Myanmar: the land of thousands of ATMs and WIFI hotspots

Following the completion of our placements in Vietnam my friend Emily and I flew to Bangkok where we stayed at a nice hotel and went shopping and stuffed ourselves silly with icecream. We caught up with my friend Vorapong, a mate of mine from law school and Ormond College, which was lovely. I also had my hair dyed even blonder than it was in December, just because I really feel like being a bottle blonde is the right thing for me at this stage of my life.

Other than the above-mentioned activities, we spent a substantial part of our weekend trying to prepare for our 12-day trip to Myanmar. The information that we had been given about Myanmar – from friends, guidebooks (no we did NOT buy the USD 40 2-year out of date Lonely Planet), web forums etc – led us to believe that several things such as ATMs and internet would be largely unavailable to us whilst travelling around the country. As such, we were trying to prepare by collecting large amounts of cash and exchanging it all into large denomination, post-2006 greenbacks without any visible markings, creases or other damage. This was quite a pain in the arse, but we managed to figure this out in between ice cream sundae binges.

Shortly before heading to the airport I mentioned on facebook that I was about to head to Myanmar. Kyi, a friend of mine from medical school, saw this and contacted me saying that her family is in Yangon and would love to help us with some things, such as sending somebody to pick us up from the airport. This turned out to be particularly helpful, as there was not only somebody to drive us to our hotel (which is nice when you are tired and in a completely new country without any local currency available to pay for a taxi), but also Kyi’s father met us at the airport, which he really didn’t have to do, but was very kind of him. I’d told Kyi that we still needed to book our internal flights (it is impossible to do this over the internet) and her father called a travel agent as soon as we were in the car and he helped us book all of our internal transport (all up: one overnight bus, one ferry down the Irrawaddy river, 2 flights, one local bus, and one special tourist bus (it turns out we were the only foreign tourists as this was essentially a religious pilgrimage bus)).

We spent our first night in Myanmar in Yangon. We arrived quite late in the evening, but had all day the next day to look around. We managed to visit two places of interest: Sule Pagoda, and Shwedagon Pagoda. Sule Pagoda is quite impressive in its own right and, refreshingly, is not full of tourists. It was the central landmark around which massive protests were held in 1988, which adds to its interest (even though there is no information about the protests on display at the Pagoda itself). Shwedagon Pagoda is the main tourist site in Yangon, and is impressive in its scale, grandeur and preservation. Here are some photos:

Shwedagon Pagoda

That evening we caught the overnight bus up to Bagan (actually up to Nyaung U, the main town for midrange hotels in the Bagan region, as Old Bagan contains only upmarket hotels). Catching the bus was quite an experience in itself. First off, the bus station was not really in Yangon. It was a 90 minute grid-locked taxi ride from our hotel to the edge of town. Other than the fact that we were a bit concerned about missing our bus this was quite an enjoyable journey, as our taxi driver was an eccentric man who loved kitschy love songs from the 80s and 90s, and also loved a bit of an off key sing along. After boarding the bus an attendant walked around with a jar that had “raincoat” written on it and was full of small bits of folded paper. She indicated that we should each select one. Emily and I both pulled out pieces of paper saying “calendar”, as did everybody else seated around us. A few minutes later the attendant came around the bus again, this time handing extremely bulky calendars (complete with pictures of the various buses owned by the bus company) to all of the passengers who pulled out calendar, and then one raincoat to the lucky passenger who had apparently won the lucky dip.

I took a phenergan tablet as I get terribly motion sick. I actually don’t really like taking these and think that I probably need to take the paediatric dose (I have trouble metabolising many pharmaceuticals and often have to take a lower than regular dose). As such the phenergan made me quite stoned and completely incapable of doing anything other than sleeping and making a fool out of myself at midnight toilet stops. This was a problem because at about 11.55pm the bus pulled over at this desolate area of highway and we were all herded out onto the side of the road. Our bus journey was on New Year’s Eve, and we had expected the moment to pass by without ceremony, so what followed came as a great surprise. The bus attendant produced a large number of hand-held fireworks and handed one to almost everybody from the bus (she skipped me, which is probably a good thing because I clearly could not be trusted to hold explosives in my condition). She then waited until about 30 seconds before midnight and started lighting all of these fireworks. Wanting to get a good picture (an unrealistic aim seeing as my camera options were iPhone 3 (circa 2008) and iPhone 4 (circa 2010)) I walked into the middle of the circle, pretty much to the place where everybody was pointing their fireworks (luckily up into the sky, not directly at me). When they started erupting I was showered with hot embers and rapidly reconsidered my viewpoint. Later in the night, at a toilet stop somewhere in rural Myanmar at around 3am, Emily and I discovered that one of the embers had fallen onto her prescription glasses and burned a fault into the lens. We are probably quite lucky that we both got off with minor little burns, and also that the unexploded fireworks that were loaded into the luggage compartment for the remainder of the (bumpy) journey did not explode.

This girl had evidently just been burnt in the face

As an American, Emily is clearly a fan of gunpowder

We spent the following two days exploring Bagan. Bagan is situated in a bend of the Irrawaddy River and consists of 3 towns (Old Bagan, New Bagan, and Nyaung U) and thousands of historical sites. Several years ago the residents of Old Bagan were forcibly moved to the newly established New Bagan to make way for expensive tourist developments in Old Bagan. Nyaung U also seemed to be a fairly new development, created primarily for the purpose of tourism (most of the mid-range hotels including our hotel were located there). We spent our two days in Bagan exploring the ruins, which were sometimes stunningly beautiful, sometimes horribly restored, and often a little bit repetitive. On the first evening we visited Shwe San Daw pagoda for sunset at the suggestion of our driver. In theory, this was a great idea, as this pagoda is central, has multiple viewing platforms, and is ugly. So, you can get a centrally located sunset, from a high vantage point, with the relatively aesthetically unpleasing pagoda cropped out. The problem with this idea was that about 1000 other tourists had the same idea. The viewing platform at the top of the pagoda (where we had prime sunset photographing positions) became hazardously crowded. One woman was almost pushed off by some horrible man who arrived just before sunset and pushed roughly through the crowds trying to get a more favourable position for himself. The next evening we went somewhere much less crowded (I can’t remember the name) and had a much more pleasurable experience, even though the view was slightly less spectacular.

I risked my life for this photo

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I didn't risk my life for this photo

On our second day in Bagan we went to all of the non-central ruins and visited the towns New Bagan and Old Bagan (both of which I found charming in their own light: New Bagan for the fact that it had a genuinely Burmese vibe and wasn’t overrun by tourists, and Old Bagan because of its physical beauty and great desserts and WIFI that we found in the restaurant of a fancy hotel). I had insisted on visiting these more remote areas as I had seen footage of a site near Bagan in a film (Samsara) and wished to visit that specific place even though I did not know its name. Alas, we could not find this amazing place so I settled for amazing desserts instead. That evening after much searching on extremely slow internet we figured out the name of the place (Mount Popa) and the fact that it was 50km from Bagan. I was devastated to have missed it, so came up with the idea that we could do it as a day trip from Mandalay (our next destination). It was quite a long drive there from Mandalay (just under 200km) but the roads in Myanmar, at least in the central plains region, are now excellent, so we had a lovely day trip there. Mount Popa is not actually a Buddhist site but rather a Nat (spiritual) site of more ancient tradition than Buddhism.

Emily in Bagan

Mount Popa

When planning our trip we had decided to spend a day catching a ferry down the Irrawaddy River. I’ve always wanted to visit the Irrawaddy River and thought that catching a ferry would be an interesting experience and also a welcome break from structured sightseeing. The ferry departed at 5am and to my disappointment was entirely set up for tourists. I thoroughly enjoyed this day however, apart from some time that I spent locked in the ferry toilet (getting locked in public toilets is a recurrent problem of mine that I just don’t understand the aetiology of) and when the stoner who was in charge of our lunch orders got my order wrong (out of the two options). It was freezing cold when we boarded the ferry, until about lunchtime, so Emily and I sat wrapped up in my sleeping bag except for a brief moment when I decided to get sunrise photos. I spent the day reading most of the new Bridget Jones novel and just watching the passing banks.

We had two days in Mandalay, the first of which we spent on our day trip to Mount Popa and also visiting U-Bein Bridge for a stunning sunset. This is an old teak bridge, part of which collapsed a few years ago and was replaced by an ugly concrete replica that bears no resemblance to the rest of the bridge. I have seen photos of this bridge from around 8 years ago that showed a bridge with a smattering of robed monks walking across it. Unfortunately there are now so many tourists (probably part of the reason why the bridge collapsed, that and the rotted out posts) that it’s hard to get a good “monk on bridge” shot. Here’s the best I managed:

We hired a small boat for about half an hour for sunset. The price that we agreed on with the guy who was paddling the boat was 6000 kyat (about USD 6), however then he found another tourist who was also looking for a boat and what resulted was a big argument about the price (he still wanted to charge the two of us 6000 and then charge the third guy an initial 3000 kyat, despite the original price being 6000 for the two of us privately in the boat) with him ultimately prevailing as he was the last remaining boat and we really wanted to see the sunset from the boat (it turns out that persistent time wasting bargaining until you’re the only option for the other person is a great strategy, that I have now adopted myself with taxis). The sunset was spectacular, but the extra passenger kind of detracted from the whole experience by virtue of the fact that he clearly did not understand boats and the simple fact that you cannot just stand up and attempt to walk around in a 3-person boat without seriously destabilising the whole thing.

Sunset at U-Bein Bridge

On the second day in Mandalay I was bedridden with pretty bad food poisoning. I won’t go into this in any more detail because nobody wants to read that.

After Mandalay we flew to Heho and from there drove to Inle Lake. Inle Lake was my favourite place in Myanmar. We had 2 ½ days at Inle Lake, the first half day we spent sleeping (Emily was exhausted and I was still quite unwell). On our second day we did a lake tour on a speedboat. When we booked this tour we were quite specific about wanting to see the southern part of the lake including In Dein, and not wanting to be taken to a bunch of shops. We’d done our research (Emily had done our research) and people were writing that lake tours had become a tourist trap with the main itineraries being “factories” where you are given a cursory tour of the working area and then paraded through a showroom where you are subjected to the hard sell. Despite the clear itinerary that we were told when we booked the tour, we were nonetheless subjected to this northern lake shopping tour. When we raised this with our guide he wanted to double the price of the tour in order to take us to the southern lake (an offer that we refused). Nevertheless, we had a great day and saw some beautiful scenery.

On our second day in the Inle Lake area we spent the morning chilling out, receiving the worst imaginable head massages (it was so bad I almost started laughing) and then that afternoon hiring bikes and riding to a local winery called the Red Mountain Winery. I actually hadn’t ridden a bike (other than an exercise bike at the gym) in almost 10 years, so I was extremely rusty and kept getting off to push my bike whenever any traffic approached. The winery was lovely. Here’s a picture. That evening we flew back to Yangon.

Completely natural and unposed sunset photo that I didn't have to pay money for 

In Dien

Village on Inle Lake

From Yangon we then did an overnight trip to the Golden Rock at Kyaiktiyo. Despite the fact that this is listed as a tourist attraction in Yangon on TripAdvisor, it is actually a lot of hard work to get there, and, in my view, not possible as a day trip unless you hire a private car and have a really long day. We caught a 4-hour public bus to the bottom of the mountain range where the rock is located. This was quite pleasant apart from the absolute lack of toilet stops and the fact that the girl sitting across the aisle from us vomited all over the aisle 2 hours into the journey. From the town at the bottom of the mountains (Kyaiktiyo) the transport situation became really interesting. The only, and I mean only, transport option up the mountain were these refurbished dump trucks. The big trays on the back, originally designed to carry loads of rubble and then mechanically tip those loads out, had been converted to hold lots of very small people. Seven “benches” (planks of wood) had been erected, and the man managing passengers insisted that we sit 6 people across. The problem was that Emily and I were significantly too large for this and the 6^th person in our row (an extremely malnourished man) was forced to squeeze into the 10cm between my greater trochanter and the edge of the truck. Effectively, he was sitting on my lap, which was not a problem in terms of weight (there was no way he weighed more than about 35kg, I think he was cachexic) but it was nonetheless extremely awkward and uncomfortable. We had initially tried to purchase tickets in the front with the driver but were told definitively that we had to ride in the back (ticket price was $2.50 for the back and $3.00 for up the front. The price sign stated that these prices included life insurance, which confused us until we started the journey and began to realise that many people had probably collected this insurance pay out).

Red Mountain winery near Inle Lake

The Golden Rock

It turned out the lack of personal space in the truck was the least of our worries. The road was absolutely treacherous; by far the most dangerous road that I have ever seen, and I’ve been on lots of dodgy Cliffside roads in India and Nepal. Luckily, due to the over-crowdedness of the truck, I couldn’t see the road too well, but I could sense how dangerous the whole situation was. Up the top of the mountain we asked around for alternative transport options for the trip back down the next morning. It turned out that only these broken down 1970s trucks were licensed to do the trip and we had no option but to get on another one to head back down the mountain. This time I insisted on riding in the front carriage with the driver due to motion sickness and because I had this theory that at least up the front we had a roll cage that would protect us in the event of the truck rolling over, which I thought was quite likely as it had frequently tipped onto two wheels on the way up the mountain. Riding up front I realised just how crazy the whole situation was. The truck’s brakes kept failing, activating the emergency brakes, the road was in much worse condition (sometimes with an incline in excess of 45 degrees) than originally estimated and the driver was chewing khat, a mild hallucinogen and driving like an absolute mad man. We made it down alive and then caught the “tourist” bus back to Yangon (we were the only foreigners on the bus, it should have been called the “upper class” bus instead). I had to take another phenergan on the bus back to Yangon, so the rest of the day is a bit of a blur to me, but apparently I went to bed at 7.30pm, which is classic phenergan behaviour.

The death trap tip trucks

Some interesting observations about Myanmar:

• -       They drive on the right hand side of the road yet drive cars designed for driving on the left hand side of the road, which makes overtaking (a common practice) extremely dangerous
• -       People are extremely friendly and welcoming
• -       Prices are extremely expensive. This would rate as the equal most expensive country that I’ve travelled to alongside Cuba in 2010 when there was still no private enterprise and there was a strictly segregated currency for foreigners
• -       One of the reasons for the high prices was the high number of tourists. Everywhere we went (except for the golden rock) was overrun with tourists. It’s clearly a new hot destination, but the problem is that tourism seems to be changing the place in a negative way (eg endless souvenir shops around tourist sites and aggressive touts). It’s also a very difficult place to travel in a flexible way. When we booked our hotels back in September (I’m a microorganiser) some places were already fully booked for January. We met several tourists who’d wanted to book as they travelled but had ended up having to choose between paying $300 a night for a luxury resort and sleeping rough
• -       There is a certain amount of excitement and anticipation about the 2015 national elections. I wish them all the best and hope that they elect some strong leaders that help the country achieve a lasting peace and prosperity.

This post is long overdue (I actually didn’t have time to write it when I was in Indonesia) but expect another one documenting my time in Indonesia shortly J

All Fall Down: Vietnam part II

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. 

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!

Obstetrics and gynaecology placement at Military Hospital, Hanoi Vietnam

I realise that I have been pretty slack with writing blog posts, but here is my excuse: I have been spending the past two weeks undertaking a student placement at Military Hospital in Hanoi, and it has been intense.

Hoan Kiem lake, central Hanoi. Sunrise. 

The hospital:

Military Hospital, otherwise known as 108 Hospital, was built by the French colonial government in 1894, originally to serve their military. Since then, it has (obviously) ceased to be French controlled, but maintained it’s military function over the various international and domestic conflicts experienced by Vietnam from the 1940s to 1970s. Now, it is a huge hospital of approximately 1500 beds (and rapidly growing) that is open to the general public.

Military museum, not Military hospital (I don't have any photos of the hospital as yet).

Overall, my impression of the hospital has been good. The hospital currently has 7 students from the University of Sydney undergoing placements (1 x 1^st year medical student, 5 x 2^nd year medical students including myself, and 1 graduate nurse). The hospital has been extremely friendly and accommodating to us and we really could not have asked for more. They have even gone to the effort of taking us on weekend excursions, which is much more than any of us expected.

The hospital is quite modern and well resourced. There is a large 9-storey building at the front of the hospital that contains the critical care and surgical departments. I have spent quite a bit of time in there up in theatres and they are clean and well equipped. They are making some efforts to prevent nosocomial infections, however this is mostly limited to during actual surgeries and doesn’t extend to simple things like regular hand hygiene on the wards. 

Again, not Military Hospital, but also a large multi-storey building.

To be honest, the biggest differences that I’ve noticed between hospitals in Vietnam and hospitals in Australia is not a resource difference but a cultural difference. This is particularly marked when it comes to pain management and patient interaction. In Australia we are very mindful of the patient and his/her overall wellbeing. Several things that are taken as a given in the Australian healthcare system (pain relief, reassurance of patients, asking for consent before certain things occur, and even having examinations, especially the sort that you see in gynaecology, done in rooms without a queue of on-looking patients) are just not common-place in Hanoi.

I felt like I needed pain relief after watching this guy performing his morning exercises by the lake.

The placement:

My placement in obstetrics and gynaecology lasted for two weeks (I’m spending the upcoming fortnight in the intensive care unit) and I managed to see and experience a lot of things in that time. I can’t possibly cover all of what I saw in this time, but I will attempt to cover, in roughly chronological order, some of the things that made the biggest impact on me.

Child innocently playing on old tank at the military museum. I wonder how aware the child is of the tank's history (former American tank captured by the Vietcong) or whether he is just awed by the impressive piece of military hardware. 

Ovarian teratoma removal via laparoscopic surgery: early in my placement (first or second day) I scrubbed in to two surgeries during which I was asked to participate. The first was laparascopic removal of an ovarian teratoma (if you don’t know what this is, google it and prepare to be horrified).  My job was to hold the laparoscopy camera and make sure that the surgeon was getting a good very of the particular areas of teratoma that he was cauterising and then excising, which was all well and good until I saw something that you don’t expect to see in an ovary: a tooth! Basically a teratoma is a tumour made up of tissues that form from different layers of embryological origin (eg teeth, hair) that is encapsulated and contained within an ovary. Whilst I knew that this was likely to be there, I couldn’t help but react poorly when I actually saw it (I became tachycardic, sweated through my scrubs, developed tinnitus and had to dismiss myself because I was sure that I was about to lose consciousness). Altogether extremely embarrassing. I attended several surgeries after that, including one immediately after where I was asked to press hard on a breast abscess to essentially drain it of pus like you would a zit. I didn’t have this problem in any of the subsequent surgeries, so I’m hoping that it was a result of the particularly disturbing pathology and not any sort of problem that will recur during other surgeries.

National flagpole at the Military History Museum.

Breast abscess drainage: as mentioned above, we had a patient with a breast abscess. She was a young lady who had given birth to her first child 3 weeks earlier and subsequently developed a terrible necrotic breast abscess that was starting to ulcerate through her skin. She had some sort of heart problem (which I gathered through a range of translations was probably Tetralogy of Fallot) so the anaesthetists were reluctant to give her general anaesthetic, so for the actual operation she had to lie there with just local anaesthetic to numb her pain. The operation itself was like draining a giant zit containing about 400ml of pus and then removing the necrotic fluid and inserting a drain. As if this wasn’t traumatising enough for her, she had to have the site re-drained everyday that week, but instead of having local anaesthetic she was given absolutely no pain relief and was only under the care of one doctor and a dumb medical student (me). She was clearly in absolute agony and I will never forget the look on her face. Never once did she cry out or complain.

My first labour: on the Wednesday afternoon of the first week I decided to sit in the delivery ward. It can be quite hard to see a vaginal delivery when you are running around to different parts of the hospital for surgeries and outpatient clinics, so I was hoping to see one that afternoon. There was only one lady in the ward that afternoon, so I sat with her for the during of the afternoon shift (about 3 hours). Again, she was in agony with no pain relief. She was younger than me, and clearly scared witless. She kept asking me whether I was worried about her baby, as her labour was not progressing, the foetal head was not descending and the cervix would not dilate past about 6cm (10cm is required for delivery). Due to the language barrier and the fact that I’m only halfway through my degree, all that I could think to do was hold her hand and comfort her. So, I sat with her throughout the whole process until she was whisked up for an emergency c-section, hoping to just provide a modicum of comfort during her ordeal. Interestingly, only staff and patients imminently about to give birth are allowed in the birthing room. The room is sterile and uninviting, and I think that it would be a horrible place to be stuck in agonising pain without any human contact other than occasionally having a nurse insert two fingers up your vagina to measure your cervical dilation. I found this girl on the ward the day before she was discharged (3 days later) and was glad to see that both she and her little baby boy were happy and healthy.

I'm pretty sure this is how you wind up in the obstetrics ward.

Vaginal deliveries: I saw my first vaginal delivery with a male friend of mine, who seemed to be quite shocked by the whole experience. I personally think that I have more right to be shocked, as I’m the one who might have to do that one day! The first vaginal birth I witnessed was during a night shift a week ago. My supervisor called me into the labour room and asked me to measure the cervical dilation. When I inserted my fingers I felt an entire baby’s head just sitting there, about to come out. I said that much, and within about 10 mins the baby was born. What shocked me most was the last minute (less than 10 seconds before the baby was delivered) episiotomy without pain relief. This occurred during both of the vaginal deliveries that I watched. No thank you!

Maternal haemorrhage and neonatal resuscitation: On the final day of my placement I saw something really heavy and distressing. I went to watch a c-section, and didn’t think much of it seeing as it was my 6^th and they had all preceded pretty simply (except for one where the epidural failed). I had seen the mother receive an abdominal ultrasound that morning that showed her foetus was sitting transversely, rather than with its head in the pelvic cavity. Initially it was business as usual with the pre-op prep and incision, however, when the surgeon had been feeling in her uterus for the foetus for about 10 seconds (it usually takes around 3-5) I started to worry. Then the mother started to haemorrhage. She lost an extreme amount of blood, probably about 3 litres, and there was blood gushing out of the incision, all over the patient, surgeons and floor. The foetus was sticking his arm out of the hole, but the surgeon could not pull him out using it because of brachial plexus damage. Eventually, after about 10 mins the surgeon managed to extract the baby and both baby and mother were in critical condition. The baby had an Apgar score of zero, meaning that it had no pulse, no respiratory effort, it was cyanotic all over, it was completely flaccid and it did not respond to any stimuli. For several heartbreaking minutes I watched my supervisor (the primary surgeon) try desperately to resuscitate this poor little baby whilst his co-surgeon stabilised the mother. Eventually, the baby emitted a feeble cry and started to breath and recover. After about 10 mins the baby was doing quite well and was pretty much left to his own devices (once being wrapped up in baby blankets) at the side of the room. I stood there hawkishly watching him because I was worried, however irrationally, that some harm would somehow befall him if he was left to his own devices. Both mother and baby were OK. The mother was transfused 3 bags of packed red cells and 2 bags of plasma. The foetus was taken with us back to the ward whilst the mother was receiving her infusion.  

Vietnam is an impressive fusion of new and old, beautiful and tragic. Here, the foreground contains objects from the Military History Museum, just a small vestige of decades of war, whereas the background contains old city walls, a relic of the ancient civilisation of Vietnam (first Kingdom established in 1010 AD).

Hanoi:

I won’t write much about Hanoi in this post, as I feel that the city warrants an entire post, not just a footnote to a post about my first two weeks of placement.  Just briefly, Hanoi is an interesting and varied city and I have had a great time getting to explore it past the level that most travellers can experience when passing through briefly. I’ve found the food both rewarding and challenging. It is rewarding due to the variety and the frequent pleasant dining surprises, but frequently challenging because I don’t eat pork (on principled grounds I prefer a vegetarian diet, but I’ve found this difficult to maintain due to my endometriosis causing me to suffer from recurrent anaemia, so instead I eat mostly vegetarian and eat meat meals when I feel like I need them, but I seek out free range meat and totally avoid cruelty meats such as pig meat, fois grois etc). One thing about Hanoi that has surprised me is the bar scene and emerging alternative arts scene. My favourite place in Hanoi happens to be hidden in some Brutalist Soviet-era warehouses just behind the hospital. I will write more about it in my Hanoi culture blog post, but for now here’s a link: http://www.wordhanoi.com/features/item/4085-zone-9

Modern Hanoi.

I will try to be slightly more regular with blog posts from now onwards. I am aiming for one every 1-2 weeks, but this will all depend on what I have to write about.