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Andrew Lam

Her short-term memory has been rendered almost non-existent.

“Why have you not called me for so long?” she asked me on the phone. “No one remembers me, no one cares if I die,” she breathed out. I felt the resentment in her voice.

“Mom, I called you three days ago,” I said.

“Liar. You did not call me, you did not,” she snapped back.

But I did call her. I call her frequently, in fact. She just can’t remember it.

Alzheimer’s has left my 88-year-old mother a mere shadow of her former self. It has loosened her grasp on reality, making her spiral down into paranoia.

In the last two years since I returned to Vietnam for work, I have not been able to go back to the U.S., but I remember to call my mother every day. My siblings still visit her at a nursing home in Fremont, but she still feels abandoned. As the disease progresses, she doesn’t even realize that her children haven’t forgotten her and still see her as often as they can.

The beautiful, energetic Hanoian woman I once knew has now been reduced to a frail and morose figure. The life she once lived, as if no longer her own, has been slipping away, piece by piece. Only memories of the most distant past remain.

I have opened her journal and copied the lines onto a computer. When the diagnosis came, my mother, knowing the days she had left with her treasured memories were numbered, decided to record them all before everything faded away – her life, the life of an immigrant, one half back in Vietnam and the other here in the U.S.

“The phone rang. I picked up. This is that woman in Los Angeles, who has diabetes and just had her leg sawn off. Another ring. This guy in Georgia had lung cancer, with only months left to live. We were best friends back in Vietnam. But someone my age, how can I possibly visit them when we’re miles apart? How can one even imagine calling their best friends as they lie dying in the hospital, only to say we’re sorry that we couldn’t see them one last time? And yet I do it every month.”

America’s a heaven for the young. There’s everything for them: toys, movies, amusement parks. But for the old? There’s nothing but loneliness.

Back in Vietnam, mother once said she never thought about living anywhere else but her homeland. “We live and die where our forefathers lived and die. Our families, lineages and loved ones are all here and nowhere else,” she said.

When we moved to the States, however, we shed our old ways of life as well. And as age catches up with us, so do our losses: friends, families, mobility, even our own minds.

Both my grandmothers spent years in the same nursing home before they passed in their 90s. My mother used to take buses to visit them every day, even though she had a day job. The nurses there often told her how blessed my grandmothers were to have someone visit them so often. “That’s how the Vietnamese live,” she responded.

Many of the other elderly people in that nursing home didn’t have someone visiting them regularly. I remember seeing old grannies on their wheelchairs casting their eyes towards the gates, waiting for someone, day after day, but no one ever came. An old lady told me she always looked forward to her son stepping foot inside the home, but he never did.

Even at a young age, my mother knew the fate that awaits the old in America.

“In the winter afternoons I often watch the leaves die on tree branches, and my heart goes astray. I think of the world I once knew, that is long gone, like streams of incense smoke carried away by the wind. I think of my hometown, of Tet in Saigon, the weddings, the trips, the family reunions. Everyone was there, the children running around, while adults chattered about life… I long for those days in the past.”

I read my mother’s entries as I wait for the flight back to the U.S. this May. My father died a couple months ago, and I could only attend his funeral online. But now I know I need to get back to my mother as soon as possible. Now my home is wherever my mother is.

I will not tell her that her dearest homeland Vietnam is on its way to becoming one of the fastest aging countries in the world; that there are many other elderly people left behind in their own homes as their offspring move to the cities; and that the strings that tie families together, thought to be unbreakable, are more frayed than ever.

An old woman collects trash in Hanoi, February 2018. Photo by VnExpress/Ngoc Thanh.

I look at Mom and her friends in their nursing home and see my own future. A future I have yet to fully envision, whether I am in Vietnam or the States, once my twilight years come for me.

For many Vietnamese, family and community are core parts of their identity. I don’t expect all the elderly to eventually choose nursing homes like in the U.S.

But I know that the demand for elderly care in Vietnam will only rise from now. The thing is, Vietnam doesn’t have many good nursing homes right now, even if a lot of people are going to need them five, maybe 10 years down the line.

Vietnam can no longer rely completely on old family traditions to sustain and assist the old in facing the inevitable passage of time. The country needs stable, strong policies in place to provide the assistance needed.

*Andrew Lam is a Vietnamese-American author. His book “Birds of Paradise Lost” in 2013 won the PEN Oakland/Josephine Miles Literary Award. The opinions expressed are his own.

Phan Huu Nghiem and his mother

On April 14, Nghiem was officially discharged from Cho Ray Hospital in HCM City. The hospital director came to meet him in person and say congratulations.Nghiem had been in the hospital longer than any previous patient.

In 2003, Nghiem, who was born in 1984, accidentally fell. The wound caused lasting bleeding and his hip bone, thigh bone and pelvis started to decay.

In 2010, Nghiem was brought to Cho Ray Hospital with severe inherited hemophilia. At that time, he used Factor VIII (FVIII) medication, a very expensive product. There was no other effective therapy for his condition.

Nghiem said that in 2014 the hematoma suddenly became pock-marked with holes like laterite, causing blood and pus to ooze out. Dr Tran Thanh Tung, head of the Department of Hematology, had to perform surgery to save the patient under the instruction of Nguyen Truong Son, who is now Deputy Minister of Health.

The major surgery was conducted with surgeons from three departments, Hematology, Urology and Orthopedic Trauma. Blood, pus and necrotic bones were removed totaling up to 3 kilograms. The necrotic mass was ingrained so deeply that when most of it was removed, the surgeons could see the patient’s intestines.

At that time, Nghiem’s abdomen was like a leather ball that had been gouged out and become empty, leaving a huge hole. Doctors tried to make a skin graft and use different methods to fill in the hole, but they failed. The wound caused a prolonged blood infection.

“I felt lighter after the surgery, because 3 kilograms of blood and pus were removed. Doctors told me that the incision would heal after one year. But it did not. They then once again told me to wait one year more. I kept waiting, but the incision was still the same. I did not ask about the incision in the third year and felt disappointed. I was just lying in the hospital and sometimes I wanted to give up,” Nghiem recalled.

Cho Ray Hospital doctors said that over the years they sometimes could not look at the mother’s eyes as they still had not been able to cure her son.

Nghiem stayed at Cho Ray Hospital for seven years after the first surgery. One day, as Nghiem and his mother felt homesick, they decided to catch a bus to return home. When he was carried into the house, blood gushed from the wound, and the bleeding could not be stopped.

Nghiem then had to return to HCM City. The driver had to drive as fast as he could all the way as he feared Nghiem might die halfway there because of bleeding. On that day, Nghiem began living in the hospital and only returned home during Tet holidays.

Nghiem’s life might have continued this way until his end of life if Dr Ngo Duc Hiep had not made a brave decision one day.

Hiep is head of the Department of Orthopedic Trauma and Burns. Not having the heart to see the patient living in such a situation, he decided to try a new costly therapy – fluid extraction with VAC method (Vacuum Assisted Closure).

All of the great efforts by the doctors and Nghiem were rewarded as the wound healed gradually.

Hiep said the dressing change alone requires a lot of patience. The bad odor from necrotic bone tissues spread throughout the room but medical workers never complained.

Nghiem’s wound eventually healed. However, due to the removal of the inflamed bone, he can only sit in a wheelchair or use crutches. He now has been officially discharged from the hospital.

“With this return, I will be able to live with joy,” Nghiem said.

According to the hospital, the 11-year treatment of Nghiem cost VND40 billion. Of this, VND38.3 billion was paid by health insurance. The remaining was paid by benefactors, responding to the call for help from Le Minh Hien, head of the hospital’s social work division.

Nghiem’s mother, Tran Thi Mai, has been next to her son for the last 11 years. Mai said she once lived on donated rice.

“They told me to feel free to have meals and help Nghiem in his treatment. They would ask for money from people to help me cover the expenses,” she said.

Cho Ray Hospital doctors said that over the years they sometimes could not look at the mother’s eyes as they still had not been able to cure her son.

Ca Linh

By Singapore International Foundation

The GECS, the largest regular economic survey of more than 1,000 senior accountants and finance professionals from around the world, has consistently captured the true scale of the global recession caused by the coronavirus pandemic, tracking the drop in confidence since the beginning and a new outlook in confidence triggered by the combined effects of vaccines and the fiscal stimulus.

This GECS has recorded the biggest jump in global confidence since the survey began 10 years ago. Between the 2020 Q4 survey conducted last December and the 2021 Q1 survey in March, there has been a significant improvement.

The authors note that the regulatory approval of several highly effective vaccines against COVID-19 and the subsequent introduction of vaccination plans in many countries has put a permanent solution to the health crisis within reach. Activity indicators covering orders, capital spending and employment all increased to some degree in the first quarter of this year – closely mirroring the level of confidence in the last quarter of 2019 before the pandemic struck.

“Having suffered the biggest recession for several decades in 2020, the global economy is on course for a relatively quick rebound,” said Michael Taylor, Chief Economist at ACCA. “The good news is that vaccination plans with continued policy support are on course to lift the global economy out of the COVID abyss this year.”

Raef Lawson, Ph.D., CMA, CPA, IMA vice president of research and policy, noted that the current path to global economic recovery differs from the financial crisis of 2007 to 2009, which resulted in a long period of subdued growth as private sector balance sheets were rebuilt through increased savings.

“This crisis is different as its root cause is health and not economic. For now, global COVID-19 infections are high relative to the vaccination rate, so risks remain significant. But the huge government support provided to both households and companies over the last year leaves both well-placed to resume spending once the health crisis is over. There are likely to be permanent changes in the pattern of spending and other long-term economic consequences of the COVID crisis.” said Lawson.

There are three factors that are heavily influencing economic prospects at present, starting with the rate of vaccinations, which can replace lockdowns to control COVID-19, thereby allowing economic conditions to return to normal. Second are major fiscal stimulus packages, such as in the U.S., which will have positive spill-over effects on other economies. Finally, particularly in advanced economies, significant savings accumulated during periods when spending was severely restricted can be a source of extra demand amid improved economic conditions.

The 2021 Q1 findings also reveal that confidence improved in all regions as did orders, with the exception of Africa. The “fear” indices – concern about customers and suppliers going out of business – showed mixed results in this survey but both remain above long run averages, underlining continued heightened uncertainty. Additionally, near-term cost concerns increased, reflecting higher commodity prices and other costs as the global economy recovers.

Further, the GECS notes that two-thirds of respondents expect higher inflation over the next five years, but there is a marked contrast between regions with North America registering higher inflation expectations than Western Europe.

North America/United States

In North America, the U.S. economy is likely to see economic growth of over 6% this year, in large measure due to fiscal policy, with measures worth around 14% of Gross Domestic Product (GDP) passed since last December. A large proportion of the spending plans in the latest America Rescue Plan are not directly related to COVID relief but are other policies of the new presidential administration. But the funds paid to households are likely to boost growth as they add to accumulated savings of those lower down the income distribution. Total household savings in over and above those that would have occurred anyway are estimated at $1.8 trillion (8% of GDP).

Last year, the U.S. economy shrank by a relatively modest 3.5%, but by the turn of the year, was growing steadily. With a significant portion of the population now vaccinated, the economy was already experiencing a strong upward trajectory even before the latest stimulus.

“Indeed, the U.S. will almost certainly be the first major economy, after China, to regain its pre-pandemic level of output, probably in the second half of this year,” Lawson said. “The risk for U.S. policymakers is that massive fiscal and monetary ease, plus accumulated savings, could boost growth to the extent that overheating and higher inflation becomes a realistic prospect.”

Taylor noted the concern about higher sustained inflation. Amid lockdowns, a collapse of global demand and a drop in commodity prices, inflation plummeted towards zero in many advanced economies and was subdued elsewhere.

“But as the post-pandemic world begins to take shape, there is now a debate about whether inflation is set to move higher, both over the short and medium term,” Taylor said. In the near-term, rising costs will lift inflation rates back towards 2% in many cases.

Fieldwork for the 2021 Q1 survey took place between February 26 and March 11, 2021 and attracted 1,004 responses from ACCA and IMA members, including over 100 CFOs.

ACCA is the global body for professional accountants, offering business-relevant, first-choice qualifications to people of application, ability and ambition around the world who seek a rewarding career in accountancy, finance and management. It works through a network of 110 offices and centres and 7,571 Approved Employers worldwide, and 328 approved learning providers who provide high standards of learning and development. ACCA has introduced major innovations to its flagship qualification to ensure its members and future members continue to be the most valued, up to date and sought-after accountancy professionals globally. Founded in 1904, ACCA has consistently held unique core values: opportunity, diversity, innovation, integrity and accountability.

By Thanh Van