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Vietnam

Health & safety

Before you go

Insurance

Even if you are fit and healthy, don’t travel without health insurance – accidents do happen. Declare any existing medical con­ditions you have – the insurance company will check if your problem is pre-existing and will not cover you if it is undeclared. You may require extra cover for adventure activities such as rock climbing. If your health insurance doesn’t cover you for medical expenses abroad (emergency evacuation is expensive; bills of over US$100, 000 are not uncommon), you should get travel insurance. The travel insurance we recommend is very flexible: you can buy, extend and claim online from anywhere in the world 24/7, even if you've already left home.

You should find out in advance if your insurance plan will make payments directly to providers or if they reimburse you later for overseas health expenditures. (Note that in many countries doctors expect payment in cash.) Some policies offer lower and higher medical-expense options; the higher ones are chiefly for countries that have extremely high medical costs, such as the USA.

You may prefer a policy that pays doctors or hospitals directly rather than you having to pay on the spot and claim later. If you have to claim later, make sure you keep all documentation. Some policies ask you to call back (reverse charges) to a centre in your home country where an immediate assessment of your problem is made.

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Internet resources

There is a wealth of travel health advice on the Internet. For further information, LonelyPlanet.com (www.lonelyplanet.com) is a good place to start. The World Health Organization (WHO; www.who.int/ith/) publishes a superb book called International Travel & Health, which is revised annually and is available free on line. Another website of general interest is MD Travel Health (www.mdtravelhealth.com), which provides complete travel health recommendations for every country and is updated daily. The Centers for Disease Control and Prevention (CDC; www.cdc.gov) website also has good general information.

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Medical checklist

Recommended items for a personal medical kit:

antibacterial cream, eg Muciprocin

antibiotics for skin infections, eg Amoxicillin/Clavulanate or Cephalexin

antibiotics for diarrhoea, eg Norfloxacin or Ciprofloxacin; Azithromycin for bacterial diarrhoea; and Tinidazole for giardiasis or amoebic dysentery

antifungal cream, eg Clotrimazole

antihistamines for allergies, eg Cetrizine for daytime and Promethazine for night

anti-inflammatories, eg Ibuprofen

antinausea medication, eg Prochlorperazine

antiseptic for cuts and scrapes, eg Betadine

antispasmodic for stomach cramps, eg Buscopa

contraceptives

decongestant for colds and flus, eg Pseudoephedrine

DEET-based insect repellent

diarrhoea ‘stopper’, eg Loperamide

first-aid items such as scissors, plasters (Band Aids), bandages, gauze, thermometer (electronic, not mercury), sterile needles and syringes, safety pins and tweezers

indigestion medication, eg Quick Eze or Mylanta

iodine tablets (unless you are pregnant or have a thyroid problem) to purify water

laxatives, eg Coloxyl

migraine medication (your personal brand), if a migraine sufferer

oral-rehydration solution for diarrhoea, eg Gastrolyte

paracetamol for pain

permethrin (to impregnate clothing and mosquito nets) for repelling insects

steroid cream for allergic/itchy rashes, eg 1% to 2% hydrocortisone

sunscreen and hat

throat lozenges

thrush (vaginal yeast infection) treatment, eg Clotrimazole pessaries or Diflucan tablet

urine alkalisation agent, eg Ural, if you’re prone to urinary tract infections.

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Pack medications in their original, clearly labelled, containers. A signed and dated letter from your physician describing your medical conditions and medications, including generic names, is also a good idea. If carrying syringes or needles, be sure to have a physician’s letter documenting their medical necessity. If you have a heart condition bring a copy of your ECG taken just prior to travelling.

If you happen to take any regular medication bring double your needs in case of loss or theft. In most Southeast Asian countries you can buy many medications over the counter without a doctor’s prescription, but it can be difficult to find some of the newer drugs, particularly the latest antidepressant drugs, blood pressure medications and contraceptive pills.

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Vaccinations

The only vaccine required by international regulations is yellow fever. Proof of vaccination will only be required if you have visited a country in the yellow-fever zone within the six days prior to entering Vietnam. If you are travelling to Vietnam from Africa or South America you should check to see if you require proof of vaccination.

Specialised travel-medicine clinics are your best source of information; they stock all available vaccines and will be able to give specific recommendations for you and your trip. The doctors will take into account factors such as past vaccination history, the length of your trip, activities you may be undertaking, and underlying medical conditions, such as pregnancy.

Most vaccines don’t produce immunity until at least two weeks after they’re given, so visit a doctor four to eight weeks before departure. Ask your doctor for an International Certificate of Vaccination (otherwise known as the yellow booklet), which will list all the vaccinations you’ve received. In the US, the yellow booklet is no longer issued, but it is highly unlikely the Vietnam authorities will ask for proof of vaccinations (unless you have recently been in a yellow-fever affected country).

For info on current immunisation recommendations for Vietnam, contact the international team of doctors at the Family Medical Practice (www.doctorkot.com) in Hanoi and HCMC. They can provide the latest information on vaccinations, malaria and dengue-fever status, and offer general medical advice regarding Vietnam.

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Recommended vaccinations

The World Health Organization (WHO) recommends the following vaccinations for travellers to Southeast Asia:

Adult diphtheria and tetanus – single booster recommended if you’ve had none in the previous 10 years. Side effects include a sore arm and fever.

Hepatitis A – provides almost 100% protection for up to a year; a booster after 12 months provides at least another 20 years’ protection. Mild side effects such as headache and a sore arm occur for between 5% and 10% of people.

Hepatitis B – now considered routine for most travellers. Given as three shots over six months. A rapid schedule is also available, as is a combined vaccination with Hepatitis A. Side effects are mild and uncommon, usually a headache and sore arm. Lifetime protection occurs in 95% of people.

Measles, mumps and rubella – two doses of MMR required unless you have had the diseases. Occasionally a rash and flulike illness can develop a week after receiving the vaccine. Many young adults require a booster.

Polio – in 2002, no countries in Southeast Asia reported a single case of polio. Only one booster is required as an adult for lifetime protection. Inactivated polio vaccine is safe during pregnancy.

Typhoid – recommended unless your trip is less than a week and only to developed cities. The vaccine offers around 70% protection, lasts for two or three years and comes as a single shot. Tablets are also available; however, the injection is usually recommended as it has fewer side effects. Sore arm and fever may occur.

Varicella – if you haven’t had chickenpox, discuss this vaccination with your doctor.

Long-term travellers

These vaccinations are recommended for people travelling more than one month, or those at special risk:

Japanese B Encephalitis – three injections in all. A booster is recommended after two years. A sore arm and headache are the most common side effects reported. Rarely, an allergic reaction comprising hives and swelling can occur up to 10 days after any of the three doses.

Meningitis – single injection. There are two types of vaccination: the quadrivalent vaccine gives two to three years protection; meningitis group C vaccine gives around 10 years protection. Recommended for long-term travellers aged under 25.

Rabies – three injections in all. A booster after one year will provide 10 years of protection. Side effects are rare – occasionally a headache and sore arm.

Tuberculosis – adult long-term travellers are usually recommended to have a TB skin test before and after travel, rather than vaccination. Note that only one vaccine is given in a lifetime.

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Dangers & annoyances

Beggar Fatigue

Just as you’re about to dig into the scrumptious Vietnamese meal you’ve ordered, you feel a tug on your shirt sleeve. This latest ‘annoyance’ is a bony, eight-year-old boy holding his three-year-old sister in his arms. The little girl has a distended stomach and her hungry eyes are fixed on your full plate. This is the face of poverty. How do you deal with these situations? If you’re like most of us, then not very well. Taking the matter into your own hands by giving out money or gifts to people on the streets can cause more damage than good. The more people are given handouts, the more reliant and attracted to life on the streets they become. When money is tight, people recognise that life on the streets is no longer so fruitful. This will hopefully discourage parents and ‘pimps’ forcing children and beggars onto the streets.

One way to contribute and help improve the situation is to invest just a few hours to find out about local organisations that work with disadvantaged people; these groups are far more likely to make sure contributions are used in the most effective way possible to help those who need it.

However, if you want to do something on the spot, at least avoid giving money or anything that can be sold. The elderly and the young are easily controlled and are ideal begging tools. If you are going to give something directly to a beggar, it’s better to give food than money; take them to a market or stall and buy them a nutritious meal or some fruit to be sure they are the only beneficiaries.

Noise

Remember Spinal Tap? The soundtrack of Vietnam is permanently cranked up to 11. Not just any noise, but a whole lot of noises that just never seem to stop. At night there is most often a competing cacophony from motorbikes, discos, cafes, karaoke clubs and restaurants; if your hotel is near any or all of these, it may be difficult to sleep.

Fortunately most noise subsides around 10pm or 11pm, as few places stay open much later than that. Unfortunately, however, Vietnamese are up and about from around 5am onwards. This not only means that traffic noise starts early, but you may be woken up by the crackle of loudspeakers as the Voice of Vietnam cranks into life at 5am in small towns and villages. It’s worth trying to get a room at the back of a hotel.

One last thing…don’t forget the earplugs!

Prostitution

Karaoke clubs and massage parlours are ubiquitous throughout Vietnam. Sometimes this may mean an ‘orchestra without instruments’, or a healthy massage to ease a stiff body. However, more often than not, both of these terms are euphemisms for some sort of prostitution. There may be some singing or a bit of shoulder tweaking going on, but ultimately it is just a polite introduction to something naughtier. Legitimate karaoke and legitimate massage do exist in the bigger cities, but as a general rule of thumb, if the place looks small and sleazy, it most probably is.

Scams

Con artists and thieves are always seeking new tricks to separate naive tourists from their money and are becoming more savvy in their ways. We can’t warn you about every trick you might encounter, so maintain a healthy scepticism and be prepared to argue when unnecessary

demands are made for your money.

Beware of a motorbike-rental scam that some travellers have encountered in HCMC. Rent a motorbike and the owner supplies an excellent lock, insisting you use it. What he doesn’t tell you is that he has another key and that somebody will follow you and ‘steal’ the bike at the first opportunity. You then have to pay for a new bike, as per the signed contract.

More common is when your motorbike won’t start after you parked it in a ‘safe’ area with a guard. But yes, the guard knows somebody who can repair your bike. The mechanic shows up and quickly reinstalls the parts they removed earlier and the bike works again. That will be US$10, please.

Beware of massage boys who, after a price has been agreed upon, try to extort money from you afterwards by threatening to set the police on you (these threats are generally empty ones).

The most common scam most visitors encounter is the oldest in the book. The hotel of choice is ‘closed’ or ‘full’, but the helpful taxi driver will take you somewhere else. This has been perfected in Hanoi, where there are often several hotels with the same name in the same area. Book by telephone or email in advance and stop the scammers in their tracks.

Despite an array of scams, however, it is important to keep in mind the Vietnamese are not always out to get you. One concerning trend we’re noticing in Vietnam, relative to neighbouring countries such as Cambodia and Laos, is a general lack of trust in the locals on the part of foreigners. Try to differentiate between who is good and bad and do not close yourself off to every person you encounter.

Sea Creatures

If you plan to spend your time swimming, snorkelling and scuba diving, familiarise yourself with the various hazards. The list of dangerous creatures that are found in seas off Vietnam is extensive and includes sharks, jellyfish, stonefish, scorpion fish, sea snakes and stingrays. However, there is little cause for alarm as most of these creatures avoid humans, or humans avoid them, so the number of people injured or killed is very small.

Jellyfish tend to travel in groups, so as long as you look before you leap into the sea, avoiding them should not be too hard. Stonefish, scorpion fish and stingrays tend to hang out in shallow water along the ocean floor and can be very difficult to see. One way to protect against these nasties is to wear plastic shoes in the sea.

Theft

The Vietnamese are convinced that their cities are full of criminals. Street crime is commonplace in HCMC and Nha Trang, and on the rise in Hanoi, so it doesn’t hurt to keep the antennae up wherever you are.

HCMC is the place to really keep your wits about you. Don’t have anything dangling from your body that you are not ready to part with, including bags and jewellery, which might tempt a robber. Keep an eye out for the Saigon cowboys – drive-by thieves on motorbikes – they specialise in snatching handbags and cameras from tourists on foot and taking cyclos (pedicabs) in the city.

Pickpocketing, which often involves kids, women with babies and newspaper vendors, is also a serious problem, especially in the tourist areas of HCMC. Many of the street kids, adorable as they may be, are very skilled at liberating people from their wallets.

Avoid putting things down while you’re eating, or at least take the precaution of fastening these items to your seat with a strap or chain. Remember, any luggage that you leave unattended for even a moment may grow legs and vanish.

There are also ‘taxi girls’ (sometimes transvestites) who approach Western men, give them a big hug, often more, and ask if they’d like ‘a good time’. Then they suddenly change their mind and depart, along with a mobile phone and wallet.

We have also had reports of people being drugged and robbed on long-distance buses. It usually starts with a friendly passenger offering a free Coke, which turns out to be a chloralhydrate cocktail. You wake up hours later to find your valuables and new-found ‘friend’ gone.

Despite all this, don’t be overly paranoid. Although crime certainly exists and you need to be aware of it, theft in Vietnam does not seem to be any worse than what you’d expect anywhere else. Don’t assume that everyone’s a thief.

Undetonated Explosives

For more than three decades four armies expended untold energy and resources mining, booby-trapping, rocketing, strafing, mortaring and bombarding wide areas of Vietnam. When the fighting stopped most of this ordnance remained exactly where it had landed or been laid; American estimates at the end of the war placed the quantity of unexploded ordnance (UXO) at 150,000 tonnes.

Since 1975 more than 40,000 Vietnamese have been maimed or killed by this leftover ordnance. While cities, cultivated areas and well-travelled rural roads and paths are safe for travel, straying from these areas could land you in the middle of danger.

Never touch any rockets, artillery shells, mortars, mines or other relics of war you may come across. Such objects can remain lethal for decades. And don’t climb inside bomb craters – you never know what undetonated explosive device is at the bottom.

You can learn more about the issue of landmines from the Nobel Peace Prize–winning International Campaign to Ban Landmines (ICBL; www.icbl.org), or visit the Halo Trust (www.halotrust.org) or Mines Advisory Group (MAG; www.maginternational.org) websites, both British organisations specialising in clearing landmines and UXO around the world. Cluster munitions were recently outlawed in a treaty signed by more than 100 countries, the usual suspects declining to sign: visit www.stopclustermunitions.org.

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