Good Morning Vietnam - Johanna Gibbs's vivid memories of southeast Asia

Language limitations and a lack of analgesia: just two of Johanna Gibbs's vivid memories of southeast Asia
The link between health and physical activity is crystal-clear in Vietnam. It's acted out in the open air every morning as young and old work out. From 5.30am the beaches and parks fill with people doing all kinds of exercise - from t'ai chi to badminton. It's an inspiring sight and even persuaded me to learn tae kwon do. The attitude to health through exercise carries through into hospital, where the idea that exercise can make you better is understood. Most Vietnamese know what a physiotherapist is. In addition, non-adherence to exercise programmes is not such a problem as in the west. Patients and relatives take advice eagerly and are good at adapting it to their own environment. This is a refreshing change and speeds up recovery.
Physios also have a highly respected position in multidisciplinary teams. Doctors often spend two years working as physiotherapists in order to become what are known as rehabilitation doctors. In addition, the doctor's practice of non-specific referrals allows the physiotherapist to act autonomously. Most physiotherapists treat private patients after work, bringing them much-needed extra income to supplement their low hospital salary (about 20 dollars a month).
I was in Vietnam to find out if I enjoyed working in a developing country, away from the comforts of the NHS. Before I started my training I had done a volunteer placement at a rehabilitation centre in Bangladesh, but found it rather frustrating because of my lack of experience. With two years of staff grade rotations at Leeds General Infirmary under my belt I was eager to try again.
A US charity, Vietnam Assisting the Handicapped, offered me a two-month post developing the physiotherapy service for amputees. I was based in a rehabilitation centre in the city of Qui Nhon, the capital of the Binh Dinh province on the country's south central coast. Qui Nhon is very much off the beaten track, and I was the only foreigner at the centre, although some westerners had visited before. The hospital director and the prosthetic director spoke some English, but the physiotherapists didn't speak any, and this turned out to be my greatest challenge, despite hiring translators.
Vietnamese patients have a high expectation of recovery, perhaps partly because of a recent upsurge in modern medicine. In fact, people tend to place a lot of trust in medicine generally, both traditional and modern. I once saw a physiotherapist inject herself with vitamin C rather than eat an orange, while the markets are full of old women selling brightly coloured pills. You mention any ailment and they point to a packet, but the pill seems to change every time you ask the question. Strangely, however, analgesia is not prescribed or encouraged.
On hearing a boy screaming with pain, I asked a physio about this and was told that the Vietnamese had a low pain tolerance. This attitude means that many patients endure a lot of pain during treatment - which is disconcerting for a soft westerner to watch. It is not always clear how much patients understand about their condition, prognosis and discharge plan. The educated patients ask questions, but they are in the minority. I am not sure exactly why doctors and physiotherapists don't give patients a full prognosis, but I think it is partly to do with giving the patient hope and partly about not losing face if nothing can be done. Unfortunately, the result is often the patient stays in the hospital far longer than necessary, paying for every day that they are there. Then, when they need wheelchairs and other equipment, patients have no money left.
When I planned my stint as a volunteer, I was keen to work with amputees, and the charity that sent me told me about the unexploded landmines, left over from the Vietnam war, that continue to disable farmers and children. But when I arrived at the centre, I found this specialty was one of the best funded and was staffed by some of the most skilled people.
Most of the new amputees were not landmine victims but had been injured in traffic accidents, due to the huge number of motorbikes. My patient load, therefore, turned out to include people with stroke, orthopaedic conditions, cerebral palsy and injuries from the so-called Agent Orange (the herbicide and defoliant, used by the US military in the Vietnam war), as well as new amputees.
Young and old were treated similarly in a gym, where six physios worked with about 10 patients a day, treating both in- and outpatients. Thanks to a charity, the equipment was fantastic compared to that of other hospitals in the area. We had separate gait re-education areas, hand therapy tables and a matted area for treating paediatric conditions.
However, the Vietnamese physios lacked confidence in using the equipment, which limited its success. They also tended to dismiss new techniques, although this attitude did not seem typical of the profession as a whole. I felt senior people were reluctant to learn new skills for fear of admitting they didn't already possess them. I decided the best way would be to teach through an 'exchange of information', where I could learn from them and, I hoped, they could learn from me.
The fact I was only 24, with just two years of postgraduate work, counted against me when I tried to encourage new practices. The Vietnamese, rightly, have great respect for older people. Although this means a huge amount of experience is handed down, the fact is treatment techniques are changing every day because of the impact of evidence-based practice. However, a lack of research funding means evidence-based practice is not so common in some developing countries. The older physios tend to stick with what they know, and new techniques are only introduced gradually as younger physios rise up the ranks. At the centre, this meant that contraindicated procedures were sometimes used. The most worrying was that patients, often children, with injuries such as supracondular and tibial plateau fractures, were pushed far beyond the pain threshold, while tied to a bed.
Strengthening exercises are not encouraged, so although transitory range is gained, there is increased inflammation and oedema, and active range is lost. I tried to change this, but the response was always that the patients were poor and couldn't afford to stay at the centre for long. Therefore, the most important goal was to regain the range of movement. The ability to squat is most important as this is the position most Vietnamese adopt to talk, wait and, of course, to go to the toilet. I did see some changes in practice while I was there, mostly involving strengthening exercises, but I will never know whether they went on to adopt any new techniques because changing practice immediately in front of a younger physio would have meant a huge loss of face. I can only hope there are fewer screams now I have gone.
The centre excelled in other ways. Patients could stay for as long as they felt they were benefiting. The environment was relaxed, with areas set aside for families to carry out most of the care. Just three nurses were responsible for 150 beds, but they only dealt with medical problems and, as most of the patients were medically stable, there wasn't a huge need for more.
The orthopaedic and prosthetic department was fantastic, producing 250 legs a month. The prosthetists were highly trained, and gave advice and recommended exercise as well as any physiotherapist could do. The most limiting factor to the patients' overall well-being was the lack of any discharge planning or follow-up care. Occupational therapists (OTs) are not recognised in Vietnam: no advice is given about how to cope at home, no adaptations are made to the patient's environment and no help offered on regaining a rewarding life. Patients are fully supported by their families, but the families often don't understand what the patient is capable of doing and so leave them lying in bed all day.
A government initiative to provide community-based rehabilitation throughout the country is now under way. This will go a long way to tackling a lot of the issues. However, the initiative needs proper teaching from experienced staff and, without OTs, skills are limited. My two months in Vietnam were fantastic but not without difficulties. Yet I gained a lot from the negative as well as the positive aspects. In particular, I learnt a huge amount about the sensitive issue of teaching new skills. You must understand the culture of the country if you are to be able to pass on your skills without causing offence.
One must have a huge respect for what is there already and accept cultures will determine the importance of certain goals - in Vietnam one example was the need to squat. Finally, we must not assume that, in the third world, people will instantly do everything we say.'
The Chartered Society of Physiotherapy - Issue: 19 April 2006

Major festivals in Vietnam

Festivals are typical folklore cultural activities organized in all regions of Vietnam. Such festivals bring peace to the heart and mind of the Vietnamese people, wipe out their pressures from daily life, and bring them closer to nature and the motherland.
As an agricultural country, most Vietnamese festivals are held during leisure times, which are spring and autumn. There are also national festivals for all Vietnamese people, including the Lunar New Year (Tet Nguyen Dan), July Full-Moon, August Full-Moon or Hung Temple festivals.
The Lunar New Year (Tet Nguyen Dan): the Lunar New Year is the biggest festival of the entire Vietnamese nation. This is the time for the whole family to get together and enjoy traditional food, visit relatives, friends and colleagues and wish them a happy new year. As perceived by all people, Tet is the end of the old year, the wrap-up of misfortunes to open up a new year of good opportunities. The New Year Eve is the most sacred moment when all family members worship and pay tribute to genii and ancestors. Apart from the New Year Eve Worshiping, other traditional rites such as "the first visitor of the Year", "buds picking" and "lucky money" are still practiced today.
Hung King National Worshipping Festival: March 10th of the Lunar Calendar is the day of Hung King National Worshipping Festival. This event is celebrated every where in the country and abroad where there are large Vietnamese communities. The major celebration is held in Phu Tho, the first capital of Vietnam under Van Lang Dynasty and the location of the Temple for 18 Hung Kings. During this event, traditional offerings are prepared, including lanterns, incense sticks, wine, betel, areca-nut, water, Chung and Day (Square and Round Sticky Rice) Cakes. In recent years, this event has been considered the National Festival with high formalities, including official music, official costumes and the participation of officials of the Party, State, Government, and Phu Tho province.
The July Full-Moon Festival (Trung Nguyen Festival): According to Buddhism, on this day, spirits of the dead come to the living world to enjoy offerings. Most families hold worshiping rites for ancestors. Upon the end of the rite, votive papers are burnt for spirits of the dead. Other offerings, including soup, parched rice, dry pancake and fruits are also prepared for wandering spirits, who are not worshiped by relatives. After the rite, offerings are given to the children as a wish of luck.
The August Full-Moon Festival: This Festival is held mainly for children. Vietnamese families, especially those with little children, always prepare for this festival. On the night of the Festival, most families have a tray of specialties for members to get around and enjoy the Moon's beauty. The specialties are mainly fruits and confectionery formed like animals. During the festival, adults usually buy toys for children. The atmosphere of the festival night is enjoyable with the laughter of children, the light of the Moon, lanterns, and candles of many kinds and children’s dancing and singing, such as Lantern Carrying Dance or Lion dance, etc.
Copyright: Ministry of Foreign Affairs. Ref. Quê Hương

Viet Nam, China discuss sea delineation

The Viet Nam-China joint working group on delineation of the sea area off Bac Bo (Tonkin) Gulf held its fourth round of talks in Beijing from January 17-18.
The two sides exchanged views and reached consensus in a number of issues, creating a basis for further negotiations and solving the matter of delineating the sea area between the two countries. Officials of the two countries agreed that the fifth round of talks will take place in Viet Nam later this year. The same day, Chinese Deputy Foreign Minister Wu Dawei, head of the Chinese governmental delegation for negotiations on border and territory, had a reception for all members of the joint working group.
(VNA)
Created by hongnt ref. Quê Hương

First-month FDI hits US$1.7 billion

Vietnam drew more than US$1.7 billion of foreign direct investment (FDI) in January, a nearly five-fold increase over the same period last year, according to the Foreign Investment Department under the Ministry of Planning and Investment.
During the period, the country licensed 35 new FDI projects with a total registered capital of US$1.65 billion, 21 percent year-on-year and 5.4-fold increases in the number of projects and value, respectively.
Meanwhile, 10 projects were allowed to add a total capital of US$65 million.
Prominent projects include a US$1.3 billion complex of five-star hotel and entertainment and culinary centres in southern Ba Ria-Vung Tau province by the US-based Good Choice Corporation and an over US$298 million resort in central Thua Thien-Hue province by the Lap An Development and Investment Ltd. Co. of Singapore.
According to the Foreign Investment Department, the number of foreign investors flocking to Vietnam to seek investment opportunities in localities continued increasing. In 2008, the Department plans to set up investment promotion centres in key international markets such as Austria, France, Italy, Japan, the Republic of Korea, and the US to attract more foreign investors to the country.
(VOV) Created by hongnt Ref. Quê Hương

Ha Long Bay hits top ten in natural world wonders bid

The World Heritage Site Ha Long Bay now ranks ninth among some 200 other nominees in the bid to become one of the seven natural wonders of the world, announced the official website www.new7wonders.com of the New Open World Organisation.
Ha Long Bay was placed tenth on January 17 and inched up a place to ninth on January 18.
One month ago, Ha Long Bay was placed sixth in the list. To support the vote, the northern province of Quang Ninh will hold a tourism week with the theme of “Ha Long Bay Heritage site” on May 2008.
(VOV) Ref. Tạp chí Quê hương

Aspects of Vietnam national development

Vietnam is located in a region considered a cradle of mankind, one of the earliest agricultural centres practicing wet rice farming, where the stone and metallurgical revolutions took place. On the basis of socio-economic development in the time of the Dong Son culture and given the struggle with nature and against aggression, Van Lang State, the first State in Vietnam was established in the 7th century B.C.
Thanks to their hard work and creativeness, Van Lang (and then Au Lac) residents created a civilization that influenced the entire Southeast Asian region. Together with the formation of the first State in Vietnam’s history was the evolution of a diverse economy and advanced culture known as the Red River civilization (or Dong Son civilization) symbolized by Dong Son bronze drum, a heritage reflecting the quintessence of the lifestyle, traditions and culture of the ancient Vietnamese.
In the cause of national building, the Vietnamese also had to cope with various foreign aggressions. During 12 centuries from the resistance against the Qin dynasty in the 3rd century B.C until late 20th century, the Vietnamese had to launch hundreds of struggles and uprisings against foreign aggression. The tactic, as stated in the Proclamation of Victory over the Wu “Binh Ngo Dai Cao,” “…Relying on surprises, we placed our weak forces before much stronger ones; In skillful ambushes, our few troops destroyed large units,” has become the rule of thumb in the wars of safeguarding the Fatherland of the Vietnamese.
Since the 2nd century B.C, Vietnam had been dominated by different Chinese dynasties for more than a thousand years. During this period, the existence of the nation had been challenged which helped give rise to the spirit of indomitability and staunchness of the Vietnamese in the struggle to maintain the nation’s vitality, preserve and build on the quintessence of its culture and the determination to gain national independence.
Despite many vicissitudes, from Van Lang, Au Lac to Van Xuan, Dai Co Viet and Dai Viet, the Vietnamese nation continued to develop in all fields, reflecting its strong vitality and unceasing evolution.
A typical feature of Vietnamese culture is the village culture. It is Vietnamese villages that have nurtured and fostered the quintessence of the traditional culture, the spirit of unity among the Vietnamese in the struggle against the domination of the North and the policy of assimilation of Northern dynasties to gain national independence, maintaining the nation’s traditions and cultures.
The Bach Dang victory in 938 opened up a new era in Vietnam’s history – the era of development of an independent feudal state, national construction and defense. As a result, the centralized-administration state was established under the Ngo (938-965), Dinh (969-979) and earlier Le (980 - 1009) dynasties.
Then, Vietnam entered the period of renaissance and development under the Ly (1009-1226), Tran (1226-1400), Ho (1400-1407) and Le So (1428-1527) dynasties. Dai Viet, the name of the country under the Ly-Tran-Le So dynasties, was known as a prosperous country in Asia. This period marked the golden age of Vietnam’s history. Economically, this period saw the development of agriculture and irrigation (with the construction of the Red River dike) and the formation of traditional handicrafts. In terms of religion, Buddhism, Taoism and Confucianism were considered the three co-existing official religions exerting great influence on people’s life. One important achievement in the Ly-Tran dynasties was the introduction of Nom scripts, Vietnam’s own writing system based on the reform of Chinese Han scripts. In addition, this period also marked the splendid development of education, science, culture, art, history and law etc. (such as the establishment of Van Mieu - Quoc Tu Giam, the first university of Vietnam, the introduction of Hong Duc Code and Complete History of Dai Viet etc.) This period was called the Civilized Age of Dai Viet. Thang Long (the old name of Hanoi capital) was officially recognized as the imperial city of Dai Viet according to the Proclamation on the transfer of the capital to Hanoi in 1010 by Ly Thai To.
From the 16th century, the backwardness and weakness of the feudal regime under Confucius ideology were revealed, feudalism fell into a decline. While many nation states in Europe were moving to capitalism, Dai Viet was bogged down in internal wars and divisions, which heavily impeded the country’s evolution despite certain developments in the economy and culture, the establishment of towns and ports and the growth of trade and exchanges between the 16th and 18th century.
In the 19th century, Western capitalist countries entered the period of imperialism and colonialism. Through missionaries and trade, the French gradually dominated Vietnam. For the first time in history, the Vietnamese nation had to cope with the invasion of a Western country. In that context, some Vietnamese intellectuals were aware of the need to carry out reforms in an effort to bring the country out of stagnation and save national independence. Many plans of reform were proposed, yet rejected by the Nguyen dynasty. Subsequently, the country was driven into backwardness and deadlock. Vietnam became a semi-feudal colony for nearly 100 years from 1858 to 1945.
After setting up the colonist rule in Vietnam, the French colonialists quickly began large-scale exploitation in the country. Capitalist production relations infiltrated in Vietnam, stimulating the formation and evolution of internal capitalist factors, and as a result, narrowing and breaking up the existing feudal production relations. Vietnam’s economy thus moved from a backward and self-sufficient economy to a colonized one totally controlled by the French capitalists. A new social structure evolved along the line of capitalism, and subsequently the division between landlords and farmers was deepened while new forces, such as the working class, the bourgeoisies and petit bourgeoisies gradually came into being. Eventually, the struggle against the French colonialists was initiated by two forces i.e. the bourgeoisies (represented by Vietnam Quoc Dan Dang and Yen Bai revolt in early 1930) and the proletarians led by the Communist Party of Vietnam.
The formation of the Communist Party of Vietnam marked the prevailing strength of the working class and revolutionary movements led by the proletarians. In August 1945, under the leadership of the Communist Party headed by Nguyen Ai Quoc (later known as President Ho Chi Minh), the Vietnamese people and the Armed Propaganda Unit for National Liberation (now the People’s Army) successfully launched a general uprising to seize power. With the Proclamation of Independence on 2nd September 1945, the Democratic Republic of Vietnam came into being.
The globe-shaking victory of Dien Bien Phu (May 1954) and the Geneva Accord (July 1954) put an end to the war of resistance against the French colonialists, opening up a new era of independence and freedom for the Vietnamese nation in which North Vietnam embarked upon the transitional period towards socialism. According to the Geneva Agreement, South Vietnam was under the temporary control of the French and the Americans in the run-up to the general elections. Nevertheless, the general elections could never be held due to the interference of the United States. The Republic of South Vietnam headed by Ngo Dinh Diem was established by the United States. Vietnam continued to be divided for more than 20 years.
Between 1954 and 1975, Vietnam had to fight another war for national liberation and unification. With untold hardships brought out for the Vietnamese people to bear, the war came to an end following the victory of the historic Ho Chi Minh Operation in 1975. Since then, the unified Vietnam has ushered into a new era of peace, unification and national construction.
However, in the first ten years of this period, many socio-economic targets were not achieved due to both internal and external reasons. Vietnam’s economy fell into crisis and stagnation and people’s lives were difficult.
At the 6th Congress of the Communist Party in 1986, Doi Moi (reform) policy was launched with focus on economic reform. This marked an important milestone in the new stage of development of the Vietnamese nation. Doi Moi policy was consistently reaffirmed throughout the later Party Congresses. With the implementation of four five-year socio-economic development plans, Vietnam, from a food importing country, has become the second largest rice exporter in the world. Vietnam also exports a lot of other commodities with well-known brands. The economy has attained high growth rate since late 20th century and early years of the 21st century, people’s lives have been significantly improved; social policy received greater attention, the legal system has become increasingly complete and social management based on the rule of law put into place.
Looking back at the formation and development of the Vietnamese nation, we can see that patriotism, self-reliance, tradition of unity and the willpower to fight for the righteous cause of the nation are the most important features and the moral standards of the Vietnamese. The tradition of industriousness, creativeness and patience originated from the life full of hardship of the Vietnamese people. The need to stand united to cope with difficulties and challenges has created close bonds between the people and the nature and among the people in the family and in the community in the family-village-nation relations. Throughout history, the Vietnamese people have been characterized by the traditions of mutual assistance, ethic-based lifestyle, benevolence, one-mindedness and sharing of hardships in needy times, flexible ways of behaviour, the tradition of eagerness to learn, respect for righteousness and tolerance. These are the powerful and endless endogenous strengths for the Vietnamese nation to embark on the cause of national construction towards the goals of strong country, prosperous people, just, democratic and advanced society.
Copyright: Ministry of Foreign Affairs Ref. Tạp chí Quê hương

Casinos will be allowed at suitable time: VN Deputy PM

The Communist Party and the state think that it is now not the right time to allow open casinos, because opinions still vary about this.
Deputy Prime Minister Nguyen Sinh Hung said so when answering questions from National Assembly deputies about whether the country should allow open casinos at the latest legislative session. He said: “It is not because we still cannot keep control over casinos. In fact, casinos are also not encouraged in the world.”
However, Deputy Prime Minister Nguyen Sinh Hung said that casinos might be allowed at a suitable time later on a trial basis. However, he stressed that this would still need thorough studies in order to avoid bad impacts on society.
According to an official from the Ministry of Planning and Investment (MPI), the ministry has submitted to the government a plan on casino development. No official information has been released about this, but sources say that the government would only consider allowing casinos to be set up within projects that have investment capital of $4bil and higher, large real estate complexes. These must be very big projects that would positively impact the whole region.
However, when talking with press agencies, Head of the Foreign Investment Agency under the Ministry of Planning and Investment Phan Huu Thang said that the requirement on investment scale would be just one of the conditions.
Meanwhile, a lot of foreign investors are planning to make investment in big real estate complexes in Vietnam which include casinos.
In September 2007, two US investors, Gillman Group and Fidelity Ventures Investment Group, unveiled their plan to develop a tourism project in Ba Ria-Vung Tau province in the south, estimated to cost up to US$5bil. It would include a financial-banking centre, a water park and aquarium, a casino, a cinema area, resorts, and others.
Quang Ninh authorities in October 2007 approved the 300-hectare tourism complex worth US$112mil. Vu Nguyen Nhiem, chairman of the provincial government, said that the investor, which is a Vietnam-US joint venture, would build major works for the complex such as a golf course and hotel. It is also seeking permission from the Prime Minister to build a casino section there.
VnEconomy (30/11/2007) Ref. Vietnam gateway