Medicine in VN (Public Hospitals & Doctors)
At best, it misses more than it hits
This Substack is about life in Việt Nam from the viewpoint of a 10-year expat who spent his first 60 years in a low-context culture.
In my time here, I’ve had more interactions with medical providers than I could count — one of the “perks” of completing more than 60 (then) and 70+ (now) laps around the sun. The stories below are from my first three years here and were published in my previous blog between 2015 and 2017. They’ve been edited for this post.
Scratch it...
In 2015, a few months after I moved here, I had an itch. It started in the only area of my body that's never been photographed, and after about 10 days was bad enough for me to go to what I was told is “the good Vietnamese hospital” here in Dalat... Hoàn Mỹ. It was partially financed by the U.S., which is why it has Mỹ (United States) in the name. Mỹ is approximately pronounced "may-e"...
Hoàn Mỹ caters to well-off Vietnamese and local expats. It is nice, beautiful, clean, and, compared to every other Vietnamese hospital I’ve been in for treatment of myself or a family member (more than a few), almost empty of patients. Fortunately, I was with a native who also speaks good English and was therefore able to convey my concerns to the intake nurse and to the doctor. He (the doctor) looked at the itchy areas and declared that my choice of underwear was the problem. According to him, briefs do not allow for proper ventilation and drying, so I should change to boxers. I tried to explain to him (through my friend/interpreter) that I just spent over two months in Ho Chi Minh where it's a LOT hotter and more humid and where I had no itching issues. I also told him that the itching started about six weeks after I arrived in Đà Lạt. He did not reconsider his diagnosis, prescribed pills and a cream, and sent me on my way. The good news is that the total hospital charges, including the doctor and the prescriptions, were less than US$15.
I changed styles (TMI?), took the pills, and used the cream while the itch took the opportunity to intensify... and spread.
Since some of you are wondering... there was nothing crawling around and causing the itch. That's the first thing I checked.
As I wrote the previous paragraph, I remembered what is still, almost 50 years later, my absolute favorite bathroom graffiti... and, of course, a bit of a story. My first job after university was in Louisville (pronounced Lou-a-vul), Kentucky, with Westinghouse Electric. Since I knew no one in town, I took a night job as a bartender at an upscale (for Louavul) discotheque called Harlow’s — as in Jean. This was 1976, when disco was very "in" and the place was jammin' every night in spite of, and perhaps because of, the bartenders’ uniform — a custom-tailored, black, double-knit jumpsuit. There are no surviving photos of me in that jumpsuit (thank the goddess!), though I can assure you it was a chick magnet! Sorry, those stories I'm saving for the book I keep hearing I should write.
Oh yeah, graffiti... the men's room at Harlow's featured small chalk boards above the urinals because some men apparently cannot resist a blank canvas, so management installed chalk boards to save the painted walls. Written on a chalkboard one night was the aforementioned graffiti:
Please don’t throw toothpicks into the urinals — crabs can pole vault
I'll wait...
As the itching spread, I sought the help of another Dalat doctor. He also told me that it was heat-related and gave me prescriptions for different pills and cream.
Within 10 days, the itch spread to most of the rest of my body and became more uncomfortable than ever.
WHAT THE HELL IS THIS???
I was still scratching furiously in HCMC a couple weeks later, so I asked around and found a dermatological hospital that usually treats only Vietnamese people. Since my Vietnamese friends who speak English were all working, I went solo. Somehow, with a bit of help from Google Translate and a lot of charades-like movements, I got through the admissions process. It looked like, and I'm guessing here, I was put to the front of the queue, because it was less than 10 minutes before I was sitting in front of a doctor who spoke passable English.
After looking at the spots on my chest
he declared them the results of a food allergy. Finally, a diagnosis that might have legs!
I immediately asked what "we" could do to determine the food to which I am allergic. His response pretty much sums up my experience of Vietnamese1 hospitals:
You will have to leave Việt Nam to determine that. Westerners' bodies are different than Vietnamese bodies and we are not trained or equipped to work with them.
He then handed me my third set of prescriptions for pills and cream and dismissed me.
WHAT??? An "educated" medical doctor practicing at a dermatological hospital in the largest city in the country thinks that medical care is different for different races? We're the same fcuking species, Doc!!!
Hoping that maybe there was something to the food allergy diagnosis — probably because I thought of it earlier myself — I decided to stop eating the one thing I now ate that I didn’t eat before moving to VN... chicken.
I figured I'd give it 10 days to work any toxins out of my system. If the itch persisted, I'd cut out something else.
When I mentioned this to a few Vietnamese friends, the response was always the same:
Yes, I know many people who cannot eat chicken because it makes them itch.
Okay...
After a week of no chicken and a total of about 10 weeks of itching, I was scratching myself raw in a couple places. My friend said she knew a good doctor who could possibly help me.
"Why didn't you say something 10 weeks ago?" was the question I did not ask.
It was Saturday, and the offices of the doctor she knew and three others we rode to were all closed. Another doctor was open, but his receptionist said he doesn't treat Westerners... ‘cause we have different bodies, remember? (She didn't actually say that, but when in Việt Nam…)
The next doctor's office we went to was open and he apparently will treat anyone. He smiled when I walked in, spoke passable English, and took the time to look at all of my itchy places, not just the un-photographed ones. He declared the cause of the itch, et cetera, as dermatitis. While giving me six different pills and a cream, he told me not to eat chicken, beef, pork, ocean seafood, or eggs while taking the 10 day's worth of pills. Fortunately, I was still allowed fruit and there were at least three decent vegetarian restaurants in town.
The last meds worked, FINALLY!
The sad news is that it took four “doctors” and three diagnoses to find one who could diagnose dermatitis.
Pathetic!
Every ex-pat here I've talked to has at least one similar story.
I went back to eating chicken, seafood, and eggs.
I told you that ^ story, so you’d better appreciate this one
(Sub-title paraphrased from a now disgraced comedian who will remain unnamed.)2
Less than a year after the dermatitis debacle, I got another itch.
This one got so bad that I was thinking about looking into a full-body skin transplant. I called Global Rescue, to whom I pay a princely sum for emergency evacuation insurance. After clarifying that it was NOT an emergency, I told them about my previous almost three months of ITCHING and everything I’d done to try to alleviate it. What a great organization! For a yearly fee — sliding scale based on how long you’ll be away from your home address — they will consult on medical issues and help you resolve them, even if it means a no-additional-charge private jet ambulance halfway across the world. Hell, I'm riding a motorbike almost every day in Việt Nam, how could I NOT have this? As long as you are at least 60 miles from home and a local doctor says they can’t fix you, GR will get you to whatever medical facility you want, anywhere in the world, if no other way is available and/or fast enough. If you break your arm, you’re probably going to get local help, though for me, if I’m conscious, anything that involves cutting through my skin or making sure my bones heal in the shape they’re supposed to be is going to happen in Bangkok or the U.S., NOT Việt Nam! If it’s something really bad and/or life-threatening, they’ll send the cavalry (check with them for details, I’m just a happy customer).
Global Rescue found a Western dermatologist (Spanish, speaks four languages) in Ho Chi Minh City who could see me a few days later. That’s 6-1/2 hours by motorcycle and 8 by bus. The good news is that I was going down anyway to bug my big bike mechanic and get him to fix my DR-Z. The Đà Lạt shop couldn't fix the oil pump, so they sent it down to him, but without in-person prodding, it could be months before got it back.
This doc would cost me more than all four Vietnamese doctors in the previous story combined (Western medicine at Western prices; my Global Rescue policy didn’t cover it, and I didn’t care! I didn’t plan on telling the doc, but I’d’ve paid US$1000 to 86 that itch!
Note: I’d already ruled out dermatitis.
While waiting to go to Saigon, I decided to do something about my nasty headaches. After eating breakfast (ăn sáng—literally “eat morning”), I walked to the place where I irregularly get a massage. I told her about the itch and she said,
Không sào (no problem).
Phúc is very good and extremely professional. In my experience, massages in Đà Lạt are more like the therapeutic massages I got in the U.S. Phúc wears a shirt and long pants under a white “lab coat”; nothing at all like the sexy, low-cut, high-hemline dresses that are de rigueur in most Ho Chi Minh City massage businesses. She’s never offered a “happy ending”, either. The hot stone massage is almost 50% more than a standard massage and, because I’m a high-roller, I sprung for the extra 30,000 (US$1.20) every time! Yes, the very good one-hour hot stone massage cost 100,000 Việt Nam dong (US$4) at that time. It’s now all of 200,000 VND (US$8).
As I wrote here two weeks ago, the women (and a few men) who work at the innumerable massage shops in Việt Nam survive on tips; the house gets 100% of the massage fee. I always tip 100-200% of the massage fee, so for Phúc back then, that meant a 200,000VND (US$8) tip. The first time I gave her the 200K, she thought it was for the massage and the tip. I can still see the huge smile that lit up her face when I gave her another 100K for the massage. There aren’t too many places in the West where you can get a great massage and make someone’s day a bit brighter, all for about US$12.
To put the amounts I’m throwing around in perspective, a “decent” 10' x 20' room with a sink, microwave, hot plate, bathroom, and sleeping loft outside the Đà Lạt city center rents for ~1.5 million VND per month ($60). That’s a lot for someone who averages 50-100,000 per massage (if the customer knows to tip) and might do three in a good day. It’s worse for those who work in Sái Gón, where that same 1.5 million gets you a 10' x 15' room with no loft, no cooking, and a shared bathroom down the hall. It is also one of the reasons most people in VN work 28-30 days every month.
The official poverty level here is a shade over US$700... per year. If you come here on holiday or to live and cannot afford to tip generously, then you’re either out of money or out of empathy. Either way, it’s time to go home and reload.
Are you wondering yet why I started with how much I itch? Or just hoping I won’t get back to it? The “good” news is that after years of my stories disappearing down the rabbit hole (right, Rich?), I’ve learned to find my way back… most of the time.
I was lying there, zoned out, enjoying my massage, when Phúc (today’s heroine) cried out,
Ôi trời ơi!
(pronounced O choy oy and meaning “Oh my god!”)
I then felt a bit of a scratch on the back of my leg. She came up to where I could see her, holding out her right forefinger. On the tip was a tiny (as in miniscule) dot. Once she had my attention, she squeezed the dot between two fingernail tips and wiped the resulting tiny red spot on the white massage table cover.
My turn for Ôi trời ơi!
She then rapidly rotated back and forth from my legs to my head, each time popping one of those little fukrs and wiping it on the table.
I had to laugh, right?
For the next 10 minutes, she pulled them and popped them. She even had me pop a couple… and the whole time she’s saying, “Nhiều, nhiều!” (many, many). I was, at the same time, embarrassed and ecstatic. SHE FOUND WHAT FOUR FUCKING DOCTORS COULD NOT and three of them used a Sherlock Holmes-era magnifying glass!!!
Yeah, I know... I thought it was a rash. Embarrassing...
While she was grooming me like a chimpanzee, I took a few photos with my phone and sent them to Global Rescue. Even though it was 2 a.m. at their Boston HQ, they responded within a few minutes:
The pictures aren’t the best, but those look like it could possibly be bed bugs…
SHITE and EUREKA! We have a diagnosis that makes sense…
Phúc speaks about as much English as I speak tiếng Việt and few of the words/phrases go well together, so it took a few minutes of charades and Google Translate (does anyone see a pattern here?) for me to understand that she was giving me a piece of paper with the name of something I should buy at the pharmacy that would kill the little fukrs faster and more efficiently than picking them off and popping them. It’d speed it up a bit to pick off those I could see and drop them into a glass of hydrogen peroxide (it’d be great if they would explode, though I doubt it) or rubbing alcohol or tequila… they might like the tequila…
It was raining HARD when I left, so I hailed a cab and had him stop at a pharmacy where I showed Phúc’s writing and got the “we don’t have it” gesture. A second pharmacy didn’t have it either. After trying a few times to tell this poor, addled soul (me) how to get to the pharmacy that would have it, the second pharmacist finally gave up, held up five fingers and said, “Năm phút” (five minutes)”, which I did understand. She returned with the prescribed package in four.
After verifying that it was what I sought, she charged me 20,000 VND ($0.80). I tried to give her another 20,000 for her trouble, but she refused to accept it. This became my favorite pharmacy until La’s aunt and uncle opened one just down the block five years later.
The first thing I did when I got home to the rental house was strip the bed, throw everything into the washer and fill it up with HOT water from the shower and a couple pots I boiled on the stove. Most homes (and hotel rooms) in VN have hot water only from an on-demand heater mounted on the wall above the shower. Even when the bathroom sink is on the same wall as the hot water heater, there is rarely a hot water pipe running to it. It’s just the way it is, so when I did dishes, I usually filled the electric kettle and added its boiling water to the cold in the sink.3
Next, I took the mattress off the frame and leaned it up against the wall outside the front door. No flippin’ way that was EVER coming back in the house! Then I vacuumed everything in the bedroom twice; soaked the bottom 18 inches of the mosquito netting in a bucket of the hottest water I could pull; and vacuumed the living room couches and carpet twice before hitting the shower with the anti-parasitic bug shampoo.
The directions say, in English, to use it three times in three days, lathering up twice each time and letting it sit for a bit the second time. For the first time in quite a while, I followed directions. Sort of. I used it a second time when I showered before bed in the hotel where I stayed for a couple nights because I no longer had a mattress, and a third time during the next morning’s shower. I’m pretty sure the three-day thing is to make sure you kill the little fkr’s eggs (shudder), so I bought a second bottle the next day.
Less than 24 hours after Masseuse/Bác Sĩ4/Groomer Phúc’s diagnosis, the itching was all but gone. For a few days I still had the occasional thought that I was itching, but that could’ve been like the pain an amputee feels after losing a limb… or there could be one of two of the little fkr’s who survived six killer baths. They won’t survive eighteen!
And yes, I’m glad this one also wasn’t crabs. Was that your guess?
A BIG Miss (a few, actually)
In late 2016, a motorcycle accident in the U.S. destroyed my right knee. After surgery to “repair” it (details in a future post),
I returned home to Việt Nam. While still on crutches and in pain, I met a Westerner who claimed to be a Swedish-trained exercise therapist. She promised to help strengthen and heal both my knee and my right shoulder that was hurting — I thought due to the crutches. She did a “comprehensive evaluation”, determined that I did NOT have a torn rotator cuff5, and assigned me some exercises.
Two weeks later, when she called to verify our next session, I told her that after the exercises, my shoulder pain was getting worse. It was now very hard to walk using the crutches. She suggested I go to a doctor or the local hospital to have a medical professional check it out. She'd only been in Việt Nam for two months, so she didn't yet know how abysmal the medical practice is in general, and especially in a small-ish town like Dalat.
I never went back to her (see footnote 5) and ignored her many messages trying to schedule further sessions. This experience strengthened my theory that the great majority of Westerners who “practice medicine” at any level in Việt Nam are here because they’re too incompetent to make a living working in the first world.
When I told my wife (La) I wanted to go to the doctor in Dalat, she was more than a little surprised because of my previous refusal to see a Vietnamese doctor for anything short of a coma. She called a friend who'd had some ortho work done locally and the friend gave her a strong recommendation for a doctor near the public hospital. We called a taxi and headed to the office.
Banks, offices, and medical practices lock the doors and close for lunch, either between 11 and 1 or 11:30 and 1:30. After showing up a few times at locked doors, I learned to look at the clock before I set out. We arrived at the doctor's office at 1:45 to find locked doors and no one answering the buzzer. At about 1:55 a woman pulled up on a motorbike and said that the doctor would not be there until 3 p.m. and that I should return then. So we did—after La called to verify that the doctor was actually in.
Upon arriving at the office, the doctor told us (he told La and she translated for me) that he did not treat Westerners.
If you're a Westerner, you're NOT WELCOME at my practice.
What? AGAIN???
La's friend had told her that this doctor is very good—most "doctors" here wouldn't qualify as valet parkers in the west—so I asked her to push for a further explanation. The doctor then said that the government would "take away my medical license if I treat Westerners.” That’s a new version of that song, but
WTF???
I was in enough pain that there was no room for any thoughts other than "STOP THE PAIN!" Under most circumstances I would have a hard time believing that even a non-democratic government (coming very soon to a super power near you) would mandate such a thing. My initial reaction was that he was lying and there was another reason he wouldn't see me, possibly racism. When I'm in great pain it's very, very difficult for me to see the best in people who are consciously extending the time during which I am in pain.
Can anyone help me?
The doctor suggested that we go to the hospital 100 meters up the road where, he confirmed, there are zero orthopedists. My pain level was so high that, even though it's the public hospital I swore I'd never go back to, I didn't want to endure a 20 minute ride to the only private hospital in town. So we called a taxi and headed up the hill.
Sorry I don't have any more photos; my phone battery died and I was in too much pain to think about taking them. Now I wish I'd borrowed La's phone to do so, especially of the hospital paperwork.
EVERYTHING in Vietnamese medical "care" is pay-as-you-go. Literally. There may be an exception made if you are bleeding out in the emergency room, though I wouldn't bet my life on it. International hospitals in the big cities take foreign credit cards, but otherwise you need either comprehensive insurance for Việt Nam, cash, or a local debit card with funds in the bank.
When I was a kid, my mom told me to always wear clean (and hole-less) underwear in case I ended up in the hospital. Here, the corollary is, “Always carry a few million VND or the phone number of someone who has it in case you end up in the hospital.”
Upon our arrival at the hospital, La pointed to a row of hard plastic chairs and said "sit down, please", so I did. She then went to the front desk to get the first piece of paper (cost 8,000 VND, about 32 cents US). This paper allowed her to go upstairs (it's all stairs, I've never seen an elevator in this hospital, so if you're in a wheelchair, you're in trouble), pay about US$1 for another slip of paper telling the doctor you've paid and it's okay for him (almost always a him) to talk with you. Five minutes later, she's back downstairs and across the hall we go (no waiting) to see the doctor.
The doctor looked at the paper, and without a word, started poking and grabbing at my shoulder. I pointed to where it hurt and say "dow", which is my version of the Vietnamese word for pain. I'm sure my pronunciation was wrong, but he got the idea. He then tried to stick his hands inside the collar of my shirt to grab my shoulder and I barely won the race to unbutton it far enough before he ripped it.
He then talked with La for a bit before sitting down at the computer to type out my next piece of paper; permission for an x-ray. While La headed back upstairs to pay 50,000 VND (~US$2) for the x-ray, I got a head start hobbling down the hall to the X-ray Department. I overshot it because "x-ray" in Vietnamese is "x quang" and I was too stoopid to remember that. I've seen it enough that I certainly should. At a minimum, the "X" in front of another word should've at least given me pause...
By the time La caught up with me, I had overshot the correct branch hallway by at least 15 meters (50 feet). That gave me the opportunity to go about 40 extra crutch-steps round trip just for fun, using a shoulder that is injured, very likely because of the f-ing crutches.
SHEESH, John, PAY ATTENTION.
NO WHEELCHAIR FOR YOU!
At this point I still had another 30 meters (100 feet) to go to x-quang followed by more than 60 meters (200 feet) back to the doctor, and my shoulder is on fire! Seeing this, La asked a nurse sitting behind a glass partition if I can use one of the wheelchairs sitting 3 meters (10 feet) from her. The nurse says that the wheelchairs are only for emergencies (that's Vietnamese for "NO!"), so I hobbled away down the hall past a woman in a wheelchair who was not bleeding out, so where’s her emergency? When we get to the x-ray department, the technician pointed to the proper door for me and La went off to find a wheelchair. By the time I get the x-ray film (most of Việt Nam does not yet have digital x-rays), La's back with a wheelchair. I was very happy to ride back to the doctor's office. I didn't see anyone crawling down the hallway, so I'm pretty sure she appropriated an empty one from the ER.
The doctor looked at the x-ray and said I need an MRI. No problem, Doc; write it up and let's go...
This was when we entered the Twilight Zone.
The doctor told us that the hospital’s MRI "is so old that it's no good for shoulders or hips... only knees, elbows, and backs."
I know I'm repeating myself, but WTF???
Refusing to take the first no for an answer, I push back—NOT something done in polite Vietnamese society—causing La embarrassment AND proving myself a barbarian. The doctor said (remember that La's translating for us and, in the case of my words, I'm sure she's also editing) that he will not send me back down the hall for an MRI because it won't be usable.
Thinking back on that exchange, Doc may’ve been telling me in the default indirect communication style here that drives me nuts, that I was too damn big to fit in the MRI unit. Maybe it was only big enough for my extremities and not my torso? I’ll never know.
I asked him if we can get one at Hoàn Mỹ, the private hospital about 25 minutes away. Of course not! They don't have an MRI machine. He then said we can get a good MRI in Saigon, like it's just down the road instead of a 7-hour drive away. So it will be a while before I get the needed MRI.
The doc then gave me a prescription for three different pills. They were, according to on-line medical resources, an anti-spasmodic (I haven't yet had muscle spasms), a pancreatic enzyme used for cataracts and removal of dead tissue (I have neither), and an anti-inflammatory (okay, this one I can probably use). The good news is that five days' worth of the three only cost 104,000 VND (~US$4). The better news is that I took only two doses before checking to see what they were and throwing 2/3 of them away. What I was thinking when I took medicine prescribed by a Dalat doctor without knowing what it was, I cannot tell you. Maybe the pain was making me stupid(er)?
This experience had me seriously reconsidering how much longer I would stay in Việt Nam.
What happens if I go down hard and can't be immediately transported to where there is competent medical care? Global Rescue is only gonna save me if I can travel — in a medical jet if need-be. If I can't, I'm toast.
Would anyone like to guess as to how long it was before I next visited a Vietnamese doctor?
Even the ER docs don’t give a shit
In January 2017, La's mother was rushed to the emergency room (via motorbike, of course) with high blood pressure… an ongoing issue for her. The first time the nurse took her blood pressure they said it was 140/80. La is trained to correctly take blood pressure and knew this was incorrect. She demanded that someone else take her mother's blood pressure. The second reading, minutes after the first, was 190/140.
Even with that bp, the doctors sat outside of the ER chatting amongst themselves and refusing to even look in the direction of her mother until La got very loud and angry with them. Most Vietnamese men do what they can to avoid being the person at whom a Vietnamese woman is directing her anger. These doctors didn’t flinch, but they did look her way.
As is standard practice in Vietnam, I had already given La the two million Vietnam dong (US$80) she had to pay the hospital up-front for her mother to get into the ER. Now the doctors asked the family if they had more money. This is because to get anything more than cursory medical attention in a Vietnamese hospital, you have to pay (bribe, a.k.a. coffee money) the doctors and nurses individually... or yell at the doctors and embarrass them until they do their job. The problem with the second method is that after that you will be ignored until you come up with the demanded cash.
While her brother and sister were calling other family members to raise cash, La posted about the doctors (with photos) on FaceCrack.
That night, in the 11 hours after her post, it was shared over 1500 times and has 500+ comments. By noon that day, she had over 2000 comments and 2600 shares. The post really hit a nerve with locals and others who are disgusted and frustrated with what they have to put up with in Vietnamese public hospitals.
Mom-in-law survived that ordeal and, many more visits to the ER later, is still on the green side.
There’s so much more to tell, though by now your eyes are probably glazing over, so I’ll end this here. Look for Part 2 of my medical experiences, coming soon-ish. If you’re not already subscribed, click the third button below. I promise those are my only itchy stories. So far.
Thanks for reading and especially for your occasional messages of support.
It’s nice to know you both enjoy my ramblings ;-)
Tapping the ❤️ at the top or bottom of the page, or leaving a comment will let me know your thoughts and feelings, which are important and valuable to me. Doing so also helps others find this article. Thank you.
Thanks for reading An Expat's Thoughts on Life! This post is public so feel free to share it.
I hope you enjoyed this post. If so, please subscribe for free to support my writing and receive a new piece every Saturday or Sunday depending on which continent you’re on. If you’re feeling generous, a paid subscription will be greatly appreciated.
As opposed to international hospitals in Việt Nam
If you must know, it’s the convicted rapist formerly known for his “Fat Albert” stories.
When we built our house, I made sure that anywhere there is water, both hot and cold are available.
Pronounced “Boc See”, it’s Vietnamese for “Doctor”.
A later MRI showed that I DID have a torn rotator cuff and the orthopedist told me her recommended exercises had made it worse.
Thank goodness for online medical resources. On more than one occasion I’ve looked up what a local doctor prescribed only to toss the meds after finding out they’d been banned in the US in 1997…Looking forward to the next chapter of this saga!
What a saga!