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"id": 571,
"title": "The Business of Medical Evacuation",
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"summary": "The industry of air ambulances is abusing Vietnam. It sours our reputation abroad and flouts our tax laws ... there are enough local providers here who have the knowledge, experience, and expertise to perform these transfers safely while putting the interests of the patient first, not those of foreign businesses.",
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"value": "<p>Imagine you’re a foreign tourist who has had the misfortune to fall terribly ill during your visit to Ho Chi Minh City. You’ve been admitted to hospital, you’re lying in the ward, and a team of people wearing white coats arrives to tell you that they’ve come to pick you up and evacuate you to Thailand—where they say you’ll get superior treatment. Before you know it, you’re on an air ambulance touching down in Bangkok, being taken to a facility with a nicer room and a softer pillow. The charge for this transfer to a bed upgrade 750 kilometers away was probably somewhere between $15,000–$20,000.</p><p>More likely than not, your flight had nothing to do with medical emergency—and everything to do with the business of medical evacuation.</p><p>International evacuation by air is a mega-million dollar industry. According to local air traffic controllers, at least one or more air ambulances enter Vietnam’s airspace every single day. Just as ambulances on the road are given right-of-way in order to save lives, so too do air ambulances enjoy priority clearance at international airports, and Vietnam is no exception. Unfortunately, this safety protocol makes the industry enormously difficult to regulate, and leaves Vietnam open to exploitation by foreign operators who neither pay taxes on their activities stemming from here, nor do any service to this country’s reputation among the international community—who have been indoctrinated to presume that no significant medical procedures are possible in Vietnam; and that if they are, they are too risky.</p><p>The fact is that a company can make a lot of money by convincing foreign patients of their need to be transferred abroad for medical treatment, even if that patient does not fully understand why. Most such patients are “evacuated” simply because they have been told by people in lab coats that it is necessary. Local doctors are also offered lucrative referral fees as incentives to recommend patients for medical evacuation, informing the air ambulance operators whenever they have an eligible case.</p><p>This “business” is further propped up by the sale of “evacuation cards” to tourists, which pronounces them “eligible for evacuation” if anything happens to them. Even for non-cardholders, regular insurers usually cover medevac expenses anyway. The cases are generally approved by doctors sitting in comfortable offices many thousands of kilometers away who have also been indoctrinated that every case in Vietnam has to be flown out. Why? Because that was what their predecessors believed, and the ones before them, and so on. Why be the one to take the risk and restrict medevac coverage in Vietnam? As a result, this practice continues.</p><p>In Vietnam, this industry is largely captured by Thai providers who fly into Vietnam on a daily basis to perform a service on Vietnamese territory without being asked to declare earnings on those activities, and therefore paying zero tax here. Millions of dollars that should have been submitted to Vietnam for many years by a company that operates here nearly every day remain unpaid. This also serves to perpetuate the impression overseas that almost any traveller who falls ill in Vietnam somehow needs a medevac.</p><p>Some of the pickup teams are extremely ill-equipped. In one case, a Thai air ambulance doctor came to our clinic to collect a reassessed patient, carrying a blood pressure machine purchased from a Boots pharmacy! A patient wired to everything imaginable, and she came with over-the-counter equipment and claimed “this is now my patient”. Last month, a Thai team was kicked out of a hospital in Danang for being under-equipped, unprepared, and without any prior understanding of the case.</p><p>The legality of such teams working in Vietnam, even for short periods of time, is highly questionable. Few of the cases they deal with are REAL emergencies. Genuinely life-threatening emergencies are usually rejected by air ambulance providers for a myriad of reasons, usually none of which are actually related to health risks. The list of do’s and don’t’s seems to be very clear in the world of medical evacuations. In this region, air ambulances obviously prefer to fly only the non-risky cases.</p><p>The industry of air ambulances is abusing Vietnam. It sours our reputation abroad and flouts our tax laws. Local medical providers should block the surrender of their patients to unlicensed foreign operators, and evacuations should be performed by local companies that are already regulated by the Vietnamese administration. There are enough local providers here who have the knowledge, experience, and expertise to perform these transfers safely while putting the interests of the patient first, not those of foreign businesses who deliberately breed fear among international visitors, damaging our reputation for the sake of profit.</p><p><i>This opinion piece by FMP founder Dr. Rafi Kot originally appeared in VietCetera.</i></p>"
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"id": 580,
"title": "Acne Agony",
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"summary": "There is no evidence to suggest that acne is caused by poor diet or hygiene. It’s no more common in Vietnam than it is anywhere else. And, while it is an infectious disease, it is not a transmissible one.",
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"value": "<p>“Mom, what’s happening with these pimples on my face?” “Oh, don’t worry, I had them too…”</p><p>Many people feel acne is a natural condition that should be accepted. It happens to almost 80 percent of the population between 15 and 30 years of age. That’s why they feel that one day it comes, if you’re unlucky, and that it will most likely eventually go away without leaving any permanent sequelae—or instead, it may leave scars or permanent pigmentation. In the meantime, it might make you feel like a monster and cause psychological trauma, because normally it happens during the building of a teenager’s self-esteem and confidence.</p><p>Acne arises from four main factors. The first is an overproduction of grease, which makes the skin look oily. The second is a blockage of follicles where hair grows from the skin. Therefore, the excess grease and the occlusion of the follicles bring about the third factor, inflammation. An infection is then produced by a resident bacteria on the skin called <i>Propionibacterium acnes</i>. All together, this is what we need to treat. There is no evidence to suggest that acne is caused by poor diet or hygiene. It’s no more common in Vietnam than it is anywhere else. And, while it is an infectious disease, it is not a transmissible one.</p><p>The overproduction of fat, the occlusion of the follicles, the inflammation and the infection— these have been traditionally treated with antibiotics and peelers, which work to peel the skin, making it more diffusely red and dry. So we dry the skin, we irritate the skin, and we will see the skin become flaky. That’s also something that people don’t like, but it has been considered part of the price to pay to get rid of the pimples—by having dry, irritated, burning skin.</p><p>For many years, acne has been treated with antibiotic creams or pills. Unfortunately, a good deal of resistance to the antibiotics has occurred, because normally the treatment is so long. This is something that we need to tell everybody who has acne, and who has the will to treat it—they must be patient. You don’t see improvements in acne even with the more efficacious treatments before 12 weeks. The full treatment should normally take place within the course of one year, and there can be relapses, so this can be very hard to cope with.</p><p>The good news is that the best medications available on the market today are used earlier, when the disease is not so advanced. That’s a new trend—ten years ago, after-the-fact treatment from powerful medicines (such as retinoid creams, benzoyl peroxide, adapalene creams, and antibiotics) were used in an escalating manner—and when the disease was really advanced, then people were put on oral retinoids. These are the best treatment for acne, because retinoids interact with inflammation, infection, occlusion, and sebaceous production— all four causes of acne.</p><p>Retinoids were formerly used in very high doses. In some cases, the reaction was so violent that you would need to inject steroids into some of the lesions. This is why retinoid treatment is sometimes associated with psychological trauma, mostly because it was used when people were already desperate from the disease.</p><p>The modern trend is to use the oral retinoid earlier and in smaller doses. Today, what we have learned is that you can help people feel less anxious about the acne and prevent the scars and the pigmentation, which is important, especially with teenagers from Asian countries whose skin is more easily tanned from exposure to the sun (in general, the darker the skin, the more risk you have of post-inflammatory pigmentation, or PIP). These days, we don’t want to treat only the acute problem, we want to treat the whole thing—we want to treat the person and their experience of life. If we can prevent the acne from becoming violent by starting with low doses and using oral retinoids with appropriate controls, we can prevent scarring and PIP from the beginning, and greatly reduce the chance of relapses of the disease.</p><p>Some are reluctant to have their acne treated, seeing it as a cosmetic problem. I completely disagree with considering acne as a cosmetic issue. We are not talking here about “wanting a smaller nose” or “bigger lips.” We are talking about “wanting skin to appear healthy.” Some people can be disfigured or even lose their jobs because they are facing the public and can be seen as dirty and untidy.</p><p>Parents who see their child starting to show a growing number of pimples on their face should consider preventive treatment. An adolescent does not have to suffer an inflammatory disease; medical options are available to greatly reduce the severity of this condition.</p><p>Parents have the power to lead their children in having a first consultation and starting treatment before acne really becomes a problem. Some early decisions, made on time, will spare kids from going through physical and psychological issues that will distract them from concentrating on learning, socializing and becoming successful in their teenage life, which is important in building the personality.</p>"
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"id": 572,
"title": "Medical Evacuations",
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"summary": "At our clinic, we now have a highly experienced medical evacuation team and have become regarded as an authority in these matters. Although we started with small cases, we have established Vietnam as one of only seven countries worldwide capable of doing ECMO evacuations.",
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"value": "<p>Medical evacuations are difficult to pull off, but in terms of complexity, there’s nothing that goes beyond extracorporeal membrane oxidation (ECMO). In these evacuations, a patient needs to be moved from one country to another while their heart is disconnected from their body.</p><p>Just like an organ transplant, it takes a team of 12 to 14 people to pull one off, involving a multidisciplinary bioengineering team, a nursing team, and a medical team. The difference is that in an operating theatre, the specialists come and go as they’re needed — while on a plane, they’re all there together, all the time. Anything can go wrong at any moment, and everyone has to rely on their sight because it’s extremely difficult to hear anything over the noise of the engine.</p><p>ECMO refers to the action of the heart and lung machine a patient is attached to while their organs are disconnected. ECMO represents the Everest of capacity when it comes to medevacs, with patients who are hanging on a thread between life and death. When a patient reaches an ECMO, it means their heart cannot pump blood any more and it has to be supported by a medical device which imitates the organ’s function. After the heart has been arrested, they will be connected to the machine in the hope that, with some time to rest and heal, things will go back to normal, so the heart can then be reconnected to the body.</p><p>Sometimes the patient will need specialized medical attention that is not available in Vietnam; in these cases, he or she must be transferred overseas.</p><p><b>Making the Impossible Possible</b></p><p>Our first ECMO medevac case was a Russian patient who collapsed at Tan Son Nhat Airport. She was rushed to the Heart Center in Saigon, but it was clear that she would need attention from a major facility abroad. At the time, there were no providers in the region who had the capacity to perform an ECMO medevac. Meeting up with her father, who flew in, we explained the situation to him and that this was a complicated procedure which we had never done before. Doable, but risky. Very. I remember her dad saying: “This is my only daughter. It’s a risk for you, but a chance for me.”</p><p>With no options available, we decided the only thing we could do was fly the patient out ourselves. Hospitals in Bangkok said they could admit the patient, as long as we found a way to transport her there. Bangkok was the choice as we opted for the shortest route.</p><p>We built an entire stretcher with machines on it, wires protruding, oxygen tanks, only to remember we had a patient to insert into all this. The end result was a stretcher with a tower of equipment on top and on both sides. It took five hours to move the patient from her bed and to reconnect her to our systems.</p><p>Thanks to Vietnam Airlines, we procured an ATR aircraft, an aircraft with a large cargo door, and together with their technicians we reconfigured the inner part of the plane, leaving an island of chairs in the mid-section for the stretcher to be installed on top, while the support team sat at the back. We took the flight with around five doctors and a nurse. We had a biomedical engineer, who controlled the electricity supply — we had to carry a lot of batteries — plus we also had a lab technician with a portable unit, just in case. We landed in Bangkok having successfully kept the patient well and alive.</p><p>The Thai Hospital proved to be another challenge as they had never moved a patient from one ECMO unit to another. Worse, the units were not of the same make. So, over the ensuing three hours, we had to do it for them.</p><p>Only on the flight back did we start to grasp the success of the transfer and the implications of it. The patient? She stayed in hospital for three months, survived and returned home.</p><p><b>In Safe Hands</b></p><p>Following this evacuation, we had another from Hanoi to China, and as I write this we’re working on another case. The one thing that makes these cases manageable is that there’s no rush to get from here</p><p>to there. While ECMO patients may be holding on by a thread, they’re not dying as long as they’re properly connected to the machine. You can usually wait another couple of days if there’s a delay. Vietnam Airlines have been a tremendous help, and we thank them for their cooperation. We have our agreements with airport authorities; we have our own gates, we have our own evacuation systems; whatever we need to clear.</p><p>At our clinic, we now have a highly experienced medical evacuation team and have become regarded as an authority in these matters. Although we started with small cases, we have established Vietnam as one of only seven countries worldwide capable of doing ECMO evacuations.</p><p></p><p><b><i>Dr. Rafi Kot - Founder and CEO, Family Medical Practice</i></b></p><p><b><i>Published in Word Magazine</i></b></p>"
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"id": 597,
"title": "Heart Attacks and Stroke/Emergency Medical Response",
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"post_date": "2017-04-27",
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"summary": "In cases of an ischemic stroke, prompt medical response can be very effective. If a victim can be taken to hospital within the first three hours of the incident, we can administer a blood clot-dissolving medication called tPA (Tissue Plasminogen Activator) that is able to restore the blood flow.",
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"value": "<p>When a Western tourist collapsed outside the Independence Palace last January, media outlets widely reported that the foreign visitor had suffered from a stroke. This wasn’t quite accurate—according to the emergency doctor who arrived on the scene by ambulance just minutes after receiving the alert, the patient had clearly suffered from a heart attack before going into cardiac arrest and was accordingly taken into intensive care at a nearby cardiology unit.<br/><br/>What stood out about this particular incident wasn’t only the misdiagnosis on the part of the media, but also the fact that the victim suffered from the attack in a prominent public place in full view of multiple passers-by, most of whom were unable to offer any assistance whatsoever. It’s sadly the case that few members of the public in Ho Chi Minh City—whether they be locals or expat residents—have the basic medical awareness required to assist in any such emergency.<br/><br/>Dr. Bui Nghia Thinh, emergency medical director at Family Medical Practice, has been an integral part of the development of Ho Chi Minh City’s first private emergency medical response system, <b>∗9999</b>. While in this case his unit was able to respond immediately to the call for help after a bystander dialed the emergency number, Dr. Thinh remains deeply concerned about spreading awareness in HCMC about the basic protocols necessary to deal with medical crises. According to Dr. Thinh, it’s mostly a lack of understanding that makes bystanders hesitant to act—resulting in delays that often cost lives.<br/><br/>Fortunately, the differences between a stroke and a heart attack are relatively simple to understand—and in the moments leading up to a cardiac incident, there are several easily-distinguishable clues that can identify what the problem is likely to be.<br/><br/>“When you’re talking about stroke, you’re talking about a cardiovascular accident in the brain,” says Dr. Thinh. “If a blood vessel supplying blood to the brain gets a clotted, that’s called an ischemic stroke. “Ischemic” means that the brain doesn’t get enough blood. If the vessel is bleeding, that’s called a hemorrhagic stroke. So there are two kinds of stroke. Both of them usually occur directly in the brain, which causes a neurological defect. You have slurred speech, you can’t pronounce words properly, you cannot raise your hand; you can feel a tingling numbness, until eventually you go into a coma. So if you see signs associated with neurological defects, that’s a stroke.”<br/><br/>“Heart attacks are different,” he continues. “If you have chest pain, discomfort in the chest, in the upper part of the body, that is the beginning of a heart attack. Usually you will see someone clutching at their chest, complaining of difficulty breathing, or breaking out into a cold sweat. The function of the heart is to pump blood throughout the body, and if it doesn’t pump enough to the brain, then the brain gets involved. The patient will then also go into a coma. At that point, it can be confused with a stroke. Before that, as the one involves neurological symptoms and the other chest pain, it’s usually easy to separate the two.”<br/><br/>While a stroke and a heart attack are two very different medical events, the end point is the same—cardiac arrest. By the time someone’s heart has stopped and they’ve lost consciousness, however, it’s no longer immediately obvious what the cause is. In either case, the response of a bystander should be the same.<br/><br/>“If you see someone lying there, you have to check before you can make any confirmation,” says Dr. Thinh. “If there’s no response, and the victim doesn’t appear to be breathing or gasping for air, then you should proceed to CPR right away. But if you check for a response and the victim is still breathing and still responds to you, then there are several questions to ask that should help determine if it’s a heart attack, a stroke or some other medical crises. Regardless, I urge people in this situation to dial our emergency number ∗9999, because in any case you will get free and proper instruction. The call-taker will question you one by one, and then lead you to the correct action.”<br/><br/>The most crucial element is time. In many acute cases—and this applies anywhere in the world, not only Ho Chi Minh City—an ambulance can take half an hour or more to arrive on the scene. Even the ambulance gets to the scene in five to ten minutes, it might be too late, as during this time the lack of oxygen to the brain can cause permanent, irreversible brain damage or death. This is why the default response to an emergency in Vietnam—attempting to take a cardiac arrest victim to hospital by taxi—very often results in death before the patient arrives at the medical facility.<br/><br/>“If you call the emergency number ∗9999, the call-taker can instruct you to assist the patient,” explains Dr. Thinh. “If there’s no response in the patient, they will assume it’s cardiac arrest, and they will coach you on how to do CPR. If there is some sort of response—it depends on how the patient responds to the caller—then the call-taker will instruct you on what to do next, and can identify the necessary management before the ambulance even gets there.”<br/><br/>One issue that proved problematic in the establishment of a 911-style emergency response system in Vietnam is that there is a degree of scepticism about the usefulness of medical instruction over the phone, especially in the case of lifesaving techniques such as CPR. “For people in Vietnam, it seems too new”, says Dr. Thinh, “but people can really do it—this has been proven in America and all over the world. The most important thing for people at that time is not to panic and to call for instructions. It’s certainly not easy at all to make a proper assessment without a medical background. If you call the emergency line, the question and response protocols can give you the best assessment possible. CPR is an essential first response in cases of cardiac arrest, and I would advise everybody to learn it—we actually run a monthly course in FMP’s District 2 medical center instructing in this technique—but if you don’t know CPR, call ∗9999, and the call-taker will talk you through it.”<br/><br/>In cases of ischemic stroke, prompt medical response can be enormously effective. If a victim can be taken to hospital within the first three hours of the incident, a blood-clot-dissolving medication called tPA (Tissue Plasminogen Activator) can be administered that is able to restore the blood flow. Dr. Thinh has already successfully treated a number of stroke victims using this method: “Within the first three hours, we save most of the cases,” he says. “We can do it here in Saigon—in this medical center we have three cases already. You can see the patients come in with hemiplegia—paralysis of half the body—and within 5-6 hours, they can walk.”<br/></p><p>In all events, time is the most critical component in emergency response. Regardless of whether or not you know CPR or have enough information about the victim to be able to figure out what has happened, do call ∗9999 within Vetnam for professional emergency assistance and stay calm. The speed of your response is likely to be the difference between life and death for the victim.<br/></p><p><b>Dr. Bui Nghia Thinh - Emergency Medical Director ∗9999, Family Medical Practice Ho Chi Minh City</b></p>"
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"id": 704,
"title": "How To Beat the Summer Heat",
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"summary": "As the thermometer climbs and we rapidly morph out of winter into summer, all of us need to remind ourselves about what we need to do to stay healthy in the summer heat.",
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"value": "<p>As the thermometer climbs and we rapidly morph out of winter into summer, all of us need to remind ourselves about what we need to do to stay healthy in the summer heat.</p><p>The danger for some is heat exhaustion, which is a condition whose symptoms may include weakness, headache, dizziness, muscle cramps, nausea or vomiting and rapid heart beat. All of this is a result of your body overheating. Causes of heat exhaustion include exposure to high temperatures, high humidity and strenuous physical activity (golfing!).</p><p>Without prompt treatment it may become a life-threatening condition. In hot weather, your body cools itself mainly by sweating. Evaporation of sweat lowers body temperature. However, when you exercise strenuously especially in hot, humid weather, your body is less able to cool itself efficiently. If you suspect a heat-related illness, stop exercising and get out of the heat.</p><p><b>Treatment:</b> In most cases, you can treat heat exhaustion yourself by doing the following:</p><p><b>Rest in a cool place.</b> Get to an air-conditioned building or at the least, find a shady spot. Rest on your back with your legs elevated higher than your heart level.</p><p><b>Drink cool fluids.</b> Stick to water or sports drinks (Gatorade). These (sports) drinks can replace the sodium, chloride and potassium you lose through sweating. Don’t drink any beverages that have alcohol or caffeine which can promote fluid loss. Your body’s ability to sweat and cool down depends on adequate rehydration. Drink plenty of water while you’re working out — even if you don’t feel thirsty</p><p><b>Apply cool water to your skin.</b> If possible, take a cool shower, sponge down or soak in a cool bath.</p><p><b>Loosen clothing.</b> Remove any tight unnecessary clothing<b>.</b></p><p>Contact your doctor if your signs or symptoms worsen or if they don’t improve within 30 minutes. </p><p><b>Prevention</b></p><p><b>Wear loose-fitting, lightweight, light-colored clothing.</b> Dark or tight clothing holds in heat and doesn’t let your body cool properly because it inhibits sweat evaporation.</p><p>Lightweight, loose-fitting clothing promotes sweat evaporation and cooling by letting more air pass over your body. </p><p><b>Avoid the midday sun:</b> Wear a lightweight, wide-brimmed hat. Use an umbrella to protect yourself from the sun. Apply sunscreen to exposed skin. Exercise in the morning or evening — when it’s likely to be cooler outdoors — rather than the middle of the day </p><p><b>Drink plenty of fluids:</b> Staying hydrated will help your body sweat and maintain a normal body temperature. Don’t wait until you feel thirsty!</p><p><b>Slow and Easy:</b> If you’re used to exercising indoors or in cooler weather, take it easy at first. As your body adapts to the heat, gradually increase the length and intensity of your workouts. If you have a chronic medical condition or take medication, ask your doctor if you need to take additional precautions. — <b>Family Medical Practice Vietnam</b></p><p></p><p><b><i>Dr. Mathieu Nalpas - Internist, Family Medical Practice Hanoi</i></b></p>"
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"title": "Cervical Cancer",
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"summary": "Most people who have an HPV infection do not show any outward signs until it’s too late... Once that happens, symptoms such as irregular menstrual bleeding, bleeding after sex, and pain can occur, depending on the size and location of the cancer.",
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"value": "<p></p><p>One of the most devastating experiences a physician faces is to see a patient with a condition that is completely preventable and treatable—but because the patient presented it too late in the course of the disease, that condition is no longer curable, or can only be partially treated even with the most invasive/aggressive techniques. Cervical cancer is exactly that kind of condition.<br/></p><p>Cervical cancer is the result of an infection by the Human Papillomavirus (HPV)—anyone who is sexually active (including vaginal, anal, or oral sex) is at risk. Even having sex just once can put someone at risk, although repeated contact at a young age with different partners does pose a much higher risk.<br/></p><p>There are many types of this virus, including about 40 that cause the majority of infections leading to cervical cancer in women and penile warts or cancer in men. Two of the types that are especially harmful (causing the most cancers) are HPV type 16 and 18. Cervical cancer is the second most common cancer in Vietnamese women after breast cancer.<br/></p><p>HPV infection has two stages: (1) a person is exposed to it; and (2) the body responds to it. If it can fight the infection off, the person will not develop cancer; otherwise the HPV will overcome the person's immune system and cause cancerous changes in the person's normal cells and malignant transformation of those cells. It can take many years between exposure and the development of cancer.<br/></p><p>“Wait a minute,” you might ask, “wouldn't I know if someone I'm having sex with someone who has a raging ‘HPV infection”?<br/></p><p>Unfortunately, no—most people who have an HPV infection do not show any outward signs until it’s too late. First of all, the cervix where the infection/cancer initially occurs is not visible to the naked eye, being well-hidden inside the vaginal canal. Secondly, even where early malignant changes do occur, it is still not visible to the naked eye. Thirdly, this infection does not cause any symptoms until the cancer has progressed. Once that happens, symptoms such as irregular menstrual bleeding, bleeding after sex, and pain can occur, depending on the size and location of the cancer.<br/></p><p>So what can be done to prevent or treat cervical cancer/penile warts in the early stages so that it doesn’t progress to a point that is harder to treat or incurable?<br/></p><p>There are two methods—receiving the HPV vaccine, and detecting the onset of cancer at an early stage when it is completely curable (compared to cancer that has progressed to the later stages, becoming bigger in size and infiltrating the surrounding organs).<br/></p><p>At this time, there are three vaccines that are FDA approved—all three of them targeting types 16 and 18, the most virulent strains of the HPV virus. Receiving one of these vaccines is recommended in the U.S. for girls and boys starting from 11 to 26 years old to help your body make antibodies that fight against HPV virus when your body is exposed to them, which is why it’s better to get it before someone becomes sexually active.<br/></p><p>“So if I'm 21 years old and already have had sex, can I still benefit from this vaccine?”<br/></p><p>Absolutely! Just because you’ve had sex already does not mean that you’ve been exposed to the strains of HPV that are virulent, such as types 16 and 18—and if you do get the vaccine, your body still has a chance to make antibodies that can fight against the virus if you’re exposed to it in future. The vaccine is also recommended for gay and bisexual men up to the age of 26 years old, as well as anyone who has a condition that makes their immunity low (such as HIV).<br/></p><p>“Now that I’m 28 years old, have not received the HPV vaccine and am sexually active, what can I do to prevent cervical cancer?”<br/></p><p>It is now possible to be directly tested for HPV 16 and 18 infections as well as the other strains most commonly associated with cervical cancer. This screening test has now been shown to be more effective than traditional Pap smear testing. Many institutions, including our own medical centers, have made the transition to replace routine Pap testing with HPV screening.<br/></p><p>Condom use can be beneficial in preventing the spread of HPV, but are not enough to protect against all HPV infections—as any skin-to-skin contact can spread the virus.<br/></p><p>The HPV vaccine, HPV testing and Pap smear testing are all available in Vietnam.<br/></p><p>There is a lot of information available on this topic, and we’re not able to include it all in one sitting; also, information is changing at a rapid pace, so new updates are available all the time. Please keep yourself updated, and don't hesitate to contact a healthcare professional with any further questions.<br/></p><p>Remember, cervical cancer is preventable!</p><p></p><p><b><i>Dr. Jane Shadwell-Li - Internist, Family Medical Practice Ho Chi Minh City</i></b></p>"
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"value": "<p>Việt Nam là một trong các nước có tỷ lệ mổ bắt con cao nhất thế giới. Theo thống kê chính thức thì tỷ lệ mổ bắt con lên đến 40-50% nhưng thực tế con số còn lớn hơn nhiều. Một khảo sát tại Family Medical Practice cho thấy hơn 80% bé đến khám tại phòng khám ra đời bằng phương pháp sinh mổ. Để so sánh thì theo Tổ chức Y tế Thế giới WHO, tỷ lệ mổ bắt con chung khoảng 15%. Ở Mỹ khoảng 32%, Anh 25%, Thụy Điển 17%.</p><p>Có nhiều nguy cơ và biến chứng có thể xảy ra khi chọn phương pháp mổ bắt con (kể cả việc mang thai lần sau). Có một điều mà bạn và bác sĩ của bạn nên ý thức khi chọn phương pháp mổ đẻ.</p><p>Chúng ta thấy có một một mối liên hệ mật thiết giữa sinh con bằng phương pháp mổ bắt con và nguy cơ bất thường chức năng hệ miễn dịch của trẻ. Tại Đan Mạch, một nghiên cứu lớn với trên 2 triệu trẻ trong vòng 35 năm từ 1973 – 2012 chỉ ra rằng những trẻ được sinh ra bằng phương pháp mổ bắt con có nguy cao bị bệnh: Hen suyễn, dị ứng, viêm khớp dạng thấp, viêm đại tràng, khiếm khuyết hệ miễn dịch và bệnh bạch cầu (tất cả đều liên quan đến các bất thường chức năng hệ miễn dịch).</p><p><b>Tại sao các nguy cơ đó lại xảy ra?</b></p><p>Như chúng ta đều biết những vi khuẩn có lợi trong cơ thể có vai trò rất quan trọng đối với chức năng của hệ miễn dịch. Các vi khuẩn có lợi tương tác với các tế bào hệ miễn dịch và điều chỉnh hoạt động của chúng. Khi thiếu các vi khuẩn có lợi, các tế bào miễn dịch sẽ mất kiểm soát và bắt đầu gây ra phản ứng viêm và gây tổn hại đến các bộ phận khác nhau của cơ thể chúng ta. Ví dụ: Phổi – Hen Suyễn; Da - Viêm da dị ứng; Khớp – Viêm khớp, Tuyến tụy – Tiểu đường.</p><p>Khi trẻ được sinh thường, bé nhận được các vi khuẩn có lợi từ khoang âm đạo người mẹ. Các vi khuẩn này nhanh chóng cư ngụ trong ruột và tương tác đến hệ miễn dịch của trẻ. Điều này một mặt giúp bảo vệ trẻ khỏi các nhiễm trùng và mặt khác tác động đến hệ thống miễn dịch.</p><p>Một trẻ sinh bằng phương pháp mổ bắt con là sinh ra một cách vô trùng. Bé không nhận được các vi khuẩn có lợi. Thực tế, các bé này phải tiếp xúc với các vi khuẩn có hại trong môi trường bệnh viện. Những vi khuẩn gây bệnh điển hình này (nguyên nhân gây bệnh) không tác động có lợi cho hệ thống miễn dịch mà còn có thể tạo thêm nguy cơ cho bé.</p><p>Các bà mẹ tương lại thân mến, hãy nhớ rằng: quyết định chọn phương pháp mổ bắt con khi không cần thiết có thể để lại hậu quả lâu dài đến sức khỏe của bé sau này.</p><p></p>"
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"title": "Sexually Transmitted Infections VND 3,965,000",
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"post_date": "2017-03-03",
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"value": "<p></p><p>In Vietnam, unsafe sexual practices are widespread. It is quite possible to have an STI for a long time before symptoms occur. Some can be transmitted even with condom use.</p><p>Our comprehensive testing package and full lab analysis for the diagnosis and treatment of sexually transmitted infections (STIs) are recommended for anyone who has any reason to suspect that they may have been exposed. Untreated STIs can weaken the immune response in your genital area or open sores, increasing your risk of contracting another STI (such as HIV).</p><p>The sessions take about one hour and include a full consultation with an infectious disease specialist and tests for HIV, syphilis, chlamydia and gonorrhea. Additional tests depend on the doctor’s advice with 10% discount on published rates.</p>"
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"title": "Cardiovascular Assessment: VND 6,900,000",
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"value": "<p>Coronary disease is one of the leading causes of death worldwide. If you have been assessed by your doctor for a high risk of having a cardiac event, a full cardiovascular examination by a trained cardiologist is critical.</p><p>Your cardiovascular screening and consultation session will include a full consultation, ECG, heart echocardiography, and carotid artery Doppler ultrasound. The cardiologist will advise you if any further procedures or courses of medication are required at the time of your consultation or as soon as possible thereafter.</p><p></p>"
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"title": "Have You Heard of Sleep Hygiene?",
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"summary": "There are a number of simple things that anyone can do to help get a good night’s sleep. The first is to find out what you are actually doing when going to bed.",
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"value": "<p>“The worst thing in the world is to try to sleep and not to,” said F. Scott Fitzgerald.</p><p>There are a number of simple things that anyone can do to help get a good night’s sleep. The first is to find out what you are actually doing when going to bed. Keeping a sleep diary can be very helpful in clarifying any patterns and habits that may be disrupting your sleeping.</p><p>Consider questions such as:</p><p>¨ What time do I go to bed and get up? Is it the same every day?</p><p>¨ Do I wake up during the night and why?</p><p>¨ What habits do I have around bedtime?</p><p>¨ What helps me go to sleep?</p><p>¨ What stops me going to sleep?</p><p>¨ Do I sleep during the day?</p><p>The answers to some of these questions may be useful in thinking about how to establish good sleep patterns.</p><p>You’ve heard of food and water hygiene, but did you know there is also such a thing as sleep hygiene. Sleep hygiene is all about the habits and practical things you can do to improve the quantity and quality of your sleep. Remember that with all habits, they take time to form and changes don’t happen overnight but within a week or two of trying establishing a new pattern most people will see some improvement.</p><p><b>Tips for good sleep hygiene</b></p><p>1. Routine – regular bed times, even on the weekends, can really help to establish and maintain habits. This includes doing the same things each night before you get into bed too.</p><p>2. Environment – a cool, quiet, comfortable place to sleep is very important. Particularly during summer in Hà Nội, when the temperatures reach up to 40 degrees at times, using your air-conditioner or fan wisely may help you sleep better and be able to cope with the heat during the day as well! Noise is a perennial problem in this city but a pair of earplugs may be a life-saver when your neighbours decide to renovate their bathroom at 3am.</p><p>3. Exclusivity – this means that your bed is only for sleeping (and other horizontal activities of the night). No working, reading or watching TV from bed! This helps your body to recognise that lying in bed equals sleep time not time to work on that last-minute presentation for the next day’s meeting.</p><p>4. There are some things to avoid to help you sleep better:</p><p>a. Alcohol – although you may feel that it helps you fall asleep, actually alcohol often causes disrupted sleep and wakes people during the night – best only in moderation.</p><p>b. Caffeine and other stimulants – We all love the sweet strong Vietnamese coffee with ice, but reconsider that last one of the day as caffeine blocks one of the hormones in your brain that tells you its time for bed. And just a quick reminder that coke, chocolate and green tea also have caffeine so stick to other herbal teas if you want a hot drink in the evening.</p><p>c. Meals – eating a heavy meal right before sleep can disrupt your sleep and exacerbate any reflux or indigestion you might have, so eat earlier in the evening, or have your main meal at lunch.</p><p>d. Stress – a big one and difficult to avoid! Try to stop work at least 30 minutes before you go to sleep and do something relaxing, a short walk or read a book. In fact any significantly stimulating activity such as strenuous exercise or watching a scary movie can impact your brain’s ability to unwind and get off to sleep.</p><p>e. Clock-watching – although it is so tempting to keep looking at the clock, it doesn’t help and usually makes you feel more frustrated at not being asleep. If you are not relaxed in bed then get up for 30 minutes and do some quiet activity in dim light before trying to go back to bed. Even lying in bed relaxed counts for something but tossing and turning will not help you get to sleep!</p><p>5. Some things that may help:</p><p>a. Early morning sunlight on your face – can help to reset the light/dark sensors of your brain so take your sunglasses off when going to work early in the morning.</p><p>b. Warm milk or herbal teas – yes, mother was right, a glass of warm milk before bed can really help. Chamomile or other herbal teas can also be effective.</p><p>c. Nap time – if you have to sleep during the day then take a nap early. Late afternoon naps will mean that your body is just not tired enough to get to sleep and can cause you to stay up late.</p><p>d. “Worry time” – if you are anxious about something and find yourself tossing and turning in bed worrying about it, then keep a notebook and pen beside the bed. You can write down any thoughts or concerns you might have in the book, which are then “safe” for you to remember tomorrow and you can tell yourself there is no need to keep thinking about them now. Schedule some “worry time” for yourself during the earlier part of the day to think about these things rather than just before going to bed.</p><p>e. Herbal remedies – there are some herbal remedies available in Việt Nam that some people find useful including Valerian, Melatonin and Rotundin. As with all herbal preparations, it is advisable to see your doctor to make sure these are safe for you to take. Herbal remedies are also a kind of medicine and may be contra-indicated in some people or interact with other medications you may be taking.</p><p>Some or all of these things will certainly help you to get a good night’s sleep, but again it takes time and practice just like any other skill. Perseverance is the key and the rewards are great!</p><p>However, if you have tried these all these things and are getting nowhere then please go and see a doctor to discuss the issues further. There are other medical problems that may be affecting your ability to sleep and some medications may also cause problems. Further investigations or treatments may be required, so don’t put it off.</p><p></p><p><b><i>Dr. Catherine Gonzalez - Internist, Family Medical Practice Hanoi</i></b></p>"
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"id": 712,
"title": "Losing sleep over insomnia?",
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"summary": "The amount of sleep needed depends mainly on how old you are. Newborn babies up to 1 year old sleep about 16-18 hours per day, school age children about 11-13 hours/day and adults 7-9 hours/day.",
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"value": "<p><b><i>A good night’s sleep…an impossible dream or a nightly reality? For those whose every night is a blissful drift off into peaceful rest you may not need to read any further, but for many of us, getting a good night’s sleep is as elusive as a traffic-free commute on a Monday morning. Hà Nội may not yet be the city that never sleeps, but the hammering of construction at all hours, loud truck horns and the odd roster crowing certainly makes it feel that way sometimes. When counting sheep no longer works, Dr. Catherine Gonzalez of Family Medical Practice Hanoi has some tips and advice.</i></b></p><p><b>What is sleep and why do we need it?</b></p><p>Sleep is a natural state of rest for the body, and is common to all mammals, birds and many reptiles and fish. Sleep is not just about energy conservation. In fact, the amount of energy saved during eight hours of sleep is about 50 kCal (the amount of energy in a piece of toast!). Sleep also serves a number of different functions in the body, including hormone regulation and metabolism, wound healing, and immune function and memory consolidation. So the old advice about getting a good night’s rest before those important exams or meetings may be more than just not feeling tired the next day!</p><p>But why do we need it? In fact, no one really knows why and most of our conclusions come from observing what happens with lack of sleep. After 17 hours of being awake, your cognitive function is the same as having a blood alcohol level of 0.05 per cent - which is the legal limit for driving in many countries around the world. Most people can testify to feeling pretty awful after staying up all night too.</p><p><b>How it works</b></p><p>The body is controlled by an internal “clock” which runs on an approximately 24 hour circadian rhythm. This “body clock” is controlled by a special part of the brain which regulates body temperature, sleepiness and the release of certain hormones. These hormones (cortisol, melatonin and adenosine) rise and fall in a regular pattern to cause wakefulness and sleepiness. External stimuli such as light or a busy work schedule can also affect and interrupt these patterns. The best night’s sleep occurs when all our internal and external signals are aligned. And the opposite is true too, which is why jet lag occurs.</p><p>Not all sleep is the same. There are actually several different stages in a sleep cycle, which lasts about 90-110 minutes in total. Sleep is divided into REM (rapid eye movement) and nonREM sleep. Most of the night is spent in varying stages of nonREM sleep, but most people will have about 3-4 periods of REM sleep during the night – the time of dreams.</p><p><b>How much sleep we really need</b></p><p>The amount of sleep needed depends mainly on how old you are. Newborn babies up to 1 year old sleep about 16-18 hours per day, school age children about 11-13 hours/day and adults 7-9 hours/day. Of course this will vary slightly from one person to the next but the amount of sleep we require is what we need not to be sleepy the next day.</p><p>Feeling well rested the next day requires adequate time but also good quality sleep.</p><p><b>What can go wrong with sleep</b></p><p>There are many different types of sleeping disorders. Some cause too much sleep like Narcolepsy, some too little, like Insomnia, and some just poor quality sleep such as Obstructive Sleep Apnoea or Restless Legs Syndrome. Poor sleep can also be an effect of other medical conditions such as heart disease, asthma, reflux, chronic pain, drug and alcohol abuse and mental illness, especially depression and anxiety. If you are concerned about any of these conditions please go and see your doctor to discuss them further, as these issues are beyond the scope of this article.</p><p></p><p><b><i>Dr. Catherine Gonzalez - Internist, Family Medical Practice Hanoi</i></b></p>"
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"title": "Antibiotics abuse and the risks to your kids",
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"summary": "The overuse of antibiotics leads to a surge of bacteria which are resistant to multiple drugs. An audit of all of Family Medical Practice's children's urine cultures over an entire year revealed that more than 25% of the pediatric urine infections were caused by multi-resistant bacteria.",
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"value": "<p>Việt Nam is among the world’s worst countries in terms of overuse of antibiotics. Much has been written about the worldwide epidemic of antibiotic abuse and the rise of "superbugs", but even against a backdrop of international attention, the excessive use of antibiotics in Việt Nam is alarming.</p><p>I once treated a Vietnamese baby who, at the age of one, had been given more courses of antibiotics than I have received in my entire lifetime. And this child is not an exception.</p><p>The overuse of antibiotics leads to a surge of bacteria which are resistant to multiple drugs. An audit of all the urine cultures carried out by Family Medical Practice over an entire year revealed that over 25 per cent of the paediatric urine infections were caused by multi-resistant bacteria.</p><p>According to studies done in Việt Nam, in local hospitals the prevalence of multi-resistant bacteria is up to 70 per cent. By comparison, in developed countries, this figure is generally under 2 per cent.</p><p><b>Interaction</b></p><p>Besides creating "super-violent bacteria", antibiotics abuse damages our immune system’s function. The "good bacteria" in our guts interacts with the immune system cells and plays an important role in balancing immune system functions. Overdoses of antibiotics kill the "good bacteria" and destroy this balance. This can lead to the development of allergies, asthma, atopic dermatitis and other chronic inflammatory conditions.</p><p>There are several factors contributing to antibiotics abuse in Việt Nam. Quite often we see doctors prescribing antibiotics, medicines which attack bacteria, for viral conditions, even when they do diagnose the infection as viral (e.g. flu, bronchitis). Antibiotics are completely ineffective in these cases.</p><p>And even when prescribed for bacterial infections, the choice of antibiotics and length of treatment are often wrong. Another important factor is the fact that up to two-thirds of antibiotics in Vietnam are sold over the counter by pharmacies. People simply skip the doctor and go straight to the pharmacist - who is not qualified to make diagnoses, but nonetheless will sell antibiotics to patients based on their symptoms alone.</p><p>Parental demand also plays a role. Sometimes parents expect antibiotics and are dissatisfied when they don’t get them. They are conditioned to receive a bag-full of medicine each time they visit a doctor, whether they need it or not. They demand antibiotics, and sometimes doctors give in and prescribe, just to pacify the parents.</p><p><b>Shopping Spree</b></p><p>Another major problem in Việt Nam is shopping around for doctors. If a doctor still insists on not prescribing antibiotics, some parents will go to another doctor.</p><p>Many times, a child will not improve after a day or two and the parents, instead of going to the same doctor, will try a different one. That doctor in turn will prescribe yet another dose of antibiotics. It is common in our clinic to see babies who have visited three or four doctors in a short period of time before coming to us.</p><p>Super-resistant bacteria are a concern for the whole community, because they affect even children who have never received antibiotics in their lives. Bacteria can share genetic information in the same way we share digital information using a USB flash drive. This is called a "plasmid". It’s a little ring of DNA that bacteria can send to each other. A plasmid can contain genes that help other bacteria resist the effect of antibiotics. When a child receives antibiotics and the bacteria develop resistance, this can be spread to other children who come in close contact with them - for example at school or kindergarten.</p><p>We should all participate in the effort to reduce antibiotic overuse. We need to educate both our doctors and our parents on the appropriate use of antibiotics. Governments should be responsible for controlling antibiotic access, making sure pharmacies are not allowed to sell them without proper prescriptions from the attending physician. — <b>Family Medical Practice Vietnam</b></p><p>****</p><p><i>*</i><b><i>Dr Jonathan Halevy</i></b> <i>is a senior pediatrician at Family Medical Practice in HCM City. He specializes in pediatric emergency medicine and neonatal intensive care.</i></p>"
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"id": 672,
"title": "Born to Run",
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"summary": "I live in an age of smartphones that help me to check my speed, the calories spent on my training, my heart rate, and to stay in contact with the friends of my childhood, sharing our battles again with the monsters and dragons always behind us, training on the streets and feeling the power of our legs, the strength of our breath trying to catch as much oxygen as possible, the heavy beating of our hearts in our chest, exactly as it was all those decades ago.",
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"value": "<p>I am a lucky man.<br/></p><p>I was born in a little province close to Chile—San Juan, one of the poorest in my country. Without smartphones, without internet, with only a few hours of cartoons each week on TV, I grew up running.<br/></p><p>It was a desert. The adults would nap during the middle of the day, it was too hot to do anything else. But we kids, we did not like to nap. We climbed to the tops of the trees during sandstorms to feel the force of the swaying boughs. We imagined the hot wind at our backs to be the fiery breath of monsters and dragons, forever chasing us. We ran like free, wild animals.<br/></p><p>At high school, we played sports. Basketball, football—and running. None of us were overweight; the food we ate, we grew ourselves, high in calories—but we burned all those calories, especially in the winters when it was so extremely cold.<br/></p><p>The opportunity to do a medical checkup was quite scarce, but I got checked at 18. Life is not always kind; I was diagnosed with a serious illness. After a complicated surgery, I was close to the end of my life—fever, shaking, infections. So many needles. The pain was unbearable. But I was fit. Unexpectedly, my symptoms disappeared. After five days without fever, they sent me home.<br/></p><p>It was two years before I could run again. Slowly at first, just a few kilometers at a time, to keep active. I ran because I wanted to be as fit as possible, because I knew that at some point, my illness would return. After my surgery, they told me that if I were lucky, I would survive maybe 10 or 15 years maximum. I knew I had to survive, and that death was always near.<br/></p><p>As I ran, the energy, power, and wellness returned to my body, and so too came the memories and joys of my childhood. I felt the monster’s breath at my back again, and I ran.<br/></p><p>I am a doctor. There is a certain magic about running and its power to heal, but I cannot ignore my profession and my medical knowledge. In fact, scientific information about the benefits of exercise has really only come to light in the last ten years. The calories you burn even after you work out. The endorphins released while running that combat depression and anxiety. The highly oxygenated blood that boosts toxin removal. The heightened neurogenesis that sharpens mental acuity.<br/></p><p>Running is linked to lower risks of cancer, longevity, and higher quality of sleep. Running is now known to help prevent and treat diabetes, high blood pressure, high cholesterol, osteoporosis, migraines, strokes, myocardial infarctions, Alzheimer's, and cancer. It improves memory, eyesight, sexual activity, self-esteem, and job productivity.<br/></p><p>In my own field—hepatology—fatty liver is one of the most common diseases worldwide. The fat inflames the liver chemically, similar to that caused by heavy drinking. It is the number one cause of liver transplantation. The leading cause of fatty liver is a poor diet and a sedentary lifestyle. The best treatment for this disease is to run.<br/></p><p>We are biologically prepared to run. Our forebears survived by persistence hunting and avoiding predators. We are like a machine shaped to run every day in an environment where food was scarce. Many modern diseases have their basis in the fact that we are not active anymore, and we eat a lot.<br/></p><p>I am a lucky man. They said I would live for 10 or 15 years. It has already been 32. Never in my dreams did I imagine I would live to reach 50. I am now 52, and I’m running half marathons.<br/></p><p>I live in an age of smartphones that help me to check my speed, the calories spent on my training, my heart rate, and to stay in contact with the friends of my childhood, sharing our battles again with the monsters and dragons always behind us, training on the streets and feeling the power of our legs, the strength of our breath trying to catch as much oxygen as possible, the heavy beating of our hearts in our chest, exactly as it was all those decades ago.</p><p></p><p><b>Dr. Pedro Trigo, Internist, Family Medical Practice Ho Chi Minh City</b></p>"
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"id": 715,
"title": "This Year, Don’t Just Lose Weight, Get Healthy",
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"summary": "Many expats think Vietnamese food is an excellent “diet” because meals include many vegetables. But beware! The fried green vegetables can have as much fat as french fries.",
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"value": "<p>It’s the New Year and guess what’s on (almost) everyone’s minds: Losing weight and dropping some of the kilograms they put on, especially during the holiday season.</p><p>Most people think they will lose weight when they come to Việt Nam. And why not? A typical Vietnamese person is quite slim. But for many expats in Việt Nam, a combination of factors can often build up to a surprising weight gain.</p><p>For those working in Việt Nam, business lunches including large amounts of food and alcohol can be the norm. Even Vietnamese people are beginning to get heavier because of increasing wealth and eating out more frequently.</p><p>Many expats think Vietnamese food is an excellent “diet” because meals include many vegetables. But beware! The fried green vegetables can have as much fat as french fries. On top of eating too much, chances are that you spend a lot of time sitting in meetings or on the computer, or riding in a car or on motorbike through the endless traffic and bumpy roads.</p><p>Or perhaps you are too busy with work. You don’t feel like venturing out into the hustle and bustle of Hà Nội after a long working day. It’s easier to buy packaged foods and cook things that are familiar in the comfort of your home. Unfortunately, in many countries, the fast foods we enjoy are not always the healthiest choices, nor best for the waistline and Việt Nam is not an exception.</p><p>It is easy to see how many variables with health condition affecting metabolism, such as hypothyroidism and age, can contribute to weight gain among expats in Hà Nội. </p><p>The solution may be more difficult. Weight loss is not easy, especially when you are in a new environment with unfamiliar food. The good news is that it can be done, but it does not come in a pill or some other quick fix! </p><p>Weight loss, most simply, is achieved by spending more energy than you take in. That means you have to burn more calories than you eat. Nature helps a good bit. In order to be alive, to breathe, to digest your food, etc., you need to burn calories for energy. Add to those calories whatever you need to maintain your physical activity. For example, if you just climb the stairs around your house and maybe occasionally around your neighborhood, you probably burn an extra 300-400 calories per day. For most people, however, this is not enough to help with weight loss, because their intake is still much higher than their energy needs.</p><p>That leaves you with two options: Eat less and exercise more! Neither of the options is particularly easy because it requires a change in lifestyle. Real and healthy weight loss should be gradual and permanent. </p><p>In order to reduce your calorie intake it is helpful to first know your goal weight. This can be attained by calculating your BMI. Body Mass Index is a measure of weight according to one’s height and can give you an idea of whether you are currently overweight or obese. You need to determine how many calories you should be eating to achieve your goal weight, as well as estimate your current intakes by doing a nutrition assessment. </p><p>Tempted by products that promise weight loss without changing your diet? Supplements that promise rapid and significant weight loss should be avoided as they are often unhealthy, and weight loss is primarily due to dehydration rather than reduction of fat. As you return to normal, the weight returns, too. Safe and healthy weight loss should be about 1/2 - 1kg per week. </p><p>As a general rule, choose foods that are higher in fiber (fruits, vegetables, and whole grains) and prepared with little or no oil. Limit foods that are fried, fatty meats, butter, cheese, and large portions of starches (noodles, rice, potatoes, and bread). Even if you don’t “count calories,” following these guidelines can be a good start to eating fewer calories. </p><p>Expats in Hà Nội can buy fresh fruits and vegetables at a fraction of the cost in many other countries. Challenge yourself to go to the local market and try one new fruit and vegetable per week.</p><p>The second half of the equation is to increase how much energy you burn. This can be challenging in Hà Nội, but certainly not impossible. If you are fortunate enough to have access to fitness facilities, by all means, use them. But if you can’t afford a membership at a gym, or just prefer to be outdoors, there are several good parks in town to walk, run, or ride a bike. If you have lived here long enough to feel brave, hop on your bicycle instead of taking a motorbike or car. </p><p>Setting goals can help you keep on track to adopting a healthier lifestyle. Try to exercise three days per week for 30 minutes, and gradually increase the length of your activity and number of days. It can also be helpful to have a partner to exercise with and share your struggles and ideas together. Lasting behavior change is generally more successful when you have somebody to do it with. </p><p>If you are committed to make a few adjustments to your diet and exercise, you will soon find yourself feeling more energetic and beginning to loose weight and becoming healthier this New Year.</p><p></p><p><b><i>Dr. Catherine Gonzalez - Internist, Family Medical Practice Hanoi</i></b></p>"
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"id": 705,
"title": "The Dangerous Taboos about Sexually Transmitted Disease",
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"post_date": "2016-11-21",
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"summary": "Sexually transmitted diseases (STDs) are a reality of life, but because talking about them remains a taboo, much inaccurate information is also widely transmitted.",
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"value": "<p>Sexually transmitted diseases (STDs) are a reality of life, but because talking about them remains a taboo, much inaccurate information is also widely transmitted. In 2010, the World Health Organization estimated that some 340 millions new cases of curable Stds occur annually. In developing countries, they are one on the top five reasons people seek medical care. SouthEast Asia is particularly affected, the result of a flourishing sex industry, massive tourism and ignorance.</p><p>In most cases, the disease could have been prevented with simple measures and appropriate behavior.</p><p><b>What are STDs ?</b></p><p>Sexually transmitted diseases (STDs) are infectious diseases caused by bacteria, viruses and parasites. Bacteria include gonorrhea, chlamydia and syphilis. Viruses include genital herpes, hepatitis B, Human Papillomavirus (HPV) and Human Immunodeficiency Virus (HIV). Parasites are responsible for trichomoniasis and pubic lice.</p><p>Common symptoms - which may occur alone or in combination - include abnormal genital discharge, burning sensation when urinating, persistent pelvic pain, bleeding after intercourse or between periods, warts, itchiness, rashes and sores in the genital or anal areas, swollen lymph glands in the groin and sudden fever. STDs do not always have symptoms. Gonorrhea and chlamydia can be active and still not show any symptoms.</p><p>Untreated STDs can result in infertility, pelvic inflammatory disease, cancer, miscarriage and ectopic pregnancy, birth defects, chronic liver conditions. Untreated HIV infection can lead to AIDS and death.</p><p>The sooner STDs are diagnosed, the easier and more effective the treatment is. Late diagnosis and treatment can lead to serious complications and difficulties recovering.</p><p><b>How to protect oneself ?</b></p><p>Bacteria and viruses can be found in sperm, vaginal secretions, saliva, pus and blood. they can be found in the genitals and in the body’s mucous membranes (throat, penis, vagina, rectum).</p><p>Transmission of STDs occurs during unprotected sex with a partner carrying the infection. The partner can be symptomatic or not, meaning that he or she can be sick without feeling ill or showing signs of infection.</p><p>Vaginal, anal and oral sex can lead to STDs, whether there is penetration or not. Simple contact between the mucous membranes is enough for transmission of some STDs.</p><p>Protected sex means avoiding contact between sperm, vaginal secretions, blood and vaginal, anal or oral mucous membranes. Some STDs are transmitted when kissing or touching the genital areas (genital herpes, hepatitis B).</p><p>Condoms are an effective form of protection when used properly. Young people must be educated about contraceptive methods and how to use condoms. The challenge is to reduce new STD infections and also to reduce teenage pregnancy.</p><p>Condoms should be used even in oral sex. If not, it is important to make sure there are no wounds or sores in the mouth, the penis, the vagina or the anus.</p><p><b>How to get tested ?</b></p><p>Being tested for STDs is easy: a blood test, urine analysis, and a vaginal smear for women. Confidentiality must continue to be the number one priority of health care facilities proposing those tests.</p><p><b>How to be cured ?</b></p><p>Treatment of STDs is often simple and short. For exemple, only one shot of antibiotics for gonorrhea, chlamydia and syphilis. Treatment can last a few days, sometimes a few months (hepatitis B). People living with HIV have to be on medications all their life. A safe and effective vaccine is proposed and recommended to prevent the hepatitis B infection.</p><p>Most STDs can be cured without complications if they are diagnosed in time. Others, like HIV, can be treated and controlled. A person living with HIV will have a normal life if taking treatment properly every day. HIV is now considered a chronic disease. It is also important to fight ignorance and stigmatization. As far as HIV is concerned, stigmatization and fear are still very strong and are affecting vulnerable population like sex workers and intraveinous drug users.</p><p>Someone infected with a STD must be responsible and inform his or her partner so that they, too, can be treated on time and the chain of further contamination will be shortened.</p><p>One STD can hide another STD. They fragilize the mucous and facilitate transmission of infectious diseases. An untreated STD can be an "open door" for HIV or other STDs. That is why, denial is the worst attitude, even if there is no obvious symptoms of disease.</p><p>According to a study published in 2002, one third of all men aged 18-55 in Hà Nội have had sex with a female sex worker, and approximately only one third of them used a condom. It would be interesting to have more recent data so as to compare with today’s behavior.</p><p></p><p><b><i>Dr. Mathieu Nalpas - Internist, Family Medical Practice Hanoi</i></b></p>"
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"id": 598,
"title": "Emergency Doctor from Family Medical Practice",
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"post_date": "2016-11-04",
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"summary": "The wellbeing of patients at hospitals or clinics is potentially put at risk as a result of doctors being called away on emergencies. Appointments are frequently cancelled, which disrupts treatments and can create more work for support staff. If ambulances were staffed by paramedics, it would speed up processes and create greater efficiency and patient care.",
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"value": "<p><b>Peter Cornish</b> <b>goes back and forth with an emergency doctor from Family Medical Practice Saigon. Photo by</b> <b>Vinh Dao.</b></p><p><i>Doctor Thinh has recently returned from America, where he undertook an extensive emergency medical response training programme designed for 911 first-responders. We caught up with him at Family Medical Practice, where he is one of the doctors accompanying ambulances on their emergency calls, to ask his opinion about Vietnam’s emergency services.</i></p><p><b>Tell us about FMP’s 24-hour emergency and evacuation service.</b></p><p>FMP has recently imported state-of-the-art ambulances, which are on standby 24 hours a day to respond to emergency situations. This is not a new service but one we’ve recently upgraded to bring in line with emergency services throughout the world.</p><p>As well as new ambulances, a critical difference in the service we now provide is the use of ProQA, which is the premier emergency response software used by 911 throughout America and in emergency centers in virtually every OECD nation, worldwide. With this system, we can now start giving medical advice to a patient or instruct a bystander in how to provide treatment within the first one or two minutes, a significant improvement.</p><p>When a call is placed to our team, the ProQA software helps our emergency crew to understand the situation and manage the patient’s emergency before an ambulance even arrives, if one is necessary.</p><p><b>When a *9999 call comes in, what are the procedures?</b></p><p>Previously, emergency victims had to wait for ambulances to arrive at the scene before they could be assessed by the doctor on board. In many cases, people opted to make their own way to their preferred medical facility in private transportation, such as by taxi. This process took time, and there was no immediate medical response available.</p><p>With our new system, the response can be immediate. Using the ProQA software, fully-trained emergency medical dispatch operators are able to provide prompt, life-saving medical advice following internationally-proven guidelines. From the second a call to *9999 is answered, the Q&A protocols kick into action, providing the fastest response to any given emergency.</p><p>Once an ambulance is dispatched and en route to the emergency, constant communication and updates are being transmitted to the ambulance crew so they can provide essential treatment once they arrive. After pick-up, the patient’s condition will be transmitted from the ambulance to the medical center in ‘real time’ via 3G from anywhere in Vietnam.</p><p><b>Who rides in the ambulance – a doctor, nurse or paramedic?</b></p><p>Vietnam is unlike many countries as doctors ride in ambulances, as well as a support nurse and driver. In most other countries, doctors are replaced by paramedics trained to deal with emergency situations.</p><p><b>What are their roles in the emergency response process?</b></p><p>Nurses in Vietnam are considered as assistants to the doctor and not decision makers. They are unable to provide extensive treatment, and that is why doctors ride with ambulances in Vietnam.</p><p>At present, Vietnamese law requires the presence of a doctor in ambulances to treat victims. This can be a problem – Vietnam has a shortage of doctors compared to some neighboring countries, with about 7.8 doctors per 10,000 people. Other countries have as many as 20 doctors for that population size.</p><p><b>What is the difference in roles and responsibilities between a doctor and a paramedic?</b></p><p>Paramedics are trained specifically to respond in emergency situations and are good in this environment. A doctor is trained to cover many aspects of medical treatment, but often lacks the specialized skills and experience needed for emergency first response.</p><p><b>Do paramedics exist in Vietnam?</b></p><p>No, Vietnam does not recognize the training and skills required for paramedics and does not include them as part of their medical service providers.</p><p>The well-being of patients at hospitals or clinics is potentially put at risk as a result of doctors being called away on emergencies. Appointments are frequently cancelled, which disrupts treatments and can create more work for support staff. If ambulances were staffed by paramedics, it would speed up processes and create greater efficiency and patient care.</p><p><b>In addition to the use of ProQA, what can be done to improve emergency response units in Vietnam?</b></p><p>I would like to see Vietnam recognize the value of paramedics in emergency situations and establish a training school to meet the current need. In the meantime, paramedics recruited from outside Vietnam would have an immediate and obvious impact on the country’s population. The first barrier we face is a job description for paramedics, as the Ministry of Health does not currently recognize the role. We need changes in the law to recognize that doctors are not needed in ambulances and that well-trained paramedics are more than sufficient. This will save the health system considerable money as well as providing a more efficient service.</p><p><b>Is there anything you would like to add? </b></p><p>People sometimes complain about the number of questions asked by our Emergency Medical Dispatchers. I would like people to understand that every piece of information provided is recorded into the ProQA system to help the calltaker and ambulance crew to manage the emergency, prepare the correct equipment, and be ready before reaching the scene of the emergency. This is essential to the well-being of the victim. If you call, be calm, answer the questions, and if you don’t know the correct answer to a question, just say that you don’t know.</p><p>I should also encourage people to subscribe to the service if they want for themselves and their family members to be protected for ambulance and emergency response under the ProQA system. The number for registration is 093 277 6971, and the fee is VND575,000/person/year. It’s very important if you want to have access to that immediate medical response if something happens without warning.</p><p><i>For more information about *9999, see</i> <a href=\"http://www.star9999.vn/\"><i>www.star9999.vn</i></a><i>.</i></p><p><b>Dr. Bui Nghia Thinh - Emergency Medical Director ∗9999, Family Medical Practice Ho Chi Minh City</b></p>"
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"id": 664,
"title": "Vietnam's Organic Produce",
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"summary": "As we should remember from remedial Biology, plants not only absorb water and toxins through their leaves, but also through their roots. So even if a farm claims not to use pesticides, it’s important they also use raised beds with imported soil or manure.",
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"value": "<p>Becoming certified organic is riddled with bureaucratic processes and requires dropping money along every step of the way, no matter what part of the world we’re talking about.</p><p>But in Vietnam, where certifications are viewed as more of a hassle than a stamp of confidence, are they really necessary? For my investigation, I made a trip to Dalat. On a spectacularly sunny spring afternoon there, I came upon what is known as “Plastic City”; an expanse of greenhouses as far as the eye can see, rivalling the agricultural behemoths of central California or the farmlands of Holland. Growing inside are millions of hectares of tomatoes, salad greens, artichokes, strawberries, flowers and tea and coffee.</p><p>It’s impressive, but there’s a looming haze over the entire region. It was a combination of the dust, heat and something else: pesticides. The vapour-like substance seemed to ooze out of many of the greenhouses and I wanted to run into the green hills. So I did, and I soon found my way walking through Golden Garden Produce.</p><p>Family owned, Bob Allen and his wife Hue have run their five hectare farmland for about 23 years. They sell their organic and hydroponic produce to resorts and restaurants in Hanoi, Nha Trang, Phan Thiet, Danang and Saigon. You may be familiar with the taste of their cut, as they own Veggy’s supermarket in D1. They grow sustainably, buying their land from 20 families, now encircled by what seems to be another 20. It was an impressive set up, using bore wells for water and growing on raised or hydroponic beds. However, they are not certified organic. Is that important? Not normally, but in a land where consumers are wary of believing Vietnamese testament, it may be important to have that extra seal of approval.</p><p>Here in Vietnam there are four certifications available: two from the EU, EC 834/2007 and EC 889/2008; one from USA, National Organic Program (NOP); and Vietnam’s own PGS. The first two must be certified by a third party agency, such as SGS, a world-leading inspection company, while the third is a Ministry of Agriculture and Rural Development (MARD) certification committee. There is not, unfortunately, a centralised database of all of Vietnam’s certified organic farms.</p><p>With no shortage of access to domestic produce, you may ask why I go through all the trouble to find and buy certified organic? Again, it’s not the necessity of a certification. When eating local it is, however, a necessity to eat produce which you know was grown organically. Plenty of small farmers (such as K’Ho Coffee) are raising their crops as such without certification. Six Senses Ninh Van Bay also raises several hectares of fruits and vegetables for their guests using traditional companion planting and chilli oil spray to keep pests at bay.</p><p>As we (should) remember from remedial Biology, plants not only absorb water and toxins through their leaves, but also through their roots. So even if a farm claims not to use pesticides, it’s important they also use raised beds with imported soil or manure. Pediatrician Dr. Jonathan Halevy at Family Medical Practice cited a 2015 study in which “All [109 surveyed Vietnamese] children had high blood lead levels.</p><p>Heavy metals in the soil are of concern here. (By the way, the accepted level of lead in the system is basically zero.) We focus more on this because we can’t necessarily test for exposure to toxins. Bloodwork would only show accumulation, so we can’t associate that to pesticide poisoning,” Dr. Halevy continued.</p><p>What does this all mean? Consider spinach, which in some parts of the world, is grown to clear lead and other hazardous material from soil which must then be disposed of as hazardous waste. Here in Vietnam, it is one of the most cultivated greens. If you want to treat your body as the temple that it is, do yourself a favour and ensure you know how your produce is grown. Better yet, buy a bag of organic coco peat and grow your own.</p><p></p><p><b>Dr. Jonathan Halevy, Head of Pediatrics, Family Medical Practice Ho Chi Minh City</b></p>"
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"title": "Arsenic And Rice",
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"summary": "It’s is difficult to answer the quetion how much rice babies can taske as rice is the staple food in Vietnam. Small babies, children and pregnant women are at higher risk and should be more careful to limit the amount of rice they eat.",
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"value": "<p></p><p>In April, the American Food and Drug Administration (FDA) issued a recommendation for parents to limit the exposure of their babies to rice, rice cereals, rice pasta, rice milk and other rice containing foods due to very high levels of arsenic found in rice.</p><p><b>What is Arsenic?</b></p><p>Arsenic is a heavy metal found in the environment (water, soil, air) which readily dissolves in water. It occurs in two forms—organic (such as in seafood) and inorganic (often from water). The inorganic type is much more harmful, although in high doses the organic arsenic can also use harm. Prolonged exposure to high levels of arsenic has been connected to the development of certain cancers (skin, bladder, kidney, lung), brain development disorders, infertility, miscarriages, diabetes and heart disease. Arsenic is also found in cigarette smoke.</p><p><b>Why Rice?</b></p><p>Rice absorbs high levels of arsenic from water and soil because of the unique way rice is cultivated in water flooded paddies. Arsenic is also found in high levels in pesticides, animal feeds and fertilizers, which increases soil contamination of arsenic on which rice is grown.</p><p>Many types of fruits and vegetables also contain arsenic but at lower levels. Fruit juices (especially apple and grape juices) were found to contain higher levels of arsenic. Brown rice has much higher levels of arsenic than white rice. There was no significant difference between organic rice and non-organic rice.</p><p><b>Why Children?</b></p><p>Children absorb higher levels or rice because their body size is much smaller, which puts them at higher risk from prolonged exposure.</p><p><b>What is a Safe Level?</b></p><p>There is no safe level. The FDA recommends limiting the amount of arsenic in babies' rice products (rice cereals, rice pasta and cookies, rice milk) to less than 100ppm (parts per million). But most of the rice grains that were tested had much higher levels and most of the rice products for babies had levels up to 1.5 to six times higher (brown rice products higher than white).</p><p><b>How Much Rice Can Babies Take?</b></p><p>This is a very difficult question to answer in a country like Vietnam where rice is the staple food. Small babies, children and pregnant women are at higher risk and should be more careful to limit the amount of rice they eat. Here are a few FDA recommendations that will help limit your child exposure to arsenic:</p><ul><li>Avoid giving rice milk to your child. There are many other alternatives, if you choose not to give regular milk or if your child is allergic to cow's milk</li><li>Avoid rice cookies, pasta and foods containing brown rice syrup.</li><li>Avoid brown rice.</li><li>Infants should consume only one serving of rice cereals a day (One serving = 1.5 cups of prepared cereals).</li><li>Children should eat up to 1.5 servings of rice a week. (1 serving = half a cup of cooked rice)</li><li>Choose basmati or jasmine rice. (they contain less arsenic than other rice types)</li><li>Use other grains such as oatmeal, barley, bulgur wheat, buckwheat and quinoa.</li><li>Avoid fruit juice (especially apple and grape). Give your child whole fruit to eat and water.</li><li>Wash vegetables and fruit thoroughly. It will reduce arsenic residue (and other toxic chemicals).</li></ul><p><b><i>Dr. Jonathan Halevy</i></b><i> is a graduate of the Sackler School of Medicine of Tel Aviv University and underwent his residency in the Pediatric Department of the Wolfson Medical Center in Israel. He is a published author on pediatric care—his Vietnamese-language book Nuôi Con Sao Cho Đung on the subject of children's health was released in 2015.</i></p>"
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"title": "FMP Launches Vietnam's First Lifesaving Emergency Response System",
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"value": "<p></p><p><i>Ho Chi Minh City, Vietnam, 21 September 2016</i>: Family Medical Practice, Vietnam's leading international primary medical health care provider, today announced the launch of its 24/7 *9999 emergency response service. This is the first such system ever to be deployed in the country.</p><p>"Vietnam has never had a system like this before," said Dr. Rafi Kot, the founder of Family Medical Practice and the driving force behind the *9999 program. "In the past, when people have had an accident, a heart attack, or a stroke, or any other emergency, they have simply called a taxi to take them to a hospital. Or they have taken a vehicle that is simply substandard functioning as an ambulance here, calling a hospital where a receptionist is responsible for the dispatch. Now life-saving support is just five keystrokes away. Press Star and then 9, 9, 9, and 9."</p><p>"*9999 is so much more than 'you call them we haul them'. Our dispatch professionals undergo rigorous training to the highest international standards as prescribed by the International Academies of Emergency Dispatch, before a state-of-the-art ambulance is sent to the scene, staffed by this country’s leading qualified medical staff, in constant contact with both the people at the scene of the incident and with doctors in our clinics," said Dr. Kot. "Once at the scene, our *9999 team will take the patient to the most appropriate medical facility for their condition—this is important to note—we are not simply fetching people and bringing them to our clinic. We will take them to the best facility possible for their required treatment."</p><p>The service is founded on ProQA technology from leading international EMR supplier Priority Dispatch, which has deployed similar systems to world-leading standards in 1,600 centers in over 52 countries. Speaking via video link to Vietnam's media, Priority Dispatch's Jerry Overton said of the system: "What we say as far as dispatch is concerned is that 'if it doesn't go well at dispatch, then it will not go well'—but Medical Priority Dispatch in its implementation ensures that there is a standard to make it go well. Remember, what we are talking about here is saving lives. Not only for cardiac arrest patients, but in Vietnam, we all know that there's a problem with traffic accidents, where mortality and morbidity and trauma is very high as far as traffic accidents are concerned. Family Medical Practice has made a commitment to HCMC and to the people of Vietnam that they are going to reduce that morbidity and mortality."</p><p>Statistics support Mr. Overton’s statement, with over 8,400 traffic accidents recorded nationwide in the first five months of this year—resulting in 3,588 deaths and 7,339 serious injuries. 2015 saw almost 9000 people die on Vietnam's roads, and almost 25,000 suffering serious injuries. A rapid response system, where trained professionals provide advice to people on the scene on how to manage the victim before dispatching medical professionals in state-of-the-art vehicles, can help in saving lives and improving treatment to people in this country.</p><p>"Our system identifies 36 different chief complaints and over 300 minor conditions off of those 36 chief complaints,” Mr Overton continued. “In other words, we are able to determine what's wrong with that patient from the point of dispatch, and we are able to ensure that the best resources to take care of that patient will be there at that scene. In comparable markets, reductions in mortality for such scenarios are in the order of 25 percent."</p><p>"Family Medical's state-of-the-art ambulances are in a league of their own in Vietnam," said Dr. Kot. "They are mobile emergency rooms, each able to sustain life for up to 72 hours. They further feature live links to our clinics that broadcast in real time a patient's vital signs to emergency doctors in our clinics, and allow those doctors to both continue to advise the medical team on the road, and prepare themselves for the incoming patient."</p><p>The Ú9999 system was pre-tested in early 2016 to stellar results, mimicking a cardiac arrest in Saigon Pearl to ensure that all systems were functioning properly. In June, the Family Medical Team also held a mass casualty trial involving the ambulances, closing its facilities to bring all doctors, emergency teams and dispatch teams to the District 1 clinic to ensure the smooth functioning of its processes in such an event.</p><p>The subscription-only service covers HCMC's districts 1, 2, 3, Binh Thanh and Phu Nhuan in its early months, with plans to expand to city-wide coverage in early 2017. Subscriptions start from VND575,000 per person per year.</p><p>-----------------------------------------------------------------------------------------------------------------------</p><p>Family Medical Practice, the first foreign-operated, multi-disciplinary primary medical health care provider in Vietnam, opened in Hanoi in 1994 and owns and operates five modern clinics based in Hanoi, Danang and HCMC. FMP is the only private medical provider in Vietnam with such national coverage. All Family Medical Practice clinics have fully-equipped ambulances described as “state-of-the-art emergency medical units” on standby 24 hours a day.</p><p><i>For more information, please contact:</i></p><p><i>sarah@vietnammedicalpractice.com</i></p>"
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"id": 702,
"title": "Medical Advice for Moving to Vietnam",
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"summary": "Moving to another country is a big change and must be taken very seriously, especially as far as health is concerned. You must prepare yourself and avoid trying to do everything at the last minute.",
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"value": "<p>You are planning to move to Việt Nam, great ! But should your mum be worried about anything?</p><p>Moving to another country is a big change and must be taken very seriously, especially as far as health is concerned. You must prepare yourself and avoid trying to do everything at the last minute. You need planning and time, especially for vaccinations. (Hepatitis B vaccination, for example, needs 6 months to be fully completed.)</p><p>So, before you go what should you do ?</p><p>First, you should look for your vaccination booklet and get ready for a few additional shots. Make sure you are up to date with routine vaccines (diphteria-tetanos-polio-pertussis vaccine, measles-mumps-rubella vaccine, hepatitis B vaccine and annual flu vaccine, if you are at risk for respiratory disease). In Việt Nam, the possibility of contaminated water and food means hepatitis A and typhoid vaccines are recommended. If you stay long term, Japanese encephalitis and rabies vaccines are also recommended for those travelling in the countryside and remote areas of Việt Nam. And, of course, don’t forget to travel with your vaccination book.</p><p>You can visit your doctor for a basic medical check-up to make sure you are in good physical and psychological condition for the trip.</p><p>Do you know your blood type? This could be a good opportunity to look for it. Keep your blood type card with you.</p><p>If you have important medical history, or if you take medicine daily, prepare your own medical record with all the information doctors will need if anything happens to you. If you are on a specific drug treatment plan, make sure you will be able to find the right drug to restock your supply in Việt Nam.</p><p>Have you seen your dentist recently ? Even if your teeth are very good, a dental checkup once a year is a good habit. The dentist will probably be very happy to note that you are taking your oral hygiene so seriously! And if you have bad teeth, you should really fix them before you go.</p><p>Same for your skin. It is recommended to visit a dermatologist once a year, especially if you are light-skinned. In Vietnam the sun can burn and fair-skinned people are more susceptible to sunburn. Take care of your skin and don’t forget your sunscreen.</p><p>Before you move, you can get a travelers health consultation to get useful and up to date medical advice you need to know about your next destination. You can usually get your vaccinations during such consultations, too.</p><p>Good health insurance is important in case you need medical care or emergency evacuation. Health insurance usually doesn’t cover risks associated with STDs (sexual transmitted diseases), so check with your insurance and act responsibly for yourself and others.</p><p>Once in Việt Nam, drink a lot of water, prevent mosquito bites (dengue fever is common in Vietnam), eat and drink safely, keep good hygiene. Challenge yourself: quit smoking and exercise more. Vietnamese people love to exercise, join the team!</p><p>And don’t forget the primary cause of mortality among young people in Việt Nam (15 to 29 years old) is road accidents.The official traffic code is rarely respected and priority usually goes to bigger vehicle. First, buses and trucks; then cars, motorbikes and bicycles;and finally pedestrians.</p><p>Be very careful when walking on busy streets and when driving a motorbike. Driving a motorbike in Vietnam is sometimes like piloting a spaceship through an asteroid field. So stay cool and banish high speed, alcohol and cell phones, which are the most frequent causes of accidents. Remember to wear a good helmet if you drive 2-wheeled machines.</p><p>You’re finally ready to travel. You’re in Vietnam. Someone phones you. You pick up the phone. Mum? I’m fine! <b>— Family Medical Practice Vietnam</b></p><p>***</p><p><b><i>Dr. Mathieu Nalpas - Internist, Family Medical Practice Hanoi</i></b></p>"
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"title": "Vaccinations in Vietnam",
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"summary": "Sometimes expat parents still don’t internalise that they live in Vietnam and not their home country,.... I always assure them that our vaccination programme covers all their home nation’s requirements, but since they are now living in Vietnam and are exposed to different pathogens, it is very important that they protect their children against these local infections, like Japanese encephalitis, for example.",
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"value": "<p>Vaccinations are a huge portion of travelling in general. Everyone has had to have them in order to gain peace of mind before embarking to their destination. The ideal time for this is four to six weeks prior to your date of departure. However, even as late as two weeks before, it is still useful to see a travel medicine doctor. Everyone should be thoughtful enough to have routine immunisations prior to visiting Vietnam, although different countries may have slightly different recommendations.</p><p>Each country has their own system and expectations depending on the various transmittable diseases and illnesses that occur in their respective zone of the world, and the country to which you are travelling. We all understand the drill previous to taking a holiday somewhere tropical, but living in a foreign country is a bit different, especially when starting a family.</p><p><b>New Country, Different Schedule</b><br/>In Vietnam, vaccinations for children and adults alike are a different animal compared to what you may have dealt with in your home country. Dr Jonathan Halevy is a physician at Family Medical Practice and specialises in vaccinations. He is often required to explain this difference to new families arriving from other nations.</p><p>“Sometimes expat parents still don’t internalise that they live in Vietnam and not their home country,” he says, “and [so] they insist on ‘sticking’ to their original country’s vaccination schedule. I always assure them that our vaccination programme covers all their home nation’s requirements, but since they are now living in Vietnam and are exposed to different pathogens, it is very important that they protect their children against these local infections, like Japanese encephalitis, for example.”</p><p><b>In Development</b><br/>Obviously the situation in Vietnam for obtaining vaccines is different as well. It’s no secret that many people make the jump out to Bangkok or back to their home country for the necessary vaccines needed for their children. Reason being, the infrastructure and cold-chain transportation needed to keep temperature-sensitive medicines stable is still developing within Vietnam.</p><p>Dr Halevy recommends only using vaccinations from a trusted source. “For example, [Family Medical Practice] only uses vaccinations that are approved and used in countries such as the USA, Canada and Australia. We don’t use locally made vaccines, or Quinvaxem, since there were quite a few reports of severe side effects and even deaths related to those vaccines. Basically, you can find most of the vaccinations in most clinics and hospitals in Vietnam, although the manufacturers and schedules may be different.”</p><p><b>Current Recommended Vaccines for Vietnam</b><br/>Everyone should be up to date with their routine vaccines, but there are specific ones that are recommended for most travellers just to be safe. If you are someone planning on staying in Vietnam for some time, it would be best to follow this guideline as closely as possible, just to be safe.</p><p>Hepatitis A and Typhoid are both illnesses contracted through contaminated water, and are both recommended for everyone prior to travel. Safe water is easier than ever to obtain in Vietnam, but sometimes fruits and vegetables can be washed in contaminated water, so it’s best to be cautious and remain aware of what you’re eating and drinking at all times.</p><p>The Japanese encephalitis immunisation may be needed if you plan on spending time in rural areas of Vietnam, or plan on staying more than a month – just to be on the safe side.</p><p>With Hepatitis B, the Center for Disease Control (CDC) recommends the vaccine if you might have sex with a new partner, get a tattoo or piercing, or have any medical procedures.</p><p>Malaria is spread via mosquito bites. If you are planning on doing any camping, or spending extended time outdoors, taking malaria preventative medication is a wise move. Usually one has to take medicine before, during, and after their trip to ensure that malaria is kept at bay, and some people report the medication being more of a hassle than the stress of potentially getting malaria. According to the CDC, malaria is only found in remote rural regions in Vietnam, and is a relatively low risk to travellers. Check with your doctor to weigh what the best option for you may be.</p><p>Rabies is found in bats, dogs, and other mammals so anyone that will be moving to Vietnam, handling animals, or generally just being exposed to potential contact with animals outdoors should definitely prioritise a rabies vaccination.</p><p>Finally, yellow fever is not technically a risk to anyone exploring Vietnam, but the Vietnamese government does demand proof of vaccination from anyone entering the country from a nation that poses a risk of yellow fever infection, which include parts of Central and South America, and Africa.</p><p><b>Kids and Vaccinations</b><br/>All children need immunisation schedules and certifications to be able to enter into school programmes. Infants and children are the most susceptible to diseases that are usually prevented by proper vaccinations. The schedule recommended by the most reputable medical organisations in Vietnam, and most everywhere, is the one recommended by the CDC, the American Academy of Pediatrics (AAP), and the Canadian Pediatric Society. It’s hands down the most evidence-based and up to date immunisation schedule in use today.</p><p>The amount of information out there concerning proper vaccination schedules for your children can be mind boggling, and it is certainly difficult to keep everything squared away when entering into the chaos of a new living arrangement, a new job, and new family dynamics, all while keeping your little ones safe from illnesses with names longer than one can adequately pronounce. Luckily there’s a plethora of resources online, and fantastic medical professionals in Ho Chi Minh City eager to help clear the air for any expecting parent or newcomer to Vietnam.</p><p><i>Always consult your doctor in regards to any and all child care treatment, or immunisation scheduling. This article is not to be taken as professional medical advice</i><br/>The Center for Disease Control<br/><a href=\"http://cdc.gov/vaccines\"><i>cdc.gov/vaccines</i></a></p><p></p><p><b>Dr. Jonathan Halevy, Head of Pediatrics, Family Medical Practice Ho Chi Minh City</b></p>"
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"title": "FMP Appeals for Community Donations Ahead of Huge Health Tour",
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"summary": "Virtually our entire team will be transported to the area to provide medical check-ups, health care advice, and vaccinations for 3,500 households in Kon Plong. The team will also provide treatment for those suffering from illness and disease, and instruct local people in basic hygienic practices, from hand washing to tooth brushing.",
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"value": "<p><b>Family Medical Practice (FMP) today put out a call for donations ahead of its outreach program to the impoverished Kon Plong region of Kon Tum.</b></p><p>The nation’s pre-eminent private clinic is seeking a range of household items to present to the people of Kon Plong, including clothing, educational materials, hygiene and cleaning supplies, and non-perishable food. The clinic is also accepting financial contributions, which will be used to buy similar necessities. FMP is asking members of the community nationwide to donate such items to any of their clinics listed below:</p><p><b>Ho Chi Minh City</b><br/>– Diamond Plaza Clinic: 34 Le Duan, District 1, HCMC<br/>– District 2 Clinic: 95 Thao Dien, District 2, HCMC<br/>– Care1 Executive Health Check Up Center: The Manor 1, 91 Nguyen Huu Canh, Binh Thanh District, HCMC</p><p><b>Da Nang</b><br/>50-52 Nguyen Van Linh, Hai Chau, Da Nang</p><p><b>Ha Noi</b><br/>298 I Kim Ma, Ba Dinh, Ha Noi</p><p>Family Medical Practice will be closing all of its clinics for a week between the 11th and the 18th of September, retaining only Emergency Services during this period. It will then undertake this huge project that will see about 20 doctors and 30 nurses and up to 70 other support staff travel to the region for a week-long, multi-site health treatment mission. Items collected will be distributed at this time.</p><p>Kon Plong is home to some of Vietnam’s most disadvantaged communities including <i>Xe Dang, Mo Nam, Ka Dong, </i>and<i> H’Re</i> minority tribes. People in these regions experience some of the highest mortality and lowest life expectancies in the region – often from preventable causes. This includes a tragically high level of prenatal mortality from home deliveries without midwives.</p><p>“Residents of Kon Plong are more than 50 km from their nearest medical facility,” said FMP Founder, Dr. Rafi Kot. “The people of Kon Plong have effectively no access to any health care, and with this in mind, we made the decision to shut down Family Medical Practice clinics for a week, and bring our team there to address the urgent needs of some of the people who have been left behind by Vietnam’s recent development surge.”</p><p>“Virtually our entire team will be transported to the area to provide medical check-ups, health care advice, and vaccinations for 3,500 households in Kon Plong. The team will also provide treatment for those suffering from illness and disease, and instruct local people in basic hygienic practices, from hand washing to tooth brushing,” Dr. Kot continued.</p><p>“Any contributions toward these efforts from the community in Ho Chi Minh City will be tremendously appreciated,” he concluded.</p><p></p><p><b>Dr. Rafi Kot - Founder & CEO, Family Medical Practice Vietnam</b></p>"
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"summary": "Few were aware that there is a public system; less would call for assistance and even fewer expect an ambulance to arrive in time to be effective. Nearly all agreed that a taxi is the best option; some expats saying they’d rather call their embassy than the helpline.",
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"value": "<p><b>A new emergency ambulance service is coming to Saigon. By Monica Majors. Photo by Vinh Dao.</b></p><p>One day I thought I was being smart by transiting on two feet instead of two wheels – until I was hit by four. The gory details of the incident aren’t important here, but as traffic continued unimpeded around the culprit-taxi and the red streak on the pavement, I was in need of medical assistance. Not only did I (apparently) not know how to successfully circumnavigate Saigon’s traffic, but I also did not know how or whom to call in an emergency (the official Vietnamese line for medical assistance is 115, by the way). The ever-so-ambitious taxi driver picked me up without consultation or approval and plopped me on the back seat of his vehicle. We then turned against traffic and zoomed toward an unknown destination – what I could only assume was either a dark hem or a hospital (50/50 at the time in my clouded mind). “<i>Benh vien</i> – hospital,” I uttered, interrupting his agitated, but concerned, tirade. “<i>Roi, roi, roi,</i>” he finally answered and delivered me quickly and carefully to the International SOS Hospital in District 3. Fortunately, the rest of the story, and my recovery, end happily.</p><p>Based on my own experience, I spoke with locals, expatriates and tourists in HCMC regarding what to do in a medical emergency. Few were aware that there is a public system; less would call for assistance and even fewer expect an ambulance to arrive in time to be effective. Nearly all agreed that a taxi is the best option; some expats saying they’d rather call their embassy than the helpline. When asked if anyone has seen an ambulance in the city, most responded in question, “You mean that cryptic-looking van that sits in traffic like everyone else?” So where are we to turn?</p><p>My question led me to <a href=\"https://www.asialifemagazine.com/vietnam/family-medical-practice-hcmc/\">Family Medical Practice Vietnam (FMP)</a>, where there is a long and arduous process well underway to offer Vietnam’s first privatised emergency response system, *9999. Starting four years ago and overseen by FMP’s CEO Dr Rafi Kot, the aim is to bring medical care in Vietnam up to date with the major world players." Dr Kot has done that through a carefully orchestrated tier of checks and balances, starting first with the procurement of ProQA, the leading automated emergency dispatch system operating in 52 countries around the world (Vietnam is now the 53rd).</p><p></p><p><b>Saving Lives</b></p><p>Where used, ProQA decreases mortality by up to 33 percent. Fully automated, operators follow on-screen prompts based on the information received from the caller. It effectively navigates operators through handling all medical queries, from itchy eyes and a running nose, to blood and ooze and heart palpitations, or the unimaginable. At the pre-ordained point of crisis, an ambulance is automatically dispatched while the operator continues to coach the caller through any helpful first-aid, or to collect more information. Two red flags here: qualified operators and effective ambulances. But Dr Kot’s taken care of that…</p><p>“I scouted and screened 1,100 candidates,” he says, “fluent in both Vietnamese and English.” Screening further for empathy and improvisation, Dr Kot narrowed it down to the team of nine that is now ready to take our calls. But before the operators were put in charge of fielding any sort of medical call, they went through a stringent programme designed to further humanise their approach. “When patients call, they will likely feel uneasy, perhaps even panicked. They need to understand the instructions and feel that the operator on the end of the phone truly understands the urgency and details of the situation. The computer system is spectacular, but we need that human connection. Communication is key,” Dr Kot continues. A drama teacher offered the team lessons on active listening and imparting confidence, while assistance from the British Council trained enunciation. The last step for the team was mastering ProQA, a surprisingly easy-to-follow software for how quintessential it is in saving lives. In addition, the system was translated and enriched into Vietnamese so as to ensure full usability.</p><p>According to FMP’s Head of Emergency Medicine, Dr Sergio Arellano, most accidents seen in the city are from motorbikes (as one would expect), and they normally happen at low speeds. Outside of such accidents there is a vast difference in the type of calls placed by locals and foreigners (including expats and tourists). Local Vietnamese will seek medical assistance for any and all related upsets to their children, but will often forego even the most telling of symptoms in adults. Expats and tourists flock to, or call, emergency rooms often for stomach-related issues, heart palpitations and shortness of breath.</p><p>Dr Arellano was brought in to lead the emergency management system, including six state-of-the-art ambulances soon to be seen meticulously navigating Districts 1, 2, Binh Thanh and parts of 3. Imported from Canada and each identical in facade, power and equipment, they are the real deal, imposing in authority and capable of barrelling through median barriers and opposing traffic like a neon-orange light-saber. All the necessary bells and whistles needed for triage, life support and transfer – including to as far away as Nha Trang – are set in these mobile ICU’s. The one thing they’re missing: paramedics.</p><p></p><p><b>Expertise</b></p><p>The terminology for paramedics does not yet exist in Vietnam and as such is not a recognised occupation for work permit purposes. Instead, a physician and nurse make up the crew in each of the ambulances. Some of the nurses are actually certified paramedics from overseas, but are hired under the slightly less authoritative title. The rest are fully qualified and licensed nurses from around the world and Vietnam.</p><p>With a fully qualified call center, unparalleled EMS software, modern ambulances and well-trained professionals, the *9999 system will be a welcome addition to a city growing as rapidly as Saigon. It’s clever too. Based on artificial intelligence within ProQA, each of the six ambulances will be positioned throughout the three districts based on the probability that an incident will happen in the immediate vicinity. This calculation dramatically shortens the response time, which in the United States is benchmarked at eight minutes from the time a call is received to aid arriving on the scene. Eight minutes. Last I checked it took me that long to clear a single block on Pasteur Street. “There are two hurdles we still need to clear: the dogma that we are better off calling a taxi instead of a helpline, and the unrelenting traffic,” Dr Kot says with the confidence that his team can do so.</p><p>FMP’s emergency *9999 line will soon be available to everybody in the city. For an annual fee, you receive the full coverage and guaranteed priority assistance from professionals. In an emergency, you’ll be taken to the nearest hospital or clinic as deemed appropriate by the attending physician. Nothing in the system is haphazard; even the number was chosen after focus groups determined which number was easiest to remember. While the programme is privatised, the People’s Committee of Ho Chi Minh City has already come through to examine the capabilities of the team and software, expressing a keen interest to advance the as yet untrusted public system. And for so many proven reasons, we’ll all be better off staying out of taxis with our bloodied elbows.</p><p></p><p><b>Dr. Rafi Kot, Founder & CEO, Family Medical Practice Vietnam</b></p><p><b>Published in Asia Life</b></p>"
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"title": "EMS Around the World: Vietnam and the Challenges of Culture",
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"summary": "Vietnamese people aren’t necessarily accustomed to the typical scary ambulance siren, and we don’t want to shock them with a loud noise because they might fall off their motorbikes... this is a perfect solution. Of the 20–30 calls to *9999 each day, only about 20% warrant a response. Interestingly, most callers are not subscribers but are willing to pay the single fee for professional help.",
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"value": "<p>Visit or live in Ho Chi Minh City (HCMC), Vietnam, and you’ll find a densely crowded urban environment that lives and moves with the pace and frenzy of any other big city. What you won’t necessarily find are the typical sights and sounds of emergency vehicles, as the national EMS and fire system is fledgling at best. </p><p>HCMC, also called Saigon, has an official population of around 13 million, perhaps 20 million if you count the undocumented immigrants from neighboring countries. Couple that with more than 7 million motorbikes roaming the city streets, and you get hordes of people on the roads, day in and day out. While that sounds like a recipe for major trauma, one saving grace of the population density is that speeds often don’t get much faster than 25 mph. </p><p>So for an ambulance or any other emergency vehicle, it’s next to impossible to navigate the gridlock and arrive at an emergency in a reasonable amount of time, much less to a hospital with a sick patient. Most residents instead opt to take a taxi, scooter, or personal vehicle to the hospital.</p><p></p><p><b>*9999</b></p><p>Dr. Rafi Kot thought a lot about this problem while treating patients at his medical clinics in HCMC. If you’re forced to sit in traffic with a patient, why not make it a spacious, well-equipped ambulance, staffed with a nurse and a physician and all the latest medical equipment you’d find in a Western EMS system?</p><p>That’s the thinking behind Kot’s <a href=\"https://www.star9999.vn/\">“EMR *9999” subscription emergency service</a>, which, for a fee of $25 USD per year, will provide a well-staffed and expertly dispatched private ambulance to treat and transport patients to the hospital of their choice. Those without a paid subscription can still use the service and pay a flat fee of $168 USD for a call.</p><p>“Sometimes our patients are so happy with the high-quality treatment and professional care of our providers, they ask if they can just be treated in the ambulance instead of going into the hospital,” says Kot.</p><p>Kot, an internal medicine physician born in Israel, launched the <b>*9999</b> service in 2017. He originally came to Vietnam in 1988 to work with an NGO organizing humanitarian medical camps in rural areas of the country. After various stints as a diplomatic attaché, rural physician, consultant, and part-time medical director for Vietnam Airlines, Kot opened his own company, Family Medical Practice (FMP), which has grown to include three clinics in HCMC, one in Hanoi, and one in Da Nang.</p><p></p><p><b>‘Do You Want to Save a Life?’</b></p><p>Kot’s journey to the launch of the EMS subscription service began more than eight years ago. He began with the number.</p><p>“We settled on ‘*9999’ because it was easy to remember,” he says. “Even a 4-year-old preschooler would be able to memorize it.”</p><p>Most important, Kot realized, was the need to provide instructions over the phone to the *9999 caller. Because response times are almost always delayed by severe traffic congestion, he needed his staff to immediately help people over the phone. </p><p>Enter Priority Dispatch and ProQA. One day Kot’s young son was watching a 9-1-1 reality show, and Kot watched in awe as call-takers calmly and efficiently ran through a script of questions. He was sold: He bought the system, brought ProQA trainers to Vietnam, worked through some challenging language and translation issues, sought advice on system status management from IAED Board of Accreditation Chair Jerry Overton, and began recruiting to train his own dispatchers.</p><p>The Vietnamese culture made this part a challenge. In Vietnam, according to Kot, people are averse to drama and any situations that might call for them to intervene with a stranger’s problem, medical or otherwise. Instead they often turn away. For these reasons Kot’s initial group of new hires had many poor fits. After weeding through more than 1,000 applicants, Kot finally landed on what he calls “the Magnificent 12.”</p><p>Initially some were shocked at the duties of a call-taker and dispatcher. “They were frozen and afraid,” says Kot. </p><p>Kot found and hired a British theater company based in HCMC that trains actors. He asked them to create dramatic emergency scenarios so trainees would learn how to deal with people screaming, panicking, and not following directions. </p><p>The training experience took eight months. Kot challenged new employees with the question, “Do you want to save a life?” </p><p>Emergency medical dispatch (EMD)-trained employees Huoy Pham and Phuong Nguyen say they are proud to work with the system and for a man who believes in quality patient care and extensive training. FMP’s *9999 EMDs are trained to provide telephone CPR instructions and adept in figuring out exactly where patients are in the large and confusing city. Both Pham and Nguyen would like to be EMTs someday. </p><p>“I haven’t given prearrival instructions for childbirth over the phone yet, but I am looking forward to doing so,” says Pham.</p><p></p><p><b>Building a Fleet</b></p><p>The other need, of course, was ambulances. In 2010 Kot traveled to the U.S. to examine a Western-style ambulance, a vehicle he hadn’t actually seen before.</p><p>Impressed by the Demers Ambulance group’s offerings at EMS World Expo in Dallas, Kot purchased four ambulances, and Demers sent them on a ship to HCMC.</p><p>Kot is now proud to have 10 ambulances in his fleet, with plans to double that number in the next few years. He’s equipped each of the vehicles with mechanical CPR devices and cardiac monitors that transmit patient data in real time back to the clinics for consultation purposes. </p><p>Recently Kot has begun upgrading the alerting systems to include low-frequency sirens after a trip to New York City, where he experienced firsthand the vibration of a low-frequency siren on an approaching ambulance.</p><p>“Vietnamese people aren’t necessarily accustomed to the typical scary ambulance siren, and we don’t want to shock them with a loud noise because they might fall off their motorbikes,” he says. “This is a perfect solution.”</p><p>Kot notes that of the 20–30 calls to *9999 each day, only about 20% warrant a response. Interestingly, most callers are not subscribers but are willing to pay the single fee for professional help.</p><p>There are the typical cardiovascular and respiratory emergencies and a fair share of motorbike trauma calls. The Southeast Asian population is also currently experiencing a higher per-capita rate of type II diabetes, and Kot wants to focus on preventive solutions.</p><p>Through the experience of developing the system, Kot has learned to press on past the challenges of the culture. “Look, I created an EMS system I think works well,” Kot says. “I say to my fellow citizens: If you want it, take it.”</p><p><br/><b><i>Hilary Gates, MAEd, NRP, is senior editorial and program director for EMS World</i></b></p>"
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"summary": "Our biggest challenge is time. In the US, the gold standard for ambulance arrival is eight minutes. 75% arrive within eight minutes of the initial call and 99% arrive within 15 minutes. It’s about the response time and how you position the vehicles around the city.",
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"value": "<p>A soon-to-be completed Emergency Medical Response Center in Ho Chi Minh City went through a full simulation of its ProQA software programme last week.</p><p>Operating 24/7 and accessible in both Vietnamese and English via the dedicated Number of Assistance <b>*9999</b>, the privately-run Emergency Medical Response Center will come complete with its own strategically placed fleet of international standard ambulances to respond to the emergency needs of patients. Initially, limited to Districts 1, 2, and 3 within Ho Chi Minh City, it will be the first service of its kind in Vietnam. The Emergency Medical Response Center will be in full operation by the end of May 2016.</p><p>ProQA software is one of the key elements of this service using over 1,500 algorithms where the software prompts the call taker, or Emergency Medical Dispatcher, what questions to ask and whether or not they should dispatch an ambulance. Used in more than 3,600 emergency call centers in 52 countries around the world, it also enables the dispatcher to provide full life-saving support to the victim or person calling the service while they are waiting for the ambulance to arrive. The service is available in both English and Vietnamese.</p><p><b>The Simulation</b></p><p>The simulation started at 2.30 pm at the Emergency Response Center on the 12th Floor of Ho Chi Minh City’s Diamond Plaza. The emergency *9999 call came from a person living in Saigon Pearl in Ho Chi Minh City’s Ben Thanh District. Her request was an ambulance for her sister, who had just gone into labor.</p><p>During the simulation, thanks to ProQA the call taker was able to ask a number of questions that then allowed her to give advice to the caller on how to deliver the baby. By the time the ambulance arrived, just over six minutes after the original call, the baby had already been delivered.</p><p>According to Dr. Rafi Kot, the brains behind the scheme, <i>“Our biggest challenge is time. In the US, the gold standard for ambulance arrival is eight minutes. 75% arrive within eight minutes of the initial call and 99% arrive within 15 minutes. It’s about the response time and how you position the vehicles around the city.”</i></p><p>He adds: <i>“The system auto-launches an ambulance and can reject it if it thinks no ambulance is necessary. This cannot be overrided by the operator. It ensures that ambulance drives are only used when necessary and enables the dispatcher to give instructions and treatment by phone until the ambulance arrives.”</i></p><p></p><p><b><i>Dr. Rafi Kot, Founder & CEO, Family Medical Practice</i></b></p><p><b><i>Published in Word Magazine</i></b></p>"
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"value": "<p>When Cindy Tu arrived in Saigon last December, she looked forward to taking that first ride through the city’s buzzing traffic. Until, of course, she got behind a Saigon bus.</p><p>“I couldn’t handle it,” says the San Francisco native. “Because I’m so sensitive to smell firstly but I’m not used to the pollution. I started wearing those medical disposable face masks, which did nothing for me. I ended up layering like three of them… then I moved on to the cloth kind that they have. That didn’t do anything for me, either. Honestly, I started getting respiratory problems and I was coughing a lot and I just felt really sick. I thought: ‘This is ridiculous.’”</p><p>In no time at all, Tu found herself seeking new ways to deal with Saigon’s ever-increasing air pollution. But while it’s easy to acknowledge that our city’s air is unclean, solutions seem to be few and far between. Eventually, Tu came across Vogmask, a line of practical, fashion-forward face masks, on a trip to Singapore. She now swears by them and has begun distributing for the brand in Vietnam.</p><p>“It’s a good investment,” says Tu. “I use it every day for two months and it makes a world of difference. Now I feel like, you know, let’s go on that ride because I’ve got my Vogmask. Because [if] I went just with nothing, no way.”</p><p>This doesn’t necessarily solve the city’s pollution problem, but Tu’s masks have made it all the way to Hanoi and around the country, helping urban residents shield themselves from airborne particles and debris. Given the fact that one quarter of the global population now breathes unsafe air, according to the findings of Yale University’s 2014 Environmental Performance Index, there’s certainly a market for this kind of protection.</p><p>In Saigon and around the world, polluted air contains two kinds of particulate matter. PM10, the larger of the two, includes all particles less than 10 micrometres in diameter and can accumulate in your lungs over time. But the real culprit is PM2.5, better known as fine particulate matter, which is about 1/30 the width of a human hair and so small that it’s able to make its way deep into a person’s lungs, causing a whole host of medical conditions, from chronic respiratory infections to heart attacks, stroke and lung cancer. In 2012, the World Health Organisation (WHO) counted 3.7 million premature deaths worldwide related to ambient air pollution, nearly a million of which were in Southeast Asia alone.</p><p>So, how dangerous is the air we breathe? According to the WHO, safe air contains an average of no more than 10 micrograms of fine PM2.5 particulate matter per cubic metre (µg/m3) per year. While Saigon may not be as bad as Beijing (56µg/m3), Hong Kong (45µg/m3) or even Hanoi (39µg/m3), our annual average is 27µg/m3, or nearly three times the acceptable rate.</p><p>As Dr Jonathan Halevy, a pediatrician at District 1’s Family Medical Practice, says: “If you live in Ho Chi Minh City and you don’t cough, something is wrong with you.”</p><p>Over the last 10 years, Dr Halevy has seen a marked uptick in the number of patients who come to his office with pollution-related conditions. While ambient air pollution is dangerous for adults, children are even more at risk: kids living in polluted areas are more likely to develop asthma, he explains, as well as sinus problems, respiratory conditions and even skin diseases like eczema and atopic dermatitis.</p><p>“It just gets worse and worse and worse,” he says. “Kids that have asthma, their asthma becomes more and more difficult to treat. It becomes more chronic [and] less responsive to treatment because they’re continuously exposed to pollution, especially kids who live near highways, kids who live near construction sites. There’s a construction site almost in every neighbourhood in Vietnam, so you can’t escape it.”</p><p>However, while there’s an obvious risk in the city, Dr Halevy acknowledges that finding a solution to the problem is no easy feat.</p><p>“At the moment, the only way to solve this problem is to get rid of the traffic and that’s impossible so you either live with it or you go away,” he says.</p><p>For individuals, something as omnipresent as air is difficult to control, however it is possible to avoid being outdoors at certain times of day, like rush hour, when air pollution is at its worst. Across the city, motorbike riders and walkers alike have adopted the habit of wearing a face mask, which some – Dr Halevy included – are skeptical to endorse, as there is limited scientific data on the effectiveness of these masks against PM2.5.</p><p>That said, a 2012 study published in US-based journal Environmental Health Perspectives found that use of a face mask can help to reduce the adverse effects of air pollution and lower the associated risks of cardiovascular disease. Conducted in Beijing, the study tracked mask wearers with a history of cardiovascular disease while walking along the city’s heavily polluted Second Ring Road. When the masks were on, patients experience lower blood pressure and improved heart rate variability as well as a self-reported reduction in symptoms and perceived exertion.</p><p>Though it depends largely upon the face mask you choose, there are some who endorse face masks as a way to protect against harmful airborne pollutants. Dr Richard Saint Cyr, a US-certified family physician, blogger at MyHealthBeijing.com and occasional health columnist for The New York Times’ China edition, has written and researched extensively on the effectiveness of a variety of face masks in Beijing’s urban areas, where he lives.</p><p>By Dr Saint Cyr’s assessment, the answer to pollution protection lies not in the local market or the pharmacy but at the hardware store. Dr Saint Cyr refers to 3M particulate respirator masks – often used by construction workers and painters – as the “gold standard”. Cheap, disposable and lightweight, these may not look much different than the flimsy surgical masks worn by many local residents but include a proper filter, fit better on a user’s face and are certified by the United States’ National Institute for Occupational Safety and Health (NIOSH). Best of all, they can be found at many of the hardware stores located around District 1’s Yersin Market and cost VND 10,000 apiece.</p><p>The only downside to a 3M mask is that you’ll look like a construction worker. As far as fashionable masks go, San Francisco-based Vogmask provides adequate protection as well as an array of colourful designs. Though they’re more expensive – your average Vogmask goes for just over VND 500,000 apiece, though it can last you up to five months, depending upon frequency of use – these microfibre masks are also effective in blocking out pollution thanks to the carbon filter inside and come with the added comfort of one or two exhalation valves. In fact, Vogmask graced the runway at Hong Kong Fashion Week last year, making it one of the only consumer-focused masks that hasn’t sacrificed function over fashion.</p><p>Whatever you choose, there are a few important things to take into consideration when buying a face mask. First, keep an eye out for masks which are certified by international standards. 3M masks, for instance, bear an N95 certification from NIOSH, meaning that they are proven to block at least 95 percent of airborne particles. If you’re unsure of whether or not a mask is actually NIOSH-certified, the organisation keeps a public list of certified products on its website. While Vogmask doesn’t appear on this list, Dr Saint Cyr ran his own Fit Factor tests on a host of face masks last year, including Vogmask. The results were positive, with Vogmask blocking out 95 percent of particles, though he acknowledges that there is no one-mask-fits-all solution.</p><p>Second, no matter the quality, an ill-fitting mask allows polluted air into the mask, reducing its efficiency. Look out for features like adjustable straps or a metal nosepiece that conforms to your face. To ensure that a mask fits well, eyeglass wearers can do a simple test: put on your mask and exhale. If your glasses fog up, air can get out of – and into – the mask.</p><p>Finally, comfort is important, particularly for those who spend long bouts of time on a motorbike. Additional features like an exhalation valve can help to make breathing easier for mask wearers and may even reduce the amount of air leakage around a mask. Straps that go over your head – rather than just around your ears – are often more effective, however some might find that ear loops are more comfortable.</p><p>While it’s safe to say there’s no overarching solution coming to Saigon anytime soon, face masks may afford users at least some protection against outdoor pollution. According to Dr Saint Cyr, these can be worn for up to a week, depending upon the levels of pollution to which you’re exposed. You’ll know when it’s time to switch masks, as breathing will become difficult when the filter is maxed out.</p><p></p><p><b>Dr. Jonathan Halevy - Head of Pediatrics, Family Medical Practice Ho Chi Minh City</b></p>"
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"summary": "While accidents aren’t completely avoidable, there are some ways that one can protect themselves should the unfortunate occurrence of an accident happen.",
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"value": "<p>Whether walking or driving, Vietnam’s roads are dangerous. While traffic is usually flowing, accidents happen every day. Approximately 14,000 people lose their lives each year in Vietnam as a result of road traffic crashes. That’s nearly 40 people every day. Motorcyclists account for a high proportion (approximately 59 percent) of the road traffic collisions in the country.</p><p>The majority of deaths and injuries on the roads are among those aged between 15 and 49 years — the group that makes up 56 percent of the total population, and the most economically active group. The World Health Organization (WHO) estimates that road traffic injuries are the leading cause of death for those aged 15 to 29 years in Vietnam.</p><p>Road injuries may be significantly reduced by the simple act of wearing a helmet. While Vietnam has a generally successful helmet law, issues arise because people either wear poor quality (or ‘fake’) helmets or don’t wear helmets at all. Certified helmets are proven to reduce the risk of death by 42 percent and severe injury by 69 percent in the event of a crash.</p><p><b>Simple Steps for Safety</b></p><p>While accidents aren’t completely avoidable, there are some ways that one can protect themselves should the unfortunate occurrence of an accident happen:</p><ul><li>Wear a real certified helmet. Helmets are a must, but it is essential that the helmet you wear is properly certified, as a fake one can shatter at the time of a crash, which will actually cause more damage than not wearing one at all. Vendors for certified helmets include HJC (72 Chua Ha, Cau Giay, Hanoi); Protec (12B Ngoc Khanh, Ba Dinh, Hanoi and 18 Nguyen Thi Minh Khai, Q1, HCMC), Andes (at shops around the country and 249-251 Nguyen Dinh Chieu, Q3, HCMC); and Saigon Scooter Centre (35 Quoc Huong, Q2, HCMC).</li><li>Don’t drink and drive. Also, don’t get on the back of a motorbike of someone who has been drinking. When in doubt, take a taxi.</li><li>Get insurance. Breaks, fractures and other injuries from road accidents can result in expensive treatment, so getting insurance is a good way to ensure that you can get the best treatment possible.</li><li>Get a Vietnamese motorbike license. Most insurance companies will not cover the cost of treatment for road accidents if the driver does not have a license from the country that they are driving in. You can have the best insurance in the world, but it probably won’t cover you if you’re driving without certification.</li></ul><p>When in doubt, see a doctor. Severe burns, cuts or fractures can result in a more serious condition if not properly treated. It may turn out to be nothing, but it’s better to be safe than sorry.</p><p></p><p><b>Dr. Brian McNaull - Medical Director, Family Medical Practice Hanoi</b></p>"
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"summary": "The best way to avoid Influenza is by keeping strict and good hygiene. When you’re in public places, avoid touching rails and handles (e.g. escalator rails); avoid touching your eyes, nose and mouth. Wash your hands thoroughly before eating or taking care of your baby. If you cough or sneeze – use a single use tissue.",
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"value": "<p>Understanding and Protecting kids against Influenza</p><p>I doubt there ’s any parent in Saigon who doesn’t at least know someone whose children were hit by this season’s powerful flu virus. If your own kids got it (you’ll probably have caught it too, if this was the case) you’ll know that this was a bad one – a major hit at the beginning followed by weeks of chesty coughing, and no guarantee that the initial symptoms wouldn’t recur. Vietnam wasn’t alone in going through the worst flu epidemic in years during recent months – in an article in the Washington Post entitled Yes, this is one of the worst flu seasons in recent memory, statistics showed an inordinate number of child deaths caused by influenza in the United States; a CNN report attributed the majority of the serious infections to strains of H3N2, which has been described by the CDC as “nastier” than other strains for causing far more hospitalizations. It’s been the same story here in Asia – Hong Kong figures show that more people were killed by H3N2 in the first two months of this year than by any flu virus throughout the whole of 2014.</p><p>It was probably me who was responsible for infecting my own children. I’m still angry with myself; that day I just knew I had it, and while I was meeting with a colleague and doing my best not to pass out, I joked that perhaps I should avoid going home that night and just stay in a motel instead to avoid exposing the kids. I should have done just that – the following week, my one-year-old daughter was admitted to a hospital while my eldest was writhing on her bed with temperatures going off the scale. I’m sure I’m not the only parent who has wondered what I could have done to avoid all this. A few months ago I was thinking about getting the flu vaccination, although recent medical reports have stated that it may not have been much use this season. A BBC health report calls this year’s flu vaccine “barely effective,” with only three percent of people who were vaccinated with it showing any resistance to the virus – about as many as you’d expect in an unvaccinated population.</p><p><b>Rent a Room</b></p><p>Our own Dr. Jonathan Halevy, who practices as a pediatrician at Family Medical Practice Vietnam, concurs that the flu vaccine hasn’t proved effective this year. Although known as a very ‘pro-vax’ physician, Dr. Jonathan is in fact highly skeptical of flu vaccinations. Citing a recent published medical review, he says “it takes 40 people to be vaccinated to avoid one case of ‘the flu,’ which means that many of the people that did get the Influenza vaccine will still get sick. In babies below two years old, the vaccine seemed to be as useful as placebo (empty vaccine), which means none at all.” There are good reasons why even those who are usually outspoken supporters of child vaccinations don’t feel the same way about flu vaccines. “Influenza,” says Dr. Jonathan, “causes symptoms of ‘the flu’ – high fever, nasal congestion, cough, headaches, muscle pain, weakness. Unfortunately, these are not specific only to Influenza. There are over 200 viruses that can cause the same symptoms. Influenza A and B viruses actually cause only 10 percent of ‘flu’ cases. It’s impossible to differentiate between ‘the flu’ and Influenza without testing.”</p><p>As for treatment of Influenza with Tamiflu, Dr. Jonathan also warns parents to take care: “There is an overuse of this medication, which may lead to fast-growing resistant viruses. The data we have so far shows that giving Tamiflu to otherwise healthy children and adults doesn’t have much benefit beyond shortening the disease time by an average of 17 hours. There are specific guidelines indicating who should be treated with Tamiflu and when. So before taking Tamiflu, you should consult with your family doctor or pediatrician and be tested for Influenza.” In cases like mine and most people’s, there’s no way to effectively set up quarantines between parent and child, and so Dr. Jonathan recommends that the only practical way to protect your family from spreading the flu virus around is to follow some basic hygiene measures. “There is no 100 percent proven way to avoid viral infections,” he says.</p><p>“The best way to avoid Influenza is by keeping strict and good hygiene. When you’re in public places, avoid touching rails and handles (e.g. escalator rails); avoid touching your eyes, nose and mouth. Wash your hands thoroughly before eating or taking care of your baby. If you cough or sneeze – use a single use tissue.” Otherwise, if you want to be completely certain that you won’t pass on your flu virus to your kids, then a night or two in a motel (presuming you have this option) may not be such a bad idea after all. You may have some explaining to do when you get home, but you’ll never have a better excuse for staying in a private room and catching up on some neglected TV series while you recover. Anything for the kids.</p><p></p><p><b>Dr. Jonathan Halevy, Head of Pediatrics, Family Medical Practice Ho Chi Minh City</b></p>"
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"title": "Myths About the Flu Vaccine",
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"value": "<p>Another year has gone by already. Brace yourselves: Flu season is coming. And along with the coughing, fevers and aches, you can expect a lot of unreliable or downright wrong information about the flu vaccine. While you can't entirely germ-proof yourself or your child, you can learn to separate fact from fiction, keep your family healthier, save time, money and frustration. Let's start by putting some of the more common myths and misunderstandings to rest.</p><p><b>I still have time—flu season hasn't started yet</b></p><p>The timing of flu season is unpredictable. While it peaks from October to January, it's hard to say when the virus will start making its rounds. Not only that, but it takes about two weeks for the vaccine to kick in. If you procrastinate, you could end up getting it too late in the season to help. And what's worse than getting both a shot and sick?</p><p><b>I'm protected because I received the flu vaccine last year</b></p><p>It's not true, because the virus strains can change every year, so last year's vaccine may not be effective against this year's virus strains. The 2016 to 2017 flu vaccine contains the following:</p><p><i>A/California/7/2009 (1118,11)pdin09-like virus</i></p><p><i>A/Hong Kong/4801/2014 (413N2)-like virus</i></p><p><i>B/Brisbane/60/2008-like virus</i></p><p><b>I can't get a flu shot because I have a cold</b></p><p>As long as you don't have a fever above 38 Celsius or any other significant Illness, It okay to get the flu shot before your cold clears up.</p><p><b>Flu vaccinations are only for older people</b></p><p>Not true. The US Centers for Disease Control and Prevention (CDC) recommends the flu vaccine for anyone six months and older. The only people that the CDC says should not receive the Flu shot are pretty rare cases, so you're running out of excuses. These are:</p><ul><li>People who have had a severe reaction to the influenza vaccine</li><li>People with a history of Gufflain-Barre Syndrome after receiving the flu vaccine</li><li>People who are moderately or severely ill should wait until they're better before being vaccinated</li></ul><p><b>The flu shot will make me sick</b></p><p>Flu shots are made with inactivated flu virus, which cannot give you the actual flu. The most common reaction is soreness or redness at the site of the actual infection. A very small percentage of people will get a low-grade fever and aches as their body builds up an immune response, but this will only last one to two days.</p><p><b>Antibiotics can kill the germs that cause colds and the flu</b></p><p>Antibiotics work well against bacterial infections, but they don't treat a viral infection like the flu. If someone develops a serious complication of the flu, such as pneumonia, then they need antibiotics. But antibiotics won't help your flu at all and may actually cause unwanted side effects.</p><p><b>I'm pregnant so I should not get the shot</b></p><p>Incorrect. The flu vaccine protects both you and your baby. The flu is, in fact, more likely to cause severe illness and complications if you're expecting. It can also cause premature labour and other health issues for your baby. And here's good news; the flu shot you get now will protect your baby after birth.</p><p><b>Flu vaccines don't work. I'll probably catch the flu anyway</b></p><p>Every year, scientists attempt to predict which strains of the flu virus will be most prevalent that fall. It's a tough estimate, as the flu can mutate in months, and sometimes even within a single season. But if you do end up catching the flu, you'll have a much milder case of it. Flu vaccines reduce the risk of flu substantially, though their effectiveness in any particular year varies. The flu vaccine cuts your risk of getting the flu by 50 to 70%.</p><p>So if you think the flu isn't a big deal, then you've probably never had the flu. Come visit Family Medical Practice Hanoi in October and November, you'll see people of all ages, dehydrated and feeling miserable.</p><p>Even worse, certain groups of people are even more vulnerable and can develop deadly complications from the flu. Thousands of people die every year from the flu—as many as 49,000, with over 200,000 hospitalized.</p><p>It's that time of the year again—flu shot time. Go get your flu shot!</p><p></p><p><b><i>Dr. Philippe Jean Collin - Pediatrician, Family Medical Practice Hanoi</i></b></p>"
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"summary": "There is no real medical treatment for dengue fever other than rest and hydration, but sometimes natural remedies can help, so we recommend papaya fruit which is rumoured to increase blood platelets faster than normal.",
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"value": "<p>A couple travelling through Asia (Thailand, Laos, Cambodia) came to see me a few weeks ago. The 28-year-old Caucasian female of the couple had been in Hanoi for the last five days. She had been suffering with sore bones and was feeling she may have overdone it in Thailand where they had been trekking, but the pain was getting worse. But she had woken that morning with a bad headache and some eye pain. "It felt like a hangover," was her first thought, but she'd had an early night. What concerned her was that when she woke she was really hot, and now was shivering. Over the previous few hours a rash had started to develop between her fingers.</p><p>I've seen this many times—patient arrives with a list of varied symptoms, and I find it's really important to talk about date of illness onset, travel history, the start of symptoms and vaccination history. This is the season for dengue fever, not to mention zika and chikungunya. And to make it more challenging, patients are diagnosing themselves before arriving. A blood sample was taken and immediately sent to the lab for analysis—it would take 30 minutes to get the results. This is a lot quicker than waiting for the symptoms of dengue to appear, which can take three to 15 days after the mosquito bite transfers a virus to you.</p><p>A range of symptoms can develop; fever and chills, painful muscles, bone and joint aches combined with headaches and retro-orbital (behind the eye) pain. Symptoms in mild cases can last from four to seven days and then disappear, and in many cases dengue's parting gesture is a painful itchy rash.</p><p>We had confirmation within an hour—dengue fever. As I've already mentioned, the symptoms of dengue fever make it easy to diagnose. The symptoms include mild bleeding in the nose and gums, and easy bruising can occur due to depressed platelet count and, in severe cases, damage to lymph and blood vessels, enlargement of the liver and failure of the circulatory system which may lead to shock, and death.</p><p><b>Treatment</b></p><p>Dengue is caused by a virus—there are no medicines or antibiotics which can be used as a cure. For my patient I immediately recommended bed rest, paracetamol and fluids. She spent two nights with us and started to feel better after the first day. We kept on monitoring her, but after rest she felt better, although still weak. She carried on with her holiday going slowly and being more careful. There is no real medical treatment for dengue fever other than rest and hydration, but sometimes natural remedies can help, so we recommend papaya fruit which is rumoured to increase blood platelets faster than normal.</p><p><b>Prevention</b></p><p>There is no vaccine to prevent dengue fever. The best way to avoid the disease is to prevent bites by infected mosquitoes, particularly if you are living in or traveling in wet, tropical areas. This involves protecting yourself and covering up when possible. Fortunately, dengue doesn't spread from person to person but you need to prevent the disease by watching your surroundings; empty or drain any standing water (pots) since the mosquitoes breed there. Wear protective clothing. The dengue mosquito likes to attack at dawn and dusk, and favourite spots are below the elbow and knee. They are generally active between August and October, but they tend not to breed during the cold times of the year. If you want, you can turn to natural repellents like lemon eucalyptus oil and lavender oil, which may give you some protection. There are also a number of plants that have mosquito-repellent properties like citronella, catnip and lavender. Place them around your house to keep mosquitoes away. Even herbs like garlic, lemongrass, basil, peppermint and rosemary may help.</p><p></p><p><b><i>Dr. Brian McNaull - Medical Director, Family Medical Practice Hanoi.</i></b></p>"
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"id": 618,
"title": "The Myth — Air Conditioning",
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"summary": "Dry, cold air can be very irritating on the airways and many babies and adults suffer from stuffy or blocked noses because of air-conditioning. It can trigger coughs or an asthma attack and worsen the symptoms of a flu. If not treated routinely, a/c filters can collect dust and mold and spread them into the air, increasing the irritation.",
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"value": "<p></p><p><i>My Vietnamese family thinks air-conditioning is unhealthy, and is reluctant to let our kids spend too much time in an air-conditioned room. But I think the Saigon heat is too much for them, and that the air pollution isn’t good for them either. Is there any truth to their belief?</i></p><p>With all those bikes and the constant dust blowing about from construction projects, it’s certainly true that the air over this city is far from fresh and it’s not always good for young children to spend a lot of time outside breathing in all those pollutants – not if they have another option. Vietnam is in the world’s top 10 most air polluted countries in the world, much of it sitting in a hazy smog over Ho Chi Minh City. It’s not even recommended for adults to do much exercise outside, let alone children.</p><p>Air conditioners filter as well as cool the air, so they’re an effective way of removing dangerous particulates that can otherwise lodge themselves in the lungs. That said, air-conditioning isn’t without its own health issues.</p><p>According to pediatrician Dr. Jonathan Halevy of Family Medical Practice, the benefits of air-conditioning are obvious. “Air-conditioning reduces humidity, keeps you cool, reduces sweating and also reduces skin irritation such as heat rash or a worsening of atopic dermatitis – and it does keep the air a bit cleaner,” he says. “Bringing down the humidity also reduces dust mite and mold growth, as well as any allergic reaction to them (such as allergic rhinitis and asthma).</p><p>“On the other hand, dry, cold air can be very irritating on the airways and many babies and adults suffer from stuffy or blocked noses because of air-conditioning,” he adds. “It can trigger coughs or an asthma attack and worsen the symptoms of a flu. If not treated routinely, a/c filters can collect dust and mold and spread them into the air, increasing the irritation.”</p><p>For the best solution, especially with kids who are sensitive to colds and flu, Dr. Halevy recommends a mixed approach: “If your kids tend to suffer from a stuffy nose when they wake up in the morning and you suspect that the air-conditioning is irritating their breathing, try using a fan at night. If that’s not an option, make sure the filters are cleaned routinely (every three to four weeks) and that the room temperature is pleasant (not too cold or too hot) – remembering that the temperature you see on the a/c screen is not the actual temperature of the room. Using humidifiers may help a little.”</p><p>With regular filter cleaning, air conditioners aren’t harmful to the health per se – your kids are more likely to benefit from the cooler temperatures than otherwise. The only real threat is the prolonged exposure to dry, cold air. Balance air-con use with fans and humidifiers, and try to keep your kids cool at all times.</p><p></p><p><b>By Dr. Jonathan Halevy - Head of Pediatrics, Family Medical Practice</b></p>"
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