Life and Beauty - This Week

Duang - One week later and with stitches removed

Yesterday we had to drive back down to Kohn Kaen for the stitches to be removed from Duang's face.  The two hour drives down and back were fairly uneventful other than the numerous motorbikes travelling the wrong way on one-way roadways; a common occurrence here in Thailand.  There were even two pickup trucks going the wrong way; not all that uncommon either.  Unlike the previous day when I almost killed a motorcyclist, there was no excitement while driving.

The previous day I had gone grocery shopping alone because Duang is still shy about appearing in public with her swollen face.  Here in Thailand we drive differently than in the USA or Canada.  We drive on the left hand side of the road.  The slow lane is the lane furthest to the left on the road.   The fast lane, the passing lane, is the furthest right hand lane of the highway.

I was in the slow lane of the two lanes of the road that go north.  A median separates these two lanes from the two south bound lanes.  The entrance to the Lotus-Tesco Shopping Center is on the left.  I put on my signal to indicate that I was going to make a left turn into the entrance and commenced to slow down to around 20 KPH (12 mph) for the turn.  I noticed a motorcycle headed towards me, going the wrong way in the gutter of my lane.  I slowed even further and determined that in making the turn I would not hit the on coming motorbike.  Just as I commenced my turn to the left. I heard a loud noise and saw a flash of color pass by on my left side in the gutter of the lane that I was in.  A motorbike flew by me on the inside of my turn.  It appeared to be going around 70 KPH (40MPH).  The motorbike driver swerved to miss me, over corrected , swerved once again and missed the oncoming motorbike.  It all happened extremely quickly but played out in slow motion in my perceptions.  I remember thinking that the motorbike driver was going to fall off the bike and kill himself if not kill the oncoming riders.  Through luck, Divine intervention, or perhaps skill, the motorbike avoided any accident and continued down the road at 70 KPH.  It was a very close call.  Unfortunately this was not the first time that I have been passed by a motorbike on the inside of a turn or been passed on the wrong side by a motorbike.

I was amazed at my reaction.  Of course I was shocked - shocked at this happening so quickly and unexpectedly as well as how stupid the motorbike operator was to have provoked the incident.  A scene from one of my all time favorite movies came to my mind, "Lawrence of Arabia".  One of his followers, a man that Lawrence had risked his life to save earlier, kills a member of another tribe. The death must be avenged and the murder punished but that would trigger the need to avenge his death if he were killed by a member of the aggrieved tribe. To avoid a tribal feud and the disintegration of his fighting force, Lawrence kills a man.  Later, obviously upset by the incident, he reports back to his commanders.  They are extremely sympathetic and try to allay his emotions with statements about how difficult war can be, and how sometimes you must do bad things in order to achieve good.  Lawrence then shocks them by informing them that they did not understand and that he was upset because he enjoyed killing the man.  No, I did not enjoy almost killing that young man but what surprised and shocked me was that I did not care that I almost killed him.

They say that life is cheaper here in Asia.  My experience is that such a perception is true.  I once commented to another foreigner that you could hire someone to kill another person for around 5,000 baht ($150).  My Thai friend added that sometimes it is done for free out of friendship.

If a Thai were to kill another Thai in an accident, he or she would be expected to compensate the deceased person's family between $3,000 to $6,000 USD.  Blood money of $3,000 to $6,000 for a vast majority of Thais, most specifically people in Isaan, is a great financial burden.  However, for me, the issue or rather surprise is that the value of a human life has been quantified, monetized, and accepted before the fact.  In the US the value is undetermined and subject to litigation on a case by case basis.  For me it seems peculiar that the value of a life is subject to the skills and effectiveness of a lawyer and sympathies of a jury.  To discuss and attempt to seek a universal value for a life before a death is a taboo for many people.

In the Muslim countries where I have lived, there was a similar attitude towards life in that whatever happened was deemed to be "God's will".  This attitude seemed to, for many people, absolve or excuse people from acting responsibly or acting prudently in terms of personal safety.

I do not make any moral judgements in this regard.  I write to inform readers how things are elsewhere.  I write to point out how things are different from place to place.

I write of this incident not to share a personal story with my readers but to share experiences and observations of life in other countries and societies.  Because I or Duang have experienced or observed things personally, I am able to write about them and to share them.  It is not about me, or us, the story is about life.

Now, back to Duang's face lift.  We went to the hospital to have the stitches removed.  Just like in America we had to wait for the doctor.  Duang's appointment was for 12:00 Noon but the doctor was not available for her until 1:30 PM.  No problem, waiting here in Isaan is very entertaining and informative.  We waited in an area that contained small offices, small rooms for medical procedures, as well as an open triage area.

It was a busy day with all the seats inside the area filled as well as some seats outside of the area filled with patients and their supporters.  It seemed that each patient had a story to tell or if they could not their support people were all too willing to tell the story.  There was a young man who was going to have a hernia repaired.  His blood pressure was 154/90 so I expect he was suffering some anxiety over his upcoming surgery.  There was a middle aged woman who was having follow up work done on her fingers and thumb.  She had sewed them together in an accident. Apparently they had become infected and the surgeon had amputated some of them.  According to Duang, the bone was good but the meat was bad.  It did seem like some of them were shorter too.  There was a middle aged woman having a procedure done on her nose - implanting a silicone shape to give her nose a more Western appearance.  There was another middle aged woman who was going to have a hernia repaired.

In addition to learning why each patient was there, we also found out how much their surgeries were costing.  The young man's umbilical hernia repair was 50,000 Baht ($1,666 USD).  In contrast my similar operation in California about 6 years ago was $15,000 USD.  The woman's hernia operation was 55,000 Baht.

After a while a tall, slender, extremely attractive person in a very nice skirt and blouse walked into the office and sat next to Duang.  TIT, This Is Thailand, I knew what she was and why she was there.  I am not sure if it was a sixth sense, her protruding Adam's apple, or her low voice that lead me to believe that she was a "Kathoey' (Lady boy).  In no time at all Duang had learned that yes she was a lady boy and she was going to have breast implants done that afternoon for 65,000 Baht ($2,166).  The presence of the lady boy and the two others that arrived later was all just a matter of fact situation.  Everyone knew and no one minded.  Thailand is recognized as a tolerant culture.  The saying of "UP2U" is popular for good reason.

Turn around is fair play even in Thailand.  While Duang was getting all the personal information from the other patients, she was telling them about her face work and showing the work to them.  She then had to explain to them why she was not going to have her nose and breasts worked on.  I understand enough know to have an idea what is being said so I explained that I did not want those changed and liked everything the way that they were - much to their amusement.  I have grown accustomed to the openness of Lao Loum culture and lack of privacy - accustomed but not accepting as of yet.  Of course I smile and chuckle every time that I compare Thai procedures with American procedures.  I remember getting pages of documents outlining the eye doctor's "Privacy Policy". the Pharmacy's "Privacy Policy", the hospital's "Privacy Policy" knowing full well that there is none, and that if I want treatment I have to accept their policy.  In reality the only privacy policy that I am interested in is how are they going to ensure that I do not show my butt or anything else to other people while in the hospital.  However, I imagine that if I were sick enough I wouldn't care.

Eventually we got moved to an area outside of the procedure rooms and in the midst of the triage area.  There was and elderly woman who had fallen down the stairs laying on a gurney.  We got to observe the doctor examining her and deciding to send her to x-ray.  A younger woman was under sedation on a gurney closer to us - she was the wife of a policeman who had gone swimming three days earlier in Pattaya.  She was now experiencing "heart trouble" and tingling in her arms.

Duang was called into the room and had me accompany her.  Once again the room and equipment were not what I been accustomed to seeing in a US hospital or even a doctor's office.  The equipment was dated and the room appeared that it could be cleaner.  The doctor examined Duang and asked her about her condition.  Everything is going very well.  He answered my concern and question.  He told me that Duang will most likely stop looking in the mirror all the time in about six weeks.  We all had a good laugh.  He then had her lay on the procedure table and removed her stitches using a sterile scalpel blade which he used without a handle and sterile tweezers.  I was able to get up and watch the procedure up close.  The stitches were a very fine blue material - it looked like they were 1/5 diameter of a human hair.  I was impressed at the ease in which he could locate them and remove them. There was no topical analgesic used - only sterile saline solution and Duang never flinched.  We will have to return in three weeks for a followup examination.

After the stitches were removed, we exited the area through the area where we were originally seated.  The lady boy had two sample silicone breast implants in her hands.  She spoke to Duang and we went over to check them out.  One was larger than the other.  He handed them to me and I got to check them out.  I told him in Thai that one was "Big-Thai" and one was "Small-Thai" but to be "Small- Foreigner" he needed two of the "Big-Thai" implants.  Everyone had a good laugh.

The cost of removing the stitches was not included in the original bill.  After paying $13, we returned home.

This experience at the hospital as well as Duang's face procedure to date once again reinforced my perception that medical care needs to be only fit for purpose.  The facilities and their condition were not what I am accustomed to or expected in the USA.  However they were effective and met our needs.

Duang's face is coming along very well and even now it is obvious that the procedure was done very well.

The Price of Beauty - At Least In Thailand

We have been back in Thailand for two weeks now; two very busy weeks.  Our time has taken up with household repairs and cleaning.  Last night we did not get home until 1:00 AM.  No - we were not in a fight or auto accident.  Duang had some work done on her face last night.

I have written a few blogs on medical care and its associated costs here in Thailand.  This blog is about the costs and procedure for Duang's blepharoplasty and rhytidoplasty - face lift and eye lifts..

Duang is approaching her 49th birthday and has been wanting to have some work done on her face for a while.  I did not think that she needed any work and I don't see anything wrong with looking your age.  However during the course of photographing Duang over 4,000 times, I was aware of certain areas around her eyes  and mouth where I  consistently made 'adjustments" when post processing her photograph.  These were also the areas that Duang wanted to be worked on. While is the United States she became interested in the television ad campaign that has saturated the airways for over a year.  I called to get more information as the ad informed.  I ended up speaking with what appeared to me to be a boiler room type operation.  The operator on the other end of the line wanted my telephone number.  Well I can be a difficult type of person especially when it comes to spending my money.  My adage when it comes to money is "I will call you.  You don't call me"  I refused to give the number and requested the additional information packet as promised on television.  About two weeks later I received a packet with basically a regurgitation of the television ad and print ads.  It was generalized as well as very lacking in specific details as to procedures, methods or costs.  The information basically pointed out that you needed to schedule an appointment with a represented doctor in the Boston or New York City area.  All in all it reminded me of the sales campaigns of the 1980s for time shares.  That was more than enough to dissuade me from pursuing the matter any further.  I told Duang to wait until we got back to Thailand and reminded her of the many foreigners who go to Thailand for plastic surgery as well as other medical procedures.

Well it turned out the Duang's brother's ("Number 4") girlfriend had a friend who had just had "face make" in Khon Kaen, 2 hours south of here.  I point out how we got the information because that is how things work around here.  As far as I know there is no telephone book or yellow page directory for Udonthani.  There is no local newspaper for the area.  We have cable television so  we do not watch local television.  As such we are not subjected to daily and nightly barrages of lawyers seeking us as clients or helpful information such as advertising by local businesses or services.  Information is passed from person to person.  Fortunately Duang has a large family as well as many friends so there is always someone or someone who knows someone that can help with needed information.

Anyhow this woman had her eyes done 5 days ago.  The doctor was the number 1 plastic surgeon in Khon Kaen and worked at two hospitals.  He had been practicing for about 15 years.  His pricing seemed very good.  However after my experience with "Doctor Feelgood" ( an earlier blog about a the man who knew how to give injections out in the rice paddies and was injecting everyone with Valium), I wanted to check this doctor out before any commitment was made. Interestingly, I have yet to be informed of any doctor or business that was considered to be #2 or even #3.  I know that they have to exist but I have no idea who they are. Arrangements were made for Duang to visit with the doctor for last night.  As most things are here in Isaan, this was not a simple task.  It ended up that Number 4's girlfriend would drive us down to the doctor along with her friend who was having the stitches removed from around her eyes.

We ended up being 5 women and myself in Thailand's equivalent of a Toyota Corolla.  Four women were in the back, one woman sitting on another woman's lap.  Duang's former sister-in-law came along to see about having additional work done on her nose - Michael Jackson Syndrome?  many woman in Isaan have silicone inserts placed in their noses to make their appearance to be more "Western"  In may cases this does not work out well.  Another female friend came along I guess to provide morale support - that is how things are done here in Isaan.  If you are going somewhere there are always plenty of people ready and available to tag along.  I survived the two hour drive with 5 Lao Loum women all speaking at the same time just about all the time.  Actually I rather enjoy the sense of family and community these situations provide.

We ended up seeing the doctor and he informed Duang's former sister-in-law that no further work could be done or should be attempted on her nose.  I am still trying to figure out what was wrong with it to begin with other than it was not a nose belonging on a Lao Loum face.  Score one for the doctor.  I liked that he was not going to slice and dice as long as you had the cash.  We had a consultation with him and my concerns were addressed and my reservations were diminished.  Some work that Dung wanted he indicated was not necessary.  The next thing that I know that happened was that Duang and I agreed to have the work done.  I was shocked when his assistant came with two pieces of paper of which Duang was required to sign once.  After signing, he said "Let's go to the operating room"  Duang entered the operating room at 8:00 PM for a scheduled 2 hour operation.  The nurse came out at 10:00 PM and informed me that it would be another hour or longer.  Duang came out at 11:00 PM, 3 hours after the surgery commenced.

We had to pay for the entire operation that night - 35,460 Baht ($1,182 USD!) including take home medications.  The hospital took my credit card to pay for the operation.  We walked out of the hospital at 11:30PM.  We will return on Monday to have the stitches removed.

When we were in the USA, I estimated that a face lift along with eye lifts would run around $20,000.  Today, prior to writing this blog, I researched estimated prices for the work in the USA and came up with about $15,000.

I walked out of the hospital with three pieces of paper.  One was an invoice for the surgeon - 20,000 baht.  Another was an invoice for 5,000 baht for something.  The third was an itemized bill for 10,476 baht from the hospital.

For the three hour operation, we were charged $81.66 for the operating room, $2.50 for the nurses, and $172.80 for medical supplies.

It is hard to believe that two upper eye lid lifts, two lower eye lid lifts and a face lift cost $1,182.  However this is in line with what we previously paid to have Duang's eardrums repaired.  I guess this is why medical tourism is a growing trend here in Thailand.  Almost $14,000 in savings over having the procedure done in the USA more than covers the round trip flight and hotel stay.

To be honest with you readers who are in the USA, the facilities and conditions of the facilities did not measure up to what we are accustomed to and for the most part expect in the USA.  However you get what you pay for or not pay for.  As was often a determination in making decisions in my construction career, solutions need to be fit for purpose.  I suspect, no I actually know, from my parents medical experiences over the past year and one-half in the USA, that Americans, be it out of their pockets, their insurance premiums, or taxes are paying for a great deal more than is necessary or required for their medical care needs.  A great deal of American medicine today as it is practiced today is "Voodoo" medicine.  The witch doctor, chants and incantations have been replaced by high tech equipment, ostentatious facilities, as well as cost insensitive procedures.  To quote a former boss of mine "The juice is not worth the squeeze"  It may not be worth the squeeze but you are all paying for it.

I am not certain that we would not accept it any other way.

Bigger is better.  Newer is better.  More expensive is better.

They just all cost more.

"Doctor" Feel Good

Yesterday there was a festival in Kumphawapi. The highlight of the festival was long boat racing on the river or more like - flooded land that runs on the edge of the downtown center.

The long boats were around 50 to 60 feet long and very narrow. From bow to stern they were packed with paddlers. The banks along the water were covered with spectators watching and cheering on their favorite team. The main road's bridge over the water was lined with spectators and flags.

In the park where the monkeys hang out, there were all kinds of booths with games such as burst the balloons with darts, food, and drink. We also saw two small elephants being paraded around the grounds.

So why am I not posting pictures of this event? I don't have any. I could not walk. I have an injured foot that severely limits my mobility.

Three days ago I was demonstrating to Duang my Lao Loum dancing moves to one of my favorite songs. The moves involved stomping with alternating feet. I did this in bare feet on the concrete and tile floor of our living room. The next morning my left foot felt as if it had a cracked bone or stepped on by an elephant.

After two days I decided to listen to Duang and have the foot checked out. She knew of a "doctor who has Santa Claus inside him who take care of people good". The translation is "There is a doctor who has the spirit of God in him which allows him to take care of people well" Her cousin was going to see him yesterday so I could go too and be taken care of. Since Duang was putting both of her good feet down and insisting that I see a doctor and would not allow me to go photograph in Kumphawapi until I had the foot looked after, I agreed. Besides this sounded interesting - "a doctor with Santa Claus inside..." I am open minded and besides this had a sense of adventure to it. Despite my open mind and sense of adventure, as my late grandmother used to say "I am not crazy ... yet".

Prior to going to see the miracle worker of the paddies, I had duang, her son and his girl friend take me to the emergency room of the private international hospital here in Udonthani. I saw a doctor and had my foot x-rayed. I do not have a cracked bone or a broken bone but I do have a sprained or bruised foot as I had suspected. Years ago I had the same injury when I cut firewood for my children in Yellowstone National Park using Rambo karate kicks. Knowing that nothing can be done other than rest the foot, elevate foot, ice the foot, take Motrin, and wear an elastic bandage on the foot, I was reassured that consulting the "doctor with Santa Claus" would cause no harm. The total bill for the emergency room visit - $23.53 U. S. dollars.

We went to Tahsang Village to pick up Duang's cousin to see the doctor. Well in the end 10 of us ended up in the pick up truck. We had to go through Kumphawapi to get to the doctor so I was able to glimpse the festival.

We drove way out into the middle of the rice farming region. Six times we had to stop to ask or to confirm directions to the place we were going to. Surprisingly, everyone knew about this guy and was able to guide us on our way. After about an hour we arrived at a typical Isaan village and found the doctor's place.

Several people were there ahead of us. I hobbled inside of his house and sat down on a wood couch in his living room which was also his clinic. Three woven reed mats, sahts, lay on the floor. Each saht had a patient laying on it. On the floor next to me were several, as in 50 or more, medical syringes. Along with the syringes were just as many hypodermic needles - factory fresh in their sealed packaging. This was a relief to see that he was exercising good practices for injections. A stethoscope lay on the floor that the doctor used to listen to each patient's heart through both their chest, and neck. Next to the unused syringes were many bundles of injectable medicines scattered about the floor. There was a cardboard box that contained different sized vials of injectable medicines. A small plastic bag was used to contain the disposed of empty vials. A Glass jar was just about filled with discarded needles.

Duang's cousin although a young woman, is partially paralyzed on her left side - I suspect fro polio or a mild stroke. I know that she also suffers from epilepsy. I asked Duang why her cousin was seeing the doctor and Duang explained to me that her cousin had been getting dizzy and passing out lately.

Her cousin laid down on the saht and the doctor checked her heart with the stethoscope and felt her ankles with his hands just as he did with every other patient. He spoke about 30 seconds with her and told her that she had a bad heart. He then gave her two injections. Since I could not move well, I had Duang bring me one of the empty vials that had been used on her cousin. The vial was "Diazepam" more commonly known as "Valium". That did it for me - there was no way this doctor was going to be doing anything for me! There was no way he was going to be doing anything for Duang! Prior to entering his house he told me that he could "take care of me one time only - 100%". I did not see a medical diploma or license on the walls. The lack of medicines other than injectables seemed suspicious to me. The fact that everyone ended up with 2 or three injections made me extremely suspicious. Knowing that he injected someone with a "bad heart" with Valium scared me. I declined as best as I could without him losing face and I was adamant to Duang that she would not be examined.

Of the 10 people in our group that went to the doctor - 6 received injections and paid their $2.94 USD. I was appalled. When we got back home I explained to Duang why I didn't let the doctor treat me and would not let him treat her. I told her that the doctor did not cure anyone but only made them "feel" better. The trip back to Tahsang Village was quiet, just about all the patients had gone to sleep.

As I was writing this blog, I discussed yesterday's events once again with Duang. I told her that I did not think that the man was a real doctor and that I knew more about medicine than him. She said "No he not doctor, he man that wants to help people. He go to school to be a doctor but not finish after two years. he learn some things in school to help people (no doubt giving injections). Santa Claus (God) told the man to help people and complained that the man had not been a Monk yet." The man went to the local authorities and told them that he had two years of school and wanted to help people so they apparently allow him to "practice medicine" She told me that the man was going to be helping people for five years and then he was going to become a Monk. She said the people felt better that he had helped them. I explained the difference between being cured and feeling better.

Doctor Feel Good makes his patients feel better but I doubt that many are cured by his efforts.

Absolutely scary - another reason why we need to know as much as we can about everything in order to make informed decisions.