For sure being admitted to a local hospital for instance raise all kind of questions apart from the language. You name it: generic or genuine medicines? surgery or acupuncture/ western or chinese plants? Local trained pediatrician or western experience? VND100,000VND or USD100 doctor’s consultation?
Why is risk different in Vietnam and Asia developing countries? Life and health risks are the same in all developing countries, foreigners just need to rewind their historic memory to their countries when industrialization started out of primary sector economy. This may be difficult for most, inconceivable at times, as it may date back to your grand-parents’ youth.
The Main local causes for added health risks
Let’s not talk about the obvious, we will have plenty of examples as the blog articles are published, but here let’s focus more on the framework for understanding then avoiding.
Natural conditions and infra-structure
Without teaching geography, Vietnam is a coastal country surrounded by the sea, subject to typhoon and monsoon. Some cities are below sea level subject to tides and floods. The sun is all year long and can be scorching at times.
Most infrastructures are in the making; the low levels of salary and the rampant corruption makes most civil works arguably qualitative and durable. That goes for road, electricity, water piping, drainage, bridges… beware accidents seems to come out the blue, from the sky.
Level of knowledge & effort commensurate with pay
There are 2 common saying that explains the level of the work you get therefore the risk exposure to low quality works: #1 ‘You pay peanuts, you get monkeys’ and #2 ‘You get what you pay for minus the commission(s) or theft’
Shortcuts on procedures and standards
From experience, it seems order, organization and discipline is not the best attribute of the Vietnamese, as far as we can experience. Therefore when top doctors get top education and on-going training abroad, the nurses or lab tests or imaging technicians may not be trained and rigorous as they should be. Unfortunately, some times they blame their low salaries not to perform to the standards.
Uneven level playing fields
in Vietnam for instance, only top hospitals receive development aid in form of health state-of-the-art training and technology. The problem lies in the lower levels for training, maintenance, spare parts, hygiene and small supplies subsidies/financing. At best, the ‘cutting-edge’ is applied and in many cases made irrelevant or simply dangerous due to improper usage.
Health sector environment
Health equipment & medical teams
A brand new piece of equipment, state-of-the-art, means regular updates and finest expensive supplies. High costs will attract 2 evils in Asia: cheaper copies, corruption of the buyers or even fakes. But also, stability of electricity, gas, heating, air-conditioning, temperature control, humidity, water supplies etc… can be the causes of troubles
Mental health consultants
They do not exist nor does psychiatric institutes as it exists in Western countries. In short, there are neuro-surgeons and psychologist anything in between is missing.
Medicines and pharmacist
Most westerners are surprised that medicines can be advertised on TV and considered a commercial goods. Accordingly, doctors are selling medicines as a trader would do. Another practice is to supply ou by the units and without box in small plastic bags with a handwritten label mentioning the name and the number of pills/intake.
In a low salary and lack education in state-of-the-art medical devices, government bodies inspectors can easily overlook some checks by ignorance, paper pushing attitude or cash incentive to sign blindly the inspection reports.
Health sector culture
The peasants don’t ask nor understand what the professor says
Culturally, Vietnam is a nation of farmers with little education or awareness in the medical field, they trust the doctor blindly and reverently. Most Vietnamese are ‘victims of their outward look’. Doctors will prescribe you the level of treatment based on what they estimate you can pay. Because of lack of social security or private money to pay for higher priced facilities -or hospitals abroad-, they will point you to the treatment they feel you can afford.
The knowledgeable hides his sources
Doctors are considered the elite with rare knowledge so they don’t share nor educate or plainly explain to their patients the symptoms and the illness. They will go straight to a diagnosis and the medicines you should buy from them. Whether to hide their knowledge, judging patients lack of erudition or to retain you as a captive ‘client’.
The Doctor never refers, showing his weakness
The 2 biggest sources of mis-diagnosis are the fear of losing face and greed. First, as a famous doctor, you should not refer to a fellow specialist, doing so is admitting your incompetence and channeling your patients to a ‘more able’ competitor. Second, is financially derived from the previous fact, as Doctors don’t want to show failure to cure, they will retain you as a paying client and try all what they have in their arsenal to cure you rather than refer
Health sector business models
The consultation is loss of time and more money can be made
A 30 minutes consultation range from 50,000-VND150,000-300,000VND by a professor. In comparison, a 5,000VND margin per pill prescribed or a 1 hour surgery is charged more than VND10,000,000+
Lab Tests and imaging.
The costs of imaging machines are huge (IRM, X-rays, PET scanners…), not surprisingly Vietnam is among the biggest prescribers of those tests, it is supported by the belief that technology brings better recovery success rates. As for lab tests, the big costs lie in genuine maintenance and consumable supplies, by experts. It is not unusual to discover scandals about rogue operators, not performing the tests properly if at all, with proper checks and ingredients.
The medicines are considered a stream of income + bonus envelopes
As all doctors can prescribe and sell medicines legally, there is a battle for their prescriptions by all the pharmaceutical labs. From hospitals, clinics or medical practitioners all types of incentives (including cash) are used to get their favours.
Surgery is the holy graal
The big money is in surgeries cosmetic, minor or major therefore in front of alternatives, most patients are channeled to the surgery rooms.
In western countries, a holistic view tend to consider surgery as the last recourse
It can be said that more than ever you need to know the local culture of health care sector to navigate safely in seeking the right specialist who will treat you to your best interest. More than ever in Vietnam, your health treatment depends on who you know, having personal friends specialists at good hospitals helps!