I always wanted to be a doctor. Apparently at the age of five or six I already told everyone of this plan, which is strange as there was nobody in the family that belonged to this profession.
While I was seemingly destined to pursue a career in healthcare, I was by no means expecting to be standing here today as CEO of a private hospital in Ho Chi Minh City in Vietnam.
I trained in Paris and practiced as a pulmonologist and internist and became a senior consultant. I was then, in 1992, offered a head of department position but had to wait for a year. I had the opportunity to go to Saudi Arabia after the Gulf War, where I stayed 2 years, and enjoying expat life I decided to forget about that position and spent a further two years in Brunei before returning to Paris. I had picked up the travel bug that would never leave me.
But how did I emerge as the boss of FV Hospital? It is the result of a remarkable series of events, beginning with a somewhat chance encounter.
One ex-girlfriend, Georgine, with whom I had lunch after my return to Paris, in October 1996, told me that a childhood friend of her current boyfriend was part of a group of people led by an architect who wanted to set up a hospital in Vietnam, calling themselves “developers”. I met with him and a couple of his partners and didn’t like them. There was also a group of doctors loosely connected to the project and with near zero experience, so I wasn’t impressed.
With Vietnam not even on my radar, I headed to Turkey to work for a contact who had set up a SOS Doctors company, a venture which fell through in 1997, prompting a return to Paris after a month’s holiday in Cuba.
With the “Developers” Upon my return from Cuba, in September 1997, I had a message on my answer machine from one of the doctors associated to the Vietnam project, so I met with them. These doctors were led by Dr Luc Mercadal who had met the architect a few years earlier and liked the project. He had gathered 5 friends, all doctors, to participate into it, having frankly not the faintest idea how they were going to do it when they started. Anyway, after this meeting with Luc I decided to change my mind and give it a go. End of September 1997: we all meet in the architect’s office, around a large conference table, on a Sunday afternoon. And it is during the 6-7 hours that this meeting lasted that we laid the foundations of the project: medically we knew more or less what we wanted to do, but the most important point is that we came up with a mechanism to raise equity - asking doctors to invest each $25,000 and in exchange not only they would become shareholders but also they will be able to come to the hospital 2 weeks a year to practice and be remunerated. Only specialists were targeted, mostly surgeons, and we wanted to attract 300+ of them.
In November 1997 I travelled for the first time to Saigon (the common name for Ho Chi Minh City) with the so-called developers and some of the doctors. We had a plan to buy an unfinished building, that looked terrible in fact, that the developers had found.
During the next 18 months I had to teach myself finance, hospital business manual, construction, equipment procurement, hospital design, legal issues and more, from scratch, a daunting prospect given I had never cast eyes on an Excel spreadsheet up until this point. However, utilising what I call the “sponge technique” (which means that I stay next to someone 16 Dossier who knows and observe, listen, ask questions, literally absorb his knowledge, try and try again until I get the hang of it), I managed to progressively grasp all these concepts.
I travelled back and forth between France and Vietnam many times in 1998 and 1999 with the chief developer, but we didn’t seem to be getting anywhere, the negotiations with the building owners lasted forever but more importantly the developers didn’t seem to have any idea on how to raise money. Worse they started to run out of money and even asked us, the doctors, to lend them some. During one of these trips I met with the chair of the Franco-Vietnamese Chamber of Commerce, Marc Villard, and asked him the name of a good lawyer. He said “please don’t tell anyone that I told you that but the best lawyer here is English, her name is Lucy Wayne”. When I met her and explained the project she told me “I’m the only lawyer here that can help you”, I liked her aplomb and decided to work with her. She agreed on a small retainer and to be paid as a success fee payable when the bank loans would be secured and disbursed. It took several years but we did it!
Architect Réda Amalou designed FV Hospital and has been working with me for two decades, most recently on a new restaurant which I opened in October 2019, the P’ti Saigon.
Here is the story of how we met.
At the end of June in 1999 I called my brother and we went to a bar called The Bedford Arms in St-Germain-des-Prés, a kind of rugby bar that opens just before midnight and closes when the last client leaves, sometimes at 9am (my personal record).
A few months earlier I had attended a rugby match in the Stade de France, and the French team lost for the first time in years against the Scots. On the evening my friends, all males, wanted to have a dinner all together. I politely refused because a friend of mine wanted to introduce me to someone more attractive. But on that evening Paris was gripped by a terrible traffic jam and my friend called me around 9pm to tell me that we would meet up in a night club later, so I called the other one and asked him where they were having dinner, and joined them. There was a nice guy at the table who had not been at the rugby match. We talked and he told me he was an architect.
Fast forward three months and I am with my brother drinking gin and tonics, when the same architect enters the bar. I recognise him and ask him whether he knew about hospitals. It turned out that he had studied in London, spoke perfect English, and during his studies had designed hospital toilets. I said “that’s a beginning…” and we agreed to meet on the next day, a Sunday afternoon, and this is how it started. In September, Réda and I travelled together to Vietnam for the first time.
Then, at the end of June 1999, the building owner was suddenly arrested and put in jail for falsifying the construction permit. We immediately realised that it was the occasion to part ways with the developers so we decided to carry on this project on our own. We had just a few problems to solve though: we did not know how to do, had no architect anymore and also, crucial point, almost no money… It was time for a drink.
For the first 2 years we had been 7 doctors, my 6 partners who were all practicing in Paris hospitals, all very busy, all married with children, none speaking more than school English, and me, single with a little bit of money after my 4 years as an expat, and speaking English fairly well. We had put each, early 1998, some money in a company that we set up in Hong Kong, but not much was left after these first 2 years. So we set out to find additional partners. We had been advised since the beginning, free of charge, by one of Luc’s childhood friends, a lawyer called Gilles Célimène. I went to see him. I explained our situation and told him that we immediately needed 20,000 dollars to continue, he told me “you have it” to which I answered “no, we don’t, that’s the problem” and he said again “you have it I tell you” then I realised that what he was telling me was that he had decided to join us. Two more doctors decided to get into the adventure: Stéphane Romano, a hand surgeon, who when he heard about it said “a hospital in Vietnam! How come I’m not aware of this?”, and Marc Péricoi, ophthalmologist, who was the only one amongst us with real business experience. We called ourselves the 10 “Founders”. To this day we are still partners.
Stéphane’s brother introduced me to a financial advising company, Alternative Finance, who helped me organise my first trip to Washington, early July 1999. About a year earlier I had met in Hanoi with Wolfgang Bertelsmeier who was the head of the International Finance Corporation (IFC) in Vietnam, IFC is a branch of the World Bank, and provides funding to the private sector in developing countries, such as Vietnam. His first question was about my experience as hospital director, I had none, and the next was about our organisation, which was essentially nothing much to talk about. A bit taken aback he listened to me anyway, and gave me a lot of advice, for example that we needed a “deep-pocket investor”, seriously competent and experienced hospital managers, links with established hospitals, all things that we didn’t have, and actually we will never have as we eventually developed the hospital without following the established rules that banks normally require. I don’t think he thought I stood a chance to succeed but he encouraged me nonetheless. We kept in touch and he kept encouraging me, which was really comforting.
One day Wolfgang told me that I should go to Washington to meet with an informal group of people who worked at IFC and were brainstorming about hospital projects financing (I didn’t know but financing hospital projects was as challenging as it gets). So I went there early July 1999 and did meet with them at the IFC headquarter in Washington DC. They gave me some advice which I didn’t realise immediately will prove to be very useful. One of them was a French health economist, Guy Ellena, who told me later that when I left that day, after the meeting, he thought he would never see me again. Alternative Finance had also given me the name of a Republican senator who I contacted and to my surprise he invited me to his mansion overseeing the Potomac for the 4th of July party. He told me about one American who had succeeded in doing business in Vietnam, Peter Ryder. I called Peter some time later in his home in Long Island, the phone rung and rung and rung, I was about to hang up but then Peter was on the phone. It turned out that he had just closed his door as he was heading to JFK airport to take a flight back to Vietnam, but he reopened the door and answered the phone, fate again... It was a short conversation and we agreed to meet in Hanoi in October or November. I thought he could be an investor for the project but he did not have the money needed for such a large project, however after I met him he suggested that I hired him as an financial advisor to help me develop the project, and after consulting with my partners I did hire him. The core team was then constituted: Lucy, Peter and Réda.
Just before going back to Vietnam in September 1999 I was supposed to travel to Manila to meet with another large bank, the Asian Development Bank (ADB), so Alternative Finance organised the trip. However, during summer they sent a fax saying that they were not interested in meeting me, the fax was sent to Alternative Finance’s office in Paris that was closed in August so nobody had seen it. I met with them on September 1st and they showed me the fax, I said “just ignore it, I am going anyway” so I went there. People in ADB didn’t really want to see me but they politely did, as I pretended never have received their fax. I saw 5-6 persons who explained how impossible it was for ADB to participate into the financing of such a risky greenfield project. The last person I was supposed to see was the French representative who shared a seat on the ADB Board with his Spaniard counterpart, Manuel Sanchez Mellero. The French person was leaving so Manuel received me instead and told me “you know Jean-Marcel you’re not in the right place, here we finance only public sector projects not private ones” so he picked up his phone and called his Italian friend one floor below, from the small Private Sector Group of ADB. And this man explained to me everything that I needed to know, how much money I would need to secure a financing, what a bank would ask to even consider financing such a project and so on. I remember his first question: “how much money do you have”? I answered “quite a bit”, and then he stared at me and said “you need at least a million dollars to develop this project”, I didn’t comment but it was then that the enormity of what we were trying to do struck me. I stayed with him 2 or 3 hours and when I left I was devastated because I thought we could never achieve what these people will demand.
Back to France in October 1999 I set out to write an Information Memorandum on the project. With the help of a specialised French accounting company I developed a cost accounting model to be able to produce numbers: number of patients, of procedures, revenues, expenses and so on, and put together financial projections. And I wrote down, over 3-4 months, the complete description of the project.
In February or March 2000 Wolfgang contacted me to tell me that a team from the new Health & Education Department of the IFC was coming to Vietnam. The brainstorming group I mentioned earlier had eventually convinced the head of IFC that in order to succeed when financing health and education private projects in developing countries he needed to set up a specialised team of experts. Karl Voltaire, who used to be the director of IFC for South America, was chosen as head of this department with Guy Ellena as his deputy. I took a plane from Roissy, there was a strike at the airport and my plane was delayed, I almost missed my correspondence in Singapore, I made it but not my luggage so I showed up at the meeting in jeans with a Lacoste t-shirt hastily bought in the Saigon streets. Guy was quite surprised to see me and even told Wolfgang “why did you invite him?”
I explained the project and gave them the Information Memorandum. I must have been convincing because they called me later to invite me for dinner and then Guy said “Jean-Marcel we are going to finance your hospital project but on three conditions: one, you get an investment licence; two, you find a piece of land; and three, you find a hospital management company.”
Lucy and I took care of the licence, which required a mountain of work. We eventually got it in January 2001.
Back in September 1999 I had been contacted by a lawyer, Andrew Fitanides, working for a real estate development company from Taiwan that wanted to develop what is now called “Saigon South”, a 750-hectare area south of Saigon, that they dubbed “the new city centre”. He explained that a hospital was needed there and wanted to talk to me. We negotiated to acquire a piece of land in the middle of it, but it was very expensive. In fact next to that piece of land there was another large land plot that was public, belonging to the People’s Committee of Ho Chi Minh City, and because it was public it was quite cheap. The situation was complicated because the Taiwanese company had formed a joint venture with the People’s Committee, called Phu My Hung, the people committee providing the 750 hectares and the Taiwanese the money to develop them. The problem was that in the Phu My Hung board there were members of the People’s Committee who opposed the idea of us acquiring that public land, a clear conflict of interest. So the People’s Committee tried to force us to strike a deal with Phu My Hung. We eventually prevailed and got the public land but not without having threatened to alert the media.
For a few months Peter and I toured South-East Asia to talk to hospital management companies, and eventually we entered into a consultancy agreement with Parkway, a large Singaporebased hospital company. They advised us on the technical aspects of the design, so Réda and I worked with them quite a lot, which meant a number of stops in Singapore on our way to Vietnam. They agreed in principle to a management agreement that would have to be negotiated later.
So by May 2000 we had fulfilled 2 of the 3 requirements laid out by IFC and we were well on our way to get the investment licence. Then Guy called me and said “now you have to raise equity, once you will have raised 6-7 million dollars we will start seriously working with you”.
How many of these challenges did he have up his sleeve? Anyway, Gilles and I looked for an office in Paris because until now I had been working from home. And then I prepared a large fund raising operation, “crowdfunding” like a learnt later it is called. I wrote a complete dossier, with 5 different folders called “The Medical Project”, “Legal Structure”, Financial Aspects”, “Architecture and Construction”, “Vietnam”, designed to be very professional-looking, then managed to get hold of doctor databases and sent by post literally thousands and thousands of dossiers to doctors all over France. We also organised presentations in many cities to which we invited doctors (a “road show” as they call it, I didn’t know that either). We started sending these dossiers early August which is not the most auspicious moment in France as most people take their annual leave that month. But it was an immediate success: in September 2000 we raised a modest $50,000, in October $175,000, in November $250,000, and in December $525,000. By March 2001 we had raised almost $3,5 million, then Guy asked a woman called Seung-Hee Nah, top finance analyst from IFC, to call me, she introduced herself and explained that we were going to start the Due Diligence Process, another term I didn’t know.
Due diligence is a nightmare to go through, they look at everything, ask myriads of questions, leave nothing in the dark, it’s probably the most difficult part of the FV Hospital project development story. It lasted several months but by the end of it they were confident enough to start discussing the loan agreements. There was a problem though, we all knew that we could not raise enough equity so not only IFC had to structure 2 loans, one classic loan and one “quasi-equity” financing, but also because IFC cannot finance more than 50% of a project we needed at least one more bank, so we called ADB again, and they agreed to participate. They did their own due diligence, which was easier than the IFC’s. Also, both banks wanted us to have a Vietnamese lender to decrease the currency exchange risk, thus Peter and I negotiated with BIDV, the Bank for Investment and Development of Vietnam. Finally, Proparco, the French development bank, heard of the project and, because their new director had defined healthcare at a priority, contacted me (while 18 months earlier Gilles and I had visited them in Paris where they flatly refused to finance our project). At the end we secured $26 million in loans and quasi-equity from 4 banks, and raised $14 million in equity from nearly 400 doctors coming mostly from France but also from Switzerland and Belgium, and from the Founders. We had raised $40 million from scratch in a couple of years! Years later, a senior finance analyst who had just joined IFC told me that our fund-raising model was used by a finance school in London to teach students creative ways of raising capital and debt.
But the challenges didn’t end there. We reached an impasse when Parkway, the Singapore healthcare company, laid down the conditions for the management side of the agreement, Lucy and I considered them unacceptable. I was in Lucy’s office with Lucy, Peter and 2 of my partners. I called Guy in Washington to whom I explained the situation. He said “I call you back” and when he called back, less than one hour later, he said “we still finance the project but you have to run the hospital yourself”. I kind of babbled that I had no experience, that this was a crazy idea, and that I had no idea how to manage a hospital, that I was only a doctor. My 2 doctor partners looked at me and said: “I don’t know what you’re thinking but man you have no choice, it’s a done deal, you’re the Director”. The loan agreements with the various banks were signed in November and December 2001 but it took 6 months to meet all the conditions precedent for a first disbursement. During the whole year 2001 Réda designed the hospital, working intensively with me and advised by Parkway. Also, in the middle of 2001, we selected a project construction management company, HBP, led by a Scottish man called James Hardie. HBP was in charge of supervising the various consultants needed (particularly engineer structure and M&E), prepare BOQs (“bill of quantities”) and costs estimates, and organise the tender process. We started the construction in September 2001, so before having formally secured the loans, using the equity raised from doctors and our own money. When finally, the first tranche of the loans was disbursed, in April 2002, we had used up everything we had and could not delay payments anymore, we had been on the brink of having to halt the construction. I’ve never spent as much money as I did spend during the next few months, between the construction, the equipment and the never-ending legal fees, staggering!
I rent an office in Saigon, started hiring people, organised the medical equipment procurement, chose the hospital information system, worked with consultants on the standard operating procedures, and on many other things like getting all necessary approvals from the authorities, recruiting and training nurses, recruiting doctors from France and from Vietnam, and much more.
FV Hospital opened on Tuesday March 11, 2003.
Since then, we have never looked back. The first years were very difficult, it took us a few years to really take off, we were on the brink of bankruptcy several times but we managed not only to survive but to build our reputation. Today, FV stands as the first JCI-accredited hospital in South Vietnam, provisioned with 220 beds and more than 1150 staff which include 130 doctors, mostly Vietnamese with some expatriate doctors, as well as state-of-the-art equipment. FV also operates an outpatient clinic in Ho Chi Minh City’s business district. The two sites cater for the local population (75% of the patients are Vietnamese), expatriates and medical tourists from Cambodia. In 2019, the number of visits in the outpatient clinics reached more than 220,000.
FV Hospital houses an enormous array of expertise and services covering the likes of cardiology, ophthalmology, oncology, paediatrics, obstetrics, and general and vascular surgery, among many others.
FV Hospital specialities and services can be broken down into three key areas:
Medical specialities: includes accident and emergency, general practice and family medicine, paediatrics and neonatology, internal medicine, dermatology, skin and laser treatment, cancer treatment and clinical psychology.
Surgical specialities: includes general and thoracic surgery, vascular surgery and phlebology, bone and joint care, urology and andrology, obstetrics and gynaecology, dental surgery, ophthalmology and refractive surgery.
Support services: includes imaging, nuclear medicine, laboratory and blood bank services, and rehabilitation services such as physiotherapy, osteopathy and speech therapy.
Finding and developing talent has been an ongoing challenge since the hospital was established, but for me it has been the most important aspect to get right. Meticulous effort was put into compiling the management team and staff cohort, a blend of expats and young, impassioned local Vietnamese men and women combining to create a winning formula, one which is demonstrated by the group’s enviable retention rates. For example, 50 percent of employees have been with FV Hospital for more than five years, while 25 percent have served more than a decade and 11 percent over 15 years at the organisation.
Finding doctors willing to risk practicing at a new hospital set up by a group of French people in Vietnam was a challenge but over time our team has got stronger and stronger, reflected by the fact that so many of our people have been here for many years, and now we are attracting great Vietnamese doctors who find in FV Hospital the working place they wanted, where they can develop their skills and build the future of the profession.
Progressive investment in technology has also been key and FV Hospital is now recognised as having the best equipment and information systems, able to provide leading edge treatments at extremely competitive prices compared to nearby countries such as Singapore.
The past 23 years in Vietnam have been something of a whirlwind ride and I have treasured every one of those years in the country I have grown to love, and I am now standing proudly as the father of two children in their teens, both born in FV Hospital.
Vietnam was starting from a very low base in terms of its medical sector, and we saw an opportunity for it to develop very quickly by introducing international standards. This is where we stand out – we are a premier hospital and have been ambitious right from the very start. I still have a government report from 1997 which stated a real need for private investment in the healthcare sector. Back then there was I think just one private hospital in Saigon, whereas today there are around 35. Huge progress has been made in the public sector as well and it needs to continue as the Vietnamese population keeps on growing and the country keeps on developing at a rapid speed.
If someone asks if I am optimistic about the future of the health sector here in Vietnam, my answer is certainly yes.
It has been a privilege to be a part of this journey
Jean-Marcel GUILLON, General Director of the Far East Medical Vietnam LTD (FV Hospital)