Vietnam - Expats and traffic accidents in Vietnam

When Lisa Hamilton received a phone call from Vietnam informing her that her son, Ryan Gallaher, had been involved in a motorbike accident, she says her first reaction was that he had broken a leg or had some other minor injury. But after her son’s friend explained the seriousness of the accident, she was in shock.

Gallaher, 35, sustained severe head injuries when he crashed his motorbike while not wearing a helmet. He had been out drinking alcohol in the southern coastal city of Vung Tau, where he had been teaching English.

Over the next five days, Hamilton struggled to get to Vietnam. She had to apply for a visa and a passport, which she did not have at the time since she had only been out of her native Canada once, before she could get on a plane. She arrived in Ho Chi Minh City on June 9 2010, five days after her son’s accident.

“I guess I must have been naive,” she says. “I thought all I had to do was get to my son and everything would be taken care of, we would come back home and everything would be fine.”

As it turned out, getting her visa and passport then travelling half way across the world was only the beginning. When she arrived in the city her son, who was in a coma, had been transported from the poorly supplied Ba Ria Hospital just outside of Vung Tau to District 5’s perpetually busy Cho Ray Hospital. She found him in the head trauma unit, a large cluttered room with around 40 beds, usually full of patients, from young children to adults. She says she found the conditions horrifying and wanted to get her son out before he became infected.

A team from Family Medical Practice in HCMC helped Hamilton make flight arrangements to Bangkok, where there were better facilities at Samitvej Hospital, and cut red tape that would allow them to get on a plane with medical equipment.

A flight was arranged five days after Hamilton’s arrival. At that point she says she had already spent US$1,800 for the ambulance from Ba Ria to HCMC, US$500 at Cho Ray and US$15,000 for the flight to Bangkok. Gallaher’s friends covered the Ba Ria Hospital bills. Her son did not have any medical insurance.

“To me the money should have never been an issue,” Hamilton says. “The issue was having to have it all upfront, having to make all the arrangements myself and getting no assistance from the Canadian government. I would have sold my soul to get my son home.”

The next 17 days in Bangkok were a roller coaster, she says. The doctors said Gallaher’s prognosis was good. They seemed to think his brain damage wasn’t permanent, but he soon developed a chest infection.

“We had to take it not one day at a time but hour by hour.”

When it came time to fly Gallaher back to Canada, initial estimates from an air ambulance company were around US$160,000 and it needed to be paid in full and upfront. Hamilton says there was no way she could have afforded that on her US$24,000 a year salary she earns as a billing clerk at a trucking company in Canada. She was forced to wait for a cheaper option. Twenty-one days after arriving in Bangkok, they were able to get an Air France flight to Paris and then to London, Ontario for US$66,000.

Hamilton arrived with her son in Canada 23 days after she had left. Including the US$40,000 bill at Samitvej Hospital, Gallaher’s family spent about US$130,000 to get him home.

To pay the bills Gallaher’s father had to take out a mortgage on his house, Hamilton used all of her savings and maxed out her credit cards. They also received some help through donations and fund raising events.

Nearly two months after his accident, Gallaher was moved to a hospital closer to home in Listowel, Ontario where he died several days later from sepsis and pneumonia, which doctors say he had likely contracted in Ba Ria or Cho Ray.

Dr Claudio Duek, an orthopedic surgeon at Family Medical Practice, says expats die every week in Vietnam from head trauma and body trauma that has left internal organs severely damaged.

He personally treats about three patients a day that have been involved in road accidents. The injuries range from fractured wrists to traumatic amputations. He says most of the accidents involve drinking and driving.

As most expats quickly find out when they begin their lives in Vietnam, the same traffic laws they obey in their home countries no longer seem to apply.

He says even after only four beers, which he admits is not a lot, a driver’s reaction time is significantly slowed down, which can be extremely detrimental in a country where traffic is so unpredictable.

Dale Keys, an English teacher in HCMC, had been driving in District 5 around 10am one morning when another driver on his right made a sudden left hand turn, cutting him off. Keys hit the bike, catapulting him over his handlebars.

He says he landed on his head, but was wearing a helmet, which prevented more serious injuries. He stood up in a daze as a local helped move his bike to the side of the road. The other driver wasn’t injured and drove away.

After a few minutes of rest he got back on his bike and sat there with blood trickling down his face while talking to his flat mate on the phone when someone tried to steal it out of his hand. His flat mate suggested he leave right away.

Keys headed to the Columbia Saigon Clinic in District 1, where doctors x-rayed his head and foot and gave him tetanus shots. Luckily he only had a minor concussion and some scrapes and bruises on his face and legs. Although he had medical insurance through his school, Keys says he doesn’t have a Vietnamese driving license so the provider wouldn’t cover the medical costs. His bills came to around US$200.

Many international medical insurance companies can be found in Vietnam. Chartis, part of AIG, and Liberty Mutual are two popular choices. Depending on the coverage you want and how old you are, plans for Chartis range from US$190 to US$10,000 a year. For basic coverage, a 30-year-old would pay about US$800 a year.

This would cover room and board at a hospital up to US$300 a day and full coverage for intensive care costs and medical scans. It also covers up to US$20,000 a year for surgical costs. Worldwide emergency evacuation and repatriation as well as local ambulances and emergency room treatment is fully covered.

As with most insurance companies, if you don’t have a valid Vietnamese driving license then the company will not cover you. It is also common in Vietnamese hospitals for a patient to have to pay for emergency services upfront then wait for reimbursement from the insurance company later on, says Nguyen Hong Ngoc, an account executive with Chartis Vietnam’s Accident and Health Division.

Greig Craft started the Asian Injury Prevention Foundation in 1999. He says he was horrified by the number of motorcycle deaths he was seeing in Vietnam and wanted to try to reduce those numbers. He likens fatalities and serious injuries on the roads here to a war. With the number of casualties each year it is easy to see why: Vietnam's National Traffic Safety Committee reported that in 2010 there were 11,060 road fatalities, around 30 each and every day.

The foundation runs numerous programs supplying helmets to children and conducting road safety public awareness and education campaigns. Craft also developed the Protec helmets, specially designed for tropical climates and now manufactured in a not-for-profit operation here in Vietnam.

He believes better road safety needs to be built on the five pillars of enforcement, education, public awareness campaigns, government policy and direct intervention such as supplying helmets to children.

“Yes, enforcement is important, but we also need a culture of safety here,” he says. Craft also admits to feeling “enraged” when he sees expatriates behaving irresponsibly on the roads of Vietnam.

Why is it then that many people who would never think of doing things like drink driving or running a red light in their home country engage in this kind of thing when they come to Vietnam?

Simple human behavior and how we respond to the potential negative consequences of our actions has much to do with it, according to HCMC-based behavioral analyst Nicole Marchetto.

“Almost all of our behavior is controlled by what we call aversive contingencies,” she says. “Why don’t we go out and drink all night? Because we will have a headache in the morning. Why don’t we speed? Because we might get a speeding ticket.”

Marchetto says the perceived reduced likelihood of, say, getting that speeding ticket here means people do things they would not dream of back in the United States, for instance. This fairly quick transition in conduct on the road is because negative consequences, in either their application or removal, have a more rapid effect on behavior change than positive reinforcement.

On the flipside, watching some of the driving habits of locals can erode an otherwise conscientious attitude. Marchetto calls this 'vicarious reinforcement'. For example, instead of circling the block to get to your destination it is quicker and easier to go the wrong way up a one-way street. “If the behavior is reinforced it will maintain, if there are no contingencies in place to stop them,” she says.

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