Friday, September 18, 2009

Private Health Care - A Thai Experience

In the interest of what Fox News Network describes to be "Fair & Balanced" reporting, I am writing about yesterday's experience at a private hospital in Udonthani, Thailand. I have written a few blogs on the public health care available to the people of Isaan - the maternity ward in Khumpahawapi, the emergency room in Udonthani, the birthing experience in Kumphawapi, Duang's brother's emergency surgery, and a couple visits to relatives. These were public facilities and as it turns out very different from the private facilities and experience.

When she was a young child, my wife, Duangchan, had both of her ear drums perforated in an incident of domestic violence. Being poor without the funds for medical care, the ear drums were never attended to. Perforated ear drums are more susceptible to ear infections and Duang was no exception to this statistic. Over the years of ear infections and lack of proper medical car, she had lost an appreciable amount of hearing acuity as well as the remnants of the perforated ear drums.

In the past year, she has had five ear infections. She has gone to the number 1 Ear, Nose, and Throat doctor in Udonthani. I have written about at least two of our visits to his clinic in previous blogs. We had been talking about how at some point in the near future he would operate and repair Duang's ears. The last ear infection did it for her. She had been afraid to be operated on but finally agreed to go forward with the operation rather than suffer from so many infections as well as loss of hearing. Yesterday was the day of her scheduled operation.

The previous day we went to the specialist for the third time regarding the last infection. On our first visit I wrote how we paid 400 baht for the visit as well a six filled prescriptions. We did not have to pay for the subsequent last two visits. The last visit was to ensure that the infection had cleared up and that there was no impediment to proceeding with the procedures.

We arrived at one of the private hospitals in Udonthani at the scheduled 8:30 A. M. time. The doorman smiled at us and directed us to the Information Desk as he opened the door for us. The interior of this part of the hospital was very nice - much like that of a three or four star hotel in the big city. I had been to the Bangkok-Pattaya Hospital in Pattaya, another private hospital, a couple of times for dental work and had a similar experience although that hospital was more like a 5 Star hotel. That hospital actually had a wing donated by the Royal Saudi family so little expense was spared.

We entered the hospital and were greeted by several prim and properly attired female personnel. They were wearing blue uniforms and small hats that reminded me of Eastern Airline stewardesses from the 1960's. One of them escorted us to the information desk and had us sit down similar to registering at a hotel. Duang submitted a paper to them that the doctor had given her the day before. They looked it over and started discussing it in Thai. In a couple of minutes a very well dressed man came up to me and introduced himself in excellent English. He was the hospital's "Manager of International Services". He explained the process to me and escorted us through the various steps up to the point where Duang was in her room to start waiting for the surgery. This was very comforting as well as very reassuring since I had no idea what was going on. Although Duang speaks Lao as well as Thai, she does not have experiences with being admitted to hospitals let alone private hospitals.

From the Information/ Admissions Desk, I went to the counter next to it, and again it was more like checking into a hotel than a hospital. The young women working in this section were just as well coiffed, dressed and made up as the greeters but did not wear hats. I was given an estimate of the costs for the surgery as well as the room.

The previous day the doctor had told me that it would be around 55,000 to 60,000 baht ($1,618 to $1,765 U S dollars). This was a good deal. I found out from Duang that he had recently done a similar procedure for the wife of a foreigner and the price was 200,000 baht. Duang had told the doctor that I am retired and that we didn't have medical insurance - all true. He told her that he knew she was Lao (Lao Loum) so he would take care of her for 55,000 to 60,000. The room was not include in his estimate. He wanted to use this hospital because they had a new microscope surgery piece of equipment in their operating room.

Part of the checking in procedure was to select the type of room we wanted. I selected the "Duluxe" room for 2,700 baht a day ($79.41 a day) which included food, and nursing care. The "Duluxe" room had a couch in it where I could and I was encouraged to spend the night. The cheapest room was a shared "Twin" for ($34.41 a day). The most expensive room was "VIP 1" for $161.76 a day.

Our "Duluxe" room was fine. It had a small color TV set with international cable channels, a small refrigerator stocked with water and soft drinks, two wood chairs, and the couch. The room had a small screened balcony over looking a school across the street. It was comparable to standard Motel 6 room in the USA.

Unlike the public hospital, the corridors and grounds of the hospital were quiet and we saw very few people. Unlike the public hospitals patients were not exposed to the open air either on their way to or from surgery.

I did read some literature on the costs for some of the hospital's procedures. The one at the top struck out like a sore thumb - "Sex Change" - $1,865 - I assumed that it was for a man to become a "woman" and I doubt if it included the room. Breast augmentation I believe was around $1,200. Prices like that are driving the Medical Tourism Industry here in Thailand, Malaysia, and India.

Perhaps a more realistic solution for the 47,000,000 Americans without health insurance would be to buy those people round trip economy air fares (about $700) to Thailand and pay for their treatment in Thailand than the outrageously expensive plans being currently argued about. I know that when I was in the USA without a job, my COBRA extension of my previous health insurance was $1,500 a month to cover myself and my wife. At that rate - $8,400 a year per person - it would have been cheaper for me to fly to Thailand and stay in a hospital every time that I needed to see a doctor in a year! Hell some one could have had two sex changes a year in Thailand for just the cost of my insurance.

Having decided on our room, and with Duang signing once on one piece of paper, I was asked to place a down payment on the estimated cost of services. I had gone to the bank the day before and withdrawn 60,000 baht for the operation so I put down 55,000baht. I was given a receipt and we were then escorted up to the room.

A nurse came in and had Duang change for the second time into hospital garments. She had changed into a more traditional hospital gown downstairs for her admission examination but for waiting in the room she had a one size fits all pair of Chinese styled cotton pajamas. We were set to go by 10:00 A.M.

We knew the doctor had clinic hours until 1:00 P.M. so we anticipated surgery would be 2:00 P.M. We were told that it would last three hours and Duang would be in the Intensive Care Unit for two hours before returning to the room. So we were prepared to do a great deal of waiting.

Around 11:00 a couple of nurses came in to take blood and hook Duang up to an IV. It was very interesting - neither nurse wore gloves or face shields for either drawing blood or setting up the IV. Drawing blood was not to easy. Duang had been told and had not eaten or drank anything since 7:00 P. M. the night before. Her blood was rather sluggish but they got enough apparently. A very small speck fell on the bed's comforter - they either didn't notice or didn't care. I washed it up when they left. They had some trouble setting up the IV but the third time and the other arm was the charm.

We bided our time watching movies and talking to Duang's son and his girlfriend. Around 1:00 P.M. the Operating Room Head Nurse stopped by to speak to Duang and inform her what to expect. She seemed to be explaining things well and in detail though it was all in Thai so I am not certain. Duang seemed to be remaining calm and was happy so it went well. Duang was then assisted into another traditional type hospital gown for surgery.

At 2:30 an orderly came by. Three nurses assisted Duang to transfer to the transport gurney. We took the elevator down to the lower floor where the operating room and ICU was. I was allowed to go up to the yellow line on the corridor floor where Duang was transferred to an operating room gurney.

I returned to the room to watch TV, stare out off of the balcony and pace the floor. At around 5:00 P.M. the Manager of International Services stopped by to see how I was doing. I told him that Duang was scheduled to be out of surgery at 5:30. He took me to the nurse's station and had then use their walkie-talkie to check on her status. Word came back that she was still in surgery. He told me that when she was out of surgery, the nurses would let me know so that I could join her in the Intensive Care Unit for her two hours of monitoring before she went back to the room.

Around 6:10 the nurse came to tell us that Duang was in the ICU. We went to the ICU and had to remove our shoes and put on slippers before entering the area. Duang was in a small room, I believe she was the only patient in the ICU. Duang was lying on the gurney bundled up as if she were sleeping outside in Northern Alberta during a winter night. She had an oxygen mask on and her vital signs were being monitored on a small HP machine on a counter next to her gurney. Outside her room, two nurses manned the desk.

After awhile the nurse took the chair from the corner of the room and had me sit down. By then Duang's son and his girlfriend had seen enough and left to get dinner.

I was fascinated. First of all I had never visited any one in an ICU before. Secondly Duang was like a zombie. Her eyes were half open but no one was home - I know because I checked her reaction (none) to my fingers crossing and headed towards her eyes. This state last for an hour and one-half interrupted only twice - once when she managed to get one finger out from under all the covers to wipe moisture from the corner of one eye, and once when she appeared to be letting me know she was OK with her finger movements and facial expression. Both times did not last long and it appeared that she had not regained full consciousness. After 1-1/2 hours almost as if she heard an alarm clock, she woke up and was fully conscious. The nurses monitored her conscious state for half an hour and we then went back to the room.

I spent the night and helped her once. After a fitful night on what had to be the hardest couch in all Udonthani, I got up a 5:00 A. M. Duang's son picked me up at 6:00 and brought me back to the house to get cleaned up. Two hours later she called to tell me her son was on his way back. The doctor had seen her and was releasing her this morning. I got back to the hospital and there was some confusion about getting released. I took a couple of trips up and down the elevator and then took the step son's girlfriend to the nurses station with me - she would tell them, get their answer in Thai and then tell Duang in Thai so that Duang could tell me in English. I didn't get to see how well this was going to work because my old friend "Manager ..." was at the door. We told him the situation. He talked to the nurses and made a couple phone calls - everything was squared away. Once the IV was removed Duang had already changed into her clothes, didn't want to shower there, didn't want to eat breakfast there, she only wanted to be back home.

An orderly came with a wheelchair and brought us all down to the second floor where they cut off her ID bracelet, I paid the balance on the bill and she got 6 prescriptions to take home.

The orderly along with one of the nurses wheeled her out the front door and we went home.

Duang was fine and has been recovering all day. The total bill was 64,696 baht ($1,902 USD)

I don't think that we could have received any better care anywhere else in the world. I know for a fact that we could not have gotten any where near that amount of care (3 hours surgery, 2 hours ICU, one night hospital room )for that amount of money in the USA.

This experience has reinforced my belief that good and adequate private medical care is available and most importantly affordable for us here in Thailand


  1. Hi Allen,
    I enjoyed your story more than most, I'm sure. I live in Nong Khai and I have been to the hospital you are talking about, I think. The fella's name was khun John, was it not?

    It is close to the "old" Robinson's near the bus station, if it is the one I think it is.


  2. Hey Bruce:

    The doctor's name is Kuhn Sulaporn if I am understanding my wife and spelling correctly. Since you live in Nong Khai, I believe you understand.

    The hospital is Panyavejinter on Prajak Rd near the Railway Station and Night Market. I believe that it was once called Hospital Paulo or something like that.

    It was fine and I would not hestitate using them again.

  3. If it is the place I'm thinking of, Khun John is the Manager of International Services.

    Nice place. They are making a strong effort to attract more foreigners.

    Some Nong Khai foreigners went there a month or so ago and were also very pleased with their services.

    I think that is Khun John in the second picture in your post.

    Glad to see you posting from Udon.


  4. Hi LXA buddie,
    I truely enjoyed the trip to the hospital. Like most of your stories I felt like I was here. The only comment is if you would have "gone big" and spent the 161.76 your couch may have been more comfortable!

  5. Bruce:

    You are right - the Manager of International Services is Kuhn John. I thoughtthat you were writing about our doctor - sorry.

    No complaints about the place although getting to it when the night market is open could be difficult. I would most likely end up dragging some additional patients in with me.

    Yep, I am Udon - got no other place to go, don't want to be any other place!



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