Vietnam Day 3

Up early this morning at 6am, Prof Tri and one of the hospital administrators Ms Anh collected us at 6.15 and we headed out for breakfast. Prof Tri was very keen we try the traditional Vietnamese breakfast of Pho, so we headed to a local Pho eatery that has been there for 3 generations. Pho is a soup or broth with rice noodles, beef and two raw eggs broken into it, and it was really nice and a great way to set oneself up for the day. It was something I was keen to try but wasn't sure where to get it. I was really pleased to have tried Pho and would recommend it.

The above shows the owner cooking breakfast and Prof Tri and Brian enjoying the Pho.

Next we headed off for coffee and naturally in Hanoi there is a street for coffee bars.

Our very hospitable hosts took us out for a very enjoyable day, we headed for Ninh Binh (pronounced Ning Bing) province which was a drive of over two hours. We had a lovely drive through the country side and arrived first at Chua Bai Dinh a fairly modern complex containing a large number of temples.

Fortunately we arrived early at about 9am and beat the crowds. It was a fascinating morning plenty of walking and loads of steps. Here are some of the photos I took.

A really interesting morning and although it was hot at times and a lot of walking the weather was just perfect.

Next we headed off for lunch. Vietnamese food is great, very fresh, simply prepared and served with delicious dipping sauces that enhance the food and the experience. Prof Tri was insistant that the food be as fresh as possible and sent Ms Anh into the first restaurant to check and it was given the thumbs up. We were early so the first and only ones there. The food was extremely fresh so fresh in fact, you will see in one the following images where they had just killed the chicken for our meal. The staff were very friendly and kindly invited me in to take some photos.

The food started with a sort of salad of fresh leaves of mint (two different types I think) and a third leaf that looked like a bay leaf but wasn't, banana cut in slices in the skin and a sour tasting star shaped vegetable which was gorgeous. Lovely dipping sauces were also provided, a peanut sauce, a sort of nam pla with chillis, and a brown sugar with lime juice. Next came two pork and two (very fresh) chicken dishes and a soup made with spinach. Just so much food and so good.

After lunch we were taken to Trang An in the Ninh Binh region. Trang An is a waterway with caves or grottoes that run through and between vast limestone cliffs that rise out of the waters and it is often compared to Halong Bay. We hired a boat that took us through the waterways and through the caves in a trip that took over two hours. We were very fortunate that it was not high season as there was very few people around. In high season there can be over a thousand boats on the water. The woman that rowed our boat was a slight person and as I said it took her over two hours to take us around and it didn't appear to take anything out of her. It was truly a memorable experience and gave a feel for what the famous Halong Bay must be like.

Time to head back to Hanoi and we met Hanoi evening rush hour. I've never seen anything like it, cars, bikes and scooters coming from all sides and angles. For dinner we were brought to a special restaurant that served mainly mushrooms in loads of different guises and varieties and as always everything was great. It is typical for Vietnamese food to be cooked at the table. A burner is put in the middle of the table and a broth already boilng is placed on the burner. Next the raw ingredients are added to the broth, in this case a variety or mushrooms and small black skinned chickens no bigger that same a Robin, and of course the head is still looking at you.,5 of these one for each of us. This cooks for 10 mins until fully cooked. The waitress serves up and we avoid the chicken. This time there is a beautiful coconut based dipping sauces. But it doesn't stop there, next raw thin slices of beef are added (really yummy), then sliced salmon and finally fresh vegetables like spinach and spring onions. It was all finished off with a serving of ice cream (though not this time in the broth). The perfect end to a prefect day.

Tomorrow it's work.

Vietnam - Days 10-12, Summary

The last few days have been about relaxing and getting home. Sunday in Vung Tau (admittedly forgettable), back to HCM city Monday to walk around city and night market and finally 24 hours getting home via Bangkok and Amsterdam. What are my impressions? Well much of the time was spent at meetings though we did get to sample some of the country. But based on my limited experience Hanoi and the north appears more traditional Vietnamese whereas HCM City in the south is more cosmopolitan and western as evidenced by the newer, bigger city and shops like Gucci, Armani, Burberry, Channel etc, etc. Though we did see a Gucci store in Hanoi as well but not on the same scale. Though I am sure that not many locals purchased here, the wealthy international visitor I expect makes up the majority of the customers. As I understand it even well-educated professionals may earn only $200 a month and we saw plenty of people living on much else, and inflation is rampant now.

I love Hanoi and some of the local areas we saw and were taken to, it whetted my appetite for more. It would be nice to visit and travel widely with other photographers to get some great images of the very varied landscape and seascapes as well as the beautiful people. The people themselves are, friendly, welcoming, quiet and sometimes shy. There are many different ethnicities with varying traditions which would be great to explore and to get to know more about. In the time available we really didn't even scratch the surface.

The food is great, a preponderance of fish and seafood, but it all seems so fresh, plainly cooked and embellished with lovely sauces, and the use of vegetables is great. Though we also sampled some of the very unusually: uterus, pigs intestine, testicle, liver and a desert which contained frogs stomach, fortunately we avoided snake! Also unfortunately they did not inherit good desserts from their French invaders but they have an abundance of fantastic fruit to make up for this.

For those of a more cultural bent, than myself, there are also plenty of museums and places that commemorate the struggle against their previous invaders, the USA and the French.

What, though, of their Haemophilia care? Well there are some very good points. Firstly there are a number of Haemophilia centres around the country, this is excellent as I have no doubt that without these centres there would be many more injuries and indeed deaths. General hospitals just don't treat as well, they don't have the expertise or the treatment and the delay or denial of treatment, or inappropriate treatment can lead to permanent injury or death. Even in Ireland, where we have good comprehensive care in centres there is a concern about being treated in none centres without this expertise, steps are being taken to try improve on this. The problem here in Vietnam though is that many patients live a long way from the centres and most do not have a decent mode of transport except perhaps on the back of a motorbike which isn't exactly the best mode of transport with a bleed or injury! This delay causes further problems.

At these centres there are very good and dedicated staff who look after their patients as well as they can, but the problem is two-fold. The lack of access to sufficient and appropriate factor replacement treatment. As a poor country it is difficult to access the most modern factor replacement concentrates so less efficient plasma derived products are used. And although these are made locally to high standards with proper screening for viruses and contaminants, sufficient treatment cannot be made to allow patients treat themselves at home when they get injured, which, would revolutionise the standard of care. Secondly, people with haemophilia here must pay a contribution towards their treatment, 20%, which for the vast majority here is a great burden and has led to great hardship. In circumstances of poverty this contribution is reduced to 5% and in these cases the treatment manufacturers will pay the final 5%, but this really only encourages poverty.

The outcome is that patients lose out on their education, can't get jobs and find it difficult to support themselves. Seeing this is very humbling and makes me appreciate the very good level of care we get. But also it reminds me of how it used to be in Ireland many decades ago. It has been a long road, a very hard-fought road, to get us where we are and this road has been paved with many instances of hardship, through lack of treatment which lead to: deformity and disablement, poor education, lack of job prospects, families ashamed of their haemophilia, poor quality of life, and indeed lives cut tragically short through injury. In the last 3 decades poor safety measures in the manufacturing of the treatment has had its own tragedy through contamination with HIV, AIDS and Hep. C, where the lives of many friends and families have been devastated. So my visit here reminds me we should not be complacent about what we have achieved, irrespective of our economy. We need to retain and continue to improve our level of care so that we should not fall back into the abyss of inadequate treatment, and we must insist on the highest level of care, in this way people with haemophilia and bleeding disorders can have full and fulfilling lives, and can contribute to society rather than be a burden on it.

So finally a country I would live to return to and explore more fully.

Vietnam - Day 8 Saigon

The morning started with a very formal inauguration of the HCM City club, which essentially is a branch of the Vietnamese Haemophilia Society. There are over 50 people attending, with high-powered doctors there and we are invited to the top table as guests. There is a TV camera for local news reporting. The opening ceremony lasts two hours the most touching contribution being from a fairly disabled man with haemophilia who is obviously overcome with emotion at the set up of this club, and what he hopes may improve overall treatment. After it finishes it gives us an opportunity to mix and talk to the haemophiliacs and parents attending. They are extremely friendly and talk freely and ask us about our services and the level of treatment we receive. In fact it's a little humbling as I soon realise that in perhaps two or three treatments I would have used up an entire years treatment for one of these young men. They can only live in hope, and repeatedly I am told our position is a dream for them.

After another fine lunch with the doctors we have a couple of workshops to discuss the way to organise a society and how to get and train volunteers.

That finishes our work for the day so we have 3 days left to enjoy ourselves.

Vietnam - Day 7, Saigon

We set off at 6.45am for our flight to Ho Chi Minh City, formerly Saigon. Vietnam is a long country it being some 1900 km between these two cities and it takes 2 hours by plane. The first impressions of HCM is a slightly more modern city to Hanoi with wider streets though the traffic is still fairly hectic.

In the afternoon we are to visit the blood bank and three hospitals that treat haemophilia. It's when you visit hospitals like these that you realise how lucky we are, there are many problems with our health service, but here things are much worse. The doctors and nurses are excellent but they cannot work miracles with the resources they have. We see crowded hospitals with no privacy and in many cases patients are sharing beds. The worse part of this is that haemophilia is readily treatable, and patients can treat themselves at home with modern treatment. When this is done there are less strains on the medical system, with patients being more healthy and requiring less hospitalisation. Instead here there is limited and poorer quality treatment which means these young men are severely disabled, which means they cannot get full education and hence appropriate jobs. Also here the patients must pay a contribution towards their treatment (20%) except if they are destitute. Salaries are poor here so that one treatment can cost as much as a months salary. So it is not unknown to sell their possessions and homes to pay for treatment. Because these children and men are not getting sufficient treatment most are disabled with deformed joins and in many cases they have lost limbs. It is a very humbling experience.

Tomorrow we are to return for the formal set up of a branch of the Vietnamese Haemophilia Society in HCM city and for workshops.

Again we are treated to a very nice seafood meal in a fine restaurant by the health care professionals in HCM city, our hosts are extremely hospitable and friendly and it is a very enjoyable evening.

Vietnam - Day 6

We were picked up this morning at 6am, we were being brought out for a days sight-seeing and to see a family with a Haemophilic boy. The province of Hoa Binh is a good 2 hour journey though we have to stop off at the hospital first to pick up all those going on the trip. We have Dr Mai and some of her team including another doctor, a few nurses, one of the nurses daughters who acts as a volunteer, a young man with haemophilia and Ms Hang who is an administrator at the hospital in the centre. On the road in a bus for a couple of hours, and it's interesting to see the country side and the small villages along the way. Where we are going isn't in fact too far away, less than a hundred kilometres, but the roads are not great, we come across slow moving vehicles, and the odd small herd of cattle. It appears that it takes forever to drive any sort of distance.

About 9 am we make it to the hydroelectric power station that produces about 20% of the country's electricity. It was built with the expertise of Russian engineers and some 37000 Vietnamese workers. It took 15 years and some 167 lost their lives in its construction. It was built in a mountain side to prevent its distraction during a war. It was completed in 1982.

We were then taken for a long boat ride on the lake, perhaps to make up for the fact we didn't get to Holong Bay. We are taken to a small temple on a tiny island in the lake.  Here Dr Mai buys some freshly barbecued fish which we eat on the boat. These are lovely people and even with a bit of a language barrier we had a great laugh and they are so hospitable.

Sorry Michael but I have to say we had another great lunch. We were taken to an excellent restaurant. The food is so fresh and great vegetables and dipping sauces.

Next we are brought to a very entertaining and ethnic dance show. We shared some local wine from a large pot using long bamboo straws.

We are then welcomed into the house of a local boy with haemophilia, our whole crew of 12 of us, are invited in to sit at two long tables they have prepared with food. As well as his parents there is his grandmother, aunts, local doctor, 3 of his school teachers and he also had a friend there with haemophilia. We were made most welcome with, food, drink, flowers, speeches and a gift each. They are truly wonderful people and hopeful that our twinning programme can produce dividends through improved overall health care for their boys and all boys with haemophilia.

It's just gone 5pm and time to set off. We've been invited to an after wedding party of one of the nurses in the Haemophilia Centre. As can be expected weddings are slightly different here, the ceremony is actually tomorrow and tonight we were invited to the brides party in her house (sort of hens party) meanwhile hubby to be is having a party in his home. The wedding album is already produced they took the photos in all the wedding garb about 2 months ago. The family treat us like royalty we are taken into the house and given the bet chairs and introduced to all the important members of the family. Then of course there's even more food. Overall a fantastic day and they have looked after us very well. Here are some photos from my iPhone today on the lake.

Vietnam - Day 4

Last night we ate out in a lovely little restaurant. Upstairs in a small room with no more than 8 tables, but lovely Vietnamese food. I had spring rolls and we all had their speciality, chicken 5 spices, I think it was called, with steamed rice. Anyway the whole thing was gorgeous and all for only 5.50€!!! Then off to the last night of the late market. Up early today, quick breakfast and we are taken to the hospital. This involves a 40 min drive from our hotel and it was a real experience driving through rush hour traffic I've never seen anything like it. We arrived at the combined blood bank and hospital, it is an impressive building, with very good laboratories, impatient facilities, dedicated staff but unfortunately they lack enough treatment to completely treat everybody. We are introduced to a large number of inpatients and outpatients and it is really heart breaking to see such young men who are severely crippled due to haemophilia. We are very fortunate in Ireland that no one suffers like this any more and it is a great pity to see such suffering when the knowledge and treatment is available in the world. We have a busy day with meetings and I cannot say much about these except it was great to see so many people, some who had travelled a great deal, to meet us. They were very enthusiastic and energetic which hopefully means that conditions will improve in the future.

Afterwards we were taken to another fantastic restaurant and I have to say Vietnamese food is gorgeous, well worth trying if you ever get the chance.

Vietnam - Day 2

The hotel is a lovely boutique hotel right in the middle of the old town. The rooms are well appointed with a laptop in each room with Internet as well as WiFi. Mind you you're not allowed access Facebook. After a few hours rest we head out in the afternoon for a stroll. The drizzle persists, and we start to get used to the manic traffic. Motorbikes and cars weave all over the street with horns constantly hooting and the pedestrians are also weaving in the traffic. It's next to impossible to walk on the pavements as there are either people sitting on them or else there are motorbikes parked on the sidewalk.

The streets in the Old Town are narrow and the smell of cooking abounds, it must be the ubiquitous Poh, a noodle soup. As well as standard cafes, there are people selling food from bikes or baskets. Every so often there are people cooking on the pavement and people sitting on little plastic seats eating and drinking. There are shops selling all types of nicknacks and small supermarkets.

We return at 6 pm to meet Dr Mai and her Assistant Ms Hang. We discuss the workshops for the following week before heading off to dinner. The schedule looks very good with visits to people's homes to see how they cope with their haemophilia. We are also invited to a nurses after wedding celebrations on Wednesday. Dr Mai and Ms Hang are very friendly and bring us to a specialist fish restaurant where we have a fantastic meal. Everything is cooked at the table, the sauces, vegetables and fish are lovely and I manage the chopsticks surprisingly well.  Afterwards we head to the market that runs every Friday, Saturday and Sunday nights. The streets are thronged with people. To finish the night off, after we leave the girls back to the hotel, Brian and I go look for the Irish bar to get a drink for Paddy's day.

Tomorrow the plan was to go to Holung Bay, but today due to the bad mist the boats were not allowed out so we've decided not risk the 3.5 hour drive there and just do our own thing. In the mean time I listen to the Ireland England rugby match on my iPhone app, amazing what you can do!!

Vietnam - Day 1

Up early at 4am for the flight to Paris, a 4 hour stop over in Charles De Gaul airport, and then on to Hanoi with Vietnam Airlines. The flight is 10.5 hours so in fact the first day is gone on traveling as we arrive on Paddy's day, Saturday 17th at 5.40am. Not much to say about long flights except I think the plane we flew on had many, many, many hours clocked up on it!!! Anyway we arrive, and the sun isn't up yet. Next we have a two hour wait to get our visas, that eventually sorted the bags are waiting for us and so is our taxi driver from the hotel, this is great as you hear all sorts of problems with scams between taxi drivers and hotels.

So the first impressions? Typical Paddy's day it is raining and misty. The drive from the airport to the city brings us through some country side and we get our first sight of Paddy fields. As we get closer to the city we see a very industrial city with a mixture of typical communist type buildings with a mix of factories: Panasonic and Yamaha to name a couple, and more historic buildings that look Vietnamese with their beautifully ornate roofs. Although its 8 am the traffic is building up and the ubiquitous motor and push bikes become even more prominent. Some stacked high with wares for the market and others with two or three passengers. The traffic runs in all directions with no apparent control, and then the pedestrians trying to cross the road, what havoc!! I'm not looking forward to trying to cross the road.

Our hotel is nestled in the middle of the old town and it is very nice and well appointed. So we decide to get a bite of breakfast and go to bed for a few hours before exploring.