healthcare

A hospice is where you go to die. Too often, a hospital is the same thing. And it's by design! Where else do you see concentrated so many germ-infested people with weakened immune systems concentrate in one place coughing all over each other? I heard once that half of hospital deaths, probably moreso in developing countries, could be attributed to unclean water and subsequent diarrheal disease. One of the most effective things a doctor can do is wash his hands. But a number of doctors and other hospital staff can't even be bothered to use soap. Beyond that, what else sets one hospital apart from another?

One thing foreigners in Vietnam worry about is quality healthcare, especially if they are retirees or have families with children. The quality of hospitals in Vietnam is increasing as the country has been developing over the past two decades but it's far from the standards of developed countries, including Asian neighbors who were once provincial backwaters compared to Saigon. The Vietnamese and foreign doctors working in Vietnam are surely capable of most quotidian treatments and non-complex surgeries but for more serious treatment many expats opt to fly out of Vietnam. Bumangrad Hospital in Bangkok is the hospital of choice for many expats in Vietnam and they're used to accepting medical tourists. One day, the Vietnamese tourism industry will figure out that people, without wasting further money on marketing, will come back to your country if you provide them good service the first time.

The question is:

Where are the region's best hospitals?

And the follow-up question: How do you determine how good a hospital is?

Country Best Average top 10 Average top 5
Taiwan1918999
Japan3719988
Thailand85630370
Singapore189705426
Hong Kong5320061137
Philippines21029591654
Vietnam225542102692
Cambodia12713*12992
Myanmar/Burma15396****
The above data was collected from hospitals.webometrics.info's January 2012 world rankings of some 17000 hospitals. You can read more about their ranking there, which isn't necessarily directly scoring the quality of a hospital and requires that the hospital has some presence online. One can only make assumptions about the quality of any hospital that doesn't have even a basic website these days. While most of the best hospitals in the world are in the United States, many are also in Japan. And I don't think any eastern/oriental medicine clinics are included here.

Countries are sorted by the average score of their top 10 hospitals. A hospital's score is based on how much research they do. I guess research hospitals are good hospitals and unfortunately Vietnam does poorly when it comes to doing and encouraging scientific research. [Vietnam fails to pay salaries to professors based on academic output and Vietnamese students aren't taught by the researchers either. Vietnam fails to convince many researchers who go abroad to come back, partly to the poor environment for scientific research.] A good research hospital will have the state-of-the-art when it comes to diseases they specialize in. Sometimes they may be the only place in the world with knowledge and treatment for rare diseases, and sometimes that could all be in the hands and head of one doctor.

Surprisingly, Taiwan beats Japan. And Thailand beats Singapore.

So the Philippines has a good (low) score for their top hospital although a very poor score for their top 10 average. The Philippines seems attractive due to its best hospital being an eye hospital which probably conducts medical research on illnesses of the eye that has been published. Except for eye surgery, expats there might generally still fly abroad for significant medical treatment, Hong Kong or Bangkok.

This type of anomoly also affects Hong Kong.

Cambodia only has two listed hospitals so it's not possible to calculate an average top 5 or 10. From the rankings one could predict the inflow of many Cambodians traveling to Vietnam for medical treatment, or flying to Thailand. This appears to be the situation. FV Hospital in District 7 has staff that can speak Khmer in order to service Cambodian medical tourists. The order of magnitude difference between Singapore and Vietnam is akin to that between Vietnam and Cambodia.

The one hospital in Myanmar is one of the worst in the world. Remember, there were only 17000 hospitals listed. One can only hope with the recent opening up of Myanmar that we'll see some hospital services to support an increasingly demanding expat population.

The following is a Wikipedia list of wiki pages for hospitals all over Vietnam. It's not a complete listing, but it may be useful especially if you are traveling to smaller towns. List_of_hospitals_in_Vietnam

Recently, I discovered first hand what a Vietnamese emergency room is like.

As I was standing at the building's entrance between two never-closing sliding doors while trying to catch a breeze at midnight on a weekday, a Honda SH (a ludicrously expensive motorbike) pulled up right next to me - actually pulling right into the hospital's ER waiting room. Held up between the motorbike's driver and a passenger was an overweight, unconscious middle-aged Vietnamese man. He had drunk too much and was now too much drunk.

The first rule of the ER at a Vietnamese hospital was that if you couldn't get the patient onto a hospital bed yourself, the hospital staff would just watch, or not, and wait until you did. I suppose it's not in anyone's job description. Corollary: they don't really care if you drive your scooter into the hospital's waiting room.

The second rule I learned is that once you fill out the paperwork for admission (you could be convulsing/dying - you'll still have to fill out all the forms before you can see anyone), there is no triage system. I watched a women pull herself into the treatment area, sit herself down on a hospital bed, and wait an hour before asking the head doctor when someone would attend to her. Hospital staff were only loosely aware of who was there, a system also known as "the squeaky wheel gets the oil" to see the patients who complained the most first. There's no formal triage, quick initial examinations to give priority to "time-sensitive" patients, something that would not only waste less time but perhaps save lives.

Third Observation: The emergency room is open all night. They expect you to go and buy your own drugs at their 24-hour pharmacy. Which is fine but at 3AM the sole pharmacist is busy getting her beauty sleep on while laid under covers (because her tiny office is the only place there with A/C and she has it on arctic blast) on a little folding cot and she will be really upset (directed at you) when you wake her up to fill your prescription. I'm not sure what else could be in her job description besides staying awake and filling prescriptions.

Result : Waiting around for 4 hours to get two shots and a prescription for various pills (which you should still Google and Wikipedia when you get home to see what they are and decide if they're necessary or even helpful). Not convinced that the treatment caused any more improvement than just laying around for a couple of hours.

I may be guilty of painting a less than spectacular picture of hospitals in Vietnam and even going so far as to suggesting that there may be room for improvement. But even Vietnamese people are voting with their dollars. They think that rhino horns and other horny appendages are a better cure for their illnesses than going to the hospital, at least a local Vietnamese hospital. But surely the newer hospitals, the international hospitals, are better, aren't they? What about the newish French Viet hospital in Phu My Hung? Next I'll talk about how the best Vietnamese hospitals stack up against hospitals around the region.

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