It takes four people to roll Sarah over for her X-ray, but she's blissfully unaware of the effort that's going into her annual check-up.
A team of vets and nurses rushes around her, taking her blood pressure, checking her teeth, feeling her organs and testing her joints for arthritis.
Like many bears rescued from bile farms around Vietnam, she has a raft of medical conditions.
"We call them our broken bears because physically and psychologically, they're done, because they've seen decades of abuse and exploitation," Jill Robinson from Animals Asia told 7.30.
"Many of them have mobility problems from being kept in a cage for so many years, with hardly any movement or activity.
"You look at the bears and you just think: 'Where on earth do we start?'"
Less than an hour out of bustling Hanoi, the Tam Dao rescue centre is a sanctuary for the people and bears who spend their days here.
Nestled in a tropical evergreen forest, and spread over an area of 11 hectares, the 199 bears who call this place home are treated to a program reminiscent of a celebrity rehab centre — individually tailored diets, an ever-changing assortment of toys to entertain them, physiotherapy sessions and a state-of-the-art medical facility.
A rescued bear lounges around in an enclosure. ( )
There are currently 199 bears at the Tam Dao rescue centre. ( )
It's a stark contrast to what these animals are used to.
Many haven't seen sunlight or felt grass under their paws for years or even decades since they were hunted from the wild for the liquid gold they produce.
Bear bile is an ingredient in traditional Chinese medicine that's used to treat everything from hangovers to cancer, and most recently COVID-19.
Its key component, ursodeoxycholic acid, has been found to be effective against some conditions including liver disease and gallstones, but nowhere near the full range of ailments it's prescribed for.
A bottle of bear bile powder from China. ( )
Bear bile extraction has been illegal in Vietnam since 2005, but there's still a black market in the country. ( )
The practice has been illegal in the country since 2005, although farmers were allowed to keep their existing bears as pets provided they were registered and not used for bile extraction.
Animal welfare groups have been working to rescue them ever since.
Tuan Bendixsen is Animals Asia’s Vietnam director. ( )
Tuan Bendixsen is Animals Asia's Vietnam director and has an Order of Australia for his services to animal welfare in south-east Asia.
He has helped with more than 200 bear rescues since joining Animals Asia in 2005, after working for the CSIRO.
"We go to the farm and, working with the local authorities, assess the condition of the bears and then try to get the bear as safely as we can, as quickly as we can out of its present cage into our own cage," he said.
"And then we start making the trip back to the sanctuary.
While some farmers have given up their bears willingly, other rescue operations can be more dangerous. ( )
"Most of the time we have the cooperation of the farmer which makes it much easier for everyone, less stressful.
"But we have done rescues where the government has forced the farm to give up the bears … so that's a highly stressful situation and it can be dangerous as well."
One former farmer who voluntarily gave up his five bears last year is Do Van Hoe.
Tuan Bendixsen with farmer Do Van Hoe. ( )
Do Van Hoe, a former bear bile farmer, handed over his five bears to the sanctuary last February. ( )
He told 7.30 he was grateful his bears had gone to a good home.
"I hope for people who also have bears, if they come to me, I would encourage and suggest that they hand over their bears to the government as it is the best thing to do," he said.
"When we hand over bears to the places where they are taken care of like what Animals Asia is doing, the bears live well and become beautiful."
Asiatic black bears, or moon bears as they're often called, are listed as "vulnerable" on the World Conservation Union's Red List of Threatened Animals, with the bear bile trade contributing to a 60 per cent decline in Vietnam's wild population in the past 30 years.
Tuan Bendixsen has worked hard on cultivating relationships with bear farmers and also the traditional medicine industry to encourage practitioners to prescribe alternatives to bile.
"Historically, people used bear bile to treat wounds. This became a deep path in their thinking and led to hunting and caging bears for their bile," said traditional medicine practitioner Vu Huu Thang.
"This pushed the bears to the edge of extinction."
Mr Thang has formulated a herbal balm for pain and bruises that he says is just as effective.
Vu Huu Thang has been working on herbal alternatives to bear bile. ( )
"I am a traditional doctor and a leader of the traditional doctor association in one of Hanoi districts. We follow the directive of the Vietnamese government [that says] protecting the environment and nature is important," he said.
"We direct members of our association who are doctors to use herbal alternatives to bear bile."
The majority of bears at the Tam Dao rescue centre are on a daily regime of medications to treat chronic conditions including hypertension, dermatitis, arthritis and pain.
Prior to being rescued, the bears had typically been kept in small cages and periodically sedated so farmers could insert a long needle into the gallbladder to extract the bile.
110 of the 200 bears in the Tam Dao sanctuary are on daily medications. ( )
Vet Sarah Donald sorts the daily medication doses for the bears at the sanctuary. ( )
Vets and staff follow a detailed spreadsheet of their individual medical needs to dispense the daily doses, which are then hidden inside treats like bananas covered in honey.
Jill Robinson said the goal was to ease their symptoms so they could enjoy the final years of life.
A bear graveyard at the Tam Dao Sanctuary in northern Vietnam. ( )
"Even though they're being incredibly [well] managed, they're pain-free, they're happy, they're reasonably healthy … when they die, every bear will die as a consequence of bear bile farming."
Ms Robinson founded Animals Asia back in the 90s after discovering bear bile farming while working for the International Fund for Animal Welfare.
Jill Robinson says her first visit to a bear bile farm changed her life. ( )
She says her first visit to a bear bile farm changed her life.
"It was like a thunderbolt of shock seeing these 32 moon bears kept in these awful tiny wire cages," she told 7.30.
"And as I was walking around, in shock, I must have backed too closely to a cage, and I felt something touched my shoulder, turned around and a female moon bear had her paw through the bars of the cage.
"And I did something really reckless that we would never do today, because we know how unpredictable and how potentially aggressive these bears can be.
One of the main hurdles to ending bear bile farming in Vietnam has been finding space to re-home them. ( )
"But her paw was there. And I took it. And she just squeezed my fingers.
"And she's changed everything. She started the whole dream of our rescues here in Vietnam and in China. And I knew that I'd never see her again. And I never did.
"But that one bear is responsible for our sanctuary in China, and for our two sanctuaries here in Vietnam, and for the end of bear bile farming here now."
An end to bear bile farming
One of the main hurdles to ending bear bile farming in Vietnam has been finding space to re-home them.
The sanctuary at Tam Dao has a capacity of 200 bears; it currently houses 199.
With approximately 240 bears remaining on bile farms around Vietnam and no prospect of releasing them into the wild due to the conditions they're usually found in, it's been difficult to find them all homes.
A rescued bear lounges on a structure in its enclosure. ( )
But Animals Asia has now opened a new sanctuary to house the final bears left on bile farms.
Australian Heidi Quine, the bear and vet team director, says it's the beginning of the end for the industry in Vietnam.
The charity has pledged to rescue the final bear by 2026.
Heidi Quine hopes other countries will follow Vietnam's path to end bear bile farming. ( )
"We're going to end bear bile farming and my hope 10 years from now is that we're looking at releasing bears into the forest in Vietnam so that bears don't need a sanctuary like this anymore," Heidi Quine said.
"And the next generation of Vietnamese children are going to be able to go out into their national parks, they're going to see bears in the wild as bears that should be free.
"That's my dream. That's my hope."
While many more animals are farmed in China, where the practice remains legal and widespread, Heidi Quine hopes the success in Vietnam will inspire other countries to end bear bile farming.
"One of the most powerful aspects of what we're doing here in Vietnam is that we are developing a roadmap that other countries in the region that may have bears on farms can look to as an example for how to end the industry," she told 7.30.
"So I think other governments around Asia, if they have bear bile farms in their country, can really look to the Vietnamese government as a model."
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