Friday, August 16, 2013

Isaan Hospital Care

Duang Bathes Her Father In the Hospital
Duang's father was hospitalized on Wednesday and remains there.  He has been in failing health for a while and I hardly recognized him on Monday when I was out at the village for Mothers Day.  He has lost considerable weight and his face now sports sunken cheeks.

On Wednesday he went to see the doctor at the Kumphawapi Hospital.  Duang knew that the hospital would be busy so she ensured that they would arrive relatively early at the hospital.  Apparently the family entourage did not arrive early enough because they were #125 in the queue.  After consultation, x-rays, and other tests, Duang's father was admitted to the hospital.

According to Duang, "Inside of my father no good".  Upon questioning her further to better understand what could be her father's problem, I learned that she has seen an x-ray of his lungs and she said that there were "big white spots that are bigger than before".  Duang's father is also short of breadth which sounds like lung cancer to me.  Why doesn't Duang know the diagnosis and prognosis of her father's health?  This is Thailand.  In general, doctor's communications, especially with the local people, are similar to that in the USA in the 1950s. Similar in that the doctor does not feel obligated to explain and ensure that patient and their family fully understand the situation. One of Duang's fears regarding her personal health issues is that the doctors would not tell her everything or even worse ... lie to her regarding her diagnosis as well as prognosis.

I have written several times about the strong social fabric of Lao Loum culture here in Isaan - the latest being early this week related to Mothers Day.  Another circumstance where strong family bonds and obligations come into practice is when a family member is sick.  Duang is the youngest daughter so she has the burden of ensuring proper care.  Her sister and brothers also help out and other family members also help out.  However it is up to Duang to ensure that her father is physically care for and lacking any help, she has to provide the care.

Physically care for a patient?  In Thai hospitals, not the international hospitals that have many foreigners as patients. but district and small town facilities that service the local population, nurses only provide medical care.  Bathing, cleaning, feeding, and assisting with bodily functions is the responsibility of the patient's family and friends. Hospital wards that I have visited in Isaan are very crowded - besides the closeness of the beds, it seems that just about every patient has two to four visitors attending to them or just socializing.  Outside of the ward, more family members and friends are located in the hallways and balconies awaiting their turn.

A Family from Bangkok Camped Out On the Ward's Balcony
During my visit at the hospital today, I left the ward to sit out on the balcony to provide more space in the ward.  There was a family camped out on the balcony - camped out literally and figuratively.  Through Duang I learned that the family has been living on the balcony for four days.  They took the bus from Bangkok to be with their father/grandfather who is in the same ward as my father-in-law.  The two children do not sleep at the hospital.  They sleep at another family member's home in Kumphawapi but the adults sleep outside on the balcony to ensure that care is available to the patient and to ensure that the patient does not die alone.

In the pediatric wards, the child patient typically has a mother or father sleeping with them in the hospital bed and often a grandmother sleeping on a saht (woven reed mat) underneath the hospital bed.

Typical Kumphawapi Hospital Adult Ward
Besides the beds in the ward, there were also beds in the outside corridors of the hospital.  Kumphawapi Hospital recently under went a major expansion.  Duang's father is in the old part of the hospital.  Some of the rooms and facilities of the old part of the hospital are being renovated or modified.  This undoubtedly is adding to the congestion at the facility.

Most of the patients were wearing adult diapers.  Stainless steel bedpans were also available for patients who could not use the common bathroom facilities.  I checked out the common bathroom facility and I was impressed with its cleanliness.  I was relieved to see that there were western sit down toilets - I could not imagine being hospitalized and having to use a squat toilet.  The bathroom also had shower cubicles.  Emptying and cleaning bedpans is a responsibility of the patient's family and friends.  The cleaning station was outside of the bathroom area on the balcony where I was sitting.  Duang used the utility sink to wash and rinse the cloths that she used to clean her father.

When I reentered the ward, I met the father/grandfather of the Bangkok family.  He had a distended abdomen that I suspect was due to cancer.  He was on oxygen and told Duang that he was on oxygen because he could not breathe and that he would soon be dead.  This attitude towards one's fate was not unique to this patient.  Duang's father has been saying good bye to family and friends for about two weeks now.  This morning, he told his sister that when he died he wanted her to contact an old friend of his so that the person could sing at his funeral.

Doctor Making His Morning Rounds

Duang was remaining at the hospital for the day, her older brother and sister would stay at night.  Before I returned to our truck to drive back home, Duang and I visited the maternity section of the hospital.  We enjoy visiting the new borns and it is good therapy after dealing with the stress of hospital visits. The maternity ward remains in its original location.  Unlike all previous visits to the ward, the door was closed.  We checked with the adjacent nurses station and were told that visitors were being restricted to protect the new borns from an outbreak of sickness.  The nurses did say that we could visit upstairs where sick babies were located.

We climbed the stairs to visit the ward where our grandson has spent some times for treatment.  There were two babies both five months old were being cared for by their families.  The babies were hooked up to IV bottles.  I stopped and spoke to and consoled each of the babies in Thai.  I am not sure if it was a sense of peace or fear, but both babies seemed to relax and be calmer from my attention.  When it was time to leave, one of the parents asked Duang for me to take care of their child before I left.  Duang asked me and I knew exactly what she meant.  Here in Isaan, Monks will puff air three times (Buddha, the Teachings of Buddha, and the Buddhist religious community) on people's injuries or pains to heal them.  I have also seen an Animist Shaman do the same to our grandson, Peelawat.  I often do the same for Duang's as well as Peelawat's hurts and pains. Tonight I asked Duang why the people asked me to take care of their baby.  She said that the family said that I loved babies and that they wanted me to take care so that the child would get better and be able to leave the hospital tomorrow.  I asked her how they knew that I understood what it meant and could do it.  She had no answer.  Perhaps the only answer is "This is Thailand" .  Many things happen here that can not be explained but can only be accepted for the way they are.

Kumphawapi Hospital, New Addition In Background


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