Health Care in Vietnam and Laos

	Vietnam	Laos	USA	Australia
Population	82 million	6 million	303 million	21 million
GDP (Purchasing Parity)	$2310	$1740	$44,070	$33,940
Life expectancy (M)	69	59	75	79
Life Expectancy (F)	75	61	80	84
Health Expenditure (USD)	$264	$85	$6714	$3122
% of GDP	6.6%	3.6%	15.3%	8.7%

Source:  http://www.who.int/countries - most numbers 2006

It was hard for me not to think about health care while traveling in Vietnam and Laos. Some of my fellow riders thought that these communist/socialist countries would of course provide cradle to grave health care to their populations. In fact, both Vietnam and Laos are developing nations, and as is typical of countries with relatively low GDPs, they have a primarily “out of pocket” payment system.  Both countries also have relatively little health care facility capacity, especially in rural areas.  Lonely Planet says about Northern Laos “for any serious illnesses consider flying to Bangkok” and warns that air evacuations can cost upwards of $100,000.

Our Laotian guide told us that if he or a family member were very sick, they would not seek care at a hospital, because it is just too expensive. The danger of pauperizing the family is too great.  A masseuse in Vietnam asked me, out of the blue, whether health care was “free” in a rich country like America. The ironies abound.  Vietnam (he told me) offers free care to children up to age 5. After that, city-dwellers can purchase insurance, and for others care is on an out-of-pocket basis.

During the second to the last riding day, one of the riders called forward to the two physicians to turn around.   A 6 or so year old boy had been hit by a pickup truck/taxi (we thought – although in retrospect it seems more likely to me he fell out of the back of the pickup).  An adult male had already rushed him (neck flopping – we were aghast considering the important role of neck stabilization to avoid spinal chord injury) and some of the onlookers were offering him a bit of rice whiskey (another clinical no-no, since it would make it more difficult to assess mental status). 

We examined him briefly – his brief neurologic exam was OK, he was able to move all extremities, and his abdomen was not tender.  He had a superficial scalp wound, and a nice lump on his back scalp.  We couldn’t have a verbal conversation with him, but he appeared to be answering questions appropriately.  There is relatively little traffic in Laos (compared to Vietnam) – and I’m guessing kids falling out of (or being hit by) cars is rare despite the rural villages clustered around the poorly marked roads.   We gave him some ice for the scalp bruise, and went on our way.  It’s not at all clear what we could have done if he appeared to have a ruptured spleen or a brain bleed.

Along the side of the road, most huts in Laos had an outdoor water faucet and a drain.  I believe this was the result of an NGO-government program to provide safe drinking water to the villages.  As much as I see a potentially tragic lack of access to medical care in rural Laos, it makes sense to prioritize public health needs like safe drinking water first.

Final Leg of the Trip

I’m back in Boston now – after an epic 36 hour journey from Hanoi.  I started on Asiana Airlines – and did a stopover in Seoul first.   (See last post about a visit to Gyeongbokgung Palace.)  From there we traveled on to LAX – where I was reunited briefly with my luggage, and reacquainted with domestic airlines.  USAirways shares a domestic terminal with Southwest – so the entire environment was chaotic.   The flight to Charlotte was overbooked, and seating took until 15 minutes after scheduled takeoff time due to the inordinate number of rollerboards coming on board.  I had my first pizza in weeks (pineapple and cheese – good, but not as good as some stir fried noodles with veggies.)  The flight from Charlotte, scheduled to leave at 10:15 was overbooked – but got off on time, and we arrived in Boston at 12:15am this (Sunday) morning.

When I say me, I mean me and the other passengers.  No sign of my luggage when the baggage handlers stopped the carousel and slammed down the exterior gate – so I couldn’t change from my shorts (lucky I had that fleece from my Seoul adventure). The US Airways lost baggage counter was busier than you’d expect at 1am. But the US Airways folks were nice and THEY didn’t lose my luggage.  Amazing how mean and angry some of the other passengers were. I just had 2 weeks in southeast asia - so I can be 'zen' about this. 

No luggage meant heading out into the cold weather here in my shorts (new meaning for being "chill"). By 1:15 am there was a line of 12 people and no taxis in sight!   I found a place under one of those heat lamps, and thought about what a challenge this could be to the Buddhist approach.   I ended up having a great taxi ride with Sayed, who kindly invited me to sit in the front seat because I was freezing. It turns out he’s friends with Sammit, who cuts my hair.  Small world! 

The luggage came by courier today – and the popped zipper on my suitcase that prompted me to fasten it with packing tape even popped back into place.   Not much sleep last night, though – so I won’t be starting the week quite as fresh as I’d like.

I’ll have a few more posts of perspectives over the next few days. Thanks for following along and being a part of my journey.

What happens when the airport toilet goes hi-tech?

Electronic Bidet in Seoul

Seoul Adventures

Me at the changing of the guards (notice my inappropriate dress)

I got out of the airport!

11 hours in an airport – even a lounge – just doesn’t seem like a good idea.  I followed a number of blog entry posts and decided to go to see Gyeongbokgung Palace.   Actually, perhaps I decided to see the Changdeokgung Palace  – which is on the UNESCO world heritage list.  However, the really helpful person at the information booth sent me right out to a bus to go to Gyeongbokgung.  Not right out. First she sent me to the stores on the third floor, where I procured a fleece.  I’m dressed in shortsleeves and shorts – and this morning it was -2 degrees Centigrade here (about 29 degrees Fahrenheit.)  Now I could have figured that out and left my fleece out of the checked luggage.  Oh well.

One other piece of unhappy news.   Early reports suggested that North Korea apparently sunk a South Korean naval vessel last night.   Later reports suggest that the vessel might have had an explosion not related to the tension between the two Koreas.  Seoul is perched diretly on the border – so although it’s a capital city it is also a potential frontier town if there is any broader conflict.   Let’s hope not.

Everyone is hugely helpful here – there were red-shirted transportation employees who knew I needed a helping hand as soon as they saw me, and whether at immigration, customs, or driving a bus – everyone wants to help. (Not everyone speaks English of course, but anyone’s English is better than my Korean!)

The roads leaving the airport are massive – imagine the Jersey Turnpike with almost no cars on it – going through a wasteland of landfill surrounding the new airport.  The ride on the airport  bus was uneventful (though a bit cold even in my newly-purchased extra fleece).  The driver spoke no  English, but made sure I knew when the stop came. As I got out of the bus, it was clear this was the right stop, but it was totally inapparent where the palace and the National Museum are!  Luckily, it was crystal clear where the police were (all over the place), and the pointed me in the right direction where the old royal buildings are just 2 blocks away form the heavily commercial district of the bus stop.

For placental burial (for the royalty only)

I wandered through the Museum – which has English translation for perhaps 1/3 of its exhibits – many of the rest of these are self-explanatory.   However, this trip has helped me see what a disadvantage it is to not understand the language where I’m traveling.  I had no idea that the Koreans revere their royal family – which brought Korea into the community of nations in the late 19^th century and pioneered improving relations with the rest of the world. I  also would not have guessed how much trouble they took to appropriate bury the placentas of royals - and early childhood education for the prince started in the womb!  

Korea's royal rule came to a dramatic end in 1910, when Japan annexed Korea – where it would plunder the peninsular nation’s resources and people until the end of World War II.   The last survivor of the royal family line died in 1950.

The Palace itself reminds me of the Forbidden City in Peking – but it’s not quite as big, and it is swarming with kids on field trips.  It’s also been restored lovingly, but there are big skyscrapers virtually touching the Palace grounds, and fighting against development here seems like a lost cause.  One more Asian incongruity is LED billboards and lights flashing upon the ancient palace grounds. The palace had ceremonial changing of the guard, and one of the staff shot my photo after asking “You cold?”  You can get a sense of this by looking at everyone else’s dress.

I had a nice hot chocolate (accompanied by Goldongbon – the royal version of bimbimbop -- at the museum coffee shop after freezing on the palace grounds.  I picked up a quick Korea travelog for the plane at the museum gift shop (Peep into at Korea, Kevin Hayes, 2005).  I was a bit disturbed to read of gastroenteritis from Korean food just as I was finishing some myself.  I skipped the Kim Chi this time – since I’m on the way home and trying to avoid a garlic dose.

Then I hoped to return to Incheon International Airport via subway –  anything to avoid standing outside in my thin fleece waiting for the bus. I found a very helpful employee who explained carefully the two transfers I’d have to make and suggested it would take two hours.  I thanked him (Come sah me don)  and went directly to the bus stop, where the same driver who dropped me off arrived quickly doing the return run. 

Next I’ll be boarding Asiana 202 to LAX – and it’s a daylight flight but I need to figure out how to sleep during that 12 hours otherwise I won’t be able to function at all when I get to the States.  I inadvertently left my zolpidem (generic Ambien) in my checked luggage, so I went to a pharmacy here where they suggested a very high dose of Benadryl.  I bought it just in case.

Back in Hanoi (and Leaving on a Jet Plane)

Reproduction of Common House at Museum of Ethnology

I struck out at Hanoi Airport.

We arrived at 5:30pm, and I searched for the Asiana Airlines ticket line – and it was nowhere to be found.  Turns out it doesn’t open until a few hours before the flight takes off.  Who knew?  I got the travel agency to give me their phone number – but even after I used the right prefix all I could get was a busy signal.  So – we decamped to the “Food Court,” where I had pretty awesome fish soup, and where there was a great wifi signal.

By 9pm, the Asiana line was open, and a helpful clerk took my itinerary and walked over a few stalls and furiously typed for about 40 minutes (2 short stories in “Good Scent from a Strange Mountains.”) The denouement was that there were no seats on the flight out of Hanoi --  and I appreciate their not keeping me in that line until 11:20!

I had made (nonrefundable) reservations at the Intercontinental in advance – and the hotel is even nicer than it sounded in the New York Times.   It’s built on an artificial island on West Lake, and luxurious beyond my imagination, especially after two weeks of drizzling showers over bathroom floors with drains.   It’s an oasis in Hanoi where all the staff speak English There was a generous breakfast buffet, a plush bed with a pillowtop and choice of 6 different types of pillows – and an outdoor pool where you can do real laps.   Honestly, it was hard getting myself out of this resort after the evening of peaceful sleep.  The internet was even fast enough to watch John Stewart ape Glen Beck (hilarious) and upload most of my photos to Shutterfly. (I’ll be posting URLs in the relevant blog entries in the future.)

Water Puppet Theater

I did get out though, and visited the Museum of Ethnology– where I read explanations about the housing and farming choices of the Dao (I spelled the tribe “Zhou” earlier – since that’s how it’s pronounced) and the Hmong.  The museum also has a huge outdoor exhibit where houses are reconstructed, including an impressive multistory community house (from Vietnam’s central highlands –not where we cycled).   There was a boisterous high school class on a fieldtrip – so it took awhile to climb down from the community house since the high schoolers were posing for multiple pictures.

Sculpture of Vietnamese captives when Hoa Lo was the French Colonial prison. 

I then went to Hoa Lo, the prison which was called the Hanoi Hilton for the dozen years that American airmen including John McCain were held prisoner there. Some Americans I know have been unhappy at the prison museum – the American POWs seem like a mere footnote, and the focus of the museum is the 60 years that the French colonials used the prison to jail various revolutionaries, including some of the founding fathers (and mothers) of current Vietnam.   The text highlights that the Vietnamese would have liked to try the Americans using criminal law, but were generous eough to feed them and give them another chance despite the damage caused by their bombing.  There are impressive sculptures of Vietnamese prisoners in the French era prison – and a memorial to the sewer used as an escape hatch by Vietnamese prisoners. There’s also the remaining guillotine used by the French to behead Vietnamese prisoners.

I did a bit more shopping – getting myself totally lost in the process – and discovered that even with all the diversity in Hanoi, there are some things that are impossible to find.  My assistant, for instance, likes exotic shot glasses.  Now I KNOW the Vietnamese and Laotians use shot glasses – we used them in a restaurant to taste the rice whiskey we purchased along the bike road.  Still none of the stalls anywhere had any shot glasses at all – never mind the ones that say “Hanoi,” perhaps with a painting of a woman with a triangular hat in a rice paddy.  I wonder now that I’ve been up and down Ha Bong asking whether in a month the place will be overflowing with them!    I also had this idea to get my son a sports jersey from Vietnam or Laos.  However, it turns out that Vietnamese and Laotians just don’t wear their teams’ jerseys.  The trendy folks wear Manchester United (AIG) or Chelsea (Samsung).

After shopping, I had a dinner of hors d’oevres at the Intercontinental.  Great shrimp paste on sugar cane. Then, I had a swim (brisk and breezy after sunset) and an exceptionally good massage in preparation for the 36 hours of flight.  Very civilized.  The masseuse told me that I should get massages regularly because my calfs were so tight.  Maybe that has something to do with cycling 800 km?

I’m writing this on an Asiana Airlines flight to Seoul – first real leg of the trip home.   I have a long layover here – so perhaps will get to see a tiny bit of Seoul outside of the airport.   

Leaving Luang Prabang

Will, Bill, Nick, Rick and me in Luang Prabang as we turned in our bikes

We had our final dinner at Le Elephant – an excellent French-Lao restaurant along Luang Prabang’s main street, Th. Sisavangvong– across the night market from our hotel.   Unfortunately the Lao set menu was  mostly beef, so I went for the French menu, with an intensely neon green vegetable soup and mushroom canellonis in a cream sauce.   Very different from the rest of the trip – and quite good. 

The night market appears to be a permanent fixture along Th. Sisavangvong.  There are acres and acres of silk hangings and puffy elephant slippers.  A little of this is made here (most probably the t- shirts, which are often so thin you can read the text on the back through the front  of the shirt).  I’m guessing that many of the goods are actually made in China, including the hangings in the style of the Hmong and other minority tribes.  But at 9:15 (preparing for a 10pm closing) the merchants start packing up – and by 10:05 you’d never even know that the market had been there!

Luang Prabang is so smoky that I felt like I had inadvertently walked into a bar when I opened the door of my (air conditioned!) hotel room in the morning.   It’s a charming city, though, with tourists all over, and restaurants ranging from American to French to Italian and Asian.   It’s also got watts and stupas all over.  Many are being renovated – and there are novice monks all over. I got out of the hotel a bit too late to witness the saffron-clad novices parading down the street and receiving the alms of small kip notes and balls of sticky rice from locals and tourists alike.  

Novice robes out to dry

National Museum

I was able to see the national museum, including a photography exhibit “The Floating Buddha” by a German photographer  Hans Georg Berger who spent years documenting the reintroduction of Buddhist education into Laos after the current government through its hands in the air when it realized it could not eliminate religion.  In fact, it’s likely the Buddhism that gives Laotians a sense of peace even in a relatively impoverished land. The quote I’ll remember from the exhibit is the one line distilling Buddhism “Cling to nothing whatsoever.”  The photos are truly amazing – I can’t find any to link to on line, though, and photography was prohibited in the museum.

The government also had an especially hard time figuring out what to do about the long legacy of the royal family in Luang Prabang, which gave way peacefully to the Pathet Lao (communists) in 1975 as the US fled the region.  The King, Queen and Prince were initially under house arrest and later taken to camps in the mountains or caves; they apparently all died there, perhaps of malaria, but it’s really a mystery.   The Palace has become the National Museum – featuring the royal family’s books, gifts from around the world, and their cars .   The museum is much like a shrine to the royalty. Like the Buddha, though, they are gone from this earth.

View from Phu Si

The guidebooks say that a walk up to the temple at Phu Si – the hill overlooking downtown Luang Prabang, is especially rewarding for the view.  Take my word for it – not in smoky March!   The temple itself is much more diminutive than many others in Luang Prabang, and I deferred on climbing down the other side to see the Buddha’s footprint.  The temple had no one else inside, though, and I sat down on a pillow cross-legged for a few minutes in the darkness there with the faint smell of incense – and did feel very peaceful

 I took a dusty 3 km walk to the Phousy Market – the less touristy market –and the sights and smells were amazing.  Not much for a tourist like me to purchase there except for dried river weed – which was delicious at yesterday’s lunch, but I’m convinced it would be river weed powder by the time I got it home, so I deferred.

Market at Phousy

We’ll be on an ATR72 prop plane out of the smoke of Luang Prabang and into the hassle and noise of Hanoi in another hour – where I will try to talk my way onto a flight a day early so that I can have two days to recover and reorient myself to East Coast time.   Given daylight savings, it’s one less hour of reorientation since I left.

4 Wheels to Luang Prabang

Today started out cool and beautiful.  We had a  nice non-Asian breakfast at Nong Kaiu Riverfront – with real (apple) juice and especially good papayas and apples, and there was a bit of a breeze that between 10-11 was almost refreshing, although it felt more like a punishing headwind after 11.

                                   

Yesterday Nick said he saw a working elephant on Highway 13 – and I  was a bit skeptical.  He had skipped lunch to power through the Nong Kaiu – perhaps he was hallucinating?  Well, if so, there is elephant hysteria – we all saw the elephant today.  The driver was pretty adamant that the elephant not drink water along the side of the road.  The elephant won, and gave the driver a bit of a soaking.

A dark cloud of smoke settled over the Nuom Ou River valley at noon.  It felt like early dusk, and the sun was obscured entirely.   There were scorched palm fronds floating through the air, and all of our eyes were burning.

Along the way, I couldn’t bear to miss taking a quick shot of the “free drug village.” Next to the sign, there were two young women with rodents on leashes – I would have glided right by had I not stopped.  Apparently these are moles – and they taste similar to squirrel.

Moles on a string - a delicacy

The perils of translation 

A special treat today was lunch at Joi’s family home.   The family’s rice farm is on the other side of the river, but in 2002 the government ‘requested’ that the village move to the ‘road’ side of the river – where the electricity was.   Now, they row across the river each day to tend their fields.

Lunch was the best of the trip.  There was dried river weed with sesame (tasted almost like crackers), bamboo shoot vegetable soup, mixed vegetables, chicken and beef, and roasted yams (with white flesh – but were they ever sweet).

Lunch at Joi's family's home. Note I couldn't take a picture without hands in the way!

I got on my bike to start the last 45 km into Luang Prabang and was immediately overcome by the smoke.   My eyes were burning so much that I had to close them so they would tear – not especially helpful in terms of ability to see.   So I hopped on the van after a few kilometers.  It was a bit disappointing to miss out on the last 20 miles of a 500 mile trip, especially since there were no hills.  On the other hand, I’m sitting in the van with the air conditioner aimed at me and the outside temperature is 38 Centrigrade (about 100 Fahrenheit), and this is feeling just fine.

Haze in midafternoon as we reached Luang Prabang 

Luang Prabang is a city full of watts and stupas – and I’m looking forward to getting to see the night market.  Some of the group is staying and doing a cooking class tomorrow – I’ll be boarding a flight back to Hanoi to begin my trans-Pacific journey.   I’m looking forward to being home, and can imagine it will be a few weeks before I can even look at a bicycle!

Addendum: Nick and I did get out of the van to ride the last km into Luang Prabang.   Cough cough sputter sputter.  The city itself was in a deep haze - but is charming -- the hotel has the best shower I've had in 2 weeks, and we had a lovely dinner at a French restaurant.  Internet is again ploddingly slow - and I'll post photos from Hanoi.


Further addendum: Full photos from trip to Luang Prabang (not edited and mostly unlabeled) are available at share.shutterfly.com/action/welcome?sid=9BZtmTVyyY8w 

To Nong Kaiu

We rode today from Udom Xai, and before breakfast  Nick and I climbed the stairs to a new Buddha statue (still in scaffolding) and both a stupa and a watt.  On the way down, there were novices coming up.  We saw some of them with covered bowls receiving small denominations of kip and sticky rice from a woman on the street below.

 

When we got on the bikes – it was an endurance marathon.   We did 105 km total – but the morning was virtually all uphill.  90+ degree heat set in by 10 in the morning –and we (that would be me) trudged up each hill hoping that around the bend the hill wouldn’t continue – usually to be disappointed.   The flowers and birdsongs were great – and I recorded a brief clip that I’ll put on YouTube when I have enough bandwidth to upload the 11 seconds.

 

Lunch was great – a spread of sticky rice, fried fish, mixed vegetables, fermented greens (not my favorite), chili relish and chicken and pork and a bit of squirrel for the carnivores.   We concluded with watermelon – which is in season here – and for sale at every village, as well as absolutely perfect mangos.   I love the fruit here.  We were watched by a pack of dogs at the empty market at the top of the mountain we climbed (it’s not market day there) – as well as a few chickens and a sow with udders dragging on the ground.    The sow scored fruit peels and the dogs got some leftover meat – pandemonium reigned.

 

Gravity was with us for the afternoon ride – although the sun followed too, and there is little canopy here.   We passed through village after village with schoolchildren running up  to say “sabbaty” and hoping to slap our hands – as if we were finishing the Tour de France.  We’re at a resort along the Nom Ou River – staying in huts with stilts and a grand balcony overlooking the river itself.  The place is really spectacular – and this time I know the canopy is really a mosquito net – not just for decoration.

 

Tomorrow is the last day of riding – a few more km but far fewer hills –and then we’ll be in Luang Prabang, the end of the cycling journey.

 

A note about posting order

Given slow internet connections, I've resorted to batching posts and sending them via outlook.  I see that they are not necessarily posted in the order I sent them -- sorry about that.   Sabaday is today's - whereas first day in Laos is yesterday's. I'm not sure how to change order. If I figure it out I'll fix and delete this post. 

Dien Bien Phu into Laos

Good morning Laos!

We got an early start out of Dien Bien Phu this morning – starting at 7 so we could arrive at Tam Trong pass – the Lao border – by 10am.   The city was already humming as we cycled by – there was a tourist bus up on blocks on one block, and loud music emanating from the Vietnamese equivalent of diners.  We rode through heavy mist as we climbed out of rice paddies – and the morning was humid but didn’t heat up too much.  The climb was long – close to 17 kilometers – and the views continued to be breathtaking (but hazy – so the photos don’t do it justice.)   The photo pictured is a shrine at the bottom of the climb.

 

The departure from Vietnam was uneventful –and the one member of our party with no visa had no trouble on the Lao side of the border.  We got a new guide and driver, and switched bikes and refit our pedals.  As we left the Lao immigration site, the scenery changed abruptly.  The tar road gave was to clay and some gravel.   The immaculate road mileage signs disappeared. The forest looked (relatively) untouched – there were not smouldering fires everywhere.

 

The bad news was that although we arrived at the border on time and suffered no unexpected delays, the road (the only road) was being widened and paved, and a large section of it would shut down from noon to four.   We thought we’d make it to a shady area by a stream, but when the noon witching hour arrived, we were stuck in a lunar landscape with no shade and 100 yards from a giant earth moving machine chomping down the mountain to widen the road. 

This being Laos, we chilled.  Our new guide, Joi , and driver Mr. Ping  prepared us lunch (tuna, packaged cheese, French rolls, and vegetables washed in bottled water) – and put a plastic mat down in the construction area and tied a tarp to the truck to protect us from the sun.   Most of us read books – and the four hours passed more quickly than you’d think!  (Joi is pronounced in between “Joey” and “Choy” – many Laotian words don’t transliterate well into English.)

 

At four it was too late to ride the 75 km by bike  - and frankly the road was in no shape for biking.  We rode in the back of the flatbed truck – the guide couldn’t bring the van because of the road.  Little did we know....

 

The road was a genuine mess – dusty throughout (no rain here since October – the rainy season is right around the corner) – and there were 6 different areas where heavy machinery had been tearing apart the mountain and put together a temporary road just at reopening time (between 4 and 5).  The road also required fording 5 streams – some of which were at least 5 inches deep.   The ride was gut-wrenching – but I was happy not to be biking through the dust, dirt, and obstacles.

 

The villages we went through (Camoo – probably spelled wrong) were very poor –and the childen had ragged clothes and many didn’t have the ubiquitous plastic sandals.   They also viewed us as a tourist attraction for themselves, and mobbed us when we stopped at another check point awaiting for the 5pm finish of one of the many construction sites.

 

Our first Lao dinner was great – we had sticky rice, the national dish, mixed vegetables, eggplant, fish soup, and pork for the carnivores.  The restaurant had an assortment of chili pastes and other condiments – so therapeutic doses of  Beer Lao were required at the table.

 

Tomorrow – 100 km on “undulating” roads that we’re assured have no construction going on!  The hotel here has no internet, but tomorrow’s hotel will – so I’ll be queuing this up to be emailed to got posted tomorrow afternoon. 

 

Photo: kids waving to our truck as we left their village

Sabaday (To Udom Xay)

Today was the first day of riding in Laos.  We started at the same restaurant we ate at last night – and at first we missed the “breakfast page” and thought we would need to have fried noodles – but it turned out the restaurant, on the riverbank overlooking the small ferry that our truck took last night.  The breakfast menu was great – they had ‘banana pancakes.’ – cakey sweet dough with a bit of salt, topped with slices of the fresh “fat” bananas that grow in huge numbers in this area. Delicious!

 

The riding was great in the morning – we did 75 relatively quick kilometers before stopping for lunch.   There were birds chirping throughout (but not many in flight – I think being seen is a survival disadvantage here). There are also wildflowers everywhere – a bit of a surprise given how dry it is. We saw men doing percussive fishing (one bashed the water with a shovel, while the accomplish used a net to catch startled fish).  Kids all over yelled out “Sabaday” to us – the Lao equivalent of ‘hello.’

 

Laos is hugely different than Vietnam.  There are fewer pigs and water buffalo – but plenty of chickens and ducks.  More of the huts have thatched roofs (whereas in Vietnam most huts had tin roofs).   There are schools at every village, and for secondary school the villagers send their kids a few villages away – and build dormitories (small huts) for them to live in.

 

We passed one village known for its rice whiskey – and a still was in full operation.  The villagers cook the rice partway, mix in yeast, and ferment it for 3 weeks in garbage cans.   Then, the mixture is put in a kettle with cold water running over the top – which causes the steam to condense, where it flows into a barrel.  Other villagers bring empty water bottles to be filled  at the still – it costs 10,000 kip (about $1.20US), and is about 50% alcohol.  Our guide says that this is all legal – but of course the problem Laos has always had is insufficient funds to run a reasonable government – and it’s hard to see how taxes could be collected on this operation.

 

We had lunch at a roadside restaurant (picnic tables with a roof overlooking the Nuam Pac River).  The restaurateurs had 2 civet cats in a cage – and Joi assured us that they were pets and had been their for years (as opposed to a future entrée).    I remember that there is a hypothesis that the SARS epidemic started with civet cats – so I’m careful not to let them cough at me.

 

The bikers had stale bread, tuna, mayo, and Laughing Cow cheese with some lettuce (washed conspicuously in bottled water), tomato and carrot.  The guides had cold sticky rice with fish soup and two relishes – one made of galangal and chilies and the other of green chilies.  (They also had squirrel and squab).  The consensus of the bikers is that tomorrow we want sticky rice too.  From my perspective, hold the squirrel and bird.

 

It was 35 degrees C this afternoon  - an even 95 degrees – and it was humid.  There were only a few hills as we followed a tributary to Udom Xay.   We were happy we only had 28 km to go.

 

The Dansavanh Hotel is absolutely stunning  -it’s got a huge lobby and large rooms—today, there is even a shower stall (yesterday, we had to shower on the bathroom floor – not my favorite approach, but apparently common here).  The staircase to the third floor is grand – and there are large elaborately carved wooden chairs and tables scattered throughout the public spaces.

 

I’m off to the internet café now to see what happened with the House health care vote in the US last night – and to post these entries.  I’ve been sending the entries by email – which gives me less control over the way they look – but allows me to do other things while the messages are being sent.

 

A Meditation on Health Care

As I sit in the Monday predawn light at Muang Khoua, a small town in northeastern Laos, the House has probably already voted on health care reform in the United States, a bit over 8000 miles away, where it is early Sunday evening.   There is no internet here – so I won’t find out the results  until we reach the larger town of Udom Xai.

 

I just finished reading “True Compass,” Ted Kennedy’s final memoir.  Toward the end of the book, he recounts his joy (and pain) upon discovering that methotrexate was indeed beneficial to adolescents with osteosarcoma, like his son Teddy Junior.

 

Teddy’s treatment, like that of the other children suffering from cancer, was free in the first six or seven months, because it was part of an NIH experimental grant….[when] the experiment ended, the patients’ families were billed for the remaining treatment.

I will never forget sitting down and listening to those parents.  Suddenly, they were faced with finding a way to scrape up three thousand dollars for each treatment. The treatments were necessary every three weeks for two years. These families were terrified.  They could not begin to afford it.   They would tell me of being reduced to grim, almost macabre calculus: How much of a chance…did their children have if they purchased the resources for only a year? Or eight months?  Or six months? …Many had already borrowed to the limit.  Others had sold or remortgaged their homes.

 

I’m hopeful that the House will have passed this legislation – however imperfect.   By regulating certain insurance practices and providing subsidies for those of modest income to obtain health insurance, we will increase “medical security.”  By mandating that all obtain insurance, we will diminish the problem of adverse selection.  In the end, we need to genuinely lower the rate of inflation of health care costs. This bill decreases the rate of future Medicare increases – so puts pressure on the provider community to find ways to continue to advance practice while restraining cost increases.   There is certainly no guarantee that this pressure alone will be enough to manage health care costs. Without this pressure, costs will continue their inexorable rise.

 

I’ll be back to travelogue tomorrow.

 

Photos from Ride to Udom Xay

 

 

Photos from Ride to Udom Xay (2)

 

Market in Dien Bien Phu

 

Rest Day in Dien Bien Phu

Today we had a noncycling day – taking it easy and viewing the  sites around the historic 1954 battle between the Viet Minh and the French that marked the end of the First Indochina War.  The film about the battle really helped explain the dynamics (once the docent changed the language to English) – the French were on the highest ground and had impenetrable defenses – which the Vietnamese breached by digging tunnels underneath. 

When we went to view the bunkers, there were a group of new Vietnamese enlisted soldiers who gathered around us, asking to have their pictures taken with us.  It’s ironic on so many levels – but typical of my experience in Vietnam – where little children are competing to say “hello” the loudest as we cycle by, and where the teenagers in Hanoi wanted to take cell phone pictures of themselves with me.   I swam a few laps this afternoon at the hotel’s (very big) swimming pool.  It was empty when I began, and as I swam a crowd of young men gathered to watch.  They wanted to try out some English afterward – of course their English is far ahead of my Vietnamese.

Two of us eat a great lunch in the hotel’s restaurant (shrimp with chili sauce and garlic).   At dinner, the larger group of us ordered the same dish – and it was also delicious, but totally different. There was a large group of European tourists in the restaurant, and our table was in the back of the large room – so we had a very leisurely dinner.

We’re saying goodbye to Binh and Tunhi, our guide and driver, tomorrow at the Lao border.    We start at 7am so that we can make it to immigration by 10:30 – Binh describes Laos as greener (“They don’t burn down the trees like in Vietnam”) but with “roads less good.”

I’m having trouble even seeing my blog right now – so I will again refrain from posting photos. I’ve been trying to email photos to the blog – but can’t tell right now if that has worked.

More news from Laos tomorrow evening.

Images from Ride to Dien Bien Phu

 

To Dien Bien Phu

We left the doomed An Lanh Hotel at 8:30 this morning in the van, which carried us 30 minutes past the continuing construction.  The rest of the day was about 100 km from Muong Lay to Dien Bien Phu – and it was glorious riding.   For starters, there was virtually no traffic.  We could hear the birds singing – and there were cicadas everywhere.   Binh tells us they are sometimes so loud that school needs to be dismissed early.

The first 45 km before lunch included a large mountain pass –  giving us great views of the Black River Valley below .   We had two flats (one of them mine), which made us a bit late.  We at lunch at Muong Chai - and it was the best of many excellent lunches so far.  The veggie dishes included green papaya salad, cabbage with garlic, and steamed squash – the fish was deep fried and had many bones. (Binh explained that Vietnamese feel that small pieces of fish might  be insulting- so they didn’t cut out all the bones).  There were a few meat dishes including attractive steamed chicken with lemongrass, and the meal concluded with a vegetable-based egg drop, tomato, and cilantro broth over rice.  Delicious!

The afternoon was supposed to be easier – but the hills just kept on coming.  (This is the day that the itinerary says the “hills are too numerous to count.”  The group waited at the top of each hill – and we streamed into Dien Bien Phu together.   The city looks like a mini-Hanoi, and has a number of boulevards and circles.  Bikes, motor scooters, cars, trucks, water buffalo, roosters and pedestrians all vie for the right of way.  I was pretty happy not to be riding this on my own!

 The hotel is another state owned enterprise the Him Lam Hotel – we entered through a long sidewalk through a residential neighborhood well off the main street, and hotel rooms on stilts are surrounded by careful plantings and wide plazas.  There is Vietnamese music playing loudly in front of the main building – and tables are being set up for some event.   There are two swimming pools, small tennis courts, and probably a lot more.  The rooms themselves are spacious and nice (I especially appreciate the air conditioning) and the bed seems comfortable. 

I do have a gripe though. The Vietnamese have a funny approach to plumbing.  In my bathroom, the sink and the bathtub both drain onto the floor, which has a  drain for the waste water.  However, the drain  is not at the lowest point of the floor.  Therefore, the waste water must cascade into the bedroom, where there is a hole in the floor and it drains below under the stilts.   The real issue is that I soaped my hands and face in the sink (silly me) when I arrived.  Hence, I now have a soapy floor.  Lesson learned.  I’m washing and brushing my teeth over the bathtub (that drain is upstream from the functional floor

drain).

Dinner was great – a special standout was sweet and sour shrimp with pineapples.  Good spicy tofu, fried fish, and greens, as well as ‘vegetarian’ soup to wash things down.  I’m always surprised by the crickle-cut French fries; Binh assures us that Vietnamese don’t eat these at home!

Tomorrow is a rest day – we’re visiting the museum commemorating the Viet Minh defeat of the French in 1953, and have some down time.   We’ve all sworn off bicycles for the day – given location, I think we’ll be taking taxis.    Wikipedia  said “There is nothing for tourists to do in Dien Bien Phu” yesterday, although that sentence has been removed when I rechecked today.  My Lonely Planet guide doesn’t even mention the city.  However, DIen Bien Phu actually sounds like fun in a Vietnam only Lonely Planet.  One way or another, it’s a chance to rest our legs.  Our ride in Laos, which starts the day after tomorrow, is supposed to be less hilly (which is a surprise to me – I think of Laos as much more mountainous than Vietnam).    Bill, one of the  cyclists, did a tour of Thailand and Laos last year – and said that the roads are generally untraveled there – something to look forward to.

By the way, this URL will take you to a satellite view of our ride from Muong Lay to Dien Bien Phu.  You'll catch us at the junction of 2 rivers (Muong Lay), and follow route 12 due south (note the many mountain ridges) to the Dien Bien Phu valley. 

Upload times are long - surprising since router is in my room!  Therefore, photos are getting a "failuer" note from blogspot.  I'll try to add photos later, although the internet might be more spotty in Laos.

That was no canopy on my bed!

That was mosquito netting!  Who knew!  These things should come with user instructions in English!

On Malarone (antimalarial) and applied some DEET last night before dinner - so I think I escaped with no bites.

To Muong Lay (Old Lai Chau)

First of all, an explanation is necessary. I thought that we would be staying last night in Muang Thanh Hotel in Tuang Dom, and tonight in An Lahn Hotel Lai Chou. Mysteriously, we stayed in the Muang Thanh Hotel in Lai Chou yesterday, and today we’re at the An Lahn in Muong Lay. It’s a riddle –what does this mean? They couldn’t move hotels from city to city!



It turns out that the old Lai Chou is to be inundated by a new hydroelectric dam. So, the old Lai Chou was renamed Muong Lay, and last night we stayed in the new Lai Chou, full of boulevards and new construction—which was previously known as Tuang Dom. (To make things just a bit more complicated, we ate lunch at a small hamlet between SaPa and New Lai Chou, which was rechristened Tuang Dom.)



A few more words about the Muang Thanh Hotel. It’s a giant structure – 7 stories tall – and it’s surrounded by grounds that include an open air restaurant on stilts over a crocodile pond, a modest water park, and life-size elephants, giraffes, and dragons. (Actually, I’m not so sure whether the dragons are life size). It’s grand inside, with a large atrium and marble stairs.



I’ve already mentioned that it was built very poorly – wires are exposed where they shouldn’t be, the marble stairs are not even, and all the slate and paving stones are cracking and coming apart. The crocodiles died (our guide, who tells us that this decrepit structure is just 5 years old, said that the climate is too cold). We had dinner in the restaurant , which looked like it was decked out for a state dinner. All the chairs were covered with yellow fabric and giant red ribbons around the back, and there were chairs arranged for hundreds. There were altogether 9 guests (our 5 riders, our guide, our van driver, and one European couple). Skip the next line if you’re squeamish. The memorable part of the pedestrian dinner was a massive cockroach which tried to climb a number of our legs, causing havoc. We made bets about whether the squashed beetle would remain under the table this morning at breakfast. Happily, it had been cleared away.

Today’s ride started with a bit of trouble; Bill took a spill as we were leaving Lai Chau. It’s not clear how it happened – it is clear how great it is to wear a helmet. We also had our third flat of the ride; the tube was replaced quickly. We climbed and descended along the riverbank the entire way – and we continued to see evidence of the amazing construction associated with the hydroelectric dam. The road we were traveling on is being relocated a few hundred feel higher on the cliff –so there were construction vehicles everywhere, and the road was often restricted to a single lane. We saw a huge gash in the cliff across the river, where a new road is being constructed because the previous road to a village will be underwater. Vietnam isn’t building just one dam – but is also building multiple subsidiary dams to control the water flow to the main reservoir. Between heavy equipment and scores of workers chopping rocks by hand, it felt like this was the kind of public works project that the US undertook in the 1930s. I thought a lot about how many of the dams we built in that era are now being removed – but the fish will not likely be restored.



The ride itself was vigorous, and I was mostly the trailing rider. (A less painful way of saying I was the slowest up the hills.) Binh, our guide, periodically stops to buy some special bananas, or relieve himself – making it less obvious that he’s waiting up for me. Thirty miles short of Muong Lay, the road was literally being reconstructed in front of us. A front loader was shifting rocks over the cliff to enlarge the road on the right, while another front loader was thrusting down showers of rocks from above, where the new road will be. We waited for 45 minutes for the road to reopen – and vehicles crossing were just about up to their axles in unpacked dirt. Given the huge amount of dust and falling debris, we all opted to take the van for that last 30km (which ended up being a gut-wrenching 2 hour ride). I love riding the bike, but that was a real relief.



I’m now at the An Lahn Hotel in Muong Lay (previously known as Lai Chau.). The hotel is a miniature paradise – my room has a bed larger than a king with a foam mattress and a canopy – and the air conditioning is just dreamy. It’s eerie that in a few months this hotel will be closed as the waters rise. Unlike last night, the dinner was quite tasty (especially the vegetarian egg rolls and the noodles; the Vietnamese fish was a bit overcooked). The restaurant was packed – with a few couples of tourists and 4 tables of young Vietnamese men. What a contrast from last night!



Nick and Bill got a serious laugh from the other patrons when they poured themselves a drink from a water jug and took a big sip. Turns out the jug had rice wine –not water – and the rice wine here (slightly cloudy but without color) is not to be chugged.



No wifi here – and my co-riders are hogging the internet machines. It’s likely I’ll post this tomorrow morning – but probably without photos due to upload time. Tomorrow, on to Dien Bien Phu. The ride is great, but I think most of us are looking forward to our “rest day” there.`

Addendum - photos are posted separately because when I try to paste text, IE7 crashes.