Friday, June 1, 2007

Visit Malaysia 2007 Report

Malaysia Travel Guide: Malaysia is a friendly, beautiful, culturally rich country and one that’s extremely good value for money to travel in. It’s modern enough to be comfortable yet full of natural beauty to be mesmerized.

Culture and Art: The mix of cultural influences in Malaysia is the result of centuries of immigration and trade with the outside world, particularly with Arab nations, China, and India, however each culture remained largely intact; that is, none have truly been homogenized. Traditional temples and churches exist side by side with mosques.

Special activities: Malaysia also offers some very special activities, and if you make room for one or two of them, they will enhance your trip immeasurably. You can choose to spelunk in the world’s largest single cave chamber in Sarawak’s extraordinary Gunung Mulu National Park, or a diving trip in the tropical waters off both Peninsular Malaysia and Borneo where you can find some of the world’s best scuba diving sites. A visit to the rain forest of Malaysia should be high on the list for anyone who has an affinity for nature, and it should be: the Malaysian rain forest is unique in the world, and the oldest on the planet.

Cuisine: Malaysia is a fabulous place to enjoy the art of eating and drinking. Malaysian Food is a multicultural fusion of Malay, Indians, Chinese and a bit of Peranakan, and this create a unique food that’s not only colorful, spicy and eclectic, but also downright tasty.

Come enjoy Malaysia with me, you can really see, feel, touch, smell and taste the hidden treasures of Malaysia. With so much to see and so much to do, one will never complain about feeling bored here. So, what are you waiting for? Come and visit Malaysia!

Vietnam Trip


This was my third visit to the Center for Traumatology and Orthopaedics (CTO) with HVO. After arriving in HCMC on Friday, March 19th, I spent two and one half weeks teaching anesthesia and organizing a trauma course at CTO. As always, I appreciated the step-by-step description given in the HVO Orientation Packet for obtaining permission to enter Vietnam and work at CTO.

My advice (unsolicited as it is) to new volunteers, is to keep an open mind and be flexible in your expectations. No matter how you try to prepare yourself before arriving, there will be something that will be different than the way you thought it would be. Although I was last in Vietnam just two years ago, HCMC is undergoing changes at such a rapid rate that I experienced many surprises- both positive (mostly) and negative.


Monday I attended the morning staff meeting and was introduced to the physicians and nurses. It was interesting to see the emergency orthopedic cases of the previous evening being presented. Case after case of traumatic lower extremity fractures was presented with x-ray pictures. The emergency operative cases were presented first (usually 20-30 per day). This was followed by the closed reductions which are casted by technicians (usually 20 per day). Fractures which require casting but not reduction are not presented and there are often 100 per day of these.

Although CTO is a 500 bed hospital, there are often too many patients admitted to fit in the allotted beds. I saw many rooms with two patients in narrow beds meant for one and patients on stretchers overflowing into the corridors. It was evident that trauma is very prevalent in HCMC and is a burden on resources.

The approximately 100 surgeons at the hospital see about 1,250 outpatients per day. They do so very efficiently because by mid-afternoon the clinic waiting room, which is packed in the morning, is almost empty. The hospital has 9 physician anesthesiologists to cover the ICU and 11-12 operating rooms. They are aided by several nurse anesthetists.

During the rest of the week I gave lectures on regional anesthesia at 7 AM for the anesthesia department. CTO had managed to get a projector so that I was able to use my laptop to show the Power Point slides I had prepared. After each lecture I spent several hours in the operating room demonstrating and observing the regional anesthesia techniques that had been discussed. The department as a whole seemed much more interested in learning these techniques than they had been when I covered similar topics 6 years earlier.

Work in the operating room was often followed by lunch in the hospital cafeteria. Here we discussed topics ranging from medical care to popular culture while we ate typical and excellent Vietnamese food. In mid-afternoon I returned to my hotel and prepared for the next days lecture. The hospital activities in general start early and slow down significantly by 3PM.

I gave the traffic accident talk to surgeons and anesthesiologists at CTO on Monday and at Cho Ray Hospital on Tuesday. It was based largely on a study done by the Hanoi School of Public Health which was presented at the Road Traffic Injuries and Health Equity Conference held in Cambridge, Massachusetts in April 2002.

I was shown around one day at Cho Ray Hospital. At 1,000 beds, it is one of the largest in HCMC and is known primarily as a neurosurgical and trauma hospital. This was my second visit and it was nice to see that there have been improvements in equipment in the operating room and the recovery room. Despite its large size, the hospital has more cases than it was planned for. I saw two patients undergoing craniotomies side by side in the same room because of a lack of available operating rooms. Visits by AO can probably best be done in coordination with CTO in the future.

On Thursday and Friday I ran a two day Primary Trauma Care course for 22 participants. Five of the instructors were Vietnamese physicians from CTO who had participated in the first PTC course that was taught two years earlier. A general surgeon from Boston, and I were the only outside instructors. The course was taught using standard lectures, scenarios, skill stations, and discussion groups. My impression was that the students were quick to absorb and open to the concepts and knowledge of the PTC course. They seemed to especially enjoy the skill stations and discussion groups. This years students did not get into the scenarios as much as the participants of two years ago. My impression from previous visits, that Vietnamese physicians prefer to start their work early and finish early, was reinforced on this visit. Teaching after 3PM is pretty much not tolerated.


I did feel that some of my lectures were more welcome than others. I believe the regional anesthesia lectures and demonstrations were appreciated as there were many questions and my colleagues seemed eager to try the techniques we discussed. Each time I visit CTO I see progress in equipment and anesthetic technique. As AO volunteers we contribute by supplementing teaching and by exchanging ideas and experiences.

Working with my colleagues at CTO is as rewarding as anything I do in medicine and as long as I can find the time, energy and finances, I will continue to visit. I am thankful that HVO makes the logistics of visiting so easy.

Vietnam Trip


This was my fourth visit with HVO to the Hospital for Traumatology and Orthopaedics, HTO. I keep thinking that I should try some of the other HVO sites for variety but Vietnam has a magic all its own and it's hard to imagine a place that would be more gratifying or more interesting.

Activities and Assessment:

On Monday through Friday I lectured at the 7 AM meeting to the anesthesia staff. The first three days I used my laptop and a projector they were borrowing from B-Braun to give talks on regional anesthesia. On Thursday and Friday I tried running a more interactive session by doing a "Problem-Based" discussion. This worked reasonably well in trying to get everyone talking but because of the translation back and forth slowing things down we didn't cover much territory. We discussed hypotension, the treatment, differential and the management of the airway in a patient with hypotension and a full stomach. The system is more geared towards lectures but I believe interactive discussion is helpful in getting an idea of how much is being absorbed by the staff and students.

After the morning lecture, I spent time in the holding area observing and doing some blocks and also going into the operating rooms to observe. There have been changes since I was there last. They now use a CO2 absorber in circuit in the OR where the scoliosis and other back cases are done with low flows. In one case I was observing the ETCO2 was measured and was quite high (60s and 70s) on a young child and I did not ask but am now wondering whether they change the absorbent often enough. The anesthesiologist also are not mixing the lidocaine and bupivacaine in the same syringe but are giving them in separate syringes at my suggestion the last time I was there. During my last visit I discussed femoral nerve blocks and I was told that the department is regularly doing these blocks now for both intraoperative procedures and postoperative analgesia. On this visit I discussed the use of suprascapular nerve blocks and superficial cervical plexus blocks as rescue blocks for failed interscalene blocks or for analgesia after shoulder surgery. The staff seemed very interested and tried it on several patients while I was there with good results. They have insulated regional needles which they use for select patients. I emphasized the importance of blocking the musculocutaneous nerve separately from the axillary nerve block.

You asked if there was "one person who really touched you during your trip" and the answer is yes. I was attempting to demonstrate an infraclavicular nerve block using a nerve stimulator on a young man scheduled for forearm surgery. The patient seemed very stoic as I kept introducing the needle without any success at finding the brachial plexus. I have to add that this is a technique I have done successfully hundreds of times and feel very comfortable doing. I finally decided to desist ("first do no harm") and do the easier and safer axillary approach to the brachial plexus. I always first block the musculocutaeous nerve separately and then the rest of the brachial plexus. To my embarrassment I had great difficulty finding the musculocutaeous as well- this was in front of about ten eager young trainees. I felt terrible. Finally I found the right spot and as soon as I injected the last drop of local anesthetic the patient was immediately wheeled to the operating room. As the patient entered the OR he looked up at me with tears in his eyes and said "help me" (to my surprise he knew those few words in English). I worried that perhaps the block wasn't working and he was frightened that he would have surgery without anesthesia.

After a successful surgery under a good block (whew!) I went to see the patient in the recovery room and he started crying again when he saw me. I asked one of the anesthesia staff what was wrong and I was told that the patient was so thankful that an "expert" from the US had taken care of him that he was overcome with relief and gratitude. I have to say that this was one of the most pleasant outcomes of a cultural misunderstanding that I have experienced and one that I will probably never see in the US.

Living Conditions and Suggestions:

I stayed in the Spring Hotel. This is the hotel I have stayed in every visit and it is still very comfortable and gives a safe feeling while being close to everything (except the hospital which is a 15 to 25 minute ride away). The most recent addition which I truly appreciated is that if your laptop has wireless access equipment, you can access the internet in your room for free. Otherwise you can still log on to one of the two computers in the lobby for free but there is sometimes a wait. I think there are many new hotels being built in HCMC as more and more tourists come and there are certainly other good hotels to stay in if you wanted to take the time to look. Prices are starting to go up but are still very reasonable compared to the US and Europe. I recommend e-mailing ahead to book a room, especially during peak tourist times.

I recommend taking one of the boats from the city to the Mekong Delta or one of the nearby beaches. If you have time and money there are many wonderful exotic and interesting places to visit. On my way to Hanoi to the Congress, I spent three days seeing Hoi An and Hue, both charming and very interesting historically.


Vietnam is a spectacular country. It is beautiful, exotic and friendly. The people I have met are intelligent, interested in education and quick learners. After visiting I feel optimistic about the future of both the medical profession in Vietnam and the country itself. Still, there is much that a volunteer can do to help. It is remains very rewarding to teach in HTO and I certainly plan to return when time permits.

Thursday, May 31, 2007

Vietnam Quang Ninh

Vietnam's northernmost coastal province, Quang Ninh runs all the way to the Chinese frontier and border crossing at Mong Cai. Inland the province is bordered by Long Son and Bac Giang to the west and Hai Duong and Hai Phong to the south.

If you're in Quang Ninh and not heading to the Chinese border crossing at Mong Cai, then you're almost definetly heading to the magnificent, breathtaking Ha Long Bay.

The coastline of Quang Ninh has to be one of the most spectacular in the world, with thousands of limestone massifs breaking through the oceans's surface and soaring into the sky. For many a highlight of their visit to Vietnam, slowing cruising through this magnificent maze-like bay, soaking up its seductive atmosphere is a truly enchanting, mystical experience.

While the vast majority of travellers visit Ha Long Bay on an organised tour from Hanoi, it is possible to see the bay using the provincial capital, Ha Long City as a base. Actually made up of the twin towns of Bai Chay and Hong Gai, Ha Long City is a bustling little tourist town with a near endless supply of junks ferrying tourists out into the bay on everything from day trips to week-long extravaganzas. A tourist attraction in its own right -- absolutely not -- but if you're going to Ha Long Bay you'll be passing through here.

Vietnam Hue

Hue, the historic capital of Vietnam, sits astride a truly majestic and beautiful river, the Song Huong (Perfume River). The north-bank is host to its share of hotels and restaurants, but the area is dominated by the old fortified city known as the Citadel, spread across more than 5 square kilometres of ground, crowding out development on that side of the river. As a result, guesthouses, hotels and restaurants have sprung up on the south bank, starting with the river road, Le Loi Street, and stretching further south. The south bank of the river has been developed as park cum promenade, with an eclectic variety of public sculptures on display.

Hue is the capital of Thua Thien Province, with a population of about 340,000. Its location in central Vietnam, just south of the DMZ, made it a scene of heavy fighting during the American War. It's 15km west of the South China Sea and about 540km south of Hanoi and 644km north of Saigon. While the city is also known for the manufacture of textiles and cement, tourism has become its bread and butter.

Hue's complex history has earned it a reputation as a political, cultural and religious centre, but nowadays, visitors to contemporary Hue will find a city that only dimly reflects on its past, and only does so as a begrudging nod to its western visitors. Like Halong Bay to the north, the complex of tombs, pagodas and palaces throughout Hue and its surrounds has been designated a UNESCO World Heritage site. But to the Vietnamese psyche, shaped by centuries of war and struggle, tempered by nearly forty years of communist rule, this heritage is largely irrelevant and completely disconnected from the present. The overwhelming sense one gets from the city, on even the most casual visit, is of an unstoppable forward drive, and of a people constantly looking to the future.

But the profitability of tourism has lead to a paradoxical situation where, in order to move forward, the citizens of Hue must pry open those doors to the past they would rather leave shut. As a result, the tourist industry here has developed into a half-hearted attempt to give the foreigners what they want and send them on their way. While this has been effective in one sense -- a steady stream of tourists keeps showing up and paying for tours -- in the larger scheme it has also meant many poorly-run tours and disappointed travellers.

At the moment, Hue is a premier tourist destination mostly in theory. In practice, it's still a work in progress. That notwithstanding, it's a beautiful, vibrant city, with great places to stay, great food, and a number of interesting things to do, on and off the well-worn tourist trail of historic attractions.

A word about Hue tours
We've heard numerous complaints about every kind of tour available in Hue. The boat tours can be cramped and noisy. Where lunch is offered as part of the ticket price, it often amounts to only a dish of beans, and you're expected to buy the rest of your meal out of your pocket. Tourists are often dropped off at tombs and ordered to return in one hour, which is hardly enough time to walk from one end the other. The cheapest tours will not provide any information about the sights. And there's a wide variety of standard rip-offs that seem to accompany each tour.

If you want to enjoy a cultural tour of Hue, you're going to have to pay for it. Go for a small group tour, book it through one of the better hotels if possible, and be sure you have time to chat with your guide before you sign up to gague the extent of his or her knowledge and language skills. Otherwise, skip the tour altogether and do it on your own. If you take a motorcycle taxi, hire one to take you there, and a separate one to take you back -- the driver may try to convince you to let him wait for you, but he'll likely charge you much more for it in the end, and there are plenty more taxi drivers where he came from. Take your time. Pack a lunch -- food and beverages in and around the historical sites are well over-priced. Don't try to see everything -- just target a few key spots. Expect nothing much more than you would from a day in the park, and you'll avoid some of the frustrations and let-downs we keep hearing about.

Touring the Sites on your Own
Everything can be visited by car, bicycle, or motorbike on your own. However, everything worth seeing is very poorly marked, and there are a lot of fuzzy maps available that put things in the wrong location. This is done partly by design -- to discourage tourists from touring on their own and force them to hire a guide. But, in fact, one of the best ways to wile away the hours in Hue on a beautiful day is to try to find someplace on your own anyway, get lost, see the countryside, stop along the way, and you'll eventually wind up some place interesting, even if it isn't the place you were heading for when you set out!

Vietnam Mui Neh

One of southern Vietnam's prime slices of beach real estate, Mui Ne is a kilometres-long sweeping bay boasting a huge range of guesthouse and resort options, with the actual village set at the far northern end of the bay. The accommodation and services scene, heavily influenced by its proxmity to Saigon which is a mere four hours away, has developed rapidly in recent years and now offers some outstanding mid-range resort options, though for budget travellers the choices are slowly dwindling.

The beach itself is yellow sand with a semi-fine grain. While the central stretch of the beach through to the northern end is poorer quality and dominated by the fishing industry, the southern stretch is ideal for swimming, sun-baking and deck-chair reclining. The beach is famous for its wind- and kite-surfing. In season, the winds here are as reliable as clockwork, though if you're planning on spending a prolonged period of time doing either, bring your own gear as the prices are not cheap.

Away from the beach, the key attraction of Mui Ne are its sand dunes, of which there are three sets which can easily be visited from Mui Ne, either independently by bicycle or motorbike or by motorbike taxi or jeep. While not of Lawrence of Arabia proportions, they are nevertheless very photogenic and with a bit of trick photography, you too can be Lawrence. Best visited in the late afternoon when the light is sublime, you can also catch the sunset from above Mui Ne village which, with its bevy of fishing boats, is particularly scenic.


If you're accustomed to beach towns you can easily walk around, Mui Ne takes some adjustment. Most of the accommodation and places to eat are spread out over a good ten kilometres of beach front. If you want to stay put, pick a spot near the services and restaurants you think you'll be patronising. The really cheap rooms are further north, nearer to town, and if you stay there, a bike or motorbike rental will be invaluable. Xe om are available, but can be hard to find later in the evening and along certain stretches of the road. The town itself isn't of much interest, and you won't be missing out if you never venture that far to the north. The road changes names somewhere in the middle -- the bit closer to Phan Thiet is called Nguyen Ding Chieu, and closer to town it's Huynh Thuc Khang.

There's a centrally-located 24-hour Vietcom ATM right next to the Saigon Mui Ne Resort. There's also an Incom bank closer to town -- it's east of the road to the white sand dunes, 60 metres to the north, and there's a sign on the main road clearly marking it. IncomBank will exchange most major currencies, and there's a 24-hour ATM on site. They don't cash travellers checks -- try one of the big resorts.

There's plenty of internet access available, rates ranging from 5,000 to 10,000 VND per hour.

The main post office is in town, but there's another branch, with a 24-hour drop box, at the Swiss Village Resort. Both offer a full range of postal services and long distance phone calls.

There's also a medical clinic at the Swiss Village -- consults cost US$20, and the Vietnamese doctor speaks English and Russian. The closest hospitals are in Phan Thiet.

Incom Bank: 05 Khu Pho Rd, Mui Ne. T: (062) 848 226, 383. Open: Mon-Fri 07:00 to 11:30 and 13:30 to 17:00.
Medical Clinic: Swiss Village Resort, 44 Nguyen Dinh Chieu, Mui Ne. T: (062) 847 497, (0918) 210 504. Open: Daily 09:00 to 21:00, 24-hour service available.
Main Post Office: 348 Huynh Thuc Chang, Mui Ne. T: (062) 849 799. Open: Daily 07:00 to 21:30.

Tuesday, May 29, 2007

Vietnam Vacation Guide


Traveling in Vietnam is not always relaxing. It can be unpredictable, intense and frustrating, but it is rewarding. Being demanding and loud, however, will get you nowhere. Remember the importance of ‘face’ - the subtle but important quality of personal dignity in Asian countries.

Vietnam responsible culture Cao Dai temple, Tay Ninh

Try to learn about the culture before you travel and broaden your experience behoy the guidebook. Guidebooks can make or break a guesthouse or hotel by concentrating people in certain places. Guidebooks are also out of date by the time they are distributed. Be willing to try alternative options.

Learn some of the local language, even the basics such as ‘hello’, ‘good bye’ and ‘thank you’ will be appreciated!

Respect the cultural differences and do not look down on, or try to change them.

Be careful when showing affection in public. Relationships in Vietnamese society are fairly traditional, so in general, it is best to limit affection to holding hands- especially in the rural areas.

Avoid patting or touching people on their heads, it is the symbolic high point in Asia.

Be aware of the importance of the ancestral shrine in Vietnam. Avoid backing up to, pointing your feet at or changing your clothes in front of it.


To be sure of not causing offense, it is best to respect local dress standards and dress modestly, especially in the countryside.

There are no areas where nude or topless swimming or sunbathing is appropriate.

Women should try to avoid wearing low - cut or tight sleeveless tops and brief, clinging shorts. It is advisable to wear a bra at all times. Men should avoid walking around bare - chested.

At religious sites, do not wear shorts or sleeveless tops, and remember to remove your shoes.

Questions, privacy and humor.

Modest character of traditional operetta, responsible culture VietnamVietnamese concepts of privacy are very different from those of Westerners, as they are accustomed to living and sharing in a close- knit community and in crowded conditions.

Don’t be offended by the very Vietnamese fascination with your personal details; How old are you? Are you married? Do you have children? Etc - questions that you may consider private. You may find the answer ‘not yet’ (Chua) to the question of marriage or children a useful one.

Don’t be taken aback if people are intrigued by your side, especially if you are tall or well built. The Vietnamese are a small, slight race and may openly display their amazement at Western bulk. Remember this when selecting your clothing!

Talk to the locals and make friends. The people of Vietnam are friendly and hospitable. They love it when they hear a foreigner try to speak their language.

Snap happy.

Mask and toys- responsible VietnamVietnam is a photographer’s dream - from the vivid greens of the rice paddies and cloud- shrouded mountain to the bustle of open- air markets and street life, there are endless photographic opportunities. However, nobody enjoys being followed by a camera, so remember to ask permission before taking photographs- and respect a refusal.

Don’t hound men and women in traditional ethnic dress for the ‘perfect colorful shot’ if they appear shy or avoid your camera, and remember that videos are even more intrusive.

Try not to get into the situation of paying for the right to take photos, as it encourages a begging mentality.

If you promise to send back a photo, make sure you are sincere in your offer.

Just say no.

It’s in your own interests to respect local regulations and practices concerning drug and alcohol. Drugs are illegal in Vietnam and their possession or usage carry harsh penalties.

Be careful about alcohol consumption, especially when visiting rural and ethnic minority areas, where as a tourist you may enjoy privileged status.

Remember that tourism can fuel the demand for alcohol and drugs, and lead to increased consumption/ use by locals, encouraging social problems.

Getting personal.

Camp out and meet locals responsible culture VietnamBe aware that in some communities it may be taboo to conduct an intimate relationship with a local.

Don’t assume that what is acceptable at home is acceptable everywhere. Vietnam is still a largely traditional society, and getting involved with a local may cause offense.

Remember also that the recipient of a foreigner’s attentions can be seriously affected within their local communities in terns of their well being, social standing and reputation.