HEALTH CARE IN VIETNAM
In 1954 the government in the North established a public health system that reached down to the hamlet level. After reunification in 1976, this system was extended to the South. Beginning in the late 1980s, the quality of health care began to decline as a result of budgetary constraints, a shift of responsibility to the provinces, and the introduction of charges. Inadequate funding has led to delays in planned upgrades to water supply and sewerage systems. As a result, almost half the population has no access to clean water, a deficiency that promotes such infectious diseases as malaria, dengue fever, typhoid, and cholera. Inadequate funding also has contributed to a shortage of nurses, midwives, and hospital beds. In 2000 Vietnam had only 250,000 hospital beds, or 14.8 beds per 10,000 people, a very low ratio among Asian nations, according to the World Bank. [Source: Library of Congress]
Health expenditures: 6.8 percent of GDP (2010), country comparison to the world: 89 Physicians density: 1.22 physicians/1,000 population (2008). Hospital bed density: 3.1 beds/1,000 population (2009) [Source: CIA World Factbook **]
In 2003, Xinhua reported: “Average monthly expenditure per person rose to 268,000 Vietnamese dong ($17) in the 2001-2002 period, up 28.1 percent from 1995. Meanwhile, healthcare services in all localities have been much improved. In 2001, Vietnam had 5.2 doctors per 10,000 people, up 60.7 percent from 1986 and higher than other regional countries such as Indonesia, Thailand and Malaysia. By 2001, the country had 836 state-owned hospitals and over 41, 000 private clinics, offering 24.4 beds to 10,000 people. [Source: Xinhua, October 30, 2003]
One survey of Southeast Asians done at the University of Washington Refugee Clinic (which is now the International Medicine Clinic at Harborview Medical Center) showed that some elder Vietnamese continue to use traditional methods, described in the section about traditional medical practices. Many use traditional remedies in parallel to Western health care, but may be reluctant to reveal this to a doctor who practices Western medicine. [Source: Pamela LaBorde, MD, Ethnomed ethnomed.org/culture/vietnamese + ]
There are few private hospitals and clinics in Vietnam. The idea of a doctors opening a private practice us unusual. Many doctors sell medicines to make money. Medical care virtually non-existent in many places even though there are many unemployed doctors
Choosing the right treatments often requires careful considerations and consultation. There are many specialists who deal with the supernatural and often combine western medicine and folk medicine in their treatments. Patients take a variety of herbal concoctions, tonics and elixirs and get vitamin injections, herbal saunas and endure special diet regimens or pray to a special guardian spirit or wear a talisman or amulet.
Doctors and Hospitals in Vietnam
In th 1990s government doctors got only $25 a month. Many supplemented their income by selling pharmaceutical drugs. After three years of government service they could go into private practice and earn more. One doctor told Malcolm Brown of the New York Times, "Starting doctors can much more money as traders and business people, so many of them abandon their medical careers. Young people look upon our generation of doctors and scientists as poor people, not to be emulated."
In 2003, News24.com reported: “A man pretending to be a doctor of traditional medicine was executed in southern Vietnam for fatally poisoning four people and robbing them, court officials said on Saturday. Pham Thanh Tuan, 40, was executed by firing squad on Wednesday in Dong Thap province after his appeal for presidential clemency was rejected last month, a clerk at the provincial People's Court said. He was sentenced to death in June 2002. His death takes the number of people executed in the communist nation this year to at least 29, according to information compiled from state media. [Source: News24.com (.za), November 1, 2003]
In the 1990s many Vietnamese hospitals were in sad shape. Some got by on subsidies of less than $90,000 a year. Virtually everything was in short supply. There were no rubber gloves. Needles were reused. Equipment was idle for lack of spare parts and patients lay on wooden palates rather than beds.
Government subsidized hospitals in Vietnam were once considered a model for the developing world. Patients received free or low cost care. Now they have to pay more for less. Money was taken away from health care in the 1990s to pay for infrastructure projects such as roads and electric lines.
Health Care After the End of the Vietnam War in 1975
Although access to health care improved by the mid-1980s, the shortages of funds, of qualified physicians, and of medicines prevented the Hanoi government from providing quality health care for more than a few. Minister of Public Health Dan Hoi Xuan acknowledged in November 1984 that the inadequacy of the public health system was responsible for the proliferation of private health services, the black market in medicines, and the consequent corruption of a number of doctors and pharmacists. [Source: Library of Congress]
In the mid-1980s, there were six medical and pharmaceutical colleges, one college-level institute for the training of managerial cadres in the health services, and more than forty secondary-level schools for mid-level paramedics and pharmacists. Physicians at "modern scientific and technical installations," according to the Vietnamese press, performed "sophisticated" heart, lung, kidney, and neurological surgery as well as microscopic eye surgery. Vietnamese doctors also were reported to be abreast of procedures in a number of other disciplines such as nuclear medicine and hematology. *
In 1945 Vietnam had forty-seven hospitals with a total of 3,000 beds, and it had one physician for every 180,000 persons. The life expectancy of its citizens averaged thirty-four years. By 1979 there were 713 hospitals with 205,700 beds, in addition to more than 10,000 maternity clinics and rural health stations; the ratio of physicians to potential patients had increased to one per 1,000 persons, and the average life expectancy was sixtythree years. *
Information concerning the health sector in the mid-1980s, although fragmentary, suggested that the country's unified health care system had expanded and improved in both preventive and curative medicine. Medical personnel totaled about 240,000, including physicians, nurses, midwives, and other paramedics. The quality of public health care and the level of medical technology remained inadequate, however, and authorities were increasingly concerned about such problems as nutritional deficiency, mental health, and old-age illnesses. Cardiovascular diseases and cancers were reportedly not widespread but had increased "in recent years." Information on AIDS was unavailable. Western medicine in Vietnam consisted of many things, mostly antibiotics, Vitamin B12 shots for "feeling bad," and IV fluids. *
Views About Western Medicine in Vietnam
Laura Uba, in her 1992 publication, indicated that Vietnamese generally distrust Western medicine. This is a common misconception. It is true that patients often cast doubts on Western treatments if results are not quick and often will not return for further treatment. However, this is frequently due to lack of understanding about treatment methods and effects of medicines. For example, as described in Uba’s paper, some patients may think procedures are meant to cure or alleviate pain, and feel frustrated when, for example, they still cough after a diagnostic X-ray. When a patient is prescribed antibiotics, it is critical that the provider explain the importance of taking the full course of medication. [Source: Pamela LaBorde, MD, Ethnomed ethnomed.org/culture/vietnamese + ]
Many believe that surgery upsets the soul or can actually cause one's spirit to leave the body. Some think injections may hurt the spirit, and therefore are hesitant to receive immunizations. Resistance to venapuncture is common for fear of upsetting the hot/cold balance. Also, during the war, peasants thought that when military doctors drew their blood, it was being given to the U.S. troops to strengthen them. Many less educated people do not realize that the body can make more blood, and believe venapuncture will weaken them. [Source: Pamela LaBorde, MD, Ethnomed ethnomed.org/culture/vietnamese+ ]
Overcrowded Hospitals in Vietnam Make Suffering Worse
In 2002, the Islamic Republic News Agency reported: “Hundreds of critically ill patients in Vietnam have been waiting for at least a month to undergo surgery, a delay that is alarming but unavoidable because of overcrowded hospitals, a report said on Saturday. At Hanoi's Cancer Hospital, patients awaiting treatment are crammed into stuffy corriders while those hospitalized sometimes share their bed with two other patients. [Source: Islamic Republic News Agency, June 15, 2002 ]
According to the official Vietnam News Agency (VNA), overcrowding also occurs at the city's Bach Mai Hospital, the Vietnam-Germany Friendship Hospital and the Endocrinology Hospital where crowds pour in every day. "The hospital receives about 1,000 patients each day and that's not even counting the out-patients," Bach Mai Hospital Deputy Director Nguyen Tri Phi said, as quoted by VNA. A run-of-the-mill health check-up should take between 10 and 15 minutes, but many patients have to wait for the whole day before being called.
Dr Cao Doc Lap, head of the Viet Nam-Germany Friendship Hospital's emergency department, said hundreds of patients were still waiting for operations. Even critically ill patients have to wait at least a month before surgery, a delay that obviously does nothing for their ailment. And still the patients stream in. Dr Nguyen Van Loc, deputy director of the National Paediatric Hospital, said the hospital had been overwhelmed with patients.
"Once we were running extremely short of beds and expecting an influx of patients so we had to line the corridors with rows of beds," he said. With the number of patients far outstripping medical practitioners, this has resulted in poor care and treatment at some medical centers. Although some hospitals are already rushing in more beds, they still cannot meet the growing demand. Doctors have been forced to take a hard-nosed approach to medical care: denying treatment to patients with minor ailments who come in from the provinces or relocating them to neighborhood medical clinics.
Vietnam Fights Diseases with Soap and Water
In 2006, Grant McCool of Reuters wrote: “Preventing disease in a developing and mostly rural country such as Vietnam can sometimes be as simple as frequently washing hands with soap. One of the countries hardest-hit by avian flu, Vietnam is geared for another "avian flu season" with the approach of winter. But amid the high-profile global threat of the H5N1 virus, the stretched Vietnamese public health system has had to fight many other diseases such as SARS (Severe Acute Respiratory Syndrome), blindness-causing trachoma and intestinal worms. One of its main weapons against these potentially deadly or disabling diseases is teaching villagers and urban residents alike to wash hands with soap combined with good sanitation practices. [Source: Grant McCool, Reuters, October 5, 2006 =]
"Hygiene is a hot topic in Vietnam because it is linked to so many diseases," said Nguyen Kim Nga, coordinator of the National Handwashing Initiative. Diseases that can be prevented with better hygiene include avian flu, SARS, trachoma, diarrhea and respiratory tract infections. The program, run by the World Bank and the Vietnam health ministry in partnership with soap companies, aims to reduce sickness and death among children under five from diarrheal diseases. =
The U.S. Centers for Disease Control estimates 14,000 children die from diarrhea every year in Vietnam. Some of them could have been saved if washing of hands with soap was the norm in their households. Nga said the program, which is also being developed in other countries, does not recommend any soap brands. "We want to make handwashing with soap so appealing to these consumers that it becomes a habit," Nga said. "Knowledge about hygiene in Vietnam is high, but handwashing with soap is rare." =
“She said researchers are monitoring actual handwashing with soap in households in eight provinces to assess how many use soap after defecating, after changing a baby's diaper, before preparing food and cooking. They hope to obtain a better idea of what would motivate mothers in particular to use soap, which can prevent transmission of a variety of pathogens. Handwashing is sometimes referred to as the "do it yourself vaccine" as research suggests that diarrheal, respiratory and intestinal infections can be cut by almost half with proper use of soap. =
Vietnam’s First Liver Transplant
In 2005, Thanh Tung wrote in Thanh Nien, “A two-year-old is receiving a liver transplant today that began at 8am at HCMC’s Pediatrics Hospital II, the first of its kind in Vietnam. The 8-12 hour surgery on the young patient is the culmination of four years of preparation with the help of Belgian experts. Around 60 professors, doctors, and medical experts from the Pediatrics Hospital II, along with HCMC’s Binh Dan, Nhan Dan Gia Dinh Hospital and from Belgium’s Clinical University of Saint-Luc will take part in the surgery, which was financed by the city. Nguyen Hong Thu, director of the hospital said that for the past four years, the hospital had sent its doctors to France and Belgium for short and long term courses and that its facilities had been updated for the surgery. [Source: Thanh Tung, Thanh Nien, December 5, 2005 ////]
The patient, a two-year-old girl whose mother is the liver donor, suffers from congenital biliary atresia or bile-duct blockage. Until the liver transplant is available, the youth had a palliative Kasai-poroenterostomy operation, transforming a loop of her intestine into a pipe to drain the bile from her liver. In October and November this year, Belgian doctors and experts from the Vietnamese Ministry of Health came to the hospital to check on the final preparations and were pleased with the results. ////
Doctor Tran Dong A, the hospital’s deputy director, shuttled from Belgium and Vietnam for the past years to learn from the foreign country’s transplant methods. Since early 2005, he has replayed twice a week to his staff a video clips featuring Belgium’s liver transplant surgery. Vice Chairman of HCMC People’s Committee and head of the city liver transplants, Nguyen Thanh Tai asked the media to dim the media spotlight prior to the surgery for fear doctors in charge were under stress. The hospital will also perform another similar surgery on a seven-month-old patient who suffers from the same condition. Liver transplants, more complicated than that of the kidney, are extremely challenging when performed on children. ////
Fake Drugs in Vietnam
A survey in 2008 showed that most anti-malaria drugs — in Vietnam and other countries of the region — were fakes traced back to China. And reports abound of other counterfeit or dangerous items sold for human consumption — including rather startling Internet rumours of a trade in fake chicken's eggs.[Source: Andre Vornic, BBC News, March 7, 2008]
According to the World Health Organization, around 8 percent of all medicines on the market in Vietnam are fake, posing a serious public health concern. The Vietnamese government has limited scope to tackle the problem, in part because the sale of drugs in Vietnam is in most cases not through regulated pharmacies, but private dealers, which handle around 11,000 drugs with a market value of $450 million (€347m) each year. Also contributing to the problem are the country’s long, often unmonitored borders with countries where drug counterfeiting is common, namely China, Laos and Cambodia. [Source: In-pharmatechnologist.com / Novis — January 20, 2005 ]
The requirement for counterfeit drug monitoring in Vietnam was made abundantly clear in 2003, when a bootleg version of the gastric ulcer drug ranitidine was identified in sales outlets. This case served as a prime example of the increasing sophistication of the counterfeiters – the product was a flawless copy of a very sophisticated tropics-compatible packaging, an all aluminium blister, which is still manufactured by only a handful of companies around the world.
Fifty employees of the drug control authority, police and customs have been trained in the use of German Pharma Health Fund (GPHF). GPHF’s Minilab, a mobile, compact laboratory that allows quick detection of drugs that are counterfeit or substandard in quality. The system is already being implemented at border crossings across the company, and its mobile nature means that it can be used by request – on a case-by-case basis – to monitor wholesale channels and in around 8,000 outlets across the country. Seaports and custom checkpoints will be included in the programme.
The Minilab has been designed so that all the devices and resources required for drug testing fit into two transportable units each the size of a standard suitcase and with a total weight of about 40 kg. It is equipped with a full set of reference substances for the 30 active substances selected and contains all necessary laboratory equipment such as test tubes, mixing beakers, pipettes, DC plates and chambers and battery-powered UV lamps of various preset wavelengths.
Plastic Surgery in Vietnam
Cosmetic surgery among both men and women has been gaining popularity in Vietnam, with nose jobs and eye surgery to appear more "Western" among the most popular procedures. Authorities in Ho Chi Minh City last year closed down several private beauty salons and clinics offering plastic surgery after two women died within a month after complications from breast enlargement procedures. [Source: Deutsche Presse Agentur, February 12, 2007 ^:^]
In 2007, Sophie Malo of AFP wrote: “After decades of war and suffering, women in booming Vietnam are embracing many Western creature comforts, including the right to look better. Beauty treatments, cosmetics and plastic surgery are all the rage here. "My husband and I have a successful business that we are very proud of," Tram says. "Unfortunately, I was not born beautiful and I have turned 50. In the restaurant business, you really need to feel confident and meet people, so I decided to have cosmetic surgery. My husband supports this decision." Marc Villard, head of operations for the French-based Pierre Fabre pharmaceutical group in Vietnam, says the beauty craze first took off in the early 1990s. "Fifteen years ago, Vietnamese women plastered themselves with thick face creams mixed with powder to make their skin whiter," he says. [Source: By Sophie Malo, Agence France Presse, January 7 2007 /-/]
“Now, women see make-up and surgery as equally viable options in the quest for good looks, and most remain ignorant of the risks associated with such operations. They don't think twice about getting a 300-dollar nose job, a 500-dollar eyelid lift or breast implants for as little as 2,000 dollars — a fraction of what a woman would pay in the West. While Vietnamese women may want to mimic their counterparts in the West, they do not want Nicole Kidman's nose or Scarlett Johansson's ample bosom, but covet the physical assets of Chinese actresses and local beauty queens. They also want procedures to be performed as quickly as possible. "Some come in for a consultation in the morning and want the surgery in the afternoon. Some don't even want a general anesthetic, because they don't want to waste time in the recovery room," Thang notes. /-/
Problems with Plastic Surgery in Vietnam
In 2007, Sophie Malo of AFP wrote: “Tram, a restaurant owner in Vietnam's largest city, is not stingy when it comes to being beautiful. She has just had her eyebrows, eyelids, neck and nose done.And then, to top it off, she went for a face lift. "After five operations on my face, as soon as I recover, I will have liposuction on my belly," says the 50-year-old woman, her face swollen and covered in bandages. Once the bandages come off, Tram could look like a wax model in Madame Tussaud's museum. But at least she feels healthy. Many others having plastic surgery here are not so lucky. Vietnam, which posted over eight percent economic growth last year, has seen the emergence of a burgeoning middle class, mainly in and around the commercial hub of Ho Chi Minh City and the capital Hanoi. Having a more generous cleavage or a slimmer nose is the new dream for many up-and-coming Vietnamese women, but demand has far exceeded supply, leaving women in the hands of unqualified surgeons often working in unsafe conditions. [Source: By Sophie Malo, Agence France Presse, January 7 2007 /-/]
“Tom Cuong Nguyen, an Australian-born Vietnamese doctor who runs the "perfect skin" ward at the Columbia Saigon Clinic, says many women suffer "complications due to the injection of an unidentified liquid into their breasts, lips or cheeks". Others looking for longer eyelashes end up with infections caused by dangerous implants, according to Nguyen Thang, head of the plastic surgery unit at the Franco-Vietnamese Hospital here. "Failure to use sterile instruments can also cause cases of hepatitis," he adds. /-/
This devil-may-care attitude, coupled with the total lack of regulations in the sector, means a windfall for surgeons — qualified and otherwise. "In Ho Chi Minh City, at least 200 plastic surgery clinics are in operation, but only 50 or so are accredited by the city health authorities," the doctor adds. Most practitioners can only operate on the face, with a hospital stay required for procedures done on other parts of the body. Nevertheless, most clinics offer breast surgeries and liposuction, using colorful ads, dubious references and certifications that may or may not be authentic. A few weeks ago, a Vietnamese surgeon was barred from practising after performing an unauthorized operation. A judicial inquiry has been opened. /-/
Practitioners say the sector itself needs a face lift. "Only Hanoi University offers a certificate programme in plastic and cosmetic surgery. Vietnam is like France 20 years ago," Nguyen says. "Most practitioners are certified ear, nose and throat specialists who can perform orthopedic and thoracic surgeries." Surgeons often train on the job here. Some become good doctors. Others instead offer their services to shady beauty salons and spas, where plastic surgery is performed in a back room with only an hour's notice. The nip-tuck craze has extended from the middle class to the prostitutes of the former Saigon, where an A or B cup may no longer be sufficient to attract high-paying clients in the city's brothels. So what about Vietnamese men? They're largely unconvinced, but some have been tempted to go under the knife for surprising reasons. "When they fail in business, their fortune teller tells them it's because their nose is too flat or they have a mole that is too close to their eyes or nose, which is considered to be a sign of bad luck," Nguyen says. "The day after, they come in for surgery." /-/
Vietnam Police Charge Fake Doctors in Plastic Surgery Death
In February 2007, Deutsche Presse Agentur reported: Vietnamese police have charged two people with conducting illegal plastic surgeries after the death of a woman who was having her nose and eyes reshaped, a policeman said Monday. "We arrested Huynh Trung Hien and charged him and his girlfriend Hang Thien Kim on Sunday on charges of violating medical regulations," said Hoang Cong Quang from the police department of Dalat, 250 kilometers north of Ho Chi Minh City. [Source: Deutsche Presse Agentur, February 12, 2007 ^:^]
“The couple, both 23, confessed to the police that they had conducted nose and eyelid surgeries on about 10 people until the death of Tran Thi Rot, 52, in November last year. Rot died from anaesthesia shock a few hours after her eyelid surgery, according to the policeman, who said neither Hien nor Kim had attended medical school. "People here knew that they conducted surgeries illegally but accepted it because it was convenient and cheap. Otherwise, they have to travel to Ho Chi Minh City for a plastic surgery as no beauty salon in Dalat has the service." If convicted with violating medical regulations, the fake doctors will face a prison term of up to 15 years. They were not charged with murder because the death of Rot was ruled an accident, Quang said. ^:^
Medical Tourism in Vietnam
In 2007, Diep Duc Minh and Xuan Toan wrote in Thanh Nien, “Vietnam’s first medical tourism facility opened last Sunday in Vung Tau, a resort city 120 kilometers southeast of Ho Chi Minh City. Medicoast comprises two main buildings, one meant for medical care and the other for entertainment services. The latter offers 130 three-star rooms and two villas with eight deluxe rooms. The VND70 billion (US$4.38 million) property belongs to the Vung Tau Tourism and Medical Care Company. Another upmarket resort, commissioned by the French Amon Financial Group, is set to be operable in Ha Tay province near Hanoi by 2010. Located in Ba Vi district, the $3million, 100 ha Thac Da resort will consist of a five-star hotel, 300 villas, and deluxe garden apartments. [Source: Diep Duc Minh & Xuan Toan, Thanh Nien, February 12, 2007]
Vietnam Bans Herbal Medicine Advertised as Aids Cure
In 2007, Deutsche Presse Agentur , “Health authorities have temporarily barred the advertising and sale of four herbal medicines manufactured by a Vietnamese company, which claimed one of them could cure AIDS, Vietnamese press reported Wednesday. Health Ministry officials took the action Tuesday against the Vietnam Natural Pharmaceutical Company, or VinaPham, after an inspection conducted together with police. [Source: Deutsche Presse Agentur, June 13, 2007 //\]
The company had taken out newspaper advertisements claiming that KiHIV could improve the circulatory, digestive, and nervous systems of people infected with the HIV virus, and could ultimately rid them of the virus after three to six months. Inspectors said the company had not registered or licensed the remedies with the Ministry of Health, and had no approval for the content of the advertisements. The pills sold for two dollars each to Vietnamese customers, and five dollars to foreigners. //\
Animist Treatment
Within many ethnic Vietnamese homes, forms of Animism are quite evident. If sickness occurs, it is not unusual to have the shaman, the medicine man, etc., come to give treatments. If the illness is that of a small child, the question may revolve about an aunt that died childless, or an ancestor who desires that his bones be given a more desirable location. In such cases the Taoist or Buddhist monk or even the shaman, etc., is just the one to ascertain the answer. For a small fee, some rice, a bit of tobacco, a chicken, or some betel (acreca) nuts, a ritual is performed and the answer discovered. If it is the ancestor's spirit who wants the bones reburied, this can be done. If it is the maiden aunt's spirit which is troubled and creating the problem, the solution may be to make little paper images of children and with a bit of paper money, burn them. This sends them off to the spirit world where the spirit is made happy, and the child is made well. Sometimes treatment given to the ill is that of acupuncture (hot cups are used to create vacuum burns or needles inserted about the body). This treatment transfers the felt pain of the patient, and is used sometimes to draw evil spirits out of the patient's body. Similar medical treatment has also been used in the Western world of Europe and North America and still may be found in other parts of the West. [Source: The Religions of South Vietnam in Faith and Fact, US Navy, Bureau of Naval Personnel, Chaplains Division ,1967 ++]
See Hmong, Other Ethnic Groups
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Text Sources: New York Times, Washington Post, Los Angeles Times, Times of London, Lonely Planet Guides, Library of Congress, Vietnamtourism. com, Vietnam National Administration of Tourism, CIA World Factbook, Compton’s Encyclopedia, The Guardian, National Geographic, Smithsonian magazine, The New Yorker, Time, Newsweek, Reuters, AP, AFP, Wall Street Journal, The Atlantic Monthly, The Economist, Global Viewpoint (Christian Science Monitor), Foreign Policy, Wikipedia, BBC, CNN, Fox News and various websites, books and other publications identified in the text.
Last updated May 2014