi cao ban mirc quy dinh ciia Chinh phii va trdn thuc tl cung cd hang chuc tinh dua

mirc trg d p len 65 nghin ddng (sdng d cdng ddng) va 200 nghm dong (d ca sd bao trg xa hdi)

F F t F

Cac ddi tugng nay ciing dugc cap the bao hidm y td hang nam vdi mdnh gia bing 3% tiln luong tdi thilu; tuy vay nhilu dia phuang vin ap dung mdnh gia nhu ngudi ngheo (70 nghin ddng/ngudi/nam)

Udc tinh cd khoang trdn 17 nghin ngudi bi hau qua chit ddc boa hgc la dan thudng (10% ngudi hudng trg d p xa hdi) dugc hudng trg d p xa hgi theo Nghi dinh 07/200/ND-CP

3.3.3 Quyit dinh sd 120 /2004/QD-TTg (5/7/2004) ciia Thii Tu&ng Chinh phit

Quylt dinh sd 120 /2004/QD-TTg ngay 05 thang 7 nam 2004 cua Thii Tudng Chinh phii Vl mdt sd chl do ddi vdi ngudi tham gia khang chiln va con

de ciia hg bi hau qua do nhidm chat dgc hda hgc do My sii dung trong chiln tranh Viet Nam

Sir ra ddi Quylt dinh 120/2004/QD-TTg thay thd quylt dinh sd Quylt dinh Sd 26 /2000/QD-TTg ngay 23 thang 02 nam 2000 ciia Thu Tudng Chinh phii la do kinh td tang tmdng, thu nhap mirc sdng ciia ngudi dan dugc nang cao,

Ciia Thii Tudng Chinh phu da thay ddi miic trg cap va bd sung chd do trg giiip

ve giao due, che do mai tang phi, cdn ddi tugng thu hudng chinh sach, khdng cd

gi thay ddi

Mice trg cap xd hgi duge dieu ehinh nhu sau:

Miic trg d p bing 300.000 ddng/ngudi/thang ddi vdi ddi tugng quy dinh tai nhdm 1 bi mic bdnh hilm ngheo do nhiem chat ddc hda hgc, khdng cdn kha nang lao ddng

- Miic trg d p bing 165.000 ddng/ngudi/thang ddi vdi ddi tugng quy dinh tai nhdm 1 bi mic bdnh do nhidm chat ddc hda hgc, bi suy giam kha nang lao ddng

- Miic trg d p bing 170.000 ddng/ngudi/thang ddi vdi doi mgng quy dinh tai nhdm 2 bi di dang, di tat nang, khdng cd kha nang lao ddng, khdng tu lire dugc trong sinh boat

- Miic trg d p bing 84.000 ddng/ngudi/thang ddi vdi ddi tugng quy dinh

tai nhdm 2 bi di dang, di tat, khdng cd kha nang lao ddng nhung cdn tu lire dugc

trong sinh boat

Tmdng hgp cac ddi mgng khdng cd dilu kien sdng d cdng ddng thi dugc

dua vao nudi duang trong cac ca sd bao trg xa hdi, mirc trg d p nudi dudng

hang thang thuc bidn theo Nghi djnh 168/2004/ND-CP ngay 20 thang 9 nam

2004 ciia Chinh phu (140 nghin ddng mdt ngudi mdt thang hoac 160 nghin

dong, 210 nghin ddng, tuy theo do tudi, benh tat) chua tinh phan trg giiip mua

F y

sam dd dung, tu trang ca nhan hang nam

- Che do trg giiip mua the bao hidm y tl vin dugc duy tri bing 3% tiln

luong tdi thidu va ca chd do trg giiip vd tin dung tir quy giai quydt vide lam, xoa

ddi giam ngheo theo quy dunh chung ciia Chinh phii

Vidn la con ciia ddi tugng nhdm l(tham gia khang chidn) bi mac bdnh hiem

ngheo do nhiem chat ddc hda hgc, khdng cdn kha nang lao ddng ( didm a, nhdm

1), dang hgc tai cac tmdng thudc he thdng giao due, dao tao ciia Nha nude ma

khdng hudng luong hoac sinh boat phi thi dugc hudng chd do uu dai ve giao due

va dao tao nhu quy dinh ddi vdi con cua bdnh binh mat siic lao ddng tir 61% ddn

80% nhu quy dinh tai Didu 64 ciia Nghi dinh sd 28/CP ngay 29 thang 4 nam

1995 eua Chinh phii (Dilu 64: Hgc sinh la con cua thuong binh, con ciia benh

F

binh va ngudi hudng chinh sach nhu thuong binh bi mat siic lao dgng tir 61%

din 80% nlu hgc tilu hgc va phd thdng tmng hgc dugc mien nop hgc phi)

Ddi tugng quy dinh tai nhdm 1 (tham gia khang chidn) bi mic bdnh hiem

ngheo do nhidm chit ddc hda hgc, khdng cdn kha nang lao ddng (dilm a, nhdm

1), dang hudng chl do trg d p hang thang, khdng thugc didn hudng ehl do mai

F ' '

tang phi khi chdt thi ngudi dam nhidm vide chdn cat dugc trg cap phi mai tang

ddi vdi bdnh binh mit siic lao ddng khi chit nhu quy dinh tai Didu 39 eua Nghi

dinh sd 28/CP ngay 29 thang 4 nam 1995 ciia Chinh phu

Dieu 39 Thuang binh, ngudi hudng chinh sach nhu thuong binh mit siic

lao dgng do thuong tat tir 61% trd ldn bi chit do dm dau, tai nan nlu khdng phai

la ngudi hudng chl do bao hilm xa hdi thi ngudi td chiire mai tang dugc d p tiln

Id tang, chdn d t miic 960.000 ddng)

Tuy nhidn ciing theo Quydt dinh nay thi vide xac dinh cac bdnh tat, miic

do di dang, di tat va kha nang lao ddng ddi vdi nhung ngudi thudc didn hudng trg cap (cua ca nhdm 1 va nhdm 2) lam can cir xac dinh mirc trg cap theo quy dinh eiia Quydt dinh nay cting chat che ban, phirc tap hon ( cd giam dinh ciia ca quan y tl cd thim quyin), khdng don giam nhu Quylt dinh 26 (binh xet cua thdn/ban, xac nhan ciia d p xa)

3.3.4 Quyit dinh 16/2004/QD-TTg (5/2/2004) eua thu tu&ng Chinh phii

Quylt dinh 16/2004/QD-TTg ngay 5 thang 2 nam 2004 ciia thu Urdng Chinh phii Vd vide trg giiip ddi vdi hg gia dinh cd tir 02 ngudi trd ldn khdng ty phuc vu dugc do bi hau qua chat ddc boa hgc ciia My sir dyng trong chiln tranh Viet Nam

F

- Ddi tugng trg giiip

Hd gia dinh cd tir 02 ngudi trd ldn khdng ty phyc vu dugc do bi hau qua

+ 400.000 (bdn tram ngan) ddng/hd/thang ap dyng ddi vdi hd gia dinh ed

4 ngudi trd len khdng ty phyc vy dugc

3.3.5 Nghi dinh 54/2006/ND-CP (26/5/2004) cua Chinh phu

Theo quy djnh tai Myc 8, Nghi dinh 54/2006/ND-CP ngay 26 thang 5 nam 2006 ciia Chinh phii vl vide hudng din thi hanh mgt sd dilu phap lenh uu dai ngudi cd cdng vdi each mang, trong dd chinh sach ddi ngudi tham gia khang chiln bi hau qua chit ddc boa hgc nhu sau:

- Ddi tugng duge xdc dinh ngu&i hogt dgng khdng chien bi nhiem chdt dpc hod hgc do My sic dung trong chiin tranh & Viet Nam bao gom: