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Some extracts from “A Thailand Diary” which may be of interest to those reading my blogpost on Hospitals in Thailand.

25/01/2015

Some extracts from “A Thailand Diary” which may be of interest to those reading the blogpost on hospitals in Thailand.

18 January

Noi rang my mobile to say that Stuart, her husband, was in hospital. Visited him this evening. He was very drowsy and seemed stressed. He had been in intensive care for two days apparently. Noi should have phoned earlier.

He had slipped on a wet floor and severely injured his left knee. Given he had been admitted to the ICU, there may have been other complications. Nobody seemed to know. Thai reticence to give out information?

His private room at the hospital was like a hotel suite. Multi-channel TV, refrigerator, small microwave, coffee maker, a comfortable sofa, and chairs. Plenty of wardrobe space and an en-suite bathroom. Some hospitals have VIP suites that include a small dining area for visitors, private phone line, and an internet connection.

You can ask for English speaking staff for a 25% premium, though that is not really necessary as most doctors and quite a few of the nursing staff speak good English. One hospital even offers a daily visit to your room by the hospital director. It’s up to each individual patient whether that particular service is value for money. Some Westerners think it is.

Thai hospitals encourage a relative to stay overnight. It’s beneficial for the patient. Nurses check patients regularly and are always on call but having a family member present overnight is seen as a positive advantage that aids patient recovery. Noi slept over every night and spent a large part of the day at the hospital. All private rooms have a foldaway bed and I have seen relatives sleeping in quiet corridors if the family member is in a public ward. Thais don’t like being too far from the family.

Thai hospitals do not have strict visiting times, and Stuart received five Thai visitors, all friends of Noi, while we were there. Most hospital visitors, anywhere in the world, try to be cheerful in front of the patient, but the Thais seem to have that concept in spades. They are ultra-cheerful and smile at every opportunity. They make it a happy shared occasion.

The Thais are like that. Funerals, too, are social occasions where the community can get together and chat as well as being a time to pay respect.

Thais always dress appropriately depending on the occasion and, significantly, in a way that shows their position in the Thai hierarchy. If your boss visited you in hospital, everyone present would realise his important position by his manner and the way he is dressed.

Noi had met Stuart in a bar ten years ago, nevertheless she still dresses in shorts and revealing clothes. Nobody minds that she dresses the way she does, though it is noticed and gossiped about, even by her friends. However, not in any malicious way. The hospital staff certainly noticed.

They are still very happy together as a couple. And she is caring and looking after him well now.

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In larger towns and cities, as in the rest of the world, traffic fumes give off unpleasant smells. Tuk tuks particularly give off very unpleasant exhaust gasses. In Thailand, the practice of slash and burn is a worse menace. The smoke from the burning of rice fields after harvest causes many respiratory illnesses and hospitalisations. Winds carry the smog even from other neighbouring countries that adopt the same practice.

Better than staying in their own homes. Thais socialise more at festivals in the wat, house-warmings, weddings, funerals, and occasions like these than dropping in for a chat or a meal at a friend’s house. They meet people and entertain in groups. At hospital visiting time, it’s common to see a dozen or so friends around a sick bed. They may never have been to the patient’s home though would certainly visit him when he is ill in hospital.

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9 September               

Went to hospital this morning with a stomach problem. Waited only a few minutes. Had the usual blood pressure, temperature, pulse, and weight checks carried out by a nurse and then was directed to the doctor responsible for stomach ailments. I signed a few forms and there was no other paperwork. All the clinical details were entered into the central hospital computer so that all medical staff could have access to my medical records.

Third in line to see the specialist who carried out the initial examination who recommended an x-ray, blood test, and a CAT scan. Thai doctors tend to send their patients for tests before confirming their diagnosis. Sometimes that may be overkill. There are reports on the internet of insurers believing hospitals in countries like India and Thailand are artificially inflating costs by recommending unnecessary tests and procedures.

Doctors in the UK, in the public sector anyway, generally diagnose, select a procedure, and await results. If symptoms persist they try other medication, request specialist advice at a different hospital, or arrange for further tests.

Thailand offers more of a “one stop” service. When they form a diagnosis they do so with the benefit of the detail amassed from the numerous tests they have asked hospital technicians to carry out. There’s no attempt to make an initial guess from the symptoms presented. There is also no “triage” system where you pass through levels of examination to determine a priority for being seen by a doctor. Emergencies are seen as such and dealt with speedily. No time is wasted with doctors asking similar questions and passing on their notes to the doctor that will eventually be responsible for your case.

Triage was set up because of the strain on state hospital resources. The system became more popular in the last decade of the twentieth century in the UK but some hospitals particularly in the north of England have reverted to a less complex and more common sense approach to assessing priority enabling most patients to be seen by one specialist doctor without going through what is really a screening process. They have found that it cuts down waiting times.

I had great difficulty in explaining triage to my Thai doctor. I doubt if I succeeded: he felt, as the hospitals quoted above clearly realised, that a patient should go directly to the specialist doctor that had been determined at the registration stage on arrival.

As in England, Thailand has both private and state hospitals. For Thai nationals and, until recently, for some expats who could elect to pay an annual fee, health care costs around 30 baht per visit or admission. Most Thais would go to a state or private hospital and not a private GP clinic, the advantages being the increased facilities available and there being specialists on site.

The CAT scan had shown inflammation of the colon which had a 90% chance of healing with medication and I was admitted. They were right to ask for further tests though having an ECG test on the heart and an x-ray were not procedures that were necessary given the symptoms as presented. I can see why health insurers are wary of hospitals. On the other hand, no harm is done (other than to one’s wallet and an insurer’s profit and loss account) and it’s best to be safe than sorry.

10 September

Private hospitals have 8-bed wards as well as private rooms. Doctors visit three times a day on average, whether you go privately or not. They see you before they start their clinic, then after lunch before their afternoon appointments, and finally before they go home for the evening. Emergency doctors are on hand throughout the night.

Nursing care is faultless. Caring comes naturally to a Thai. Examples of uneaten meals being removed because a patient can’t self-feed are unheard of. A Thai would have difficulty understanding that such incidents are not uncommon in western hospitals. The patient-staff ratio varies between 6:1 and 12:1 depending on how many beds are occupied. Unless there is a serious road traffic accident or a natural disaster, beds are always available.

A member of the family is encouraged to stay with the patient overnight and a flatbed is provided. Visits during the day do not suffer restrictions and can be of psychological benefit. Thais love talking and gossiping. They also know when the patient needs rest and quiet.

Friends and colleagues often come in groups and it became clear that they see it as an automatic cultural response rather than as a duty. It’s a difficult concept to explain. Thais see hospital visits, funerals, house-warmings, and other functions as a chance to socialise with friends and neighbours, and to show a caring attitude. Some fruit and snacks are routinely brought. You’ll see your acquaintances more at functions and situations such as being ill in hospital than at organised dinner parties.

In the West you entertain your friends at home and they reciprocate. In Thailand, Thais meet up with people they know outside their own homes, normally at a restaurant or, as in this case, around a hospital bed. Your visitors may bring food for themselves so that they can share a meal with you. It’s a social occasion. You visit people’s houses of course though not with the same frequency as you would in the West.

11 September

Only one other patient on the ward was a farang. He said that Thais visit only to show off, they are only acting as if they are compassionate. They only sit and chat to each other and don’t come specifically because you are ill as they would in the West.

He certainly had a lot of Thai visitors, friends and relatives of his wife. Some had come quite some distance to see him. Robert has been in Thailand a year, having lived and married his Thai wife, Tong, in England where they stayed for twelve years. He’s looking at their reasons for visiting with western eyes.

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In the bar areas of Thailand’s cities and towns you’ll often notice a few farangs, either sitting alone or in small groups, nursing a beer and contemplating how Lady Luck has dealt them a weak hand in Thailand. Some have lost a great deal of money in the country by buying a house in the name of a wife or girlfriend only to find that the relationship was purely a scam to obtain property for the family or to be re-sold.

Some have suffered crippling hospital bills which include overpriced services and the cost of unnecessary procedures. Hospitals are businesses and you need to choose those that the ordinary Thais use. For all expensive purchases, get a Thai you know well to give you advice on where to shop and the places to avoid.

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Only around 20 million of the country’s 64 million population earn enough to pay tax: the highest rate being 35% for the extremely wealthy. Spending on welfare, education and hospitals is consequently low while high earners keep a large part of their income.

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9 October

Mana’s wife went into the maternity wing of the local state hospital today. It was not completely free as in some western countries. She will pay a flat fee of 30 baht. That would be more than reasonable in the West. It represents 10% of the minimum daily wage here. For the Thai, even 30 baht can be significant if there are many visits to doctors or hospitals. Wealthier Thais use private hospitals and, although they pay less than farangs in most cases, don’t seem disinclined to pay for unnecessary medication and procedures. Many will boast of their hospital bills.

Visitors to Thailand often think in dollars, pounds, and euros and see the country as an inexpensive place to live. Reflecting in terms of percentages of your own daily income puts costs into a real perspective.

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One Comment
  1. Matt Owens Rees permalink

    Reblogged this on Matt.Owens.Rees; Thailand Writer.

    Like

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