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"title": "Color Me Run 2018",
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"summary": "This May 12, Family Medical Practice was a proud medical sponsor of the extraordinary COLOR ME RUN held in HCMC’s District 7. The festival was attended by over 10,000 people and included runners of all ages—children from as young as three were seen participating on the day!",
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"value": "<p>This May 12, Family Medical Practice was a proud medical sponsor of the extraordinary COLOR ME RUN held in HCMC’s District 7. The festival was attended by over 10,000 people and included runners of all ages—children from as young as three were seen participating on the day!</p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/Color_Me_Run_2018_14.jpg\" class=\"format-left\" /><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/Color_Me_Run_2018_4.jpg\" class=\"format-left\" /><p></p><p>The event kicked off at 9 am. There were two medical stations on site manned by professional medical team members (including nurses and hi tech ambulances on standby along the race route). The event organizer Pulse Active’s volunteer staff were easily recognisable in their striking shirts bearing the important safety message: IN CASE OF EMERGENCIES DIAL *9999. Announcements about our emergency services number were also made throughout the day to ensure that all present knew what to do in case of an unexpected medical event. All race kits also included our first aid tips pamphlet to ensure everyone was prepared in case of injuries.</p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/Color_Me_Run_2018_9.jpg\" class=\"format-left\" /><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/Color_Me_Run_2018_5.jpg\" class=\"format-left\" /><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/Color_Me_Run_2018_10.jpg\" class=\"format-left\" /><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/Color_Me_Run_2018_8.jpg\" class=\"format-left\" /><p></p><p>The much anticipated event closed out after 9 pm with popular young artists (including Sam Tsui) taking over the stage, seeing young people celebrating with music and dance and keeping with the day’s theme: SHOUT OUT LOUD!</p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/Color_Me_Run_2018_15.jpg\" class=\"format-left\" /><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/Color_Me_Run_2018_22.jpg\" class=\"format-left\" /><p></p><p>Many thanks to all participants and we will be sure to see you all again next year!</p>"
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"summary": "Dr. Pedro L. Trigo recently presented a talk on the virus’ origin, spread, and status as an epidemic at Puma Vietnam office.",
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"value": "<p>As one of FMP’s many approaches to raise public awareness on COVID-19, internist Dr. Pedro L. Trigo recently presented a talk on the virus’ origin, spread, and status as an epidemic at Puma Vietnam office.</p><p>More than 60 Puma staff engaged with Dr. Pedro on pressing concerns regarding new emerging cases in Vietnam; preventive measures and controls that are and should be in place; as well how to recognize symptoms and what tests and medical facilities are available at hand.</p><p>Dr. Pedro explained the complexity of COVID-19 and compared it with SARS and MERS—the two types of coronavirus that have affected humans on a large epidemic scale in the recent past. With time, as we have witnessed with China’s alarming numbers of cases and deaths at its peak, to its recovery now underway, we will see a similar pattern emerge in other epicenters currently being hard hit by the virus. Dr. Pedro reminded the audience to continue practicing daily hygiene; to avoid crowded places if possible; and to wash their hands often as well as wear masks when one is sick so as to not spread any infection to others.</p><p>At the end of the talk, Dr. Pedro emphasized the importance of staying abreast of good quality information from reliable sources and to be able to understand the differences between facts and fiction—as there are many widespread rumors and incorrect information being spread on the internet.</p><p></p>"
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"summary": "The decision to breastfeed can give your baby the best possible start in life. While that’s true, it’s still an intimate and personal choice—and there are many factors that can weigh on a mother’s decision. In healthcare, we can guide parents to recognize the benefits breastfeeding brings to both mother and child, but we must also respect and support women for whom breastfeeding is not possible or is not the best choice.",
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"value": "<p>THE DECISION TO BREASTFEED can give your baby the best possible start in life. While that’s true, it’s still an intimate and personal choice—and there are many factors that can weigh on a mother’s decision. In healthcare, we can guide parents to recognize the benefits breastfeeding brings to both mother and child, but we must also respect and support women for whom breastfeeding is not possible or is not the best choice.</p><p>According to UNICEF, 24% of babies in Vietnam are breastfed (either exclusively or with formula feeding) up to the age of six months—higher than the overall global rate. The official recommendation from the WHO is that women are advised to breastfeed exclusively for the baby’s first six months of life, without the need for additional solid food or fluids, including water. Breastfeeding reduces the risk of many diseases that are a threat to infants, including Sudden Infant Death Syndrome (by 36%); middle ear</p><p>infection (otitis media), allergic rhinitis, and childhood leukemia (by about 18%).</p><p>There are also some studies that show children who are breastfed tend to have a higher IQ, and are less likely to be obese or overweight in adolescence and Adulthood.</p><p>The benefits to the mother include a reduced risk of pre- and postmenopausal Breast cancer (because of the reduced exposure to estrogen) And a reduced risk of ovarian cancer.</p><p>These benefits increase with longer periods of breastfeeding. It’s usually considered best for mother and baby to experience close skin contact immediately after birth to trigger a bond that also helps to stimulate the production of breast milk.</p><p>After giving birth, it takes about two or three days for the milk to come in to the breast. The first milk that comes in is something called colostrum, a creamy yellow liquid containing high levels of antibodies—which are proteins that fight infections and bacteria. Babies only drink about 5–10 mls of it, after which the breast milk begins to be produced in its normal form. Normally when a baby suckles, the first part of the milk taken will be more watered down. Milk with a higher fat and nutritive content comes in at the end. It’s often recommended that breastfeeding mothers should make sure that they are allowing their baby to stay on long enough to get what they need and not switch too early, so that the baby is getting the creamy fat content at the end.</p><p>It’s unfortunate that some mothers do experience significant challenges in feeding their babies that can be overwhelming, especially in the absence of professional help from a midwife or lactation consultant.</p><p>Around 30% of women will experience at least one breastfeeding problem in the first two weeks after delivery, and many of those will consult their doctor. The most common reasons for stopping breastfeeding in those early weeks is the baby not suckling or rejecting the breast, as well as painful breasts/nipples. After the first few weeks, the most common reason for stopping breastfeeding is reported as insufficient milk—which can include the perception of insufficient milk. Appropriate management and support for these problems is therefore key to achieving ongoing breastfeeding. Low milk supply is the most commonly reported cause of mothers choosing to stop breastfeeding.</p><p>However not all mothers who worry about low milk supply have an actual issue. Perception of low milk supply is a common problem, when parents misinterpret normal newborn behaviors—such as cluster feeding (prolonged periods of frequent brief feeds), growth spurts, and frequent feeding—or misunderstand how breastfeeding works, not appreciating that breasts may come to feel softer as the weeks go by; a baby’s swallowing pattern may change; or that response to a breast pump is not a measurement of milk supply. Milk production is a feedback mechanism—the more you feed, the more milk is produced, and the less you feed, the less milk is produced—so if the mother starts supplementing breast milk with bottle feeding, this may lead to an actual decrease in her milk production.</p><p>Sometimes there really is an issue with milk transfer, in that the milk isn't being effectively withdrawn from the breast by the baby. The most common cause of this isn't an illness—it's more to do with positioning and attachment of the baby at the breast. If the mother is not positioned correctly while breastfeeding or the baby is not attached to the breast well, feeding will become more painful and this will lead to ineffective milk transfer. The best indicators of low milk supply are the frequency of wet nappies and weight gain (after five weeks of age).</p><p>Rarely, in perhaps 2–5% of cases, there is an underlying medical problem. Issues such as retained placenta, hyperthyroidism, and heavy bleeding during delivery can affect the pituitary gland, which affects milk supply. One third of women who have polycystic ovarian syndrome will have problems with their milk supply—breast surgery can also be responsible for this situation, as can the effect of hormonal contraception.</p><p>Pain in breastfeeding can have a significant impact on the relationship and whether the mother chooses to continue breastfeeding her child. Cracked or sore nipples are common and are usually due to positioning and attachment issues. This is common in the early days of breastfeeding, and usually with practice and patience the issue resolves itself and the woman can carry on without needing to see a doctor. However, breastfeeding isn’t supposed to be painful, and if the problem continues for a long period it is advised for the mother to seek help from a medical or health professional.</p><p>If it does continue, it can cause fissures and acute pain—which will then affect breastfeeding. Applying a small amount of breast milk on the nipple can be very protective and restorative, as well as using purified lanolin (which is found in a lot of commercial nipple creams). Sometimes an antibacterial ointment is also necessary.</p><p>Cracked nipples are caused by attachment problems, when the baby is not attaching to the breast properly.</p><p>Usually, when a baby attaches to the breast, it will make a wide open mouth so the top lip is way above the nipple, and make strong sucking motions. But if the baby is latching onto the nipple only, this will eventually cause nipple pain. Sometimes when milk is not effectively removed from the breast, a painful condition called mastitis may arise, which presents as a wedge-shaped area of the breast that becomes painful, red, hard or firm, and hot. It may be accompanied by symptoms such as fever and chills, body aches, tiredness, nausea, and vomiting. It occurs when milk is held too long in the duct, causing distension—a blocked duct that then gives rise to mastitis. Blocked ducts are normally caused by poor positioning and attachment. When mastitis does occur, it is important to present to your doctor early to assess whether treatment is needed and to get advice on positioning and attachment to prevent the problem in the future.</p><p><b>POSITIONING AND ATTACHMENT TIPS MEDICAL COLUMN</b></p><p>Dr. Olivia Wyatt was born in South Africa and raised in Botswana, where she worked with HIV patients with Harvard Medical School and the Clinton Foundation. Now a mother of three—daughters Aggi Rose and Evie and son Louis—Dr. Olivia regularly</p><p>convenes FMP’s Saigon International Mother and Baby Association, a group supporting new and expecting mothers with parenting guidance and information, where she leads discussions on topics such as feeding, sleeping, development milestones, colds & coughs, and vaccinations over coffee, tea</p><ul><li>Sit comfortably with your back well-supported and your lap flat.</li><li>Keep baby’s body in a straight line facing the breast.</li><li>Support baby’s neck, shoulders and back so he/she can easily tilt back the head.</li><li>Ensure baby’s lower lip and chin makes contact with the breast first.</li></ul><p><b>SIGNS OF EFFECTIVE ATTACHMENT</b></p><p>Usually, if the nipple is brushed against a baby's top lip and nose, it will fully open its mouth. This is called rooting, and every suckling animal has the same instinctive response. It will latch on naturally when the nipple touches the top of the mouth, which draws in quite a large part of the breast rather than just the nipple. If the mother and baby are properly guided, the baby will get used to the correct rooting response, and the more frequently it will occur.</p><p>Trained healthcare professionals can support mothers and educate them about the best positions for the strongest attachments. A lactation consultant—or a midwife, or a nurse—can help to educate new mothers on how breastfeeding works, what to expect, what's normal, and what's not often talked about, especially in the early stages.</p><ul><li>Baby has a large mouthful of breast.</li><li>Baby’s chin is firmly touching the breast.</li><li>Baby’s mouth is wide open.</li><li>Feeding doesn’t hurt.</li><li>No change in shape or color of the nipple after feeds.</li><li>Baby’s cheeks stay rounded while sucking.</li><li>Baby takes long, rhythmic sucks and swallows with occasional pauses.</li><li>Baby finishes feeding independently.</li></ul><p>Baby should produce regular soaked/heavy nappies. Bowel motions should be soft and yellow from day 4/5 with two or more dirty nappies a day and poos at least the size of a large coin.</p>"
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"value": "<p>Recent statistics from Vietnam’s National Traffic Safety Committee show that road crashes kill almost one person every hour in this country. More than 9000 traffic accidents occurred in the first half of 2019 alone, killing nearly 4100 people and injuring more than 7000. Foreigners in Vietnam are involved in 500 accidents every year. Most of these crashes involve motorbikes.</p><p>With so many bike accidents in Saigon, trauma management is an extremely important part of emergency ambulance response. First responders generally follow two key strategies: “Stay and Play” and “Scoop and Run”. What happens at the scene of an incident always depends on the situation and condition of the victims.</p><p>The standard of care for ambulance medicine internationally is to bring patients to the hospital setting in the best possible condition. When the situation allows, ambulance teams will do the most they can to relieve emergency departments, ranging from preliminary diagnostic measures to determine a provisional diagnosis to stabilizing and initiating treatment to prevent the patient from deteriorating. This requires proper medical equipment on board, as well as a certain know-how on the part of the ambulance team. That all falls under the “Stay and Play” category.</p><p>“Scoop and Run” is where the situation requires the ambulance to pick up the casualty and then take them to a medical facility as quickly and safely as possible, where a more complete diagnostic can proceed. In that case, we don't want to have the emergency medical team remain on site for too long. In Vietnam, “Scoop and Run” is the normal ambulance response strategy, partly because the role of paramedics is not recognised in local law.</p><p>This means that for ambulance teams, a fast and efficient rescue protocol plays a very important role. In trauma management, the algorithm we use is called ABCDE. It stands for Airway (check the patient’s airway for patency), Breathing (check if the patient is breathing sufficiently), Circulation (check that the patient’s blood pressure and heart rate are maintained), Disability (check if the patient has sustained any immobilizing injuries) and Exposure (thorough physical examination of the patient to detect less obvious injuries).</p><p>This systematic approach is used everywhere in the world. It's a symptom-based method ensuring that whatever might kill a patient first is treated first. For example, a casualty doesn’t have much time to live if their airway is obstructed, impairing breathing, so that problem must be treated before anything else—and if the patient is bleeding from a major artery and the bleeding isn’t stopped by putting pressure on the wound, the patient will very likely die.</p><p>After completing ABCDE and achieving a stable condition of the patient, the next priority is pain management for patient comfort. Broken bones should be splinted and immobilized to prevent further damage, and open wounds dressed to prevent further infection.</p><p>An important and relatively recent change to the ABCDE protocol is that C-spine (neck) trauma has been prioritized further, so a trauma team will check the C-spine simultaneous to looking at breathing, circulation, and so on. The reason is that if an accident is serious, head trauma is usually involved—and this is especially dangerous in Vietnam, where few people wear proper helmets. Bystanders at an accident are usually unaware how serious damage to the C-spine can be, and it is often overlooked by improperly trained medical personnel. People who see a victim lying unconscious on the ground who has just been in a motorbike accident tend to drag them to the side of the road. That isn’t necessarily life-threatening if the victim has a broken leg, but if someone has a broken C-spine and is dragged, it can be fatal. Whenever our ambulance team suspects a C-spine injury, they will manually immobilize or apply a stiff-neck collar around the patient’s neck immediately to protect it.</p><p>In cases of severe and major trauma, every minute counts. It’s critical for all members of an emergency medical operation to be trained in the ABCDE method to ensure that to ensure that everyone follows the same protocol—therefore aligning their priorities in the management of trauma victims. This is true of our medical operation in Saigon, where everyone is trained in this method—from the doctors and nurses to the emergency responders in the ambulances.</p><p>We also have fantastic resources both on board the vehicles and in our medical centers. I can say with confidence that our ambulances are the best in the country, fully equipped with mobile Intensive Care Unit technology. At our clinic, we have a state-of-the-art CT scanner for precise imaging; an on-site laboratory to perform blood and other specimen testing with the fastest possible turnaround; and in case referral to another hospital is required, the ambulance is right there to transport them immediately.</p><p>I've heard about a lot of trauma cases here where people are brought to a local hospital and had to wait to even be seen, despite the fact that time is crucial in trauma emergencies. It’s not that they’re not a priority, but that these facilities are overcrowded—there can be as many as three patients to a bed, and naturally staff can be overwhelmed by the volume of patients.</p><p>When trauma patients come to our medical center, I have seen first hand that they receive priority treatment. All of our emergency doctors are trained in the ABCDE protocol to assess the urgency and risk to the patient. By following the protocols and with the resources we have at hand, we can complete diagnostics and initiate definitive medical treatment time efficiently.</p><p>If someone gets into a motor vehicle accident and a bystander calls ∗9999, the ambulance can be dispatched within minutes—depending on the severity of the emergency, and guided by the same global-standard ProQA protocols that are used by 911 in the US. Our ambulance team—consisting of an ambulance driver, at least one nurse and one doctor—will perform an initial assessment on site (a quick ABCDE) and transport the patient quickly and safely to the nearest appropriate hospital, if needed—and is capable of providing lifesaving emergency treatment en route. When the patient is handed over to our emergency doctor at FMP, their condition will be re-assessed following ABCDE (in case it has changed)—followed by a full diagnostic workup (for example, laboratory testing, ultrasound, X-rays or CT scan to objectify the severity of injuries).</p><p>Once all the tests and checks are complete, a doctor will have a full appraisal of the situation and will know if a particular treatment or surgery is necessary, if the patient should be kept under observation for several hours or can be sent home. Until that moment, trauma management is all about assessment and treatment of the most urgent symptoms in order of greatest risk to the life of the patient.</p><p></p><p><b>Dr. Linh Ngo - Emergency Doctor, Family Medical Practice HCMC</b></p><p><i>A dedicated doctor with broad clinical expertise, Dr. Linh Ngo is both a German board-certified general surgeon with a colorectal specialty and an emergency medicine physician. He has taken postings in Ethiopia, Sierra Leone and Bangladesh, and plans to engage in volunteer work in remote areas of Vietnam.</i></p>"
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"value": "<p>The secret behind the hidden charm. Vietnam's HIV threat</p><p>"It’s like a ticking bomb here in Vietnam,” says Dr Serge Gradstein from Family Medical Practice, a foreign-operated multidisciplinary medical practice in Vietnam.</p><p>“It’s a serious problem that needs addressing.”</p><p>Dr Gradstein believes the true scale of HIV infection rates is unknown despite some official reports stating otherwise.</p><p>“I think if we had the numbers, they would be very alarming.”</p><p>HIV remains a public health threat in Vietnam despite efforts to reduce new infection rates over the past two decades.</p><p>Dr Serge Gradstein worked at Israel's largest HIV clinic in Tel Aviv in the 1980s and 1990s. Photo by Mike Palumbo</p><p>UNAIDS, the leading global organisation that supports a coordinated response to HIV and AIDS, reports that national estimates point to an increasing proportion of new infections among key populations of people at risk of contracting HIV.</p><p>It is estimated in Vietnam there were around 11,000 new HIV infections in 2016 and 8,600 AIDS-related deaths in 2017.</p><p>The prevention needs of high-risk populations in Vietnam are either not being fully met or have no specific interventions tabled to combat HIV</p><p>Estimates point at somewhere between 220,000 and 280,000 people were living with HIV in Vietnam in 2017</p><p>While UNAIDS reports the prevalence of the disease among Vietnamese adults between the ages of 15 to 46 as being at just 0.4%, there isn’t enough reliable data to paint a clearer picture of the scale of new infection rates in Vietnam.</p><p>This concerns medical professionals like Dr Gradstein who are at the frontline of the diagnosis and treatment of people with HIV.</p><p>"I’ve seen an increase in numbers [of people being diagnosed with HIV in Vietnam], but in the absence of hard data, I can’t say if it means anything or not,” he explains at Family Medical Practice in central Ho Chi Minh City.</p><p>"It may just be that we have a service with specialist doctors for HIV that accounts for the increase in people presenting at the clinic with HIV.</p><p>"But from our experience, we know there are people who don’t use condoms and people who don’t get tested for STIs (sexually transmitted infections), including HIV."</p><p>The late night bars and karaoke venues of the Thai Van Lung neighbourhood or "Japan Town" in Saigon. Photo by Olga Rozewin</p><p>Dr Gradstein’s observations correlate with data reported by UNAIDS on the number of people living in Vietnam who know their HIV status.</p><p>There just isn’t a definitive number.</p><p>What is fairly certain however, is that the highest incidences of HIV are estimated to be among populations who inject drugs, men who have sex with men, and sex workers.</p><p>A 2016 estimate states that 3.7% of sex workers in Vietnam have HIV, while for men who have sex with men it is 12.2%, and 14% among people who inject drugs.</p><p>“I see more men [than women for consultations], but I’m certain there is a huge unknown population under the carpet,” Dr Gradstein says of the possible epidemic confronting Vietnam.<br/><br/>"The turning point was in the mid-90s when we started to give the 'cocktail'"</p><p>Before coming to Vietnam in 2012, Dr Gradstein worked at Israel’s largest HIV clinic in Tel Aviv during the 1980s and 1990s when Israel experienced its first and second waves of Ethiopian immigrants fleeing war and famine.</p><p>Ethiopia was already in the midst of an HIV epidemic and so it was only a matter of time before HIV-positive Ethiopians began to present at his clinic.</p><p>Dr Gradstein had trained initially as a paediatrician before training to specialise in infectious diseases.</p><p>It was around this time that he headed up the paediatric department of the HIV clinic in Tel Aviv and for the first time began treating HIV-positive patients on a scale much larger than he ever had previously.</p><p>Many of his patients included children.</p><p>"It was then that we started to learn ‘real’ medicine,” recalls Dr Gradstein.</p><p>"We saw lots of malaria, tuberculosis and HIV [among the immigrants]. It took a while for them to come to our attention because of the time it took for their resettlement.</p><p>"The first priority was to house and feed them and then they were referred to the health system for medical examinations."</p><p>"The turning point was in the mid-90s when we started to give the ‘cocktail’, which brought about a dramatic fall in mortality and morbidity, including mother to child transmission rates. I saw it right before my eyes. It was impressive," he says.</p><p>The cocktail that Dr Gradstein referring to is the combined drug treatment known as HAART or Highly Active Antiretroviral Treatment.</p><p>It is also sometimes referred to as cART (combination antiretroviral therapy) or ART (antiretroviral therapy).</p><p>In addition, there is increasing awareness, at least within the gay community says Dr Gradstein, of the existence of PrEP (pre-exposure prophylaxis).</p><p>PrEP is a newly-accepted means of prevention which is a combination of two antiretrovirals branded as Truvada that can be taken on a permanent basis by individuals at risk of exposure to HIV.</p><p>As a result, the prospect of being diagnosed with HIV today is much less traumatic than it was 20 or 30 years ago. According to Dr Gradstein, people have become less fearful of the disease as a result, especially given the likelihood of fewer complications and serious side-effects from modern day HIV treatments.</p><p>In many ways, he says, someone who has Diabetes, may actually experience greater complications with their health than someone with HIV.</p><p>"There was hysteria, absolutely," says Dr Gradstein, of the impact the emergence of HIV and AIDS had on communities in the 1980s.</p><p>"In certain communities, everybody knew somebody who had died from AIDS, but today that doesn’t exist as much."</p><p>Vietnam, however, has been a new and different learning curve for Dr Gradstein.</p><p>When he arrived here back in 2012 to take up his position with Family Medical Practice, he was struck by the cultural difference, particularly by what he believes is an overarching Vietnamese cultural norm to suppress certain things, including issues related to health.</p><p>While he is at pains to highlight that this is merely his personal perception from his experiences of living and working here, he is confident that it has played a role in ensuring that HIV remains a public health threat in Vietnam.</p><p>Expatriate gay and straight men are sometimes guilty of lowering their guard during sexual encounters</p><p>"For instance, in industrialised countries, people are more proud and open about being a gay man, but in Vietnam there is more of a stigma attached to sexuality. If it doesn’t fit within the social norms of society, it tends to get covered up more. Men might be married with children, but be unofficially gay, which can potentially be a threat to their wives and children (if they take risks when they have sex)," says Dr Gradstein, who goes on to clarify that high-risk sexual behaviour isn’t just isolated among men who have sex with men.</p><p>As figures show, sex between heterosexual partners carries high-risks as well if appropriate precautions aren’t taken.</p><p>Some expatriate gay and straight men are at times guilty of lowering their guards during sexual encounters leaving them exposed to a greater risk of contracting HIV.</p><p>It is something he finds baffling given that it is assumed in general that expatriates would have a better knowledge of the associated risks of having unprotected sex with multiple partners.</p><p>"Coming here to Vietnam, for some reason many seem to forget about the risks," he says. "It’s quite incredible sometimes. They seem to stop using protection because they are geographically in Vietnam."</p><p>Left on the shelf. "They seem to stop using protection because they are geographically in Vietnam." Photo by Mike Palumbo</p><p>On the flip-side, there are men presenting with HIV phobia.</p><p>While the reluctance of people wanting to get tested for HIV has long been documented and understood, there is a type of patient who over-tests, sometimes for good reason because of the choices they have made, but often without good reason, except that in their minds they have contracted the disease.</p><p>"HIV phobia is one of the classic ones now. It’s not a question of logic. It’s more of an emotional problem that should be addressed on an emotional level," explains Dr Gradstein. “Because people can suddenly find themselves exposed to higher risk here, some people have a tendency to become more anxious than others and so they use an encounter to fuel their anxious state."</p><p>The curious thing about HIV phobia, says Dr Gradstein, is that while there is perhaps a higher chance of contracting HIV through sex in Vietnam than in countries like Australia, people can misguidedly attribute much of their anxiety to HIV.</p><p>They forget other more prevalent and serious STIs, like Hepatitis B which, unlike HIV, is easier to contract and can survive outside the body for a long period of time.</p><p>It is believed that Hepatitis B infection rates in Vietnam hover somewhere between 8% and 40% of the population depending on geographic location. Yet, HIV still attracts all the hype.</p><p>"If you just focus on HIV, you’re likely overlooking other major communicable diseases, like Syphilis for example, which is making a comeback because it’s much more infectious than HIV," says Dr Gradstein.</p><p>"The way forward with all of this is better education and more effective campaigns about sexual health for all communities living in Vietnam, because that will go a lot further towards building a safer, healthier and happier society, rather than simply pushing it under the carpet."</p><p>If you're seeking professional help & advice on this topic, contact Family Medical Practice</p><p><b>Dr. Serge Gradstein - Pediatrician, Family Medical Practice HCMC</b></p>"
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"value": "<p></p><p>August 22, Dr. Miguel from Family Medical Practice gave a mental health talk to BIS students.</p><p>"To coincide with the launch of our new Wellbeing curriculum at BIS HCMC, we were delighted to welcome Dr Miguel de Seixas, a psychiatrist from <a href=\"https://www.facebook.com/FamilyMedicalPracticeVietnam/?__tn__=KH-R&eid=ARCgD0mvnBkp4Q_mLya3Nle7fVyrmrjt2Q2B-l0tpnRdcAZI-grL6kwgwtqJcUIvZ_omQ_t51LHOMmDF&fref=mentions&__xts__%5B0%5D=68.ARAw0Td_RCuEyaroe1CYa39VaRiJ8ysECZt36mHYTqanAA_t1Xy39Ak4w14uVNPUHoIBF7_1q9khIRjOB7WDe1vvG1aJwHzkOPT2p2a4-KIPIX_u1TqI0f0z8RBKtg0kOhOPux0LOMuEGLwzDYSTPZ4jtZVJPa0kmtWUxZCQuxVxMN4sOPGPHke88N7A4OkDb2ODT3xd0hqKc-xBBzAifbUtoGcXozECU7Et4IpnM_qY28qhfA46uto-4WXqeDhR2vm_JsAGFzFjf0ieum__Ug7AerdVzzfEA9ACGRl5-TjxvEizD3DWB3swH9S1YjMk-HSIxsMsWhWDt5Xpx7Edrpt92vFF0ZjaWDOAKAemJOMB4XdJCq90Q5h9_7G1nrE6blF8qgt6SCOgtViu9Abn3vQ1Sc6JyQhJoKbxRuXhhR2YDvTCRU_WNRg_zaJ6NZX2nzPzB0EmsH9srQQktUhGmHN_H2ZzU5gNq1fwwRtX0lEmj1_VD_WVP3p77vfF\">Family Medical Practice Vietnam</a>, to speak on the important topic of teenage mental health.</p><p>Dr Miguel spoke to our Year 8, 10 and 11 students about the importance of looking after their mental health and presented a range of different strategies they could adopt to be ‘mentally healthy.’</p><p>The students will be building upon these ideas over the next year as part of the wellbeing curriculum at the Secondary Campus.</p><p><a href=\"https://www.facebook.com/hashtag/wellbeing?source=feed_text&epa=HASHTAG&__xts__%5B0%5D=68.ARAw0Td_RCuEyaroe1CYa39VaRiJ8ysECZt36mHYTqanAA_t1Xy39Ak4w14uVNPUHoIBF7_1q9khIRjOB7WDe1vvG1aJwHzkOPT2p2a4-KIPIX_u1TqI0f0z8RBKtg0kOhOPux0LOMuEGLwzDYSTPZ4jtZVJPa0kmtWUxZCQuxVxMN4sOPGPHke88N7A4OkDb2ODT3xd0hqKc-xBBzAifbUtoGcXozECU7Et4IpnM_qY28qhfA46uto-4WXqeDhR2vm_JsAGFzFjf0ieum__Ug7AerdVzzfEA9ACGRl5-TjxvEizD3DWB3swH9S1YjMk-HSIxsMsWhWDt5Xpx7Edrpt92vFF0ZjaWDOAKAemJOMB4XdJCq90Q5h9_7G1nrE6blF8qgt6SCOgtViu9Abn3vQ1Sc6JyQhJoKbxRuXhhR2YDvTCRU_WNRg_zaJ6NZX2nzPzB0EmsH9srQQktUhGmHN_H2ZzU5gNq1fwwRtX0lEmj1_VD_WVP3p77vfF&__tn__=%2ANKH-R\">#Wellbeing</a> <a href=\"https://www.facebook.com/hashtag/bishcmc?source=feed_text&epa=HASHTAG&__xts__%5B0%5D=68.ARAw0Td_RCuEyaroe1CYa39VaRiJ8ysECZt36mHYTqanAA_t1Xy39Ak4w14uVNPUHoIBF7_1q9khIRjOB7WDe1vvG1aJwHzkOPT2p2a4-KIPIX_u1TqI0f0z8RBKtg0kOhOPux0LOMuEGLwzDYSTPZ4jtZVJPa0kmtWUxZCQuxVxMN4sOPGPHke88N7A4OkDb2ODT3xd0hqKc-xBBzAifbUtoGcXozECU7Et4IpnM_qY28qhfA46uto-4WXqeDhR2vm_JsAGFzFjf0ieum__Ug7AerdVzzfEA9ACGRl5-TjxvEizD3DWB3swH9S1YjMk-HSIxsMsWhWDt5Xpx7Edrpt92vFF0ZjaWDOAKAemJOMB4XdJCq90Q5h9_7G1nrE6blF8qgt6SCOgtViu9Abn3vQ1Sc6JyQhJoKbxRuXhhR2YDvTCRU_WNRg_zaJ6NZX2nzPzB0EmsH9srQQktUhGmHN_H2ZzU5gNq1fwwRtX0lEmj1_VD_WVP3p77vfF&__tn__=%2ANKH-R\">#BISHCMC</a>"</p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/Teenage_mental_health__BIS_school_22th_August_1.jpg\" class=\"format-left\" /><p></p>"
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"summary": "The coronavirus outbreak is currently at its peak, and the world is trying every possible means to understand the mechanism of this virus and how to eradicate it. Dr. Rafi Kot explains how this virus is different from other epidemics he has witnessed, why the virus is here—probably to stay—and what we should know in order to co-exist along with it.",
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"value": "<p>The coronavirus outbreak is currently at its peak, and the world is trying every possible means to understand the mechanism of this virus and how to eradicate it. <b>Dr. Rafi Kot</b> explains how this virus is different from other epidemics he has witnessed, why the virus is here—probably to stay—and what we should know in order to co-exist along with it.</p><p>These days we are experiencing a worldwide outbreak of the coronavirus knownas COVID-19.</p><p>Two previous coronavirus outbreaks, SARS and MERS, caused a severe disease with a mortality rate of around 8%. However, there are important differences between these two coronaviruses and COVID-19. MERS and SARS were both clearly distinguishable diseases, clinically speaking. During those outbreaks, it was easy to isolate and define patients. What is different about the current COVID-19 outbreak is that there is likely to be a very large group of infected people who are only minimally sick. They exhibit only a very mild form of the disease, which is now managing to get past our safety nets—resulting in an inability to define and isolate that group. On the other spectrum, there are what we call “index cases” (or “super spreaders”)—a person who (and it is still not understood why) spread the virus in a much more infective manner than other people.</p><p>SARS did not pass from human to human until the SARS patient was clinically ill. In the current outbreak, even that population with a minimal or very mild form of the sickness seems to be able to infect others. The assumption is that the infectivity coefficient of a COVID-19 patient is between two to six people, which means that every infected person could potentially transmit the disease to up to six others on average.</p><p>The coronavirus outbreak is currently at its peak, and the world is trying every possible means to understand the mechanism of this virus and how to eradicate it. Dr. Rafi Kot explains how this virus is different from other epidemics he has witnessed, why the virus is here—probably to stay—and what we should know in order to co-exist along with it.</p><p>To compare infectivity coefficients, a flu patient will likely infect two others; every SARS patient infects up to three patients; and a measles patient—which is a highly infectious disease—will infect up to 12–18 new people.</p><p><b>Genetic Hop</b></p><p>To understand how the virus spreads, it’s important to note that ALL coronaviruses stem from animals, and animals are their reservoir. At a certain stage, each of these viruses made a “genetic hop”, enabling them to infect humans. Once humans were infected, the viruses became human-to-human diseases and spread quickly. The COVID-19 virus centers itself in the respiratory system, which is also its springboard for infecting others.</p><p>15% of COVID-19 patients suffer from an acute disease, which presents mainly as bilateral pneumonia (meaning that both lungs are affected). There is no direct antiviral therapy for such a condition. We use antibiotics and oxygen if there is a secondary infection, and in extreme cases we move patients on ventilators until they recover.</p><p>Other symptoms, such as fever and pain in the muscles and throat, occur as well—very similar to a normal flu. COVID-19 is more severe than the flu, however (the mortality of flu is 1:1000), but not as severe as in SARS, where the mortality rate was at 8-9%. The mortality rate from COVID-19 ranges currently from 1-2%; however it is very difficult to assess the real numbers and to know how many people have been minimally affected by the virus (minimal symptomatic cases) who have not been factored in to the statistics. This is also one of the reasons why the CDC has started to check people who suffer from the flu in 5 major cities in the USA for COVID-19 infection.</p><p><b>Stopping the Outbreak</b></p><p>The SARS outbreak was stopped mainly due to good isolation methods and policies, and also perhaps to the seasonal behavior of the virus. It’s unclear how much COVID-19 is susceptible to weather changes. Currently data related to the outbreak is foggy, due to two main reasons:</p><ol><li>Method of infection (patients with minimal disease).</li><li>The limitation of lab tests—there are no quick tests available, and the tests are only performed among the suspected sick and not among the entire population, leading to an inability to know how large the carrier population is, leading to likely underestimates of the morbidity rate and the epidemic itself.</li></ol><p><b>Can a Vaccine be Developed?</b></p><p>It will take a year, at best, and likely up to 18 months to develop a vaccine (depending on if the WHO and CDC will approve clinical trial shortcuts against the Helsinki committee), by which time this outbreak will most probably be behind us. A patient exposed to the disease develops temporary immunity for a few years, which diminishes as the virus genetically modifies itself, or due to a normal weakening of our immune system over time.</p><p><b>Are Official Public Reports Reliable?</b></p><p>Health authorities worldwide are operating within a complex situation. Everyone is working on a basis of missing information. It is not simple. It’s also the case that control centers and control mechanisms can usually only be evaluated after several cycles of an outbreak. As I am writing these lines (18/2), the latest numbers from the CCDC (Chinese Center for Disease Control) are emerging. So far, this is the latest and largest analysis of the data available so far :</p><ul><li>80.9% of cases suffer mild to almost minimal symptoms and have recovered.</li><li>13.8% are in a moderate to acute condition</li><li>4.7% are in critical condition.</li></ul><p>Adults face the highest risk; the mortality rate is at 2.3% of the entire infectedpopulation. In Hubei it stands at 2.9%.</p><ul><li>The highest death rate—14.8%—is the population over 80.</li><li>There has been no mortality recorded for children under 9 years old.</li><li>The mortality rate among the population below 39 years old is low, at 0.2%</li><li>Adults over 40 years old are at 0.4% mortality; over 50 are at 1.3%; and over 60jump to 3.6%.</li><li>Males are at a higher risk than females—2.8% vs. 1.7%.</li><li>Cardiovascular patients face the highest risk, followed by diabetics and those with respiratory disease.</li></ul><p>The data sample size used to derive these results is quite significant, and seems wide.</p><p>There is a fear that in those countries not issuing full reports about the sickness, there may be many minimally sick patients who are not even mentioned. The fact that there are no reports does not necessarily mean that the scrutinizing mechanisms in place are effective—rather that the disease is still in a quietly accelerative mode.</p><p>That again is the reason for the CDC to declare immediate active efforts to identify COVID-19 in five labs in the USA. These include New York, Chicago, Seattle, San Francisco and Los Angeles. The labs will routinely check all patients with ANY flu-like syndromes or anything resembling flu-like symptoms, as well as for coronavirus. These tests will enable the authorities and the CDC to have an early warning regarding a quiet spread of the virus in the USA, hence the ability for early prevention—“the golden window time”—which is so critical in terms of early response, but which has been missed in China.</p><p>As of the time of writing, there are 600 patients in isolation who are mostly returnees from China. One coronavirus patient has been identified as positive over the last few days. The assumption among most countries and the WHO is that we are facing a global issue, one that is not going to go away within the next 2–3 weeks—and its spread into the Western world is a matter of time only.</p><p>To recap, I can only ask that the public refrain from consuming the fake news, films, and clips that are produced en mass spreading conspiracy theories and inflating bad news. Use common sense, and keep things in proportion. This is neither an apocalypse nor the end of the human race.* A much more common illness, influenza, kills about 400,000 (FOUR HUNDRED THOUSAND) people every year, including 34,200 Americans last flu season and 61,099 the year before.</p><p>We have been through SARS, the bird flu, and many other epidemics—and we have prevailed, and we shall prevail this time too.</p><p>As to the authorities, it is important to come out with one voice daily, and transparently announce accurate infection statistics for Vietnam and the region. An app has now been created for that purpose—however I would remind everyone that this is not a disease of apps and screens, it is a human disease, and therefore a human voice and personality should address the public daily. Not a phone or website.</p><p>It is sad that being a veteran of so many epidemics, the communication between health authorities and the public still leaves so much to be desired.</p><p>*Source: CDC</p>"
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"value": "<p><i>Social distancing</i> is a preventive measure to keep people from being in close or frequent contact with each other in order to avoid the spread of a disease. It is used when we face outbreaks of infectious diseases, such as with the case of COVID-19. Social distancing is different from <i>quarantine</i>, a term referring to the separation and restriction of movement of people who were exposed to a contagious disease while they are monitored to see if they become ill. It is also different from <i>isolation</i>, which refers to the separation of people who are sick from those who are not in order to prevent the spreading of the disease.</p><p>The various unknown factors about COVID-19, the confusing and sometimes conflicting information we get about it, the concerns about the risk of contamination and the readiness of health systems to cope with patients have all understandably caused people to be cautious. We see travel restrictions, a rush to buy face masks and hand sanitizer, schools closed, gatherings postponed, and all kinds of special measures being taken. Why would one not be cautious about that which is most precious to us—our health and the health of our loved ones? This is a sensible concern, based on self-preservation and intuition. It is not unexpected that people would spontaneously initiate a form of social distancing by themselves.</p><p>These special measures aim at containing the spread of the infection in its most acute phase. Despite the disruption they may cause, people tend to understand them. After all, we have all heard that special times require special measures. However, as the weeks pass and the disruption continues, it becomes increasingly important not only to focus on the relative benefits of social distancing but also on the costs of such a change from our normal habits, including the costs to our physical and mental health.</p><p>Those costs include the concern, anxiety or downright fear about your health and the health of your loved ones, about being off work, about potential loss of income and job security. They include frustration with the uncertainty about how long this disruption will continue and the difficulties in helping one’s children remain happy and healthy while they are away from their friends and from their normal activities. It includes the reduction in physical activity and the consequences of this reduction in physical and mental health indicators. It includes increased screen time, distance from support networks, and boredom. In some cases, it includes feelings of depression and hopelessness, including a relapse in anxiety or mood disorders.</p><p>In children and adolescents, social contact is a protective factor for mental health. Isolation can have significant consequences, contributing to a depressed mood, low energy levels and a loss of interest in activities. Exercise and outdoors activities are also important to help children and adolescents cope with stress, as well as having a positive impact on physical health, mental health and cognitive functions. The risk of depression is lower when people exercise regularly. Lower levels of screen time are associated with reduced odds of depression—but with lack of school, outdoor activities and exercise, it is probable that screen time would increase in most households.</p><p>In order to balance the benefits and costs, I propose we think in terms of preparedness to face COVID-19 instead of focusing solely on minimising the acute risk of infection through avoidance. Look for credible sources of information without getting trapped in the emotional rollercoaster that 24/7 news channels provide. Avoid loneliness by staying in touch with your friends. Talk about your experience and support each other, so that your family and friends feel able to talk to you if they are not coping. Help your children do so as well. See this period as an opportunity to get to know the children you are raising better. Learn ways to relax together. Have limits on your family's screen time—not just your child's. Maintain good sleep habits, be active, eat well. Look after yourself and your families. Seek help when you need it. Be smart, and be prepared.</p><p></p><p><b>Dr. Miguel de Seixas - Psychiatrist, Family Medical Practice HCMC</b></p><p><b>Dr. Miguel Fernando Dinis de Seixas</b> is a member of the Royal College of Psychiatrists who has treated people with conditions such as depression, anxiety, self-harm, suicidal tendencies, bipolar disorder, obsessive compulsive disorder and schizophrenia.</p><p>He trained in Cambridge and London and is a member of the Royal College of Psychiatrists.</p>"
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"value": "<p>Hepatitis B infection rates in Vietnam are among the highest in the world. The virus establishes a permanent struggle with the body’s immune system in the liver, destroying hepatic tissue and impairing its ability to filter and purify your blood stream. This gives rise to cirrhosis, unsightly physical conditions such as bloating and discoloration, and in many cases cancer of the liver followed by death.</p><p>If you’ve been assessed by your doctor as being at a high risk of suffering from Hepatitis B, it is critical to undergo a full examination by a specialist to find out how to minimize the danger to your health. We offer a comprehensive hepatitis B testing program to provide all the basic screening procedures and a series of full consultations with a liver specialist. This will help you and your doctor to better understand your risks and to help you take the next important steps in managing this threat.</p><p>As this program and any corresponding treatments can take time, costs and frequencies of consultation can be highly variable. For more information on screening or to book an appointment with our specialist, please contact reception at the clinic closest to you.</p>"
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"value": "<p><b>Must-read guide to babies and infections</b></p><p>Behind the eardrum is a space called the middle ear. It’s a resonating chamber, like the body of a violin or guitar. It amplifies sounds coming from the outside through the eardrum, and within it is a system of small bones that transmit sound signals to the inner ear and onward to the brain.</p><p>This space is connected to the nasopharynx (nasal cavity) by a canal, one of the spaces in the upper respiratory tract that can fill with mucus or pus whenever inflammation occurs. When this happens in the middle ear, the surrounding tissues become engorged by mucus or swelling, and this impairs drainage toward the nasal cavity—creating ideal conditions for bacteria to proliferate there and causing a condition we call otitis media.</p><p>It’s very common in small children for a number of reasons. Some kids are always getting congested, and because of their smaller anatomy, the drainage canal is narrow and can block easily. The middle ear is not a sterile space, so if it fills with fluid, it’s easy for flora from the nasal and oral cavities to spread there and cause a serious infection, as well as a constant sensation of pressure and painful discomfort within the ear.</p><p>There are a few types of bacteria that are generally responsible for this condition. The most dreaded of these is now a thing of the past: the Haemophilus influenzae bacteria, a very virulent organism that used to<br/>be an enormous problem in children’s medicine before the advent of the HIB vaccine—which is now given to almost every child, including kids in Vietnam.</p><p>An efficient HIB vaccine was difficult to create. Haemophilus proteins alone cannot stimulate a strong immune response, so an ingenious vaccination method had to be used to jolt the body’s immunity into action.<br/>To do this, researchers tried combining Haemophilus with a protein issued from an unrelated pathogen like diphtheria, known to have a powerful impact on the immune system. The vaccine that resulted stimulated a protection that worked strongly against Haemophilus. Nowadays, Haemophilus infections have dropped to almost zero, so this vaccine was very successful.</p><p>Unfortunately, vaccination has not been as effective against the second bacteria in the list that usually causes otitis media: pneumococcus. The problem with pneumococcus is that it has a lot of serotypes, which means that no single vaccine can work against all the varieties that exist. But there are around a dozen types that are more common, and the vaccines we have against these are actively sufficient.</p><p>Vaccination is extremely important in fighting serious infections and also has a beneficial effect in reducing the incidence of otitis media, because it is a very good preventive measure against Haemophilus influenzae—and to some extent, also against pneumococcus. By contrast, treating the condition after it takes hold is quite problematic.</p><p>The trouble with otitis is that it occurs within an enclosed space that is not well irrigated by blood vessels. Normally to treat a bacterial infection, we administer antibiotics that will be carried by the blood to the site of the infection. With otitis, because you don’t have blood vessels in the middle ear, you’ve got nothing that can deliver the medicine.</p><p>It’s not enough to have a good antibiotic that kills the bacteria in the lab; you need one that you can give in higher doses without being toxic—such as antibiotics from the penicillin family. Derivates of penicillin (amoxycillin, cefuroxime, etc.) have a particularly safe profile that enables us to increase their dosages significantly without the risk of increased side effects, so we often prescribe these kinds of antibiotics for children. Pneumococcus, however, develops a resistance to penicillins quite easily. This sometimes makes treating otitis more difficult. First of all, we need to use high doses to address the low-grade resistance of the bacteria, or prescribe antibiotics that can overcome that resistance. If the simple antibiotics don’t work, perhaps we have to escalate and use a more potent medicine. But due to the problem of poor irrigation within the middle ear, even this treatment can fail. The pus and fluid within the middle ear will continue to build up and cause pain, discomfort and disorientation.</p><p>Nature has a solution for this problem, in that there is a little triangular membrane in the eardrum that is a bit weaker than the rest, like a security door. It can perforate when the pressure builds inside the middle<br/>ear without causing functional damage, and then the pus can drain out and the tissue will eventually heal. It’s the body’s answer to how not to get an ear infection that can’t be controlled.</p><p>Of course, when the child’s mother sees the pus draining out of the ear, she will certainly panic. In fact, the baby will feel much better at that point, because the pressure will immediately vanish. This is where the ENT doctor is sometimes necessary—when we have a child with unbearably painful otitis who is not responding to antibiotics, we may decide to do the perforation surgically. Generally once the pus has been removed, you don’t need any more antibiotics.</p><p>The procedure hurts, but it lasts a fraction of a second, and after that there is no further pain. It’s painful because the exquisitely tender eardrum is particularly sensitive to pain, as a membrane that is supposed to feel delicate vibrations. After it’s over, thankfully, the pain is gone. The difficult thing is to get the child to accept the surgeon to get to the ear!</p><p></p><p><b>Dr. Serge Gradstein - Pediatrician, Family Medical Practice HCMC</b></p>"
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"summary": "There’s now an emergency response service in the city that will provide immediate assistance even before the ambulance arrives.",
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"value": "<p>As Vietnam’s medical landscape continues to evolve, <b>Ho Chi Minh City’s first 911-styled emergency service</b> (EMR ∗9999) may be the first step towards adopting international emergency standards that could eventually see advanced paramedical and ambulance services extending nationwide. Funded by private investment, EMR ∗9999 not only features a fleet of hi-tech ambulances with built-in life-preserving technologies, but it also introduces the globally-recognized ProQA response system—a computerized set of protocols that guides emergency call-takers as well as real-time ambulance dispatch.</p><p>Professional emergency medical dispatcher (EMD) <b>Marvin Mesina</b> has been based in Saigon for the past nine months to oversee the implementation of the <b>ProQA system</b> and train the team who answer emergency calls. To learn more about the challenges of instituting such a vital healthcare service in the Vietnam context, we speak with Marvin about his experiences in developing this program.</p><h2><b>What qualifies you to be an EMD trainer, and how did you come to work in Vietnam?</b></h2><p>I started in 2007 in Montreal at Urgences-santé, one of the largest ambulance providers in Quebec—it’s the only one in Montreal. They take a minimum of 900-1000 calls in 24 hours. I was lucky, I worked there for eight years and didn’t have any horror stories—I never had anybody trying to kill themselves on the line or anything like that, although my colleagues did. For us, someone who’s having a cardiac arrest on the phone is a daily routine, so that’s not something extraordinary. I’ve had a childbirth case, so that was one of the highlights. But at some point I stopped taking calls, because I was the team leader, supporting the team.</p><p>While I was in Montreal, a businessman in the Philippines acquired the ProQA system, and I started getting in touch with them saying, “I’ve been doing this for eight years, maybe I could give you a hand in the project.” The Philippines is my country, I was happy and excited to see that this was happening there. At that time, 911 would get you the Pizza Hut hotline!</p><p>While I was there, an executive from Family Medical Practice in Vietnam came over to get some ideas, and he asked me what my position was. I told him I was taking care of training, so he offered me the chance to come here for a month to train the EMDs in Vietnam, and then after that he offered me a job. I love it here, you can’t complain when it’s sunny all the time.</p><h2><b>What is the experience of taking emergency calls like?</b></h2><p>I think most EMDs will tell you that whenever they hear the phone ring, there’s always a certain level of anxiety, because you never know what you’re going to get. Someone could have been shot, or it could be someone having a heart attack. So there’s always that level of excitement. One thing you learn in training is that when you lose that excitement, it’s time for you to quit. You might sound like a robot when you’re following the protocol scripts, but you still need a certain level of compassion. Empathy is a big thing when you’re trying to comfort someone saying “listen, I’m here to help you”—they can feel it in your voice. If you don’t sound sincere, they’ll know it.</p><p>Actually, an EMD dispatcher has a stress level above a paramedic or a firefighter, because an EMD gets yelled at on the phone for something minor, but a paramedic can calm people down when they get there, because the patient sees someone is there to help. With us, they don’t see us, they just hear someone asking them protocol questions on the phone, which is annoying. The ProQA system that we use is really the most efficient way to get the right emergency assistance to them as fast as possible, but they don’t know that.</p><h2><b>What did you think of the setup here compared with what’s available overseas?</b></h2><p>It’s better than I expected. I didn’t know at first that it was going to be privately-owned by a clinic. In the Philippines we were managing networks of ambulances, all owned by different companies, so we had a nationwide coverage area. We’re not there yet here. The service is growing, and after we expand our ambulance fleet and our coverage area this month, the visibility will go up. The number of calls is starting to increase, especially in the weekends, but it will take time for people to understand that we’re not just for subscribers or to bring business to the clinic. We accept calls from anyone within the area we cover and take them to whatever medical facility will give them the best treatment, not only Family Medical Practice.</p><h2><b>What’s the difference between the calls you’d get overseas and the calls you get here?</b></h2><p>Besides problems like psychiatric issues and suicides, it’s exactly the same thing. Some people might even call you for a fever or a minor headache.</p><h2><b>You said that everything is the same except for psychiatric calls?</b></h2><p>Because here, psychiatric problems are taboo, right? When I first asked the EMDs what they knew about that, most of them didn’t even know that it exists in Vietnam because it’s a taboo. When you have those family values, people hide psychiatric problems from society. I think it’s an Asian mentality that even when someone in your family has a psychiatric illness or is an alcoholic or drug user, you don’t talk about it, and even if they’re sick, you just hush-hush, because you don’t want to be judged by the community.</p><h2><b>What has been the greatest challenge in implementing ProQA here?</b></h2><p>Traditionally, Vietnamese people haven’t been relying on the national ambulance system, I think it’s because the emergency hotline has to take the time to verify if an emergency case is genuine, and also the ambulances they have here aren’t fully equipped. There’s no immediate care, guidance or medical instructions over the phone—it’s only about calling and waiting for the ambulance to arrive, which heavily impacts the mortality rate.</p><p>That’s the thing we need to educate the locals here on—that there’s now an emergency response service in the city that will provide immediate assistance even before the ambulance arrives. I think they should stop taking motorbikes or taxis to hospital, because a lot of people die on the way before they get medical care. We can now save a lot of those lives by giving basic medical advice over the phone that can stabilize the patient while they wait for an ambulance.</p><p>By contrast, most expats here know that we have to ask a series of questions about the emergency that they’ll have to answer before we can respond with the most appropriate solution, depending on the severity of the case.</p><p>Another problem is that we don’t have paramedics as a job in Vietnam. I guess when we have those, then things will start to change. Because paramedics are not recognized in this country, the emergency doctors have to play the role and run around fetching patients outside, which is inefficient. Instead, they should be at the medical centers attending to patients at the facility.</p><h2><b>Will you stay here a long time?</b></h2><p>I want to see where EMR ∗9999 goes, I’m curious. My original plan was to stay for six months to see how it improves and evolves. It’s been nine months now, I’ll stick around for a while. It is a promising project; it might sound clichéd, but it is to help people. It’s a business, but it’s a business to help others. I am that kind of person who has a certain compassion—I do feel I should be helping people!</p><p></p><p><b>Marvin Mesina - ∗9999 Emergency Call Center Manager, Family Medical Practice Ho Chi Minh City</b></p>"
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"title": "Covid-19 Talk at Bien Dong POC",
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"value": "<p>On 28 February 2020, Dr. Hung from Care1 presented another talk on the outbreak and epidemic of COVID-19 to the employees of Bien Dong POC, an oil and gas company, in HCMC. Dr. Hung provided information of the virus, its current status and statistics, as well as answered many anxious questions from over 20 + audiences on the epidemic virus.</p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/61A61BDA-41C1-4467-A60D-5E52EB2738AE.jpeg\" class=\"format-left\" /><p>With an aim to continue supporting the community with good, quality information on facts and preventive measures including the importance of practicing daily hygiene, FMP hopes to help keep unnecessary fear at bay and minimise the spread of incorrect information in the community</p>"
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"summary": "Menstruation, bleeding, period pain, and related issues are often hard topics for women to discuss even among themselves, as many cultures still view them as taboo. It is nonetheless important to recognize that each woman has a right and obligation to take care of her body and health, and that starts with becoming more aware of what your body is telling you.",
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"value": "<p>In most cultures, it’s rare to talk about menstruation—which downplays the universal role it has in the lives of women. It’s very important for women to understand their own cycle, because abnormal bleeding may be the first warning sign of a deeply concerning health problem she may otherwise be unaware of.</p><p>Between menarche and menopause, a woman has an average of 400 to 500 periods. That is a lot. Back in the time when it wasn’t uncommon for women to have 8–10 babies, they would have perhaps 80 to 100 menstrual periods in their lifetimes. This is because when pregnant and during breastfeeding, periods do not occur. Now we only have from zero to two babies, meaning that for most women bleeding occurs almost every month.</p><p>Because menstruation is so frequent, it can be difficult to know when abnormal bleeding happens. There are many things that cause it, but the most common causes differ widely between the various age groups—from as young as 20 to 40 years old; after 40 years old; and beyond 50 years of age. It also ranges from benign causes—such as a slightly shorter or longer period, or the early stages of a perfectly normal pregnancy—to life-threatening causes such as cervical cancer, endometrial cancer, or ectopic pregnancy (which happens when the fetus develops outside of the womb).</p><p>For the 20–40-year-old age group, the common causes of abnormal bleeding are usually fertility related—such as spotting in the early stages of pregnancy, conditions such as PCOS (polycystic ovary syndrome), medicines such as birth control pills or the IUD (intrauterine device) used for contraception, or an infection of the pelvic organs. Excessive bleeding can be a sign of problems such as miscarriages and ectopic pregnancy.</p><p>The worst case scenario for this age group is cervical cancer—caused by the human papillomavirus (HPV), which is a preventable condition. I recommend that young women and girls receive an HPV vaccination before they are sexually active, as it is the most reliable, accessible, and economical option to avoid infection and a higher risk of cervical cancer.</p><p>For women over 40 years old but who have not yet experienced menopause, the most serious cause of abnormal bleeding can often be endometrial cancer.</p><p>In post-menopausal women, abnormal bleeding can be caused by hormone therapy such as tamoxifen for breast cancer, or hormone replacement therapy used to treat menopausal issues—or it can be a sign of cancer itself of the cervix or endometrium.</p><p>Frustratingly, it is tricky to recognize when bleeding is out of the norm, as there is a high level of variance in period frequency and the volume of blood loss during a period between individual women. What is a normal period for one woman may be too long or too much for another. Outside of excessive bleeding, there is little to clearly distinguish between normal and abnormal bleeding, as they have mostly the same texture and consistency.</p><p>For that reason, it’s advisable for women to keep a detailed record of their normal periods. Information such as the frequency of their menstruation or how many tampons or pads they usually use can be very valuable for a doctor. This will also help women to identify when bleeding happens at an unusual time. If this happens, it should be taken seriously and women should consider a check-up, especially if the bleeding is excessive. For all age groups, excessive bleeding is a definite call for an immediate visit to your gynecologist.</p><p>Knowing what to do when a woman has determined that her bleeding is not normal is the next important step. I have read worrying research that indicates as many as 50 percent of college-aged women are unaware of dangerous conditions such as cervical cancer. They may know even less about what signs to look out for and what to do if they recognize the signs.</p><p>Tests such as Pap smears, which can help pinpoint a woman’s health issues in the very early stages, are now standard in most Asian countries. I would recommend yearly testing, as it is relatively accessible in most countries. HPV testing is a good option also, especially in countries which are relatively advanced with their HPV vaccination programs.</p><p>Menstruation, bleeding, period pain, and related issues are often hard topics for women to discuss even among themselves, as many cultures still view them as taboo. Many women are taught that it is shameful to discuss their own bodies in such a way. It is nonetheless important to recognize that each woman has a right and obligation to take care of her body and health, and that starts with becoming more aware of what your body is telling you, and making sure you have the necessary knowledge and vaccinations.</p><p><b><i>Dr. Nana Akino’s</i></b><i> medical studies in gynecology and the aging process in women inspired her to conduct in-depth research on counteracting the effects of aging on the ovaries during her Ph.D. studies. She is particularly interested in supporting women’s health, reproductive health and all gynecological issues, including hormone replacement therapies.</i></p><p></p><p><b><i>Dr. Nana Akino - Gynecologist, Family Medical Practice Ho Chi Minh City</i></b></p>"
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"summary": "\"A significant part of our lives is spent in the workplace—let’s make sure this part of our existence is as positive as possible\".",
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"value": "<p></p><p>No matter what kind of job we do, the average person spends more time at work than on any other activity. Our work environment impacts our health and well-being, and our personal health impacts greatly on our work output and efficiency. It is therefore important to create and maintain a healthy workplace environment, for the benefit of both employers and employees.</p><p>Most of us spend a full third of our lives working—but very few people would say that they consciously take good care of their health while working, or that their employers provide a working space that supports and enhances their state of health. Most people regard work as a “necessary evil” of life and look forward to the next holiday and retirement. But what if this could change?</p><p>Up until recently, the focus has been on avoiding physical injury in the workplace, and this is regulated by various agencies like OSHA (e.g. mandating the hours of work, wearing appropriate protective clothing, making sure floors are not slippery, that air conditioning or ventilation units are properly maintained, that staff facing a computer monitor every day keep the screen at eye-level, and that arms and wrists are poised at the most natural position while seated).</p><p>More recently, many companies have become more aware of the benefits associated with investing in employee health (beyond just physical health). Good health means less sick days, which is good for business.</p><p>Psychological health in the workplace is now becoming more and more important. Research shows that it is not only essential for the well-being of the employee, but this also directly impacts on the productivity and quality of work produced by the employee. Psychological safety for the employee thus directly translates into better staff retention and higher productivity for the company.</p><p>The World Health Organization (WHO) emphasizes four key elements that every workplace should have to ensure their health. These four elements are:</p><ul><li>A healthy physical environment<br/>• Psychological safety<br/>• Resources for health<br/>• Participation in the community</li></ul><p>A healthy workplace is defined as one in which workers and managers collaborate in using a continual improvement process to protect and promote the health, safety and well-being of all workers and the sustainability of the workplace. Employers are very unlikely to reach their goals if their employees do not provide and proactively ensure a working environment that can support good physical and mental health.</p><p>When the environment where employees are working brings comfort and safety, they feel healthy and happier. This also motivates people to come to work every day and to be more productive—just imagine a person who dreads going to work because it’s going to be a dirty office with poor air ventilation and an unreasonable and mean boss—versus looking forward to spending a day in a pleasant, clean office where colleagues and bosses are respectful and encouraging. Which scenario encourages more motivation and productivity and new ideas?</p><p>There are numerous examples. Ergonomics, for one, is vital in any physical environment—this is the science of designing a workplace in a way that considers the capabilities and limitations of workers, removing risk factors that can lead to musculoskeletal injuries and allowing for improved human performance and productivity. The most common ergonomic considerations involve positions related to computer, desk and chair. Beyond this, certain touches in décor can positively influence an employee’s sense of well-being—such as a place to put a picture of family or any other personal item that provides encouraging thoughts or helps staff to relax or be more productive—as long as such things meet the business needs as well.</p><p>Studies show that better lighting can increase an employee’s work rate by 23%. Other statistics also indicate that workers who have a view of the outdoors are likely to be 25% more productive, and process calls 12% faster. Employers can also make sure the working space sounds, looks, feels and smells great. Adding plants in the office can be calming and also act as air purifiers.</p><p>Color is also very important in a working place, as certain colors can help to boost workers’ productivity. Yellow interiors are energizing, expressive, radiant and happy; blues are more intellectual and stimulate the mind, helping staff to stay focused. Greens promote balance, calmness and security, and also symbolize nature, the environment, growth and development. Red may be the color of fire, blood and violence; however it is known to promote bold decisions, and it is also good for restaurants and sales offices.</p><p>Beyond these more physical considerations, psychological safety in the workplace is of paramount importance. Essentially, a psychologically healthy environment is one where an employee can work without fear of negative consequences to their self image or career.</p><p>Organizational behavioral scientist Amy Edmonston introduced concepts of psychological safety in her book <i>The Fearless Organization: Creating Psychological Safety in the Workplace for Learning, Innovation, and Growth.</i> She wrote that a safe workplace is one fostering trust and respect, where people feel comfortable working and being themselves. She emphasizes that a person should not be afraid to speak their mind during team meetings, even if his or her idea is different or opposite to the majority or consensus.</p><p>For the employers out there—just to clarify—a psychologically safe work place is not one in which the employee is “happy” per se (some employees will be happier at home or playing computer games all day), but rather, one in which employees feel safe to speak their mind, safe from being bullied, and safe from sexual harassment— and where they can express their real opinion so as to not suppress their creativity and ideas that can contribute to the success of the business.</p><p>Any leaders or team members who discourage staff from speaking up, ridicule them for different suggestions or being different, or punish someone for expressing different opinions, are acting in a way that is detrimental to the success of the team and the business. To this end, the management of an organization plays an important role in ensuring a corporate culture and organizational structure that provides psychological safety to its employees, and make sure its supervisors are there to help the employees do the best job they can.</p><p>In the long run, psychological safety benefits the company by increasing staff retention (saving money on recruitment), through increased productivity and better quality work from the existing team, and providing a better public image for the company. Provision of personal health resources should also not be overlooked. This can simply include information made available about exercise, nutrition, and health insurance or ways to balance one’s lifestyle between work and rest being made available in the workplace. Staff should be encouraged to exercise by providing exercise facilities; employers can also remind them about healthy<br/>dietary options or provide healthy fruits and snacks on-site.</p><p>Safety talks onsite during lunchtimes, such as talks on ergonomics, breathing exercises and cancer screenings, can be of great benefit to employees—as can providing annual flu shots on-site to all employees free of charge to minimize staff sick days.</p><p>Another good example that can be implemented in places of work is N.E.A.T.—Non Exercise Activity Thermogenesis. This is a method focusing on expending calories even when not exercising. Workers can use everyday activities to increase their energy expenditure without having to exercise, which is particularly good for people with busy schedules who can’t go to gyms easily. Examples of these activities are using stairs instead of elevators; doing one’s own household chores; parking a bike or getting out of a taxi 1–2 blocks away from the destination to fit in a brief walk; and getting up from one’s work desk every 30 minutes to stretch. At lunchtime, staff should not eat lunch at their desk, but instead take a walk to a restaurant or canteen.</p><p>One last thing to consider in having a healthy workplace is corporate participation in community activities to improve the health of the workers, their families and the members of the community in general. This can involve taking part in group activities both inside and outside the business.</p><p>A significant part of our lives is spent in the workplace—let’s make sure this part of our existence is as positive as possible.</p><p></p><p>Dr. Jane Li Shadwell</p>"
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"value": "<p>Download our services pamphlets:</p><ol><li><a href=\"https://drive.google.com/file/d/1Z0gzKy9yDWWkGtlBpo1jNHQqr_o0crxo/view\">Feeding Problems</a></li><li><a href=\"https://drive.google.com/file/d/1DyFKWGm-ijgiZNT9JzzmIVWBgKWbkgRa/view\">Caring for Your Skin in Saigon</a></li><li><a href=\"https://drive.google.com/file/d/12pDwUCrWKG56obhrNskG12GnOHQwbQO2/view\">Cardiovascular</a></li><li><a href=\"https://drive.google.com/file/d/1c8Fe24PP9_1vhgX3JzWcKab4wR8DPIOm/view\">A Guide for Treating Fever in Children</a></li><li><a href=\"https://drive.google.com/file/d/1PxF0DJrMKMqsOqeziALHw5uQMELvsVdy/view\">A Guide to Healthy Eating for Young Children</a></li></ol>"
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"value": "<p>On 26 February, Family Medical Practice’s Founder and CEO Dr. Rafi Kot made a presentation on CORONAVIRUS OUTBREAK to the staff of the Repsol office.</p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/BSKottalk.jpg\" class=\"format-fullwidth\" /><p></p><p>Dr. Kot addressed more than 40 employees of the global energy firm, presenting an overview of the current status of Covid-19 both worldwide and within our community. He provided details of the various strains of coronavirus and the pandemics we have experienced thus far, including SARS, swine flu, the Hong Kong flu, and MERS. Based on the symptoms and a close genetic analysis, Covid-19 is 88% similar to SARS, but there is a significant difference in the rate of transmission.</p><p>According to Dr. Rafi, current CCDC statistics on COVID-19 mortality for each age group show the highest death rate (14.8%) is among the population aged above 80. There has been no mortality recorded for children under 9 years old. For cases between 30–50 years old, the mortality rate below the age of 39 stands at 0.2%, while for over 40 years old it is at 0.4%.</p><p>To give attendees a deeper understanding of the virus and how it damages the respiratory system, Dr. Rafi explained the complex workings of its DNA, portraying this virus’ complex medical issues in easily comprehensible terms.</p><p>Before the talk closed, Dr. Rafi reminded everyone to continue practicing daily hygiene by washing hands regularly, wearing a mask if one is not well so as to protect others from getting sick, and encouraging people to seek medical care if they feel sick.</p><p>This is one of many talks FMP will be organizing for mid- to large-sized corporate groups with the goal of engaging with our community, informing them of the latest updates, and most importantly easing fears and minimizing the unnecessary spread of incorrect information.</p>"
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"post_date": "2020-02-12",
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"summary": "Many women experience a difficult child delivery, which can take a serious toll on the body and the mind. Doctors often place a great deal of importance on monitoring a baby’s health and development in the months after birth, but due consideration isn’t always given to the mother—and sometimes important medical issues can be missed while everyone’s focus is fixed on the baby.",
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"value": "<p>The first three to four months of having a child are the most challenging by far, especially for first-time mothers. People usually talk about how wonderful it is to have a baby—and it is wonderful! But people don't always talk about the struggles and the isolation, the sleep deprivation and the monotony of spending time with a newborn who can't communicate their needs. These things can be difficult, especially with social media adding pressure to look like you're enjoying every minute—because that’s all you see in the snapshots from other moms and babies. Often a mother can feel like she is the only person struggling with such a big change to her life.</p><p>Many women experience a difficult child delivery, which can take a serious toll on the body and the mind. Doctors often place a great deal of importance on monitoring a baby’s health and development in the months after birth, but due consideration isn’t always given to the mother—and sometimes important medical issues can be missed while everyone’s focus is fixed on the baby.</p><p>In many developed countries, it’s now standard to perform a postpartum checkup on the mother around six weeks after delivery to ensure she is physically recovering from the pregnancy, as well as to check that her emotional needs are being met, while addressing any medical needs she may have going forward. These check-ups are a great opportunity to talk to mothers about how the labor went, to ask if there were any difficulties that she had in the first few months of the baby's life, and to discuss issues like contraception and psychological wellbeing. They also provide an opportunity to ensure there were no physical consequences of the labor, including checking scars, wounds, and so on. We can also perform a Pap smear or HPV screening, something that can otherwise tend to be skipped following childbirth.</p><p>Having a child can greatly change the dynamic of the relationship between a woman and her partner as well, and this can be another difficulty that people can't easily prepare for before the baby arrives. Being able to talk these things through with someone can provide a therapeutic reassurance that everything is completely fine—and that postnatal worries and sleep deprivation are all part of the normal spectrum.</p><p>Many mothers suffer from emotional difficulties in the months following birth. Sleep deprivation too can be brutal—which is why it’s a torture technique! By its nature, it reduces your ability to objectively assess what’s happening around you, and can result in stressful changes in hormone levels. This is when physical wellbeing and mental wellbeing can become intertwined and take a toll on the mother. This typically involves feeling overly worried about small matters, ruminating, and not being able to rest as a result. It’s often very important for mothers to reach out to other families for support and to meet with other moms in their situation, especially if they are going through emotional difficulties. If possible, they could also seek community support services such as playgroups or professionally led groups to share and discuss maternal and child care issues.</p><p>For mothers in this situation, the postpartum checkup can be an opportunity to assess these emotional upsets, restoring some perspective and relieving stress—or otherwise to initiate medical treatment in serious cases.</p><p>The check-up also allows the physician to examine any physical consequences of the birth. These can include recovery from stitches or scars, as well as check if there is any separation of the abdominal muscles. A doctor will also check for issues such as blocked ducts that may interfere with breastfeeding. We can give advice on the types of exercises that a mother can do to aid recovery of normal movement, or refer the mother to a physiotherapist if the need is there.</p><p>Contraception is also an issue that can be overlooked by new mothers, which is why a postpartum check-up can be helpful in providing information on this issue—it’s not unheard of for a woman to find herself pregnant again just two months after giving birth, which can be quite a surprise! Generally, if a mother is exclusively breastfeeding, the body’s own hormones will work to prevent conception—although this method is not particularly reliable, especially when the baby is taking even a little supplemental formula milk. Mothers can consider taking a contraceptive pill from six weeks after delivery—and while combined oral contraceptive medicines used to be not recommended for breastfeeding mothers, it has recently been shown to be a safe method of contraception even at this time. This can be a relief for mothers who experience negative side-effects of progesterone-only pills, as evidence suggests combined pills have no detrimental effect on mother or child.</p><p>The beauty of this examination is that so many issues can be dealt with during a single consultation at six weeks after delivery. If any issues are identified then—either physical or mental—it provides the opportunity to follow up in a structured way.</p><p>While postpartum checkups are rarely done as a matter of course in Vietnam, new mothers can schedule appointments with physicians who have experience in the procedure overseas. Additionally, our practice’s SIMBA group for new mothers is currently the only professional lead support network for women with babies, helping mothers to network and support each other during this challenging and rewarding experience.</p><p></p><p><b>Dr. Anna Donovan - Internist, Family Medical Practice Ho Chi Minh City</b></p><p><b><i>Dr. Anna Donovan</i></b> <i>studied at the University of Manchester and Liverpool School of Tropical Medicine before serving the San bushmen as a volunteer physician in Namibia. She has extensive experience in giving postpartum check-ups from her time working in the UK.</i></p><p></p>"
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"summary": "Đặc điểm sinh học của cơ thể là luôn sẵn sàng để chạy. Tổ tiên của chúng ta trước đây cũng sống bằng cách kiên trì săn bắn và ẩn nấp để tránh khỏi thú ăn thịt. Chúng ta được định hình như một cỗ máy chạy để săn mồi mỗi ngày trong một môi trường khan hiếm thức ăn.",
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"title": "Demystifying Coronavirus",
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"summary": "While MERS was caused by a coronavirus that jumped from bats to camels and then to humans, the new coronavirus seems to have originated in bats that jumped to snakes and then humans who either consumed it or otherwise came into contact with the infected animals. But this theory is still not proven, and a deep investigation on this topic is now underway.",
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"value": "<p></p><p>Coronaviruses are a large family of viruses that infect mostly animals, although a few of them have spread to humans as well. The infections they cause can range from mild to severe. The most common members of this family that regularly infect many people around the globe are known to cause a mild upper respiratory tract infection—the common cold. Some others coronaviruses can cause more serious and deadly diseases such as MERS (Middle East Respiratory Syndrome) and SARS (Severe Acute Respiratory Syndrome).</p><p>A new strain of coronavirus, now called COVID-19, recently emerged in Wuhan city, in China’s Hubei province. The outbreak was initially linked to a large seafood and animal market in the city of Wuhan, where transmission of the virus most likely occurred via a jump from animal to human. But currently there is a growing debate about where and how the infection started. While MERS was caused by a coronavirus that jumped from bats to camels and then to humans, the new coronavirus seems to have originated in bats that jumped to snakes and then humans who either consumed it or otherwise came into contact with the infected animals. But this theory is still not proven, and a deep investigation on this topic is now underway.</p><p>These viruses were initially thought to have only been transmitted from animals to humans. This presumption was later contradicted by the discovery, using mathematical models, that the viruses were highly contagious and could be transmitted from person to person. Now it is evident just how easily and frequently infection from person to person can occur, and what is the cause of the deep concern about a global pandemic.</p><p>The virus replicates within humans cells by using our own cellular machinery against us. A virus is actually just a ball of genetic information that uses a biological host to multiply from one to millions. Just as any written information would require ink and paper to form a book, so too does the virus need the materials available within a host to reproduce itself, as it has no cell structure of its own. When it infects a person, it hijacks the body’s cells, each of which contains ample biological machinery—the equivalent of loads of paper and ink—to produce millions of copies from one single viral invader.</p><p><b>Symptoms of COVID-19</b></p><p>Just as the hepatitis virus targets the liver, COVID-19 targets the lungs, where it causes respiratory inflammation. In most cases, the symptoms it causes are similar to those of the common cold, such as dry cough and fever. In severe cases, especially when the patient has some preexisting risk factors (such as old age or comorbid conditions) the infection causes pneumonia-like symptoms—for instance, a progressive cough and difficulty in breathing with severe lung inflammation</p><p>The time from exposure to the appearance of symptoms is usually between 2–21 days. Because of the long incubation period, the virus can be transmitted during this asymptomatic phase. This came to light during cases in Germany where the virus was transmitted from a Chinese woman to a number of German colleagues before her infection became evident for her. Such a situation can be precarious, as monitoring the spread of the virus could become extremely challenging.</p><p>Also, the virus poses a higher risk in colder regions because it survives longer on surfaces at low temperatures, which makes it difficult to contain in places with large populations (such as Wuhan) during the winter. Even with the world-class hospitals and highly skilled medical staff and scientists they have in Wuhan, the infrastructure wasn't enough for the sudden surge in severe pneumonia patients. Also in the early stages of the epidemic at least 7% of medical staff in the region—including doctors and nurses—were exposed to the virus while treating infected patients due to the lack of preparedness and shortage of beds. This made controlling the outbreak more daunting for the Chinese authorities. Since that time they have taken a more cautious approach along with other authorities worldwide. Crucial information has been released by Chinese scientists and medical practitioners in other countries as cases of the infection are reported around the world.</p><p>Since the virus can't sustain itself for long in high temperatures, on top of the government closing schools, there have been relatively fewer cases in places like Ho Chi Minh City, which has a warmer climate. Still, the virus has taken almost 3000 lives globally out of 85,000 cases of the infection that have been officially reported. The preliminary fatality rate of COVID-19 is around 2% in China (but in China excluding Hubei province, it is just 0.16%) in comparison to 9.6% for SARS and 34% for MERS.</p><p>However, as SARS affected just 800 people and MERS around 2500, it is evident that COVID-19 is far more contagious. Therefore, it poses a higher risk than influenza—which has infected more than 25 million people but has a fatality rate of 0.1%. If the spread of the COVID-19 contagion goes unchecked, it could lead to a much higher number of casualties than those that influenza has caused so far.</p><p><b>Preventative Measures</b></p><p>So far, 80% of fatalities have been reported in people aged more than 60. Moreover, 75% of those who succumbed to the infection had underlying chronic diseases such as diabetes, asthma, high blood pressure and/or cancer. The virus seems to affect more men than women—which could be linked to genetic disposition or different hormonal patterns—and children are also less likely to be affected, perhaps related to their higher levels of immunity against the coronavirus. Essentially, adults with low immunity are more prone to infection.</p><p>People are advised to consume healthy, well-cooked food and place an increased focus on sanitizing surfaces and maintaining cleanliness. Frequently washing hands and letting sunlight into houses could be of help too.</p><p>As the virus is highly contagious, it can spread from an infected person to another person by sneezing, coughing or personal contact. Physical barriers such as face masks can help prevent transmission when someone is close to an infected person. Also, distance should be maintained from people infected by the virus as well as those showing symptoms of the infection.</p><p>Any kind of masks will be equally effective here, as most of them provide almost the same level of protection against airborne virus transmission and respiratory droplets in this case. However, when there are no cases in a community, there is no benefit to wearing a mask, and the World Health Organization does not advise people to use mask except in risky scenarios, i.e. when there is a chance to be close to an infected person.</p><p>Being in crowded places and traveling to risky areas such as China, South Korea, Northern Italy or even Japan and Singapore may carry a risk of developing an infection. Currently regardless of any personal interest for travel, the government already banned many destinations because of the chance of becoming infected. It is tourism that has affected Vietnam more, contrary to the common belief that its proximity to China is what makes Vietnam more vulnerable to the virus. But the fact is this was not the case, and there are only 16 confirmed cases in Vietnam—most of them related to a group of Vietnamese workers who went to Wuhan for training. It would therefore be appropriate to postpone any unnecessary travel plans. For similar reasons, expats need not consider leaving Vietnam for their home countries, as their risk of exposure while traveling is far higher than it is by staying in this sunny, tropical country.</p><p><b>Diagnosis and Treatment</b></p><p>Lab tests and CT Scans are primarily used to make a provisional CODIV-19 diagnosis. Those suspected of carrying the infection will receive personal health care by medical practitioners and be quarantined. Medical authorities responsible for containing the coronavirus will be notified so that necessary medical care can be provided to the patient, and further proliferation of the virus can be avoided. Test kits are currently limited and are not available to the public or for testing on the healthy.</p><p>In case patients experience mild cold symptoms, or do not feel well in general, it’s recommended they take care of themselves at home just as they would when suffering from a common cold, while maintaining a distance from others—especially family and friends. If the symptoms are aggravated or become worrisome, medical practitioners should be consulted for further treatment. Our Family Medical Practice medical centers are observing strict site access protocols to ensure they remain safe and exposure-free places to seek treatment as usual.</p><p>There is no antiviral treatment or vaccine available right now. Some studies have already been initiated to derive a cure against the virus, deploying a scientific double-blind strategy where neither the medical practitioner administering treatment nor the patient knows if they are receiving potential treatment or a placebo. This is the only method that can tell us if a treatment is really useful or not. The studies will not be complete for some time, so results will be available in the near few months—however, if proper measures continue to be taken (namely those communicated by medical practitioners and government authorities) and through careful personal care and hygiene, a more widespread contagion can be prevented.</p><p></p><p><b>Dr. Pedro L. Trigo — Internist, Family Medical Practice HCMC</b></p>"
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"id": 993,
"title": "Dehydration and Risk of Orthopedic Injuries",
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"post_date": "2020-01-24",
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"summary": "Dehydration has an impact on your heart, endocrine system, digestion and nervous system, and also contribute to orthopedic injuries.",
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"value": "<p></p><p>Summertime always comes with an elevated risk of dehydration. To sportspeople, this risk is of even greater concern. Athletes can lose up to three quarts of fluid per hour during exercise, so staying hydrated can be difficult.</p><p>Dehydration has an impact on your heart, endocrine system, digestion and nervous system, and also contribute to orthopedic injuries.</p><p><b>Risks of Orthopedic Injuries</b></p><p>During exercise, heat cramps can occur as your body loses too much water. These cramps are not only uncomfortable, but can also impact your form and endurance. Poor form leads to a variety of orthopedic injuries, such as muscle strains and tears—or even fractures. Heat exhaustion can cause dizziness, fatigue, headaches and even a loss in consciousness. Such symptoms make it very difficult for your body to properly function, increasing the likelihood of injury.</p><p>To decrease the chances of dehydration during summer is a fairly easy task. Plan ahead and maintain an awareness of your body throughout the day to help you stay hydrated despite the rising temperatures.</p><p><b>Tips for staying hydrated</b></p><ul><li>Before exercising—up to two hours before starting your activity, you should be consuming around 20 ounces of water.</li><li>During your workout or outdoor activity—drink between seven and ten ounces of water every 10–20 minutes.</li><li>After exercising—drink at least eight ounces following exercise.</li><li>Throughout the day—keep up with the water intake as your body continues to lose fluids even when at rest.</li><li>Sports drinks and coconut water can provide an added benefit of replenishing electrolytes lost through sweat, but added sugar can be a negative. Plain water is your best bet.</li><li>Listen to your body—if you start to experience symptoms of dehydration such as fatigue, dizziness, headaches, nausea, vomiting or muscle cramps, stop exercising immediately.</li></ul><p>Source: <a href=\"http://www.trinityorthopedics.com/dehydration-risk-orthopedic-injuries/\">http://www.trinityorthopedics.com/dehydration-risk-orthopedic-injuries/</a></p>"
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"title": "Novel Coronavirus (2019-nCoV)",
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"title": "Contraception",
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"summary": "Many people want to use contraception, but many don’t even know how to obtain knowledge about it—and while they may search online or ask friends, the lack of education and an embarrassment to talk openly about sex quite often means that they end up with the wrong information.",
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"value": "<p>I practice at an international clinic treating both foreigners and locals, but it’s usually my Vietnamese patients who ask me for basic advice about contraception. The lack of knowledge about this important health issue within the Vietnamese community can be staggering.</p><p>A large part of the problem is that it’s still hard to talk about this in our society: people want to use contraception, but many don’t even know how to obtain knowledge about it—and while they may search online or ask friends, the lack of education and an embarrassment to talk openly about sex quite often means that they end up with the wrong information. Many local couples practice traditional contraception (the rhythm method and withdrawal) without realizing just how unreliable these strategies are.</p><p>My foreign patients at least have a better grounding in terms of the basics, but those with local sexual partners often grossly underestimate their partner’s level of understanding. There are a lot of foreigners here who have faced unwanted pregnancies by presuming that just because their partner seems well-acquainted with international lifestyles, they probably know how to use contraceptives correctly. The truth is that they may be very under-informed. Many local women, for example, may purchase oral contraceptives over the counter without understanding that this medicine needs to be taken on a daily basis, not only on the days they have sex.</p><p>One of the consequences of this knowledge gap is that underage pregnancy rates are very high in this country. It’s commonly thought that many young women don’t want to use condoms because they are embarrassing to buy and interrupt sexual intercourse—and I know for a fact that many women consciously choose abortion as a preferred form of contraception. This is very dangerous. I do urge younger people who are sexually active to choose a contraceptive method that actually prevents pregnancy from occurring. If a young woman has an unwanted pregnancy and chooses to have an abortion, it can affect her reproductive health in the future—procedural abortions can scar the uterus and can affect future fertility, and in the case of a late abortion, there is a high risk of haemorrhage. Sometimes when an abortion goes wrong, the whole uterus must be removed.</p><p>Traditional methods are still observed by many couples in Vietnam, and it is often the habit of married people to forego modern methods such as condoms because, in their minds, they are associated with unmarried lifestyles. These people may not understand that the rhythm method is only useful in women who have a very regular cycle —although even then there is still some risk of pregnancy, even on “safe” days. Many mature wives often choose to sacrifice an unplanned pregnancy for economic reasons, and this demographic is a major contributor to Vietnam’s enormous abortion rate.</p><p>Most patients who consult with me will have already used a preferred method for contraception. If they want to change, I will ask them about their situation, because the method will only be effective if the client actually wants to use it—that is very important. My advice will also depend on the woman’s age. Married women in Vietnam often prefer the IUD, although for young women, I tend to introduce condoms or the oral pill, and often both. If the woman has already had children and doesn’t want any more, I may introduce female sterilization.</p><p>My priority is to introduce oral pills and condoms, although there are several other methods available here. In fact, most contraceptive methods are not hard to come by in Vietnam; we’re not lacking anything in terms of availability. I think the main barrier to progress in this area is to do with the mind. That’s the only thing that prevents people from taking action. They are too shy to learn about contraception, have it, buy it, use it or convince their partner to use it.</p><p>Vietnamese women are often resistant to using hormonal methods such as contraceptive pills because they feel they are somehow unnatural, or worry that if they use a method that prevents menstruation, the “bad blood” will not be released from their body. I often need to explain to my patients that hormonal methods are now very safe, as the dosages are lower than they were in the past—but still high enough to prohibit the activity of the ovaries. Previously, high dosages were used that would cause many side effects, such as weight gain or high blood pressure. After many years of study, medical researchers have found ways to balance the hormone levels in these drugs. Those methods that prohibit menses (such as the lunelle injection or the implant, both of which can repress ovulation for around three years) also prevent build-up of menstrual blood from occurring, so it’s normal for women using these contraceptive methods not to have their regular period or to only experience spotting.</p><p>Most hormonal methods use a combination of the female hormones estrogen and progesterone. Progesterone is only used on its own when a woman is breastfeeding. After breastfeeding stops, they will be switched to the combined hormone method, which is far more effective.</p><p>I still recommend the contraceptive pill as the preferred hormonal contraceptive. Although they do not offer any protection against STIs, they are inexpensive in Vietnam and available over the counter in most pharmacies. They do not prevent menses, have less side effects, and are easy to start and to stop using. I don’t recommend the implant for younger women, because when your ovaries are inactive for such a long time at that age, your ability to restore your fertility is lower and it takes more time for your ovaries to become active again.</p><p>Condoms are still the best form of contraception in that they also protect against STIs, although their use remains problematic in Vietnam. Many couples use them incorrectly, putting them on just prior to ejaculation or only using them during menstruation! There are other barrier methods available such as the female condom or diaphragm, but they’re exceedingly rare and not popular at all—I would say that only 1 in 100 of my patients will have even heard of them.</p><p>There are few people who are not embarrassed to buy condoms, although for those who just can’t face the salesperson, online delivery is an option. However, many substandard brands are on the market, and expired condoms are often still sold, which break easily. It’s important to check before you buy them or use them—they have an expiry date. Check the foil package too—if it’s broken at all, you cannot use it. Good quality condoms are oily inside; you should check carefully for holes, and after use you must check the condom again by squeezing it to see if there are any ruptures. To use condoms correctly, you must use one every time you have sex, and keep it on until the end.</p><p>Doctors don’t often prescribe condoms to patients, but I often provide free condoms in my consultation room, especially to young people. When we talk about condoms, I will remind them that in case of a mistake, you must have another method to support the condom, such as the emergency oral pill. Although the effectiveness of this pill is very low—only 75%—I still advise its use. I advise two methods in case one doesn’t work.</p><p>Vietnam is still a very traditional country, and people are so reluctant to reveal personal information about this topic that the statistics we have are not particularly reliable. Culture still represents a huge barrier to people who want to be better informed. Many women will ask me to avoid recording any information about their sexual history or previous abortions, because a woman’s virginity is still an important factor to prospective husbands. Men who fail to contain their ejaculation will still claim to have withdrawn safely, and some women will believe themselves protected from pregnancy based only on “feeling lucky”. Our abortion rate alone has prompted some discussion in government about how to introduce sex education in schools; however, this has yet to occur. I do believe it vital that sex education becomes more widespread here in order to help solve some of these problems. For now, it remains important to be very cautious in practicing safe sex in Vietnam, and I would advise anyone not to hesitate to consult with a specialist to gain accurate knowledge and to learn how to use a contraceptive method correctly.</p><p>INFO BOX</p><p>Condoms (<i>bao cao su</i>): Popular brands include Durex (VND13,000–18,000 each); Sagami VND9,000–15,000 each); Power Men (VND8,000–15,000 each); True-X (VND11,000–16,000 each); and Okamoto (VND9,000–18,000 each). Shop easily and anonymously at Lazada or search from many Vietnamese language Facebook stores.</p><p>Oral Contraceptive (<i>thuốc tránh thai</i>): Available at any local pharmacy. Prices vary from VND10,000–150,000/blister pack. Always consult a doctor for advice on the right brand for you. Popular brands include Mercilon, Drosperin, Rigevidon, and Diane35.</p><p>Morning After Pill (<i>thuốc tránh thai khẩn cấp</i>): Available at local pharmacies. Prices range from VND10,000–150,000/pack. Popular brands include Postinor, Mifestad 10, and Mifepristone.</p><p>Hormone Patch (<i>miếng dán tránh thai</i>): Evra (VND234,000/box of three patches) is a common brand in Vietnam. Available at Pharmacity.</p><p>Female Condom (<i>bao cao su cho nữ</i>): more expensive than normal condoms at around VND70,000–90,000 each. Available in specialist sex shops and online.</p><p>Diaphragm (<i>màn chắn tránh thai</i>): VCF brand (VND120,000/box of three). Available at Pharmacity.</p><p>Medical Procedures: An IUD insertion (<i>vòng tránh thai</i>) can be performed at Family Medical Practice or any major hospital. For female sterilization, vasectomies, lunelle injections (<i>thuốc tiêm tránh thai</i>) or implants (<i>que cấy</i>), recommended hospitals include (International) FV and Hanh Phuc; (Local) Tu Du and Hung Vuong.</p><p></p><p><b>Dr. Tran Thi Kim Nguyet - Gynecologist, Care1</b></p>"
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"summary": "Given everything I’ve seen in this field, I can feel why people feel safe revealing these kinds of fears in the kind of secluded non-public clinic I work in now. I see the guilt, the fear, maybe the religious aspect; it’s psychologically very complicated. Compared with the prognosis of early AIDS sufferers, I think these fears are understandable. It remains a truly terrifying disease.",
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"value": "<p><b>Dr. Michael Alkan</b> has undertaken countless medical missions in locations all over the world, seeking adventure in the human jungle throughout his career. He was witness to the emergence of the AIDS epidemic, and went on to open AIDS clinics and work as an AIDS preceptor in a number of countries affected by the disease. The following is his own account of his life’s work to help those afflicted with the virus.</p><p>At first, it wasn’t called HIV, it wasn’t called AIDS. They called it GRIDS, gay-related immunodeficiency syndrome. The year was 1980, and I was a research fellow at UCLA, the San Fernando Valley program. We saw the very early non-diagnosed suspected cases, and we infectious disease doctors suddenly found that we had to learn a new trade.</p><p>The first of all the publications started with one letter to the editor, <i>13 Cases of Pneumocystis Carinii Pneumonia in Gay Men</i>. The disease itself was well-known; it afflicts children with lymphoma after chemotherapy, destroying what’s left of their immune system after the lymphoma has eliminated the rest. Gay men were known for amebiasis, herpes, and a lot of other troubles, but not for <i>P. Carinii Pneumonia</i>. So we were being exposed to something that we had never seen before.</p><p>This is what science is all about. You see something that doesn’t fit, you ask your colleagues if they have also seen it, and yes, if it doesn't suit the picture, you publish it. Eventually we all found out what it was, and then the world was different.</p><p>I went home in around 82 or 83. One day, while making rounds, I came upon a young hemophilia patient who must have been about 20 years old. He had been admitted because of fever, and he had these funny spots on his skin. It was the first case I diagnosed with HIV. We didn’t have the blood test yet. What we had was a surrogate test for lymphocyte function, and that test turned positive, which strengthened my point. He eventually passed away; there was a big presentation to the whole hospital, and everybody doubted the diagnosis because nobody knew what it really looked like, as there was no diagnostic test. When the test came out in 1985, I pulled his serum out of the freezer, and it was genuinely positive. So this boy, whose face is a clear picture in my memory, was my first real encounter with HIV.</p><p>We were sailing in totally uncharted waters. We had no idea what we were doing, we had no idea how to prevent transmission; this was long before the inversive precautions came out, when every body fluid is suspected until proven otherwise—and even after proven otherwise. We imported knowledge from immunocompromised cancer patients to the AIDS patients, who had similar symptoms. These were the days when what we could do for the patients was to help them die in peace. There was no treatment, and it was very very difficult.</p><p>The next thing that happened was that I won a scholarship to go for six months and work in the Beth Israel medical center in lower Manhattan in New York. One of the four buildings in the hospital was a detoxification center for drug addicts. A lot of them carried HIV and were AIDS patients. The epidemic was rampant at the time; at any given moment there were more hospitalized AIDS patients than were ever diagnosed in the whole country of Israel. For six months, I was exposed to everything. By that time, we knew exactly what it was, we knew the biology, we had a serological test. It was the absolute beginning of the antiretroviral treatment, and all of a sudden we had tools, we had something to work with.</p><p>My return to Israel from the US coincided with the influx of Jews from Ethiopia. This community was rural, from the north of the country; there was no HIV among them. However, they were encouraged to move to Addis Ababa by Jewish organizations who provided for them and gave them subsistence money. Now, you can imagine that for this money, some of the men went and bought sex. And if it was a single mother with three children, she was probably selling sex in order to make ends meet. As a result of that, the government of Israel decided to test anybody who came from Ethiopia, and whoever was found to be seropositive was sent to one of the six AIDS centers in Israel. I ran one of them.</p><p>We called it the Infectious Disease Clinic. People with urinary tract infections sat next to people with HIV, except that the color of the skin of the Ethiopians was a giveaway. In the beginning, it was all about patting them on the shoulder and helping them to cope, giving them horrible information, and catering the information to their culture. Luckily, we had an Ethiopian nurse, and she taught me how to reveal the bad news to the patients with the language barrier, cultural barrier, their vocational barrier.</p><p>And it went like this:</p><p>“Welcome to Israel. When you came here, do you remember that they drew your blood to test for lots of kinds of diseases? All your tests are good! Except that one test shows that there's a virus in your blood. You're healthy! But there's a virus in your blood.”</p><p>And then I would shut up, and <i>wait</i>. If he asks, “what's the virus,” I know where to go. If he asks “how can it be that I have something in my blood and I'm not sick,” I know where to go. If he doesn't ask anything, I proceed, I go on.</p><p>And I say, “In Israel, unlike Ethiopia [which is not true anymore], the government gives you free treatment for this virus, and we will see to it that you will be healthy.” In some cases, the patient would say, “Do you mean AIDS?” And again I would know which way to go.</p><p>The clinic grew to be much more efficient with the development of new medications and new testing systems. From being in total darkness, we ended up giving top-notch treatment to people.</p><p>One day, one of the drug company reps came to me and said, “We need a doctor to go and work for the national AIDS program in Botswana.” I said, “When's the next flight?” not really knowing where Botswana was. I had to look it up and find out that this is the Kalahari Desert, and it is one of the most interesting countries that I've ever known.</p><p>In the year 2000 in Botswana, the government had declared AIDS a national emergency. Botswana had 1.5 million inhabitants, and 1/3 of them were infected with HIV when they started the process. The government didn't only do it because of humanitarian reasons; they did it because of the diamond industry which is the backbone of the financial situation in Botswana. They knew it could break down with all of the employees dying of AIDS.</p><p>I took two tours of duty there. The most amazing thing was at the beginning. They said, “Doctor, tomorrow the HIV orientation course for doctors and nurses will start, it’s six days and you're registered to attend.” I said, “Come on guys, I’ve been taking care of AIDS patients for 18 years!” They said, “Never mind that. You should also take the exam at the end.”</p><p>So for six days I learned how to teach African doctors about HIV. And I learned more than from any of the teachers from the questions that the audience were asking. I understood where the black holes were, where they didn’t want to go, that they didn’t want to touch them, that they didn’t want to take care of AIDS patients. They considered this as voodoo, as punishment from the gods, or something like that. Of the only two responses that I heard about condom use, one was, “I don’t eat a banana with a peel,” and the other was “if I have a candy, I take the wrapper off first.”</p><p>They had to invent a new word in the English language, “AIDS preceptor”, which is a doctor who will teach local medical teams not to be afraid of touching patients and treating them. I opened two separate AIDS centers in peripheral Botswana; all the American universities were on top of them wanting a piece of the pie, and the drug companies were donating anti-AIDS medications. I was teaching, I was working with the doctors, with the nurses, and touching the patients physically, which meant a lot to the patients and to the doctors as well.</p><p>I did two missions to Botswana, followed by two missions to Nigeria, followed by two or three to Ghana, and then Ethiopia, Eritrea and Somalia. One thing led to the other. The big hurdles were not only money; they were education, manpower, some things that take a whole generation to trickle into the population.</p><p>I shouldn't say this, but I have yet to see a more promiscuous society than what I found in Africa. An unmarried nurse in our clinic in Ghanzi, the middle of the Kalahari, had two children.The fact that she had two sons was the reason why suitors were knocking at the door every day, because she had proved that she was fertile, she could give you children. So they wanted to marry her. But after marriage, on Saturday nights they would go to the watering hole in the center of the village and have more beers than they should, and there would be 15-year-old girls there, who for a beer would have sex. Or, if they liked you very much, it was not only a beer, maybe some money or some clothes.</p><p>The meaning of prostitution in Africa is different from what it is in Western culture. So you may understand how AIDS spread in African countries so fast.</p><p>After that, I was recruited to teach in Gondar in Ethiopia, which is in the middle of the Amhara region, a very conservative town during the daytime, and where at night there are nightclubs which you shouldn’t go to. The School of Public Health had been summoned by the government to take nurses and health officers, and within the course of six months give them a Master's degree in Public Health–AIDS caretaker. And I was asked to give the first two weeks of teaching, which was a refresher of nursing school; what is a virus, what is a bacteria, what is the immune system like. I did this five times, and it was a joy.</p><p>That was the last convolution of my HIV AIDS career. Ten years ago I retired.</p><p>At first, I still followed the literature and tried to stay alert to changes, but then the changes were so fast that I decided to let go. Now, I will gladly counsel a patient regarding HIV, and then transfer him to a younger doctor to give treatment, because the field is developing faster than I can follow.</p><p>It’s a different world! Back then, your average patient died within 13 months of your diagnosis, and there was nothing you could do about it, you just watched him melt away. Now we have a situation where this is regarded as something like hypertension, heart disease or diabetes—a chronic condition which, when properly treated, can lead to a normal life for another 30 years. And the new tricks with drugs against HIV are really fantastic! We drafted a paper about the hardships of being under AIDS care, because some drugs you needed to take with food, others you needed to take on an empty stomach, some were taken in the morning, some at night. Today, it takes one tablet before bedtime and that's it! So we've come a long way.</p><p>Here in Saigon, the most common AIDS-related concern I see are people who are near psychosis from the fear of having AIDS when they don't have it, and you can't confuse them with facts. They can be Vietnamese, American, Japanese, Korean, it doesn't matter—the fear is there, irrespective of culture. When you show them the results, “Look, it's safe, you’re OK!” And they say “No, I’m not!”</p><p>Given everything I’ve seen in this field, I can feel why people feel safe revealing these kinds of fears in the kind of secluded non-public clinic I work in now. I see the guilt, the fear, maybe the religious aspect; it’s psychologically very complicated. Compared with the prognosis of early AIDS sufferers, I think these fears are understandable. It remains a truly terrifying disease.</p>"
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"value": "<p></p><p>Some of the toughest issues for expat families resident in Ho Chi Minh City are those which would be non-issues back home. Your kids’ educational prospects become a complex puzzle; playing outside without worrying about the heat and air quality are a major headache; and things that would be dealt with automatically by the public system overseas are suddenly issues that require research and decision-making where none were needed before.</p><p>One of those issues is vaccination. As a parent in my home country, vaccinating my kids would simply be a matter of following the doctor’s schedule – I’d have no concerns about quality of care, it would be easy for me to find out which shots were due to be administered and on which dates, and I’d be reasonably confident that I wouldn’t completely mess it up. The opposite is true in Vietnam – I’ve no idea if the local clinics or vaccines are any good, no idea if I shouldn’t be taking my kids off to Singapore every six months for their boosters, and no idea if I’d be paying through the nose at an international clinic for the same thing that I could get at the local hospital for less than a hundred thousand VND. My fears of messing up my kids’ vaccination program and rendering them vulnerable to life-threatening diseases are suddenly not as close to zero here as they would be elsewhere.</p><p>Dr. Truong Hoang Quy and Dr. Jonathan Halevy, who practice pediatrics at Family Medical Practice (34 Le Duan, D1), are quick to reassure parents in situations like mine. According to Dr. Quy, Vietnam’s 30-year-old vaccination program is actually very good, generally administered according to the same international standards you’d expect in other countries. While some of the schedules vary in certain respects from those overseas – mainly because the risks of exposure to certain diseases are variously higher or lower here than they are abroad – they do have a very comprehensive, standardized program.</p><p>While that’s reassuring, a little Google research turns up some worrying figures. In 2013, there were several reports about babies dying hours after getting a Quinvaxem shot. There was a subsequent investigation by both the Vietnamese Government and the WHO, and they concluded that the vaccine was safe – but after restarting the program, again there were reports of infant deaths.</p><p>Dr. Halevy is quick to put this in perspective. “The big issue about vaccination in Vietnam is not the vaccines themselves, but the safety issues in their administration”, he explains. “For example, if the vaccine was not kept in the proper way, or if the vaccine had expired when it was given. The 5-in-1 Quinvaxem issue became significant because at the time, there was a worldwide problem with the availability of Pentaxim, produced in France and Belgium. The authorities here had to use Quinvaxem, which contains a different kind of pertussis (whooping cough) vaccination, produced in Korea.”</p><p>“It might be related to the fact that the pertussis vaccines in new shots such as Pentaxim and Infanrix do not contain the whole bacteria, only certain molecules”, he says. “It’s known that the Korean vaccine contains the whole bacteria. It was used up to 20 years ago in all the countries in the world, but it was known to have more side effects – that’s why they came up with a new vaccine that has less. But if you look at the numbers, Quinvaxem was given to millions of kids in Vietnam. The reports were very scarce, so we’re talking about 0.0000-something percent of risk of death. Of course, the vaccine is very important to prevent the death of little babies from pertussis. So if you take all these factors into consideration, the Quinvaxem is still a better solution than no vaccination.”</p><p>“When you look at the national view, the vaccine saves the lives of babies; it prevents pertussis from happening” he says. “There’s always a tiny little risk in any medication you can get – even Tylenol can kill you. You need to take into consideration the side effects and the benefits of the vaccination – or the medication, or the medical procedure. Everything you do in medicine has two sides, it has benefits, it has side effects. You need to consider if the benefits outweigh the risks.”</p><p>It should be observed that problems associated with the subtleties of vaccine storage and delivery in Vietnam are mostly restricted to provincial areas. “I think that in most cases where there are side effects, it’s in remote areas, not in the center”, says Dr. Quy, “because it’s important that vaccines are stored in the fridge at two to eight degrees. So in mountainous areas, for example, sometimes the electricity is cut. It’s difficult to store vaccines properly in these conditions.”</p><p>While it’s safe enough to put your kids through their shots at a local clinic, there are some important differences between what is generally offered on the national program and what is available at an international clinic. Vaccines at some international medical centers may be more advanced than those offered locally – and sometimes there are nuances regarding certain vaccinations that local clinics may not necessarily pay attention to that may be dealt with more effectively at private clinics – it always pays to ask.</p><p>“if new vaccine comes out, the Vietnamese administration has to conduct research and implement a ‘pilot’ or test in small groups of people”, explains Dr. Quy. “They have to make sure that the vaccine is suitable and safe for Vietnamese people.” While this is standard practice in any country, it’s common for these studies to take longer in Vietnam than they do elsewhere, meaning that newer, more effective vaccines will often take a few years before getting onto the national program.</p><p>With expats like myself, the problem is that we come from different countries, and different countries have different schedules. “It can be quite a mess”, says Dr. Halevy. “A lot of people don’t understand that when a certain country chooses which vaccinations to put on their program and which not, many times it’s not for medical reasons, but economic reasons. A certain country will decide not to put a hepatitis B vaccination on their program, not because it’s not necessary or not effective, but because economically, for that particular country, it’s not cost-effective. In certain countries, they don’t give BCG vaccinations for tuberculosis, because they have low risk, low exposure to TB – but in countries such as Vietnam and Thailand which are high risk, you need to have the BCG vaccination.”</p><p>As with anything difficult in Vietnam, part of the solution comes from being proactive. First of all, if you go to any clinic, you need to be sure that it’s working with an updated vaccination schedule. You need to be certain that the vaccinations they have cover both local and international requirements. If you live in the UK or in Germany your kids really won’t need a Japanese encephalitis vaccination, but if you live in Vietnam, it’s very important. You’ll also need to understand that there’s a difference between countries when it comes to vaccinations, so you need to be a little more flexible. Some parents decide that they’ll only follow their own country’s vaccination schedule, but the key message here is that because you live in a different country, there are different risks and requirements.</p><p>“One thing I always recommend to parents when they get a vaccination, is to make sure they get a stamp, not just write the date”, says Dr. Halevy. “Just writing the date, anybody can do that, so it’s not proof that a child got a vaccination. If they have a clinic stamp, I always recommend that they take their phone, take a picture of the book, and save it online. Expats tend to move from one country to the next, and they have a tendency to lose the vaccination records. It’s very important not only when you’re a kid, but when you’re an adult and you emigrate to another country or go to college or university, they always require an immunization record. A vaccination you get today, you might need proof of it ten, twenty years from now.”</p><p>With different needs for different expat families who need to be mindful of the fact that they’ll need to be immunized against two different exposure conditions – those of here and those back home – parents can still elect to vaccinate at local clinics and ask directly for vaccinations that are not prescribed at the national level.</p><p>The doctors’ own clinic, Family Medical Practice, follows a very similar schedule to the national recommendation. “We took the recommendation of the Center for Disease Control in the U.S., and we took the schedule in Canada, the WHO recommendations, and we created a standardized vaccination schedule”, says Dr. Halevy. “We took the vaccinations recommended specifically in Vietnam, such as typhoid, meningococcal, Japanese encephalitis and hepatitis A, and we added that to ours. So what you get here is very comprehensive.”</p><p>“We put a lot of emphasis on vaccinations”, he says, “because as paediatricians, preventative medicine is the major pillar of pediatrics. We emphasize vaccinations, regular checkups, developmental checkups – because when you detect problems earlier you can treat them earlier, and this will have better outcomes.”</p><p>Q&A:</p><p><i>Should foreigners be going overseas for the Pentaxim vaccination?</i></p><p>It’s not necessary. Availability in Vietnam is now good – for the time being.</p><p><i>Can I get vaccines not listed on the national schedule in Vietnam?</i></p><p>Check with your doctor for the availability of non-scheduled and updated vaccines.</p><p><i>I don’t know which vaccinations my child has received abroad so far.</i></p><p>Check your national schedule and call home if there is any doubt. The presence of some antibodies can be detected in a blood test. If there is a serious suspicion that your child has not been properly vaccinated, a booster or fresh series of vaccinations may be administered – this is not harmful.</p><p><i>Can my child be vaccinated for all eventualities?</i></p><p>Some vaccines (such as for yellow fever, unnecessary unless you plan to take your child to West Africa) are available at the Hospital for Tropical Diseases (190 Ben Ham Tu, D5). Do ask your doctor for the optional rabies vaccine if you plan to travel to areas such as Bali, where it is endemic.</p><p><i>Should I just skip the vaccinations and wait until we get home?</i></p><p>In 2014, after many parents elected to avoid the MMR vaccine, hundreds of children died from catching this highly virulent disease. Vaccinations save lives.</p>"
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"compressed": "https://media.fmp-data.bliss.build/images/ID_Passport.format-jpeg.jpegquality-75.jpg"
},
"post_date": "2020-01-13",
"category": {
"id": 1,
"name": "Announcement board",
"slug": "announcement"
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"subcategory": {
"id": 1,
"name": "News",
"slug": "news"
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"tags": "",
"summary": "Dear Valued customers,\r\nAs required by the Ministry of Health, from now on, every patient must present his/her ID/Passport at every single visit before using the medical services at Family Medical Practice Hanoi.",
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"content": [
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"value": "<p></p><p>Dear Valued customers,<br/>As required by the Ministry of Health, from now on, every patient must present his/her ID/Passport at every single visit before using the medical services at Family Medical Practice Hanoi.<br/>For children, the parent/Legal Guardian/CAREGIVER please provide us his/her ID/Passport together with your ID/Passport.<br/>If parent/Legal Guardian/CAREGIVER authorizes another person to accompany his/her child to FMP Hanoi for medical examinations and/or treatment, please provide us parent’s ID/Passport and the authorized companion’s ID/Passport beside consent letter.<br/>Please follow this requirement but feel free to ask any questions.<br/></p><p>Best regards,<br/> Family Medical Practice Hanoi</p>"
}
],
"meta_title": "",
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{
"id": 556,
"title": "“My beloved doctors” painting contest by FMP Hanoi",
"slug": "my-beloved-doctors-painting-contest-by-fmp-hanoi",
"slug_en": "my-beloved-doctors-painting-contest-by-fmp-hanoi",
"slug_vi": "fmp-hà-nội-phát-động-cuộc-thi-vẽ-tranh-thiếu-nhi-bác-sĩ-em-yêu",
"slug_ko": "my-beloved-doctors-fmp-hanoi-주관-사생-대회",
"slug_ja": "ぼくわたしの大好きなお医者さん-fmp子どもの絵コンテスト2019開催",
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"id": 205,
"url": "https://media.fmp-data.bliss.build/original_images/Air_competition.jpg",
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"post_date": "2020-01-13",
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"summary": "FMP Hanoi together with Art tree kicks off this year painting contest “My beloved doctors” in Hanoi.\r\nEntry period from 15.04.2019 through 21.07.2019. Results announcement and awards ceremony will be held at the end of August with total 22 prizes.\r\n12 most outstanding entries will be published in 2020 calendar by FMP Hanoi.",
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"value": "<p>FMP Hanoi together with Art tree kicks off this year painting contest “My beloved doctors” in Hanoi.</p><ul><li>Entry period from 15.04.2019 through 21.07.2019. Results announcement and awards ceremony will be held at the end of August with total 22 prizes.</li><li>12 most outstanding entries will be published in 2020 calendar by FMP Hanoi.</li></ul><p>Hanoi, 13/4/2019. Family Medical Practice Hanoi in collaboration with Art Tree introduces “My beloved doctors”, the first painting contest by FMP in Hanoi. This contest hopes to encourage children and youth to share their art talents, express the love for life and most of all, get their creativity and imagination flowing. This contest is also part of FMP celebration for Children’s day 1St of June 2019.</p><p>Artistic creation is one of those activities that foster a child’s intellectual and motor skills development. From small “scribble-scrabble” to complex sketches, drawing helps a child learn perseverance and motivation to complete a work. Additionally, colors can enhance children’s feelings about the world around them. Through art they can express their thoughts and visualization of their own world with freedom and creativity.</p><p><i>Entry to painting contest by FMP Vietnam 2015</i></p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/Air_competition_1.jpg\" class=\"format-fullwidth\" /><p></p><p></p>"
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"<p><b>Theme</b></p>",
"<p><b>My Beloved Doctor</b></p><p></p>"
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"<p><b>Organizers</b></p>",
"<p>FMP + ART TREE</p>"
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"value": [
"<p><b>Eligibility</b></p>",
"<p>This contest is open to all children aged under 12 (birthday from 31.12.2007 onwards) who is a customer of FMP Hanoi.<br/>There are 3 age categories: Under 6 years old, 6-10 years old, and 11-12 years old.</p>"
]
},
{
"type": "multi_column_text",
"value": [
"<p><b>Number of entries</b></p>",
"<p>The author may submit up to 02 entries.</p>"
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"<p><b>Advice</b></p>",
"<p>Drawing and painting entries shall demonstrate author’s impressions about:<br/> – A doctor or medical staff that he/she loves<br/> – A familiar or trusted medical center.<br/> – Anything that makes contestant feel connected with his/her beloved doctor or medical staff<br/> – Imagination of the doctor or medical staff that contestant wishes to become in the future</p>"
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{
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"value": [
"<p><b>Material specification:</b></p>",
"<p>Any means of drawing or painting on paper (pencils, crayons, water color, ink color, acrylics, powder color…)</p>"
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},
{
"type": "multi_column_text",
"value": [
"<p><b>Size:</b></p>",
"<p>A3 (29,7cm x 42cm) or A4 (21cm x 29,7cm)</p>"
]
},
{
"type": "multi_column_text",
"value": [
"<p><b>Entry period</b></p>",
"<p>15/4/2019- 21/7/2019</p>"
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{
"type": "multi_column_text",
"value": [
"<p><b>Award ceremony and exhibition</b></p>",
"<p>End of August 2019</p>"
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{
"type": "text",
"value": "<p></p><img src=\"https://media.fmp-data.bliss.build/original_images/Air_competition_2.jpg\" class=\"format-fullwidth\" /><p></p><p><i>Entry to painting contest by FMP Vietnam 2015</i></p><p>Total prize value up to 50 mil dong including:</p><ul><li><b>01 First prize:</b> One color set (US Art Supply 46-Piece) + 3.000.000 VNĐ scholarship at ART TREE + Certificate</li><li><b>02 Second prizes:</b> One color set (Darice – Studio )+ 2.000.000 VNĐ scholarship at ART TREE + Certificate</li><li><b>03 Third prizes</b>:One color set (126-Piece) Deluxe Mega Wood Box+ 1.000.000 VNĐ scholarship at ART TREE</li><li><b>06 Fourth prizes:</b> First Aid Kit Standard +600.000 VNĐ scholarship at ART TREE</li><li><b>10 runner-up prizes:</b> Gifts from FMP & ART TREE (calculated by total likes, shares on of entries on Facebook FMP)</li><li>Entries won the First, Second, Third and Fourth prizes will be selected to be published in FMP’s 2020 calendar. All of prized entries will be displayed in exhibition at FMP.</li></ul><p><b>Requirements:</b></p><ul><li>Eligible entries must be original artworks with author’s signature. Backside of the artwork shall indicate details:</li><li>Name of the painting, author’s name, address and contact information (contacts of parents or guardians)</li></ul><p>Entries can be submitted at FMP Hanoi or by postal service to:</p><p><b>Marketing department, 4th floor, FMP Hanoi, Diplomatic compound, 298I Kim Ma, Ba Dinh, Ha Noi.</b></p><p>Please specify on envelope with: “My beloved doctor” painting contest</p><p><b>Selection criteria:</b></p><p>Contestants are categorized by age:</p><p>Under 6, 6-10 years old, 11-12 years old.</p><ul><li>1st, 2nd, 3rdand 4th prizes: based on 10-point scale assessment – average point by judges from FMP and ART TREE</li><li>Runner-up prizes: selected based on number of votes (total likes, shareon FMP Facebook)</li></ul><p><b>Rules and regulations:</b></p><ul><li>All entries’ copyrights will automatically belong to FMP Hanoi.</li><li>FMP Hanoi reserve future usage of all entries with authors’ credits for full-scoop PR and publicity.</li><li>Final winners are assessed and determined by the judges.</li><li>Original artworks will not be returned.</li><li>Organizers shall not be held responsible for any incorrect, inaccurate personal information and artwork’s content submitted by author.</li><li>The organizer FMP Hanoi reserves the rights to all final and conclusive decisions about the contest including results and prizes.</li></ul><p>————————————–</p><p>Family Medical Practice Hanoi is the first 100% foreign owned clinic in Vietnam with 25 years of experience providing quality healthcare by our team of international physicians and the latest in medical equipment and diagnostic tools. It is among our top priorities to offer high standard services and treatment for customers of all ages, for you to lead a healthier and happier life. Founded in 1994, FMP has been involved with and initiated various social responsibility activities. It has always been our mission to contribute and give back to the society with our precept “Your health. Our care”.<br/> Art Studio ART TREE – a member of the UNESCO Center for Fine-Arts, is a pioneer in the field of fine art training that incorporates soft skills with European-based teaching methods. ART TREE is also one of the first art centers to offer painting courses for both children and adults with the motto of providing leading teaching methods, giving students the opportunity to have a wonderful experience in every lesson.</p><p>Follow our contest at: <a href=\"https://www.facebook.com/FamilyMedicalPracticeHanoi/?ref=settings\">https://www.facebook.com/FamilyMedicalPracticeHanoi</a></p><p>Organizers,</p><p><b>FMP – ART TREE</b></p>"
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{
"id": 1065,
"title": "Coronavirus_Fact vs Fiction",
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"slug_vi": "coronavirus_fact-vs-fiction",
"slug_ko": null,
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"url": "https://media.fmp-data.bliss.build/original_images/shutterstock_289132154.jpg",
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"post_date": "2020-01-04",
"category": {
"id": 6,
"name": "FMP on COVID-19",
"slug": "updatesoncovid19"
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"subcategory": {
"id": 25,
"name": "FMP services_COVID-19",
"slug": "fmpservicesCOVID-19"
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"tags": "",
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"locations": [
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"COVID-19 is currently the DEADLIEST DISEASE in the world",
"COVID-19 is a MILD ILLNESS IN MOST CASES. *The ordinary flu kills more people every single year than COVID-19 does."
],
[
"COVID-19 is a DEATH SENTENCE.",
"THE MORTALITY RATE OF COVID-19 IS VERY LOW. Almost all those who \nhave died are older age groups with pre-existing chronic health conditions."
],
[
"Only SPECIAL MEDICAL-GRADE MASKS CAN PROTECT me from the disease.",
"The best protection available is to KEEP WASHING YOUR HANDS. Masks may be somewhat effective in decreasing the risk of spreading the disease. If you need to SNEEZE, BRING YOUR ELBOW IN FRONT OF YOUR NOSE AND MOUTH to avoid germs spreading through the air."
],
[
"ONLINE ARTICLES ARE THE BEST SOURCE\n of information about coronavirus.",
"Many inaccurate articles about the virus have been posted online. Take information directly from TRUSTWORTHY SOURCES such as the WHO and CDC."
]
],
"cell": [],
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"first_col_is_header": false,
"table_caption": "Novel Coronavirus (COVID-19) "
}
},
{
"type": "text",
"value": "<p>*Source: CDC</p>"
}
],
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},
{
"id": 953,
"title": "6 Biggest Sunscreen Mistakes",
"slug": "6-biggest-sunscreen-mistakes",
"slug_en": "6-biggest-sunscreen-mistakes",
"slug_vi": null,
"slug_ko": null,
"slug_ja": null,
"overview_image": {
"id": 494,
"url": "https://media.fmp-data.bliss.build/original_images/cm08095289_l.jpg",
"compressed": "https://media.fmp-data.bliss.build/images/cm08095289_l.format-jpeg.jpegquality-75.jpg"
},
"post_date": "2019-12-27",
"category": {
"id": 5,
"name": "Blogs",
"slug": "blogs"
},
"subcategory": {
"id": 18,
"name": "Dermatology",
"slug": "dermatology"
},
"tags": "",
"summary": "Correctly applying a high-SPF broad-spectrum sunscreen on exposed skin is the best way to prevent sun damage.",
"related_pages_title": null,
"related_pages": [],
"locations": [
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431,
430,
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428
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"content": [
{
"type": "text",
"value": "<p></p><p>Correctly applying a high-SPF broad-spectrum sunscreen on exposed skin is the best way to prevent sun damage. However, most of us have burned or tanned when we thought we were protected. Here is a list of mistakes that people often experience using sunscreen:</p><p><i>Using expired sunscreen</i></p><p>Sunscreen is classified by the FDA as a drug, and has a shelf life. Throw out old sunscreen that has expired or been stored at temperature or climate extremes, as the formula and active chemicals may have broken down.</p><p><i>Not putting enough sunscreen on</i></p><p>The protection factor of sunscreens is dependent on the dose of product you apply. Not enough sunscreen means that SPF 50 sunscreen is not giving you SPF 50 protection.</p><p>Adults need to apply 1 oz of product to their skin when wearing a bathing suit. The face and front of the neck needs an average of a 5-cent-piece amount.</p><p><i>Not reapplying every 2 hours and after swimming, sweating or rubbing product off.</i></p><p>Sunscreen comes off, so you need to reapply it. It breaks down as it blocks UV rays. Each ray blocked degrades chemical filters, because that’s how these filters work.</p><p>When relying on sunscreen to protect your skin, you need to reapply every 2 hours while in the sun or when it’s washed or rubbed off your skin.</p><p><i>Only wearing sunscreen on sunny days or for midday sun exposure.</i></p><p>Clouds don’t block enough UV rays to help prevent sun damage. Also, UVA is out all day—sun-up to sundown, this ray is out and ready to damage your skin. It can cause skin thinning, wrinkling, sun spots, and skin cancer.</p><p>Get in the habit of putting sunscreen on exposed skin every morning.</p><p><i>Depending on the sunscreen in your makeup or moisturizer to give you protection.</i></p><p>The amount of sunscreen product you apply is important and directly correlates with SPF protection. Read the UV active ingredient filters. Are they zinc oxide? The UV filters in makeup and moisturizer are chemical filters that expire and provide poor protection in the first place.</p><p>What you want for sun protection is products that have SPF, 30+ and broad spectrum. Use a real SPF 30+ broad spectrum sunscreen applied in the correct amount. Separate your moisturizing step and makeup step from your sunscreen step.</p><p><i>Depending entirely on sunscreen for sun protection.</i></p><p>Sunscreen is a lot of work. An adult in a bathing suit, applying 1 oz every 2 hours goes through a 4 oz tube during a full day outside. It’s impractical, and it’s a lot of product. Use multiple strategies to protect your skin.</p><p>Wear sun protective clothing. If you are in and out of the sun on an average day, your regular clothing may be adequate.</p>"
}
],
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},
{
"id": 197,
"title": "The Lifesavers of Saigon",
"slug": "lifesavers-saigon",
"slug_en": "lifesavers-saigon",
"slug_vi": "lifesavers-saigon",
"slug_ko": "lifesavers-saigon",
"slug_ja": "lifesavers-saigon",
"overview_image": {
"id": 131,
"url": "https://media.fmp-data.bliss.build/original_images/newsfeed_2.jpg",
"compressed": "https://media.fmp-data.bliss.build/images/newsfeed_2.format-jpeg.jpegquality-75.jpg"
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"post_date": "2019-12-26",
"category": {
"id": 3,
"name": "Media & Press",
"slug": "media-press"
},
"subcategory": {
"id": 1,
"name": "News",
"slug": "news"
},
"tags": "lifesavers, saigon",
"summary": "Family Medical Practice is proud to announce that the film ‘The Lifesavers of Saigon’, featuring *9999—the only... /...internationally accredited... amublance service in Vietnam—has made the official selection for the Oregon Documentary Festival.",
"related_pages_title": null,
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"content": [
{
"type": "text",
"value": "<p>Family Medical Practice is proud to announce that the film ‘The Lifesavers of Saigon’, featuring *9999—the only... /...internationally accredited... amublance service in Vietnam—has made the official selection for the Oregon Documentary Festival.</p>"
}
],
"meta_title": "",
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{
"id": 956,
"title": "How to Check your Moles for Signs of Skin Cancer",
"slug": "how-check-your-moles-signs-skin-cancer",
"slug_en": "how-check-your-moles-signs-skin-cancer",
"slug_vi": "how-check-your-moles-signs-skin-cancer",
"slug_ko": "how-check-your-moles-signs-skin-cancer",
"slug_ja": "how-check-your-moles-signs-skin-cancer",
"overview_image": {
"id": 497,
"url": "https://media.fmp-data.bliss.build/original_images/pc004102517_l.jpg",
"compressed": "https://media.fmp-data.bliss.build/images/pc004102517_l.format-jpeg.jpegquality-75.jpg"
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"post_date": "2019-12-26",
"category": {
"id": 5,
"name": "Blogs",
"slug": "blogs"
},
"subcategory": {
"id": 18,
"name": "Dermatology",
"slug": "dermatology"
},
"tags": "",
"summary": "It’s important to be vigilant about any changes to moles and spots on your skin.",
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"locations": [
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"content": [
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"value": "<p></p><p>Most people start to see moles appear in childhood and early teenage years. Unfortunately, the more moles you have, the greater your chances of getting cancer. If found early enough, however, they can be treated successfully. For this reason, it’s important to be vigilant about any changes to moles and spots on your skin.</p><p>Moles should be observed carefully for any signs of change. Most moles on your skin will look similar, so look for any moles that stand out as different to the others. If you do identify any changes, it doesn’t necessarily mean you have cancer, just that you need to follow it up with a visit to your GP. Along with moles, pay attention to birthmarks, beauty marks and any brown spots that may have changed. If a new mole appears after the age of 25, ask your GP to have a look at it.</p><p>Here are some things to look out for when checking your skin:</p><ul><li>New moles</li><li>Moles that have increased in size</li><li>The outline of a mole has become etched</li><li>A change in color from brown to black or varied in color</li><li>Raised spot or one with a lump within it</li><li>A surface that becomes rough, scaly or ulcerated</li><li>Moles that itch or tingle</li><li>A mole that weeps or bleeds</li></ul><p>There are three main types of skin cancer, including melanoma, basal cell carcinoma and squamous cell carcinoma.</p><p>Melanoma is the least common but most dangerous. It can start in an existing or new mole or spot and change over months. If left unnoticed and not treated in the early days, the cancer can move to the internal organs and can cause death.</p><p>The Basal Cell Carcinoma and Squamous Cell Carcinoma are more common than melanoma. They are slow growing cancers but should still be treated early to ensure they don’t spread and reduce the damage they can cause.</p><p>Monthly self-checks will allow you to notice changes in your skin and pick up any cancerous or precancerous spots. Follow these steps to complete a thorough skin self-check:</p><ol><li>Look in the mirror and check all of your face and neck, paying close attention to nose, lips, mouth and ears.</li><li>Check your scalp using a hair dryer and a hand mirror to inspect under your hair.</li><li>Check backs of hands and palms, including between fingers and under your nails</li><li>Undress completely and stand in front of a full-length mirror.</li><li>Check arms including elbows and underarms in a mirror.</li><li>Next, check chest and torso.</li><li>Turn your back to the full-length mirror and use a hand-held mirror to look over the length of your body.</li><li>Sit down to check the front and sides of each leg from thigh to shin then feet, including your soles, between the toes and under toenails.</li></ol><p>Remember to make an appointment at your nearest Family Medical Practice medical center if any of your spots are suspicious looking or you aren’t sure of anything.</p>"
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{
"id": 955,
"title": "HIV and the skin",
"slug": "hiv-and-skin",
"slug_en": "hiv-and-skin",
"slug_vi": "hiv-and-skin",
"slug_ko": "hiv-and-skin",
"slug_ja": "hiv-and-skin",
"overview_image": {
"id": 496,
"url": "https://media.fmp-data.bliss.build/original_images/46509144172_de8dc81940_b.jpg",
"compressed": "https://media.fmp-data.bliss.build/images/46509144172_de8dc81940_b.format-jpeg.jpegquality-75.jpg"
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"post_date": "2019-12-26",
"category": {
"id": 5,
"name": "Blogs",
"slug": "blogs"
},
"subcategory": {
"id": 18,
"name": "Dermatology",
"slug": "dermatology"
},
"tags": "",
"summary": "What is this early connection between HIV and the skin? There is a very common skin ailment that may be the first hint that an otherwise healthy young patient is HIV positive. This ailment is shingles.",
"related_pages_title": null,
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"locations": [
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"content": [
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"value": "<p></p><p>People are often shocked to learn that several times per year, I have to give a patient the news that they are HIV positive. This is true even if that patient feels healthy, and has no skin signs of HIV. What is this early connection between HIV and the skin? There is a very common skin ailment that may be the first hint that an otherwise healthy young patient is HIV positive. This ailment is shingles.</p><p>Shingles is caused by the same virus that causes chickenpox. If you were exposed to this chickenpox virus, or even if you had the chickenpox vaccine (which is a weakened version of the live virus), you may get shingles decades later. In order to get shingles, you must have had chickenpox first, or the vaccine. But chickenpox can be so mild in children, that some people who get shingles do not even recall ever having had chicken pox.</p><p>The risk of getting shingles increases as you age, especially after age 50. Part of the reason for this is that your immune system weakens as you age. But early HIV also weakens the immune system. This is why if shingles occurs in a relatively young person, especially with certain risk factors, it can be an indicator for HIV. This is because the HIV virus weakens the immune system in all patients, regardless of age.</p><p>I recently saw a male patient in his early 30's whom I diagnosed with shingles. Because of his young age, I ordered a blood test for HIV. Most of the time, the HIV test is negative in patients with shingles. In addition, the patient insisted there was no way he could have contracted HIV. I explained to the patient that although he was probably right, my policy is to always be thorough, and rule out every possibility, no matter how unlikely.</p><p>The test did come back positive, and I had to give the patient the unfortunate news. Although the news brings on a mix of emotions, the early diagnosis greatly improves the effectiveness of treatment, as well as overall prognosis. The patient later admitted that he did have a risk factor that he was embarrassed to disclose, even to me, his physician of more than 10 years.</p><p>Although most patients want to be honest and thorough, reasons such as lifestyle, infidelity, etc. can cause the patient to omit items in their history, thinking it won't make a difference in their diagnosis. An experienced physician will always go beyond what the patient says, to fit all the pieces of the puzzle together.</p><p>Our skin is our body’s largest organ, and the health of our skin is often a prime indicator of our overall health.</p>"
}
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{
"id": 719,
"title": "Health Talk on Stress Management",
"slug": "health-talk-stress-management",
"slug_en": "health-talk-stress-management",
"slug_vi": "health-talk-stress-management",
"slug_ko": "health-talk-stress-management",
"slug_ja": "health-talk-stress-management",
"overview_image": {
"id": 326,
"url": "https://media.fmp-data.bliss.build/original_images/Health_talk_on_stress_management_in_Danang_events.png",
"compressed": "https://media.fmp-data.bliss.build/images/Health_talk_on_stress_managem.format-jpeg.jpegquality-75.jpg"
},
"post_date": "2019-12-10",
"category": {
"id": 2,
"name": "Events",
"slug": "events"
},
"subcategory": {
"id": 8,
"name": "Health Talks",
"slug": "health-talks"
},
"tags": "",
"summary": "Providing community talks, Family Medical Practice hopes that all employees and their families can gain more awareness of stress’ effects and develop healthy habits to fight it.",
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"value": "<p><b>Health talk on Stress Management in Danang</b></p><p>On December 08-09, Family Medical Practice successfully conducted talks on Stress Management for employees of Pullman Beach Resort in Danang.</p><p>Two groups of more than 100 staff of the resort were explained about what the signs and symptoms of stress are and how stress leads to different ill effects on one’s health - both body and mind by the speaker - Dr. Christopher, also Medical Director. The doctor explained how stress increases the risks of conditions like heart disease, high blood pressure, depression and obesity. In addition, the participants were showed the ways to deal and manage stress such as positive self-talk, emergency stress stoppers, social support and pleasure finding from relatives and friends as well as daily relaxation.</p><p>It’s rightly said, “worrying won’t stop the bad things from happening, it just stops you from enjoying the good”. Therefore, by providing these talks, Family Medical Practice hopes that all employees and their family’s members can gain more awareness of stress’ effects and develop healthy hahits to fight it.</p>"
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{
"id": 899,
"title": "SIMBA session weekly",
"slug": "simba-session-weekly",
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"slug_vi": "simba-session-weekly",
"slug_ko": "simba-session-weekly",
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"post_date": "2019-11-28",
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"id": 2,
"name": "Events",
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"value": "<p></p><p>Our Japanese SIMBA group held a very special session this week with a tour at our D2 medical center and emergency ambulance service.</p><p>7 Japanese mums and 10 children between 0–5 years old joined yesterday’s tour of the new facilities. The mothers learned more about our recently expanded D2 Medical Center and enjoyed the opportunity to meet and exchange information.</p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/SIMBA_session_weekly.jpg\" class=\"format-left\" /><p></p><p>The group visited several parts of the medical center, including the alarm center where emergency calls are handled; the operating theater where our orthopedic procedures are performed; and the dermatology room which houses our new scar treatment clinic. They also toured our inpatient rooms—one mother commented that they looked like hotel suites—as well as our rooms for psychiatric and physiotherapy treatments, and our salt room, which is currently under preparation to offer halotherapy treatments for patients with respiratory problems such as asthma.</p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/SIMBA_session_weekly_3.jpg\" class=\"format-left\" /><p></p><ul><li>The SIMBA mothers were also introduced to our in-house laboratory, which enables our clinic to provide rapid test results with minimal waiting time, and our endoscopy room under Japanese gastroenterologist Dr. Masato, which features one of the most advanced endoscopes in the country.</li><li>While the mothers appreciated visiting the pharmacy and vaccination rooms, where nurses explained the available medication and how vaccines are stored safely, the children loved the pediatric consultation room with all the colorful fish decorations. The ambulances were an exciting feature of the tour as our emergency staff were able to explain the high-tech facilities on board and stress the importance of our *9999 emergency service.</li><li>Although the small children had been scared of going to the doctor in the past—usually frightened of taking vaccinations—they were delighted to get to know the medical center better.</li><li>After the tour, the mothers spent some time taking tea and coffee (and the favorite cakes that have become staples at our regular meetings!) while the children played together. One of the mothers had previously been a long-term patient at FMP and mentioned how supportive FMP, especially the Japanese team, have been—and said that she and her husband are very grateful.</li><li>In other news of interest to our Japanese community, FMP has hired a new Japanese gynecologist—who will be a great addition to our current team of physicians. Our new doctor is fluent in English as well as Japanese and so will be able to provide services to women from throughout our community.</li></ul><p>Clinic and ambulance tours for mums and children are a wonderful way to explore the facilities at Family Medical Practice. For more information about future tours, please contact our marketing team on (028) 3822 7848.</p><p>-- Family Medical Practice Vietnam: <a href=\"https://l.facebook.com/l.php?u=https%3A%2F%2Fwww.vietnammedicalpractice.com%2F%3Ffbclid%3DIwAR3LUR8Y9CNY8cf1l_mfylOT6y8xds2qhDUQvHs5l6tqx63AyJeU4vS9F1g&h=AT1IG28hjMZFVeQLG2MpSYNoCUx1ZV-gaA7VJBQmPcA9w96zEDStm0ArmkUBHsyVQvK8vrOI0moIJlO-WiLNOozi3E659Qe4c7iBiD5yM5VhpFk2Hys2ExTtsRmzukKRcuh9YxWIisozu4MafjuRpdFIHJ1hTXUtLcfIeABWnXZS--qXyClYXCsYK-s87D7R0KB6RjGRBitZRW-tf00bCf-wGnA6ZB9X8PwTdet-M0_jxY7dBtHYr9ZxnbTFTYHCLZXxpzRmERk0j9iDFL2boAQFbweOdg7ynEFNtHO6wxEk1smIUg0d2xgdwNlLpJMv_PJRLgDFA70VvJEXuIIe-gBU_ZArj5LHu30vx4AnvktqW_8btOCLTZYN1EMq9JI3p8qZAFjYcdyFbt9W5czvnl_em-wIVsx6LE2TSlM1c4bxuVz5bJnQLr0PP8nOlxmMogtxPqhu5GmISBVa0CRt2MtPcsPyUkNmvhXz5y1PlSBCluDEq-CHWq87V-7a-rOyQVtQY29smvnIPp0STaATdG8UiE01QJlkldWMnsASQsURPEaxbg1nfRQoxPyvleeNuC1FiEkDY6a0bbVaifwD2xfMCBEUPxhW1vcBOtx0KS3UXuzj_g0_tY9ibpCi5_NH_KVBsZc\">https://www.vietnammedicalpractice.com/</a></p>"
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{
"id": 823,
"title": "First aid workshop at Imperia An Phu residency- District 2",
"slug": "first-aid-workshop-imperia-phu-residency-district-2",
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"overview_image": {
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"post_date": "2019-11-28",
"category": {
"id": 2,
"name": "Events",
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"id": 9,
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"type": "text",
"value": "<p>45 local residents from Imperia An Phu took part in an FMP first aid workshop to enhance their knowledge and practical skills in helping to save lives. The workshop was convened in Vietnamese by FMP nurse Thanh Sang.</p><p><a href=\"http://example.com/documents/5/First_aid_workshop__Imperia_An_Phu_residency_D2_Nov_28th_2019_3.jpg\" target=\"_blank\">First aid workshop @ Imperia An Phu residency D2</a></p><p>A range of the Imperia’s residents showed up to participate, including several more senior members who joined the event with their families, as well as six children younger than 10 years old. The group raised many questions—such as, in the case of a broken rib cage, do we still perform CPR? How is CPR performed on an infant? Should it be used in a drowning case? And should we use mouth-to-mouth resuscitation with strangers if we are concerned about the potential to transmit disease?</p><p>👶 Issues related to choking were also discussed in the course, such as what to do if you start choking when alone, what to do if a baby chokes on milk during breastfeeding, and how choking happens in children and infants. One participant asked if it’s more important to call emergency services before performing the Heimlich maneuver, or if it’s only necessary to call if this intervention fails.</p><p>🚑 Our team introduced the *9999 ambulance response number to residents and encouraged all present to place a free call to the hotline if any emergency arises. The course participants were informed that anyone can call this number for medical advice or assistance from anywhere in Vietnam.</p><p><a href=\"http://example.com/documents/6/First_aid_workshop__Imperia_An_Phu_residency_D2_Nov_28th_2019_2.jpg\" target=\"_blank\">First aid workshop @ Imperia An Phu residency D2</a></p><p>🗓 A second workshop is scheduled to be held at the Imperia on May 25th for Korean residents. As the talk will be presented in English with the assistance of a Korean translator, all members of the community are encouraged to attend the session.</p>"
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{
"id": 739,
"title": "Child Abuse Talk by Dr. Jane and Dr. Miguel",
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"post_date": "2019-11-26",
"category": {
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"value": "<p></p><p>On November 26, two FMP physicians presented talks on CHILD ABUSE as part of Amcham’s Child Protection and Safeguarding symposium, a special event focusing on the need to protect children from all forms of abuse.</p><p>The event was held at New World hotel and introduced by veteran educator Dr. Dennis Larkin, who works with international school boards in providing board governance training, strategic planning and child protection training and programs.</p><p>Dr. Larkin opened the discussion by questioning what prevents people from dealing with the issue of child abuse, including concerns about reputation, cultural differences, and having insufficient systems in place, as well as not wanting to break up a family or send a perpetrator to jail. He said that it is critical to take abuse personally, commenting “there is nothing more personal than the abuse of a child”. He also stressed the importance of institutions—especially schools—having a “systemic and systematic way to deal with child protection” and proactively creating a policy to deal with cases before they arise.</p><p>FMP psychiatrist Dr. Miguel de Seixas’s presentation discussed the need for caution and careful consideration on the part of medical practitioners in assessing abuse cases. He noted that child mistreatment can include acts of omission (not providing appropriate care) and commission (perpetrating acts of abuse either intentionally or unintentionally). He also noted that the negative effects of child abuse can depend on a child’s vulnerability as well as resilience, and that not all cases can be treated the same way. He did emphasize that most instances of abuse in childhood predict at least one adverse health outcome that can occur as late as adulthood.</p><p></p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/Dr_Jane__Dr_Miguel_on_CHILD_ABUSE_1.png\" class=\"format-fullwidth\" /><p></p><p>Our infectious disease specialist Dr. Jane Shadwell-Li discussed signs of child abuse that doctors usually encounter and reminded attendees that a doctor’s response to child abuse is complicated by the fact that symptoms are not only physical and emotional, but also evidence of a crime. She noted that doctors need to consider certain red flags when assessing a potential case of child abuse, such as severe trauma with no explanation (or an implausible explanation) given by the caregiver, or if serious injuries are attributed to pets, other children, or the result of activities the child is too young to perform. She presented statistics showing that injuries to the torso, ear and neck in children less than four years old are highly indicative of abuse, as are bruises with identifiable shapes.</p><p>Dr. Jane’s presentation ended with a strong key message reminding educators and those caring for children that a fear of mistakenly suspecting sexual abuse should not be a reason to stay silent. If you suspect abuse or neglect, don’t wait for someone else to speak up – your report could save a child’s life. Children cannot stop child abuse – only you can.</p><p>Dr Jane also shared information concerning the Ho Chi Minh City Department of Home Affairs’ new policy on the prevention and handling of child abuse cases, which includes new hotlines for victims and their families. HCMC callers suspecting abuse can dial 1900.54.55.59 or 1800.90.59 to speak with a counselor who can take action to protect the child.</p>"
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{
"id": 960,
"title": "8 Awesome Health Benefits of Dark Chocolate",
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"post_date": "2019-11-20",
"category": {
"id": 5,
"name": "Blogs",
"slug": "blogs"
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"subcategory": {
"id": 19,
"name": "Healthy Living",
"slug": "healthy-living"
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"tags": "",
"summary": "One of the benefits of dark chocolate is its free radical fighting ability. One of dark chocolate’s most impressive attributes is its high antioxidant content.",
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"locations": [
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"type": "video",
"value": "https://draxe.com/nutrition/benefits-of-dark-chocolate/"
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{
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"value": "<p></p><p>It’s important to realize that not all chocolate is created equal, not even close. The potential health benefits of processed, highly sweetened chocolate are slim to none, but the health benefits of dark chocolate are numerous and quite impressive.</p><p>One of the benefits of dark chocolate is its free radical fighting ability. One of dark chocolate’s most impressive attributes is its high antioxidant content. Two groups of antioxidants prevalent in dark chocolate are flavonoids and polyphenols. Dark chocolate’s cocoa has actually been shown to have the highest content of polyphenols and flavonoids, even greater than wine and tea.</p><p>Dark chocolate flavanols can also help make blood platelets less sticky and able to clot, which reduces the risk of blood clots and stroke. The results showed that flavonoid-rich dark chocolate intake significantly improved heart circulation in healthy adults.</p><p>The cocoa butter found in dark chocolate contains equal amounts of oleic acid (a heart-healthy monounsaturated fat found in olive oil), stearic and palmitic acids. Palmitic acid in dark chocolate can increase cholesterol levels, but thankfully it only makes up about a small portion of the fat in dark chocolate—plus dark chocolate has a lot of great plant nutrients that make up for palmitic acid.</p><p>Previous research showed that “acute as well as chronic ingestion of flavanol-rich cocoa is associated with increased blood flow to cerebral gray matter and it has been suggested that cocoa flavanols may be beneficial in conditions with reduced cerebral blood flow, including dementia and stroke.”</p><p>The researchers found that not only did dark chocolate lowers the blood pressure of the hypertensive diabetics, but it also decreased fasting blood sugar.</p><p>The dark chocolates, cocoa powder and cocoa beverage in the study all contained natural or non-alkalized cocoa. This is important to note since the alkalinization of cocoa has been shown to destroy healthy polyphenolic compounds. It was also revealed that dark chocolate’s antioxidant capacity was higher than all of the super fruit juices except pomegranate.</p><p>Researchers found the contrast sensitivity and visual acuity were higher two hours after eating dark chocolate bar compared to eating milk chocolate. The study, however, concludes the duration of these effects and their real-world implications require further testing.</p><p>Another benefit of dark chocolate is its potential as a cancer-fighting food. A recent review of studies on the cancer protective properties of cocoa concluded that the evidence is limited but suggestive.</p><p>Dark chocolate is good for you as long as you choose the right product. Dark chocolate has been shown to improve so many common and chronic health problems. With all of its natural and health-promoting components, dark chocolate is an antioxidant powerhouse and a superfood that’s truly a joy to eat. It’s been shown to boost heart and brain health, along with fight disease—just some of the many benefits of dark chocolate.</p>"
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{
"id": 959,
"title": "Types of Fish You Should Never Eat + Safer Seafood Options",
"slug": "types-fish-you-should-never-eat-safer-seafood-options",
"slug_en": "types-fish-you-should-never-eat-safer-seafood-options",
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"slug_ja": "types-fish-you-should-never-eat-safer-seafood-options",
"overview_image": {
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"url": "https://media.fmp-data.bliss.build/original_images/yaytg407218_l.jpg",
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"post_date": "2019-11-20",
"category": {
"id": 5,
"name": "Blogs",
"slug": "blogs"
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"subcategory": {
"id": 19,
"name": "Healthy Living",
"slug": "healthy-living"
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"tags": "",
"summary": "The best fish options are ones that come from sustainable fisheries, are lower in contaminants and high in omega 3 fatty acids.",
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"value": "<p></p><p>It’s vitally important to get ample omega-3 fatty acids, and certain FISH may serve as potent sources. But due to things like fossil fuel emissions, heavy metals like mercury are winding up in the water and building up in our fish.</p><p>Some fish have been so overfished that they are on the brink of collapse—and losing them could impact the ocean ecosystem in a way that could lead to a cascading effect, impacting so many other species we rely on for nutrition, too.</p><p>Let’s take a look at fish you should never eat:</p><ul><li>Tilapia contains very low levels of beneficial omega-3 fatty acids and, perhaps worse, very high levels of omega-6 fatty acids. That means the natural fish oil benefits found in this fish are not likely adequately boosting your omega 3s. The low omega-3/high omega-6 ratio is a potentially dangerous food for people living with heart disease, arthritis, asthma and other allergic and autoimmune disease symptoms who are vulnerable to an exaggerated inflammatory response.</li><li>People are recommended not to eat some species as they are at the verge of extinction. Those species include: Atlantic cod, Beluga sturgeon, Atlantic Bluefin Tuna, and Atlantic Flatfish.</li><li>Not only has Chilean seabass overfishing left this species in serious trouble, this type of fish is also considered not safe to eat due to elevated mercury levels. Harvesting this fish from Chile is plagued by poor management and by bycatch problems.</li><li>Mercury is also the main concern when it comes to avoiding swordfish. This large, predatory fish contains such elevated levels that women and children are recommended not to eat it.</li><li>The dangers of farmed fish, particularly farmed salmon, are enough to make your stomach turn. Most salmon marketed as “Atlantic” salmon is farmed, meaning fish are raised in conditions that have been shown to be ridden with pesticides, feces, bacteria and parasites.</li><li>A 2016 study found 70 to 80 percent of pangasius samples were contaminated by vibriobacteria—the microbes behind most cases of shellfish poisoning. Raw or undercooked pangasius, the authors warned, could pose a hazard to consumers.</li></ul><p>Here are some ways to make smarter seafood choices:</p><ul><li>The best fish options are ones that come from sustainable fisheries, are lower in contaminants and high in omega 3 fatty acids.</li><li>You can obtain the EPA and DHA omega-3 fatty acid benefits found in fish by consuming a phytoplankton supplement. In fact, certain fish are high in omega-3s because they eat phytoplankton. Phytoplankton are rich in amino acids, antioxidants, minerals and omega-3 fatty acids.</li></ul><p>When you do eat fish, it’s safe to stick with wild-caught Alaskan salmon, Pacific sardines and Atlantic mackerel.</p>"
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{
"id": 849,
"title": "Influenza Vaccination 2019",
"slug": "influenza-vaccination-2019",
"slug_en": "influenza-vaccination-2019",
"slug_vi": null,
"slug_ko": null,
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"overview_image": {
"id": 392,
"url": "https://media.fmp-data.bliss.build/original_images/Influenza_Vaccination_2019_promotion.jpg",
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"post_date": "2019-11-01",
"category": {
"id": 1,
"name": "Announcement board",
"slug": "announcement"
},
"subcategory": {
"id": 11,
"name": "Promotions",
"slug": "promotions"
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"summary": "",
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146
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"content": [
{
"type": "text",
"value": "<p>Get your flu vaccination now to help protect yourself and those around you.</p><p>Special price from now until 31 December 2019: 360.000VND per shot.</p><p>For more information, please contact your nearest Family Medical Practice medical center. </p><p>Tel: (028) 3822 7848</p><p>Email: hcmc@vietnammedicalpractice.com</p>"
}
],
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{
"id": 963,
"title": "Exercise at your desk",
"slug": "exercise-your-desk",
"slug_en": "exercise-your-desk",
"slug_vi": "exercise-your-desk",
"slug_ko": "exercise-your-desk",
"slug_ja": "exercise-your-desk",
"overview_image": {
"id": 794,
"url": "https://media.fmp-data.bliss.build/original_images/shutterstock_226122967-1.jpg",
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"post_date": "2019-10-20",
"category": {
"id": 5,
"name": "Blogs",
"slug": "blogs"
},
"subcategory": {
"id": 19,
"name": "Healthy Living",
"slug": "healthy-living"
},
"tags": "",
"summary": "Small amounts of exercise throughout the day is more beneficial than one long session once per day.",
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"locations": [
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"content": [
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"type": "video",
"value": "https://blog.hif.com.au/fitness/exercise-session-at-your-desk"
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"value": "<p></p><p>Corporate life requires us to sit at a desk all day, limiting our opportunities to exercise. Sitting down for the majority of your working day can cause long and short term health problems. Sitting for hours at time means you aren’t using your legs and glute muscles, which you need to be strong and stay stable on your feet and avoid injuries. Your hips flexors can also shorten, and your spine can degenerate prematurely. You are also likely to gain weight and are at risk of metabolic syndrome.</p><p>Small amounts of exercise throughout the day is more beneficial than one long session once per day. During the day, you can do some exercise without leaving your desk.</p><p><b>Stand Up to Work</b></p><p>Stand up desks have become popular in workplaces in recent years. One hour standing will burn 50 calories more than sitting. Just a few hours of standing every day will add up to 750 calories per year.</p><p>You can choose a flexible desk that can switch from standing to sitting during the day. In this way, your legs can rest when you’ve had enough standing. If you aren’t into standing, try replacing your office chair with an exercise ball. Your core muscles will be improved as you keep your balance on the ball.</p><p><b>Exercises at your Desk</b></p><p>Keep your body active during the day by doing a few exercises at your desk. Some of the exercises are so subtle that colleagues won't even know you are doing them. Others aren’t, but don’t let that stop you. Encourage your workmates to join you in a quick exercise session. If you want to get serious, you can all keep a yoga mat under your desk which you can roll out and find your zen.</p><p><b><i>Shoulder blade squeezes</i></b></p><p>Squeeze your shoulder blades as if you're holding a small object between them for 10 seconds before releasing and repeating.</p><p><b><i>Shoulder Shrugs</i></b></p><p>Raise your shoulders and hold for 5 seconds before releasing.</p><p><b><i>Chair Squats</i></b></p><p>Keep your arms out in front of you, lower yourself onto your chair before quickly standing again.</p><p><b><i>Tricep Desk Dips</i></b></p><p>Stand with your back to your desk and place both hands at shoulder width length around the desk edge. Bend your arms then straighten keeping tension on your triceps muscles.</p><p><b><i>Ab Squeezes</i></b></p><p>Keep a daily workout on your chair by taking a deep breath, tighten your abdominal muscles and hold for 5–10 seconds.</p><p><b><i>Leg Extensions</i></b></p><p>Sit in your chair, extend one leg to a horizontal position, hold for a few seconds before lowering back to the starting position.</p><p><b><i>Move around the office</i></b></p><p>Find reasons to leave your desk occasionally. Go and see a colleague at their desk rather than picking up the phone or sending an email. Take the stairs rather than the lift or escalator whenever possible.</p><p>Among work sessions, reward your productivity with a quick walk around the block to get your blood circulating and heart pumping.</p>"
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{
"id": 851,
"title": "Sleep problem at BVIS international school",
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"value": "<p></p><p>Last week Family Medical Practice’s head pediatrician Dr. Jonathan Halevy addressed a group of 40 parents at BVIS international school on the topic of sleep problems and how to develop healthy sleep patterns.</p><p>Dr. Jonathan emphasized the importance of sleep, which can assist and support brain function and development, and explained what happens when a person lacks sleep.</p><p>There is a high prevalence of sleep disorders throughout childhood and adolescence. 25–50% of preschoolers and up to 40% of adolescents experience problems with sleep. About 30% of children diagnosed with ADHD may actually suffer from a sleep disorder.</p><p>Dr. Jonathan also explained about the circle of sleep, which includes four stages: essentially stages 1–2 are forms of light sleep, while stages 3–4 are deep sleep and REM sleep when dreaming usually occurs.</p><p>During the talk, Dr. Jonathan explained about sleeping hours and the problems of each age, including newborns, infants, toddlers, preschool, school-aged and adolescent children. In order to have a good sleep, he kept reminding everybody to establish a solid bedtime routine, with no screen before bed and no caffeine in the evening.</p><p>For more information, please check out Dr. Jonathan’s article Counting Sheep in Oi Vietnam here: <a href=\"http://oivietnam.com/2017/05/counting-sleep/?fbclid=IwAR2biGLkU5uBNxXTuq3XEoQagPyh6gj-ecQnQk42faUOXdUPOdCCAcwMijo\">http://oivietnam.com/2017/05/counting-sleep/</a></p>"
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{
"id": 832,
"title": "Constipation in Children Talk at British International School",
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"post_date": "2019-10-11",
"category": {
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139
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"value": "<p></p><p>Last week, Family Medical Practice’s pediatrician Dr. Nguyen Huu Linh held a talk for BIS parents on constipation, a common condition that is always of great concern to parents.</p><p>Based on years of his own experience in treating pediatric patients, Dr. Huu Linh explained to parents about the signs they should look for if their children get constipation—from the frequency of their going to the toilet and the time they spend in there.</p><p>The doctor also encouraged the parents to have their children diagnosed and receive correct and timely treatment to avoid further complications.</p><p>After the talk, parents raised a lot of questions about their children and were happy to hear the answers provided by Dr. Huu Linh.</p><p>To make an appointment with Dr. Huu Linh, please visit reception at our District 2 medical center.</p>"
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{
"id": 825,
"title": "First Aid Demo at Indonesian Consulate's House",
"slug": "first-aid-demo-indonesian-consulates-house",
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"post_date": "2019-10-10",
"category": {
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"name": "Events",
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"id": 9,
"name": "First Aid Courses",
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"content": [
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"type": "text",
"value": "<p></p><p>On October 10, ∗9999's emergency nurse Mark Javier presented an engaging workshop to the Indonesian Ladies of HCMC at the residence of the Indonesian Consul General. The workshop covered basic life support and how to perform immediate CPR to save a life in danger.</p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/First_aid_demo_at_Indonesian_Consulates_House_October_10_2.jpg\" class=\"format-left\" /><p></p><p>Participants took an active interest in learning about the out-of-hospital five links of the Survival Chain for adults and infants, and took turns to practice chest compression exercises on the mannequins.</p><p>Following practical training, protocols on vital guidelines when calling ∗9999 for immediate emergency assistance and ambulance dispatch were provided by the ∗9999 alarm center manager Marvin Mesina. The ladies exchanged their emergency experiences in Vietnam and shared positive reviews of ∗9999's life saving services.</p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/First_aid_demo_at_Indonesian_Consulates_House_October_10_3.jpg\" class=\"format-left\" /><p>For more information on ∗9999’s emergency first aid workshops and courses, please contact our marketing team on (028) 3822 7848, or enquire at the reception of your nearest medical center.<br/></p><p></p><p></p>"
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{
"id": 957,
"title": "How to Get Rid of Bacne",
"slug": "how-get-rid-bacne",
"slug_en": "how-get-rid-bacne",
"slug_vi": "how-get-rid-bacne",
"slug_ko": "how-get-rid-bacne",
"slug_ja": "how-get-rid-bacne",
"overview_image": {
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"post_date": "2019-09-13",
"category": {
"id": 5,
"name": "Blogs",
"slug": "blogs"
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"subcategory": {
"id": 18,
"name": "Dermatology",
"slug": "dermatology"
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"tags": "",
"summary": "Bacne (or back acne) refers to whiteheads, blackheads and cysts on the back, which can occur in both men and women—though it’s more common in men",
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"value": "<p></p><p>Bacne (or back acne) refers to whiteheads, blackheads and cysts on the back, which can occur in both men and women—though it’s more common in men. As with acne on your face, bacne is caused by hormonal changes; excess oil production and bacteria; excess dead skin cells that clog pores; and also excessive sweating and tight clothing.</p><p>How can we get rid of bacne?</p><ol><li>Topical antibiotics: Wash your back daily with a salicylic-based body wash or gel that helps exfoliate dead skin and isn’t too drying (salicylic acid is a chemical exfoliator). You could also try a body wash or gel that contains benzoyl peroxide, which kills acne-causing bacteria.</li><li>Avoid wearing tight workout clothing like spandex that can irritate the skin and lead to breakouts. Wear loose, breathable fabrics that are designed to whisk sweat away from your skin.</li><li>Always shower right after exercising, or use portable salicylic or glycolic acid pads in case you’re unable to.</li><li>Use a physical exfoliator or scrub that contains little exfoliating beads once or twice a week, or get prescription strength oral or topical antibiotics from your dermatologist.</li><li>Always apply sunscreen. Choose an oil-free sunscreen with an SPF of 30 and apply to your back. Don’t use acne-fighting soaps and lotions, since they can leave your skin more vulnerable to sunburn.</li></ol>"
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{
"id": 872,
"title": "Advanced Cardiac Life Support and Pediatric Advanced Life Support",
"slug": "advanced-cardiac-life-support-and-pediatric-advanced-life-support",
"slug_en": "advanced-cardiac-life-support-and-pediatric-advanced-life-support",
"slug_vi": "advanced-cardiac-life-support-and-pediatric-advanced-life-support",
"slug_ko": "advanced-cardiac-life-support-and-pediatric-advanced-life-support",
"slug_ja": "advanced-cardiac-life-support-and-pediatric-advanced-life-support",
"overview_image": {
"id": 408,
"url": "https://media.fmp-data.bliss.build/original_images/ADVANCED_CARDIAC_LIFE_SUPPORT_and_PEDIATRIC_ADVANCED_LIFE_SUPPORT_-_Septem.jpg",
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"post_date": "2019-09-01",
"category": {
"id": 2,
"name": "Events",
"slug": "events"
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"subcategory": {
"id": 28,
"name": "Emergency Training & Drills",
"slug": "Emergencytrainingdrills"
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"value": "<p></p><p>From the end of September up to the first week of October, all of FMP’s physicians, nurses, and emergency team members participated in ADVANCED CARDIAC LIFE SUPPORT and PEDIATRIC ADVANCED LIFE SUPPORT training.</p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/ADVANCED_CARDIAC_LIFE_SUPPORT_and_PEDIATRIC_ADVANCED_LIFE_SUPPORT_-_Sept_LzMVGWV.jpg\" class=\"format-left\" /><p></p><p>Following American Heart Association guidelines, our team of practitioners participated in bi-annual ACLS and PALS training to refresh their knowledge of emergency procedures. The guidelines themselves are updated every five years and all medical practitioners are recommended to stay up to date with current protocols. The next update is expected to be released next year.</p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/ADVANCED_CARDIAC_LIFE_SUPPORT_and_PEDIATRIC_ADVANCED_LIFE_SUPPORT.jpg\" class=\"format-left\" /><p></p><p>The emergency protocols are of vital importance in saving lives, and we ensure all staff and practitioners treating patients are familiar with them. It’s also important that each member of our emergency teams are well trained and abreast of their roles when responding to a crisis situation—including who is the team leader, who should manage IV insertion, medication, defibrillation, and patient airway monitoring.</p><p>With all systems in place and medical staff training renewed, internationally recognized protocols can be effected immediately once an emergency is diagnosed, making emergency care at Family Medical Practice maximally effective in saving lives and restoring health.</p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/ADVANCED_CARDIAC_LIFE_SUPPORT_and_PEDIATRIC_ADVANCED_LIFE_SUPPORT_1.jpg\" class=\"format-left\" /><p></p><p>IN CASE OF EMERGENCY, DIAL ∗9999 FOR ASSISTANCE.</p>"
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{
"id": 726,
"title": "Traveler's Guide: Holiday Insurance",
"slug": "travelers-guide-holiday-insurance",
"slug_en": "travelers-guide-holiday-insurance",
"slug_vi": "travelers-guide-holiday-insurance",
"slug_ko": "travelers-guide-holiday-insurance",
"slug_ja": "travelers-guide-holiday-insurance",
"overview_image": {
"id": 336,
"url": "https://media.fmp-data.bliss.build/original_images/Travel_Insurance.jpg",
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"post_date": "2019-07-19",
"category": {
"id": 3,
"name": "Media & Press",
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"tags": "",
"summary": "Most travellers visiting Vietnam opt to use private hospitals or clinics, as these are usually equipped with English-speaking medical staff and are able to file insurance claims for patients. However, travellers are quite often confused about how health insurance works for different medical services.",
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885,
884,
883,
882
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"value": "<p>Finding a travel insurance provider with decent medical coverage that is recognised in Vietnam can be a bit like finding a needle in a hay-stack. Yet, it's possibly one of the most important part of your holiday prep to get right. To save you endlessly Googling 'the best travel insurance for Vietnam', Da Nang Medical Practice has put together a guide to the best medical insurance policies for a Vietnam holiday.</p><p>Most travellers visiting Vietnam opt to use private hospitals or clinics, as these are usually equipped with English-speaking medical staff and are able to file insurance claims for patients. However, travellers are quite often confused about how health insurance works for different medical services. The following guide on how this is dealt with at Family Medical Practice and some advice on the best policies may be helpful for those who intend to travel to this beautiful country.</p><p><b>Why Take Out Health Insurance For a Holiday in Vietnam?</b></p><p>No matter how long you’re staying in Vietnam, medical insurance is essential, particularly when you’re travelling to a country in which rules and regulations are not the same as they may be at home. Medical insurance not only helps to protect you and your family against financial and health risks, but also brings you peace of mind as you travel, make discoveries and have exciting adventures in unfamiliar lands. Something unexpected could happen at any moment, but if you’re covered by insurance, you won’t have to pay the full cost of what could be a huge number of bills. Your insurance should cover you and your family for outpatient services, but more significantly for inpatient, evacuation and repatriation. It’s recommended that you arrange your medical insurance prior to arriving in Vietnam.</p><p><b>Which Insurers Provide The Best Plans?</b></p><p>It’s obvious that medical insurance is a good investment before any trip, and a travel medical plan with benefits should be based on the length of your trip, your age, your medical history and the medical and evacuation coverage limits.</p><p>You may be wondering where to buy your travel insurance: comparing policies from different travel insurers is the most common way for people to choose an insurance cover customised to their needs and at the best price. Some reputable insurance companies which Family Medical Practice often processes claims to are GlobalHealth, Allianz Worldwide Care, Liberty, InterGlobal and Insmart, among others.</p><p><b>Do All Travel Insurance Policies Offer Cashless Hospitalisation?</b></p><p>Today, most health insurance policies offer cashless hospitalisation and route your policy through a Third Party Administrator (TPA). Family Medical Practice (FMP) has established direct billing agreements (also called Third Party Agreements) and maintained a close working partnership with a number of international and local insurance providers so that different medical services can be provided as a cashless service. This enables FMP to claim directly from the insurance company on your behalf in case of inpatient or medical evacuation services. In these cases, you will not have to pay cash upfront for your treatment. FMP’s specialist staff will take care of all the paperwork associated with the claim process.</p><p><b>What Are The Administration & Claims Procedures?</b></p><p>You are advised to present your personal insurance card (and if possible your table of benefits, your proof of identity and medical history record, if any) when you arrive for your first consultation before you meet the doctor. For those insurance companies that FMP has direct billing agreements with, FMP will process the billing directly. In this case, you are requested to sign a credit card guarantee form upon registration. This requires you to present a valid credit card. If any amounts are declined or excluded by your insurance company after FMP submits the claim, the specialist will notify you of any shortfall. You are asked to settle the outstanding amount within 48 hours, failing which FMP will then debit the amount to the given credit card. All payment scheme information is treated as highly confidential.</p><p>In order to make a claim directly on your behalf, the specialist will communicate with your insurer and send a medical report of your current situation with any other required documents. Your insurance company will then review your benefits and send FMP a Guarantee of Payment for all the treatment fees (in most cases). If hospitalisation is approved, you may pay deductibles, coin-sure or copay, depending on your policy. In case cashless billing is not approved, you will need to pay the expenses upfront and submit the bill for reimbursement later (this is very rare).</p><p>Regarding outpatient services, you will need to pay fees upfront. FMP will issue relevant papers relating to the visit including medical reports, certificate and any itemized bills. You will then submit these papers along with a copy of your passport (photo side and visa side); a copy of your insurance card; a self-claim form (if any); and your own bank account details to your insurance company for reimbursement.</p><p><b>What do I Need If I Have An Accident Or Serious Illness?</b></p><p>Ask the staff at the hotel where you’re staying, go to the nearest medical facility, or make a call to the FMP Danang hotline on +84 913 917 303.</p><p><b>What Else Do I Need To Pay Attention To?</b></p><p>It’s advisable to give a copy of your insurance plan to a family member back home who can provide information in case you lose yours or are unable to provide it. In addition, keep your insurance company and emergency contact details somewhere they can easily be found, as well as your hospital bills, so as to make any claims easier.</p><p></p><p><b>Dr. Hazel Gallardo-Paez MD - Family Medicine, Family Medical Practice Danang</b></p>"
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{
"id": 683,
"title": "TB or Not TB",
"slug": "tuberculosis-screening-hanoi",
"slug_en": "tuberculosis-screening-hanoi",
"slug_vi": "tb-or-not-be",
"slug_ko": "tb-or-not-be",
"slug_ja": "tb-or-not-be",
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"post_date": "2019-07-19",
"category": {
"id": 3,
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"tags": "",
"summary": "Health education, not only in the field of tuberculosis, definitely in the field of HIV, should be mandatory in the public school system. That this is one of the keys to better understanding, and then people will not be surprised or shocked by how we deal with these treatment issues. The bottom line is that we can cure almost all patients with tuberculosis, and prevent the spread of the disease, if diagnosed in time and treated appropriately.",
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"value": "<h2><b>Tuberculosis (TB) is rampant.</b></h2><p>It’s everywhere. According to the WHO, tuberculosis kills more people annually than HIV/AIDS and Vietnam ranks near the top globally in TB outbreaks. A third of the world’s population has tuberculosis and when they cough or even talk, they can spread it – especially in classrooms, buses, elevators, hospital rooms; really anywhere absent of good air circulation. So what can we do besides wear a surgical mask on airplanes, buses and in crowded public places?</p><p>Here to answer this question is Professor Michael “Mick” Alkan, M.D.</p><h2><b>Professor Alkan, tell us about tuberculosis.</b></h2><p>Tuberculosis is as old as mankind. Fossilized human skeletons have been found with signs of bone tuberculosis. DNA extracted from the preserved lungs of some 3000-year-old Egyptian mummies contain identifiable sequences of the tuberculosis microbe. It is a disease that hits all mammals, different variants of the bacterium, and a special thing about this bug is that it’s coated in a very special material, a polymer, which cannot be touched by anything. You can pour acid on this bacterium and it will laugh.</p><p>It is a very peculiar organism. It takes for ages to grow it. It’s not one of those that multiplies very fast and then you’re overwhelmed, and that’s why the disease is sometimes difficult to diagnose, definitely difficult to treat. We know today that it’s not the bacterium that eats up the patient; it’s the patient’s attempts to handle this bacterium, which takes away all his energy. Scientists have described the terminal tuberculosis patient as “anergic”—no energy. The immune system totally gives way because it’s exhausted from fighting a futile battle against the bacterium. The bacteria are “eaten” by macrophages, members of the immune system, and the bacteria not only outlive the immune cell, they multiply inside the immune cell, so the patient ends up with dead cells and multiplying bacteria and a lot of debris. This debris is called caseation necrosis (caseation necrosis is a condition of cellular death that usually occurs in the lungs that takes on a crumbly, dull white appearance that resembles cheese).</p><p>The center of this process will have dead tissue, half liquid. Around it will be the immune response and some scarring so you get a little ball where the outside is protected and the inside is havoc, and it happens in the lung because the way we are infected by tuberculosis is that we aspirate bacteria, which are in tiny little droplets so small that they float in the air for hours for us to breath in. So in the lung now is this little ball. In most people when the immune system is intact, when we are not malnourished, when we are not mentally depressed, when we enjoy good health, we can handle this. Maybe there will be a little leakage and it will be stopped in a lymph node next to the lung and we call that a primary complex—two little balls. And we can live with these two little balls to happy old age and have no further trouble (this is known as latent TB).</p><h2><b>How is TB diagnosed?</b></h2><p>Now, our methods of diagnosing TB will not be able to separate latent from rampant tuberculosis because all we can tell is that the immune system knows the bacterium. I wish we could quantify and say ‘this man is very sick’, ‘this man is just latent’—we cannot. What happens is, if the disease progresses or if for some other reason the immune system gives way, this will diminish the body’s ability to contain this little ball and then the little ball becomes bigger and bigger with more and more caseation necrosis in the middle, and this happens in the lung.</p><p>The lung is made of two major components; one is a blood vessel and one is air. So this ball might burst into a blood vessel and then you get tuberculosis everywhere. We call that miliary TB. Or else the ball will burst into one of the windpipes and then you’ll have enormous amounts of coughing, sometimes with blood, full of bacteria. Now, instead of having a solid ball of cheese-like necrosis there is now a cave in the lung because air replaces this gunk, and this is called cavernous tuberculosis, one of the most contagious forms of tuberculosis. If you see that you must isolate the patient.</p><p>This brings me to the picture in the developing world. In lesser developed societies we have a microclimate where the whole family sleeps in the same room, and it usually is a very small dwelling with not too much ventilation. Houses in the highlands of Papua New Guinea have no windows because it gets cold at night. And the door is barred and closed and grandma is sleeping next to the little kids and she’s coughing. Don’t ever take a public bus in Ethiopia because they close all the windows, and they smoke. The bottom line is we cannot change that, so the hallmark of preventing the spread of tuberculosis is early recognition, diagnosis, isolation and treatment.</p><h2><b>How is TB treated?</b></h2><p>Now, for the diagnostic tests we do for tuberculosis in a healthy community; let’s take the school system in Ho Chi Minh City. We have classrooms that are, in the best of cases air-conditioned and closed in, and we have students sitting there. I don’t want anybody to cough tuberculosis on the students so what will I do? I will test each of the students by injecting a component of the bacteria, completely dead, it’s called PPD, purified protein derivative of the bacterium, into the skin and come two days later and look for induration (a thickening or hardening of the skin). I’m actually looking for macrophages that came here because they have knowledge about this foreign protein because they have seen it before.</p><p>If the hardness is zero to five millimeters I say this person has never seen this bacterium. The PPD test is negative. If it is more than 10 millimeters in diameter I say this person has seen mycobacterium tuberculosis. This person is sent for a chest x-ray. If the chest x-ray is normal, even if he has tuberculosis he is not infective because TB infects only by spewing out bacteria and if he doesn’t have anything on the chest x-ray I’m not doing any more work-up. That’s it. I have skipped five to ten millimeters, which is called weakly positive PPD, which is bad news. Usually the cause is that that person was immunized against tuberculosis as a baby or exposed to cousins of the bacterium, which don’t cause tuberculosis, but still his immune system recognizes a little bit. I don’t know what to do with that.</p><p>Do you want to treat it with one drug for six months or with two drugs for 4 months? There are several protocols. Number one, we don’t know that the bacteria that caused this positive PPD are sensitive. If you worked in a hospital, a hospital that had people who were resistant, maybe you need second or third line drugs that this bacterium has never smelled before. And they are second and third because they are more toxic. Do I take a healthy person and make him sick with my treatment just so that in 50 years he will not develop tuberculosis? Big questions. If he is HIV positive I’m adamant, yes you must treat, if he’s just a healthy young person, maybe no.</p><h2><b>How are people with or without a BCG (the tuberculosis vaccine) affected? </b></h2><p>Unfortunately, it’s a live bacterium, so if a child is born with HIV and I give him a shot he might have what we describe as miliary TB and die. Another issue is that in the best of cases BCG renders immunity to 70 to 75% of cases, which, for a vaccine, is not good, but it’s the best we have. There’s constant argument about whether it should be given to everyone or shouldn’t. </p><h2><b>What can those living in Vietnam do to prevent the spread of this bacterium other than wearing surgical masks or staying out of places with poor ventilation?</b></h2><p>There is a very delicate balance between increasing knowledge and not causing panic. So on one hand, all that we have said is educational, is increasing knowledge, but then you might start saying, ‘I’m not going here or there because it’s too dangerous, people are coughing, what will happen to me’? So it’s a tightrope, and I think that health education, not only in the field of tuberculosis, definitely in the field of HIV, should be mandatory in the public school system. I think that this is one of the keys to better understanding, and then people will not be surprised or shocked by how we deal with these treatment issues. The bottom line is that we can cure almost all patients with tuberculosis, and prevent the spread of the disease, if diagnosed in time and treated appropriately.</p><p><b>Family Medical Practice</b> As the first foreign-owned multidisciplinary medical provider in Vietnam, Family Medical Practice (FMP) has consistently remained at the forefront of internationalstandard medicine since 1995. With a diverse multinational team of physicians and the latest in medical equipment and diagnostic tools, FMP offers extensive healthcare and emergency medical services nationwide to Vietnamese, expatriate, and corporate customers.</p><p><b>Professor Michael Alkan</b></p><p>Infectious disease specialist Professor Michael Alkan is a physician and retired Lieutenant Colonel who has undertaken countless medical missions around the world. He was instrumental in turning Beersheba‘s community hospital into a university tertiary care center with laboratories. He developed a curriculum for new medical schools in Nepal and Ecuador and upgraded the curriculum in Central Asia, Tajikistan and Kyrgyzstan. His experience includes disaster relief work worldwide, treating patients in New York in the early days of the AIDS epidemic, opening AIDS clinics and working as an AIDS preceptor in Botswana, Nigeria, China and several other countries. Professor Alkan has been spending his summers at FMP for the past several years.</p><p><i>Interview by</i> <b><i>Daniel Spero</i></b></p>"
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"title": "Legal and HR director Michal Jacob at HR Digital Summit hosted by UpUpApp",
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"value": "<p></p><p>Last Wednesday FMP’s legal and HR director Michal Jacob was among five guest panelists at a digital HR summit hosted by employee engagement firm UpUpApp.</p><p>The goal of the summit was to bring together business leaders and HR decision makers to respond to an emerging business need to develop an effective strategy of awareness and adoption in HR—with case studies from a range of European and International companies.</p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/FMPs_legal_and_HR_director_Michal_Jacob_UpUpApp_22_June.jpg\" class=\"format-left\" /><p></p><p>The panelists shared ideas on how to fully integrate digital technologies as an integral component of the business process, as well as the inevitable organizational challenges that are brought about by digital revolution.</p><p>There were 250 attendees at the summit, which was addressed by five speakers covering five topics, including leading a digital transformation, reimagining HR, leveraging talent management technologies, revolutionizing employee engagement and learning and development strategies.</p>"
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"value": "<p></p><p><b>Dr. Miguel at Corporate Mental Wellness event</b></p><p>This Thursday, FMP psychiatrist Dr. Miguel de Seixas spoke at a corporate MENTAL WELLNESS event hosted by insurance provider Aetna and the American Chamber of Commerce at the Reverie Saigon.</p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/Dr._Miguel_at_Corporate_Mental_Wellness_event_3.jpg\" class=\"format-left\" /><p></p><p>Aetna’s country manager Minh Nguyen opened the discussion noting that companies can lose millions from issues such as work-related stress and anxiety, which can affect employee morale and productivity.</p><p>Dr. Miguel agreed, adding that stigmatism and lack of access to resources and information about mental health and wellness is problematic in Vietnam. This led to discussions with the other panelists on how individuals can adopt self help approaches from daily rituals such as practicing breathing techniques to setting a positive mindset. On a larger scale, companies can build cultures that allow employee development and communication through team-building workshops and access to counseling.</p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/Dr._Miguel_at_Corporate_Mental_Wellness_event_1.jpg\" class=\"format-left\" /><p></p><p>For those suffering from stress and other symptoms of anxiety at the workplace, Dr. Miguel said that it is important to recognize that we are not isolated from our environment, and that we can influence our sense of well-being through techniques such as properly “finishing” the work day, treating your body well and keeping a positive mindset.</p><p>By remembering to treat ourselves well and taking active steps to influence our surroundings at home and at work, we can move towards breaking the cycle of feeling overwhelmed by pressures that could otherwise contribute to anxiety disorders.</p><p>While awareness and attitudes toward mental health in Vietnam are improving, more needs to be done to help those who suffer from depression, anxiety or other psychological disorders feel more included in society. An extra step toward tolerance could see a huge shift in perception among the wider community. This event represented an early step in raising wider awareness of these issues and reducing the stigma around mental illness.</p><p>To consult with Dr. Miguel on mental health issues or to seek psychiatric support, contact reception on +8428 3822 7848</p>"
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"id": 889,
"title": "Fire Drill at British International School",
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"value": "<p></p><p>∗9999 was on the scene this morning to support the British International School’s annual FIRE DRILL. The drill was held at 10.30 am in the school’s Thao Dien campus. As arranged for the event, a staff member dialed the ∗9999 emergency number and informed the call taker that there was a fire at the school. Our team sent an ambulance out to the scene to assist a mock casualty, providing simulated medical care as is done in a real emergency.</p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/Fire_Drill__BIS_school_June_20th.jpg\" class=\"format-left\" /><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/Fire_Drill__BIS_school_June_20th_4.jpg\" class=\"format-left\" /><p></p><p>Please note that the ∗9999 emergency number responds to calls for emergency medical assistance only, and does not provide fire rescue or extinguishing services.</p><p>For more information, please call the customer service number on 093 277 6971 M–F 9am–6pm.</p>"
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"title": "CPR and Heimlich Maneuver Workshop",
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"value": "<p></p><p>More than 30 staff at Bong Sen hotel joined our CPR AND HEIMLICH MANEUVER workshop convened today (June 7) by FMP trainer/nurse Thanh Sang. Employees from various departments participated in the session as an opportunity to review and practice first aid techniques.</p><p>The course participants had a number of questions for Nurse Sang, including whether or not to perform CPR on victims with hypertension, or if there is any risk of contracting any disease from the casualty.</p><p>They also asked what to do if a family member has high blood pressure, and how to deal with a choking victim with a large physical frame—especially in a situation where the staff member performing the Heimlich maneuver cannot reach around a victim’s waist.</p><p>The staff were introduced to the *9999 emergency response call center and ambulance service, and were given magnets and stickers to help them raise awareness of the lifesaving medical service.</p><p></p><p>For more information about FMP’s first aid sessions, please contact our marketing team on (028) 3822 7848, or enquire at reception at your nearest medical center.</p>"
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"title": "*9999 Protocol Training Workshop",
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"post_date": "2019-06-03",
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"value": "<p></p><p>📌 Last Thursday, Family Medical Practice organized a *9999 PROTOCOL TRAINING WORKSHOP on our emergency ambulance service for the staff of the Palace Saigon hotel.</p><p>👥 A total of 26 people joined the 1.5 hr session from the hotel’s front desk, room service, security, and kitchen. To support our emergency response service, course convenor Nurse Thanh Sang instructed the staff in basic first aid skills via a training session equipping them with lifesaving techniques in case of emergency. This instruction provided skills in CPR to sustain casualties in the event of cardiac arrest, as well as how to apply the Heimlich maneuver to relieve victims of choking.</p><p>💬 Beyond these central first aid skills, the staff also asked questions related to drowning and what to do in case a hotel guest has a bone stuck in their throat during a meal, learning how to react in such cases.</p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/9999_PROTOCOL_TRAINING_WORKSHOP__Palace_Saigon_Hotel_June_3th.jpg\" class=\"format-right\" /><p></p><p>👉 For more information about FMP’s first aid training, please contact our marketing team on (028) 3822 7848, or enquire at reception at your nearest medical center.</p><p>-- Family Medical Practice Vietnam: <a href=\"https://www.vietnammedicalpractice.com/?fbclid=IwAR1lMXKnI_9J_GunSwRBzUUSw4trTdWUOk9X3eJqMNYr1MpDEEIoUuc-6hk\">https://www.vietnammedicalpractice.com/</a></p><p>-- Emergency Medical Response *9999: <a href=\"https://www.star9999.vn/?fbclid=IwAR0_Ojg-xhEiUb6M_jbL5lKJnHzqO3QjpYolTBbt4S2Yl2vd704e4sPocVE\">https://www.star9999.vn/</a></p>"
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"id": 847,
"title": "Safe Sex at the Canadian International School",
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143
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"value": "<p></p><p>FMP pediatrician Dr. Jonathan Halevy’s SAFE SEX presentation—a popular health talk with middle and high school students—was delivered at the Canadian International School on Thursday to an audience of around 90 teenagers from the school.</p><p>Dr. Jonathan helped the students understand how to protect themselves when they become sexually active. He explained how safe sex guards against STDs, unwanted teenage pregnancies and abortion, and demonstrated how to use contraception by using eggplants, cucumber and bananas as props. The students were invited to trying unrolling condoms onto the fruit—an entertaining and appropriate way to teach these emerging adults a critical lesson in sexual health. All students were very eager to volunteer.</p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/Safe_Sex_the_Canadian_International_School__31_May_2.jpg\" class=\"format-left\" /><p></p><p>Dr. Jonathan encouraged students to buy a box of condoms to practice in private. He said that if asked by their parents what they learned at school to say that the doctor told them to practice wearing condoms at home!</p><p>The doctor also emphasized the importance of CONSENT to have sex—no one should feel forced or pressured into sex.</p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/Safe_Sex_the_Canadian_International_School__31_May_1.jpg\" class=\"format-left\" /><p></p><p>For more information on our presentations to schools, please contact our marketing team on (028) 3822 7848, or enquire at reception at your nearest medical center.</p><p>Family Medical Practice Vietnam: <a href=\"https://www.vietnammedicalpractice.com/?fbclid=IwAR3aceVNo_jYNXFyGMOMfsvE3dX8Jbgs0ASkvQYxYGDxiQE3px-4OchFrkI\">https://www.vietnammedicalpractice.com/</a></p>"
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{
"id": 845,
"title": "Immunity on Children at British International School",
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"post_date": "2019-05-30",
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"value": "<p></p><p>This Wednesday our pediatrician Dr. Nguyen Huu Linh conducted a health talk on the subject of IMMUNITY IN CHILDREN for a group of mothers and children at the BIS infant campus.</p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/IMMUNITY_IN_CHILDREN__BIS_school_May_30_2.jpg\" class=\"format-left\" /><p></p><p>Dr. Linh introduced basic concepts on the subject, including what the immune system is, its function, and what factors can make a negative impact on immunity. He also explained how parents can improve a child’s natural immune system by using the following techniques:</p><ul><li>Nutrition—diversity of food types, breastfeeding for as long as possible (at least for the first six months).</li><li>Vaccination—the importance of vaccination to ensure children will be protected.</li><li>Hygiene—particularly using gentle body wash and hand hygiene when taking care of children.</li><li>Good Sleep—uninterrupted sleeping, no milk feeding after 9 pm.</li></ul><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/IMMUNITY_IN_CHILDREN__BIS_school_May_30_3.jpg\" class=\"format-left\" /><p></p><p>The mothers expressed great interest in the information shared during the presentation based on Dr. Linh’s clinical experience. They also asked several other questions beyond the immunity topic about such issues as enlarged and infected adenoids/tonsils and when to consider surgical intervention; recurrent fever and sore throats; and how mothers can help to resolve acute constipation in their children.</p><p>Future topics addressed by Dr. Linh may include dietary supplements, gastroesophageal reflux, air pollution and constipation.</p><p>-- Family Medical Practice Vietnam: <a href=\"https://www.vietnammedicalpractice.com/?fbclid=IwAR21Zkgszqs2p3sUBmHvpZQs5T7WVjBCtceWx1LlE_HxCihPovi2BJlZ2sk\">https://www.vietnammedicalpractice.com/</a></p>"
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"summary": "Human suffering comes in many forms, and emotional suffering affects almost everybody at one point or another.... What prevents many people from seeking critical support or medical treatment for their mental health, however, is not knowing when their emotional state is serious enough to endanger their mental wellbeing. If you're waiting until things get dangerous, you're probably leaving it too late already.",
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"value": "<p>Human suffering comes in many forms, and emotional suffering affects almost everybody at one point or another. In some cases, that suffering can be so profound and have such an overwhelming impact on everyday life that it’s vital to get help. What prevents many people from seeking critical support or medical treatment for their mental health, however, is not knowing when their emotional state is serious enough to endanger their mental wellbeing. In terms of getting help, I often say that if you're waiting until things get dangerous, you're probably leaving it too late already.</p><p>There are all kinds of reasons why someone might have a low mood—and having low moods is actually part of the spectrum of normality. The difference between that and what would be called clinical depression is sometimes very difficult to distinguish. A case of serious depression will occur over a longer period of at least two weeks, and will be accompanied by other symptoms. As well as feeling generally low emotionally, someone with depression may experience a lack of energy, lost interest in regular activities, lost ability to experience pleasure, changes in sleep patterns, and changes in appetite, in concentration, and in motivation.</p><p>Psychiatrists used to make a distinction between cases of depression primarily caused by internal biological factors (endogenous depression) and those primarily caused by external psychological factors (reactive depression). According to this understanding, endogenous depression would explain cases where, for no apparent reason, a person would experience one or more depressive episodes. Reactive depression would occur in reaction to some kind of tangible life event. There has, however, always been a significant overlap between these two, to the point where the validity of this distinction is now questioned. The current conceptualization of depression is essentially one of a clinical syndrome, defined by a number of features while not being bound to any specific cause, involving both biological and psychological factors.</p><p>Sometimes it’s part of a normal adjustment that people do have thoughts of “ending it all” as a way of escapism. It’s still worth discussing these thoughts with somebody and trying to find a better way of managing. Most of the work on prevention of suicide that we psychiatrists engage in needs to happen early, because recovery is often about how you manage your own mental health, as opposed to treating a mental illness.</p><p>People living in a foreign country are classically exposed to experiencing alienation and loneliness, which are significant risk factors to mental wellbeing. What is often difficult to adjust to in the expat experience is the lack of the familiar support networks that might exist in their own countries. This is especially true in a country like Vietnam, which does not currently have the kind of established health system that can provide a safety net for people suffering from mental illness. There's less social support, and there are very few trained therapists and professionals.</p><p>Most foreign residents here have left behind friends in a different time zone on a different continent, people who could otherwise give you a good word of advice or “grab you by the neck” when you need it. This suggests that, in the absence of the normal support systems, an individual in this situation needs to be more proactive, responsible and assertive in managing their own health.</p><p>When people are put in extreme circumstances where their familiar sources of support are not there, then they will be at risk of suffering from major depression, a serious mental illness that can affect multiple aspects of a person’s life and dictate the need for treatment. While this can involve medication, I am an advocate of people having some kind of a plan to manage their condition in the long term. These “wellbeing plans” should take note of what circumstances can have a positive or negative impact on your mental health; what the symptoms of depression are and what to do when they occur, when to panic and when not to panic, and who to call at each stage—including who knows about your condition and what would constitute an emergency. It’s different for every person.</p><p>It has been my practice in the past to treat my patients for an acute episode, and then, when things started getting better, help them to form their own wellbeing plan, with strategies to manage going forward and carrying on with good mental health. Such a plan helps a person to manage, and that in itself greatly reduces the risk of relapses.</p><p></p><p><b><i>Dr. Miguel Fernando Dinis de Seixas - Psychiatrist, Family Medical Practice Ho Chi Minh City</i></b></p>"
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"id": 893,
"title": "Konnit Fast’ N’ Fun Tournament 2019 at Phu My Hung District 7",
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"value": "<p></p><p>Yesterday, our *9999 team was pleased to see a huge turnout of young racers at the Konnit Fast’ N’ Fun Tournament 2019 in Phu My Hung. Our ambulance services were on standby for the full day event, with staff at our medical station taking care to protect the safety of the young racers on the field aged from two to five years old.</p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/the_Konnit_Fast_N_Fun_Tournament_2019_Phu_My_Hung_D7_May_27_7.jpg\" class=\"format-left\" /><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/the_Konnit_Fast_N_Fun_Tournament_2019_Phu_My_Hung_D7_May_27_2.jpg\" class=\"format-left\" /><p></p><p>Congratulations to the little racers who braved the heat and, more than anything, enjoyed their participation outdoors! Thankfully, medical incidents were minor and kept to a minimum, and the most important thing was that a great time was had by students and parents alike.</p><p>The most exciting speed race of the day was the fast n' fun crawlin' race with the participation of a number of toddlers who exercised their newfound crawling abilities in their first ever race to the finish line. We expect to see some of these young challengers competing again at Konnit on their bikes in the years to come!</p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/the_Konnit_Fast_N_Fun_Tournament_2019_Phu_My_Hung_D7_May_27_6.jpg\" class=\"format-left\" /><p></p><p>Family Medical Practice has co-operated with konnit since the first races in 2017, as well as at other sporting events for children.</p><p>*9999 is the first international emergency ambulance response service styled after 911 in Vietnam. For more information, please visit <a href=\"http://www.star9999.vn/?fbclid=IwAR3aNYNPlyNPkz4Cr0xVmEwL2-3JRy9U6M0XexwOoO85T6tdHu7pmxKqFUI\">www.star9999.vn.</a></p><p><a href=\"https://www.facebook.com/hashtag/konnitfastnfun?source=feed_text&epa=HASHTAG&__xts__%5B0%5D=68.ARBaLQBknVbmt4Bv1wMBm8c4rECBNCyEB0DybKpIGIC8WeyRVk_mj95MYOS8RNL3UdRx4Hv7WEWdx5gGsxM7tBtfPJZbFkOYAzB-TG4NGIxdzBCdw4iJy9hnPK9r9o-M6Bguq0FuDrr6gNfj7HD5vDurIwdM2gi1f7kjc9aIGsmOdMMWJG346s28nlyNZiT6GnSaH85r74ii4Sd-VR2OtLfYGf97cu8009vBnsA5jcYvxqu_bp4WvrxJfmXbubXtfLjv6LwINY3gWZVlF6tNHYFQSdFY5L7-677ne5B41WDlCnzny6FWLmzyCyuXG4jtsuCdub57u55DstttpEJP6vpH2kL6&__tn__=%2ANK-R\">#konnitfastnfun</a> <a href=\"https://www.facebook.com/hashtag/nationalchampionship?source=feed_text&epa=HASHTAG&__xts__%5B0%5D=68.ARBaLQBknVbmt4Bv1wMBm8c4rECBNCyEB0DybKpIGIC8WeyRVk_mj95MYOS8RNL3UdRx4Hv7WEWdx5gGsxM7tBtfPJZbFkOYAzB-TG4NGIxdzBCdw4iJy9hnPK9r9o-M6Bguq0FuDrr6gNfj7HD5vDurIwdM2gi1f7kjc9aIGsmOdMMWJG346s28nlyNZiT6GnSaH85r74ii4Sd-VR2OtLfYGf97cu8009vBnsA5jcYvxqu_bp4WvrxJfmXbubXtfLjv6LwINY3gWZVlF6tNHYFQSdFY5L7-677ne5B41WDlCnzny6FWLmzyCyuXG4jtsuCdub57u55DstttpEJP6vpH2kL6&__tn__=%2ANK-R\">#nationalchampionship</a> <a href=\"https://www.facebook.com/hashtag/konnitfastnfuncrawling?source=feed_text&epa=HASHTAG&__xts__%5B0%5D=68.ARBaLQBknVbmt4Bv1wMBm8c4rECBNCyEB0DybKpIGIC8WeyRVk_mj95MYOS8RNL3UdRx4Hv7WEWdx5gGsxM7tBtfPJZbFkOYAzB-TG4NGIxdzBCdw4iJy9hnPK9r9o-M6Bguq0FuDrr6gNfj7HD5vDurIwdM2gi1f7kjc9aIGsmOdMMWJG346s28nlyNZiT6GnSaH85r74ii4Sd-VR2OtLfYGf97cu8009vBnsA5jcYvxqu_bp4WvrxJfmXbubXtfLjv6LwINY3gWZVlF6tNHYFQSdFY5L7-677ne5B41WDlCnzny6FWLmzyCyuXG4jtsuCdub57u55DstttpEJP6vpH2kL6&__tn__=%2ANK-R\">#Konnitfastnfuncrawling</a></p><p>-- Family Medical Practice Vietnam: <a href=\"https://www.vietnammedicalpractice.com/?fbclid=IwAR3a8HexbkFEVj_6QlIugjeecXDEb5ul3RpLDra6m4HmAQImpo8pnvrLovY\">https://www.vietnammedicalpractice.com/</a></p>"
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{
"id": 1015,
"title": "Tendonitis: What Are Your Joints Telling You",
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"summary": "Tendonitis can occur due to repetitive movements, injury and other related conditions, such as tennis elbow.",
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"value": "<p></p><p>Aching joints is a form of inflammation known as arthritis, tendonitis, or bursitis. You feel stiff after sitting or sleeping for a long period of time. Your mobility is hindered by persistent pain. Or a past injury starts flaring up again.</p><p>When injured or worn out over time due to any number of factors, bones, tendons, and the protective cushion around them can become swollen and sore.</p><p>Athletes are at a heightened risk of joint pain and tendonitis. Patients with tendonitis may experience localized pain, swelling, warmth, and redness. Tendonitis can occur due to repetitive movements, injury and other related conditions, such as tennis elbow.</p><p>Tendonitis is commonly mistaken for arthritis. Going to the doctor for early diagnosis is crucial, as the symptoms that arise are almost identical. Our tendons are thick, cordlike, fibrous tissue structures that attach muscles to bone and help our joints move. There are hundreds of tendons throughout the body—however, certain tendons in the body are more prone to problems than others.</p><p>Common treatments include resting the affected joint, physical therapy, modified activities, and taking over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen. It will take several weeks for patients with tendonitis to recover, but it may vary depending on the person’s case.</p><p>In case the tendonitis pain doesn’t go away, they may provide a referral to a rheumatologist, orthopedic surgeon, or physical therapist for specialized treatment. Symptoms include pain with movement and a joint that’s tender to touch.</p><p>Source: <a href=\"https://www.movementortho.com/2017/09/15/tendonitis-what-are-your-joints-telling-you/\">Movement Ortho</a></p>"
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"title": "European International School Clinic Tour At FMP Dist 2",
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"value": "<p></p><p>📍 👭On May 17, FMP hosted another fun tour of our District 2 medical center for 35 international students from the European International School. In exploring the facilities and observing how our various medical professionals do their job, the students gained a new appreciation for the important work doctors do in our community.</p><p>🚑 The students were divided into groups to make sure that everyone had a closer look at all the different parts of the medical center. In the emergency room, they discovered what each of the lifesaving machines are and how they work. The children had the chance to go inside the ambulance with Nurse Mark, who sounded the siren when the kids were on board so that they could hear how loud it can be. We also told them that if they witness any emergency to remember to dial the ambulance response hotline *9999.<br/></p><p>👋 When visiting Nurse Margaux, the children were taught how and when to wash their hands. They also visited the pediatrics room, where the pediatrician showed them what an X-ray looks like when someone swallows a toy, and how the finger bones look on an X-ray film.</p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/Fun_Tour_D2_medical_center_European_International_School_May_17_2.png\" class=\"format-left\" /><p></p><p>🙋♂️ In one activity, our Dr. Agnes called for a volunteer to lie down so she could trace out the shape of their body. She asked the group if they knew what organs the body was made of and what each organ was for. When she got to the heart, one thoughtful child said that apart from it helping keeping a person alive, it allows the person to feel love.</p><p>💬 At another point, our emergency doctor Dr. Sergio and gastroenterologist Dr. Masato entertained the children and asked them questions about their health. One student asked about his broken hand, while another consulted about a tooth that had fallen out. Dr. Sergio gave them tips on how not to break bones next time, and how to clean their teeth!</p><p></p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/Fun_Tour_D2_medical_center_European_International_School_May_17.png\" class=\"format-fullwidth\" /><p></p><p></p><p>💌 FMP welcomes school groups to visit our facilities and learn more about the medical profession in the hope of spreading awareness of the importance of health and safety in our community. For more information on booking a school group, call marketing on (028) 3822 7848.</p><p>-- Family Medical Practice Vietnam: <a href=\"https://www.vietnammedicalpractice.com/?fbclid=IwAR2u5RfcQVuD4M_cdVCHj7oF5PYwiznAJJJmH_vnRkxv48tO_t8E4Oiwh5o\">https://www.vietnammedicalpractice.com/</a></p>"
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{
"id": 862,
"title": "Substance Use Talk at Renaissance International School",
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"post_date": "2019-05-14",
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"value": "<p>Yesterday afternoon at Renaissance International School, FMP’s psychiatrist Dr. Miguel engaged with around 100 middle high school students, delivering a talk on the issue of substance use.</p><p>The frank and open discussion challenged students’ perceptions of alcohol, tobacco and drug use. When asked, some of the students felt that certain substances are positive in bringing relief from pressure and stress—while others felt that they cause disillusionment and loss of control.</p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/Subtance_Use_Renaissance_International_School_-_May_14th_3.jpg\" class=\"format-left\" /><p></p><p>❗️Dr. Miguel stressed the importance of being properly informed about substances before trying them, referring the students to <a href=\"https://l.facebook.com/l.php?u=http%3A%2F%2Ftalktofrank.com%2F%3Ffbclid%3DIwAR0q1_aaTYrP47ZoTtPnxMOdex39SWXBnuUE_DlAsr-NdFJaMX_t05jIf-8&h=AT1rA6RVRvhNHpWhFiObh_tIwLzNpzyamg5r4kJJT0jzN-XJ2RjDMqahLJaz7FOGnnwOxAgDDQeBZW7OW54XTMtaV0vxKHiHipnMNKNuF3h3CgtP6IbpOGZLHwH5NUJhqMAT1_k6-dRksoXhFrK3QflzWv7u79TF9f50R0g0l4RaLt3NbTJKehqdA9jzTzGFDdPWVlvjpL72nfgrgxP6kxF_n8Lwe8dEQumf2e0Xf_16Jjkv1j3_hW2Q9yyUECeTzqnbFe48UIRgmZTViQ6FxLzr6hEe-TpwkSHFbXi1t0Is055AvnzHWmiOxMJs_SsYltIsqvm5kW5936mYmHyXhpG0gbHHewXPSDHpaaI5wPDRbXjZOp-9iumjAbhRL21xV8g0Rrt7yH3o6Auuq09OcnKKk2nwx3sRIbIXF-bKsQyKOzmsF1VQWPJ44WylsMtlfx895ZW3h542dbAKaHkkauKE4P4CdAHzEtfyj1SBIcLd8MnLU9m9zWMXe1ETnmAoPOk59hkag2TCKb1C5BDe388vGOVxxw8V24z3k6tL7xffIDHUUX-kP7xIvMDh-NPwiXh5T3dLp4np7Sais6KGw8dUUCoVMXnmiiJ0k3nR1azPeArsgzRT6ejI8CFvB4tHSEqIxkENVI3NHNzu69ArnBqlxdywF3DanQ02fI349btCl3nZ3dBdfPLsY8ayNbHcprYTA45yVLdx6Ne0U0zWjIKmMMzpFwkqL2UCDU-rTjbJybWjVw9BUrWyiCo\">talktofrank.com</a> for detailed and honest information about such drugs as heroin, happy pills, cocaine, and marijuana. On the subject of peer pressure to take drugs, he advised the students to consider why they would want to take substances or why not—because this kind of reflection can reinforce the decisions they make about drugs.</p><p>Dr. Miguel added that the hardest part about talking to teenagers about drugs is that you can’t just say “don’t do drugs”; we use a different approach to let students consider how they should think for themselves and resist peer pressure. He also touched on how families and parents can play a role, especially in leading by example to show children how to deal with stress.</p><p>According to statistics from a national survey of drug use and health, up to 50% of drug use by minors can be prevented by parents holding regular, serious conversations with their children.</p><p>--<br/>Dr. Miguel Fernando Dinis de Seixas is a member of the Royal College of Psychiatrists who has treated people with conditions such as depression, anxiety, self-harm, suicidal tendencies, bipolar disorder, obsessive compulsive disorder and schizophrenia. He trained in Cambridge and London and is a member of the Royal College of Psychiatrists.</p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/Subtance_Use_Renaissance_International_School_-_May_14th_4.jpg\" class=\"format-left\" /><p></p>"
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{
"id": 669,
"title": "The Defibrillator—Treating the Leading Cause of Heart Attacks",
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"post_date": "2019-05-13",
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"name": "Media & Press",
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"summary": "There is no doubt in my mind that defibrillators should be everywhere. It’s often the case that bystanders will manually pump a patient’s heart via CPR until a specialist arrives with a defibrillator; sadly, the majority of people who fall victim to cardiac events aren’t so lucky. Ambulances take time to arrive, and the people standing by may have no idea how to perform CPR properly.",
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"value": "<p>When a cardiac event occurs, you usually only have minutes to respond. With so little time at hand, the technique most people turn to is CPR. But is CPR really the way to get a heart beating again?</p><p>The heart muscle is a pump controlled by electrical impulses, delivering oxygen-enriched blood to every system in the body. Death encroaches very quickly if the pump fails, as many of the body’s systems will shut down within minutes without oxygen.</p><p>CPR is a technique to manually squeeze the blood through the arteries by putting pressure on the heart’s chambers. While this may not do anything toward fixing the pump itself, it can delay the shutdown of the rest of the body for long enough to allow a doctor to arrive in an ambulance with the equipment needed to get the heart working again.</p><p>One of those pieces of equipment is called the defibrillator. Many people have seen this device in movies, where it is often used in the most dramatic cases of cardiac arrest. The defibrillator is perhaps the most critical lifesaving element in most heart attacks — because contrary to common understanding, the cause of most fatal heart failures is not that the heart has suddenly stopped beating; it’s actually rhythm trouble. It’s like a drummer who can’t keep time, and the music just can’t go on without that regular pulse.</p><p>Rhythm trouble is like a storm in the heart. There’s a lot of electrical activity, but no mechanical coordination. For the heart to work effectively, there must be good synchronization between its parts to keep the blood flowing in the right direction. If the cells are contracting randomly, then the pump will fail even if there’s no blockage or damage to the muscle.</p><p>To save a patient’s life, you need to stop that storm immediately, because no one can survive without circulation for very long. To beat the storm, you need to administer a powerful electric attack to overcome the chaos within the heart — so we place the defibrillator pads on the chest and blast the patient with a solid burst of energy. The desired effect is that the heart will be immediately paralyzed, just for a moment; then everything will reset, and the heart’s normal electrical activity will be resumed when things start up again.</p><p>There is no doubt in my mind that defibrillators should be everywhere. It’s often the case that bystanders will manually pump a patient’s heart via CPR until a specialist arrives with a defibrillator; sadly, the majority of people who fall victim to cardiac events aren’t so lucky. Ambulances take time to arrive, and the people standing by may have no idea how to perform CPR properly.</p><p>Cardiologists like myself now recommend that defibrillators be installed widely, just as fire extinguishers are often found in public buildings. Five star hotels should definitely have one—travelers nowadays tend to consider spending their week in paradise where this kind of medical equipment is available, and Vietnam is sometimes skipped on international itineraries because of the lack of such medical facilities in its resorts.</p><p>The main cause of heart attacks is electrical trouble, and the main treatment is the defibrillator. They’re not difficult to use, and the audio instructions tell you exactly what to do. Anyone with a basic understanding of how to use the machine can apply the pads and follow the instructions to give the patient the best chance of recovery. </p><p></p><p><b>Dr. Guillaume Nguyen Forton</b> <i>is in charge of cardiology at Family Medical Practice’s clinic in HCMC. He has had 25 years of experience in both Cardiology and intensive care units in France, and has been in Vietnam for over a decade.</i></p>"
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{
"id": 676,
"title": "Hand Reconstruction",
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"summary": "Modern hand surgery is a miracle. The techniques and procedures I am trained in today involve rebuilding bones and joints, re-implanting severed fingers, and restoring function even after the hand has been catastrophically destroyed. The hand is such an intimate part of the body, and to be able to return the use of a hand to someone who has lost it is very moving and satisfying.",
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"value": "<p><i>Modern hand surgery is a miracle. The techniques and procedures I am trained in today involve rebuilding bones and joints, re-implanting severed fingers, and restoring function even after the hand has been catastrophically destroyed. The hand is such an intimate part of the body, and to be able to return the use of a hand to someone who has lost it is very moving and satisfying</i>.</p><p>Procedures like this emerged around the time of World War II, but in those days it required several different specialists – an orthopedic surgeon, neurosurgeon, vascular surgeon, and finally a plastic surgeon. Later, the idea was conceived to create a super-speciality where one person could do all of those kinds of things.</p><p><b>A Sophisticated Practice</b><br/>Since then, hand surgery has become a very sophisticated practice. A modern hand surgeon should be prepared to graft skin or transfer fragments of bone, as well as to perform microsurgery to sew together nerve cords with nylon threads thinner than a human hair.</p><p>During the time when I was working in Spain, one of the many procedures I would perform was to reimplant amputated fingers. I would establish the bone, inserting pins into the fractures to make the connections; then I would need to reconstruct the arteries, then smaller blood vessels, and then the nerves and tendons. That’s a significant surgical procedure, but if done within the first six hours, the success rate is very high.</p><p>One part of this kind of procedure is to reconnect nerves. Nerves come bundled into cables, and to rejoin a severed thread, it’s important that each nerve ending is reattached to its correct partner on the opposite side – get it right, and the nerve will grow together again. If this happens with just 30% of the reattached nerves, we can consider the procedure a success. The nerves will grow back into the muscle at a rate of 1 mm per day – too late, and the muscle will atrophy and no longer work.</p><p><b>The Future of Hand Surgery</b><br/>Some exciting discoveries are now being made in the use of PRP (platelet-rich plasma) that are likely to shape the future of hand surgery. PRP is nothing new – it’s a blood extract that has been used as a kind of surgical glue within the body since 1972. Recently we have started to use PRP as part of the treatment to repair tendons and ligaments, something that will revolutionize the way we reconstruct the tissues of the body.</p><p>Blood platelets enriched with stem cells contain a lot of growth factor. It can already be used to repair bones, and now we’re starting to use it to repair cartilage, which is something that we’ve never been able to do before. These days, all indications show that when you use this form of PRP, it can help to create new cartilage when put in the right place.</p><p><b>Transplants and Prosthetics</b><br/>In Spain, we’ve now had several hand transplants from one donor to another patient. Hand transplantation is not easy. You have to go through a psychological process and serious counselling before you are considered eligible. The reason is that the hand is such an important part of your body, so if a patient starts to feel the new hands are not their own, they may end up with a sense of horror and want them removed.</p><p>Of course, if you cannot save the hand or the patient is not eligible for a transplant, we can fit a prosthesis. There are a range of options, from non-functional cosmetic hands that attach like a glove (they remain fixed to the arm by vacuum suction or by a strap) to biomechanical hands that look real. These have now advanced to the point where they can be controlled with the mind through sensors positioned over the severed nerves that can detect electrical signals from the brain.</p><p><b>Bike Accidents</b><br/>In our community here in Ho Chi Minh City, serious fractures and orthopedic traumas are rare. Probably the most common injuries I see here are clavicle and ankle bone fractures from bike accidents. The majority of these are breaks in the middle of the bone that leave the ligaments intact, usually managed by fitting a cast to let the bone heal. It’s just a pity that it’s almost impossible to protect against breaks in a bike accident, because when you fall, some part of you is going to land on something hard.</p><p>Bone is living tissue, it changes every day. So take care of your living skeleton, and drive safely.</p><p></p><p><b>Dr. Carlos Eduardo Tata Rojas - Orthopedics</b></p>"
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"title": "Managing Cardiac Events",
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"post_date": "2019-04-16",
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"summary": "There are so many things that can go wrong with the cardiovascular system, leading to a heart attack, stroke, or other cardiac emergency.",
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"value": "<p>There are so many things that can go wrong with the cardiovascular system, leading to a heart attack, stroke, or other cardiac emergency. As a cardiologist, I think it’s important to keep the information we share with the public as simple as possible—because when a cardiac event occurs, you usually only have minutes to respond, so there’s no need to waste time trying to figure out if a victim is suffering from a “myocardial infarction” (heart attack) or a “pulmonary embolism” (the clotting of blood vessels in the lung). It’s best to leave such technical details to the doctors, whereas the most urgent issue for the bystander is to call the *9999 emergency number* and perform Cardiopulmonary Resuscitation (CPR). If a patient experiences an intense gathering pain in the chest that feels like a blockage or a heavy pressure within the ribcage, time is the critical factor, and it’s important to stick to the basics.</p><p>What many people don’t understand about CPR is that it’s not exactly a treatment for cardiac arrest in itself. The heart muscle is a pump controlled by electrical impulses, delivering oxygen-enriched blood to every system in the body. Death encroaches very quickly if the pump fails, as many of the body’s systems will shut down within minutes without oxygen. CPR is a technique to manually squeeze the blood through the arteries by putting pressure on the heart’s chambers. While this may not do anything toward fixing the pump itself, it can delay the shutdown of the rest of the body for long enough to allow a doctor to arrive in an ambulance with the equipment to get the heart working again.</p><p>One of those pieces of equipment is called the defibrillator. Many people have seen this device in movies, where it is often used in the most dramatic cases of cardiac arrest. What isn’t well known is that the defibrillator is perhaps the most critical lifesaving element in most heart attacks—because contrary to common understanding, the cause of most fatal heart failures is not that the heart has suddenly stopped beating; it’s actually rhythm trouble. It’s like a drummer who can’t keep time, and the music just can’t go on without that regular pulse.</p><p>We call this <i>ventricular arrhythmia</i>—a total electrical storm in the heart. There’s a lot of electrical activity, but no mechanical coordination. For the heart to work effectively, there must be good synchronization between its parts to keep the blood flowing in the right direction. If the cells are going crazy and contracting randomly, then the pump will fail even if there’s no blockage or damage to the muscle.</p><p>To save a patient’s life, you need to stop that storm immediately, because no one can survive without circulation for very long. To beat the storm, you need to administer a powerful electrical attack to overcome the chaos within the heart—so we place the defibrillator pads on the chest and blast the patient with a solid burst of energy. The desired effect is that the heart will be immediately paralysed, just for a moment; then everything will reset, and the heart’s normal electrical activity will be resumed as things start up again.</p><p>There is no doubt in my mind that defibrillators should be everywhere. It’s often the case that bystanders will manually pump a patient’s heart via CPR until a specialist arrives with a defibrillator; sadly, the majority of people who fall victim to this situation aren’t so lucky. Ambulances may take time to arrive, and the people standing by may have no idea how to perform CPR properly.</p><p>Cardiologists like myself now recommend that defibrillators be installed widely, just as fire extinguishers are often found in public buildings. They’re now found on planes and private yachts, for example. Five star hotels should definitely have one—travelers nowadays tend to consider spending their week in paradise where this kind of medical equipment is available, and Vietnam is sometimes skipped on international itineraries because of the lack of such medical facilities in its resorts.</p><p>I would go further to suggest that defibrillators should be installed in public places and on any business premises. The reason why is simple—the main cause of heart attacks is electrical trouble, and the main treatment is the defibrillator. An excellent semi-automatic defibrillator can be purchased for one or two thousand dollars; they’re not difficult to use, and the audio instructions tell you exactly what to do. Anyone with a basic understanding of how to use the machine can apply the pads and follow the instructions to give the patient the best chance of recovery.</p><p>Rebooting the cardiovascular system is often the answer to overcoming an emergency. Sometimes it takes a little more than that, which is why you want to have a medical professional arriving in an ambulance as soon as possible after the event occurs. Treatment can begin immediately upon ambulance arrival, and in some cases it’s even necessary for a doctor to open the arteries or perform an IV before transferring the patient to an interventional unit. This is the importance of rapid response, and the reason why you should call the medical emergency hotline as early as possible.</p><p>The path to restoring true health for the heart is a process that takes a far longer time. Sometimes the heart has been damaged beyond repair, and transplantation is the only option. This is nothing simple—such a patient would have to undergo a medical evacuation, usually to their home country, to be put on the national waiting list while the search for a compatible donor gets underway. Here in Vietnam, where heart transplants are—shall we say, “less trendy”—prospects would be grim, especially for locals without the option of going overseas.</p><p>When I see a patient who has recently suffered a cardiac event, I need to follow a whole diagnostic process to understand what course of treatment needs to be administered. In fact, I can establish the most likely causes of the event just by asking a few simple questions—how old are you, are you a smoker, and do you suffer from hypertension or diabetes? Following that, there are a number of tools at my disposal to narrow things down. I can perform a Doppler ultrasound to check the carotid arteries for clots from the heart or a buildup of plaque constricting the blood flow. I can run a Holter Electrocardiogram (ECG) to detect rhythm trouble that could manifest in another attack. I can also perform a cardiac echo test to check for damage in the heart muscle itself and assess the extent of that damage. This, combined with a thorough physical examination, is usually enough to know what the treatment should be. I may need to perform an invasive procedure to insert a small balloon into the carotid artery to push out a blockage, or I may need to prescribe a series of medicines to dissolve clotting in the blood. Besides that, a recovering patient may need to make significant lifestyle and dietary changes to avoid further stresses on the heart and its systems—in particular regarding cholesterol intake.</p><p>If all that seems like a huge rigmarole, it most certainly is. The key here, of course, is to avoid a situation where you’re at risk of a heart attack or cerebral stroke, or needing extensive medical treatment or even a transplant following a heart failure. Certainly call for help if you start to experience symptoms of an impending attack; it’s much better to get to the emergency room before you drop rather than leave yourself at the mercy of bystanders who may or may not know CPR while the clock is ticking. Before even that is a danger, make those lifestyle changes before you need them for recovery, before your life is threatened by a cardiac event. Eat better (especially cutting down on your cholesterol intake), quit smoking, and fit some exercise into your day. If you have even borderline high blood pressure, this needs to be carefully managed—high blood pressure remains one of the leading causes of mortality worldwide. Especially if you’re over 40, visit a cardiologist to have a cardiac assessment done so that you know your risk. There are so many factors that can cause cardiovascular disease, and you want to make sure to avoid them as much as possible.</p><p><i>*In case of medical emergency, dial *9999. Callers will receive advice, rapid emergency response, and in cases such as stroke or myocardial infarction, medical treatment begins immediately upon doctor arrival.</i></p><p><b><i>Dr. Nguyen Forton Guillaume Ngoc Kim</i></b> <i>is in charge of cardiology at Family Medical Practice’s clinic in HCMC. He has had 25 years of experience in both Cardiology and intensive care units in France, and has been in Vietnam for over a decade.</i></p>"
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"id": 673,
"title": "Hepatitis B",
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"post_date": "2019-04-16",
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"summary": "War-torn livers ravaged by hepatitis B are a serious health issue in Vietnam. Protection is not only available, but can save lives and prevent the onset of liver cancer.",
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"value": "<p></p><p>We all know what happens to a city under siege. As the enemy approaches, the defenders steel themselves to fight to the last man to protect their homes. The battle is fierce, the casualties many. No matter who wins, one thing is for certain, the city itself will sustain significant damage, and perhaps even be left in ruins.<br/></p><p>This is what happens to the liver during a hepatitis B infection. The virus — a platoon of ugly little organisms that look like lumpy soccer balls — descends on the liver’s hepatic lobules to nest inside them and multiply. Your liver’s natural defences — the heroic immune cells — leap into action, destroying the virus wherever it lurks. In many cases, your immunity prevails, but the real loser ends up being the hepatic lobule itself, which is often demolished in the fighting.<br/></p><p>If the battle is prolonged (chronic infections are incurable and will rage within your liver for the rest of your life), then the scarring from all this destroyed liver tissue builds up and transforms this soft pink organ into a mottled, hardened wasteland, impairing its ability to filter and purify your blood stream, giving rise to cirrhosis, horrid physical conditions such as bloating and discoloration, and in many cases, cancer of the liver followed by death.</p><p><b>Hepatitis B in Vietnam</b><br/></p><p>Unfortunately, Vietnam is a country where hepatitis B is a massive problem. Of the three hepatitis B infection rates recognized by the WHO — low (<1.5% of the population); intermediate (<7.5%); and high (7.5% and above) — the numbers for Vietnam are off the charts. Here in the relatively wealthy city area, the infection rate is somewhere between 8 and 10%; but in the poor countryside, it’s much worse; in some parts, the level hovers around 40%.<br/></p><p>Transmission of hepatitis B usually happens differently here than it does in Western countries. Overseas, the virus is most commonly spread by sexual contact. It’s also associated with reused drug and tattoo needles, and unscreened blood transfusion (although this is now very rare). In Vietnam, as in many Asian countries, hepatitis B is an endemic condition associated with mother-to-child transmission during birth. It is also connected with hygiene-related concerns, as well as sex without protection.<br/></p><p>The infection of babies and infants is more nefarious in many ways than it is in adults. An adult’s mature immune system responds swiftly to the contraction of hepatitis B, setting off a war that drains the body of its strength and manifests in symptoms similar to influenza or dengue. An adult is likely to overcome the infection in the end and fully recover from the disease.<br/></p><p>When a small child or baby gets hepatitis B it’s a different story. There’s no battle; the virus simply enters the liver and sets up its occupation with minimal resistance, getting on quietly with the business of building its colony unnoticed from the outside. It’s only years later after the virus has invisibly laid waste to the entire liver, that symptoms start to manifest themselves, by which time it is often too late. In many cases, the only remaining options are limited to undergoing a liver transplant (which are not available in Vietnam) or simply waiting for the end.</p><p><b>Fighting Back</b></p><p>So how can we fight back against hepatitis B? There is a vaccine. The Engerix B vaccine enables the body to train the immune cells to produce supersoldier antibodies capable of eradicating the invaders without sacrificing the hepatic lobules. This strategy is called active immunization.<br/></p><p>Passive immunization can be achieved where complete antibodies are delivered directly as a serum, similar to how breastfeeding mothers can pass on their own antibodies for some infections (not including hepatitis) to their babies through their milk, while their babies’ immune systems are still developing.<br/></p><p>However, once hepatitis B progresses to the chronic phase without proper treatment, there is no going back, and the only way ahead is to try to survive this infection. In such cases, the key is to discover the presence of the disease as soon as possible. Early in the years-long struggle with your immune system on the warground of your liver, the organ will largely function as normal; it is only in the very late stages that your liver won’t work at all.<br/></p><p>Early detection means that the condition can be managed, and this is usually where my role as a doctor comes in. While we can’t remove the virus from your body completely, we can prescribe medicines to prohibit it from replicating itself and taking up arms again. If you are a chronic sufferer of this disease, you can still live a normal, healthy life by routinely taking this type of medication.<br/></p><p>War-torn livers ravaged by hepatitis B are a serious health issue in Vietnam. Protection is not only available, but can save lives and prevent the onset of liver cancer.<br/></p><p>Make sure you’re up to date with your hepatitis B vaccinations and are immune to this infection, and if there is any doubt, please get tested. Late detection can be a very serious matter.</p><p></p><p><b><i>Dr. Pedro L. Trigo -</i></b> <b><i>Internist, Family Medical Practice Ho Chi Minh City</i></b></p>"
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"id": 1201,
"title": "Fire Drill at Diamond Plaza",
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"value": "<p></p><p>The emergency team of *9999 has supported Diamond Plaza in one of their annual fire drills.</p><img src=\"https://media.fmp-data.bliss.build/original_images/Diamond_Fire_drill_3.jpg\" class=\"format-fullwidth\" /><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/Diamond_Fire_drill_2.jpg\" class=\"format-fullwidth\" /><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/Diamond_Fire_drill_1.jpg\" class=\"format-fullwidth\" /><p></p><p>Understanding the importance of immediate response to disasters such as traffic accidents and fire, *9999 service invests not only in the modern equipment but also in the forces of doctors, nurses and ambulance drivers.</p><p></p><p>*9999 emergency doctors and nurses are well-trained and professionally respond to any emergency cases.</p>"
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{
"id": 686,
"title": "Fighting Bacteria",
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"post_date": "2019-03-27",
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"summary": "By properly adhering to the standard vaccination system, you give your child the best chance of developing a robust and healthy immunity that will serve as a lifelong protection against infection.",
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"value": "<h3>Strengthening your child’s immune system</h3><p>Bacteria, viruses and other pathogens are all around us—it’s impossible to avoid them. Fortunately, we have a way to protect ourselves against the threat of infection in the immune system.</p><p>When the human body is exposed to a threat from a pathogen, it fights back by analyzing that threat, designing antibodies, and then producing enough of them to disable the infection. It will also remember the design so that it can easily produce more antibodies later if a similar threat is encountered. We call this form of memory immunity.</p><p>A child’s immune system is much weaker than an adult’s. When a child is born, his or her immunity is like a blank sheet of paper. They’ve had no exposure to pathogens, so there’s no memory of how to fight them.</p><p>Usually, a child’s first exposure to bacteria is in the birth canal. This exposure contributes to the development of the child’s general health and the sensitivity of the immune system. Children delivered by C-section do not have the same exposure as those naturally-born, which could impair normal development.</p><p>All babies, however, have weak immunity during the first weeks of life. At this time, they are normally protected by the antibodies they receive from the mother’s milk. That is the importance of breastfeeding: babies cannot produce their own antibodies efficiently, so they need to get them from breast milk. This is called passive immunity. Unfortunately, there are no antibodies in formula milk because antibodies are created by a very delicate and complicated process in the human body. Babies who drink formula milk cannot receive this protection.</p><p>Immunization before six weeks of age for most antigens results in a weaker response and poorer immune persistence, mainly because of the immaturity of the immune system. Doctors need to wait until a baby’s immune system is strong enough to produce antibodies efficiently and fight disease. With the exception of hepatitis B, bacille Calmette-Guerin (BCG) and OPV—which are all given at birth—the recommended age to give most vaccines is at two months, or six weeks at the earliest.</p><p>When functioning properly, the immune system can identify a variety of threats including viruses, bacteria and parasites, and also distinguish them from the body’s own tissue. Children with immunodeficiency are more likely to get both recurrent and life-threatening infections, because their immune systems do not have the strength to fight. On the other hand, a child whose immune system hyper-reacts to infection will suffer from allergies, where the body’s immune system will fight uselessly against a non-threat, causing its own health complications.</p><p>A child with an autoimmune disease has an immune system that fights against the body’s own tissue by mistake. For example, diabetes type 1 is an autoimmune disease where the body produces antibodies that fight its own pancreatic tissue. Other examples are Hashimoto’s, thyroiditis, and SLE. It’s clear that the immune system is very important—it plays a central role in fighting disease. To a child, developing a mature immune system is crucial to good health throughout all stages of life.</p><p><b>Improving Child Immunity</b></p><p>The immune system is sorted into two types. The first is innate immunity. This is what the body has available to it from birth. Physical barriers like skin and mucus form part of this system, protecting against non-specific pathogens. The cough reflex, skin oil, and earwax all help to expel pathogens from the body. Some kinds of cells in the body produce chemicals for innate immunity, which are called interferon and interleukin.</p><p>The second is <b>adaptive immunity</b>. That means that when the body is exposed to a threat, it produces antibodies specific to that pathogen and then remembers those antibodies. This natural ability is what makes vaccination possible.</p><p>So how can we augment this ability and improve the natural immune system?</p><p>The first way is <b>nutritio</b>n. This is very important, especially for infants of less than one year of age who rely on breast milk for their antibodies. We now recommend breastfeeding for as long as possible—at least until twelve months of age—and exclusively for at least the first six months. By seven or eight months, we need to provide babies with a variety of foods from different food groups. The protein, fat, carbohydrates and even minerals and vitamins in solid food are very important in improving the health of the immune system.</p><p>Unfortunately, many parents routinely give children multivitamins and mineral supplements without seeking medical advice. This is not a good practice because with some vitamins, an overdose is toxic. Oil soluble vitamins such as vitamins A, K and E can be very dangerous in overdose, causing seizures, nausea and vomiting. Vitamin D is an exception. Babies normally produce their own vitamin D in response to direct sunlight, but as the exposure to ultraviolet radiation in sunlight is risky, it’s better to supplement the diet with one drop containing 400 international units of vitamin D per day.</p><p>Another problem is that parents sometimes overfeed their children. While good nutrition boosts the immune system, overfeeding can lead to diabetes. Obesity and gastro-oesophageal reflux are also potential consequences of overfeeding in infancy.</p><p>The second way is <b>sleeping quality</b>. Good sleep is very important in nurturing the developing immune system, so a child should have an environment that is conducive to the quality of sleep. A newborn baby should sleep 18 hours per day, and a toddler 12–13 hours per day. A preschooler should sleep 10 hours per day. It’s important not to disturb a sleeping child which is another reason to avoid bottle feeding infant children; many parents wake their baby to feed, compromising their developing immune system.</p><p><b>Hygiene</b> is the third way to boost immunity—it is most important to wash hands before preparing meals, or after going to the toilet. The immune system includes the skin and its oil, so washing the hands helps to reduce the spread of pathogens. It’s also vital that very young infants avoid contact with sick people, and are not exposed to smoking in the home, chemicals (choose organic food where possible) and pollutants in the air.</p><p>The last one is <b>vaccination</b>. Vaccines use our knowledge of the immune system to mimic infection, generate immunologic memory, and prepare the body for future infections. It’s very important to follow the vaccination schedule. The schedule is carefully planned to take into account the developing immune system. If we vaccinate too early, the baby has insufficient ability to produce antibodies. If too late, then the risk of a child being infected without the protection of immunity becomes greater.</p><p>By properly adhering to the standard vaccination system, you give your child the best chance of developing a robust and healthy immunity that will serve as a lifelong protection against infection.</p><p></p><p><b>Dr. Nguyen Huu Linh, Pediatrician, Family Medical Practice Ho Chi Minh City</b></p>"
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"title": "Anne Hill International School Field trip to FMP",
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"slug_vi": "anne-hill-international-school-field-trip-fmp",
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"slug_ja": "anne-hill-international-school-field-trip-fmp",
"overview_image": {
"id": 718,
"url": "https://media.fmp-data.bliss.build/original_images/Anne_Hill_school_2.jpg",
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"post_date": "2019-03-20",
"category": {
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"id": 7,
"name": "Clinic Tours",
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"value": "<p></p><p>This week our children went on a field trip to Family Medical Practice. During this field trip, we explored how medical science had improved and saved many people’s lives. We learnt the proper way of washing our hands, the functions of a medical air nebulizer, the sounds of an ambulance siren and more. We also made sure to remember the emergency number just in case when one of our family member falls in!</p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/Anne_Hill_school.jpg\" class=\"format-left\" /><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/Anne_hill_school_3.JPG\" class=\"format-left\" /><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/anne_hill_school_4.jpg\" class=\"format-left\" /><p></p><p>On behalf of AHI families, we would like to thank Family Medical Practice for the warm welcome and informative sessions.</p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/Anne_hill_school_1.jpg\" class=\"format-left\" /><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/anne_hill_school_5.jpg\" class=\"format-left\" /><p></p><p>Learn, Grow, Play. The AHI Way.</p><p></p>"
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{
"id": 709,
"title": "How We Waste the Asset of Antibiotics",
"slug": "how-we-waste-asset-antibiotics",
"slug_en": "how-we-waste-asset-antibiotics",
"slug_vi": "how-we-waste-asset-antibiotics",
"slug_ko": null,
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"overview_image": {
"id": 624,
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"post_date": "2019-03-18",
"category": {
"id": 3,
"name": "Media & Press",
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"subcategory": {
"id": 2,
"name": "Articles by our Doctors",
"slug": "Articlesbyourdoctors"
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"tags": "",
"summary": "The tragedy of the commons is when you have a common asset like antibiotics, individuals are acting independently according to their own self-interests, depleting the resource through their collective actions.",
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{
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"value": "<p>In an earlier article I brought up the problem with overuse of antibiotics and how it makes it increasingly more difficult to treat common infections and in some cases where there are no antibiotics left to use (<i>vietnamnews.vn/life-style/481171/the-antibiotic-apocalypse-and-what-you-can-do-to-prevent-it.html#SvckYvh8ha0PlXCO.97).</i></p><p>The other day I had a patient who was diagnosed with pneumonia. The family had a relative who had been treated at a larger Vietnamese hospital and during that time caught an hospital infection and died. Our patient was treated with IV antibiotics for five days as we could not guarantee that any oral antibiotics would work due to resistance. The outcome was fine and the child survived. But it is a problem that even with the strongest IV antibiotics we don’t always know if the treatment will be effective.</p><p>The tragedy of the commons is when you have a common asset like antibiotics, individuals are acting independently according to their own self-interests, depleting the resource through their collective actions. The most common examples are unregulated grazing on common land or the depletion of fisheries in the oceans.</p><p>This is a good analogy for the erosion of the effect of antibiotics. Compounds with antibiotic effects have been used by organisms throughout evolution. Alexander Fleming, who first discovered penicillin, was a microbiologist. He studied bacteria, but he was so sloppy with his cultures that mold started growing and killed the bacteria. Many scientists might have seen this as a failed experiment, but Fleming saw the potential this mold, penicillin, had to save lives, and it has, but he also noticed in his experiments that bacteria developed penicillin resistance.</p><p>Antibiotics are drugs that work on bacteria, different antibiotics work for different bacteria.</p><p>Antibiotics have no effect on viruses. If we use antibiotics for viral infections there is a risk of adverse effects as diarrhea as many good bacteria in the gut are necessary. Unnecessary antibiotic use also selects the bacteria that have resistance genes, these are then spread and become more common with risks for treatment failure if the resistant bacteria cause infections.</p><p>Although there are prescription regulations in Việt Nam, most drugs including antibiotics are available in private pharmacies. A large proportion of antibiotics used are not prescribed by a physician but bought directly from private pharmacies and used as self-medication. Also, many healthcare providers have their own clinics where they conduct examinations and sell drugs. In studies we have conducted, the majority of children had used antibiotics within the past month, mostly for viral infections.</p><p>In the clinic I met many children who has been to healthcare providers and received several drugs including antibiotics, where in most cases they were not needed.</p><p>How can we tell if we have a viral or bacterial infection? Viral infections generally effect many parts of the body, like a flu when you get respiratory symptoms with a runny nose, cough, fever and possibly muscle ace. Bacterial infections are usually more localized and more severe, like pneumonia which causes difficulty breathing, a cough and high fever.</p><p>In many cases it is hard to know if you or your child has a viral or bacterial infection, so it is best to go to a healthcare provider. However, that might not be enough. In many cases lack of resources including staff, time, equipment and competence might still cause uncertain diagnosis with the risk of unnecessary treatment with antibiotics and other drugs. Providing good examination and diagnostics is expensive – you need well trained staff, tests and equipment. Drugs are relatively cheap – and hence many times it might be tempting to skip some diagnostics and just use antibiotics.</p><p>Antibiotics are not only used on humans, but also for livestock, poultry and aqua cultures. Often they are used not for treatment of diseases but as a growth promoter. This is now banned in the EU but still common in many countries like Việt Nam. One of the antibiotics that is now the last resort for some human infections when bacteria are resistant to all other antibiotics – colistin – is used a lot for veterinary use and as growth promoter. We can now see how resistance genes formed in animal bacteria has been found in human bacteria and caused severe infections. The overlap between human and animal health is called “one health” – as what we do with animals will ultimately affect us.</p><p>The overuse of antibiotics in the community, hospitals and for animals has led to a situation where we now have bacteria that are resistant to almost all antibiotics, so called “superbugs”. These are now spreading in hospitals causing infections that are very hard to treat with high rates of mortality and costs. Also, these superbugs follow discharged patients out in the community where they spread.</p><p>For you as individual this might seem to be overwhelming – as with global warming – what can I do about it? The most important is to avoid self-medication with antibiotics, in case of disease go to a healthcare provider that can do through examination – then you will increase the chance to get the right diagnosis and treatment as well as avoid unnecessary antibiotic use. — <b>Family Medical Practice</b></p><p><i>*Dr. Mattias Larsson first came to Viêt Nam in 1997 conducting research on child infections and antibiotic use and resistance. In 2003 he defended his PhD and graduated from his medical training. Since then he has spent about half of his time in Sweden working as a physician in paediatrics and infectious diseases. The other half in Việt Nam and other developing countries working with medical training and research. Dr. Mattias speaks English, Swedish, German and Vietnamese as well as some Spanish. At Family Medical Practice (Hanoi ), he is participating in providing diagnostics care and treatment with the best international evidence based standards.</i></p><p></p><p><b><i>Dr. Mattias Larsson - Pediatrician, Family Medical Practice Hanoi</i></b></p>"
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{
"id": 1078,
"title": "Kindergarten Medical Facility Tour",
"slug": "kindergarten-medical-facility-tour",
"slug_en": "kindergarten-medical-facility-tour",
"slug_vi": "kindergarten-medical-facility-tour",
"slug_ko": "kindergarten-medical-facility-tour",
"slug_ja": "kindergarten-medical-facility-tour",
"overview_image": {
"id": 727,
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"post_date": "2019-03-07",
"category": {
"id": 2,
"name": "Events",
"slug": "events"
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"subcategory": {
"id": 7,
"name": "Clinic Tours",
"slug": "clinic-tours"
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"tags": "",
"summary": "Family Medical Practice Vietnam were happy to welcome 20 students of a Korean Kindergarten in a friendly and informative medical center tour at our District 2 medical center on Friday, April 29th, 2016.",
"related_pages_title": null,
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"locations": [
759
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{
"type": "text",
"value": "<p></p><p>Family Medical Practice Vietnam were happy to welcome 20 students of a Korean Kindergarten in a friendly and informative clinic tour at our District 2 Clinic on Friday, April 29th, 2016.</p><p>In this activity, the students had a chance to explore our medical facilities and ambulance, to 'become a doctor' by using the stethoscope to check the internal sounds of a human body, and to learn more knowledge about body's part under the instruction of Dr. Orly - our Pediatrician and Early Childhood Development Specialist.</p><p>We usually provide this kind of clinic tour for schools, in order to create an opportunity for children to enhance their knowledge about medicine and health care facilities, as well as helping the them not to be fear when seeing a doctor in the future.</p>"
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{
"id": 1077,
"title": "Angel Kindergarten Medical Facility Tour at D2",
"slug": "angel-kindergarten-medical-facility-tour-d2",
"slug_en": "angel-kindergarten-medical-facility-tour-d2",
"slug_vi": "angel-kindergarten-medical-facility-tour-d2",
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"overview_image": {
"id": 728,
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"post_date": "2019-03-06",
"category": {
"id": 2,
"name": "Events",
"slug": "events"
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"subcategory": {
"id": 7,
"name": "Clinic Tours",
"slug": "clinic-tours"
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"tags": "",
"summary": "Family Medical Practice welcomed students from Angel Kindergarten to our District 2 medical center on August 17th, 2015. As an extracurricular activity, the students had a chance to 'become a doctor' which included many interesting activities such as: measuring their friends' heights and weights, becoming an emergency doctor and working on our ambulance, using stethoscope to check the internal sounds of a human body, and also having a friendly talk with Dr. Orly, our Pediatrician.",
"related_pages_title": null,
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758
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{
"type": "text",
"value": "<p></p><p>Family Medical Practice welcomed students from Angel Kindergarten to our District 2 Medical Center on August 17th, 2015.</p><p>As an extracurricular activity, the students had a chance to 'become a doctor' which included many interesting activities such as: measuring their friends' heights and weights, becoming an emergency doctor and working on our ambulance, using stethoscope to check the internal sounds of a human body, and also having a friendly talk with Dr. Orly, our Pediatrician.</p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/Angel-Kindergarten-Clinic-Tour-at-D2-3.jpg\" class=\"format-fullwidth\" /><p></p><p>By providing this kind of medical facility tour, we hope that we can create an opportunity for children to enhance their knowledge about medicine and health care facilities, as well as helping the children not to be fear when seeing a doctor in the future.</p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/Angel-Kindergarten-Clinic-Tour-at-D2-1_GlRUC55.jpg\" class=\"format-left\" /><p></p><p>If schools and kindergartens would like to arrange similar activities at our medical center, please contact our Marketing Department via email: marketing@vietnammedicalpractice.com or telephone number: <b>(08) 3822 7848 ext. 5</b></p>"
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{
"id": 721,
"title": "Food Poisoning",
"slug": "food-poisoning",
"slug_en": "food-poisoning",
"slug_vi": "food-poisoning",
"slug_ko": "food-poisoning",
"slug_ja": "food-poisoning",
"overview_image": {
"id": 873,
"url": "https://media.fmp-data.bliss.build/original_images/Food_poisoning.jpg",
"compressed": "https://media.fmp-data.bliss.build/images/Food_poisoning.format-jpeg.jpegquality-75.jpg"
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"post_date": "2019-03-06",
"category": {
"id": 3,
"name": "Media & Press",
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"subcategory": {
"id": 2,
"name": "Articles by our Doctors",
"slug": "Articlesbyourdoctors"
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"tags": "",
"summary": "People who prepare food and are sick can spread their germs via food by not washing their hands before handling it. If the food is not properly washed and cooked, germs from one food item can get to another.",
"related_pages_title": null,
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"locations": [
871,
870,
869,
868,
867
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{
"type": "text",
"value": "<p><b>What is food poisoning?</b></p><p>Food poisoning is caused by eating food that contains germs such as bacteria, viruses or parasites. This illness can cause stomach upset, abdominal pain, nausea, vomiting, diarrhoea and fever. The symptoms can range from a relatively mild discomfort to a more serious life-threatening disease.</p><p><b>How can these germs get into the food?</b></p><p>People who prepare food and are sick can spread their germs via food <a href=\"https://www.coastvietnam.com/hoi-an-travelplanner-weather\">by</a> not washing their hands before handling it. If the food is not properly washed and cooked, germs from one food item can get to another.</p><p><b>Is there anything I can do on my own to prevent it from getting worse?</b></p><p>I always tell my patients that when these symptoms start to develop, the first thing you have to do is to keep yourself hydrated. Drinking plenty of fluids prevents you from getting dehydration. You can drink sports drinks or oral rehydration mixtures to replace fluids and minerals lost through vomiting and diarrhoea. Oral re-hydration powder like Oresol</p><p>can be purchased cheaply from a local pharmacy. Be sure to mix the powder in safe water. You can make your own mixture by dissolving 1/2 teaspoon of salt and 6 teaspoons of sugar in one litre of clean drinking or boiled water.</p><p>In terms of what food to eat, it’s better to avoid caffeine, fatty meals and dairy products. The reason for this is that it makes you bloated and will slow your recovery. If you can keep food down, bananas, toast, rice or salt crackers are a gentle way of replacing some of the calories and electrolytes you’re losing.</p><p><b>What happens if I’m not getting better, and when should I seek help?</b></p><p>Generally, symptoms should pass in a couple of days, but should you start to show signs of serious dehydration—including dark or decreased urine, dizziness, palpitations, muscle cramping that’s separate from stomach cramping, or a fever of over 101 degrees that doesn’t break—you should see a doctor. That’s especially important for children, the elderly or those with an underlying medical condition.<br/>Pregnant women or those that suffer from diabetes, inflammatory bowel disease and anyone taking immunosuppressant drugs should also let their doctor know if they are suffering from a stomach problem.</p><p>Seek immediate medical attention are if you are vomiting blood, if you notice mucus or pus in your diarrhoea or if you experience neurological symptoms like numbness or tingling.</p><p>Is it food poisoning?</p><p>The symptoms of food poisoning usually develop within a few hours of eating something, if you have not recently eaten or if you’re the only one who got sick after eating a certain dish, you more likely picked up a viral illness in another way—from a sneeze, a handshake or a contaminated doorknob, for instance. For these infections, symptoms usually start one to three days after exposure with clinical symptoms that mirror those of food poisoning -- vomiting, diarrhoea, abdominal discomfort and fever. Treatment is exactly the same whether it be food poisoning or a stomach bug.</p><p><b>Precautions</b></p><p>The Vietnamese are no more resistant to a bout of food poisoning or contracting a stomach bug than you or I, and though it might not seem like it when you visit the local wet market or restaurant where litter and food is scattered all over the floor -- food hygiene practice is generally of a high standard wherever you dine. Exceptions to this are places where food has been left to stand unheated (this is just as likely to be your hotel buffet as it is anywhere else) or food that is being handled and shared (like rice crackers). Tap water is strictly off limits to all, unless it has been thoroughly boiled and ice is made from filtered water. In smaller, local joints where there are no freezers, ice will be delivered, again this will be made from filtered water, but dependent on the delivery style, it may have been subjected to a scattering of road dust on it’s way to the restaurant--if that concerns you, go without.</p><p><b>What to Pack</b></p><p>Though you can easily pick up medication from local pharmacies if you get struck down with diarrhoea the thought of trotting along to the shops is not going to fill you with joy. Instead, be prepared -- pack rehydration salts and over-the-counter anti-diarrheal or anti-nausea medication (Imodium or Pepto-Bismol). In most cases, medical intervention is unnecessary, though it is worth taking it easy and sweating it out in the comfort and safety of your hotel or resort until the symptoms have passed, remembering to take steps to keep your illness from spreading to others -- frequent hand washing and avoiding close contact from others.</p><p></p><p><b><i>Doctor Christopher M. Suazon, Director, Danang Family Medical Practice</i></b></p>"
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{
"id": 1075,
"title": "Montessori Kindergarten Medical Facility Tour",
"slug": "montessori-kindergarten-medical-facility-tour",
"slug_en": "montessori-kindergarten-medical-facility-tour",
"slug_vi": "chào-mừng-học-sinh-trường-mẫu-giáo-montessori-đến-tham-quan-phòng-khám-fmp-quận-2",
"slug_ko": null,
"slug_ja": null,
"overview_image": {
"id": 732,
"url": "https://media.fmp-data.bliss.build/original_images/Montessori-3.jpg",
"compressed": "https://media.fmp-data.bliss.build/images/Montessori-3.format-jpeg.jpegquality-75.jpg"
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"post_date": "2019-03-05",
"category": {
"id": 2,
"name": "Events",
"slug": "events"
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"subcategory": {
"id": 7,
"name": "Clinic Tours",
"slug": "clinic-tours"
},
"tags": "",
"summary": "Family Medical Practice was delighted to welcome the children from Montessori Kindergarten to our FMP D2 Medical Center in May, 2015. We offered a clinic tour and ambulance tour for the students, hoping that it would help them know more about health care and emergency services.",
"related_pages_title": null,
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756
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{
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"value": "<p></p><p>Family Medical Practice was delighted to welcome the children from Montessori Kindergarten to our FMP D2 Medical Center in May, 2015. We offered a clinic tour and ambulance tour for the students, hoping that it would help them know more about health care and emergency services.</p><p></p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/Montessori-1_E1S7v96.jpg\" class=\"format-left\" /><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/Montessori-2.jpg\" class=\"format-left\" /><p></p><p></p><p></p><p></p><p>If schools and kindergartens would like to arrange similar activities at our medical center, please contact our Marketing Department via email: marketing@vietnammedicalpractice.com or telephone: (08) 3822 7848 - ext.5</p>"
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{
"id": 1076,
"title": "Renaissance International School Medical Facility Tour",
"slug": "renaissance-international-school-medical-facility-tour",
"slug_en": "renaissance-international-school-medical-facility-tour",
"slug_vi": "buổi-tham-quan-phòng-khám-của-học-sinh-trường-quốc-tế-renaissance",
"slug_ko": null,
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"overview_image": {
"id": 733,
"url": "https://media.fmp-data.bliss.build/original_images/Renaissance-International-School-Clinic-Tour-2.jpg",
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"post_date": "2019-03-05",
"category": {
"id": 2,
"name": "Events",
"slug": "events"
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"subcategory": {
"id": 7,
"name": "Clinic Tours",
"slug": "clinic-tours"
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"tags": "",
"summary": "On July 7 and July 13 - 14, 2015 Family Medical Practice Ho Chi Minh City was delighted to give students from Renaissance International School a Medical Facility Tour at Diamond Plaza. We hope that via this activity, students were able enhance their knowledge about health care facilities and had an interesting extracurricular activity during this summer vacation at the same time.",
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{
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"value": "<p>On July 7 and July 13 - 14, 2015 Family Medical Practice Ho Chi Minh City was delighted to give students from Renaissance International School a Medical Facility Tour at Diamond Plaza. We hope that via this activity, students were able enhance their knowledge about health care facilities and had an interesting extracurricular activity during this summer vacation at the same time.</p><p></p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/Renaissance-International-School-Clinic-Tour-2_l69T7nF.jpg\" class=\"format-left\" /><p></p><p></p><p></p><img src=\"https://media.fmp-data.bliss.build/original_images/Renaissance-International-School-Clinic-Tour-3.jpg\" class=\"format-left\" /><p></p><p></p><p>If schools and kindergartens would like to arrange similar activities at our medical center, please contact our Marketing Department via email: marketing@vietnammedicalpractice.com or telephone number: (08) 3822 7848 - ext.5</p>"
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{
"id": 1073,
"title": "NO_ENGLISH",
"slug": "Koreanclinictour-20180427",
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"slug_vi": null,
"slug_ko": "호치민시-한국-유치원-2군-패밀리-메디컬-클리닉-방문",
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"post_date": "2019-03-05",
"category": {
"id": 2,
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"id": 7,
"name": "Clinic Tours",
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{
"id": 1074,
"title": "NO_ENGLISH",
"slug": "medicalprogram-20180625",
"slug_en": "medicalprogram-20180625",
"slug_vi": null,
"slug_ko": "국제학교-재학-고등학생-대상-체험-프로그램-시작",
"slug_ja": null,
"overview_image": {
"id": 692,
"url": "https://media.fmp-data.bliss.build/original_images/36230228_2094613797479699_6755938266177863680_o.jpg",
"compressed": "https://media.fmp-data.bliss.build/images/36230228_2094613797479699_675.format-jpeg.jpegquality-75.jpg"
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"post_date": "2019-03-05",
"category": {
"id": 2,
"name": "Events",
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"id": 7,
"name": "Clinic Tours",
"slug": "clinic-tours"
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{
"id": 698,
"title": "Platelet-Rich Plasma in Orthopedics",
"slug": "platelet-rich-plasma-orthopedics",
"slug_en": "platelet-rich-plasma-orthopedics",
"slug_vi": "platelet-rich-plasma-orthopedics",
"slug_ko": null,
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"overview_image": {
"id": 679,
"url": "https://media.fmp-data.bliss.build/original_images/shutterstock_1585064824.jpg",
"compressed": "https://media.fmp-data.bliss.build/images/shutterstock_1585064824.format-jpeg.jpegquality-75.jpg"
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"post_date": "2019-02-18",
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"summary": "Famous athletes like Tiger Woods, Rafael Nadal, Lionel Messi and Cristiano Ronaldo have received platelet-rich plasma injections for various problems such as sprained knees and chronic tendon injuries. These types of conditions have typically been treated with medication, physical therapy or even surgery.",
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"value": "<p>The use of biologics such as platelet-rich plasma (PRP), mesenchymal stem cells or growth factors in the orthopedic office setting is becoming more common due to an increased demand for alternative methods of non-surgical management of soft-tissue and musculoskeletal conditions.</p><p>Famous athletes like Tiger Woods, Rafael Nadal, Lionel Messi and Cristiano Ronaldo have received PRP injections for various problems such as sprained knees and chronic tendon injuries. These types of conditions have typically been treated with medication, physical therapy or even surgery. Some athletes have credited PRP with their being able to return more quickly to competition.</p><h2><b>What is PRP?</b></h2><p>Blood is mainly a liquid called plasma but it also contains small solid components: red cells, white cells and platelets. The platelets are best known for their importance in clotting blood. However, platelets also contain hundreds of proteins called growth factors which are very important in the healing of injuries.</p><p>PRP is plasma but with many more platelets than what is typically found in our blood. The concentration of platelets and growth factors in PRP can be 5 to 10 times higher than usual.</p><p>After taking a blood sample (usually 15ml), PRP preparation separates the platelets from other blood cells during a sterile process called centrifugation. The concept is attractive because the patient’s own blood is used under sterile conditions, limiting the possibilities for disease transmission and infections.</p><h2><b>How does PRP work?</b></h2><p>In simple words, what PRP does is to boost our own healing processes. Laboratory studies have shown that the increased concentration of growth factors in PRP can potentially speed up the repair process of our tissues. To boost healing, the injury site is treated with the PRP preparation. This can be done in one of two ways: PRP can be carefully injected into the injured area or it can also be used to improve healing after surgery for some injuries.</p><h2><b>What conditions can be treated with PRP?</b></h2><p>Chronic tendon injuries, surgical repair of tendons and muscles, osteoarthritis and fractures are some of the common conditions where PRP injections are currently applied. Recent findings showed that PRP injections are associated with pain relief; increased function in activities of daily living; increased motion and strength compared to corticosteroid injection.</p><p></p><p><b><i>Dr Andres Sosa - Orthopedic Surgeon, Family Medical Practice Hanoi</i></b></p>"
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"id": 671,
"title": "1 in 5 women",
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"summary": "If you have been victim of sexual assault, go to an emergency room as soon as possible—this is an emergency. The ER doctor will assess what kinds of specialists need to be notified depending on whatever injuries have been sustained.",
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"value": "<h3>Seeking medical help and reporting sexual assault is one of the most important things you can do</h3><p>It is incredibly difficult to imagine oneself as the victim of sexual assault, yet statistics show that one in five women will be. When something like this does happen, it’s important to remember that any kind of sexual assault or violence is a crime—and anyone who is a victim has the right to seek both justice and receive medical care. This is just as true in Vietnam as it is anywhere else in the world.</p><p>When a woman has been sexually assaulted and is seeking help, the key factor is time. For help to be most effective, she should contact the police department and a medical clinic as soon as possible. Expats or travelers should also notify their country’s consulate or embassy.</p><p>Sometimes victims will be persuaded by other people not to file a police report. They are told that the police won’t care, or that they don’t speak English, or that nothing will be done. Such advice is in itself an assault on a woman’s right to decide for herself to speak out and take action. Sexual assault is against the law, and it should be reported to the police and documented. A woman seeking to notify the police can ask others for help, such as a front desk staff or receptionist of a hotel, a friend or consulate personnel.</p><p>From a medical perspective, it is important to seek medical attention right away—to treat the injuries (which can be both external and internal), to check and treat for sexually transmitted disease, and for pregnancy assessment—and ideally this should take place at a clinic or hospital with a gynecologist, infectious disease specialist, or surgeon depending on the injuries. Even victims who are not sure whether or not to report the assault to the police should still get medical attention as soon as possible.</p><p>The laws regarding sexual assault vary from country to country, so the response a foreigner might expect from her consulate/embassy can vary too. It is still best to report the event and obtain consular advice in addition to reporting the crime to the local police—this helps the victim to document the occurrence and receive advice and assistance from her own government.</p><p>Rape kits—otherwise known as sexual assault evidence kits—are usually used to collect evidence in cases of sexual assault. These are not yet available here in Vietnam, although some consulates/ embassies do have them. They usually contain:</p><ul><li>Instructions & checklist</li><li>Bags and paper sheets for evidence collection • A comb</li><li>Documentation and forms</li><li>Envelopes</li><li>Material for blood samples</li><li>Swabs</li><li>Specimen containers</li></ul><p>DNA evidence usually needs to be collected within 72 hours in order to be properly analyzed, but other types of evidence can last much longer. When a rape kit is not available, law enforcement agencies should work together with the medical staff to discuss an appropriate course of action consistent with the law/ guidance from local authorities.</p><p>In order to help the authorities to preserve evidence—and also to ensure that medical personnel can properly assess the extent and site of the injuries and provide the most appropriate treatment—sexual assault victims should avoid:</p><ul><li>Bathing</li><li>Showering</li><li>Washing hands</li><li>Using the restroom</li><li>Changing their clothes</li><li>Combing their hair</li><li>Cleaning up the area where the assault occurred</li></ul><p>It’s important to note, however, that even if a victim has done any or all of the above, it is still not too late to report the incident to the police and go to the doctor. There are other ways to collect evidence. It’s advisable to bring an extra set of clothes, as any garments worn during an attack may be collected as evidence also.</p><p>Usually, evidence collection focuses on an attempt to try to discern the extent of injury and identify the perpetrator. Victims of assault are asked to “preserve the scene” and not to wash, even though that will usually be the first impulse. Hair/nail samples, pieces of clothing, and personal belongings might be collected. A statement will be taken, and usually law enforcement officers will work closely with medical staff to collect any body fluids for examination and identification.</p><p>Seeking Medical Help:</p><p>If you have been victim of sexual assault, go to an emergency room as soon as possible—this is an emergency. The ER doctor will assess what kinds of specialists need to be notified depending on whatever injuries have been sustained. These might involve:</p><ul><li>A gynecologist—to assess for pregnancy and administer emergency contraception.</li><li>An infectious disease specialist— to assess and treat any sexually transmitted infections.</li><li>A surgeon—to assess and treat any fractures/lacerations/ bleeding.</li><li>A counselor—victims of sexual abuse have gone through a traumatic experience, and may be in shock. If possible, assessment by a counselor is recommended.</li></ul><p>In the US and UK, a SANE (sexual assault nurse examiner) is usually notified, who will follow the rape/sexual assault protocol. Vietnam has its own protocols for when a sexual assault is reported, although the specific practices may be different from hospital to hospital.</p><p>In any case, a victim should expect her injuries be taken care of as well as to be asked about details of the events. Some questions can seem very personal and detailed, but this is important not only</p><p>to make sure all possible injuries have been evaluated, but also to guide DNA collection for evidence and identification of the perpetrator. A victim will also be asked about her past medical history, medications, allergies, and menstruation status before getting a head to toe examination—including an internal exam of her mouth, vagina, or rectum. During the exam, samples might be collected and sometimes photographs will be taken— consent will be obtained first.</p><p>It’s recommended for victims to be offered sexually transmitted disease testing for infections such as gonorrhea, chlamydia, HIV, and genital herpes, etc, depending on the circumstances of the assault. In some cases, a victim might need to take antiviral medications to prevent HIV transmission after high risk exposure. These can prevent the virus from taking hold, and usually the medication has to be taken for one month. Negative tests are usually repeated a month or three months later to make sure they stay negative, as some diseases do not show up positive immediately after exposure. For this reason, if the risk is high, empiric treatment for the most common STIs can be given regardless of the initial result.</p><p>Also, pregnancy status will need to be assessed, and a morning after pill may be offered if necessary. As a matter of fact, any woman can obtain emergency contraception at almost any pharmacy in Vietnam, although to use it properly, it is important to speak to a medical provider—if used too late or if the wrong dose is taken, it will not be effective.</p><p>While the trauma of a sexual assault can make a dramatic impact on any woman’s life, taking assertive steps in the immediate aftermath can help to restore her sense of dignity and control, which is very important to the wellbeing of any person.</p><p></p><p><b>Dr. Jane Shadwell-Li - Internist, Family Medical Practice Ho Chi Minh City.</b></p>"
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"id": 690,
"title": "The Doctors who Face Death",
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"post_date": "2019-01-22",
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"summary": "In the ICU, I have become used to death; I have seen people from 15 years to 99 years old pass away. Over time, it still affects you. Some doctors burn out and have to go back, see other kinds of patients, stay in another part of medicine. It’s worse when the doctors in ICU start not to care.",
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"value": "<p>I didn’t imagine I’d end up working in the ICU (Intensive Care Unit) when I first studied medicine. I was thinking of going into surgery, because I love anatomy and I don’t mind the blood. But there was one time when I visited my uncle working in a hospital, and he introduced me to a doctor who showed me around the department. I loved it—the adrenaline, the challenge of the patients, the sudden shifts in tempo. A patient can come through from ER at any moment while the nurse is shouting she needs something five minutes ago, and you have to move immediately. I realized I like this environment a lot, working with acute patients.</p><p>I started my residency in a hospital near my home. It was tough. The first thing I realized is that I knew nothing about medicine. After seven years in medical school, I had all the theory, and the grades—but when you see your first patient, you just think… what do I do now? That’s when you realize you have to start to understand medicine again. Because the patient hasn’t read the books. The patient presents with symptoms—“I have a headache, a fever, my back is painful…” You have to figure out what’s going on. The books just say “this disease comes with these kinds of symptoms”, but seeing a patient is a whole different thing. The patient cries, gets annoyed, is a good person or a bad person, may have had the symptoms for a while and been very uncomfortable, but doesn’t know what it is or when it started. That’s the human contact side of medicine, and it is difficult to teach and understand. Many residents quit within the first three months.</p><p>But ICU is a special area of medicine, because for a patient to be admitted to ICU, there must be a chance that the patient will die. That is more or less the condition of entry. We live constantly in the ICU with this kind of thing, and death is very common; it is very normal.</p><p>When I was a supervisor, I had a first year resident (who after this became a great doctor) but on that first day, after we finished the doctors’ meeting, I assigned her first patient, who was in a very serious condition. Everyone knew this patient was going to die. But we know that this is part of ICU. Five days later, the patient died, in the morning, and I saw her crying. So I sat her down and asked, “What’s going on?” She said, “Oh, I miss my patient, I worked so hard with him, I thought he was going to make it…” So I had a really tough talk with her. I told her, “This happens, this is ICU. The patients die. All the patients here on these beds have a chance of dying. It could be 50%, 20%, 80%, 90%—but any of them could die. Suddenly or not. You are constantly living with that. You have to talk to the family about that. But you can’t be too involved.”</p><p>It’s the first lesson you learn in ICU. You can’t be too involved with the patients.</p><p>I once read an article about we Latin American people. We have a problem as humans, with death. We know that all of us are going to die at some moment. We buried our fathers, our fathers buried their fathers, our sons will bury us, this is life. Death is the only 100% certainty. The article showed that Latin American people have a problem living with that. When we doctors say, yes, your father, your son, your mother, your uncle, your friend will probably die, it could take a few hours or days, but it’s impossible to do anything because the damage is too severe. We have a problem accepting that.</p><p>In Latin America we don’t accept euthanasia. It’s a crime. Because we can’t tolerate death; it’s overwhelming for us. We always hope a miracle will happen, to change the facts of the situation. Sometimes it’s very difficult.</p><p>In the ICU, we often have very young patients who have suffered a car or motorbike accident that destroyed their brain, themselves, and died.</p><p>We humans can die in two ways. Our heart stops, or our brain stops working. But the brain dead have a problem if their heart is still beating. The body is warm, you look at the monitor and you have the pulse, everything. That is very complicated for the family to understand. What is lying on that bed is a thing, it’s not a person. The person is gone. We can sustain that situation, but there is no way back. That’s the only thing in medicine that is 100% certain. But even so, it can still be difficult to understand.</p><p>The problem sometimes is not that the patient survives, it’s <i>how</i> the patient survives. Which person you give back to the family. Sometimes the patient is not the same. The brain can have contusion, hemorrhage, damage. You do a lot of work with the patient, the patient improves, the patient is still alive—but not the same. If the person is lying in bed, in a coma, or opens their eyes but without consciousness, we give that patient to the family and say, “This is your son, 22 years old, but more like a plant, a vegetable.” And that is the worst part because in the beginning the family says to you, “I want my son to live…” But sometimes, what is life? If I give you the same person before the accident with a couple of scars, nothing else, that’s one thing. But if I give you a person who can barely open their eyes, without a part of their skull, lying in bed… that’s another thing entirely. Some families have the resources to keep their sons, their siblings alive with all the comforts at home, and perhaps they will. But others do not have those resources. It’s very expensive to keep a person living. You even need a nurse to change their pants—and again, is that your son?</p><p>One of the treatments we can offer is comfort. At the end of the day, we are not gods, and the human body has its limits, medicine has its limits, and we doctors have our limits too. Sometimes the only thing we can offer the family, for the patient, is comfort. They don’t have to have pain, they don’t have to suffer at all. Because believe me, nobody dies easy, nobody dies in a good way. This is from the movies. People only die sadly, and it’s a very traumatic moment. And the only thing you can offer the family is to say OK, he or she won’t suffer anything, feel nothing, never realize what’s going on. There are drugs we can use to put the patient in a coma. They are anaesthetics, hypnotics, used to decrease consciousness. We use drugs that are 80 times stronger than morphine, and in higher doses, to ensure the patient doesn’t feel anything. After that, it depends on what you want to believe. But for sure, the patient won’t suffer their death. That is the best we can offer for the last time, for the family, for the patient.</p><p>In the ICU, I have become used to death; I have seen people from 15 years to 99 years old pass away. Over time, it still affects you. Some doctors burn out and have to go back, see other kinds of patients, stay in another part of medicine. It’s worse when the doctors in ICU start not to care. I’ve seen doctors burn out, and become—not a butcher, that’s a very strong word—but they start not to care whether the patients live or die. It’s just another bed. “OK, the patient in bed number 4 died, great, we need that bed.”</p><p>Or even worse—they start to feel like a god. You decide if the patient lives or dies. That is when you are overwhelmed by the power of this position, because with the patient, the ventilation, the drugs, all the monitors, if the patient needs those things to live, you are the person who can shut it down and say “OK, the patient has died.”</p><p>The only way is to protect yourself from this kind of burn-out is to always remind yourself, “I am human, I can make mistakes.” Sometimes we doctors start to think, “I’m a god, I can manage this without any problem, it’s easy for me…” and when we make a mistake we realize, “this is not so easy, I’m human.”</p><p>You can imagine facing the family after making a mistake with a patient. It’s very tough. That is why the most important thing about being a doctor is humility. I am a doctor, nothing less; I am not God, not perfect, I am human. This is a profession, it’s work. We like to be doctors, to be with patients, treat the challenges, fight disease. But always the best doctors are those with the greatest humility.</p><p></p><p><b>Dr. Julián Alberto Strati - ICU, Family Medical Practice HCMC</b></p>"
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"id": 958,
"title": "Sun, Skin, Scar - Actinic keratosis",
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"name": "Dermatology",
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"summary": "Actinic keratosis is a precancerous lesion that can develop into a carcinoma. It normally appears in sun-exposed areas—as opposed to melanomas, which can appear anywhere on the skin.",
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"value": "<p></p><p>Sun, Skin, Scar</p><p>Love to bathe in the sun? Then it’s time to check your face, lips, ears, back of your hands, forearms, scalp, and neck for these signs.</p><p>Actinic keratosis is a precancerous lesion that can develop into a carcinoma. It normally appears in sun-exposed areas—as opposed to melanomas, which can appear anywhere on the skin.</p><p>It’s typically a patch of raw skin that looks a little like eczema, but instead of appearing in areas of flexure (such as behind the knees or elbows) it appears on the “roof” of the body; the ears, nose, scalp (especially in people with fair skin and not much hair), the back of the arms, the back of the hands. Sometimes it’s not so visible—it might look normal, but feel somehow wrong—or it could be raised, scaly, non-healing, sometimes itchy or burning. When we see a skin lesion with these features, diagnosis can be relatively straightforward.</p><p>They’re very common in people who are frequently exposed to the sun—sailors, surfers, beach-lovers, pool-lovers. It’s typical in older men, but can occur early depending on the type of skin; especially with people who have many freckles or who were sunburned when they were a young child when the skin is comparatively weak. They don’t occur as broad rashes, but more like mushrooms—you might have two or three, four maximum, not very close together. On the scalp, however, there can be many. The interesting thing is that they can be mostly invisible, so the skin changes happen much earlier than when the effects can be seen visually.</p><p>It’s very important to treat this condition, as the mutations in the cells can lead to the development of squamous cell carcinomas and cancer. The fact is that actinic keratosis has a 10–30 percent chance of becoming, over a period of around ten years, a squamous cell carcinoma. So if we find it, we don’t give it a chance.</p><p>There are different strategies of treatment. One of the strategies is “kill on the spot.” You see the lesion and you freeze it or treat it with something that is destructive. Normally on this kind of lesion, it’s not necessary to do a biopsy, you don’t need to make a cut. But most skin clinics choose “destroy on sight.” It’s done repeatedly—once you have some, you have to go back after a few months to check for more.</p><p>There are also certain “field treatment” strategies using an immune stimulator called imiquimod. An alternative product is ingenol mebutate, which is derived from the plant <i>Euphorbia peplus</i>. These medicines burn the cancer cells via a direct chemical reaction. Imiquimod increases the skin’s immune awareness toward anything that is strange (and especially viral), which is why we use it to treat warts and cancer. When you put imiquimod on your body, if you have a healthy immune system, it triggers a very strong inflammatory reaction—not only in the lesions that you are treating, but also in the neighboring skin. The visual effect is very ugly, but it disappears after about a week or two and takes with it the existing lesions and any potential ones that are developing unseen. Finally, the skin is rejuvenated, and usually looks fresher and healthier than it did before, free of spots.<br/></p><p>It’s good to examine your skin for anything that doesn’t heal, is pinky, scaly or scar-like. Actinic keratosis typically has volume or an atrophy; they can get discolored or have a whitish, spidery aspect. Any lesions like this that are raw and don’t heal should warrant a dermatological check-up. At the clinic, we can examine the skin and do a dermoscopic check to see if treatment is necessary.</p>"
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"summary": "It’s important to recognize that surgery is not always 100% successful, and even if it is a very low risk procedure, it is no different for arthroscopic surgery. We must keep in mind that even if they are rare, it is still a surgical procedure subject to complications.",
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"value": "<h3>Learn more about arthroscopy, a minimally invasive operation to repair a damaged joint</h3><p>Arthroscopic surgery is a revolution in orthopedics, and it has changed the way we operate on joints. This minimally invasive procedure has given us the power to accurately examine joints from the inside, making a diagnosis with 100 percent accuracy. Not even an X-ray, CT scan or MRI can provide such results—with arthroscopy, you can see everything clearly and sometimes even fix the problem immediately.</p><p>Arthroscopy is where you make a very tiny incision in the skin around a joint—such as the knee or elbow—and insert a thin fiberoptic scope. This simple device gives us a very clear view of the anatomy of the joint—the cartilage, the meniscus, and all the minute structures between the bones. If there is damage, it’s usually quite apparent, and if (for example) you need to repair the damage or remove some tissue, you can cut another tiny hole and insert a separate instrument inside to do the job.</p><p>The science of arthroscopy has come a very long way. In the beginning, the procedure was really only used as a diagnostic tool. With the development of new techniques, materials, instruments and tools for treatment, we have learned to use arthroscopy to treat many disorders—especially soft tissue disorders like cartilage tears, meniscal tears, ligament ruptures and damage to other anatomical structures.</p><p>A good example is a torn meniscus, which is a very common sports injury. It’s a stretchable fibrocartilage within the knee that can easily rip with vigorous activity. 20 years ago, a meniscus tear was treated with open surgery—a surgeon would open the knee using a five or six-inch incision to get inside the joint and remove the part that was damaged.</p><p>With arthroscopy, we approach the same procedure with a very, very small incision. Whereas previously we may have just removed the part that was damaged, with the development of new arthroscopic techniques we can now try to repair the tear with a suture, pulling it together and allowing it to heal.</p><p>During my work as an orthopedic surgeon, I have focused my interest on arthroscopy of shoulder and knee and I have seen just how far the technique has come and what it has allowed us to achieve in our practice.</p><p>I started my training in Perugia, Italy under the supervision of Dr. Giuliano Cerulli, one of Europe’s most respected and highly regarded surgeons. In the early stages, as most practitioners often do, I had the opportunity to learn techniques and practice on cadavers while visiting cadaver labs once or twice a year.</p><p>After my specialization, I focused my training in arthroscopic surgery of the knee at the Aberdeen Royal Infirmary Hospital, Scotland and soon after, in Spain. Thanks to the supervision of senior consultants, I developed an interest in arthroscopy of the shoulder. From the start, I was impressed with how this mini-invasive surgery was able to resolve serious issues such as recurrent dislocation of the shoulder.</p><p>Regarding this pathology, I clearly remember my first successful case in which, via this arthroscopic technique, I was able to resolve a complex case involving a young man, whose quality of life was severely affected by episodes of recurrent shoulder dislocation. Under this mini-invasive procedure, soft tissue (labrum) damage was repaired, thereby fixing a problem that in most cases requires open and aggressive surgery.</p><p>Arthroscopic surgery has an important role in the treatment of injuries to athletes. It has a significant role in the surgical treatment of ligament injuries, such as anterior cruciate ligament reconstruction; and the surgical repair of tendon tear, such as rotatory cuff tear.</p><p>I believe that Vietnam’s very young population is gradually becoming more and more involved and interested in practicing sports; therefore we will be seeing an increase in sport injuries for which arthroscopic surgery will have a larger role in treatment.</p><p>It’s important to recognize that surgery is not always 100% successful, and even if it is a very low risk procedure, it is no different for arthroscopic surgery. We must keep in mind that even if they are rare, it is still a surgical procedure subject to complications. I also think that surgery should not always be the first choice, which is the reason why I always try to present an alternative option for patients, so as to give them the chance to explore forms of conservative treatment.</p><p>In conclusion, arthroscopic surgery is a procedure that offers great advantages to patients, and can often resolve or improve joint conditions, but it requires specific and extensive training from the orthopedic surgeon.</p>"
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"id": 707,
"title": "Treating Brain Damage the Cool Way",
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"summary": "Cold can damage us in two ways; either through localised frostbite on a body part, or through hypothermia, where the core temperature of the body sinks.",
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"value": "<p>Do you shiver in the cold? If you do then you handle it better than some people. Without our protective mechanisms, the body’s core temperature can quickly drop and there is a risk of frostbite. At the same time, a body that is cooled down copes better without oxygen, something which researchers can utilise to save lives.</p><p>We are now entering the cold season. Researchers have started to use the fact that when the temperature of our bodies goes slightly down we need less oxygen to treat newborn babies that suffer from asphyxia or lack of oxygen at the moment of birth, helping the plasticity/restoring mechanisms of these children’s brains.</p><p>Cold can damage us in two ways; either through localised frostbite on a body part, or through hypothermia, where the core temperature of the body sinks.</p><p>The body’s main defence against cooling is shivering, and how effectively we shiver is also individual. This causes the muscles to release energy, providing warmth and keeping the body temperature up. But some people do not shiver at all and are unprotected against the cold. The lower the body temperature, the lower the metabolism. This means the organs use less oxygen, for example.</p><p>It is this mechanism that is now being consciously used in several ways in healthcare. In cases where patients have oxygen deprivation of the brain, called asphyxia, due to example decreased blood flow – which is one of the most common complications during delivery – cooling has been shown to be an effective way of saving the brain. </p><p>By beginning cold treatment early within the first six hours, we think there is potential to save the nerve cells that die as a result of oxygen deficiency. The brain is stressed as a result of oxygen deficiency and a cascade of biochemical processes begins. For example, the nerve cells begin unrestrainedly producing the signalling substance glutamate, something which ultimately results in an excess of calcium – leading to the death of the nerve cell. Slowing down the brain’s metabolism by early cooling may be one way to reduce this excessive production of glutamate.</p><p>For neonatal care the cooling treatment lasts for 72 hours. Sweden was one of the first countries in the world to introduce cooling treatment for children with acute oxygen deficiency. About one quarter can be kept alive or saved from severe brain injury by cooling. Despite this, not all children receive the treatment they need since it must be initiated within six hours of birth. Because the majority of hospitals cannot offer proper cooling, the frail, newborn babies must be immediately transferred; a decision requiring quick actions on the part of a skilled paediatrician. During the transfer, the child is often placed in a normal transport incubator.</p><p>There is a need for simpler and safer transfers of children who need cooling treatment. Linus Olson, PhD, and a civil engineer and researcher at the Karolinska Institutet currently working in Vietnam, is involved in a research study testing a cooling mattress on newborn children with acute oxygen deficiency. The mattress works without either electricity or water, which means it can be used in all ambulances and hospitals. It is made of a plastic shell filled with something called phase-change material, which can transform from a solid to a liquid, using the child’s body heat as a source of energy in the process. After about an hour on the cooling mattress, the child reaches a temperature of about 33.5 degrees. A big plus is that the mattress then maintains this temperature in a stable way. It is also a lot cheaper that the equipment currently used for cooling treatment. In addition to the opportunity to improve transfers, we see the potential for improved neonatal care all over the world. Cooling treatment is currently introduced in hospitals in Vietnam. In this study, the mattress will be used to deliver cooling treatment at several hospitals and during transport. The goal is to save lives and reduce brain injuries among children with acute oxygen deficiency. So far the study confirms that the mattress is effective in these contexts, and there are plans to introduce it more permanently in neonatal care in Vietnam. In the long-term, other countries with less developed neonatal care will be of interest. The cooling mattress is also being tested in a study in Sweden. In the first stage, newborns with oxygen deficiency will be randomly selected to be transferred by air, either in a normal transport incubator or on the cooling mattress.</p><p>Cooling to protect the brain may help more patient groups than it is currently being used for, such as stroke patients or cardiac arrest patients. However, these people are often conscious, and then need to be anaesthetised. Cooling treatment may be refined further in the long-term, with better data concerning what body temperature is actually optimal and how long the cooling should last.</p><p></p><p><b>Dr. Mattias Larsson - Pediatrician, Family Medical Practice Hanoi</b></p>"
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"title": "The Antibiotic Apocalypse and What You Can Do to Prevent It",
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"post_date": "2018-12-10",
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"summary": "Working with the Vietnamese healthcare sector for two decades, I have watched in real-time the deterioration of the effectiveness of antibiotics where we now have ‘super-bugs' spreading everywhere that can cause infections that are untreatable.",
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"value": "<p>The child of my friend, who is 13 months old, was admitted to a Vietnamese hospital with meningitis. He was treated for two weeks and recovered. During the third week he developed a blood infection. Despite being treated with the strongest broad-spectrum antibiotics, he died. I was at the hospital working and got involved. I have spent 20 years researching the use of antibiotics and resistance to them in Việt Nam and other countries. With this tragedy, it became personal and affected me deeply.</p><p>Working with the Vietnamese healthcare sector for two decades, I have watched in ‘real-time’ the deterioration of the effectiveness of antibiotics where we now have ‘super-bugs’ spreading everywhere that can cause infections that are untreatable. How did we get here?</p><p>Antibiotics are one of the pillars of modern medicine and have contributed to the enormous improvement of health that we have seen globally in the past decades. It has enabled the decrease of infections as a cause of mortality and enabled surgery and transplantation.</p><p>Antibiotics eliminate some bacteria, including benevolent bacteria that support our metabolism but unfortunately overuse creates resistant strains that cause infections that are difficult to treat. Over time, the effectiveness of antibiotic treatment is eroded and there are not enough new antibiotics being developed to replace those that are no longer effective.</p><p>In Việt Nam, antibiotics are frequently used, often when not necessary and easy available at pharmacies. Correct diagnostics are time and resource consuming. Tests are not always available and often more expensive than drugs. When doctors cannot determine if illness is due to virus or bacteria, many prescribe antibiotics. There are economic incentives to sell drugs and drug companies often reward doctors for using their drugs.</p><p>In a study conducted in 1999, we interviewed parents about their children’s health, if they had been sick, used any drugs and took samples of bacteria. 75 per cent had used antibiotics in the last month, most without prescription and antibiotic resistance was common. The survey was repeated 7 and 14 years later showing increasing antibiotic resistance where antibiotic tablets are not effective for treatment of bacteria causing pneumonia and urinary tract infections, increasing the need for IV antibiotics, and placing a burden on the healthcare system and costs.</p><p>As most of the antibiotics were bought from private pharmacies and used for the common cold – caused by viruses – we did a study on how private pharmacies treat respiratory infections. Questionnaires were used to assess knowledge and fake patients to assess practice. Most pharmacy staff knew that antibiotics cannot treat the common cold. However, half of the pharmacies still dispensed antibiotics. After a three-step intervention, knowledge and practice improved, but still one-third dispensed antibiotics. The reason mentioned was that the pharmacy staff thought that the patients wanted antibiotics even though they knew it might not be necessary. Knowledge might not always be a good predictor of practice.</p><p>Antibiotic use in the community might influence the possibility of treating life-threatening infections in hospitals. Resistance genes are often separate from the bacterial genes on plasmids coding for resistance to several different antibiotics, can replicate faster and be transferred directly between bacteria, like data files between computers. When the bacteria are stressed due to antibiotic use, the replication of these resistance genes increases by several thousand times and bacteria give generously to each other – if you give me one shield I give you another and we both survive. This means that if you take one antibiotic, you also select for resistance to other antibiotics. This is a problem in hospitals where a lot of antibiotics are used, especially in intensive care units. Many patients may be admitted with one disease but during treatment, they become colonised with bacteria resistant to almost all antibiotics, so called ‘super-bugs’ causing infections that are very hard to treat with a high risk of death.</p><p>In 2013, we assessed the rate of hospital acquired infections at intensive care units in 16 Vietnamese hospitals. Among almost 5,000 patients, one third of both children and adults had hospital acquired infections. Many were caused by ‘super bugs’ that were resistant to almost all available antibiotics. In order to get an infection, a person has to be colonised by bacteria, so we also assessed colonisation with ‘super bugs’ in several hospitals and found that almost half of the patients were colonised.</p><p>However, we have also seen that if we can detect colonisation early, at admission, patients that are colonised can be separated from other patients, with the result that the risk of transmission, hospital acquired infections and mortality can be decreased. This shows that in hospitals, it is important to screen for ‘super bugs’ and to have good hygiene, with the beneficial result that there is a decrease in the risk that the ‘super bugs’ spread in the hospital and then out in society. </p><p>So – what can you do to preserve the power of antibiotics for our children and grand-children? Most importantly, don’t use antibiotics without a doctor’s prescription. When you choose where to go for examination, choose a clinic that can provide good diagnostics, then take the relevant tests that give you a clear diagnosis. By doing this, you will avoid unnecessary antibiotic use and help keep antibiotics effective for when they are really needed. As a bonus, you will decrease the risk of adverse drug reactions and diarrhoea as well as keep alive the good bacteria that help our metabolism and which can also affect our mental wellbeing.</p><p></p><p><b><i>Dr. Mattias Larsson - Pediatrician, Family Medical Practice Hanoi</i></b></p>"
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"id": 680,
"title": "Mental Health Matters",
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"post_date": "2018-12-03",
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"summary": "Mental health problems are one of the main causes of the social and economic burden of disease worldwide. Depression is considered to be the second leading cause of disability across the globe, and a major contributor to the burden of suicide and even ischemic heart disease.",
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"value": "<p>In the early hours of an April morning students at Nguyễn Khuyến High School were performing a morning exercise routine when teachers spotted a pupil standing on the roof of a four-story building on campus. The teachers asked the pupil to get back inside and asked two classmates to assist in the effort. </p><p>One of the classmates climbed on the roof in an attempt to persuade the pupil to return inside of the building. The pupil remained silent, smiled, cried, and ran off the building. This teenager was confirmed dead on arrival to a local general hospital.</p><p>I recently became aware of this story through a short yet compelling article by Duy Khang, from Tuổi Trẻ News. This article was powerful, written in a crisp way that did not detract from the principal messages. These were messages of respect and of pain. At that same time millions of people across the country were sleeping or starting their days unaware of what had happened; however, for the people directly touched by this death, life will no longer be the same.</p><p>The practice of medicine relies greatly on stories. Scientific knowledge and technological advances are essential but insufficient in the face of the need for people to recognise, interpret, process, and be moved by the stories of illness. In people with mental health problems those stories are often lived in isolation. In some cultures having mental health problems can carry an implication of weakness, of shame, causing the person or family to lose face. It can be damaging for the future prospects of the individual or even their families. This is a strong disincentive to share those stories and seek help.</p><p>Mental health problems are one of the main causes of the social and economic burden of disease worldwide. Depression is considered to be the second leading cause of disability across the globe, and a major contributor to the burden of suicide and even ischemic heart disease.</p><p>Data from the National Alliance on Mental Illness (USA) show that approximately one in five adults in the USA experience mental health problems in a given year. It estimates that only 41% of adults with a mental health problem received treatment in the past year. Suicide is now the second leading cause of death for people aged 15-24 years in the USA. British epidemiology data does not differ by much.</p><p>Despite epidemiological data in Viet Nam not being as available as in more economically developed countries, data from the Ministry of Health last year suggest that 15 per cent of the population has stress-related mental problems, and only a fifth of such people access treatment.</p><p>In September 2018, Việt Nam News reported on the director of the National Institute of Mental Health’s (Dr Nguyễn Doãn Phương) statement that over 28 million people in Việt Nam are dealing with mental health problems, about a third of which were young people. There is greater recognition of mental health problems in Việt Nam; more people are interested in visiting health professionals and accessing appropriate treatments. This is a good development and will hopefully push for a better-resourced mental health system.</p><p>The recognition of mental health problems and the ability to seek help and avoid the sense of isolation are essential. Sustainable mental health systems need to rely on prevention; on having patients, families and communities that are well-informed and have an active role in managing their mental health; on having the ability to seek help with the right treatment at the right time; and on doing so in a way that preserved most of our resources. Mental health problems can manifest in a variety of ways, such as:</p><ul><li>Feeling sad or down;</li><li>Confused thinking or reduced ability to concentrate;</li><li>Excessive fears or worries, or extreme feelings of guilt;</li><li>Extreme mood changes, ‘highs’ and ‘lows’;</li><li>Excessive anger, hostility or violence;</li><li>Inability to cope with daily problems or stress;</li><li>Withdrawal from friends and activities;</li><li>Significant tiredness, low energy;</li><li>Problems sleeping;</li><li>Major changes in eating habits;</li><li>Detachment from reality;</li><li>Paranoia;</li><li>Hallucinations;</li><li>Alcohol or drug abuse;</li><li>Sex drive changes;</li><li>Suicidal thinking.</li></ul><p>These symptoms can indicate the presence of specific psychiatric conditions, like a mood disorder such as depression or bipolar affective disorder, an anxiety disorder or a psychotic illness. When identified promptly these conditions are often treated effectively, with medications, psychological treatments, changes in lifestyle and additional support.</p><p>The identification of these problems can lead to difficult but important conversations about how someone can look after their own mental health or how friends and families can support each other. Our health, including mental health, is our most valuable capital, worthy of our care and attention.</p><p>Mental health problems are not a sign of weakness, or a cause for shame. It is often a sign of difficulty, of doubt, of fear and of pain; sometimes of loneliness; sometimes of loss.</p><p>On that tragic April morning, everyone lost.</p><p></p><p><b>Dr. Miguel de Seixas</b> is a member of the Royal College of Psychiatrists who studied in Portugal and the UK. Over the years, Dr. Miguel has treated people suffering from depression, anxiety, self-harm, suicidal tendencies, and those who have been diagnosed with mental health conditions such as bipolar disorder, obsessive compulsive disorder and schizophrenia.</p>"
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"title": "Acute Respiratory Infections in Children",
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"post_date": "2018-11-19",
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"summary": "Acute respiratory infections are the most common causes of both illness and mortality in children under five with an average of three to six episodes of ARIs annually. The proportion of mild to severe ARI varies between high- and low-income countries.",
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"value": "<p>Acute respiratory infections (ARIs) are classified as upper respiratory tract infections (URIs), from the nostrils to the vocal cords in the larynx, including the sinuses and the middle ear, or lower respiratory tract infections (LRIs), from the trachea and bronchi to the lungs.</p><p>ARIs are the most common causes of both illness and mortality in children under five with an average of three to six episodes of ARIs annually. The proportion of mild to severe ARI varies between high- and low-income countries, due to different pathogens (bacteria and virus), risk factors such as poor nutrition and access to healthcare and treatment. About 5.6 million children under the age five died in 2016, 15,000 every day, about 20 per cent due to ARI (WHO, 2017).</p><p><b>Upper respiratory tract infections</b></p><p>URIs are the most common infectious diseases, especially in children, and are commonly transmitted in crowded settings such as kindergarten. They include rhinitis (common cold), sinusitis, ear infections, acute tonsillitis, epiglottitis and laryngitis. The vast majority of URIs have a viral etiology and antibiotic treatment is not needed. Because most URIs are self-limiting, their complications are more important than the infections. Acute viral infections may predispose children to bacterial infections of the sinuses and middle ear. Coughing helps to remove mucus, preventing aspiration and LRIs as pneumonia.</p><p><b>Acute pharyngitis and tonsillitis</b></p><p>Acute pharyngitis with pharyngeal redness, swelling and tonsil enlargement is in more than 70 per cent of cases caused by viruses in young children and antibiotics are not needed. Streptococcal tonsillitis is rare in children under two years of age and more common in older children. If not treated, poststreptococcal rheumatic fever may cause inflammatory lesions in tissues such as joints and heart.</p><p><b>Lower respiratory tract infections</b></p><p>The most common LRIs in children are pneumonia and bronchiolitis. The respiratory rate is a valuable clinical sign for diagnosing acute LRI in children who are coughing and breathing rapidly. The presence of lower chest wall retraction can identify more severe cases. </p><p>The most common causes of viral LRIs tend to be seasonal. If the examination and test indicate viral causes no antibiotic treatment is needed. Inhalation of salbutamol can help to decrease inflammation in the respiratory tract, open up the airways and remove mucus.</p><p><b>Pneumonia</b></p><p>Pneumonia often presents itself with fever, difficulty of breathing and fatigue, and possibly painful breathing. Viruses are responsible for about half of all pneumonias in children. Measles, RSVs, parainfluenza, influenza type A and adenoviruses are the most common causes of viral pneumonia. Bacterial pneumonia is often caused by <i>Streptococcus pneumoniae</i> (pneumococcus) or <i>Haemophilus influenzae</i>. Radiology and tests as full blood count and CRP may be helpful to differentiate between viral and bacterial etiology. </p><p>Atypical pneumonias with symptoms such as a dry cough, low grade fever and headaches are caused by pathogens such as <i>Mycoplasma pneumoniae</i> and <i>Chlamydia pneumoniae</i>, which can be treated with antibiotics.</p><p>Tuberculosis often presents with persistent cough for several weeks, sometimes blood in sputum, low grade fever, nightly sweating and weight loss. Tuberculosis can be treated with a combination of antibiotics. </p><p>Pneumonia is often spread in hospitals and may be difficult to treat due to high antibiotic resistance.</p><p><b>Bronchiolitis</b></p><p>Bronchiolitis occurs predominantly in the first years of life. The clinical features are rapid breathing and wheezing and in some cases lower chest wall indrawing and fever. The main cause of bronchiolitis are viruses such as RSVs, metapneumovirus, parainfluenza virus and influenza viruses.</p><p><b>Many respiratory infections can be prevented with vaccines! </b></p><p>Vaccines cause antibodies to develop in the body and protect from disease, it is as you would have a disease without being sick. Vaccination is important not only to prevent disease for the individual but also to prevent transmission in the society. If more then 80 per cent of people are vaccinated it is low risk that a disease can spread. This is called herd immunity.</p><p><b>Influenza A vaccine</b></p><p>Influenza is a serious disease that can lead to hospitalisation and sometimes even death. Every flu season is different. Millions of people get the flu every year, hundreds of thousands of people are hospitalized and thousands die. An annual seasonal flu vaccine is the best way to reduce your risk of getting sick and spreading it to others. Everyone six months of age and older is recommended to get a flu vaccine every season.</p><p><b>Hib Vaccine</b></p><p><i>Haemophilus influenzae</i> type b (Hib) is a bacteria that causes serious diseases such as meningitis (an infection of the lining of the brain and spinal cord), pneumonia, epiglottis (severe swelling in the throat, making it hard to breathe), infections of the blood, joints, bones, and pericarditis (covering of the heart). It usually affects children under 5 years old. Before Hib vaccine the mortality in Hib B infections was about 5 per cent. Since use of the Hib vaccine began, the number of cases of invasive Hib disease has decreased by more than 99 per cent.</p><p><b>Pneumococcal vaccines</b></p><p><i>Streptococcus pneumoniae</i> is a bacteria that is the most common cause of pneumonia and meningitis. CDC recommends pneumococcal vaccines for all children younger than 2 years old, all adults 65 years or older, and people 2 through 64 years old with certain medical conditions. — <b>Family Medical Practice</b></p><p><i>*</i><b><i>Dr. Mattias Larsson</i></b><i> first came to Viet Nam in 1997 to conduct research on child infections and antibiotic use and resistance. In 2003 he defended his PhD and graduated from his medical training. Since then he has spent about half of his time in Sweden working as a physician in pediatrics and infectious diseases. The other half has been spent in Vietnam and other developing countries working with medical training and research. Dr.</i> <i>Larsson</i> <i>speaks English, Swedish, German and Vietnamese as well as some Spanish. He will complement the team at Family Medical Practice in Hanoi, and intends to participate in the development of diagnostics care and treatment towards the best international evidence based standards.</i></p><p></p><p><b><i>Dr. Mattias Larsson - Pediatrics, Family Medical Practice Ho Chi Minh City</i></b></p>"
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