H

VIETNAM TRAVEL

 

Health

Before you go - In Transit - In Vietnam

IN VIETNAM

AVAILABILITY OF HEALTH CARE
The significant improvement in Vietnam's economy has brought with it some major advances in public health. Rural areas can still pose a problem when it comes to finding good health care, however; although foreigners with hard cash will receive the best treatment available, even bars of gold cannot buy blood tests or X-rays when the local clinic doesn't even have a thermometer or any aspirin. If you become seriously ill in rural Vietnam, get to Ho Chi Minh City (HCMC) or Hanoi as quickly as you can. If you need any type of surgery or other extensive treatment, don't hesitate to fly to Bangkok, Hong Kong or another renowned medical centre as soon as possible. Government hospitals in Vietnam are overcrowded and basic. In order to treat foreigners, a facility needs to obtain a special license and so far only a few have been provided. The private clinics in Hanoi and HCMC should be your first port of call. They are familiar with the local resources and can organise evacuations if necessary. The contact details of the best medical facilities in Vietnam are listed in the Hanoi and HCMC chapters. These are the only cities where you are likely to find health facilities that come close to meeting the standard of developed countries. Self-treatment may be appropriate if your problem is minor (eg travellers' diarrhoea), you are carrying the appropriate medication and you cannot attend a recommended clinic. If you think you may have a serious disease, especially malaria, do not waste time - travel to the nearest quality facility to receive attention. It is always better to be assessed by a doctor than to rely on self-treatment. Buying medication over the counter is not recommended, as fake medications and poorly stored or out of-date drugs are common. Check the expiry dates on any medicines you buy. If you need special medication then take it with you.
INFECTIOUS DISEASES

Dengue
This mosquito-borne disease is becoming increasingly problematic throughout Southeast Asia, especially in the cities. As there is no vaccine available it can only be prevented by avoiding mosquito bites. The mosquito that carries dengue bites day and night, so use insect avoidance measures at all times. Symptoms include high fever, severe headache and body ache (dengue was once known as 'breakbone fever'). Some people develop a rash and experience diarrhoea. There is no specific treatment, just rest and paracetamol - do not take aspirin as it increases the likelihood of haemorrhaging. See a doctor to be diagnosed and monitored.
Filariasis
This is a mosquhu-borne disease that is very common in the local population, yet very rare in travellers. Mosquito-avoidance measures are the best way to prevent this disease.
Hepatitis A
A problem throughout the region, this food -and water-borne virus infects the liver, causing jaundice (yellow skin and eyes), nausea and lethargy. There is no specific treatment for hepatitis A, you just need to allow time for the liver to heal. All travellers to Vietnam should be vaccinated against hepatitis A
Hepatitis B
The only sexually transmitted disease that can be prevented by vaccination, hepatitis B is spread by body fluids, including sexual contact. In some parts of Southeast Asia up to 20% of the population are carriers of hepatitis B, and usually are unaware of this- The long-term consequences can include liver cancer and cirrhosis.
Hepatitis E
Hepatitis E is transmitted through contaminated food and water and has similar symptoms to hepatitis A, but is far less common. It is a severe problem in pregnant women and canresult in the death of both mother and baby. There is currentlyno vaccine, and prevention is by following safe eatingand drinking guidelines.
HIV
The official figures on the number of people with HIV/AIDS in Vietnam are vague, but they are on the rise. Health-education messages relating to H1V/AIDS can be seen all over the countryside, however the official line is that infection is largely limited to sex workers and drug users. Condoms are widely available throughout Vietnam.
Influenza
Present year-round in the tropics, influenza (flu) symptoms include high fever, muscle aches, runny nose, cough and sore throat. It can be very severe in people over the age of 65 or in those with underlying medical conditions such as heart disease or diabetes; vaccination is recommended for these individuals. There is no specific treatment, just rest and paracetamol.
Japanese B Encephalitis
While a rare disease in travellers, at least 50,000 locals are infected with Japanese B Encephalitis each year in Southeast Asia. This viral disease is transmitted by mosquitoes. Most cases occur in rural areas and vaccination is recommended for travellers spending more than one month outside of cities. There is no treatment, and a third of infected people will die while another third will suffer perma-nent brain damage.
Malaria
For such a serious and potentially deadly disease, there is an enormous amount of misinformation concerning malaria. You must get expert advice as to whether your trip actually puts you at risk. Many parts of Vietnam, par ticularly city and resort areas, have minimal to no risk of malaria, and the risk of side ef fects from the tablets may outweigh the risk of getting the disease. For most rural areas, however, the risk of contracting the disease far outweighs the risk of any tablet side effects. Travellers to isolated areas in high-risk regions such as Ca Mau and Bac Lieu provinces, and the rural south, may like to carry a treatment dose of medication for use if symptoms occur. Remember that malaria can be fatal. Before you travel, seek medical advice on the right medication and dosage for you. Malaria is caused by a parasite transmitted by the bite of an infected mosquito. The most important symptom of malaria is fever, but general symptoms such as headache, diarrhoea, cough, or chills may also occur. Diagnosis can only be made by taking a blood sample. Two strategies should be combined to prevent malaria - mosquito avoidance, and antimalarial medications. Most people who catch malaria are taking inadequate or no antimalarial medication. Travellers are advised to prevent mosquito bites by taking these steps: Choose accommodation with screens and fans (if not air-conditioned). Impregnate clothing with Permethrin in high-risk areas. Sleep under a mosquito net impregnated with Permethrin. Spray your room with insect repellent before going out for your evening meal, Use a DEET-containing insect repellent on exposed skin. Wash this off atnight, as long as you are sleeping under a mosquito net. Natural repellents such as Citronella can be effective, but must be applied more frequently than product-containing DEET Use mosquito coils. Wear long sleeves and trousers in light colours.
MALARIA MEDICATION
There are a variety of medications available The effectiveness of the Chloroquine and Paludrine combination is now limited in most of Southeast Asia. Common .side effects include nausea (40% of people) and mouth ulcers. It is generally not recommended. Lariam (Mefloquine) has received a lot of bad press, some of it justified, some not This weekly tablet suits many people Serious side effects are rare but include depression anxiety, psychosis and seizures. Anyone with a history of depression, anxiety, other psycho logical disorder or epilepsy should not take Lariam. It is considered sate in the second and third trimesters of pregnancy. It is around 90% effective in most parts of Southeast Asia but there is significant resistance in parts of northern Thailand, Laos and Cambodia. Tab lets must be taken tor four weeks after leaving the risk area. Doxycycline, taken as a daily tablet, is a broad-spectrum antibiotic that has the added benefit of helping to prevent a variety of tropical diseases, including leptospirosis tick-borne disease, typhus and melioidosis. The potential side effects include photosensitivity (a tendency to sunburn), thrush in women, indigestion, heartburn, nausea and interference with the contraceptive pill More serious side effects include ulceration of the oesophagus - you can help prevent this by taking your tablet wish a meal and a large glass of water, and never lying down within half an hour of taking it. It must be taken for four weeks after leaving the risk area. Malarone is a new drug combining Atovaquone and Proguanil. Side effects are uncommon and mild, most commonly nausea and headaches. It is the best tablet for scuba divers and for those on short trips to high-risk area. It must be taken for one week after leaving the risk area. Derivatives of Artesunate are not suitable as a preventive medication. They are useful treatments under medical supervision.
SCORCHED OEUF POLICY
There have been periodic outbreaks of avian influenza or bird flu in Vietnam in the past few years. Dozens people have died and the threat of human-to-human transmission remains very real. Now the H5-N1 strain has now gone global, Vietnam is no longer in the spotlight. However, when outbreaks occur, eggs and poultry are usually banished from the menu in many hotels and restaurants. Even where eggs are available, we recommend a scorched oeuf policy. Ensure they are well cooked in whatever shape or form thy come. No runny omelettes, no sunny side up. Don't take risks or you might end up with egg on your face. A final option is to take no preventive medication but to have a supply of emergency medication should you develop the symptoms of malaria. This is less than ideal, and you'll need to get to a good medical facility within 24 hours of developing a fever. If you choose this option the most effective and safest treatment is Malarone (four tablets once daily for three days). Other options include Mefloquine and Quinine but the side effects of these drugs at treatment doses make them less desirable Fansidar is no longer recommended
Measles
Measles remains a problem in some parts of Vietnam. This highly contagious bacterial in lection is spread via coughing and sneezing Many people born before 1966 are immune as they had the disease in childhood. Measles starts with a high fever and rash and can be complicated by pneumonia and brain disease. There is. no specific treatment
Rabies
This uniformly fatal disease is spread by the bite or Iick of an infected animal - most commonly a dog or monkey. Seek medical advice immediately after any animal bite and commence post-exposure treatment- Having a pretravel vaccination means the postbite treatment is greatly simplified. If an animal bites you, gently wash the wound with soap and water, and apply iodine based antiseptic. It you arc not vaccinated you will need to receive rabies immunoglobulin as soon as possible.
Schistosomiasis
Schistosomiasis (also called bilharzia) is a tiny parasite that enters your skin after you've been swimming in contaminated water - travellers usually only get a light infection and hence have no symptoms. If you are concerned, you can be tested three months after exposure. On rare occasions, travellers may develop 'Katayama fever' - this occurs some weeks after exposure, as the parasite passes through the lungs and causes an allergic reaction -symptoms are coughing and fever. Schistosomiasis is easily treated with medications.
STDs
Sexually transmitted diseases include herpes, warts, syphilis, gonorrhoea and chlamydia. People carrying these diseases often have no signs of infection. Condoms will prevent gonorrhoea and chlamydia but not warts or herpes. If after a sexual encounter you develop any rash, lumps, discharge or pain when pass¬ing urine seek immediate medical attention. If you have been sexually active during your travels have an STD check on your return home. While abstinence from sexual contact is the only 100% effective prevention, using condoms is also effective. Condoms are widely available throughout Vietnam; when purchasing, ensure the package hasn't been stored in the sun as the rubber could have deteriorated.
Tuberculosis
Tuberculosis (TB) is rare in short-term travellers. Medical and aid workers, and long-term travellers who have significant contact with the local population should take precautions, however. Vaccination is usually only given to children under the age of five, but adults at risk are recommended pre- and post-travel TB testing. The main symptoms are fever, cough, weight loss, night sweats and tiredness.
Typhoid
This serious bacterial infection is spread via food and water. It gives a high, slowly progressive fever and headache, and may be accompanied by a dry cough and stomach pain. It is diagnosed by blood tests and treated with antibiotics. Vaccination is recommended for all travellers spending more than a week in Southeast Asia, or travelling outside of the major cities. Be aware that vaccination is not 100% effective so you must still be careful with what you eat and drink.
Typhus
Murine typhus is spread by the bite of a flea whereas scrub typhus is spread via a mite. These diseases are rare in travellers. Symptoms include fever, muscle pains and a rash. You can avoid these diseases by following general insect-avoidance measures. Doxycy-cline will also prevent them.
TRAVELLERS' DIARRHOEA
Travellers' diarrhoea is by far the most cornmon problem affecting travellers - between 30% and 50% of people will suffer from it within two weeks of starting their trip. In over 80% of cases, travellers' diarrhoea is caused by a bacteria (there are numerous potential culprits), and therefore responds promptly to treatment with antibiotics. Treatment with antibiotics will depend on your situation - how sick you are, how quickly you need to get better, where you are and so on. Travellers' diarrhoea is defined as the passage of more than three watery bowel-actions within 24 hours, plus at least one other symptom such as fever, cramps, nausea, vomiting or feeling generally unwell. Treatment consists of staying well-hydrated. Rehydration solutions like Gastro-lyte are the best for this. Antibiotics such as Norfloxacin, Ciprofloxacin or Azithromycin will kill the bacteria quickly. Loperamide is just a 'stopper' and doesn't get to the cause of the problem. It can be help¬ful, for example if you have to go on a long bus ride. Don't take Loperamide if you have a fever, or blood in your stools. Seek medical attention quickly if you do not respond to an appropriate antibiotic.
Amoebic Dysentery
Amoebic dysentery is very rare in travellers but is often misdiagnosed by poor-quality labs in Southeast Asia. Symptoms are similar to bacterial diarrhoea, ie fever, bloody diarrhoea and generally feeling unwell. You should always seek reliable medical care if you have blood in your diarrhoea. Treatment involves two drugs: Tinidazole or Metroniadzole to kill the parasite in your gut and then a second drug to kill the cysts. If left untreated complications such as liver or gut abscesses can occur.
Giardiasis
Giardia lamblia is a parasite that is relatively common in travellers. Symptoms include nausea, bloating, excess gas, fatigue and intermittent diarrhoea. 'Eggy' burps are often attributed solely to giardiasis, but work in Nepal has shown that they are not specific to this infection. The parasite will eventually go away if left untreated but this can take months. The treatment of choice is Tinidazole, with Metro-nidazole being a second-line option.
ENVIRONMENTAL HAZARDS

Air Pollution
Air pollution, particularly vehicle pollution, is an increasing problem in most of Vietnam's major cities. If you have severe respiratory problems speak with your doctor before travelling to any heavily polluted urban centres. This pollution also causes minor respira-tory problems such as sinusitis, dry throat and irritated eyes. If troubled by the pollution leave the city for a few days and get some fresh air.
Food
Eating in restaurants is the biggest risk factor for contracting travellers' diarrhoea. Ways to avoid it include eating only freshly cooked food, and avoiding shellfish and food that has been sitting around in buffets. Peel all fruit, cook vegetables, and soak salads in iodine water for at least 20 minutes. Eat in busy res¬taurants with a high turnover of customers.
Heat
Many parts of Southeast Asia are hot and humid throughout the year. For most people it takes at least two weeks to adapt to the hot climate. Swelling of the feet and ankles is common, as are muscle cramps caused by excessive sweating. Prevent these by avoiding dehydration and excessive activity in the heat. Take it easy when you first arrive. Don't eat salt tablets (they aggravate the gut) but do drink rehydration solution and eat salty food. Treat cramps by stopping activity, resting, rehydrating with double-strength rehydration solution and gently stretching. Dehydration is the main contributor to heat exhaustion. Symptoms include feeling weak, headache, irritability, nausea or vomiting. sweaty skin, a fast, weak pulse and a normal or slightly elevated body temperature. Treatment involves getting out of the heat and/or sun, fanning the victim and applying cool wet cloths to the skin, laying the victim flat with their legs raised and rehydrating with water containing a quarter of a teaspoon of salt per litre. Recovery is usually rapid, though it is common to feel weak for some days afterwards. Heatstroke is a serious medical emergency. Symptoms come on suddenly and include weakness, nausea, a hot dry body with a body temperature of over 41°C, dizziness. confusion, loss of coordination, seizures and eventually collapse and loss of consciousness, Seek medical help and commence cooling by getting the person out of the heat, removing their clothes, fanning them and applying cool wet cloths or ice to their body, especially to the groin and armpits. Prickly heat is a common skin rash in the tropics, caused by sweat being trapped under the skin. The result is an itchy rash of tiny lumps. Treat by moving out of the heat and into an air-conditioned area for a few hours and by having cool showers. Creams and ointments clog the skin so they should he avoided. Locally bought prickly heat powder can be helpful. Tropical fatigue is common in long-term expats based in the tropics. It's rarely due to disease and is caused by the climate, inad¬equate mental rest, excessive alcohol intake and the demands of daily work in a different culture.
Insect Bites & Stings
Bedbugs don't carry disease but their bites are very itchy. They live in the cracks of furniture and walls and then migrate to the bed at night to feed on you. You can treat the itch with an antihistamine. You can try to prevent or minimise their bite by using your own sheet sleeping bag cover. Lice inhabit various parts of your body but most commonly your head and pubic area- Transmission is via close contact with an infected person, although body lice can come from contaminated bedclothes. They can be difficult to treat and you may need numerous applications of an antilice shampoo such as Permethrin, or in the case of body lice, with medicated creams or ointments. Pubic lice are usually contracted from sexual contact. Ticks are contracted during walks in rural areas. They are commonly found behind the ears, on the belly and in armpits. If you have had a tick bite and experience symptoms such as a rash (at the site of the bite or elsewhere). fever or muscle aches you should see a doctor. Doxycycline prevents tick-borne diseases Leeches are found in humid forest areas. They do not transmit any disease but their bites are often intensely itchy for weeks afterwards and can easily become infected. Apply an iodine-based antiseptic to any leech bite to help prevent infection. Bee and wasp stings mainly cause problems for people who are allergic to them. Anyone with a serious bee or wasp allergy should carry an injection of adrenaline (eg an Epipen) for emergency treatment. For others pain is the main problem - apply ice to the sting and take painkillers. Most jellyfish in Vietnamese waters are not dangerous, just irritating. First aid for jellyfish stings involves pouring vinegar onto the affected area to neutralise the poison. Do not rub sand or water onto the stings. Take painkillers, and anyone who feels ill in any way after being stung should seek medical advice. Take local advice if there are dangerous jellyfish around and keep out of the water.
Parasites
Numerous parasites are common in local populations in Vietnam; however, most of these are rare in travellers. The two rules to follow if you wish to avoid parasitic infections are to wear shoes and to avoid eating raw food, especially fish, pork and vegetables. A number of parasites are transmitted via the skin by walking barefoot including strongyloides, hookworm and cutaneous larva migrans.
Skin Problems
Fungal rashes are common in humid climates. There are two common fungal rashes that affect travellers. The first occurs in moist areas that get less air such as the groin, armpits and between the toes. It starts as a red patch that slowly spreads and is usually itchy. Treatment involves keeping the skin dry, avoiding chafing and using an antifungal cream such as Clotrimazole or Lamisil. Tinea versicolor is also common - this fungus causes small, light coloured patches, most commonly on the back, chest and shoulders. Consult a doctor. Cuts and scratches become easily infected in humid climates. Take meticulous care of any cuts and scratches to prevent complications such as abscesses. Immediately wash all wounds in clean water and apply antiseptic. If you develop signs of infection (increasing pain and redness) see a doctor. Divers and surfers should be particularly careful with coral cuts as they become easily infected.
Snakes
Vietnam is home to many species of both poisonous and harmless snakes. Assume all snakes are poisonous and never try to catch one. Always wear boots and long pants if walking in an area that may have snakes. First-aid in the event of a snakebite involves pressure immobilisation via an elastic bandage firmly wrapped around the affected limb, starting at the bite site and working up towards the chest. The bandage should not be so tight that the circulation is cut off. and the fingers or toes should be kept free so the circulation can be checked. Immobilise the limb with a splint and carry the victim to medical atten- tion. Do not use tourniquets or try to suck the venom out. Antivenom is available only in major cities.
Sunburn
Even on a cloudy day sunburn can occur rapidly. Always use a strong sunscreen (at least factor 30), making sure to reapply after a swim, and always wear a wide-brimmed hat and sunglasses outdoors. Avoid lying in the sun during the hottest part of the day (from 10am to 2pm). If you become sunburnt stay out of the sun until you have recovered, apply cool compresses and take painkillers for the discomfort. One percent hydrocortisone cream applied twice daily is also helpful.
WOMEN'S HEALTH
Pregnant women should receive specialised advice before travelling. The ideal time to travel is in the second trimester (between 16 and 28 weeks), during which the risk of pregnancy-related problems is at its lowest and pregnant women generally feel at their best. During the first trimester there is a risk of miscarriage and in the third trimester complications such as premature labour and high blood pressure are possible. It's wise to travel with a companion. Always carry a list of quality medical facilities available at your destination and ensure you continue your standard antenatal care at these facilities. Avoid rural travel in areas with poor transportation and medical facilities. Most of all, ensure travel insurance covers all pregnancy-related possibilities, including premature labour. Malaria is a high-risk disease in pregnancy. WHO recommends that pregnant women do not travel to areas that have Chloroquine-resistant malaria. None of the more effective antimalarial drugs are completely safe in pregnancy. Travellers' diarrhoea can quickly lead to dehydration and result in inadequate blood flow to the placenta. Many of the drugs used to treat various diarrhoea bugs are not recommended in pregnancy. Axithromycin is considered safe.
In the urban areas of Vietnam, supplies of sanitary products are readily available. Birth control options may be limited so bring ad¬equate supplies of contraception. Heat, humidity and antibiotics can all contribute to thrush. Treatment is with antifungal creams and pessaries such as Clotrimazole. A practi¬cal alternative is a single tablet of Flucona-zole (Diflucan). Urinary tract infections can be precipitated by dehydration or long bus journeys without toilet stops; bring suitable antibiotics.
TRADITIONAL MEDICINE
A number of traditional medical treatments are practised in Vietnam. Herbal medicine, much of it imported from China, is widely available and sometimes very effective. As with Western medicine, self-diagnosis is not advisable - see a doctor. Traditional Chinese doctors are found wherever a large Chinese community exists, including HCMC, Hanoi and Hoi An. If you visit traditional Chinese doctors, you might be surprised by what they discover about your body. For example, the doctor will almost certainly take your pulse and then may perhaps tell you that you have a 'slippery' or 'thready' pulse. They have identified more than 30 different kinds of pulse. A pulse could be empty, prison, leisurely, bowstring, irregu¬lar or even regularly irregular. The doctor may then examine your tongue to sec if it is slippery, dry, pale, greasy, has a thick coat¬ing or possibly no coating at all. The doctor, having discovered your ailment, such as wet heat, as evidenced by a slippery pulse and a red greasy tongue, will prescribe the proper herbs for your condition. Once you have a diagnosis you may be treated by moxibustion, a traditional treatment whereby various types of herbs, rolled into what looks tike a ball of fluffy cotton, are held near the skin and ignited. A slight vari-ation of this method is to place the herb on a slice of ginger and then ignite it. The idea is to apply the maximum amount of heat possible without burning the patient. This heat treatment is supposed to be very good for diseases such as arthritis. It is common to see Vietnamese people with long bands of red welts on their necks, foreheads and backs. Don't worry, this is not some kind of hideous skin disease, but rather a treatment known as cao gio, literally 'scrape wind'. In traditional Vietnamese folk medicine, many illnesses are attributed to 'poisonous wind', which can be released by applying eucalyptus oil or tiger balm and scraping the skin with a spoon or coin, thus raising the welts. The results aren't pretty, but the locals say this treatment is good for the common cold, fatigue, headaches and other ailments. Whether the cure hurts less than the disease is something one can only judge from experience. Another technique to battle bad breezes is called giac hoi. This one employs suction cups, typically made of bamboo or glass, which are placed on the patient's skin. A burning piece of alcohol-soaked cotton is briefly put inside the cup to drive out the air before it is applied. As the cup cools, a partial vacuum is produced, leaving a nasty-looking but harmless red circular mark on the skin, which goes away in a few days. Looks pretty weird on the forehead though! There is some solid evidence attesting to the efficacy of acupuncture. Some major surgical operations have been performed using acupuncture as the only anaesthetic (this works best on the head). In this case, a small electric current (from batteries) is passed through the needles. If done properly the practice doesn't hurt. Knowing where to insert the needle is cru¬cial. Acupuncturists have identified more than 2000 insertion points, but only about 150 are commonly used. The exact mechanism by which it works is not fully understood. Practitioners talk of energy channels or meridians that connect the needle insertion point to the particular organ, gland or joint being treated. The acupuncture point is sometimes quite far from the area of the body being treated.
Nonsterile acupuncture needles pose a genuine health risk in this era of AIDS. You would be wise to purchase your own acupuncture needles if you plan on having this treatment in Vietnam
DRINKING WATER

The number one rule is be careful of the water, ice can be particularly risky; if you don't know for certain that the water is safe, assume the worst. However, a lot of the ice in Vietnam comes from factories introduced by the French, so it is as safe as the bottled water. Following these rules will help you avoid water-borne diseases.
Never drink tap water.
Bottled water is generally safe - check the sea! is intact at purchase.
Boiling water is the most efficient method of purifying it.
The best chemical purifier is iodine. It should not be used by pregnant women or those people who suffer with thyroid problems.
Water filters should filter out viruses. Ensure your filter has a chemical barrier such as iodine and a small pore size, ie less than four microns