YOUR INSIDER'S HEALTH CARE GUIDE
IN HO CHI MINH CITY 🇻🇳 SINCE 2008
SAIGON INSPIRATION HEALTH
SAIGON INSPIRATION HEALTH DR. WHO?: THE CULTURE OF SELF-MEDICATION IN VIETNAM
The tropical climate in Vietnam brings with it many common health ailments such as the cold, the flu and mosquito-borne diseases such as dengue fever and malaria. You may have fallen victim to one of these at some point in time—how did you deal with it?
Did you visit a doctor? Or did you get your medication from a nearby pharmacy?
Dr. Self-Service
In the research paper “The Determinants of self-medication: Evidence from urban Vietnam” by the University of Economics Ho Chi Minh City, researchers surveyed 183 people to determine common choices of treatment for certain ailments..
One-hundred sixty two respondents, 88.5 percent, self-medicate to treat a cold; 120, or 65.5 percent, to treat a cough; 115, or 62.8 percent, to treat a runny nose; and 104, or 56.8 percent, to treat throat symptoms such as sore throats.
These numbers signify a relatively high proportion of people who would prefer heading to a nearby pharmacy to get over-the-counter drugs, including antibiotics, without seeking a doctor’s prescription for a condition that they are not totally sure of. It could just be a common cold, or a flu caused by a new virus strain. However, too much of something is not always a good thing, especially when it comes to antibiotics.
The Antibiotic Paradox
According to the US Centers for Disease Control and Prevention (CDC), antibiotic effectiveness is viewed as a shared resource. “Using an antibiotic now increases the opportunity for bacteria to develop resistance and thus reduces our ability to use that antibiotic in the future.” And this is exactly what is happening in Vietnam today.
In a report by the World Health Organization (WHO), Vietnam was included in a list of countries with high antibiotic-resistant infections. “In recent years, Vietnam has witnessed a growing threat of antimicrobial resistance brought about by the excessive and irrational use of antibiotics at all levels of the healthcare system and the public as a whole,” the report read.
A More Logical Option
Based on the results of the above mentioned survey, 34.2 percent of respondents chose to self-medicate due to the easy access to legally available medicines, 29.4 percent felt hospitals were too far from their homes and 26.1 percent felt hospitals would cost more.
It’s not too difficult to buy drugs from drugstores and pharmacies in Vietnam without a doctor’s prescription. Although regulations are in place to prevent such acts, they are barely enforced and largely ignored.
Nguyen Van Kinh, director of the National Tropical Diseases Hospital, who likened the purchase of medicines—especially antibiotics—to “buying vegetables”, also said a majority of Vietnam’s pharmacists lack proper medical training and routinely disregard regulations that make prescriptions mandatory for antibiotics, as he told Thanh Nien News.
According to Nguyen Vu Trang, deputy director of the Central Tropical Diseases Hospital, the resistance rate to carbapenems, the strongest group of antibiotics, has risen to 50 percent, mostly from gram-negative bacteria, which have an impenetrable cell wall.
Resistance to third-generation cephalosporins, another powerful group of drugs, has surged to more than 60 percent in the country. But to figure out why the Vietnamese are resorting to antibiotics and self-medication, two questions need to be asked: why not see a doctor instead? And how did this culture start in the first place?
“Vietnamese use antibiotics like eating rice. They go to the pharmacy to pick up antibiotics anytime they feel sick,” he added. A typical course of action for someone feeling ill in Ho Chi Minh City would be heading down to the nearby pharmacy, explaining his/her symptoms to the staff and, depending on the ailment, get issued a course consisting of a cocktail of various drugs, including antibiotics, in a little resealable plastic bag. The total cost usually doesn’t amount to more than VND200,000 (US$9).
Most patients eventually recover from their ailment, leading them to believe that this is a safe and medically legitimate way to treat their case. It is also much cheaper than the total cost of transportation, consultation and medication accrued for a trip to the clinic or hospital and, not to mention, much faster too. According to the Ministry of Health, the waiting time to see a doctor at major public hospitals averages between four to seven hours.
Invisible Risks
It’s impossible to know what effects the medicines might have, another risk of self-medication. Although drugs in pharmacies and drugstores are mostly safe and many of the brands are imported, you may still run the risk of developing allergies to drugs you’ve never taken before, which might lead to further medical complications.
Although pharmacists know that certain types of drugs can’t be used together, they don’t have access to your medical history and unless they ask, or if you tell, they will not know your current or past medical history; this too, could lead to potentially disastrous consequences.
So What Can You Do?
Of course, you can’t choose to not get sick, but prevention is always better than cure. Here are some of the most common ailments in Vietnam and how you can prevent them.
Flu: Reduce your risk of getting a flu by practising good hygiene and getting an annual flu vaccination. If you do feel flu-like symptoms, it’s advisable to visit a doctor and get a prescription for antiviral medicines. Make sure you cover your mouth when you cough or sneeze to prevent the spread to others.
Dengue Fever/Malaria: The best way to prevent dengue fever and malaria is to avoid mosquitoes in the first place. Mosquitoes lay eggs in stagnant water. Ensure that your home is clean and dry, with all drains covered. If you live in an area that has plenty of mosquitoes, get a mosquito net customised to fit your windows.
Food Poisoning: Wash your hands and utensils before use, keep raw food away from ready-to-eat products and refrigerate or freeze perishable foods within two hours of purchase. Also, try to avoid eating at places with questionable hygiene standards. If there are more flies than customers, it’s probably not worth it.
Heat-Related Symptoms: Ensure you’re wearing loose and lightweight clothing and constantly rehydrate yourself. If you’re feeling dizzy or weak, find a sheltered area and take rest there. Although you can’t escape the possibility of getting ill, make sure you get a proper diagnosis from a doctor, the appropriate vaccinations, and only resort to antibiotics to fight an infection—with your doctor’s approval, of course.
SAIGON INSPIRATION HEALTH CAN VIETNAM’S ELDERLY CARE SYSTEM HANDLE ITS RAPIDLY AGEING POPULATION?
With one in 10 people aged 60 or older, Vietnam is slowly en route to an “ageing phase”, a term to describe a situation where about 10 percent of the country’s population is above the age of 60. However, with an ageing population comes the increased need for infrastructure and resources catering to elderly healthcare.
And this is where the problem lies.
Vietnam’s population is expected to creep into the “aged population” range, where 10 to 20 percent of people are aged 65 and above, within the next 20 years. However, the current social safety net for the elderly such as pensions and support schemes can only cover about 30 percent of the overall required costs.
According to Carlos Galian, an expert with the International Labor Organization in Vietnam, “the pension scheme will start running a deficit in 2020 and the reserves could be totally depleted by 2029, causing big problems for Vietnam’s economy.”
Falling Through the Cracks
According to data from HelpAge Global Network’s Global AgeWatch Index, a non-contributory social pension of about US$9/month is offered to elders above the age of 80 and to those aged 60-79 who are identified as “poor”; those aged 60-79 who have a severe disability as well as those 80 and above who are poor, living alone and without family support receive US$13.50/month; and those over 80 with a severe disability receive US$18/month.
There are about 1.4 million people across the country above the age of 80, along with about 100,000 people between the ages of 60-79 receiving this pension. An additional 1.8 million pensioners receive a formal pension as part of social insurance. This leaves a gap of about five million elderly people who do not receive any form of pension or benefits.
Lack of Knowledge
In October, Deputy Minister of Health Pham Le Tuan emphasised that long-term care for the elderly in Vietnam is a common process in which social care takes a leading role. Currently, 80% of the elderly are receiving care at home and in the community, but caregivers still lack knowledge and there should be a strategy to improve their knowledge.
This sentiment is shared by Dr. Thao Tran Phuong, specialist at the Gastroenterology and Hepatology Department at Victoria Healthcare Vietnam. “Most caregivers that families employ to look after the elderly are general caregivers, not specialised in elderly care and they may not have the necessary training and experience to handle elderly patients,” he said.
The Allure of Geriatrics (or Lack Thereof)
The dearth of specialist caregivers for the elderly can be narrowed down to a few reasons according to Dr. Thanh Nguyen, nutritionist at Victoria Healthcare Vietnam and lecturer at Pham Ngoc Thach University of Medicine. “Geriatrics is still pretty new in Vietnam. Medical schools only started this program about 10 years ago” she said.
Dr. Thao added that “geriatric studies is not very popular among medical students, so out of each graduating batch, very few actually end up as geriatric doctors.” “In most countries, the gap could easily be filled in by foreign doctors, but in Vietnam, everything is done in Vietnamese and that language barrier will be a huge problem,” he said.
The biggest reason, however, according to both doctors, is the lack of a dedicated medical facility for the the elderly in Vietnam. “At this point in time, only certain hospitals have wards dedicated for geriatric care, and this is just in Ho Chi Minh City, which has the best standards for geriatric care in Vietnam.” said Dr. Thao. Medical facilities aside, what about the elderly living at home?
Home Improvement
Dr. Thanh believes other social factors play a part too. “In Vietnam, it is common for the family to look after the elderly at home. Therefore, the idea of a nursing home is almost considered a taboo.” “When a family decides to put their elderly in a nursing home, there is a chance that they will be viewed by their neighbours and relatives as unfilial.” she said.
“However, most of these families don’t have the knowledge of how to properly take care of the elderly,” she said. “There are no materials or resources available that teach them how to do so, and this can be quite dangerous.” According to Dr. Thao, the most common issues among the elderly include cardiovascular diseases; diabetes; stroke; dementia; complications from falls; and cancer—especially lung cancer among men..
What Next?
Dr. Thao strongly believes that the right way forward is for the authorities to establish a new hospital dedicated to elderly patients. Not only will it ease the load on geriatric wards in current hospitals, it will also kickstart interest in the field.
“When a new dedicated hospital is built for the elderly, it will open up many opportunities for the recruitment of geriatric specialists and in turn, will raise more interest in this field.” he said. “With more specialist doctors and nurses available, the standards of elderly healthcare will improve dramatically.”
Dr. Thanh believes that besides a dedicated facility, there should also be more daycare centers available for the elderly within the city, and also in the various provinces. Mindsets towards nursing homes also have to be changed, and more resources for elderly care should be made readily available for families who prefer keeping their elderly at home to equip them with knowledge on how to properly care for them.
Dr. Thao believes that human resources can play a huge part in shifting the mindset of would-be doctors towards geriatrics, and hopes to see this change happen soon to alleviate the shortage of geriatric specialists, and to better prepare for the increased demand in the future.
SAIGON INSPIRATION HEALTH CAN VIETNAM’S FOOD CAUSE CANCER? DEPENDS ON WHO YOU ASK
In April, a parliamentary working group was ready to publish a damning report on the health effects of unsafe food. The most serious accusation was not the food industry’s role in causing 26,500 hospitalisations nor its purported role in 164 deaths in the five-year period the working group studied ending in 2016. It was the General Assembly’s striking accusation that unsafe food was responsible for the stratospheric rise in new cancer cases in Vietnam.
Then, the group was suddenly disbanded. The report was labelled “inaccurate”, a danger to consumers and food producers, according to a response by the Health Minister Nguyen Thi Kim Tien reported by VNExpress International. Chronic infection, not food, causes cancer, the minister said. The remarks have done little to abate a widespread public belief in the opposite, an idea corroborated by medical professionals in remarks we’ve reported in the past.
The Billion Dong Question
So, is food safe in Vietnam, or not? A positive answer to that question could lead to enormous fortunes for this county’s pig farmers who since 2012 have been in limbo with the Chinese market due to a ban on Vietnamese pork.
Vietnam could export elsewhere, and indeed has been approached by Ukraine in a bid to secure pork for the east European nation. But missing out on China means missing out on a big, pork-hungry group of consumers right next door. Although China contains a fifth of the world’s population, the country consumes about half of the world’s pork.
The country’s pork farmers are struggling to keep up. China has been remaking a pork production model that’s recently had to scale quickly from a collection of small farms to a larger, more robust industrial-scale operation in the service of meeting its 50 million-plus tonne annual pork demand. Nguyen Tuan Viet, director of VIETGO Co Ltd import-export consultancy, observed that Chinese farmers are currently falling five million tonnes short of the country’s need.
Vietnam could fill that cheaply. Chinese pork prices have fluctuated wildly between about US$2.70 and US$2.20 per kilogram this year. Vietnam’s US$2-per-kilogram pork—a three-month high—looks comparatively attractive.
Mr Viet made the statement in May 2017. At that time, Chinese officials were in formal negotiations with the Vietnamese government to settle terms of an agreement to lift the ban on pork from their southern neighbour. At the time, Vietnamese pork farmers were hungry for some kind of relief as their pig raising operations were generally not profitable due to the low prices.
The problem? Pig health and the quality of production have remained an unresolved concern for Chinese officials responsible for green lighting Vietnam’s entry into their country’s pork market. Except for a few temporary suspensions of the bans, Vietnam’s pork has remained officially forbidden from the market since 2012 over concerns of foot-and-mouth disease.
Vietnam’s Pigs Sneak Over On “Feet”
So, health concerns over Vietnam’s pork have led to a stiff ban from the Chinese market. Officially, that is. Unofficially, a sophisticated network of suppliers and complicit Chinese authorities are ensuring a steady supply of cheap Vietnamese pork makes it into China. About 15,000 pigs were making it into the country each day when Chinese state broadcaster CCTV broke its investigatory report in 2016.
The illegal supply network has been known since at least 2015 when Reuters reported that Hong Kong smugglers were earning up to $50 a trip offering themselves as “feet”, individuals who carry supplies of illicit meat on foot.
“You have people stuck with meat on the Vietnam side of the border they can’t sell. They start taking it up and down the river and breaking it into smaller units to bring it in,” a Shanghai-based meat industry advisor told Reuters. “It’s more underground and therefore more dangerous.” No additional reporting indicates the network has been meaningfully hindered or disrupted.
Infected Meat
The Chinese ban on Vietnam’s pork is not without cause. An extensive 2016 World Bank report on food safety cited an alarming rate of salmonella infection in pork sold at local markets: about half of the meat tested. China’s pork hungry populace is rivalled by the appetites of their southern neighbour. With 27 kg of pork eaten per person per year, Vietnam is one of the world’s most robust pork markets.
China’s pork consumption is larger still at 44 kg per person annually. Most pork in Vietnam is produced nationally, and 83 percent of it comes from small farms, the World Bank report’s authors observed.
The report stopped short of ringing a public health alarm bell because the observations don’t have a larger body of public research with which to understand these data points and standards of enforcement. The report also cited that Vietnam’s food producers were failing to win consumer confidence, arguing stiffer enforcement might help broker that relationship.
Loss of Trust
Vietnam’s food producers will also have to win the confidence of the public health experts and businesses that have publically cast aspersions on the nation’s food safety architecture. “I don’t believe there are clean vegetables (in the market) anymore,” Nguyen Lan Dung, chairman of the Vietnam Biotechnology Association, said at the conference, remarks reported by VNExpress.
In August 2016, Mr Nguyen and other food safety experts met with business actors in Hanoi to talk about the state of the country’s food safety. He said the thousands of pesticides and chemical additives—“90 percent of which come from China,” Mr Nguyen added earnestly—posed a danger to consumers in Vietnam due to a lack of consistency in usage methods.
The conference was abuzz with the findings of a National Institute for Food Control report that found excessive pesticide levels in nearly half of the 120 samples tested. About 60 percent of the meat the regulator’s inspectors tested was unsafe for human consumption. “It’s impossible to control how our farmers use [pesticides],” Mr Nguyen observed at the conference.
The National Institute of Food Control is one of several federal regulatory agencies working with the Ministry of Health and the Ministry of Industry and Trade to create and enforce food safety standards. Each reports to the vice-prime minister. The experts at the Hanoi conference commented that customers’ fears of food handling that puts cost efficiency over safety are mostly founded.
For the business actors in the room, the blame for the state of food safety and consumer confidence fell to the regulators and their lack of coordination. “There are inspection teams from the health and agricultural sectors. Then there are teams from the ward, district and even inter-agency teams from a municipal level. Why can’t these teams share their test results to save costs and cut the onerous red tape?” said seafood store chain Director Tran Quan.
A Tough, Unsexy Problem
Food safety is important, but perhaps some of the passivity it engenders is due to an inability to properly contextualise its failures.
About halfway through the World Bank’s report is a section on the health risks of foodborne illness. The report’s authors first confess the difficulty of honestly assessing the industry’s real level of risk. “ … risk analysis is still not well understood and not much applied in the developing world, including Vietnam,” citing a lack of human and monetary capital. The writers note that outbound food from Vietnam is rigorously checked, while food grown and consumed domestically receives a “low systemic application of risk-based approaches to food safety due to lack of…resources….”
But if there’s something serious to worry about from that kind of hazard, the report doesn’t clearly state it. The report instead follows the pork salmonella datapoint with a page of worrisome-sounding findings from people who’ve studied Vietnam’s food: the salmonella risk is mentioned within a laundry list of other health violations including incidents of intestinal disease-causing Cyclospora and E. coli, which was found in at least 16 percent of vegetables tested in a two-year period ending in 2014.
In the conclusions section, the authors state that food borne microorganisms, pesticides and antibiotic residues “appear to be much higher [in Vietnam] than those in developed countries,” and “the status of antibiotic residues and reported resistance is alarming with an increasing trend over time,” but more study is needed.
The C-Word
The 2017 World Bank report does, however, include a note about a lingering and easy to understand concern widely believed to emerge from unsafe food: cancer. There are 10 mentions of the C-word in the World Bank’s study. Most are cagey observations noting some of the health hazards observed in the research as connected and potentially related to cancer, but it stops short of saying anything conclusive about the relationship.
That’s a strong contrast with public perception about cancer’s relationship with unsafe food. “Unsafe food is the top cause of cancer in Vietnam,” a Vietnamnet Bridge story wrote in 2016. The bombshell claim came from the deputy chair of the Vietnam Cancer Association who said unsafe food was responsible for 35 percent of cancer cases.
The news came as health officials were reporting an explosion of cancer diagnoses: cancer infections nearly doubled from 2000 to 126,307 in 2010. The upward trend is expected to continue to 190,000 in 2020. Because most cancer diagnoses come late—nearly 75 percent of diagnosis come after the second stage—a diagnosis is almost certainly a death sentence. Vietnam has about 70,000 cancer-related deaths annually.
The science on the connection between food and cancer has, however, not reached a consensus yet. The claim was questioned in a paper aptly titled Food safety in Vietnam.
“There is a very common belief that eating foods contaminated with pesticides or other chemicals is an important cause of cancer. However, the proportion of cancers caused by contaminated food in Vietnam is unknown,” the study’s five authors, two of them Vietnamese researchers, said.
“Generally, there is far more concern about the carcinogenic impact of food than the evidence to support this,” they write. If the increase in cancer rates is due to an increase in diagnoses and longer lives, does food play a role in that? The science doesn’t have a firm answer on that question, the authors state.
“Undoubtedly, some cancers are associated with diet, but risky behaviours (e.g. smoking, alcohol abuse)…,” they write. “However, there is much that is unknown about the long-term effects of chemicals in food.”
The Best Answer
So maybe not cancerous, but is food safe?
The question is frustratingly hard to answer because the efforts to clarify it are largely uncoordinated. The most complete picture comes from the Ministry of Health’s data, information that the World Bank says is likely incomplete, but is nonetheless the most comprehensive information set in existence.
Acknowledging that “safe” is a relative term, the Ministry of Health’s data suggest Vietnam’s food is relatively safe compared to another common consumer behaviour, riding a motorbike. Motorcyclists make up about half of the approximately 14,000 road fatalities that Vietnam reports to the World Health Organization annually. The number of people who have died of food borne illness in Vietnam: about 40 each year.
The safest food according to the Ministry of Health is the meal served at a restaurant or school; only eight food borne disease outbreaks were recorded in 2015 at these locations.
Street food ranked remarkably well in these statistics. Only 12 of the 129 food disease incidents occurred from a street food vendor. The most serious offender was the private kitchen. Of the 179 food disease outbreaks recorded in 2015, 85 were traced to food that was prepared in the home.
Fear Factor
If that’s an unsatisfying note on which to end, know that the question of food safety is generally a sticky one. Acknowledging that some of the data is awful and cemented public perception may be difficult to shift, the question of food safety is just hard to answer in general because “food technologies often involve ‘fear factors’ that make them seem more worrisome than other risks—for example, eating pesticide-contaminated vegetables is (incorrectly) perceived as being more risky than riding a motorbike,” the Food Safety in Vietnam authors point out.
In lieu of certainty, some have gone to satire. The Vietnamese tell a joke about their food’s safety: “If you don’t eat, you’ll die; if you eat, you’ll die slowly.”
SAIGON INSPIRATION HEALTH HOW SAFE IS THE WATER IN VIETNAM ?
How do you get your water? Most likely, you buy it in a store or have it delivered to your house. Apart from Dalat’s spring water, no tap water in Vietnam is considered safe to drink, a condition common in Southeast Asia and developing countries in general.
However, Vietnam’s current water situation has improved substantially. As Amy Keegan, the project lead on the online water accountability platform WASHWatch, wrote in an email, “Since 2000, over 9.5 million people [in Vietnam] have gained access to clean water and over 15.8 million people have gained access to decent sanitation.”
Many of the people who benefited live in Vietnam’s rural community, where indoor plumbing can still be considered a luxury. However, the fight for country-wide clean water and sanitation is far from over.
A Closer Look
Much of the water and sanitation progress can be attributed to encouragement and funding from the United Nations. According to the goals of the 2010 Human Right to Water and Sanitation resolution, which was resubmitted during the 2015 UN conferences, 17 goals and 169 targets are to be achieved by 2030 to ensure that clean water and access to proper sanitation is available for everyone on the planet.
So, how is Vietnam holding up to these goals?
According to WASHwatch, well overall. “Vietnam has made tremendous progress with WASH access over the past few decades and is above the regional average for East Asia and [the] Pacific,” Keegan wrote. The regional sanitation average is 68 percent, while Vietnam’s is 78 percent; the regional water access average is 89 percent, while Vietnam’s is 92 percent.
Vietnam has made 19 commitments over four separate resolutions, and the country is well on its way towards completing all within the specified time frames. However, writes Keegan, “The only WASH section of the goals that Vietnam is not going to achieve is hygiene due to stagnation of access.”
Clean Water?
Access to water is one thing; access to clean water is a different matter. Right now around 93 percent of the drinking water in Ho Chi Minh City comes from two treatment plants on the Dong Nai River and Saigon River, while the remaining 7 percent comes from groundwater sources polluted by seawater intrusion and chemical contamination.
Water pollution is a persistent and often fatal problem for both river and groundwater sources. Tests done by the Vietnam Institute of Biotechnology in 2009 showed high levels of e-coli in Vietnam’s drinking water, and some samples contained ammonia levels 6 to 18 times higher than the allowed level.
Another test by the Ho Chi Minh Health Department in the same year found arsenic levels to be higher than acceptable standards set by the World Health Organisation; bottled water was found to contain bacteria, results that led to the closure of 38 water bottling firms.
Chemical Buildup
Reports show that industrial zones expel one million cubic metres of untreated sewage per day, which accounts for 70 percent of country’s daily industrial wastewater. As the vast majority of the tap water distributed in towns and cities comes from rivers along industrial zones, river contamination poses serious risks for almost everyone in Vietnam. People who live in southern Vietnam and the Mekong Delta region are most seriously affected.
This environmental blight has been noted and addressed, most notably in 2012 when the World Bank approved a US$50 million loan to build wastewater treatment plants in eight industrial zones. No information is available about their progress.
Further news was announced in April of this year that 30 of the 32 industrial zones on the Dong Nai River have water treatment plants, and together they can treat 135,000 cubic metres of the 96,000 cubic metres of wastewater produced daily by these plants.
These facilities do help, but news of their construction runs in tandem with reports that the Dong Nai River still faces large amounts of chemical contamination. As Amy Keegan from WASHwatch wrote, “there is still work to be done.” Currently, 1 in 10 people still do not have access to water, and 1 in 5 people don’t have access to basic sanitation. And with chemical pollution looming large, we’re all currently facing the downsides of rapid industrialisation.
SAIGON INSPIRATION HEALTH ARE FACE MASKS REALLY EFFECTIVE AGAINST AIR POLLUTION ?
Ho Chi Minh City is Vietnam’s largest and busiest city, with a population of 13 million at last official count. Motorbikes are by far the most dominant and easy means of transportation for the bulk of people, with over 7.4 million bikes and a rapidly growing number of cars in the city.
While they are a convenient to get from A to B, they are also harming the city’s air quality, which leads to higher health risks especially for navigating in traffic. So the question for urban residents is: how can you protect yourself against air pollution? Are face masks the solution?
Inconvenient Air Truths
According to Vietnam-based Green Innovation and Development Centre, 41.82 percent of the air quality in HCMC was classed as ‘unhealthy’ in the first quarter of 2017, compared with 32.12 percent for Q1 2016. Global air quality is measured daily through the air quality index (AQI) with extreme values ranging from ‘good’ (0-50), through to ‘hazardous’ (301-500).
The average hourly AQI in HCMC during Q1 2017 was 100.8, up from 91.2 in Q1 2016 — a clear sign that air quality is worsening. Naturally, such conditions cause many people to wear face masks in an attempt to protect themselves.
There are a variety of masks on the market but the cheapest and most widely used are the cloth and surgical masks, which can be bought all over HCMC for as little as VND5,000. But they actually offer little to no protection from harmful pollutants.
“People think the cloth masks work, but they’re bad and do nothing,” says Tom Druk, founder of filtered mask manufacturer, Air Quality Blue. “The surgical masks aren’t doing a much better job because they don’t seal around your face and they don’t have the right type of filter,” he explains.
Dr Roma Patel of Nottingham University Hospitals, UK, adds that cloth and surgical masks offer people “a false sense of reassurance”. She says, “There is very limited evidence on the efficacy of cloth and surgical masks for this purpose. In particular, they have been found to be poor against diesel combustion particles. Their effectiveness is variable and can provide a false sense of reassurance.”
Better Options
But there is a range of filtered face masks, like those from Mr Druk company’s AQ Blue in Vietnam and China. The masks work in a similar way to a magnet, attracting pollutants to an electrostatically charged filter and trapping more than 95 per cent of particles sized between 0.3-2.5 micrometres – considered to be the most dangerous particle size.
“The particles coming out of the motorbikes are mixed with some really nasty stuff like oil and metals from the friction in the engine, carbon, which you can’t see and our masks protect against them,” he says.
As Dr Patel explains, “Fine particles from pollutants can end up deep seated within the lungs, which gradually reduce the oxygen carrying capacity of the system.”
Health issues like heart disease, strokes, asthma and cancer have all been linked with poor air quality. A 2014 study by the World Health Organization found that in 2012, seven million people died as a result of air pollution exposure. “Pollutants are damaging to our health both in the short and long term,” Dr Patel says.
“The way we respond to them varies depending on our genetics and lifestyle. However, prevention is always better than cure hence appropriate steps should be taken to minimise their impact on our health,” she adds. GreenID echoes this sentiment and stresses the importance of choosing the right type of face mask protection.
Companies such as Mr Druk’s AQ Blue and US-based 3M sell disposable face masks in Vietnam. Typically, they can be used for around 30 hours, which Mr Druk estimates would last around two weeks in HCMC for the average commuter.
SAIGON INSPIRATION HEALTH ENDANGERED ANIMALS: THE VICTIMS OF HEALTHCARE
While the sale and trade of rhino horns has been banned and airport authorities have seized hefty amounts of the illegally traded product—much of it on its way to China, indisputably the biggest offender and consumer of these prohibited items—a recent report on the state of enforcement and rhinoceros welfare says the market is doing just fine.
A blockbuster report by US-based NGO Elephant Action League traces the route South Africa’s rhinos make to China placing much of the blame on a neighboring enabler and reliable smuggling cooperator: Vietnam.
A Coveted Object
It’s difficult to know exactly, but the report alleges hundreds of rhino horns arrive in Vietnam every year on their way to China, as much of half of the total black market supply. Of 85 seizures of animal contraband recorded by animal rights-cum-data analytics firm C4ADS, 18 were destined for Vietnam making the country the third-highest trafficker of illicit rhino horn behind Mozambique and China, the country of destination for the bulk of the illegal rhino horn supply traded around the world.
In 2015, of 59 smugglers arrested of Asian descent, the largest share, 35, were Vietnamese nationals.
This is despite the decision from South Africa, home to 80 percent of the rhino population, to categorically deny trophy hunting permits to all Vietnamese in 2012. Between 2009 and 2016, 466 kilograms of Vietnam-bound rhino horn were seized, a stockpile worth a baffling amount on the black market. Rhino horn had fetched as much as US$60,000 per kilogram in recent years.
The NGO reports that some Vietnamese demand exists for rhino horn, but much of what enters and is sold in the country ends up in the hands of a Chinese customer. “Illegal rhino horn trade’s main market is in China,” said Nga Nguyen, Communication Public Awareness & Demand Reduction Program Supervisor with Education for Nature—Vietnam (ENV).
However, “it’s hard for criminal[s] to get into China through airport custom.” The land border between China and Vietnam presents less of a challenge than direct entry. The Elephant Action League’s report said anything less than a direct and forceful challenge from governments to this illicit trade is unlikely to stop further depletion of rhinos.
“Even when governments and their representatives are committed to tackling poaching and trafficking, their strategies are fragmented” and frequently spearheaded by environmental groups powerless before the incumbent bureaucracies.
Formidable Opponents
Both Nguyen and the Elephant Action League fault lax inspection and product control at the Chinese-Vietnamese border, making northern Vietnam a hotbed for illegal rhino trade. What’s more, the Elephant Action League’s report says rhino horn trade is a multinational activity unbound by political boundaries unlike the law-enforcement bodies that police them.
“The transnational organised crime networks involved in wildlife trafficking limit regionally and nationally-based law enforcement authorities’ abilities to effectively investigate and prosecute the key network middlemen,” the report says. “As a result, trying to address transnational rhino horn trafficking networks in isolation from within rhino range states or destination countries is ineffective” and inefficient.
That’s the very opposite of the crime networks they are tasked with quelling. They “are everything that the government bureaucracies and law enforcement agencies rallied against them are not,” the report plainly states. “They care more about their own benefit and right than the animal’s right,” she said.
The Vietnamese rhinoceros became extinct in 2010 when the last one was killed in Cat Tien National Park, an ecological reserve close to Tan Phu in south Vietnam. There are fewer than 30,000 rhinos remaining worldwide. The report also documents Vietnam’s growing presence as a customer as well as a transit point for the rhino horns. That has only grown recently in spite of medical evidence summarily rejecting all claims of rhinoceros products’ alleged healing power.
Questionable Healthcare
Demand reportedly spiked in 2011 when an unnamed government official was rumored to have been cured of his cancer from ground rhino horns, a substance that is chemically identical to human nails, researchers have determined through extensive testing.
Nguyen said the bogus health claims are rooted in traditional Chinese medical practices, stories that the horn of a rhino can be used to cure a person ailing from cancer or a hangover. There are also a number of wealthy Chinese who want a rhino horn as a status symbol.
Both Vietnam and China are signatories to CITES, the Convention on International Trade in Endangered Species of Wild Fauna and Flora, a multinational agreement to fight endangered animal trade. They were among the 80 countries who signed the document before it was ratified in 1975.
In addition to being one of the largest and oldest animal rights covenants in the world, it is among the weakest.
About 50 percent of the member states have failed at least one of the treaty’s four basic requirements for members: laws against banned animal trade, consequent penalties for this trade, confiscation laws governing seized specimens, and the designation of animal management authorities.
Rhino allies suffered a setback in April when South Africa legalised domestic trade of a stockpile of rhino horns, which authorities had acquired through either investigation-related seizures or from ecological parks which surrendered them from dead rhinos to prevent their circulation on the black market. However, the Elephant Action Group says no demand exists for rhino horns in South Africa, and those horns have instead been making their way to China through Vietnam.
Maybe Vietnam’s comfort level and tolerance of illegal rhino horn trade is due to its amenability to the sale and consumption of other exotic animal products. Bear bile and snake hearts are, in some parts of Vietnam, treasured parts of tourists’ experience.
As late as 2013, VICE had published a gawky, Hemingway-esque piece plainly titled “I Ate and Drank Cobra in Vietnam’s Snake Village”. “Feel like swallowing a snake’s still-beating heart? Le Mat (a village about 5 kilometers away from Hanoi’s Old Quarter) is the place to go,” the author wrote, detailing a decadent afternoon unscrupulously dining on exotic reptiles.
More often than not, however, consuming animals is not a feature of local or indigenous custom, but a sideshow created solely to entertain and coax money from foreigners too ready to believe a less developed nation still traffics in outright barbarism as sport.
With regards to the success of animal trade bans, there appears to be little change in the laws’ efficacy domestically. Of the 156 animal trafficking-related criminal cases reported in Vietnam between 2014 and 2016, about 17.9 percent resulted in prison time, according to ENV’s August 2017 crime report. During a two-year period ending in 2013, the 177 criminal cases opened resulted in an arrest for 21.5 percent of complaints.
The report emphatically states that clear penalties, preferably lengthy jail sentences, are an obvious remedy for a would-be criminal’s perception that their risk is negligible compared to the rewards.
SAIGON INSPIRATION HEALTH IS VIETNAMESE FOOD REALLY HEALTHY ?
Vietnamese food is delicious and it is often cited as one of the healthiest cuisines in the world. To make sure that this was true, we spoke to Antoine Yvon, the head nutritionist at CMI hospital in Ho Chi Minh City. You will finally know if all those banh mi sandwiches are good for you, if you should drink the broth of your pho or not, and the name of Vietnam’s only super fruit. The interview was translated from French.
The health benefit of a Vietnamese food diet
What is your general professional opinion about Vietnamese food? Is it as healthy as people think it is?
Vietnamese food is one of the most healthy and balanced in the world. As a professional, I have seen that dishes and ingredients used in Vietnamese cuisine can cover all the dietary needs on protein, lipids, carbohydrates, vitamins and minerals because there is a great natural diversity of agricultural products. It is this diversity and variety that are the foundations of a healthy and balanced lifestyle.
The way to eat food is also a very important factor that can influence the nutritional value of food. Eating with chopsticks, using multiple dishes, and sharing with people allows you to eat more slowly, to chew the food longer and in the end causes a better digestion and assimilation of nutrients, without overloading the digestive system. Therefore, the social and cultural aspect of eating Vietnamese food is a reason why eating Vietnamese food is healthy.
The reputation of Vietnamese food as healthy is correct as long as we eat traditional dishes. The economic growth has considerably changed the way Vietnamese people eat by bringing some Western habits and products.
Modern Vietnamese eating habits are straying away from the ideals described above, with more and more processed products, enriched with artificial nutrients, artificial flavorings, rich “bad fat” (trans fat and saturated fat are not essential) and simple carbohydrates added to food, particularly all the dairy products which were unknown a few decades ago (pasteurized cheese, sweetened condensed milk, flavored yogurts) and all junk food (cakes, pastries, ice creams, sodas, fast food).
Even though Vietnam is one of the countries with the lowest rate of obesity in the world if we look at the overall population, some categories have results that are not so positive: children and teenagers. The number of Vietnamese children under five years old with weight problems has doubled in four years in Vietnam, while at the same time it has decreased by 25% in the U.S.
What Vietnamese food should be avoided? What are the healthiest options?
As long as you eat traditional food, there is not food that you should avoid. You must just make sure to avoid processed food as much as possible. It is also best to avoid deep fried food and those grilled on a barbecue. The most healthy dishes are the soups (among which are pho), spring rolls, fruit and vegetable salads, claypot dishes, rice dishes with meat or fish cooked in sauce and fresh fruit juices.
What are the typical health problems developed by Vietnamese people from their eating habits?
The change of habits mentioned above are causing an increase in the number of cardiovascular diseases and metabolic disorders (infarctus, diabetes, metabolic syndrome), obesity, cancers, particularly among children. Also, the increased consumption of alcohol among men increases the number of liver and digestive system cancers.
The healthiest fruits in Vietnam
Is there any Vietnamese superfood (a dish or a product with superior health benefits)?
Though not often eaten apart from during traditional festivities, the little know “gac” fruit (or red melon), often nicknamed the “fruit of paradise” is the fruit with the highest concentration of carotenoids in the world (a precursor to Vitamin A). The gac contains 75 times more lycopene (an antioxidant) than tomatoes. It can be considered a super fruit. Its taste is close from red melon and carrots. It is more and more popular in the U.S. or Europe as a eating supplement.
What are the most recommended local fruits and vegetables (dragonfruit, sapoche, kumquat, etc)?
You might know the expression, “an apple a day keeps the doctor away” – what is the Southeast Asian equivalent of our trusted apple?
Even though there are a lot of vegetables in traditional vietnamese food, the average daily consumption is twice less than the recommendations from the World Health Organization. 40% of cancers in Vietnam are linked to food consumption (principally because of processed food, bad eating habits and bad eating hygiene).
It is certain that if more fruits and vegetables were eaten, the situation could improve. Unfortunately, people are buying less fresh fruits and vegetables, because they are suspicious about the hygiene and sanitary conditions of them, and more canned products which are poorer in essential nutrients.
More important than the qualities of certain food, the most important is to eat enough and regularly the greatest variety of fruits and vegetables. If we had to categorize them according to how rich they are in nutriments, we could differentiate:
– The richest ones in vitamins and antioxidants (lychee and rambutan, chinese celery, ceylon spinach, guava, papaya, kiwi, dragon fruit)
– The ones with the most sugar (to be careful with): lotus seeds, sweet potato, taro, banana, grapes, cherries, mango)
– The ones that are hydrating and less sweet: berries, watermelon, melons, citruses (oranges, pomelo, lemon, kumquat), apple, star fruit, gac fruit
Vietnamese are among the largest consumers of durian fruit, known for its smell more than for its qualities. It is called the king fruit here. In Indonesia, it is considered an aphrodisiac. In Vietnam, it causes several deaths every year (the mix of alcohol and durian is toxic for the liver and excessive consumption can cause hypertension). The link between what people eat and how healthy they are is not obvious yet for many Vietnamese, which causes a lack of interest for nutrition.
Eating street food in Vietnam: Sauces, pho, banh mi, herbs…
Should we avoid Vietnamese sauces?
Sauces are a very important part of the Vietnamese food experience. A meal without sauces is like a meal without bread in France. You should not ban them. Even the sauces that are very sweet or salty should not be banned totally. At reasonable doses, they represent only a fraction of the food intake compared to carbs like rice. Keep it simple and traditional!
Is pho healthy? Should the broth be drunk or left aside?
The pho, the most famous Vietnamese food, is certainly one of the most balanced dishes I know. Eaten all day long, it contains carbs, good proteins (beef or chicken), few fat, a lot of water, a lot of dietary fibers, vitamins, minerals (herbs and vegetables) and antioxidants (spices, chili, lemon).
Who does not feel full after eating a Pho? If you want to balance it even more, you can add a raw vegetable salad with vegetable oil for appetizers or a fruit salad for dessert. Add a few dry fruit too like nutmeg, peanuts, almonds.
The broth should be drunk because a lot of water-soluble vitamins and minerals are dissolved in the water during cooking. They are intact inside the broth (except for the B1 vitamin, B3 and C that are partially altered), a gold mine full of nutritive ingredients.
The broth is as important as other ingredients of the pho. It is a source of water and thus hydrates and cools the body (just like nomads in the desert drink hot tea: a hot brew cools and hydrates the body better than cold water). The body reacts to hot liquids with several cooling processes (perspiration, transpiration, more efficient digestion, etc.).
Is banh mi healthy?
The banh mi is a sandwich that can be made in a multitude of ways depending on where you eat it. More often, it contains a source of proteins (pork, chicken, ham), some vegetables (lettuce, carrots, green bean sprouts), bread and sometimes industrial soft cheese (The Laughing Cow brand).
The white bread used is not as filling as rice and noodles and is poor in good fat and fibers. You should be careful in making sure the ingredients added are not processed food (pate, sausages, cheese) and that not too much sauce is added (particularly if it sugar, or fat).
You could replace the processed cheese with a yogurt (made of milk! It is not bad if the portion is reasonable and it can complement well a banh mi, nutritionally speaking). Contrary to pho, the banh mi does not hydrate the body well. You can accompany it with a fresh drink while you eat such as a lime juice, coconut water or sugar cane juice.
Do the herbs added to the recipes have nutritional or health benefits (cilantro, mint, cinnamon herb, etc.)?
Aromatic herbs contain a lot of antioxidants and vitamins, whatever they are, often with a higher concentration than that found in most fruits and vegetables. It is because they smell good that they are so interesting because the aromatic molecules, the ones responsibles for the good smell, are also directly responsible for the medicinal properties of those herbs.
They have diuretic, anti-inflammatory and antiseptic properties. Not only do they contain very little calories, they are an interesting source of fiber and contain phytosterols that could help, if taken in high dose, reduce the cholesterol and triglyceride levels. Very helpful to improve one’s cardiovascular health.
However, the overall daily intake is relatively small compared to other ingredients. Parsley contains three times more Vitamin C compared to oranges but you’ll need three bowls to cover the daily recommendations. Not very easy! Still, if you consume herbs all day long at different meals, it will cover part of your nutritional needs.
I would recommend to consider them for what they are, aromatic plants. They can make your dishes more tasty and delicious. The healthy part is a bonus. Cinnamon herb is an excellent diuretic and anti-inflammatory. Mint can help if you have nausea and it helps digesting, just like coriander.
Conclusion: Vietnamese recipes are healthy, but be careful with the ingredients
There is a Vietnamese paradox: even though Vietnamese food is naturally healthy, full of flavors and nutrients, the trend is towards artificially flavored, industrially processed and nutrient enriched food. Pay attention to where you eat and the ingredients used in the preparation of the dishes. A pho might be healthy somewhere because natural ingredients are used, while another one won’t be as nutritionous because it uses food enhancers.
*Credit: Antoine Yvon – Dietetician/Nutritionist at the CMI Ho Chi Minh City. You can contact him for an appointment (in French). His website: www.nutrytion.fr.
References: – Food database CIQUAL 2013 – SMILING 2013 – Food composition table for Vietnam, National Institute of Nutrition, Vietnam. 2013 – World Health Organization. https://www.who.int/. 2014 – Food and Agriculture Organization (FAO) 2014 – L’histoire de l’alimentation. Jean-Louis FLANDRIN, Edition Fayard. 1996 |
SAIGON INSPIRATION HEALTH THE CREATIVE DESTRUCTION OF HEALTHCARE
“Creative destruction” in healthcare does not mean a smart doctor damaging an unfortunate patient. The term actually applies these days to far-reaching changes on the horizon for healthcare. In the end, the consumer/patient can benefit from convenience and efficiency digitally. Now at the 10th anniversary of the smartphone, we find convenience and access to information, products and services as never before.
Just as “bricks ’n’ mortar” retail stores are under attack from mobile outlets in developed countries, this “fourth revolution” is coming to healthcare. The wedding of digital technology and good healthcare is producing greater advantages for patients, in terms of access, careful follow-up, information and convenience. The sun may be setting on feeling ill, then trudging to the clinic, waiting for hours, spending a few minutes in the doctor’s bailiwick, paying and then trudging home again.
A Digital Future
Each year brings new digital healthcare apps and uses that can make obtaining good healthcare much more accessible and well-informed. A whole spectrum of services is already available in Vietnam for the patient’s convenience.
Digital healthcare brings the doctor to the patient rather than the other way around. It also provides access to much information previously only known to doctors, and it gives a mobile platform for evaluating the doctor or clinic and spreading the word quickly.
mHealth Technologies, JSC, a startup in Vietnam, has developed its own platform and technology that is on-par with highly developed countries. This allows patients to quickly evaluate available online doctors and arrange a telemedicine consultation wherever they are, through website wellcare.vn or the Wellcare mobile app and chatbot.
This virtual consultation allows the doctor and patient to determine best treatment options at home, or whether a physical visit is best. Diag and mHealth can do blood testing from the patient’s home and report the result to the patient digitally. There is also remote monitoring for blood pressure, EKG; blood sugar etc., through ihealth.com.vn and the Foracare “smart” medical equipage.
Jio Health, through a mobile app, offers home visits from physicians. Victoria Healthcare’s WebView allows the patient to review results and communicate directly with the doctor from a secure internet platform. The patient can also book appointments through this portal.
Via Smartphone from Home
Victoria Healthcare offers medical advice and education through an mHealth chatbot (a digital “robot” enabled by AI technologies that can answer questions and direct the patient to the right service, or doctor). Victoria Healthcare also uses an advanced electronic healthcare record, assuring privacy, completeness and portability for the patient.
This e-record allows easy access for quality assurance and data collection, and is available securely to any Victoria doctor from any location, including at home. Smartphone and tablet texted pictures are routinely used to show doctors particular findings, and doctors and their teams can digitally follow-up patients. Studies in the UK and USA have shown that better health outcomes result from careful follow-up through digital portals.
As mHealth Technologies develops its product lines, it will be expanding chatbots and artificial intelligence to better direct patients and answer their questions. This will all lead to better and more seamless care in or out of the doctor’s room. However, digital penetration has not yet been deep in Vietnam. Most patients are older and not as comfortable with high tech.
A major advantage of digital health is accessing remote locations. However, the people in these areas may not be as tech savvy or have the required coverage. So, although digital healthcare could alleviate much of the crowding in large city hospitals, while serving patients with higher quality in their homes, the technology is only slowly taking hold.
Bumps in the Road
Although Victoria Healthcare and others use these digital modalities to integrate clinical care, traditional care and digital are often done independently, leading to worse outcomes through lack of coordinated care.
Online payment methods work best, such as PayPal and credit cards. However, most Vietnamese prefer to pay by cash, which is more difficult with digital outlets. So, at this time, a better and more convenient way of care is available but has not been widely adopted. But the opportunity is there for those who can overcome technical and payment barriers and integrate well with the other side of the clinic walls.
SAIGON INSPIRATION HEALTH LET YOUR CHILD BE SICK ?
In Để Con Được Ốm (in English, “Let your child be sick”) Victoria Healthcare International Clinic’s lead pediatrician Nguyen Tri Doan and writer Uyen Bui claim that “99 percent” of childs’ illnesses are not treatable by medicine, and will actually be harmed to a greater extent with the medicine than by the illness alone.
Taking “antibiotics is not good for a child’s health and immune system,” Bui says. “We want to warn parents to avoid doing this and let their child be sick even when the symptoms are terrible.”
Illness, the Natural Way
Doan and Bui recommend using as little medication as possible. For example, treating a child with a high temperature who is vomiting ought to be done with just paracetamol for palliative care. Vomiting is just a natural defence, Bui argues, and should be seen as a natural part of the healing process.
If the fever becomes too high and causes discomfort, the pain reliever can be used. If “a child just get high temperature but he still feels fine, paracetamol is not necessary,” Bui says. There are limits to this more passive method of treating child illness.
The book outlines conditions for when a child’s illness needs a more active approach and immediate medical attention. In the event of a fever, parents should allow the fever to resolve itself unless it lasts beyond 24 hours, in which case they should defer to treatment from a doctor.
Similarly, if a child is ever so tired that they can’t recall basic facts about their life like his or her parents’ name, or if a child seems so tired they can’t do anything, parents should seek medical attention, Bui and Doan recommend.
Fighting Stereotypes
Doan and Bui also tackle another child health issue affecting Vietnamese parents: misconceptions about what their child’s body ought to look like. “Để con được ốm” has two translations in English, the other being “Let your child be thin”.
Bui explains that Vietnamese parents place a high premium on their child’s weight, but rather than the Western obsession with thinness they are obsessed with visible weight gain. Parents often mistakenly worry that a thin child is suffering from an eating disorder.
To fix this misdiagnosis, Bui says parents will often overfeed their child, potentially creating a problem that didn’t exist before. Parents will have their child eat while playing and watching TV between meals. This often comes from comparing the child to their perhaps larger peers, but Bui says she and her co-author “want to alarm them to let their child develop at his individual pace,” she says.
“Don’t compare their child’s weight to another,” she adds.
All told, the book addresses a group of 20 healthcare misconceptions like this, “mistakes that are too popular that every parents always [makes] when they become a parent”, like dealing with illnesses, managing illness symptoms, training parents to assess sound advice from bogus instructions and the proper use of medicine.
In the year since the book has been released, it has generated positive feedback from parents, Bui says. Over 70,000 copies have been sold.
In addition to re-framing the discussion about what to accept during a child’s illness, Bui says the book is about building more surety in parents by advising best practices and reminding parents that their powerlessness before their child’s infection isn’t ineptitude, it’s just the natural state of affairs. Bui says parents tell her the book has made them “feel more confident in [themselves] and have … good care of their [child] whenever [they] got sick.”
Because the book does not cite studies and is based largely on professional judgements from Doan’s experience, Bui hedges against applying the book’s advice too precisely, stating that it’s a “skill” book rather than a medical text.
SAIGON INSPIRATION HEALTH THE INTERNET OF MEDICAL THINGS, OR THE FUTURE OF HEALTHCARE IN VIETNAM
Vietnam’s health system is dealing with many of the same challenges faced by other countries with emerging economies. These include rising consumer demand and expectations from a hospital sector that is experiencing overcrowding, poor access, mal-distribution of resources between urban and rural markets, as well as a medical establishment that is not oriented to service excellence or to providing efficient continuing care to patients with the chronic diseases associated with ageing and affluence.
Future Plans
Numerous initiatives are underway to transform Vietnamese healthcare to provide more access including building new public facilities, expanding the private healthcare sector and universal insurance coverage which will have the concomitant effect of further increasing demand. Vietnam’s healthcare system is at a crossroad and a guiding principle must be established to optimise the performance of a system benefiting from increased financing, investment and new facilities.
The aims of a transformed system must include the triple aim of affordability, improved patient experiences and accountability for improved clinical outcomes.
By accelerating the pace of transformation, the triple aim can be achieved. Fortunately, Vietnam is becoming one of the world’s most connected countries, reflected in the over 40,000,000 “smart” mobile devices now in use along with an equal number of personal
computers and a burgeoning number of connected wearable devices that monitor health. We must more broadly deploy this “internet of medical things” along with the data generated and use the available advanced logic for guiding the delivery of higher quality, more efficient and safer medical care.
This new digitally supported system will empower patients to make the best decisions for improving their own health and wellbeing. By supporting the widespread adoption of digital tools to support virtual care by doctors we will be able to improve care management and access across a continuum of care that includes other digitalised trading partners including specialists, ancillary services, pharmacies and hospitals.
The Internet of Medical Things
The internet of medical things (IoMT) is a powerful disruptive force that can accelerate the transformation of healthcare from the current state. It will enable patients and doctors be connected any time, any place with anyone with a smartphone or tablet or sensors.
Exponential data will be created, stored via cloud computing and exploited to provide necessary medical information to doctors and patients to work as aligned partners to ensure care that embodies the five P’s: personalised, predictive, preventive, precise and participative.
Personalised care takes into consideration the unique characteristics of each individual. Predictive care identifies the potential risk for future disease occurrences. Preventive care plans for proactive actions to mitigate the identified disease risk. Precise care identifies which treatments will be effective for individual patients based on genomic, environmental and lifestyle factors.
Personal connected healthcare technologies offer a venue for us to re-imagine a transformed health system in Vietnam where people are empowered to take responsibility for their own health and wellness.
Consumers must have the tools and information needed to take charge and make healthier personal choices.
It won’t happen tomorrow unless we all work together today. Every hospital and doctor group should undertake a digital strategy. Patients, healthcare providers and government must embrace improved health as a shared objective and align their goals, standards and practices accordingly.
SAIGON INSPIRATION HEALTH DOES VIETNAM HAVE AN OBESITY PROBLEM ?
Right now Vietnam is straddling two different worlds: at either end of this long and narrow country you have two powerhouse cities while a smattering of smaller cities follow suit. Although Hanoi and Ho Chi Minh City get the lion’s share of the press, they make up just 25 percent of the country’s overall population.
The vast majority live in rural landscapes, where life is completely different. The realities of these two landscapes—rural towns and metropolises—differ in all aspects, from infrastructure to education to food and diet. While the former two examples affect the quality of life, the latter affects the length of it.
As Dr. Nguyen Thi Dan Thanh, a nutritionist at Victoria Healthcare and lecturer at the Medical University wrote to me in an email, “Community-wise, Vietnam currently is in a nutrition transition period, which is characterised by the existence of both the nutrition problems in advanced and advancing economies.
On the one hand, malnutrition remains an issue; on the other, obesity and lifestyle-related problems have increased rapidly, which puts weight on government policy.” She concluded, “All in all, more and more people are facing some kind of nutrition-related problems, but the sad thing is that it is hard to find an appropriate resource to help them.”
The Vietnamese Paradox
Nutrition-based health problems and non-communicable diseases are wreaking havoc on the population of Vietnam, a curious problem for a country with a deep-seated pride and love for its traditionally healthy cuisine. Commonly lauded as one of the most healthy cuisines in the world, nutritional experts are quick to list the many benefits of a purely Vietnamese diet.
Antoine Yvon, a former nutritionist at Centre Medical International, wrote in a former issue of #iAMHCMC that “[a]s a professional, I have seen that dishes and ingredients used in Vietnamese cuisine can cover all the dietary needs on protein, lipids, carbohydrates, vitamins and minerals because there is a great natural diversity of agricultural products.” He goes on to conclude that “It is this diversity and variety that are the foundations of a healthy and balanced lifestyle.”
The common example is usually a bowl of pho. Here you have everything you need for a balanced diet: fats, proteins, starches and, of course, plenty of vegetables.
Building a Foundation
“Nutrition is the foundation for everything that we do,” Phil Kelly says simply. “You can be very, very healthy and not exercise. If you exercise and don’t have your nutrition and lifestyle right, you can be unhealthy.” Kelly describes the basic tenets of nutrition and its part in health: our bodies are in a continual process of rejuvenation.
Our cells grow and die, renewing our skin and cellular tissue—the cells of our bones, for example, completely regenerate every 10 years. However, the strength of the cells, and therefore the strength of our bodies and health, depends primarily on the food we use to fuel the process.
Antoine Yvon says that 40 percent of cancers in Vietnam are linked to food consumption, caused mainly by processed foods, bad eating habits and the presence of pesticides and chemicals. Professor Hoang Dinh Chau, the director of the Hung Viet Cancer Hospital, says that in Vietnam more people die from cancer caused by unsafe food than from smoking, a shocking statistic when you consider that over 45 percent of men in Vietnam smoke habitually.
Cancer is just one example. Other non-communicable diseases caused by poor diet include cardiovascular diseases, diabetes and chronic pulmonary diseases; it’s estimated that 7 out of 10 deaths in Vietnam are caused by cancer or one of these chronic diseases.
Getting Bigger Faster
The decline of nutrition standards, and the adverse effects that come with it, is nothing new to Vietnam, or even the world. Case in point: obesity.
A well-publicised study published in The New England Journal of Medicine last July found that worldwide, 2.2 billion people are considered overweight. Unsurprisingly, the US was found to have the greatest number of obese adults (79.4 million people, almost a quarter of the population), while Vietnam and Bangladesh were tied for last—8.1 million people in Vietnam were overweight, less than two percent of the adult population.
While these results are undoubtedly good—especially for a country ranked seventh-to-last in terms of daily physical exercise, according to a global survey put out by Stanford University—the rising rate of obesity is cause for alarm.
The obesity numbers have risen steadily in recent years, although the exact statistics depend on which studies you read. A recent study by the University of Washington has shown a 6.8 percent obesity rate in Vietnamese children aged 2 to 19 (to put this in context, the US’s current rate is 28.5 percent), while a survey by Vietnam’s National Institute of Nutrition has listed the childhood obesity rate in urban cities to be as high as 40 percent in major cities, an increase of almost 10 times from a decade ago.
While it can’t be called a fully fledged epidemic at the moment, Antoine Yvon points out that the number of Vietnamese children under five years old with weight problems has doubled in the past four years, and the rate of obese grade-schoolers in Ho Chi Minh City tripled from 2002 to 2009.
The municipal administration of HCMC aims to keep the rate of overweight and obese children under five years of age at less than 12 percent by 2020; as of yet, no public campaigns have been pursued.
East vs. West?
The changes in health, especially in urban and increasingly modernised areas, seem to point to a widespread shift in the way Vietnamese people feed themselves and their families. This has roughly correlated with Vietnam’s entry into the World Trade Organisation in 2007.
Has the influx of Westernised food products spurred the changes?
Jake Pulkrabek, a barbecue specialist who owns Jake’s American BBQ in District 1, said that although Western food is now more prevalent in Vietnam, that doesn’t necessarily mean that Vietnamese people are flocking to it. Pulkrabek’s business model emphasises American authenticity, and for him that starts with the ingredients.
“When you’re trying to make something as authentic as possible, you have to use a lot of imported ingredients. So that always brings up the price a bit more than the local cuisine, which makes it a little more challenging for the locals to come and try it.”
Hitting the right price points is important in a country still in the throes of development, where the average annual income per capita is below US$2,000 in HCMC. Even fast food, considered a cheap food option in Western countries, is a spendy splurge in Vietnam.
Although around 85 percent of Pulkrabek’s clientele are expats or foreigners on business trips, he has noticed a loyal following among Viet Kieus—Vietnamese people who have spent time or grown up abroad, many of whom are heading back to Vietnam. With a more diverse palate and a taste for Western cuisines, Viet Kieus act as a bridge between the two culinary worlds, aided by a growing middle-class income that allows for a dinner out.
Dr. Thanh from Victoria Healthcare considers the issue from all angles. “As a specialist in nutrition, I do welcome the wide introduction of foreign foods in Vietnam,” she writes. “I can understand the worried views, however, from my opinion, food is a pleasure, and having the opportunity to try different foods is a blessing; why do we have to reject it? Eating right does not mean we have to starve until death. It means we have to be smart and put everything on our plate with a sense of control.”
Worse Before it Gets Better
Rather than throwing the baby out with the bathwater, experts have been looking at individual factors in the shifting food landscape, above all: portion size, sugar consumption and an increased use of processed ingredients.
Phil Kelly is adamant that portion size plays a big role. “With a rising economy and additional [spending money], people are going out and enjoying more food. It’s treating yourself.” Kelly has observed that Vietnamese eaters are generally controlled, but he sees voracious appetites in children especially, encouraged by parents who might not understand the adverse ramifications of too much food.
On a cultural level, Kelly also worries about the ubiquitous use of sugar in modern Vietnamese cooking, a culinary trend especially prevalent in the South. Studies have shown that diabetes rates have grown particularly in the Mekong Delta region. Kelly recalls that when he moved to Ho Chi Minh City five years ago, “when [I] asked for no sugar, it was quite an issue to really explain it.” Today he sees more knowledge of the health defects of sugar, though the use of it in cooking is still strong.
Above all, Dr. Thanh worries most about sugar consumption in young people today. She writes that on the weekend, it’s common to see young people clutching a sugary milk tea. This, combined with “the habit of using sugar in almost every recipe, especially nuoc mam,” is cause for concern.
The government is also taking note of excess sugar consumption and has proposed an additional tax on imported soft drinks—a controversial proposition that has garnered plenty of criticism from advocates of free trade. The tax would join the ranks of neighbouring countries like Cambodia (10 percent tax) and Thailand (20 to 25 percent tax), although nothing has yet been mandated.
When asked about the issue, Jake Pulkrabek sees similarities in America: “In America, we’re getting to the point where everything we eat is out of a box or a bottle.” As convenience stores like Circle K, Family Mart and recently 7-11 have taken hold in the FMCG market, chances are the situation will get worse before it gets better.
Education Is Key
As Vietnam modernises and the middle class continues to grow, consumer spending has outpaced public education and awareness of health and nutrition.
Many people agreed that the general perception of health and the body is limited, leaving the market open for global food distributors whose sales in Western countries have stagnated.
“The whole snacking phenomenon came about when food companies were searching for new markets,” Phil Kelly notes. “It wasn’t that we needed to snack. Highly advertised packaged snacks came into existence for a purpose… When was the last time you saw a TV advert for broccoli?”
Dr. Thanh describes her own journey towards becoming one of Ho Chi Minh City’s first Vietnamese nutrition specialists when she saw the adverse effects of some foods: “I came to the conclusion that nutrition is one of the most [serious] problems for patients, but at that time we were not taught nutrition at school. That was the reason I chose to join a newly established nutrition department in my university.”
Today Dr. Thanh is pioneering nutrition education with the help of Victoria Healthcare. She heads up a program called MyPlate, which counsels Vietnamese women about healthier cooking options.
And just as Vietnamese people who have spent time abroad come back with altered palates, they also come back with new information and outlooks about food in general. Cindy Kawak, General Manager of Propaganda Bistro, has noticed a shift: “They come back with different knowledge, with different views of health and the world. And they share it.” Kawak describes her experience becoming vegetarian, and seeing the curiosity of her staff. “Now some of them want to go that way too. They see that it’s not killing me, but in fact quite the contrary.”
Small shifts are perceptible on the business side of things as well: a recent Nielsen’s Consumer Confidence Index report for Vietnam has determined that 34 percent of Vietnamese consumers list health as a number one concern; Nguyen Van Viet, the chair of the Vietnam Beverage Association, has reported a trend away from sugary drinks and towards juice drinks or drinks with reduced sugar.
But a clear top-down educational structure has yet to be developed. At the moment, most people in Vietnam gain knowledge through their own efforts, rather than at school or through media campaigns. As food-related disease rates inch higher, can knowledge be gained before the damage is irreversible?
SAIGON INSPIRATION HEALTH DEADLY CONSEQUENCES: THE LACK OF SWIMMING INSTRUCTION IN VIETNAM
The then-18-year-old swimmer Nguyen Thi Anh Vien made national headlines in 2014, when she won the first ever Asian Games medal for Vietnam in swimming.
Born in Can Tho, Anh Vien was one lucky Vietnamese child, as she began swimming with the guidance of her grandfather. The majority of Vietnamese children, however, do not receive swimming lessons at a young age. A recent survey found that only 35 percent of children in the Mekong Delta and 10 percent in the Red River Delta can swim.
A National Epidemic
This lack of swimming skills is closely linked to the consistently high number of drowning cases among Vietnamese children and teenagers. In 2005 and 2006, a total of 7,249 children died from this preventable cause, as reported by the Ministry of Health (MOH).
A 2016 report by the Ministry of Labour, Invalids and Social Affairs (MOLISA) shows that this shocking number has not fallen after a decade: an average of 6,400 people die from drowning in Vietnam each year, over 50 percent of whom are children. This means that everyday, about 10 Vietnamese children die from drowning, the highest rate in Southeast Asia.
There are numerous reasons why this is such an epidemic across the country. Vietnam is famous for its 3,260km coastline, as well as for its bevy of rivers, springs and lakes throughout the country. These landscapes of scenic beauty are potentially dangerous environments, as children like to spend time there during summer months, often without adult supervision. There are also frequent risks of flash floods in mountainous landscapes, and rip currents along the coastline—especially in the country’s central region.
Even uncovered water storages, wells and construction holes can cause child drowning, as young children are not entirely aware of the inherent dangers while playing near these things. Left on their own when their parents are busy working, they might accidentally trip and fall, or even climb inside, not knowing how to get out.
Preventable but not Prevented
According to WHO, drowning is the leading cause of death among Vietnamese children aged 5 to 14. Yet, swimming lessons are not a compulsory part of the school curriculum, and generally Vietnamese parents do not view swimming as an indispensable survival skill.
Only parents in big cities like Hanoi, Saigon and Danang are likely to send their kids to private swimming classes held during the summer at various swimming pools around the city. These range from inexpensive and overly crowded public pools to highly priced private pools inside hotels or condominiums.
The price for a basic swimming course is not cheap compared to the average monthly income, around VND2 million (US$90) per child. However, many parents would rather pay more than this amount for their children to join a summer English course instead.
In rural areas, swimming facilities are few and far between, hence the lack of adequately trained teachers. Children who manage to learn to swim are mostly taught by their family members or even their friends, in a pond or river near their village.
Many believe that swimming can be self-taught, as our “reflexes” kick in when thrown into water. However, these reflexes are only seen in babies for a short period of time underwater, and more importantly, babies are not strong enough to be able to swim.
The use of safety devices, such as life vests, ring buoys and floaties, is largely limited to swimming pools and beaches, and rarely seen in countryside waters, where they might be most helpful.
Hope for the Future?
While there are no policies in place to encourage and facilitate swimming learning among Vietnamese children, organisations such as SwimSafe have stepped in to provide primary school children in Danang with free swimming lessons.
As Nguyen Thi Anh Vien said during the launch of the “Fund for Drowning Prevention and Swimming Literacy for Vietnamese Children” by the Vietnam Aquatic Sports Association in 2016, “I wish that more and more Vietnamese children would know how to swim, and there would be no more heartbreaking accidents caused by drowning.”
These facilities do help, but news of their construction runs in tandem with reports that the Dong Nai River still faces large amounts of chemical contamination. As Amy Keegan from WASHwatch wrote, “there is still work to be done.” Currently, 1 in 10 people still do not have access to water, and 1 in 5 people don’t have access to basic sanitation. And with chemical pollution looming large, we’re all currently facing the downsides of rapid industrialisation.
SAIGON INSPIRATION HEALTH FRESH AIR OR GHASTLY GASP: GETTING CLEAR ON SAIGON’S AIR
The Culprits
According to IQAir, a Swiss company that specialises in air purifiers, the main causes of air pollution in Vietnam are traffic and industrial, handicraft and construction activities, with traffic accounting for 70 percent of pollution in urban areas. The air that we breathe is laced with carcinogenic substances. According to research by the World Health Organization’s cancer agency and Yale University, Vietnam is among the top 10 countries in the world for air pollution.
Measuring It
Air pollution consists of different components: oxides of nitrogen which consists of nitrogen dioxide (NO2) and nitric oxide (NO); carbon monoxide (CO); sulphur dioxide (SO2); and particulate-matter (PM), which includes particles that measure below 10 micrometres (PM10) and the more dangerous 2.5 micrometres (PM2.5)—dangerous because that’s small enough to bypass your body’s natural filtration system and end up deep in your lungs. (The diameter of a strand of human hair is 50-70 micrometres.)
Most PM2.5 particles are byproducts of organic compounds, combustion and metals, which mostly originate from industrial zones and exhaust fumes from vehicles.
What’s That Smell?
However, air pollution isn’t just limited to factories and combustion. In September 2016, the Da Phuoc landfill, run by Vietnam Waste Solutions Inc (VWS) in Binh Chanh District, was caught in a stink when it was found to have been illegally discharging sewage that exceeded safety limits.
This ended up with residents in District 7 and neighbouring areas having to deal with a bad stench for a few months, which only got worse during the rainy season and reached unbearable levels at night. The operator ended up getting fined more than VND1.5 billion (US$66,000).
What You Can Do
Air pollution affects the entire troposphere — the lowest levels of the atmosphere in which we mere mortals live — but is anthropogenic, meaning it’s man made and something you can’t easily escape from.
So how can you play your part to ensure you’re not contributing to it?
The first step is to limit the amount of exhaust fumes on the road by either carpooling, riding a bicycle if the journey is short or taking a bus. If you’re driving or riding a motorbike, ensure that your vehicle is well-tuned and maintained, change the oil and filters and check your tyre pressures and wheel alignment. If you’re going to be stationary for a while, turn off your engine. Idling is just contributing unnecessarily to the pollution.
Other than the roads, you can also make a few adjustments to some of your daily tasks. Conserve energy by turning off your lights and electric appliances when not in use, use energy efficient light bulbs and appliances, use water-based or solvent free paints, and buy products that say “Low VOC”. Make sure all containers of household cleaners, chemicals and solvents are sealed, to prevent any of them from evaporating into the air.
Or just eat your way out of this problem
According to new medical evidence discussed in a New York Times opinion piece on air quality and diet, a Mediterranean diet — fish, nuts, fruits and whole grains — may go a long way towards strengthening the health of those who are low on high-quality air (read: us). There’s some interesting new research out there that suggests Vitamin B, fish oil and broccoli sprout extract drives down heart rate variability of individuals exposed to air pollution.
So, have some fish tonight and maybe finish off with a banana for that Vitamin B. It may be the best defence against HCMC’s unhealthy haze.
SAIGON INSPIRATION HEALTH VIETNAM’S CHALLENGING HEALTHCARE SYSTEM
As Vietnam continues to rapidly evolve, the country will need to do its fair share of systematic restructuring to meet higher demands. This includes reshaping its $12 billion healthcare industry to meet international standards. This is not an easy task.
The Current State of Healthcare in Vietnam
Everyone probably agrees that Vietnam could use a bit of advice in regards to its healthcare management. With nearly 30 years of experience working as a doctor in Vietnam, Dr. Rafi from Family Medical Practice is in a good position to offer many informed suggestions on how to produce better results in the field of healthcare.
First, it is important to know that there are two kinds of healthcare systems running concurrently in Vietnam: one is the government ran hospitals, and the other is the foreign dominated private sector. The private sector is made up of small independent clinics. Understanding the difference between these two healthcare options is key in understanding how we can all work together to create a more efficient system for everyone.
The simplest suggestion that could be made in regards to hospital improvement is to focus on a thorough reorganisation of its current system. One of the most significant problems is the lack of modern equipment. Locally produced technology is implemented in many hospitals. Unfortunately, this is not sufficient to provide quality service to patients as it doesn’t meet international standards. Additionally, local doctors often rely too much on the equipment that they have as a crutch rather than a tool, and this can often result in poor treatment.
Issues like overcrowding, poorly trained doctors, a lack of proper pharmaceuticals, and an overall disinterest in systemic modification have left many people wondering just what exactly is going on here. On this ward, we have three doctors and ten nurses for 1,200 hemophilia patients. And, we have to take care of all other blood disorders that come in for treatment… it is better than three years ago.” – Nurse at Vietnamese hospital
Creating Clinic-style Services
Overcrowding is another issue to be addressed, as anyone who has ever entered a local hospital can immediately notice. What are some ways that Vietnam can restructure their system in order to facilitate less traffic in hospitals? One idea presented by Dr. Rafi is to create small clinical establishments as an alternative to hospitals. Often, locals from the countryside have to travel to major cities in order to get proper medical treatment.
The current structure for medical care is too centralised in cities, leaving those residing outside of major centres in need of better treatment in close proximity to their homes. Perhaps if there was more of an interest and motivation to privatise the rural hospitals, there would be a significant increase in patient care. One important thing to mention here is that this kind of restructuring would not cost much money at all. Instead, it would require time spent planning, rethinking and reorganising, while cooperating with private sectors and medical authorities.
Enhancing the Private Sector
The private sector is clearly on the rise as more privately ran hospitals are opening in HCMC, as well as other major cities. This has occurred as a result of the underdeveloped options available, which have sparked a desire in private interests to help create more efficient treatment facilities.
The government allows foreigners to practice in Vietnam, but they are limited to primary care and are usually (given a few exceptions) not allowed to operate or own their own hospitals. There is clearly a hesitance to allow foreign doctors and hospital managers to enter the “healthcare bubble”. As a result, you have two different systems (private sector and government ran) operating parallel to each other, when in reality they should be working together to create a better model.
Perhaps building a better network and creating more cooperation between the two sectors would be the more practical way, especially considering that the private sector has seen growth in the past several years. A report also showed that there are more than 30,000 private polyclinics, 87 small-sized maternity hospitals, 30 foreign-invested clinics, and 29 clinics with involvement of foreign doctors across the country.” (ngocentre.org)
Doctor Quality
Another important issue to discuss is the quality of doctors here in Vietnam. It seems that most people, both foreign and local, don’t often trust your average run-of-the-mill physician, and for good reason. The Vietnamese population spends over $4 billion a year seeking medical treatment in places like Bangkok and Singapore due to the limited amount of qualified and skilled practitioners available here. They don’t trust the services provided at the hospitals, corrupt doctors and therefore decide to have medical attention attended to abroad.
Another reason for this is that unlike Thailand, whose doctors are trained overseas and then return to practice in their home country, the best Vietnamese doctors leave for international quality training and do not return to Vietnam. This is because the salary is low, the working conditions are not ideal, and there is not really any benefit for them to utilise their skills here.
In many other countries doctors often enjoy a handsome salary, high social status and strong government support. However, this is often not the case in Vietnam. This pushes the well-trained doctors away and enables “grey medicine” to occur. We’ve all heard the stories about how some doctors choose to compensate for their low salary, and these are often shocking to hear.
“The Vietnamese population spends over $4 billion a year seeking medical treatment in places like Bangkok and Singapore due to the limited amount of qualified and skilled practitioners available here.”
On a rather more positive note, it is worth mentioning how the prevalence of English is having a direct correlation on the education of doctors. Considering the fact that learning English is inarguably a high priority in Vietnam, the results are clearly carried over to one’s inherent ability to self-educate.
Doctors now have the ability to comprehend international medical publications, research data and other valuable information that was inaccessible before. Doctors that are driven and have a thirst for knowledge can readily use the internet as a tool to learn more about medicine and apply it to their daily practice.
What’s Next for Health Care in HCMC?
While the country progresses economically, people are becoming more educated and aware that there are serious problems facing healthcare. As locals also become more exposed to higher quality services offered in other countries, we can be sure that the demand for changes to be implemented will be on the rise. The question is, how will such public outcry be handled and will there be attempts to refine the system on a national scale? If not, Vietnam will continue to put its money into the pockets of other doctors abroad, and the less fortunate will bear the burden of such a system.
SAIGON INSPIRATION HEALTH WHY SO NOISY? NOISE POLLUTION TAKES TOLL IN VIETNAM
While many have talked about air pollution and its risks to human health, the ramifications of noise pollution in Vietnam’s big cities is usually underestimated. A study released July 20 by the Ministry of Health’s Institute of Occupational Health and Environment found that between 10 and15 million out of the 52 million people working in Vietnam are exposed to excessive noise.
VnExpress quoted the report, saying noise levels on 12 major streets and junctions in Hanoi were measured between 77.8 and 78.1 decibels during the day, way beyond the safe level of 70.
The report goes on, asserting that the average noise level of Hanoi at night is between 65.3 and 75.7 decibels, higher than the safe level of 55 In Ho Chi Minh City, 8 out of 14 spots with noise detectors also violated acceptable levels, according to measurements recorded in June. In industrial zones the problem is even worse, the report states.
Contributing Factors
Scientists believe the main factor at play in Vietnam’s high level of noise is traffic. There are around 7.5 million motorbikes in HCMC, Vietnam’s most densely populated city with a population of 12 million. Hanoi ranks second with around six million motorbikes. The sounds of motorbikes, cars and honking, especially during rush hour, have become typical features of Vietnam’s big cities.
Vietnamese people have the habit of beeping horns often as they drive, although there are regulations on horn-honking. The noise also comes from the increasing number of construction sites in the cities, a result of rapid urbanization.
Residents usually complain that fashion shops play music at high volumes, and neighbours sing karaoke loudly throughout the night. Road users are sometimes frightened by the motorbikes that are revved up with modified, loud exhausts, which produce near-deafening sounds, done apparently only to attract more attention.
In residential areas, people with little awareness of public spaces turn on high-capacity speakers for weddings, parties and other large events, which can negatively affect residents in the neighbourhood. Food sellers on the streets also contribute to the noise, though many tourists have said they like the sounds of street vendors, as they make Saigon and Hanoi special.
Health Effects
Doan Ngoc Hai, director of the Occupational Health and Environment Institute, said that noise pollution can have long-term effects, including hearing loss, sleeping disorders, high blood pressure for adults and cognitive impairment for children. Although noise pollution is the second-most dangerous kind of pollution after air pollution, Doan complained that it receives little attention from companies and organizations.
Up to 80 percent of companies in a recent survey do not have any solution for noise control, while they are aware that workers’ productivity decreases if they work in an excessively noisy environment. Only 10 to 15 percent of the surveyed companies arrange hearing checkups for workers.
Doctor Le Cong Dinh of Bach Mai Hospital in Hanoi told Ha Noi Moi newspaper that around 500 to 600 people come to the hospital every day for ear, nose and throat conditions, of whom 15 to 20 percent have hearing problems. Nguyen Thi Quynh, a resident of Hanoi, told the newspaper her family members have sleeping disorders and her children are less focused due to excessive noise.
SAIGON INSPIRATION HEALTH BEHIND THE BLEACH: VIETNAMESE WOMEN’S OBSESSION WITH WHITE SKIN
Rochelle Nguyen, a 25-year-old Vietnamese-Canadian woman who teaches at a prominent English centre in Ho Chi Minh City, explained how she went to get a health check in order to obtain a work permit. “They take a urine sample. They check your eyes. They check your teeth. They check your skin.” (Rochelle accompanied the word skin with air quotes.)
She related this story over a bowl of bo kho in a tiny eatery located in one of the off-the-beaten track hems of Phu Nhuan District. Rochelle explains how she was doubtful about the proposed skin test, but decided to subject herself to it anyway because she needed to in order to work.
“All they looked at were my hands, back and forth, and then [the doctor] was like, ‘Hm. Your skin is really dark. You must like the sun…You’d look better if you were lighter. Lighter girls are prettier.’ It wasn’t even like, ‘Stay out of the sun; it’s bad for your skin’ or anything like that!”
Rochelle was floored by both the non-medical nature of the doctor’s advice, and the boldness with which he dismissed her skin tone as unattractive. The question arises: why are so many Vietnamese women obsessed with having white skin?
Ho Chi Minh City’s ‘Street Ninjas’ Avoid the Sun
On a walk around Ho Chi Minh City, you can see the care in preserving skin whiteness in the fashion of the women driving around on scooters and motorbikes. Women are covered almost entirely from head to toe in combinations of helmets, scarves, sunglasses, facemasks, long sleeves, gloves, long pants, and socks (even if they’re wearing open sandals).
This ‘street ninja’ motif, as it has been dubbed by some, has become a staple style in Ho Chi Minh City’s fashion culture, while serving the purpose of shielding women from sun rays.
Photographer Mona Lippi explores the culture of skin covering amongst Vietnamese women in her series of photos entitled “White Skin”. While many might see this penchant for covering as something that strips the wearer of individuality, Lippi marvels at the distinctiveness of each subject.
Lippi said, “I was very interested in the original, colourful, modern individuality of each driver. Vietnamese love to keep their white skin and even in the humid tropical heat, they wear many layers to keep out the sun.”
Many Vietnamese women would rather sweat while wearing layers of clothing than expose their skin to the browning effects of the sun’s rays.
Whitening Agents in Vietnam’s Skin Care
You can also see reflections of the obsession with skin whiteness while perusing the skin care aisle of a local Co-Op mart. For example, finding lotion that isn’t advertised as having some kind of skin-bleaching properties is nearly impossible.
My, a 25-year-old local Vietnamese woman from the centre of Vietnam, gave her thoughts about the ubiquity of skin-whitening products. “Vietnamese people prefer to have white skin. In their minds, white skin stands for being rich and beautiful so they want to buy a skincare product that helps them to have white skin.”
It becomes clear that there are assumptions about class attached to skin color, a sociological fact that is not particular to Vietnam, but is ubiquitous throughout Asia.
Mimi, a 24-year-old woman of Vietnamese descent who was raised in Europe, wrote via Facebook messenger that “In terms of historical classism, and the way it was explained to me very early on by my own parents, it was only royalty and wealthy people who could afford to sit indoors and avoid the sunlight. The working class had to be out and about in the fields, on the streets, hence the exposure to the sun and darker skin.”
Nguyen Oanh in an interview with Asia Life Magazine supported this assertion by saying, “For Vietnamese women, being white means that you are beautiful, that you are a person who has money and doesn’t work too hard. Darker skin means you have to work hard and you don’t have time to make yourself more beautiful.”
Tu, a 30-year-old local woman from Hanoi adds that there’s also an east Asian influence at play. When asked about skin-whitening products, she notes that they have been “…endorsed by celebrities, advertised on national TV for decades. Influenced greatly by Japanese and Korean culture since early 2000s, where women there have naturally lighter skin.”
On another note, Tu points out that the penchant towards white skin can also be attributed to the lack of options provided by makeup manufacturers.
Vietnamese women with darker skin “… have no makeup products that match their skin tone just yet. That’s why having lighter skin allows them to have more natural looking made-up faces. It’s quite a homogenous society, so there’s a delusion that one could obtain exceptional white skin by paying a lot of money for products. The truth is that some people’s skin will just remain the same tone, unless [they use] invasive intervention.”
When asked her own opinion about why women in Asia seem to be obsessed with having lighter skin, she adds, “They associate lighter skin with a better lifestyle. Probably from years of being colonised.”
What’s Colonialism Got to Do With It?
What does colonisation have to do with it? My Tho is a city of about 220,000 with only a handful of western expats living there. Even though there are a dearth of westerners taking residence in My Tho, a good percentage of the advertising aimed at the local population features caucasian faces. One could wonder who the target audience for this marketing is, considering the fact that nearly the entire population of My Tho are local Vietnamese folks.
Are the beauty standards being promoted the result of the ‘opening’ of Vietnam to the absorption of western ideals via globalisation? Are they an echo of Vietnam’s colonial past and its relationship with Europe via the French?
Vietnam has a history of incorporating the ideas, fashion, cuisine, architecture and religion of former colonisers into its own culture. As a historical practice, Vietnam has traditionally expelled its subjugators while keeping some positive aspects of their cultures. (“Thanks for the Buddhism and the noodles, China, but you have to go now.” “Thanks for the banh mi, the infrastructure, and the modifications on the ao dai, France, but we’re done here.”)
It is likely that at least some ideas about whiteness and its proximity to wealth and power were handed down from Vietnam’s former status as a French colony.
Fewer Incidents of Skin Cancer in Asia?
Vietnamese women’s avoidance of the sun does have a practical benefit. During the sun-drenched months of the dry season, the sun’s rays are powerful and dangerous. People in western countries who have the inverse obsession as the Vietnamese and enjoy tanning, pay a high price for their sun-worship. Although this is at least partially due to genetics and lack of melanin in caucasians, white westerners have the highest incidents of skin cancer in the world.
Vietnam ranks on the list of incidents of skin cancer by country, 165th out of 183, according to the World Life Expectancy website. It even ranks lower than Iceland, Finland, and Norway, countries that experience dark winters lasting for months.
The preference for white skin amongst Vietnamese women is influenced by a score of factors. Even men get caught in the undertow of perpetuating beauty standards that hold white skin as being preferable. Recent studies have shown that Asian men are investing in skin bleaching products, possibly influenced by imported media from East Asia.
Perhaps in time, Vietnam will become so influenced by its western counterparts that one day tanning beds will be a staple of Vietnamese spas. In the meantime, we can be sure that the ‘street ninjas’, covered from head to toe on the eternal quest for the milkiest of skin, will remain iconic features in the tapestry of Vietnam.
SAIGON INSPIRATION HEALTH 11 TIPS TO STAY HEALTHY WHILE LIVING IN HO CHI MINH CITY
Life in Ho Chi Minh City has a unique set of health challenges that can easily be managed with our following tips!
So you’ve set your eyes on Vietnam as your destination to relocate, or maybe you’ve been living here a while? It’s no surprise: the South East Asian metropolis has quickly become one of the top global destinations for expatriates, providing some of the highest quality of life in the world for expats, thanks to a relatively low cost of living, a booming economy and access to pretty much everything you could want or need.
However, as a bustling city in a mostly subtropical developing country, Saigon’s physical health hazards abound. Add to that the stress that comes with being far from home, navigating a completely foreign culture and not having a solid support system of loved ones and friends. Maintaining mental and physical health can be a challenge.
But don’t worry! If you follow these 11 tips on how to maintain your health and wellness while living and working in Ho Chi Minh City, you’ll be able to stay on top of your game and get the most out of your new life here.
1. Listen to the Health Signals your body
To stay healthy, be aware of the signals your body is sending you. The common flu-like side-effects of most diseases can and will eventually occur. Horror stories of food borne illness, mosquito-borne viruses, parasites and communicable diseases can make some symptoms seem terrifying.
More often than not, they are signals of manageable, non-disease related issues like dehydration, sleep deprivation and exposure to higher levels of pollutants, to name a few. Listen to your body and be sure to seek professional advice whenever concerned.
2. Familiarize yourself with the Healthcare Landscape
Before you arrive, research clinics, hospitals and urgent care centres near your workplace and home. That way, you know where to go in case of an emergency. The Vietnamese Government invests greatly in pharmacies and hospitals, so there are options all around Saigon.
Pharmacies can be found in most neighborhoods and all you need is a generic name of the medicine you need, or you can just describe your symptoms to your local pharmacist and get most medications for a cheap price.
3. Choose Healthy Food Options
Food in Vietnam has different microorganisms, and the food safety standards are low for most places. As you eat your way through the country, use discretion. See how the food is prepared, make sure it is cooked fresh and has not been sitting too long, or that it is re-cooked to piping hot before serving. If you want to maintain a healthy and well-rounded diet, the best option is to cook your own food at home. That way you can control the quality of what goes into your body.
4. Maintain Physical Health with Activity
International sporting activities like CrossFit, soccer, weight lifting and yoga are on the rise in Saigon, as locals continue to search for the perfect daily routine for healthy body and mind. Simply visit your local park in the morning or early evening and you’ll see people flocking to stretch and move their bodies. Most districts have local and foreign gym options, parks with calisthenics equipment or boutique studios offering other means to keep active.
5. Explore some Alternative Medicines
Overseas, traditional Asian practices like cupping therapy or acupuncture can cost a fortune. In Vietnam, these wellness regimes are commonplace and much more accessible. Like anything, you should research the practice and practitioner and seek professional medical advice before you get any type of treatment for any disorder.
6. Wear Protective Clothing
The heat in Vietnam can be unbearable. Still, it’s important to protect your body! Overexposure to the equatorial sun can cause health issues, so wear light clothing to cover up commonly exposed skin areas. Dawn and dusk are high times for disease-carrying mosquitoes, so cover your limbs in long, loose-fitting clothes to avoid getting bit. Also, air pollution is a big problem throughout the city, so try to make wearing a filtration face mask part of your daily routine to protect your lungs from gases and dust.
7. Prioritize your Mental and Emotional Health with Self-Care
It is easy to get lost in the excitement of socializing, the demands of work deadlines and the overall adjustment phase we all go through when relocating to Vietnam. In order to avoid having a mental or emotional breakdown, take time out for yourself! Go to a spa, Netflix and chill, read a book in the park, meditate, anything to help you decompress and reset your frame of mind.
8. Look after your Relational health and Keep in Touch
Homesickness comes and goes. To cope with it, be sure to reach out to people who make you feel at home. Part of the adjustment process is sharing what you are going through. Just err on the side of caution: keeping in touch with loved ones abroad can make homesickness even worse!
9. Make New Friends
Your family and friends back home won’t always be able to relate or understand what you are going through, which can feel isolating. However, most foreigners here are going through similar challenges, which is why they are generally easier to talk to than your friends back home. And people start to feel like family very quickly. Both foreigners and locals are warm and easy to approach and most people are willing to help if you ask.
10. Explore New Things
Humans love familiarity, and even in a place like Vietnam it’s easy to get too comfortable with routine. As you settle in, don’t forget to continue to try new foods, see new angles of your city, take a short staycation or vacation to a nearby town or province, keep your experience here dynamic so that you’re constantly stimulated and don’t begin to feel stagnant.
11. Take up a Hobby
In a place like Saigon, you will be a ‘big fish in a small pond’. In many hobbies that are popular back home such as stand-up comedy, singing or dancing, you may face less competition and pressure to outperform others. Saigon is a great place to get your feet wet, dabble, and try some new things! Be brave and challenge yourself to something outside of your comfort zone. Plus, classes are often way more affordable here.
Staying Healthy in Ho Chi Minh City is totally doable!
No matter where you go to live in the world, maintaining a healthy lifestyle takes work! Even though life in Vietnam will present itself with health challenges, if you follow these simple tips, you are sure to take some of the mess out of the stress and have a more balanced Vietnam Expat experience in Ho Chi Minh City.
SAIGON INSPIRATION HEALTH SAIGON’S CAN COUNT ON A WEALTH OF HEALTHCARE PROVIDERS
Looking for an effective oncologist or just need to get a routine annual teeth cleaning? Look no further than City Pass Guide’s list of health specialists in Ho Chi Minh City. We’ve compiled a list of 14 healthcare providers including doctors in a range of fields and specialties. And they’re all working in Saigon here to get you well again.
Cardiology
Tam Duc Heart Hospital
4 Nguyen Luong Bang, D7, HCMC, Vietnam / +84 28 5411 0025
hospital@tamduchearthospital.com / tamduchearthospital.com/home/en
Dedicated to all matters of the heart, Tam Duc Heart Hospital has been the go-to cardiology stop for years. Private clinics will have excellent cardiology departments, but the heart is Tan Duc’s bread and butter.
Oncology
FV Hospital
6 Nguyen Luong Bang Tan Phu, D7, HCMC, Vietnam / +84 28 5411 3333 /
information@fvhospital.com / fvhospital.com
FV’s Hy Vong Cancer Centre is top-of-the-line and has the Joint Commission International’s Gold Seal of Approval. Both Dr. Vo Kim Dien and Dr. Tran Thi Phuong Thao are highly experienced and fluent in English, French and Vietnamese.
Gastroenterology
Victoria Healthcare
20-20Bis-22, Đ. Đinh Tiên Hoàng, Đa Kao, D1, HCMC, Vietnam / +84 28 3910 4545
info@victoriavn.com / victoriavn.com
Helmed by Dr. Nguyen Vinh Tuong, a member of the American College of Gastroenterology and the American Society of Gastrointestinal Endoscopy, this department is fully equipped and internationally known.
Obstetrics and Gynaecology
Hanh Phuc Hospital
Binh Duong Boulevard, Thuan An District, Binh Duong Province / +84 274 363 6068
info@hanhphuchospital.com / hanhphuchospital.com
The most well-known and beloved women’s health department in the city. Top marks go to Dr. Robert Riche, a native of France, who runs the department with great aplomb and bedside manner.
Diagnostics
The Diag Medical Center
414-420 Cao Thanh noi dai, D10, HCMC, Vietnam / + 84 28 3979 8181
info@diag-center.com / diag-center.com
If you need to get a blood test, a screening or a general checkup, there’s no better place than the Diag Medical Center. It just opened a new and beautiful facility earlier this year.
Dentistry
Westcoast International Dental Clinic
27 Nguyễn Bá Lân, Thảo Điền, Thu Duc City, Vietnam / +84 903 670 159
17-19 Ly Tu Trong, D1, HCMC, Vietnam / +84 28 3825 6999
info@westcoastinternational.com / westcoastinternational.com
You’ll be able to find cheaper dentistry in the city, but if you want some quality work and peace of mind, we recommend Westcoast. One major advantage here is the large range of top-of-the-line dental equipment.
Elite Dental
75 Huỳnh Tịnh Của, Phường 8, D3, HCMC Vietnam / +84 28 3933 3737
inquiry@elitedental.com.vn / e.elitedental.com.vn
Patients love Elite Dental’s team: they’re warm, friendly and knowledgeable. They also specialise in dental implants.
Psychology
The International Center for Cognitive Development
191 Nguyen Van Huong, Thu Duc City, Vietnam / +84 0965 729 346
ICCD.hcmc@gmail.com / iccd.info
Azrael Jeffrey and his team of fully accredited mental health practitioners have been serving the Ho Chi Minh City community for two years. Plus, initial meetings are free of charge so you can find out if they’re a good fit.
Pediatrics
Victoria Healthcare
20-20Bis-22, Đ. Đinh Tiên Hoàng, Đa Kao, D1, HCMC, Vietnam / +84 28 3910 4545
info@victoriavn.com / victoriavn.com
Victoria Healthcare’s newest clinic includes not one but two floors entirely dedicated to pediatrics. One level is for checkups, while the other handles children with infectious symptoms—no cross-contamination here.
Hanh Phuc Hospital
Binh Duong Boulevard, Thuan An District, Binh Duong Province / +84 274 363 6068
info@hanhphuchospital.com / hanhphuchospital.com
Famously operating on “Singapore Standard”, Hanh Phuc has a pediatric centre, a safari-themed patient ward and a neonatal intensive care unit. They’re the real deal.
Neurology
Columbia Asia
Street 22/12, Lot 178, Hoa Lan, Binh Duong Province / +84 274 381 9933
customercare.binhduong@columbiaasia.com / columbiaasia.com
Columbia Asia’s Binh Duong hospital includes a high-quality neurology department. It can treat issues including Alzheimer’s, epilepsy, stroke and many more brain-related disorders.
Dermatology
Stamford Skin Center
99 Suong Nguyet Anh, D1, HCMC, Vietnam / +84 28 3925 1990
info@stamfordskin.com | stamfordskin.com
Internationally run and well staffed, this high-tech palace of skin care doesn’t just stop at dermatology. Come here for all your issues involving hair and nails as well, but expect an international-sized bill when you’re done.
Tropical Medicine
Centre Medical International
30 Phạm Ngọc Thạch, D3, HCMC Vietnam / +84 28 3827 2366
info@cmi-vietnam.com / cmi-vietnam.com
Dr. Nicholas Lagüe is one of the only tropical medicine specialists in the city. Vaccinations and treatments for tropical diseases should be presented to this qualified professional.
Optometry
Ngoc Toan Optical
106 Le Thanh Ton, D1, HCMC, Vietnam / +84 28 3823 2059 / 101eyewear.com
This small mom-and-pop glasses shop is a great and trusted place to a good eye checkup at a reasonable price. Vietnamese-owned, they speak fluent English, so you’ll be sure you’re in good hands.
SAIGON INSPIRATION HEALTH WHAT ARE THE HEALTH BENEFITS OF AIR FILTERS IN VIETNAM ?
Residents of Vietnam are seeking to combat the health risks caused by poor air quality by investing in air filters for their homes. The US Consulate monitors the Air Quality Index (AQI) on an hourly basis, and recent air pollution levels have been alarming.
The AQI is measured in ranges from 0 to 500, with 0 being the optimal level and anything from 100 to 300 classified as unhealthy, especially for sensitive groups such as children, the chronically ill and the elderly. Levels above 300 are deemed hazardous for the entire population. In late April and early May, HCMC saw AQI levels reaching as high as 200.
How Do Air Filters Work?
Air filters range greatly in the ways in which they work, their prices, and quality. Namni Goel, a professor at the University of Pennsylvania told Time Magazine that “Ionisers generate negative air ions, which attract dust and allergens and other positively charged airborne particles and basically lock them in.” However, a drawback of ionisers is that they produce ozone. Although ozone exists naturally in our atmosphere, it does so at low levels of concentration. At higher levels it can cause respiratory damage.
High Efficiency Particulate Air (HEPA) filters are rising in popularity due to their ability to trap up to 99.9 percent of particles from the air. Rufus Edwards, an Associate Professor of Public Health at the University of California, Irvine says that in large spaces “the amount of air in a room far exceeds the amount of air they are able to clean.”A Finnish study found that installing these filters into the heating, ventilation and air conditioning (HVAC) systems reduced exposure to particulates by up to 27 percent, which Edwards described as “enormous”.
The downside to the HEPA filters is that they are costly. They can also be noisy, some of them as loud as an air conditioner. The benefits of having a HEPA system are clear, especially for families with small children, people with allergies, asthma, or those who are susceptible to cardiovascular disease. Overall, they can be of immense value to anyone who believes that you can’t put a price on good health.
Where to Shop for HEPA System
Two top brands to check out are Coway, a highly rated Korean brand that is available at Coway.com.vn, Nguyenkim.com or Lazada.vn. Prices range from just under VND6 million to VND12.5 million. IQ Air, a Swiss company established in 1963, sells high performance air purifiers that filter out the finest pollution particles called PM2.5. No prices are listed on the brand’s website, iqair.com, but according to expat blogger ExpatHeather.com, these beauties can set you back as much as USD2,500 or close to VND60 million.
SAIGON INSPIRATION HEALTH WATER FILTRATION IN VIETNAM: MERE FUSS OR A MUST HAVE ?
You know better than to drink water from the tap, of course. But is filtered water enough to protect you from the dubious water quality of Saigon? Ask Aron Szabo, a water quality specialist with water filtration vendor BWT and the answer you get may not help you fall asleep tonight.
“It’s not just about drinking,” he said matter of factly. “You take in more water in a shower and bath. The largest surface for (liquid) exchange is your skin.” Depending on where you are showering in the city, your shower water may be served with non-negligible amounts of cyanide. In the North, you may have arsenic in your water supply.
A persistent problem that is ubiquitous almost everywhere is the levels of chlorine in the water. Szabo said the weak integrity of the city’s water pipe system—Szabo estimates about 26 percent of the water in Saigon’s water pipes exits through holes in the infrastructure—means that there’s an almost constant exchange of chemicals between the dirt outside of the pipe and the water inside the pipes. To combat this, the country’s water treatment specialists have introduced chlorine into the water treatment process.
That by itself isn’t a problem; in fact many European cities take the same approach to protecting their water quality. The issue is the amount of chlorine used in treatment. Water consumed in any city in Europe may have around .1 ppm (parts per million) of chlorine. A swimming pool has on average around .5 ppm chlorine in its water.
Vietnam’s water averages around .7 to 1 ppm in chlorine content. Test your water to determine if this is a problem and how severe it is. But you’ll know if your chlorine content is over acceptable levels with a few telltale signs: irritated skin and damaged or lost hair.
Help On the Way
Saigon recently brought on-line a water quality control system used in more than 100 countries specifically to help recover some of their lost water. Announced in January, the city’s water management company, Saigon Water Corp., launched an automated water-control system that will be able to, among other capabilities, immediately detect leaks, bursts and failed pipes in real time.
At the announcement, Saigon authorities noted that this is an important first step in recovering the 50 million cubic metres of water—the equivalent of 20,000 Olympic-sized swimming pools—lost annually. The losses add up to about $10 million in lost revenue per year.
Be Proactive
The incoming fix notwithstanding, Szabo said it’s within all Saigon residents’ interest to be proactive about this problem. A home water filtration system can be an easy and painless addition to your home. BWT can install their home water filtration system in about 15 minutes.
Depending on the kind of water filter you settle on, you may not have to replace the filter for up to a year. BWT’s water filters are nearly peerless in their thoroughness. The water filtration system filters items down to .01 microns in size, the size of your average virus and waterborne medication.
The city’s chlorine levels may be more serious than just the superficial concerns, like losing your hair or having itchy skin. Szabo cited emerging research showing breast cancer patients have high levels of chlorine in their cancer tissue. He warned that the link hasn’t been proven yet between cancer and chlorine but the possibility is one worth considering when weighing whether you can go without a high-quality water filtration system.
SAIGON INSPIRATION HEALTH POLLUTION, WATER AND DISEASE IN SAIGON: WHAT YOU SHOULD KNOW
We are all in danger of the negative effects of air pollution, water contamination, unclean food, worms and tropical diseases in HCMC. I sat down with Dr. Nicolas Lagüe from Centre Medical International to learn how we can manage to avoid these health problems.
Air Pollution
It’s no secret that there are substantial pollution problems in Vietnam. However, just how dangerous the air is, and exactly what effects it has on our health can be difficult to decipher. The main parts of the body that are affected by air pollution are the nose, throat, ears and lungs. Whether you are on a motorbike, in your car, walking or in your apartment, exposure to air pollution in HCMC is nearly unavoidable, and we need to make a personal choice if living here is worth the risk, especially considering how difficult it is to evaluate the related dangers.
Although driving a car exposes you to slightly less toxicity than when you are on a motorbike, it is still not enough to make a significant difference. In regards to your home, location is key. The further from the busy areas the less pollution there is, and the higher up your apartment the better. Therefore, if air quality is a major concern for you, try to find a flat on the highest floor possible. The closer to the ground your apartment is, the more exposure it receives.
The air contains toxic particles and nanoparticles, which can come from a variety of sources. One interesting fact I learned from Dr. Lagüe was that the non-exhaust particles, like the iron, copper and barium that are released during the breaking of a car or motorbike, produce significant nanoparticles.
This fact, combined with the high concentration of exhaust emissions, make stopping at red lights a prime hotspot for heavy toxic air. According to the expert himself, the best way to protect yourself, outside of not living in the city, is to wear a proper mask. For this, you will need to spend the money and get a thick carbon cloth mask (FFP3 class) which will help filter out the bigger pollutants in the air.
Drinking Water Contamination
Everyone knows the first rule of thumb when living in most developing countries – don’t ever drink the tap water! It contains dangerous levels of nitrates and iron, not to mention a variety of other unsafe chemicals. The best way to ensure you are taking in the cleanest drinking water is to stick to mineral water. Alba is the name of one local company that is producing high quality bottled mineral water that contains an impressive amount of bicarbonates.
Bicarbonates are great for balancing the body’s gastric acidity levels and are also highly effective in preventing dental cavities. Not only is mineral water a sound alternative to many of the questionable drinking water sources available, but its health benefits are scientifically backed and heavily researched throughout the world.
Another suggestion is to constantly switch the brands of mineral water that you drink due to the fact that each brand is comprised of different levels of electrolytes. A regular rotation like this is good for the body, and helps you maintain a healthy level of energy.
Food, Worms and Bacteria
Statistically, Vietnam does have a lower quality of food than most countries, which can result in an array of digestive problems, amongst other health related issues like diabetes, heart disease and cancer. However, the main concern lies in regards to bacteria and worms, and these are real threats that every resident needs to be taking precautions against.
Let’s make it known that there are numerous varieties of worms and parasites out there and they are very easy to acquire. You might have worms and not even show any symptoms. Dr. Lagüe highly recommends that everyone living here take Zentel every six months.
This is readily found at pharmacies all over town and is highly effective in expelling any worms that you may have. Worms and other parasites can lead to other more complicated issues if left untreated, like schistosomiasis, a condition that can cause diarrhoea, abdominal pain, a bloody stool or much worse.
In regards to food, the number one cautionary measure to take is with vegetables, as they can very easily harvest bacteria. Just by touching the outer skin of contaminated vegetables, larvae can be transferred into your body. It is suggested that any vegetables you buy need to be thoroughly washed while wearing gloves.
Meat is another cause of concern, but also a debatable topic. Keep in mind that everyone’s body is different, and each individual can have different levels of immunity to different bacteria. Although it’s an undisputed fact that unrefrigerated meat increases the chances of bacterial contamination, doctors often disagree on how dangerous it is to consume it.
Consumers should do their best to buy quality meat that is within their budget. Annam Gourmet is one trusted shop that sells quality meat that has been properly stored, and it’s a notable place to buy safer products. I’ve interviewed doctors that passionately advised against eating any street food under any circumstance, while others have said it’s perfectly fine to indulge once in awhile. Either way, it’s best to know your body and act accordingly.
Tropical Diseases in Vietnam
The best way to avoid many tropical diseases is to get vaccinated before you come to Vietnam. As many of the symptoms crisscross each other, it is often very difficult to identify what exactly you might have. Vietnam also has limited medical technology, which can make diagnostic processes more difficult. If you feel any strange symptoms like fatigue or joint pain as a result of a suspected insect bite, seek a medical expert immediately to get some blood work. Hydration and proper rest are crucial during this time.
Some of the most prevalent tropical diseases in Vietnam are Dengue Fever and Zika Virus. The danger with these viruses is that their symptoms vary and there is not much technology available in Vietnam to give proper blood tests. Do your best to wear mosquito repellent, especially outside of the city limits, where the number of mosquitos increases.
There are several types of mosquitos which can carry dangerous tropical diseases, and many cannot withstand the pollution of the city. However, once you leave the city limits, and the pollution levels are lower, there is a substantially higher risk of exposure. As a whole, it’s next to impossible to control if you are bitten by a mosquito or not. The best thing you can do is to be aware of the symptoms of Dengue and Zika, and if you experience them do not procrastinate seeking treatment.
SAIGON INSPIRATION HEALTH EYE CARE IN VIETNAM: WHAT YOU SEE IS WHAT YOU GET
Dr. Nam Tran Pham is one of Ho Chi Minh City’s most recognised eye care specialists. We sat down with her at the American Eye Center in District 7 to discuss the state of eye care in the city. Read our interview below.
In your opinion, is the ophthalmology industry in Ho Chi Minh City developed?
Ophthalmology is doing well. There is good access to technology, and the training for ophthalmologists is improving all the time; education always takes a long time to catch up to international standards, but it’s getting there. Now doctors are going to national and local conferences, and there is more activity in the community.
What about the optometry industry in Saigon?
The optometry industry here is not yet developed. It was only a few years ago that medical schools in Ho Chi Minh City began to offer optometry programs. There are a lot of opticians [who are, of course, not allowed to diagnosis or treat various eye diseases], but optometry is just catching on.
What do you offer at the American Eye Center in Saigon?
We offer everything from general eye care, to contacts and glasses, all the way up to eye surgery. We specialise in LASIK surgery, cataract treatment and lens replacement.
Do many patients come in for laser eye surgery?
Yes, they come in to treat different eye conditions with LASIK. Patients can come in for laser eye surgery if they have Myopia, Hyperopia, Astigmatism or Presbyopia. Myopia is nearsightedness, meaning distant objects are blurry for the patient. Hyperopia is farsightedness, meaning nearby objects are blurred. Astigmatism blurs objects both nearby and at a distance. Presbyopia is when patients have “old eyes” in their 40s and above; this happens when the eye lens hardens with age, and loses its ability to properly focus on close objects.
Is laser eye surgery only good for a short while, or does it last for a lifetime?
Patients already in their 20s have stable eyesight, and will most likely just need one LASIK procedure in their life. Those who get laser eye surgery when they are younger may need to wear glasses at some point, since their eyesight has not fully stabilized yet. Less than 5% of people who get LASIK actually need to come in for a second time for a touch-up.
What are some common eye problems we should be aware of in Ho Chi Minh City?
Since so many people ride their motorbikes here, you get a lot of patients who get debris and dust in their face. UV problems are also common because of the strong sun; this can lead to early cataracts, [which can cloud the eye lens and prevent natural light from reaching the retina, causing blurred vision, and glare and halos around objects]. I would recommend two things. First, purchase quality sunglasses with proper UV protection. Second, I would advise riders get a windshield on their motorbike to block debris that may fly into their eyes. These two things should provide good eye protection.
How is Ho Chi Minh City in terms of prices for eye procedures, when compared to nearby countries? And does this affect medical tourism?
It’s affordable when you compare it to overseas treatments. Public hospitals are not expensive since Vietnam has government subsidised health insurance, and private eye clinics in Ho Chi Minh City have the same level of treatment as those in Singapore and Thailand, but at lower prices. Medical tourism for eye care exists here, with patients coming from Europe, America and Australia to get procedures done.
What are the most common eye problems you get at your clinic?
Infections are very common these days. And cataracts is a big issue; this is the number one cause of vision loss around the world. Glaucoma and cataracts cases are as common here as in America.
Are there trustable eyeglass centres in Ho Chi Minh City?
For eyeglasses, there are a lot of Chinese and Indian items that are marketed as something of higher quality. It’s difficult for people to find quality here, you simply have to locate a reputable source. If you don’t, you may end up getting cheap lenses that cause headaches and visual distortion. Some of my friends in the industry say that 90% of glasses in Ho Chi Minh City are “fake”.
What does the future hold for eye care in Ho Chi Minh City?
As people travel around and get exposed to quality medical care abroad, they will have higher expectations for eye care in the city. Medical education is constantly improving, as is technology, so higher standards for clinics will follow. The bad news is that nearsightedness will increase among youth here. Roughly 80-90% of children in East Asia have Myopia; it’s an epidemic. This is due to kids growing up in front of multiple screens.
All photos by www.americaneyecenter.com
SAIGON INSPIRATION HEALTH VIETNAM’S HEALTHCARE: IT’S NOT ALL THAT BLEAK
Although many may disagree, over the past 25 years Vietnam has shown the world that they have made significant improvements in healthcare, and will continue to do so as they develop economically.
The World Health Organization and Forbes have identified several areas where Vietnam has proven to be an example to the world in regards to effective nationwide immunisation, low rate of infantile death, massive improvements in regards to water contamination and access, an extremely high life expectancy rate, and low maternal mortality rates. Let’s have a look at what the expert data says, and see if this opens our eyes to a brighter future for Vietnam’s healthcare.
World Leaders in Vaccination
Despite the abundant amount of tropical, bacterial and viral diseases that Vietnam faces, statistically they have done a remarkable job compared to the rest of Southeast Asia and many other countries abroad in providing nationwide vaccinations to combat threatening diseases. While sitting down for a small chat with Dr. Mason Cobb of Victoria Healthcare, he briefly discussed this topic and shared a bit of professional insight as to why Vietnam has one of highest immunisation rates on the planet.
He attributes this to excellent quarantine strategies, and extremely strict regulations set in place by the Ministry of Health that require vaccinations for children. From a social standpoint, Vietnam is about as family-oriented as you get, and the protection of their children is of major concern.
All of these sound practices have given Vietnam the edge in regards to immunisation and as a result they have been able to witness significant drops in diseases over the past 15 years. According to UNICEF, as of 2012, there is 97% immunisation coverage for hepatitis B, 91% coverage for tetanus, 98% coverage for tuberculosis, 97% for polio, and 96% for meningitis. These rates are staggering considering the overall wealth of Vietnam, and these numbers put many countries to shame.
“Vietnam has also set an example for the world in terms of mobilising the population during health promotion campaigns. This was evident during tetanus eradication and Expanded Programme on Immunisation activities.” (World Health Organization)
Low Rate of Infantile Death
Another example of Vietnam’s positive ability to take care of its citizens’ health lies in their extremely low rate of infantile death. This might come as a shock considering their economic situation and lack of modern technology in their hospitals. However, paediatrics is highly valued, as is maternal and infantile welfare, and much is to be said for Vietnam in this regard.
In particular, the Ministry of Health has prioritised infantile health and they have made a valiant effort to make improvements in this area. The structure of society demands that women and children be taken care of and the statistics for this area of healthcare are quite favourable.
“With a steady decline in maternal mortality, child mortality and malnutrition over the past decades, Vietnam has exceeded expectations for a middle-income country.” (World Health Organization)
Estimates developed by the UN Inter-Agency Group for Child Mortality Estimation (UNICEF, WHO, World Bank, United Nations Population Division) at childmortality.org have shown that Vietnam has had a massive improvement in child mortality rates. From 1964 to 2015, rates dropped from 95 to 21.7 deaths per 1,000 births. For a shocking comparison we can look at the rates of other developed countries as follows: France 29/1,000, Australia 25/1,000, Canada 33/1,000 and the U.S. with 30/1000. What more needs to be said here?
High Life Expectancy
Another example that Vietnam’s overall healthcare is improving lies in the strong statistics that back the country’s surprisingly high life expectancy. Perhaps hospital care isn’t the most comfortable, but at the end of the day what is important is that you make it out of the hospital alive.
Although healthcare is just one element that accumulates with other factors to determine how long one might live, we can’t deny that the statistics clearly prove Vietnam has a higher life expectancy than many countries that have seen much more development.
“Vietnam is still a poor country, ranking 135th in the world in 2013 (according to World Bank data) based on GDP per capita. Still, when compared to its Southeast Asian counterparts, its overall quality of care, in particular for basic primary care, appears surprisingly good.” (PwC Vietnam)
Thailand and Indonesia both have two to three times the disposable incomes, yet Vietnam has exceeded them in life expectancy. But what is Vietnam’s secret, and how have they managed to pull this off with significantly less resources?
There could be many possible answers to this question, but according to PwC, a globally recognised company that assists countries with an array of financial, legal or problem solving strategies, this could possibly be attributed to the massive amount of hospitals and beds per citizen. This is another area that Vietnam is very strong in.
Although many argue the hospitals are awful and the conditions are poor, we cannot overlook the fact that from a numerical standpoint they have more beds per citizen than almost all other Southeast Asian countries, coming in second only to Singapore. From this standpoint, we must agree that this is quite an admirable feat for such a poor country. The beds might not be the best, but they are there.
Nationwide Water Sanitation Improvement
Yes, there is lots of water contamination and that’s a fact. However, when discussing water, contamination is just one facet of a very complex issue that has many branches. The availability of drinkable water and having access to proper toilet facilities are issues that people often overlook.
Just 25 years ago, two out of five people in Vietnam did not have access to acceptable drinking water. In the city, tap water and wells were easy to come by, but 80% of the population lived in rural areas where these were a rarity.
“Today, 98% of Vietnam’s more than 90 million residents have access to improved drinking water sources and 78% of the population uses toilets that meet international standards.” (World Health Organization)
A few decades ago, people had to rely on local streams and rivers for their water source. Three out of five people did not have access to a toilet or similar facility. However, over the past 25 years a lot has changed.
“Use of improved sanitation facilities in Vietnam has more than doubled – from 36% in 1990 to 78% in 2015. And open defecation, where people do not use any form of toilet, has been reduced from 39% to 1% over the same time period.” (World Health Organization)
Whether you agree that Vietnam is doing a good job managing its healthcare or not, the numbers don’t lie. Vietnam is growing and healthcare, like everything else, is in a state of evolution. By looking deeper into the past, we are able to see the present a bit more clearly. Vietnam is without a doubt moving in the right direction and there will be many more momentous changes coming to light in the coming years.
Source:
www.who.int/bulletin/volumes/91/4/12-112425/en/
www.unicef.org/infobycountry/vietnam_statistics.html#0
www.data.worldbank.org/indicator/SH.DYN.MORT?locations=VN
www.who.int/bulletin/volumes/91/4/12-112425/en/
www.pwc.com/vn/en/advisory/deals/assets/the-vietnamese-healthcare-industry-moving-to-next-level-pwc-vietnam-en.pdf
www.who.int/features/2015/viet-nam-water-sanitation/en/
SAIGON INSPIRATION HEALTH VIETNAM STILL STRUGGLING WITH UNSAFE FOOD
New cases of food poisoning across the country have once again highlighted the need for better food safety management in Vietnam. On July 29, a group of tourists from Laos were rushed to a hospital with food poisoning after having dinner at a restaurant in Da Nang.
As many as 26 tourists were sent to the emergency room where doctors treated them for stomach pains, vomiting, diarrhea, fever and dizziness; 20 more tourists from the same group were admitted the following day suffering from the same symptoms.
Four of the victims were children, and the youngest was just two years old. On August 1, local authorities fined the N&M Restaurant VND25 million (US$1,100), but they were unable to collect samples of the food that allegedly caused the poisoning.
This was the second case of mass food poisoning reported in the central city this year. The case prompted Da Nang’s health department to establish a hotline to provide information to diners about restaurants and eateries that have alleged food safety issues. At least a dozen of food poisoning cases have been reported this year across the country, which have affected both locals and foreigners.
A Major Concern
A government report delivered to a meeting of the National Assembly, Vietnam’s top legislature, on June 5 said that 86 percent of Vietnamese people were concerned about food safety. More than a fifth of the three million businesses involved in the food industry had committed safety violations, with more than 1,700 food poisoning cases killing 164 people in the past five years, the report said.
The World Bank also wrote in a Vietnamese food safety report released on March 27 that food safety is a major concern for the public, and produces high levels of anxiety each time there is a high-profile food safety incident. Vietnam’s reputation amongst its trading partners as a major food exporter is vulnerable, as trade statistics show levels of contamination, according to the report.
Food-borne illnesses are notoriously difficult to assess in any country, but the level of contamination found in Vietnamese food for domestic consumption justifies public and trade concerns, it stated. The report found that the primary cause of food-borne illnesses come from bacterial contamination, rather than from chemicals, which could be prevented by better levels of hygiene throughout the production chain.
World Bank statistics showed that 80 percent of pork and 85 percent of vegetables are mostly sold in wet markets in Hanoi and Ho Chi Minh City, while 76 percent of pork is slaughtered in small and dirty facilities. It said that the most prevalent microbiological hazard in pork in Hanoi and Ho Chi Minh City is salmonella, with the bacteria found in 30 percent of the pork samples taken at slaughterhouses, and 40 percent of the pork found on sale at local markets.
According to the report, regular use of agricultural products such as antibiotics, pesticides and chemical fertilisers, poorly-regulated or illegal imports, lack of traceability and cross-contamination are also important factors to improve; the biggest challenge, however, lies in changing the growing and raising practices of the vast numbers of small farmers.
Ineffective Management
According to VnExpress, the Vietnamese government has been urged to put food safety higher on the national agenda and to issue policies strong enough to encourage the production and supply of safe food.
The World Bank said that Vietnam has a modern food safety regulatory framework with foundations in place for further improving food safety performance and outcomes, but much more could be done to make it result-focused and risk-based.
The Food Safety Law, adopted in 2010, has regulations on the management of many kinds of foods, including street food. But a lack of effective enforcement has done little to reduce the number of food safety and hygiene issues.
Moreover, overlaps in food safety management have frustrated many in the industry. VNExpress quoted a seafood store owner as saying, “There are inspection teams from the health and agricultural sectors. Then there are teams from the ward, district and even inter-agency teams from a municipal level. Why can’t these teams share their test results to save costs and cut the onerous red tape?”
Under new food safety laws revised in July, the maximum punishment for food poisoning and other food safety violations in Vietnam was raised from 5 to 20 years in prison. Fines were also increased tenfold to VND500 million (US$22,425). However, as yet no criminal punishment has been given to food safety violators.
SAIGON INSPIRATION HEALTH BURSTING AT THE SEAMS: HEALTHCARE AND MEDICINE IN VIETNAM
• Vietnamese healthcare struggles to keep up with population growth
• Vietnam has one of the best hospital beds-to-inhabitants ratios in Southeast Asia, falling only behind Singapore
• Hospitals in major cities in Vietnam are at 80% occupancy
The quality and availability of healthcare are critical components for people who are looking to relocate to a new city. However, not much has been said or is known about healthcare in Vietnam outside of the country. So, is the quality of healthcare in Vietnam good? The short answer is yes, although it’s not at its best at the moment. However, it’s certainly improving.
Dealing With the Numbers of Those Seeking Healthcare in Vietnam
As with any other developing country, major cities grow rapidly, and so do their populations. This results in a strain on the infrastructure and especially healthcare facilities as authorities try to balance demand and supply.
According to Business Monitor International, healthcare expenditure in Vietnam was US$16.1 billion in 2017, making up about 7.5% of the country’s Gross Domestic Product. This figure is expected to hit US$20 billion by the end of this decade, a result of changes in living standards and an ageing population.
Overcrowding in hospitals, shortage of medical staff and obsolete equipments and intensive care units have been some of the problems that the healthcare sector have been dealing with. To prove the lack of confidence in their own system, Vietnamese patients have spent close to US$2 billion seeking medical treatments abroad, according to data released by Export.gov.
Understanding The Structure of Healthcare in Vietnam
Vietnam’s healthcare works on a decentralised system where provinces, districts and communes have autonomy to implement their own healthcare policies. The organisational structure of Vietnam’s healthcare system is divided into these four groups:
CENTRAL LEVEL
Under the purview and management of The Ministry of Health, this level consists of the government healthcare sector, together with hospitals, research institutions and universities.
CENTRAL-AFFILIATED PROVINCE/CITY
A collection of hospitals and medical centres, medical colleges, nursing and pharmacy programmes.
DISTRICT LEVEL
District health centres mostly offering medical and preventative services such as vaccinations.
COMMUNE LEVEL
Focusing on primary healthcare services at a community level.
In terms of quantity, Vietnam’s healthcare network actually has a sizeable number of hospitals across the country. As of figures from 2017, there are about 1,160 public hospitals, in branch, provincial and national levels. However, 75% of these hospitals were built more than 20 years ago. There are also about 185 private hospitals scattered across the various cities bringing the total number of beds to over 200,000, or an average of 22 beds per 10,000 people.
Regionally, Vietnam has one of the best beds-to-inhabitants ratio compared to its neighbours, falling only behind Singapore which has an average of 27 to 10,000. However, while the figure may seem good on paper, it glosses over another important factor: the occupancy rate.
Are Vietnamese Hospitals Bursting at the Seams?
Vietnamese hospitals have been exceeding the 80% threshold occupancy rate set by the World Health Organisation. The worst hit are its national-level hospitals in the major cities which have hit occupancy rates far exceeding 100%. In 2009, K Hospital hit a record 250% occupancy rate and more recently, Vietnam National Cancer Hospital registered an occupancy rate of 172%, Bach Mai Hospital at 168% and Cho Ray Hospital at 139%.
Although the reasons for overcrowding in hospitals can be pinned on a variety of reasons from population numbers to inefficiency, another reason is simply down to the general mindset towards the system. Patients living in rural areas would rather take a 50km journey to a national-level hospital in the city than to a smaller hospital within their province as they feel the quality of care would be much better.
Every efficient and demanding public service system requires a huge, well-trained workforce. Unfortunately, Vietnam’s healthcare industry is facing problems here too. With a shortage of doctors and nurses tending to the huge number of patients every day, many of them are overworked, with stressful conditions and relatively low wages.
According to Dr. Tran Quoc Khanh, Resident Doctor at Vinmec Hanoi and Spine Surgeon at Viet Doc Friendship Hospital, he believes the number of patients he has seen in his hospitals could be higher than in many other parts of the world.
“Did you know we had about 67,000 surgeries in Viet Duc Friendship Hospital in 2018 alone? Not many hospitals around the world has reached that amount and there were also a few surgeries that lasted between 4 to 10 hours”, he said.
He also added that one of the critical resources all hospitals need is blood. “No matter how good the doctors are, or how advanced technology is, no matter how well-trained the medical staff is, if there’s not enough blood, we will never be able to keep the patient alive”. He added that demand for blood has always been high at Viet Duc Friendship Hospital.
Public hospitals in Vietnam rely largely on a State budget to maintain and upgrade their facilities, equipment and services. Even though the budget has increased in recent years, it’s still struggling to keep up with modern day demands.
Other factors affecting the confidence of residents in Vietnam’s healthcare sector are the shortage of medical equipments for critical care, as well as the wide availability of pharmacies, which has turned out to be a double-edged sword: patients who start relying on self-medication for small ailments to save a trip to the hospital. As previously reported, the practice has created powerful new antibiotic-resistant bacteria.
Vietnam Plans its Way Forward
In 2014, Vietnam issued Decision 68, a national strategy to develop the country’s pharmaceutical industry by 2020. The plan under this strategy is to gradually replace imported medicines with domestically produced ones, keeping medicines available and affordable.
Decision 68 also covers public health, preventative medicine and primary care systems. According to the plan, the target by 2020 is to have 25 hospital beds, with at least eight physicians and two pharmacists available for every 10,000 people.
The total number of hospital beds has increased from 209,485 in 2011, to 254,885 in 2016. The government has highlighted the growing demand for beds by also increasing the share of private beds to 20% of the total beds by 2020, affording a higher quality of care for patients by building new private hospitals through public-private partnerships.
Looking Outwards
Besides strengthening the industry through domestic production, Vietnam is also embarking on foreign investments of up to 100% in healthcare establishments, pharmaceuticals, medical devices and medical training units.
These include hospitals, polyclinics and specialised clinics; homecare and nursing services; emergency evacuation services; and all activities related to pharmaceutical production and medical devices from manufacturing, testing and storage. Only distribution is not covered in this plan.
Investors can also set up a vocational training unit or even a university for medical training and educational purposes either privately, or through public-private partnerships.
Taking Hospital Technology Into the Future
One way to curb the healthcare industry’s problems is through the use of technology. The government has begun piloting new systems which could potentially integrate healthcare with the internet of things.
One of the new systems is a Swedish-based single electronic medical record which communicates with a Microsoft-developed, cloud-based patient information system, entirely mobile and cloud-based.
Another system consists of wireless medical device packs, the size of a small suitcase. These packs include devices for measuring blood pressure, blood glucose, a 12-channel ECG, stethoscopes, thermometers, dermoscopes and other rapid tests. The tele-assessment apps within these packs communicate directly with clinicians in hospitals situated in urban areas and are saved to a single electronic medical record and processes pre-analysis work for clinicians to make assessments.
While it’s still not clear if the goals set out for Decision 68 will be achieved, what is certain is that the healthcare industry is not just growing in numbers, but there is also a huge potential for businesses and investments, something that could propel Vietnam’s healthcare sector to be among the continent’s best.
SAIGON INSPIRATION HEALTH CULTURAL DIFFERENCES? THE BIRTH OF PSYCHOLOGY IN SAIGON
A young Vietnamese woman is pulled in two directions: on the one side, she’s just received a big promotion at work, and she’s excited about where her career is taking her; on the other, her family constantly reminds her that she has to think seriously about getting married and settling down.
The choice is ultimately up to her, but it often leads to anxiety and depression. It’s these sorts of scenarios, involving the battle between traditional values and modern opportunities, that lead people to seek Psychotherapist Azrael Jeffrey’s services at the International Center for Cognitive Development (ICCD). “It’s about supporting them in their endeavors, and with what would make them happy, whether it be quitting their job or moving to another country,” he says.
At the moment Jeffrey and his team at ICCD are among the few fully accredited mental health practitioners in Ho Chi Minh City—but that doesn’t mean there’s not a need for them. Vietnam’s National Institute of Mental Health (NIMH) stated in 2016 that 30 percent of Vietnam’s population suffer from some form of mental illness, primarily depression (25 percent).
According to the Vietnam Veterans of America Foundation (VVAF), the rate of diagnosable mental disorders in Vietnam is 15 percent, a noticeable difference. These wide variants point to a larger problem: an incomplete portrait of mental health issues in Vietnam.
A Shadowed History
Mental health in Vietnam has been compartmentalised. Jacqueline Langton, a psychologist with a private practice in HCMC, notes that, “Degrees and specialisation for doctors in psychiatry have been well supported here in Vietnam. In contrast, psychology is still in its infancy.”
Psychiatry was practised mainly in the form of government-run mental hospitals, which took in patients suffering from severe mental illnesses like schizophrenia and delusional disorders (60 percent of patients, according to Ministry of Health statistics), mood disorders (15 percent) and stress-related disorders (15 percent).
Alternatively, the Western concept of help being sought during stressful times or dark life moments was completely foreign. A stigma began to form against seeking help, although Langton notes that this is an issue in her native Australia as well.
“In Vietnam I see stigmas shifting between generations; in Vietnam a student may openly talk about experiencing depression but struggle with discussing it with their parents, or their parents may struggle sharing that information outside of their immediate relatives,” she says.
A Matter of Perception
This purveying stigma has led many to believe that psychology couldn’t be integrated into Vietnamese society as it is in North America and Europe. When Azrael Jeffrey founded ICCD two years ago, he noticed that it wasn’t the Vietnamese who had a problem with it—it was the foreigners: “Most people thought it was silly. There was the stereotype that Vietnamese people don’t like psychology. It’s not true. They’re curious about it.”
Both Jeffrey and Langton noted that the problem of practising psychology in HCMC wasn’t that it was frowned upon, but rather that there was no system of reference for it, leading to difficulties when it came to paperwork. Jeffrey, for example, remembers hiring a speech pathologist—the first in the country. “Getting a work permit was hard. There was no “speech pathologist” career they could enter. It didn’t exist in Vietnam yet.”
Molding Young Minds
Right now the vast majority of formally registered psychologists in Vietnam are expatriates, but this is likely to change in the coming years. Apart from individual sessions, Azrael Jeffrey also counsels college students, and he’s seeing more and more interest in the field of psychology.
Rather than study in Vietnam, where counselling programs are still quite limited, Jeffrey encourages interested students to pursue their education overseas. “When they come back in five or six years, Vietnamese psychologists will probably take the forefront here,” he predicts.
For now, it’s all about changing cultural perceptions, and this might be easier than previously supposed. Jacqueline Langton has noticed a definite shift in the perception of psychology in her seven years in Vietnam, as has Jeffrey. “I’ve seen tremendous change,” he says. “When I first came here and said I was a psychologist, it would clear the room. Now I say it and people come up to me and start asking questions.”
SAIGON INSPIRATION HEALTH TOXIC FOOD ADDITIVES PLAGUE VIETNAM
Chemically-treated water spinach is in the news again. In September 2016, authorities discovered three households in HCMC’s Cu Chi District that had chemically treated 1.5 tonnes of spinach with green dye, usually reserved for colouring cloth.
Again, in November 2016, another establishment was found dying the popular Vietnamese side dish, this time in Dong Nai Province. Around 100 kg of raw water spinach was found beside a basin with green dye. The chemical was bought at the Kim Bien market in District 5, which sells artificial flavouring and dyes for food.
Here is an excerpt from Vietnamnet.vn about Kim Bien:
“Chemical sellers at the market advertise a kind of white powder, priced VND80,000 ($4) per gram, saying that only one spoon is enough to make a pot of 100 litres of water have the flavor of beef. Using this unknown substance, restaurants don’t have to simmer cow bones to have sweet beef broth.”
From the same article, an expert source says that the “unknown powder” may be Sodium Metabisulfite, a food and cosmetic preservative that is also used as an industrial bleaching agent.
Here is another excerpt:
“Just five minutes after being soaked [in a] solution, the skin of dead chickens will turn yellow like fresh chicken. Many people come here to buy this chemical for only VND250,000 per litre,’ a trader said…. [traders] also introduced buyers to chemicals to process different kinds of food, to make fresh food from poor quality materials.”
Food chemical problems are not limited to dyes and preservatives: the Treatment Department of the Ministry of Health relayed that in the first half of 2011, there were 3,000 cases of pesticide poisoning, with over 100 deaths. According to Professor Nguyen Vinh Truong of the Hue University of Agriculture and Forestry, “the country’s total importation of chemicals used for plant protection in 2013 was 5,000 times over that in 1994.”
Pham Manh Thong, Head of Unit 5, Environmental Crime Prevention Department (C49) of the Ministry of Public Security, released information that over 9 tonnes of salbutamol was imported into Vietnam in 2015; of this, 10 kg were used properly, while a majority was used in pig farming to create lean meat. The substance, used to open air passages in the lungs of asthma patients, is bought by many companies for VND2 million/kg, and eventually sold to farmers for around VND8 million/kg, according to a C49 officer.
While toxic food additives and harmful pesticides are financially convenient, in the long run they look to be quite deadly. Vietnam had 126,307 cases of cancer in 2010 – a number that expects to rise to 190,000 in 2020. Dr. Nguyen Ba Duc, Deputy Chairman of the Vietnam Cancer Association, gave three factors that cause cancer in Vietnam: genetics, pollution and diet. Unsafe food accounts for 35% of cancer cases in the country.
Annually, Vietnamese spend $1.16 billion treating just six types of cancer, according to Tran Van Tuan, director of the Institute for Research on Cancer Prevention and Treatment. Dang Huy Quoc Thinh, deputy director of the Ho Chi Minh City Oncology Hospital, said that:
“The uncontrollable issue of food hygiene in Vietnam, including food containing toxic chemicals which will affect health for generations, will not only cause cancer but many other diseases…. In recent years, the problem of foods containing toxins or carcinogens has been raised in the mass media, but the issue is still not under control…. Such types of food are sourced from rotting meat dipped into toxic chemicals to make it look and feel fresh.”
Shortsighted gains have created a habit of cutting costs at the expense of health. While cancer rates rise, food hygiene, additive awareness and less reliance on pesticides are slow to catch up. It does not help that cancer patients are having difficulty paying for their treatment: out of 1,200 cancer patients from Bach Mai Hospital and K Hospital in Hanoi, 22% said they were having difficulties paying the hospital fees during the first year of cancer treatment. Out of the 560 that said they did not have any financial difficulties in the first 12 months, 41% said they began to face economic hardship after the first year.
