Vietnam //

Health

Vietnam’s health problems read like a dictionary of tropical medicine. Diseases that are under control elsewhere in Southeast Asia have been sustained here by poverty, dietary deficiencies, poor healthcare and the disruption caused by half a century of war. The situation is improving, however, and by coming prepared and taking a few simple precautions while in the country, you’re unlikely to come down with anything worse than a cold or a dose of travellers’ diarrhoea.

When planning your trip it’s wise to visit a doctor as early as possible, preferably at least two months before you leave, to allow time to complete any recommended courses of vaccinations. It’s also advisable to have a trouble-shooting dental check-up – and remember that you generally need to start taking anti-malarial tablets at least one week before your departure.

For up-to-the-minute information, it may be worth visiting a specialized travel clinic; most clinics also sell travel-associated accessories, including mosquito nets and first-aid kits.

Vaccinations

No vaccinations are required for Vietnam (except yellow fever if you’re coming directly from an area where the disease is endemic), but typhoid and hepatitis A jabs are recommended; it’s also worth ensuring you’re up to date with boosters such as tetanus and polio. Additional injections to consider, depending on the season and risk of exposure, are hepatitis B, Japanese encephalitis, meningitis and rabies. All these immunizations can be obtained at international clinics in Hanoi, Ho Chi Minh City and Da Nang, but it’s less hassle and usually cheaper to get them done at home. Get all your shots recorded on an International Certificate of Vaccination and carry this with your passport when travelling abroad.

For protection against hepatitis A, which is spread by contaminated food and water, the vaccine is expensive but extremely effective – an initial injection followed by a booster after six to twelve months provides immunity for up to ten years. Hepatitis B, like the HIV virus, can be passed on through unprotected sexual contact, blood transfusions and dirty needles. The very effective vaccine (three injections over six months) is recommended for anyone in a high-risk category, including those travelling extensively in rural areas for prolonged periods, with access to only basic medical care. It’s also now possible – and cheaper – to have a combined vaccination against both hepatitis A and B: the course comprises three injections over six months.

The risks of contracting Japanese encephalitis are extremely small, but, as the disease is untreatable, those travelling for a month or more in the countryside, especially in the north during and soon after the summer rainy season (June–Nov), should consider immunization. The course consists of two or three injections over a month with the last dose administered at least ten days before departure. Note that it is not recommended for those with liver, heart or kidney disorders, or for multiple-allergy sufferers. If your plans include long stays in remote areas your doctor may also recommend vaccination against meningitis (a single shot) and rabies.

Mosquito–borne diseases

Both the Red River and Mekong deltas (including Hanoi and Ho Chi Minh City) have few incidences of malaria. The coastal plain north of Nha Trang is also considered relatively safe. Malaria occurs frequently in the highlands and rural areas, notably the central highlands, as well as the southern provinces of Ca Mau, Bac Lieu and Tay Ninh. The majority of cases involve the most dangerous strain, Plasmodium falciparum, which can be fatal if not treated promptly.

The key preventive measure is to avoid getting bitten by mosquitoes (which carry the disease), but if you’re travelling in high-risk areas it’s advisable to take preventive tablets.

Mosquitoes are also responsible for transmitting dengue fever and Japanese encephalitis. Dengue is carried by a variety of mosquitoes active in the daytime (particularly two hours after sunrise and several hours before sunset) and occurs mostly in the Mekong Delta, including Ho Chi Minh City, though the chances of being infected remain small. There is a more dangerous version called dengue haemorrhage fever, which primarily affects children but is extremely rare among foreign visitors to Vietnam. If you notice an unusual tendency to bleed or bruise, seek medical advice immediately.

There are several things you can do to avoid getting bitten. Mosquitoes are most active at dawn and dusk, so at these times wear long sleeves, trousers and socks, avoid dark colours and perfumes, which attract mosquitoes, and put repellent on all exposed skin. Sprays and lotions containing around thirty to forty percent DEET (diethyltoluamide) are effective and can also be used to treat clothes, but the chemical is toxic: keep it away from eyes and open wounds.

Many hotels and guesthouses provide mosquito nets over beds or meshing on windows and doors. Air-conditioning and fans also help keep mosquitoes at bay, as do mosquito coils and knockdown insecticide sprays (available locally), though none of these measures is as effective as a decent net.

Bites and creepy–crawlies

Bed bugs, fleas, lice or scabies can be picked up from dirty bedclothes, though this is relatively unusual in Vietnam. Try not to scratch bites, which easily become septic. Ticks picked up walking through scrub may carry a strain of typhus; carry out regular body inspections and remove ticks promptly.

Rabies is contracted by being bitten, or even licked on broken skin or the eyes, by an infected animal. The best strategy is to give all animals, especially dogs, cats and monkeys, a wide berth.

Vietnam has several poisonous snakes but in general snakes steer clear of humans and it’s very rare to get bitten. Avoid walking through long grass or undergrowth, and wear boots when walking off-road. If bitten, immobilize the limb (most snake bites occur on the lower leg) to slow down absorption of the venom and remove any tight-fitting socks or other clothing from around the wound. It’s important to seek medical assistance as quickly as possible. It helps if you can take the (dead) snake to be identified, or at least remember what it looked like.

Leeches are more common and, though harmless, can be unpleasant. Long trousers, sleeves and socks help prevent them getting a grip. The best way to get rid of leeches is to burn them off with a lighted match or cigarette; alternatively rub alcohol or salt onto them.

Worms enter the body either via contaminated food, or through the skin, especially the soles of the feet. You may notice worms in your stools, or experience other indications such as mild abdominal pain leading, very rarely, to acute intestinal blockage (roundworm, the most common), an itchy anus (threadworm) or anaemia (hookworm). An infestation is easily treated with worming tablets from a pharmacy.

Heat trouble

Don’t underestimate the strength of the tropical sun: sunburn can be avoided by restricting your exposure to the midday sun and liberal use of high-factor sunscreens. Drinking plenty of water will prevent dehydration, but if you do become dehydrated – signs are infrequent or irregular urination – drink a salt and sugar solution.

Heatstroke is more serious and may require hospital treatment. Indications are a high temperature, lack of sweating, a fast pulse and red skin. Reducing your body temperature with a lukewarm shower will provide initial relief.

High humidity often causes heat rashes, prickly heat and fungal infections. Prevention and cure are the same: wear loose clothes made of natural fibres, wash frequently and dry off thoroughly afterwards. Talcum powder helps, particularly zinc oxide-based products (prickly heat powder), as does the use of mild antiseptic soap.

Sexually transmitted diseases

Until recently Vietnam carried out very little screening for sex workers, injecting drug users and other high-risk groups. As a result, sexually transmitted diseases such as gonorrhoea, syphilis and AIDS had been flourishing, though fortunately awareness is growing and the number of AIDS victims, at least, is levelling out. It is, therefore, extremely unwise to contemplate casual unprotected sex, and bear in mind that Vietnamese condoms (bao cao su) are often poor-quality (more reliable imported varieties are available in major cities).

Getting medical help

Pharmacies can generally help with minor injuries or ailments and in major towns you will usually find a pharmacist who speaks English. The selection of reliable Asian and Western products on the market is improving rapidly, and both Ho Chi Minh City and Hanoi now have well-stocked pharmacies. That said, drugs past their shelf life and even counterfeit medicines are rife, so inspect packaging carefully, check use-by dates – and bring anything you know you’re likely to need from home, including oral contraceptives. Tampons and reliable, imported brands of condoms (bao cao su) are sold in Hanoi and Ho Chi Minh, but don’t count on getting them easily elsewhere.

Local hospitals can also treat minor problems, but in a real emergency your best bet is to head for Hanoi or Ho Chi Minh City. Hospitals in both these cities can handle most eventualities and you also have the option of one of the excellent international medical centres. Note that doctors and hospitals expect immediate cash payment for health services rendered; you will then have to seek reimbursement from your insurance company (make sure you get receipts for any payments you make).

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