I’m writing this post from Hanoi
International Airport (edit: and on the plane), well aware that I am overdue
for a blog post. Yesterday I had a moment when I realised that I am ready to
move on to my next destination (Myanmar via a very short stop in Bangkok). My
friend and I headed to Zone 9, by far my favourite place in Hanoi, with the
intention of eating a final batch of “wunder waffles”, buying a thank you card
for our supervisors from a craft store, and wandering around our favourite
brutalist buildings for one last time. When we got there we discovered that
Zone 9 had been shut down, with metal gates barring the entrances and some sort
of official ordinance (in Vietnamese) attached to the gates. The exact reasons
behind its closure are unclear but we suspect it is a combination of:
ineffective bribery, some of the instalments (for example the queer exhibition)
being too challenging for the tastes of government officials, or perhaps the
developer who owns the plot of land has finally decided to demolish the old
buildings to build some sterile new housing development. Officially, the reason
for the closure seems to be a fire that occurred almost two months ago, killing
six people. Apparently closure was on the cards well before this fire, which
has finally provided an excuse for definitive action. Whatever the reason for
its closure, the loss of this art space is a crying shame.
Zone 9, Hanoi
Placement part 2: Intensive Care Unit
The second two weeks of my placement were
quite a contrast to the first two weeks. I was placed in the ICU and it was not
my thing. I haven’t studied intensive care in
Australia yet, but I imagine that this is a place where cultural variables have a large impact on medical care.
As I mentioned in my previous blog post, Military Hospital was historically a hospital reserved for government officials but has now opened its doors to the general public. Three distinct groups of patients are treated at Military Hospital: military personnel, insured patients and uninsured patients. The amount of their costs covered by insurance/government is highest for military personnel and lowest for uninsured patients, and likewise the duration and quality of care received operates on this same hierarchy.
As I mentioned in my previous blog post, Military Hospital was historically a hospital reserved for government officials but has now opened its doors to the general public. Three distinct groups of patients are treated at Military Hospital: military personnel, insured patients and uninsured patients. The amount of their costs covered by insurance/government is highest for military personnel and lowest for uninsured patients, and likewise the duration and quality of care received operates on this same hierarchy.
Visiting the women and children’s hospital
in Da Nang
Over Christmas I flew down to Da Nang and
Hoi An to visit my friend, Emily, who was doing a student placement at the
hospital down there. On boxing day I attended the hospital with her, mostly
because I was just curious to see how it compared to the hospitals in Hanoi.
The only ward I got to spend time in was the neonatal intensive care unit
(NICU), which was well worth visiting for more time then I had available to me.
I saw several babies with birth defects, including one with Spina Bifida
(incomplete closing of the developmental neural tube at the caudal end, leading
to a sac of cerebrospinal fluid, and sometimes lower body nerves, poking
through a hole on the baby’s back) and two with VATER association
(co-occurrence of birth defects that occur in a pattern including: Vertebral abnormalities, Anal atresia, Tracheoesophageal fistula, Renal abnormalities and Limb defects). There was also an
abandoned infant who had been born without a cerebral cortex and had
subsequently developed severe hydrocephalus (his head was about the same size
as mine).
Hanoi by night
The patients there who made the greatest
impact on me were two of a set of triplets. These babies were born at 23 weeks’
gestation and weighed just 600g each. Their birth had been traumatic. Their
mother had preterm premature rupture of the membranes (her waters broke early
and she went into labour). Their
sister, the third triplet, had died before being admitted to NICU. The issue of
resuscitation and treatment of severely premature babies is fraught, and
practice varies widely around the world. At their gestational age and size
there was only a 30% chance that each of them would survive (I found a Kiwi
neonatology website that has a great algorithm that helps you calculate
survival rate based on studies in developed countries). Whilst 30% seems
somewhat hopeful (if you’re an optimist), there’s still only a 10% chance that
the child will survive without profound neurological disability. And that’s if
the child has first world medical treatment. I found this article from The
Guardian helpful for an overview and some commentary on the issues surrounding
extremely preterm treatment: http://www.theguardian.com/society/2007/feb/21/health.lifeandhealth
For these babies, the prognosis was
terrible. One of the babies had disseminated intravascular coagulation (DIC)
caused by the trauma of birth as she was born in the breech presentation (legs
and buttocks first), which can be very traumatic for the foetus. DIC is a
condition where the blood coagulates all around the body, exhausting the body’s
clotting factors. As a result of this, there is also haemorrhage, and this baby
had severe bruises all down her limbs and was not a healthy colour (a brownish
dark red). The prognosis for anybody with DIC is grim (about 10 to 50%
mortality). This baby had no chance. Even the relatively healthy sister had very
poor prospects for survival, due to her immaturity meaning that her vital
organs (principally lungs, but also brain, heart and kidneys) were inadequately
developed to sustain her without extremely prolonged and intensive medical
treatment. There have been several cases of babies younger and smaller than
this surviving, but as far as I can tell these have all occurred in countries
with state of the art medical services. In Vietnam babies born before 25 weeks’
gestation are not treated, as their prospects are too poor to justify the
resources. Whilst I understand that this is pragmatic, and that pragmatic
choices must be made in healthcare settings with finite and limited resources,
I couldn’t help but think about the old comatose people being kept alive in ICU
for years and then wishing that this money could instead be spent on improving
the odds for babies such as these ones.
There was not much that could be done for
these babies, so we decided to stay with them and watch them live out their
(tragically short) lives. What followed was absolutely heart breaking. The
babies barely looked human. Their skin was thin and transparent, and they were
so small that they could have fit in the palms of my hands. Their heads were
barely larger than the size of lemons.
I tried to think of them as strange little
non-human creatures (it helped that they looked a little bit like ET) because I
thought that this might help deal with the awful thing that I was witnessing,
but this plan failed when they started demonstrating themselves to be all too
human. Lying next to each other, they were clearly aware of each other’s
presence. Although they were probably profoundly blind, the sister with DIC had
her head constantly turned towards her sister, like she was trying to look at
her. Then, while we were standing watching them, she reached out her arm
towards her sister and placed her hand on her sister’s hand and they lay there
like that for ages, just touching each other’s hand, looking like a couple of
little buddies who were strangely attune with each other and glad to have
somebody else to share their plight with. Gestures like this happened several
times whilst we were watching them; they would stop holding onto each other if
one became acutely distressed (for example struggling for breath). Without
fail, they would return to reaching out for each other. Such an undeniable
signal of their humanity made watching them all the more heartbreaking. The sister with DIC died while my
classmates and I were there. I don’t know how long the other sister lived for
(I had to leave the hospital to catch my flight back to Hanoi), but I am
certain that she died within the following 24 hours. RIP little babies L
Out and about in Vietnam
Over the past fortnight I’ve managed to fit
in a reasonable amount of travel around Vietnam.
As mentioned above, I flew down to Da Nang
and Hoi An for Christmas and boxing day. I travelled to Hoi An in January 2007,
and the town itself hasn’t changed much (except that most of the roads are
paved now and I think that they might have been unpaved back then). This is
probably because the old town section of Hoi An is a UNESCO world heritage
site, so large development/destruction there is impossible. The surrounding
areas, however, were monumentally changed. There was a new freeway connecting
Da Nang and Hoi An, and between this freeway and the coast there were a myriad
of large-scale upmarket resorts. I can’t remember any of them being there last
time I visited (one or two may have, but this was just kilometre upon kilometre
of casinos and hotels). My friends and I travelled to some Cham Kingdom ruins
(called My Son) on Boxing Day morning. When I visited Vietnam in 2007 with my
friend Liz we wished to see these ruins, so we hired a car and spent a morning
at the ruins, which we had to ourselves as no other tourists were visiting that
morning. On this occasion, there were at least 1000 tourists at the ruins,
along with a gift shop, a cultural performance involving a kazoo (my least
favourite instrument) and a massive car park to accommodate the large number of
tourist coaches. I still enjoyed the ruins, however it was disappointing to see
how overrun the place had become.
Typical Hoi An street scape (minus tourists)
I challenged myself at the My Son ruins to get pictures without other tourists in them. It was quite a challenge, but I was quite successful (photo has not been edited at all, this is the actual colour)
My Son from afar
My experience at Halong Bay was similar to
my experience at My Son, which makes me think that being disappointed with
something the second visit around is probably a hazard of visiting a country
that’s become a hot tourist destination when you visited it before it was so
common. Halong Bay is a beautiful natural wonder, but unfortunately there doesn’t
seem to be any regulation of the number of tourists allowed to visit it each
day, nor the impact of that tourism. Consequently, the bay was significantly
more crowded and polluted than I remembered it being in 2007.
Halong Bay by day
Halong Bay by night
One place that I visited in Vietnam that
I’d never visited before was Sa Pa. This was a real highlight for me, but got
off to a rocky start. When I originally decided to go to Sa Pa a couple of
weeks prior to heading up there (you have to book your train tickets quite a
while in advance) it was to do some unplanned trekking with friends (a small
group of 6 people). Our plan was to take a train to Lao Cai, then a bus to Sa
Pa, and then start trekking and find a place to stay when tired at night. Our
hotel was insistent that we wouldn’t be able to book our accommodation at such
late notice, so reluctantly we agreed to let them book us one night in a hotel
and one night in a home stay. A few days before leaving for the trek, we
discovered that they had not only booked us on an all-inclusive package tour
with a set itinerary and a guide, but they’d also put us in a group of 23
students. I found the prospect of doing this unappealing on many levels,
including the fact that the price they were charging for the tour was
ridiculously inflated, so decided that I needed to be assertive and tell them
not to book me on this tour (instead to stick to plan A and just book me a
train ticket). Two of my friends followed suit and we ended up having a lovely
weekend. After doing some internet research that showed how cheap the nice
hotels in Sa Pa are, and how easy it is to plan trekking once you are there, we
decided to book two nights at H’Mong Sa Pa Hotel, which was highly rated on
Tripadvisor (it deserved this rating) and then plan our adventures from there.
This ended up being perfect. The hotel was mostly vacant (it would have been so
easy to book on arrival) and the owners were super friendly and knowledgeable.
View from our hotel in Sa Pa
Local children that we passed on our trek
We had a difficult time getting to Sa Pa.
Our train left at 9.50pm and was due in at around 6am. When I woke up at 7am in
a panic that I’d missed Lao Cai and the train might be heading back to Hanoi, I
discovered that we were only halfway along our journey. We were trapped with no
food, water or entertainment (actually, I was reading one of those Charley Boorman
epic adventure books and, amusingly, he managed to travel from Ireland to
Turkey in the chapters that I read whilst travelling just 100kms). Eventually,
we heard from the other students that our hotel (Rising Dragon Hotel in Hanoi)
had instructed us to get off the train at the next station, as they’d organised
for somebody to come and pick us up and drive us the rest of the way (only
35km) as the train was expected to take another 4 hours to travel that
distance. What a relief! So, we disembarked, and waited for around 45mins in a
small town for our lift to arrive. Problematically, when the lift arrived they
had a separate sign for my two friends and I who weren’t doing the group tour.
They then took us aside and told us that the hotel had initially told them to
pick us all up, but had then contacted them and told them that they weren’t to
drive the three of us. By that time the train had pulled away from the station
and all of the public buses to Lao Cai had departed, so we were stranded
because of the hotel’s pettiness about us not being on the group tour. After a
bit of rigamarole we managed to convince them to let us sit in the little fold
down aisle seats for a grossly inflated price and, eventually, after much
claustrophobia and travel sickness (I have a real travel sickness problem) we
arrived in Sa Pa where we were greeted by our super friendly and accommodating
hotel owners, who immediately welcomed us with a hot drink by the open fire
place and told us that they’d already turned on the heaters and electric
blankets in our rooms so that we’d be comfortable. It turns out that one of the
trains heading in the other direction had derailed and then toppled sideways
down the bank that the tracks were on (a passenger train, alarmingly) and
that’s why the trains were so severely delayed.
Typical view from trek in Sa Pa
Ready made "Turducken"
We ended up having two days in Sa Pa,
instead of the 3 days as planned, due to this day of transit. My friends and I
organised to visit a H’Mong village the following day to have lunch in the
house of a lovely local lady, Mee. We met Mee at the hotel in the morning and
she took us to the local market where we bought fresh produce that we would use
to prepare the lunch. Then we hiked up to Mee’s village, an uphill journey of
about 12kms. The countryside was stunning and we didn’t encounter a single
other tourist, gift shop or sign of damage caused by irresponsible tourism.
Having lunch with Mee and her family was an amazing experience, especially when
they bought out something called “medicine wine” and left us with no choice but
to do a bunch of shots with them. All that I will say about this is: (1) they
clearly didn’t realise how much of a lightweight I am, and (2) drunken snowball
fights are the best! The following day I was ill with food poisoning (not from
the lunch, but something that I’d picked up in Hanoi that had been giving me
troubles for a few days and finally decided that it wanted a dénouement that
day. I spent the day in my beautiful and warm bed, and my friends hired
motorbikes to go to the (apparently very beautiful) national park with Phil and
Hoa (the owners of the hotel). Apparently they had a lovely day and I wish I
could have joined them, but I was in no fit state to be straddling the back of
somebody’s motorbike. Despite missing out on this day trip, I am very pleased
with how Sa Pa turned out. We discovered upon arrival that some of the key
villages that the trekking companies take tour groups to (on tours like the one
we were supposed to join) have been purchased by corporations that now charge a
fee to enter the village. One particularly good example of this is Cat Cat
village, which is right near Sa Pa town and a total tourist trap. Tourists are
charged 40,000 ding dong (about $2) to enter the village, and none of this
money goes to the local people. Moreover, since land ownership in villages in
the region operates on a shared community basis, the people of Cat Cat
discovered that they no longer had land rights and that the corporation that
had purchased the village also owned their houses (which they are now renting
back to them). This is exactly the type of tourism that I condemn, and I am
glad that my visit to Sa Pa did not encourage this sort of enterprise. (I can’t
find many more details about this corporate ownership issue on the internet –
our hotelier, Phil, said it’s all a bit “hush hush” – but considering the
commercialisation of the area and the strange village entry fee I find Phil’s
explanation entirely plausible).
With our host, Mee, in Sa Pa
I’m not going to write too much about
Hanoi, except for a comment on the food. For anybody visiting Hanoi, I
recommend the following eateries (I’m no foodie, but I can vouch for the fact
that you won’t get ill and the places have a nice vibe and plenty of vego
options):
- - Hanoi social club (all meals and drinks): chilled and amazing. Became my favourite place to eat in Hanoi (it was a 5 min walk from my gym so super convenient)
- - Ray Quan (dinner and flavoured rice wine, get the cinnamon): a fascinating place right by central station where you literally walk along the train tracks to get to the restaurant and then watch the trains pass by right next to the door.
- - Koto (food): opposite the Temple of Literature
- - Yin and Yang Café (food): quality food in the old town, not too oily. Lots of grilled options and vegetarian. Good juices.
- - The Kafe (food, baked goods): Hanoi does hipster
- - Tamarind café: great vegetarian food
- - Fanny’s (icecream): amazing! I tried salted caramel, ginger and chocolate and they were all amazing flavours
- - The Note Café (patisserie): great cakes and macaroons, cute concept
- - Club Ly (food, classy): beautiful old French building and great range of food that is pretty reasonably priced considering the setting and quality
- - Quan An Ngon (food): interesting concept – the kitchens are set up around the perimeter like a bunch of market stalls so that you can wander around with the menu and inspect the food before deciding what to choose
- - The Intercontinental Sunset Bar (drinks): stunning
- - The Kitchen (drinks): fairly newly opened establishment serving nice cocktails with a view overlooking Hoan Kiem Lake and the big intersection next to it
- - Cong Caphe (drinks): amazing Vietcong themed venue with fascinating décor, including old photos
- - Sofitel rooftop bar at Westlake (drinks): simply stunning
- - Bar Betta (drinks): nice vibe
View from Ray Quan as a train passes (photo taken from crappy 4 year old smart phone whilst sitting at my table)
Really, I feel like I’ve just scratched the
surface of the city and there is a lot more to discover, but all of these
places were worth returning to.
I'm off to Burma today (yes, I'm no longer on the plane to Bangkok, I am slower and longer winded than I expected). Expect some Burma adventures to be written up in about 2 weeks' time!
