The government plans to cover everyone under the system, however, not all conditions will be covered. Everyone must be covered under the government system, which means that there are those who will be vulnerable to the system because of pre-existing conditions, or a family history of extremely devastating medical conditions. Despite this, authorities have are convincing each other that the benefits outweigh the lack thereof.

Vietnam’s current health care law does not require all citizens to be covered, but the government is looking to change that. The population of Vietnam is about 88.57 million, of whom only 30% are forced into compulsory health care schemes while only 11% are in voluntary programs—voluntary health care programs are obviously more beneficial to the people. This new system in Vietnam would force all citizens to be covered under the universal health care system, even if some would rather be on a private plan with more benefits. Currently, those who don’t have health insurance are just left to fend for themselves while their life or death is no concern of anyone else.

The system the government has come up with is just a government-run health care system NOT a government-paid health care system. This means that each citizen is required to pay an annual fee for health care—a fee which exceeds the majority’s annual household income. Where will these families get the money if this health care system is mandatory? Chances are, they are going to be told not to be so “extravagant” so they can pay for their health care despite whatever vulnerable financial situation they may already be in.

Vietnam tried to create a successful health-insurance system in 1989 but fell short and are beginning to create a new system modeling Thailand’s recent success. In 2003, the Vietnam Social System (VSS) had taken over the health-insurance system from the Ministry of Health and established a Department of Health Insurance in 2005. They are now pushing harder for a successful health care system, hopefully to be completely established by 2014 with the Universal Coverage Citizens’ Health Insurance law. This recent push was in response to the Health Insurance Law that had taken effect on July 1, 2009.

Is this the best thing for Vietnam? Thanh Nhan Hospital vice director Chu Thi Du admits that her hospital has been operating at a huge loss each year. She tells the media that “Last year, the loss was 18 billion dong,” which is $92,355 American dollars. (1) This is in result to being unable to turn away patients who were not covered under any health insurance program. She also states in the same interview that it is because of this that “they have to seek help from the media in publishing their stories so that they can have some donations.” (1)

In a democracy, universal health care is debatable because economics and citizens’ sources of income are not determined by the government. In such a poor country with so many hands tied by the government preventing families to build their own wealth from such a difficult place—would government run health care be best?

(1) NationalMultimedia.com

“Mind if I smoke?” asks Khôi to his girlfriend, who sits on the other side of the table in a Saigon cafe.

Smoking condition in Vietnam is a serious public health problem if not being addressed seriously. For every hour we spend on OneVietnam Network, there are 5 tobacco related deaths in Vietnam. Do you think Neil’s 10,000 deaths per year on the road is bad? Now, quadruple that number will give you a total estimated 40,000 caused by smoking, and this will increase to about 70,000 by 2033 if we don’t take an effective measure. Some experts even believe this figure could be much under-reported due to deaths outside of hospitals.

Khôi used to sit by Daddy after dinner watching him smoked. “Con h?n Cha là nhà có phúc.” Young Khôi would proudly imitate his every move, picked up his left over bud and started to put it in his mouth. Khôi was 4.

About half of 86 million adult males use tobacco in Vietnam. This makes the country one of the highest in the world (other countries are China, Malaysia and Laos). Young Vietnamese school boys start to pick up the habit of smoking from as early as 13 years of age. Up to half of all smokers will die prematurely from tobacco related diseases that include cancers, heart disease, stroke, birth defect, infertility, impotence (Yes gentlemen, how cool is that?), and many more. Ha Noi School of Public Health estimates the costs from cancer, circulatory, and respiratory diseases resulting from smoking is more than 75 million USD per year.

Now at the age of 21, Khôi already smokes an average of 1 and 1/2 packs a day. Today, however, being deeply sad about his father’s diagnosis of oral cancer, Khôi’s almost on his last cigarettes of the second pack. He needs a night out, so Khôi calls his girlfriend.

Although there are only 2 percents of the Vietnamese female population who smoke, second-hand smoking by these women also shares the same health risks mentioned above. A survey conducted by the Hanoi Medial University in 2005 shows that 2/3 of Vietnamese women and more than 60 percents of school children aged 13-15 years old are regularly exposed to second-hand tobacco smoke at home and in public places. Worldwide, of the more than 600,000 deaths caused every year by second-hand smoke, 64 percents occur in women.

Fortunately, there are already efforts by the Ministry of Health, World Health Organization (WHO) and World Lung Foundation (WLF) to raise awareness. In December 2004, Vietnam ratified the WHO Framework Convention on Tobacco Control. It has banned all forms of advertising, increased taxes on cigarettes and last year added larger warning labels to packaging. From December 2009 to January 2010, the “Cigarettes are Eating You Alive” campaign was launched and spread through television, posters and the press. Beginning January 1st, 2010, smoking would be prohibited in all public spaces. In May, 2010, results from the survey of the “Cigarettes are Eating You Alive” revealed that 77 percents of Vietnamese people who had seen anti-smoking materials oppose being exposed to second-hand smoke in public places.

If we all wish Vietnam to be a better place in the future, then smoking is one problem must not be ignored.

“Mind if I smoke?” asks Khôi to his girlfriend, who sits on the other side of the table.
“Yes, Khôi. Please don’t!”

It is no surprise that smoking can cause numerous diseases.  The insult begins  in the mouth where smoke, heat, and carcinogenic products interact directly with oral tissues.  As the ad above points out, ‘Tobacco causes mouth disease’.

In particular, oral cancer can be one of the scariest and most debilitating of diseases linked to smoking.  The Oral Cancer Foundation reports that close to 36,000 Americans will be diagnosed with oral or pharyngeal cancer this year in addition to causing 8,000 deaths.  More startling is that of the 36,000 diagnosed, only half will be alive in 5 years.   Surprised?

We’re not there yet.

The death rate for oral cancer is higher than cancers which we hear more often about – cervical cancer, Hodgkin’s lymphoma, or malignant melanoma (skin cancer).  Yet the puzzling thing is that oral cancer is … treatable.

Consider this:  “The death rate associated with this cancer is particularly high not because it is hard to discover or diagnose, but due to the cancer being routinely discovered late in its development.”

If smoking can lead to oral cancer, and oral cancer is treatable, what can we do to lower the death rate?  For starters, quitting is the most absolute best way to extend one’s life and prevent the onslaught of cancer formation.   Although it may take several decades of smoking for the accumulative damage to develop into cancer, tobacco use in all its forms is at the top of the list of risk factors in individuals over 50.   Statistics show that at least 75% of those diangosed at 50 and older are tabacco users.   New data are developing but have yet to be released.   The situation worsens when tobacco use is paired with heavy alcohol use,  leading to a synergistic effect that increases the risk of cancer development by 15 times.

Oral cancer is treatable if caught early.  To illustrate this point, imagine the oral mucosa as a multilayered cake that is rotting away from top to bottom.  The cake perhaps can be salvaged early on by removing the top layer that has rotted.  However, over time the cake will rot throughout rendering it unsalvagable.  Oral cancer is often discovered too late when the cancer has penetrated throughout the layers of the mucosa, enabling the cancer to metastasize or break free into the blood stream where it can spread to other locations.   When this event has occured, the outcome of treatment is very poor.

Patients often miss early signs because oral cancer can present without pain or symptoms (or symptoms that are not readily recognizable).  It is extremely important to receive annual check ups by your dentist.  Make sure that when you come in for your 6 month recall or cleaning, you are also receiving your oral cancer screening.

Maricopy Department of Public Health

WHO Viet Nam (http://www.wpro.who.int/vietnam)
VINACOSH (http://www.vinacosh.gov.vn/)
WORLD LUNG FOUNDATION (http://www.worldlungfoundation.org/)

http://www.clickkhongthuocla.vn

Oralcancerfoundation.org

Here is her story:

I would like to introduce myself and ask for help in search of a potential cure.  My name is Viet Lam and I am 37 years old.  I am grateful for the many wonderful opportunities that were given to me.  I was born and lived in Vietnam for eleven years before my two siblings and I defected on a small boat.  After refugee camps, we settled in the United States of America.  Through the generosity and the kindness of many people, I graduated from college and went on to obtain a medical degree.

Practicing internal medicine in California allowed me to serve a diverse community.  Yet, I did not truly grasp what my patients and their families go through until May 2007 when unexpectedly, I was diagnosed with an advanced aggressive Large B-cell Lymphoma.  How could it be possible when I led such an active life?  I did not have significant symptoms, except intense itching.  After going through the usual emotional stages, I was determined to overcome this obstacle.  With the help of a great medical team and loved ones, I successfully went through eight cycles of R-CHOP chemotherapy.  Equipped with a new life perspective, I lived each day to its fullest.  In 2009, a wave of suspicion and fear crashed over me when the same intense itching and new profound fatigue hit me.  It was confirmed that I had widespread recurrence.  My determination and optimism did not reward me with a remission after an additional three cycles of R-ICE chemotherapy.    I do not have a matched donor in my family, like 70% of patients needing a marrow transplant.  Therefore, my only chance for a potential cure is an unrelated donor match.

My Chinese Vietnamese ethnicity provides me not only a unique life perspective, but it also makes it much more difficult to find a match. This is why I am asking you, particularly those from a Non-Caucasian background, to consider being a potential donor. There is a tremendous and urgent need for thousands of people who continually hope for a miracle.  I am encouraged and hopeful that we can expand our national registry and particularly those of under-represented backgrounds.  Through your awareness and support, I believe that we can both close the registry gap and provide a second chance at life for those thousands of patients.  I thank you for learning more about the National Marrow Donor Program and for the gift of life.

Viet’s online journal at Caring Bridge highlights her struggles with  lymphoma and her call for help for herself and others in her shoes.  For Asians, and particularly Vietnamese, the registry of bone marrow donors is dismally small.  Orange County Weekly News recently published an article highlighting the plight of Asian Americans in need of bone marrow transplants and the shortage of Asian donors.

If you would like to help Viet and lymphoma/leukemia patients by becoming a donor, the National Marrow Donor Program has a program called Be the Match that can send you a registration kit for you to become a donor.  The registration kit is free of charge, which will be sent to you once you have filled out an online questionnaire.

Please lend a hand in helping Viet and lymphoma/leukemia patients of Vietnamese descent by spreading the word and expanding the registry of donors.

Special thanks to David Pham of UCSF for sharing this story with us.

Dr. Reiss is still working but struggling to keep up energy. She has to get blood transfusions often to keep up her blood oxygen level.  We need people to continue pass the world along and get registered in the bone marrow registry.  She still hasn’t found a match, nor have thousands of others.  I just got confirmation that I am in the registry through asianmarrow.org.  We need everyone to do this.

If you haven’t already, please advise your friends and family to register to be a bone marrow transfer, especially those on Vietnamese ethnicity.  It is a simple process that could save many lives.  Even some of us here at VTP have gotten our kit to register.  To ease your mind of the mystery, the kit looks like this:

The kit comes free in the mail and has a prepaid envelope.  It’s an easy, pain free activity that could save Dr. Reiss and many others like her.  If you have further questions, please do not hesitate to contact me.

New Donor Information

Asians for Miracle Marrow Matches
244 S. San Pedro St. #503
Los Angeles, CA 90012

http://www.asianmarrow.org

Phone (888) 236-4673
Fax (213) 625-2807

1) Go to the website, sign up for the free kit
2) When the kit comes, rub the cotton swab in your mouth, send it back
3) You’re done

It’s a pain free process that could save a life.  Contact information and more about Dr. Reiss in the letter below (sent by one of her former patient, Dylan Russell).

My family’s OB/GYN, Dr. Anh Reiss (Nguyen), needs a bone marrow stem cell match for a fatal bone marrow disease that she was diagnosed with in February of 2009.  Here is a recent news story on Channel 2 in Houston: Video

We just had a baby last year and have a four-year-old, both of whom were delivered by Dr. Anh Reiss at SW Memorial, in Houston, Texas, which is where Dr. Reiss offices. Unfortunately, none of her family members were a match, and being Vietnamese makes her potential donor pool very small, since so few in the Vietnamese community participate in such donor programs.

Dr. Reiss’s Facebook page is as follows: [link].  The page will explain the disease and how you can help.  What Anh Reiss needs most is as many people of Asian, but mostly Vietnamese, descent to provide cheek-swab samples so that we can find a match.  Free swab kits can be obtained from http://www.asianmarrow.org/ or http://www.aadp.org or http://www.aabmf.org/.  Please email me if anyone has any questions.  I will try to answer all questions.  Thanks!

Dylan and Skye Russell
281-678-7700 (cell)
713-742-3161 (wife’s cell: Skye Russell)
713-977-8686 (work)
work email: russell@hooverslovacek.com

P.S. PLEASE HELP!!  Dr. Reiss graciously helped our family through some tough times and difficult lost pregnancies.  We love her.  We would like to return the favor and help her and her family in such a difficult time.

Rapid improvements in Vietnam’s health system since 2000 has taken the world by surprise.  Infant and under-five mortality rates in Vietnam have  improved to be comparable to countries with substantially higher GDP per capita.  Vietnam’s social health insurance program now covers almost half of the population, and the goal is universal coverage.

Although Vietnam has made significant headway in health care reforms, it still faces significant challenges such as high out-of-pocket spending.  Vietnamese households face catastrophic health care spending, beyond what they can afford, because the government’s health insurance program not yet covers the majority of household medical costs.

The World Bank’s case study provides an indepth analysis and offers possible solutions to this issue along with the challenges facing Vietnam’s health care system.   I encourage Vietnamese expatriates who are doctors, pharmacists, other health professionals, and those aspiring to be health professionals to read this World Bank  report.