hospital
Medical tourism to and from Vietnam: Which hospitals should an expat in Vietnam go to for treatment?
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 |
|---|---|---|---|
| Taiwan | 19 | 189 | 99 |
| Japan | 37 | 199 | 88 |
| Thailand | 85 | 630 | 370 |
| Singapore | 189 | 705 | 426 |
| Hong Kong | 53 | 2006 | 1137 |
| Philippines | 210 | 2959 | 1654 |
| Vietnam | 2255 | 4210 | 2692 |
| Cambodia | 12713 | * | 12992 |
| Myanmar/Burma | 15396 | ** | ** |
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.
The world is flat. Globalization means it's possible to get customer service from India on products made in China sold in America. But it also means you can move your wealth and yourself from high cost geographical areas to ones where labor is cheap as is the cost of living.
People are more hesitant to move to another country when they have bills to pay and they need to worry about finding a good job abroad. For retirees, a country's job market has much less value. For a retiree, it makes sense to live someplace where wages are low, opposite to the rest of the working population. American retirees are increasingly retiring abroad.
Typical foreign countries for Americans to retire to are in Spain and Latin America as well as France, although France and the rest of Old Europe are quite expensive due to the weak dollar relative to the euro. Some Latin American countries like El Salvador use the US dollar, others like Belize, peg their currencies to the dollar.
The more adventurous Americans consider retiring to Asia, especially cheap Southeast Asia. Only the wealthy consider retiring (and denouncing their American citizenship for tax purposes!) to Singapore. But the Philippines is a popular country for retirees, especially American war veterans. But why not Vietnam?
Cost
Cost of living in Vietnam is cheap. That blog post tells you all you need to know about the cost of living in Saigon. The most expensive part of Vietnam (or most of Southeast Asia) is the plane ticket there and if you're planning to stay long term, with few and infrequent trips back to North America then you could live in Saigon or Hanoi for $600/month or spend double that and live two lives. I will tell you what you need to know to find cheap housing in Vietnam. Inflation, out of control for many years, is now back to single digits. You can argue that other poor countries are cheap to live in as well, but Ho Chi Minh City is pretty inexpensive for a "city" and there are always small towns in the countryside (or Mekong Delta) which are an order of magnitude cheaper.
Healthcare
Vietnam doesn't have the best hospitals in the region but quality of healthcare is improving with newer international hospitals such as FV (Franco-Viet) Hospital. Nonetheless, healthcare is still an issue. Cost of healthcare is extremely cheap. Prescription medicines are usually generic and cost nickels. You can buy pills by the pill. Medical procedures without medical insurance are affordable. For more serious hospital needs many expats fly to Bangkok, which is a 1 hour and often under $100 flight away. However, most medical care and procedures can be done in Vietnamese hospitals now. But this is a concern for expats in all developing Southeast Asian countries. Vietnam itself is even a medical tourism receiving destination for people in Cambodia.
Things to do
Vietnam has islands, beaches, 2.5 major cities, an incredible variety of unique cafes. But perhaps more importantly, beer and liquor are really cheap. (Vietnam is neither a religiously conservative Muslim country nor a nanny state.) Bottles of popular beer are around 75 cents/ea. Pirated DVDs are $0.50/ea, and cable TV, which has American movie channels like HBO and Cinemax as well as foreign service channels from countries like Japan, Korea, Singapore, France, and Germany, is maybe $5/month. I hear it now costs an average of $23 to watch a movie in Japan. In Saigon, movie theaters are 10-15% of that cost! Watching traffic in Ho Chi Minh City from a sidewalk cafe is free, or the cost of a 50 cent coffee. Vietnam's a very foreign country - you'll find something interesting to do.
Expat community
You won't be alone, although you may be forced to rub elbows with Australians, Kiwis, Canadians, British, and other people from all over the world. You may even meet some Vietnamese people. There are a number of American-owned restaurants and bars and plenty more which serve "American" food like pizza, burgers, and tacos. Americans gather to celebrate the 4th of July and Thanksgiving where turkey is available at some restaurants and hotels in Saigon. There is also a Burger King at Tan Son Nhat Airport, Domino's delivery all over Ho Chi Minh City, and KFC's on nearly every corner.
Vietnam also has the benefit of not having of not having the reputation of being a sex tourism destination like Thailand, Cambodia, or the Philippines. You won't have to convince family and friends back home that you're not just here to buy sex.
Language
English is not one of Vietnam's or most of Asia's strong points, although Singapore, Malaysia, and the Philippines have the highest percentage of decent English speakers. However, thousands of Americans and Europeans live and work in Vietnam without speaking even basic conversational Vietnamese. I would recommend learning some Vietnamese but it's not at all necessary. Vietnamese language lessons start from $2.50 an hour. On the other hand, English teachers are in huge demand in Vietnam. You can retire in Vietnam and make $15/hour or more teaching English on the side.
Visas
Some countries around the world have retirement visas. For example, Malaysia and the Philippines both have special visas for retirees. Vietnam doesn't have one but it's easy for a retiree from the US or other Western countries to live in Vietnam indefinitely as a tourist. The cost is about $25/month until you marry a Vietnamese girl. Vietnam C2 tourist visas can be renewed indefinitely. You could also set up a business in Vietnam and get a business visa. "Set up a business."
Climate
Even within the States, Americans are preferring to retire in warmer climates - Florida, Arizona, Nevada. Vietnam has both tropical weather in the south and four seasons in the north. The temperature is warm all year round in Saigon whereas Hanoi's winters dip into the 50s, and it's not unheard of for it to actually snow in Sapa. I prefer warm to cold, but sometimes Saigon does get too hot.
Religion
Vietnam is culturally and historically a Buddhist country. According to government statistics though it's more atheist in its beliefs. But, significantly, some 1/10th of the country is Christian and there are churches everywhere. Unlike Indonesia, belonging to an organized religion is not legally required here.
Which is not to say that Vietnam is Shangri La for retiring expats but for the slightly adventurous who can stand to be away from "home" for many months at a time, who enjoy warmer weather, who appreciate value when it comes to money and don't want to sink their savings into a "retirement visa account", and who prefer being able to drink and eat as much as they want - then why not ask other expats why Vietnam isn't the place to retire?
© 2010-2014 Saigonist.
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