[Preface: 4 years ago I wrote about bootstrapping startups from Vietnam and in recent years we've seen waves of "digital nomads" settling down in Vietnam. The situation for startups in particular in Vietnam has developed rapidly since but it's still a good base for "bootstrappers". The following is one long-term Vietnam expat's view on another trendy digital nomad hotspot.]

Have you heard? Chiang Mai, a city in the north of Thailand, is a top destination for digital nomads. What's a digital nomad? It's those people you see sitting in cafes all day with MacBooks. There are thousands of them in Saigon, at thousands of cafes throughout the city, but mostly around District 1.

When you've been hanging around Bangkok or Saigon, you'll find that Chiang Mai is much quieter. Peaceful. The honking has stopped, and you have space. There's a lot less going on here. And all the travel agencies are encouraging you to trek outside the city where there's even less. This is a small provincial outpost, not a cosmopolitan regional economic hub. But it draws in a ton of tourists.

The heart of the city is the square-shaped Old City, surrounded by a moat, which is still filled with standing water. This area is full of guesthouses and hotels and places for backpackers and tourists to hang out and get their backs rubbed. There are a number of streets in Chiang Mai which could be called "massage districts" due to almost every shop being a massage shop - 100 baht for 30 minutes, 200 baht for an hour. Massage may be the city's main industry. The city as a whole shuts down early, including the Old City. It's the complete opposite of Bangkok's Khaosan Road. But the masseuses stay open until the last bars close. Walking Street is full of white people laying in chairs on the sidewalk getting rubbed down by Thai people until midnight.

Contrast this with Saigon. Saigon is the kind of city that stays up late. There's always someplace to go eat and drink that's open. It's loud and noisy. You can get your massages here too but the masseuses will always be young women, not the aunties (or grannies or sometimes even male masseurs) who pull your limbs in Chiang Mai. So Chiang Mai is good for saving money by not going out, and maybe not dating local women.

Cafes with wifi, air conditioning, power outlets. And coffee. This is the natural habitat of the digital nomad. Chiang Mai's cafes are clustered in the Nimmanhemin / Nimmanheminda neighborhood outside of the Old City. This is a trendy area with shopping and trendy eateries as well as a handful of cafes. It's not a big neighborhood, but it's outside of the tourist circuit. Chiang Mai has a more artsy feel to it per capita / square meter compared to Vietnamese cities, and this street is a mix of hipster and yuppy, although such concepts just don't really apply in Southeast Asia.

Ploen Ruedee Night Market

But another great hangout spot (for white people) in CM with a similar creative-consumption vibe is Ploen Ruedee Night Market, "international food park", by the night market / bazaar. But it and the whole area are closed / dead on Sundays.

I've gotten used to cafes in Saigon having a certain standard of size to accommodate lots of customers, availability of power outlets, free iced tea, and fuss-free wifi. And there are more cafes in Saigon which fit this bill than any other city in Southeast Asia. For people settling in Chiang Mai's Nimmanhemin neighborhood and seeking cafes, it's not hard to find one. But they will be smaller and easily already full, or won't have any power outlets (this is common), or the wifi will be limited. Saigon has more quantity and variety when it comes to cafe styles.

Nimmanhemin cafes

Internet speeds in Chiang Mai can be decent. But a lot of the wireless networks have problems - being oversubscribed, being owned by telecom providers and requiring a subscription from them, being free to guests but only for an hour or two, and you'll only be able to connect to wifi with one device instead of both your laptop and your phone, etc. As cutthroat as Vietnamese businesses are, Saigon wifi providers aren't sophisticated enough to make you pay to access them, ever. A lot of Chiang Mai wifi networks are open as in unencrypted, whereas almost all wifi in Saigon will use WPA, just no login. As a consumer, you don't want to access wifi networks which are open but require logging in with an account tied to your passport or phone number.

Punspace coworking in Chiang Mai

Chiang Mai has a few coworking spaces. For digital nomad noobs and gurus alike. Here you'll find community. Chiang Mai has a small fraction of the population of Bangkok or Saigon. If you "nomad" here, your community will be people just like you, not local people. While Vietnam and Saigon in particular has a community and ecosystem of internet / technology professionals who are not nomads, Chiang Mai does not. Saigon has "real" expats, people sent there by multinational corporations to work there, as well as all the smaller companies who still need or desire to hire foreigners (and not just for teaching English). Saigon is economically diverse, providing both access to a workforce with skills which a business may need, as well as being a market for selling services to. If you are developing products and need developers or marketers you can hire from the millions of young people working in Ho Chi Minh City, and their salary will be affordable to bootstrapping startups. You might even meet investors who fund your project in Saigon. Chiang Mai is more like a resort for internet forum dudes, some who are "killing it" and others who have no idea what they're doing but are keen on experience "Southeast Asia lite". Also, apparently working at Chiang Mai coworking spaces puts you at risk of being rounded up by the immigration police who have recently raided them looking for foreigners working on tourist visas.

There is no "digital nomad visa". And most of us aren't eligible for work visas. Visas are an issue, but the visa situation is better for Westerners in Vietnam than in Thailand. People are frequently denied visas to Thailand which is rare for visitors to Vietnam, although you need to arrange a tourist visa (3 months) before you arrive in Vietnam instead of upon arrival. There are agencies in Chiang Mai explicitly advertising "visa run" services, which you'll have to do after 30 days or so. They take you by bus to a bordering country - Myanmar or Laos. You might be refused at the border returning to Thailand for staying there too long. Thai immigration might deny people who've done multiple consecutive visa runs. Vietnam, despite its bureaucracies and unclear regulations, is much more certain and easier in this regard with no requirement to stay outside the country for months before being allowed back in.

But Thai people are pleasant and friendly. It's the Land of Smiles. Vietnamese people can learn a lot from Thais about attracting global tourists by providing better customer service instead of turning them off through rude behavior (which the Vietnamese person won't realize is rude) and through blatant overcharging or scams. I can't emphasize enough how nice and not rude Thai people are (generalizing). Thai people know how to queue.

Saigon is no nomad paradise. But it still manages to attract all kinds of people who stay for a long time. There are various communities and it's still really cheap. Living here is comfortable. Chiang Mai is also a comfortable place for new nomads. It's open to newbies, and is an "Asia-lite" compared to the edgier environment of Saigon. The digital nomad to local population ratio is quite high. There are more options for employment, entertainment / nightlife, dating, events, diaspora communities, etc. in Saigon, but more choice can also be confusing or distracting. Saigon can be more stressful whereas Chiang Mai promotes stress relief in its scenery, less hectic traffic, and massages. Chiang Mai can be a few degrees less hot compared to the hottest times in lower altitudes. Does "digital nomad" define who you are? Do you need to be a member of a digital nomad community above all other concerns? Then maybe Chiang Mai is sufficient. If you seek more, and want to be exposed to variety, insanity, and unexpected things daily, then start discovering Saigon.

Some other comments:
1. Chiang Mai is a clean city, but there are random poop smells. Saigon has random urine smells (where guys pee on the street).
2. Chiang Mai has an uncomfortable "burning season" from February til April when the air is full of smoke from fires in the surrounding farmland and people leave the city. The smoke in the air is so bad that there are days the planes can't fly in Chiang Mai causing the airport to shut down and stranding anyone trying to leave, so it's best to stay out for that season.
3. Thailand uses Thai script to write their language, a script similar to Khmer, but undecipherable to most foreigners. Signs are often not translated into English. Chiang Mai street names are hard to find. Vietnam is the opposite in that even Vietnamese names can be written and read (letter by letter) by foreigners and every building on every street has its address marked outside making it easy to always know where you are (this mostly works).
4. Chiang Mai is a small and compact city, but increasingly full of cars. The traffic isn't too bad yet but can still back up at intersections. There is basically no bus system or public transit, besides individual trucks. There are also few taxis (making it unreasonable to hail one on the street) but many tuk-tuks.

A hospice is where you go to die. Too often, a hospital is the same thing. And it's by design! Where else do you see concentrated so many germ-infested people with weakened immune systems concentrate in one place coughing all over each other? I heard once that half of hospital deaths, probably moreso in developing countries, could be attributed to unclean water and subsequent diarrheal disease. One of the most effective things a doctor can do is wash his hands. But a number of doctors and other hospital staff can't even be bothered to use soap. Beyond that, what else sets one hospital apart from another?

One thing foreigners in Vietnam worry about is quality healthcare, especially if they are retirees or have families with children. The quality of hospitals in Vietnam is increasing as the country has been developing over the past two decades but it's far from the standards of developed countries, including Asian neighbors who were once provincial backwaters compared to Saigon. The Vietnamese and foreign doctors working in Vietnam are surely capable of most quotidian treatments and non-complex surgeries but for more serious treatment many expats opt to fly out of Vietnam. Bumangrad Hospital in Bangkok is the hospital of choice for many expats in Vietnam and they're used to accepting medical tourists. One day, the Vietnamese tourism industry will figure out that people, without wasting further money on marketing, will come back to your country if you provide them good service the first time.

The question is:

Where are the region's best hospitals?

And the follow-up question: How do you determine how good a hospital is?

Country Best Average top 10 Average top 5
Hong Kong5320061137
The above data was collected from's January 2012 world rankings of some 17000 hospitals. You can read more about their ranking there, which isn't necessarily directly scoring the quality of a hospital and requires that the hospital has some presence online. One can only make assumptions about the quality of any hospital that doesn't have even a basic website these days. While most of the best hospitals in the world are in the United States, many are also in Japan. And I don't think any eastern/oriental medicine clinics are included here.

Countries are sorted by the average score of their top 10 hospitals. A hospital's score is based on how much research they do. I guess research hospitals are good hospitals and unfortunately Vietnam does poorly when it comes to doing and encouraging scientific research. [Vietnam fails to pay salaries to professors based on academic output and Vietnamese students aren't taught by the researchers either. Vietnam fails to convince many researchers who go abroad to come back, partly to the poor environment for scientific research.] A good research hospital will have the state-of-the-art when it comes to diseases they specialize in. Sometimes they may be the only place in the world with knowledge and treatment for rare diseases, and sometimes that could all be in the hands and head of one doctor.

Surprisingly, Taiwan beats Japan. And Thailand beats Singapore.

So the Philippines has a good (low) score for their top hospital although a very poor score for their top 10 average. The Philippines seems attractive due to its best hospital being an eye hospital which probably conducts medical research on illnesses of the eye that has been published. Except for eye surgery, expats there might generally still fly abroad for significant medical treatment, Hong Kong or Bangkok.

This type of anomoly also affects Hong Kong.

Cambodia only has two listed hospitals so it's not possible to calculate an average top 5 or 10. From the rankings one could predict the inflow of many Cambodians traveling to Vietnam for medical treatment, or flying to Thailand. This appears to be the situation. FV Hospital in District 7 has staff that can speak Khmer in order to service Cambodian medical tourists. The order of magnitude difference between Singapore and Vietnam is akin to that between Vietnam and Cambodia.

The one hospital in Myanmar is one of the worst in the world. Remember, there were only 17000 hospitals listed. One can only hope with the recent opening up of Myanmar that we'll see some hospital services to support an increasingly demanding expat population.

The following is a Wikipedia list of wiki pages for hospitals all over Vietnam. It's not a complete listing, but it may be useful especially if you are traveling to smaller towns. List_of_hospitals_in_Vietnam

Recently, I discovered first hand what a Vietnamese emergency room is like.

Vietnam has been labeled an "enemy of the Internet" by Reporters Without Borders. There have been a lot of cases of bloggers being targeted, harrassed, and arrested. But RSF (Reporters Sans Frontieres - French for Reporters Without Borders) are possibly speculating heavily on many of their other arguments such as banning Internet (gaming) cafes near schools, the real origins of DDoS attacks, Considering Internet penetration in this rather populous country, with Internet usage continuing to rise rapidly each year, and an explosion of Vietnamese businesses operating on the web, it might be a bit of hyperbole to say that Vietnam and the Internet are enemies, just like people mistakenly still think that Vietnam and America are still enemies. But censorship of websites is an issue here in Vietnam. It's an issue in all of Vietnam's neighbors in Southeast Asia.

First, to the north of Vietnam lies the vast Middle Kingdom of China (China isn't properly part of Southeast Asia but it does border many Southeast Asian countries). China has been labeled #1 Enemy of the Internet for implementing a technologically advanced firewall (the Great Firewall of China). In China, hundreds of popular American websites are blocked including Google, YouTube, Facebok and Twitter. Search queries are also monitored for keywords and then stopped if a person is searching about a sensitive topic like the Tiananmen Square massacre. Chinese are forced to use local versions of social media (like Sino Weibo) which are more easily controlled by the Chinese government. You could try to draw parallels to Facebook versus Zing Me and other social networks in Vietnam but the huge difference is that Facebook is still accessible and the one and only social media platform in Vietnam. TOR (The Onion Router, used for anonymously browsing the Internet and TOR .onion sites) is also blocked in China.

Malaysia isn't your typical enemy of the Internet. Its government (like Vietnam) encourages a digital ("multimedia", a term from the 1990s) economy with various initiatives like Cyberjaya and the Multimedia Super Corridor and when those initiatives started, just as the Internet was blowing up around the world, the government declared that the Internet was to remain free and uncensored. But Convervative Muslims in charge do want to limit certain cultural shortcomings by censoring scenes in movies with nudity or even just cleavage and sex or even just kissing.

Singapore - the country where chewing gum is banned and could get you caned. It's also a country with a rather long blacklist of blocked websites, mostly porn sites like YouPorn or In Vietnam, pornography is illegal and you won't find Playboy or other girly mags being sold at magazine stands. But online, while ostensibly the Internet censorship laws are for blocking online porn, no porn sites are actually blocked (I've checked some of them - for research purposes). In Singapore, to a lesser extent, bloggers have been shut down and so has a random website about traveling while infected with HIV due to unfavorable portrayal of Singapore's policies towards HIV carriers. But no reports of bloggers being jailed unless they were also jaywalking, chewing gum, dancing in public places without a proper permit, bringing durian onto busses, or being a graffiti artist.

Thailand demonstrates a tactic that has been used in Vietnam, Cambodia, and probably many countries. Websites are not strictly speaking made illegal by the government. Rather, the government makes secret requests to ISPs to make certain websites unavailable. ISPs can decide to comply or ignore the request but ignoring the request comes at a high cost and so ISPs will generally block any website upon request. This means now over 100,000 websites are blocked in Thailand, putting it in the same league as China! Out of the rest of the countries in the region Thailand and Cambodia are the only kingdoms. Thailand has lese majeste laws making it illegal to insult the monarchy. This has led to arrests of people saying potentially offensive things about the king on social media sites like Facebook or even for liking or retweeting such statements.

Cambodia follows Thailand and Vietnam's leads when it comes to Internet censorship (Cambodia also gets their Internet connection from those two countries). When the government "requests" that certain websites are blocked the ISPs generally comply making it unnecessary to outright criminalize the websites in Cambodia. At the same time, governments deny censoring any websites and ISPs also release confusing messages regarding any block or whether it's an official block or just "technical difficulties". Like in Vietnam, certain blogs hosted by massive blogging platforms like Blogger and Bloghost have caused both entire platforms to be blocked by ISPs, not just the offending blogs. A certain controversial artists has had his website blocked, as has the NGO Global Witness, who fights againgst natural resource exploitation, corruption, and human rights abuses, probably for writing stuff like Cambodia should not stand for UN Security Council until land grabs and repression stop. Strangely, the prime minister of Cambodia briefly banned smartphones and 3G due to the potential of being able to view sexy streaming videos on one's mobile phone.

In Burma, the problem isn't just that some websites are blocked. Rather, all websites are slow and access can be unbearably limited to the point where they are functionally blocked. In general, Internet access is hard to subscribe to and then expensive to use, unaffordable for most Burmese. They also apparently have the same networking gear used for censorship as in China. With recent changes in attitudes towards the West and to media, with promises of no longer censoring newspapers, this is one country to watch in the future from any angle.

Laos, on the other hand, appears to not censor anything on the Internet.

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