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

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.

It Takes A Village to Heal A Child - At Least In Isaan

It has been a few days since my last blog. The lack of blogs has not been due to a lack of subjects but because we have been very busy. Much of our time has been spent at the hospital in Kumphawapi. Our grandson, Peelawat, has been hospitalized for three days.

Peelawat has been been living in Tahsang Village with his mother at his Great-Grandmother's home. In Tahsang Village, he spends a great deal of his time playing with his two and one half year old cousin, Kwan, and three year old neighbor, Tay. Like all other 16 month old children in Isaan, Peelawat's play involves walking around bare foot, playing in the dirt, running after chickens and puppies. All the toddlers carry evidence of their play on their ankles, legs and arms. Nicks, scrapes, and scabs bear testament to the fun that they have been having on these hot and humid days in Isaan.

Monday morning, we received a phone call from Duang's daughter saying that Peelawat was sick. He had a fever and had experienced a couple seizures. Previously when he had fevers, Peelawat had experienced seizures. At first this was extremely concerning to us but after researching I determined that these seizures are somewhat common in young children. Later I found out that Duang as well as her two children had the same experience with fevers when they were young. This made me somewhat more relaxed but I still had concerns about epilepsy or some other serious condition. Duang's daughter had a cousin take them to a clinic in Khumphawapi to see a doctor. Peelawat had a seizure at the clinic. He received treatment and returned to Tahsang Village.

Later that evening we received another, more stressful, call from Duang's daughter saying that Peelawat was running a fever, had additional seizures, and was being hospitalized. Peelawat and his parents had been taken to the hospital in Kumphawapi by one of the uncles in Tahsang Village who had a pickup truck. Most people in Isaan have motorbikes but out in the villages few people have trucks and even fewer have cars. People with vehicles are often called upon to help out in emergencies. With the emergency notification, Duang, her son, and I headed off to Kumphawapi.

We arrived at the hospital and found Peelawat in the Emergency Room. He seemed so small and defenseless laying on the gurney swathed in a blanket with an oxygen mask on. He was very feverish and in that quasi conscious state that a high fever induces. After a while, he was transported to the Pediatric Building of the hospital. Since the NICU is located on the second floor and there is no elevator, I had to carry him up the two flights of stairs to the NICU.

Although the sign above the entrance to the ward said "NICU" (Natal Intensive Care Unit), the room was more of a children's ward than what we expect to find as a Intensive Care Unit in the USA. The room was very similar to other hospital wards here in Isaan. It was a large room divided in two sections by a five foot high block wall. Each section contained 16 beds. A couple of ceiling fans provided ventilation for each of the sections. At the end of the room there was a large area that had several shower stalls and toilet stalls. Just to the left of the entrance to the bathroom area, there were a couple of large steel cabinets with hospital linens. There was a fairly large Nurse's Office, which was air conditioned, at the middle and front of the ward. Approximately 4 nurses were in and out of the office.

Here in Isaan, the Nurses handle taking vital signs, and giving medicine. They do not provide care for the patients such as bathing, dressing, changing bedding, feeding, or assisting in the personal hygiene of the patients. The family and friends of the patient provide patient care. Since there are such large families and such a strong sense of community here, the hospital wards are always filled with people. In addition there are many people congregated outside of the wards - eating, resting, and socializing while they await their turn to give care and comfort to the sick. While this may be reassuring during times of normal sickness, I fear the consequences of this behavior if the fears of a SARS, H1N51, or some other horrible epidemic become reality. Containment will not be possible.

The ward was filled with patients from two weeks old to about 12 years old. Each patient had two to four people attending to them. Surprisingly, many of the adults caring for the little patients were men. Lao Loum men are very involved in the raising of their children. Uncles are also involved in helping to care for their nephews and nieces. Peelawat had his grandfather, grandmother, mother, father, uncle, a couple of great aunts, a great uncle, and two cousins - a couple more attendants than typical that night. The ward was filled with the sounds of babies crying out of fear and from pain.

The young patients were placed in full sized hospital beds. The beds had been modified for young patients by the addition of smooth nylon string in a lattice pattern to reduce the spaces on the pop up rails on the side of the bed. Very young patients sleep with their mother in the hospital bed. Older patients mothers or fathers sleep under the hospital bed or on the balcony outside of the ward - if they get to sleep at all.

Duang and her daughter kept busy wiping Peelawat down with tepid water to break his fever. I occupied myself trying to comfort him. Peelawat was confused about the situation. One thing that he was sure of as well as adamant about - he wanted out of the hospital. He remembered the way into the ward and he was constantly pointing toward the entrance indicating that he wanted OUT and expected me to take him out.

Sadly just about every time that Peelawat calmed down a little bit and started to get some much needed sleep, a Nurse came by to check his temperature, collect blood, or give him a shot. After awhile, the Nurses decided to connect Peelawat to an IV. Just about every other patient on the ward was hooked up to an IV. One of the younger Nurses tried to put a needle into his foot. She tried and tried to no avail. Peelawat very quickly understood what was going to happen when the piece of surgical tubing was wrapped around his arm or leg. After about 5 minutes of stabbing and jabbing Peelawat to connect an IV, I said "Enough. No More, she doesn't know what she is doing. Get someone else to try". Thankfully, whether they understood me or not, another Nurse took over. Three nurses moved Peelawat's bed over to be in better light to assist in finding a vein. In the end it took a third nurse to finally connect the IV.

A Doctor was not available to examine Peelawat or any of the other patients until the next morning. I tried to determine what medicine Peelawat was getting - fighting against the language barrier as well as the cultural barrier. Medicine in Isaan is similar to the type of medicine practiced in the USA 50 years ago and longer ago in the USA - The Doctor is always right, the Doctor has no obligation to explain treatments, the patient is just to take the medicine given to them, and the Doctor is infallible. After some time I learned that Peelawat had been given an antibiotic. This seemed reasonable to me and reassuring. I was also satisfied that blood as well as urine samples had been collected. After four hours we left the hospital and returned home.

The next morning, we were back at the hospital at 8:00 A.M. I noticed that Peelawat's ankle was swollen, very hot, as well as surrounded by a black band. It was obvious that there were several red ant, weaver ant, bite marks on that leg - not an unusual sight on village children in Isaan. I pointed this out to Duang and she told me that some people in Tahsang Village had the same thing only higher on their body and they had died. This was not comforting news. Duang informed me that some of the old people in the village know what to do. She added that they make medicine and blow it onto the affected area. I asked what kind of medicine and she disturbed me once again - "same same Momma chew" Betel nut? I asked her to make sure that the Doctor took a good look at that area. I was suspicious that Peelwat had what is often commonly referred to, in accurately, as "Blood Poisoning". The actual condition is "Bacteremia", bacterial infection of the blood. The Doctor had not arrived at the ward by Noon when I left. The Doctor had been delayed because of so many adult patients in the other building. Duang called the Village to arrange for one of the older villagers to be brought to the hospital to treat Peelawat. When Duang returned home she informed me that the Doctor had not seen Peelawat but he had authorized more antibiotics for Peelawat. She also told me that a man from the village had visited and given Peelawat the first of his three "treatments"

Duang returned to the hospital the next morning to help her daughter to care for Peelawat. Her daughter and son-in-law had spent two mostly sleepless nights at the hospital. The good news was that Peelawat was feeling better. He had been chasing the same stray cat out the ward that I had chased the night before. The hospital has several stray cats that have run of most of the facilities. The cats eat the uneaten food off of the metal trays that are placed at the end of the corridor awaiting pick up at some time. I suspect that the cat's diet is also supplemented by rodents since I have not seen any around.


At 5:30 P.M. I returned to the hospital with Duang's son and his girl friend. As we pulled into the parking lot we saw a very good sight - Peelawat and Duang were sitting outside waiting for us. Peelawat had a shunt installed in his hand but other than that he looked excellent. His fever was gone and he had his energy back. He enjoyed having his photograph taken and had to see each picture on the camera's monitor after it was taken. He eagerly displayed his "Big Smile" more like a soundless lion's roar when asked.


We went back upstairs to the ward and let Peelawat play on the outside balcony. Peelawat still was pointing to the exit and now that he was mobile, he often took off for the stairway to leave the facilities. Peelawat amused himself by playing with the various shoes placed outside the doorway to the ward. Peelawat kept himself busy by trying on the various shoes. He wore mens as well as women's shoes irregardless of their size. He was very adapt at ensuring that he selected matching shoes. Later he started to play with a bed table that was stored on the balcony. He amused himself turning the crank on the table and pulling as well as pushing the table along the corridor. After awhile he indicated to me that he wanted to get on top of the table. Being a somewhat indulgent grandfather and somewhat bored, I placed him on the table. Peelawat lay on his stomach and had such a big smile as I pushed him down the corridor that I decided to share his pleasure with Duang. I wheeled him into the ward and quickly discovered that the nurses were not amused. Duang scolded me and Peelawat and I went back outside. We limited ourselves to the simple pleasure of sitting in a chair and kicking our feet back and forth while learning the English words for parts of our face.



After awhile, Duang's son returned from Tahsang Village with one of the village elders to give Peelawat his second treatment. The man had a small plastic bag with a green leaf, slices of Betel Nut, and some wood chips. He placed the items into a small brass mortar and ground them together with a small brass pestle. He sat next to Peelawat on a concrete bench on the outside balcony. Peelawat was not afraid at all and sat patiently next to the man. The man, a spiritual leader, chewed the ground up concoction and soon had a mouth full of red liquid. He examined Peelawat's infected leg, said some chants, and sprayed the red liquid on the infected portion of his leg three times. Peelawat observed the ritual with interest. The man also placed his hand on Peelawat's head and said some chants before blow air three times on the top of the head. Peelawat then pointed to a scab on his other leg to the shaman and said "Nee" (here). Somehow Peelawat inherently understood what the shaman was doing and he was pointing out to him another one of his injuries for special treatment. We all had a good laugh. Having been informed by Duang that Peelawat had received more intravenous antibotics at 6:00 P.M. and that the Doctor had scraped the skin on his leg while putting some medicine on it, I was not opposed to the traditional treatment.

After the man completed treating Peelawat, Peelawat thanked him by giving him a wai, the Thai gesture of respect which is similar to the Western prayer gesture. We left the hospital at 9:00 P.M. much relieved that Peelwat is well on his way to recovery. Peelawat will be released today from the hospital once the doctor has checked him.

Once again the differences between health care in Isaan and health care in the USA had been made very apparent. Here in Isaan health care is much more of a community effort. Family members as well as friends or neighbors are heavily involved in caring for the sick. The play on the old African proverb ("It takes a village to raise a child") - "It takes a village to cure a child" is not too far from the truth - at least here in Isaan.

Exposure to National Healthcare - Thailand

Last night there was a family emergency. Duang's youngest brother was stricken with severe abdominal pain. We got the call around 5:30 PM from his girlfriend that he was in the hospital.

Thailand has a Universal National Healthcare program. The program was instituted in 2001by Shinawatra Thaksin, the Thai Prime Minister who was deposed in a 2006 military coup. He remains very popular in the rural poor districts of Thailand largely due to this program as well as other programs aimed at the poor people.

Under the Thai program, poor people can sign up to get a special ID card that they can use to obtain medical services in their health district. Typical office visits cost the member 30 baht - approximately $0.90 U S Dollars. Procedures and hospitalization costs the member 30% of the invoice with the program paying the remaining 70%.

Initially Duang was informed that her brother needed an operation and that she as a family member needed to sign a release for the operation to commence. Since we were not familiar or comfortable with driving in the city to the hospital, we called Duang's son to drive us to the hospital.

We arrived at Wattana Hospital, which is a private hospital in the center of Udonthani. Duang's brother was in a small diagnostic room in the Emergency Area of the hospital. He was on an IV and was receiving oxygen. He was in considerable pain. After awhile the situation clarified somewhat. He was stricken at his home and a neighbor brought him to the nearest hospital which happened to be the private facility. He had received emergency treatment to stabilize him and to diagnose his condition including an ultrasound scan. The cost for these services were 2,060 Baht or approximately $60.58 - very cheap by USA standards but very costly to a Lao Loum performer. His girlfriend did not have enough money to pay the bill. She borrowed 2,000 baht from me to pay the bill so that we could move on to the next step. The cost of the required operation was out of the question so he needed to go to the big public hospital in Udonthani - across the pond from the private facility.

This sounds reasonable, and easily manageable. But this involved Universal Healthcare Program and like just about any government run program in any country, things are not as they seem or should be. As I wrote above, Duang's brother had an ID which allows him to obtain medical services in his health district. A person's health district corresponds to where they are listed in "Tambien Baan" - "Blue House Book". The Blue Book for Thai residents and the Yellow Book for foreigners lists the house or apartment address and lists the names of all occupants. Since Duang's brother is listed in the Blue Book for Duang's parent's house in Tahsang Village, his health district is Kumphawapi.

Kumphawapi is approximately 60 kilometers (37 miles) from the center of Udonthani with Tahsang Village about another 12 kilometers (7.5 miles) further out. This geography lesson is important especially in regards to this family emergency. Duang's brother had moved to the center of Udonthani and had not changed either his parent's house blue book or the blue book for where he was now living. Because his medical district was Kumphawapi, he was obligated to first seek treatment at the public Kumphawapi Hospital. If after evaluation at the Kumphawapi he or any other Universal Healthcare participant from that health district is deemed to need services of a larger or more sophisticated facility, they are transported typically to Udonthani or more rarely Koen Kaen (about 90 KM, 56 miles to the south).

This seemed a little incongruous to me and I asked Duang several times about this to ensure that I understood the situation as well as requirement. I fabricated a scenario where Duang would have a accident at her parent's house and had a broken leg and arm. She said that she would have to go to the Udonthani Hospital for treatment rather than the closest hospital in Kumphawapi. I assume that in a true emergency, the patient would be treated and the paperwork sorted out later.

Thankfully we pay for our own health care using private facilities. Duang has an ID card for Universal Healthcare as a backup. Private health care is still affordable for expats in Thailand. Two weeks ago Duang went to the Doctor with a stiff neck and back - the cost for the visit, two injections and two prescriptions - $3.00 U S dollars. Some expats have had their children delivered by C-Section for $850 U S Dollars.

Last night we left Duang's brother at the private hospital around 6:30 P. M. after Duang took his health care ID with her. As we left we could hear his groans and cries of agony. We headed to Tahsang Village to obtain the Blue House Book. From Duang's parent's house we were to stop at the hospital in Kumphawapi to get a medical release or transfer document that would allow her brother to be admitted into the public hospital in Udonthani. We stopped at a small shop to get some photocopies of the necessary documents made prior to stopping at the hospital.

We arrived at Kumphawapi Hospital and went to the admission desk. Since it was past normal working hours, there was only a single administrator. Duang explained to her the situation. The clerk in typical bureaucratic fashion wanted to know why he was at a hospital in Udonthani rather than coming in to their hospital for treatment. Duang told her that he had been working in Udonthani when he got sick. The clerk said that she could not make those types of decisions regarding transfer of patients to other facilities and told Duang to come back in the morning. Duang gave her a good piece of her mind and ended up with an apology but no patient transfer paper. We headed back to Udonthani.

Through a couple of phone calls we determined that Duang's brother was now at the big public hospital in Udonthani - apparently people realized how serious his condition was and overcame the bureaucratic quagmire. The hospital is the one that we had visited several times before (11 Jan 2009 Blog "Busted Up In Isaan").

Two hours after leaving Duang's brother, we were finally back with documents and copies for his girlfriend to sort out his paperwork the next morning. We found her brother in a ward on the sixth floor of one of the many buildings of the hospital complex.

Since it was getting on in the evening, approximately 8:30 P. M., people were busy settling in for the night. People are the relatives and friends of the patients. They range in age from 2 years old to 70 years or older. Since many of them arrived from outlying villages, they spend the night at the hospital. The hospital complex is made up of several buildings interconnected with covered walkways and ramps which provide many areas that are protected from rain. The hospital has installed concrete benches and tables in many of these semi-protected areas for visitors to bed down and eat their meals.

As we walked through the hospital complex we came upon many hand washing stations. The hospital had several signs and posters encouraging people to frequently wash their hands. The stations had running cold water, soap dispenser, paper towels, and a garbage can. People were making good use of the facilities and most of them had run out of paper towels. Many of the visitors at the hospital were wearing surgical masks. The Thai government has a very extensive education and awareness program regarding Swine Flu. It is apparent that this program is having an effect on people's efforts to prevent the spread of infection. Throughout Udonthani you see people wearing masks and washing their hands in public locations.

We took the elevator up to the sixth floor and as the door opened we encountered six patient beds set up in the elevator lobby on the sixth floor. All six beds had patients hooked up to IVs. Scattered amongst the beds were woven reed mats, sahts, on the floor. Relatives were sitting on the sahts eating and socializing.

Duang's brother was located in the second ward on the floor. To reach his ward we had to walk through an open ward of 64 male patients - all the beds were filled with patients in various conditions.

Each ward is made up of three bays with 21 beds in each bay. There is no air conditioning in the wards. Cooling is provided by ceiling mounted fans with some small ventilation fans in the windows providing some air circulation. There is a balcony running along the exterior of the ward where patients, and visitors can sit on concrete benches. There is no door on the entrance to the balcony so some air circulation is provided. There is a room one one side of the ward where the nurses are stationed. I saw 5 nurses for the 64 patients in the ward. There was one orderly also available in the ward. The ward was filled with visitors to the patients - all standing around the beds since there were no chairs for visitors.

Many of the visitors were providing care to the patients. Some people were changing the patient's clothing while others were washing the patients with wet cloths. I did not see any hospital staff performing these tasks. Some of the visitors had brought pillows from home for the patients to use.

Duang's brother was in a great deal of distress. Eventually a very young man came by dressed in typical street clothing for a young college man - it turned out that he was a doctor. I asked him what was wrong with Duang's brother and he said that he believed it to be a perforated ulcer and that they would be operating on him in a couple of hours. Apparently Duang's brother was #6 in line for the operating rooms.

Around 9:00 P.M., a nurse started her rounds but seemed more occupied in announcing that everyone had to leave now because visiting hours were over. She complained to Duang's brother that he was making too much noise - which was not surprising since he was only on a saline IV without any pain medication. His chart did not indicate that he gotten any pain killers. We left hoping and wishing all the best for him.

We returned the next day to check on her brother. It was amazing- he looked so much better. He had his operation the previous night to repair what was indeed a perforated ulcer and was on some pain medication. He had a relatively small neat bandage on his abdomen. He was able to communicate well with everyone. I was amazed.

Like people the night before, his visitors took care of him. His girlfriend washed his body with a damp cloth and after completing his "bath", his mother, brother, girl friend, and sister changed his bed clothes. I noticed that his urine collection bag strapped to the side of the bed was full and close to overflowing. I meant for Duang or some one to let a nurse know so that it could be emptied. I didn't see any hospital personnel readily available but it didn't matter. Duang and her oldest brother promptly took care of the problem. Medical care here in Isaan is definitely personal and up close.

This experience with National Healthcare although initially frustrating and the standard definitely not what I am accustomed to appears to have turned out well. I guess that it is kind of like airplane landings - a good one is any landing that you can walk away from.

Baby Business - More Days At The Hospital

A recent blog entry concerned itself with Udonthani General Hospital. Today's blog will be about Kumphawapi Hospital and will provide more insight into Thai life or more specifically - Isaan life.

Duang's daughter is 8+ months pregnant and is due to deliver in three weeks.

On Saturday she came into Udonthani to have an Ultra-Sound scan. Isaan is different than locations that I have lived in the USA. There are many private places throughout the city where you can go in and have a Ultra-Sound - unless it is a Saturday or Sunday!

Manchester United Football (Soccer) Team has a slogan "You will never walk alone". Their team paraphernalia is very popular over here including apparel with the team slogan. That slogan only needs to be slightly modified to describe life here in Isaan - "You will never be alone". Beside all of Duang's relatives (92 cousins), there is a very strong sense of community in Isaan. These two factors create an atmosphere that is unlike any I have experienced elsewhere.

Duang's daughter, her husband, Duang, Duang's son, his girlfriend, and I all piled into the pickup truck and headed into the city center in search of an Ultra-Sound Clinic. There seems to be an Ultra-Sound Clinic every 5 blocks in the city center. Unfortunately the clinics are not open on the weekend. The clinics have signs written in Thai - a sort of Sanskrit script rather than Roman script that English is written in. Often the signs will be written in green and at times will have a green cross to indicate medical related. As we drove around and around the city in our quest, I developed or thought that I had come to an understanding of what the writing for a clinic looked like. As we went along one street, I looked to the side and saw a clinic. I motioned Duang's son to pull up to the place. As we approached, we realized that the clinic was open, had ultra-sound scanning, but was a veterinary clinic. We all had a good laugh - well everyone except for Duang's daughter. Late term pregnant women don't have the greatest senses of humor. My honest mistake was not mitigated any by Duang's son's continual hysterical laughing. I did point out that ultra sound scanning a dog was the same as scanning a woman and most likely much cheaper. This only encouraged Duang's son to laugh more once she had translated to everyone. The quip did not amuse her daughter.

After wandering around the city for about an hour, we went to one of the private hospitals in Udonthani. We went to the scanning room and everyone was allowed in. The ultra-sound was much better resolution than the ones that I remeber for my sons thirty years ago. We could see ribs and internal organs in addition to counting the number of fingers as well as toes. Oh yeah - the baby is a boy. The cost of the Ultra-Sound scan with report for the doctor was $35 USD.

On Monday morning we got a call that Duang's daughter was in the hospital with pain. I drove Duang to the Kumphawapi Hospital about 25 miles from our home. One of my earlier blogs in August was about the Maternity Ward of this hospital. The parking lot was filled so I dropped Duang off at the front of the hospital and drove off to find a parking spot elsewhere. Duang told me to meet her where we had gone before.

After parking the truck, I went into the neo-natal ward where we had visited before. I entered the ward and walked around looking at every patient to see if she was Duang's daughter. No one seemed to mind me wandering around although it was obvious that most were curious about a falang walking around. After assuring myself that she was not there I walked outside and headed towards the main administration/reception building. On the way, Duang's son-in-law saw me and brought me to the new area where she was.

Duang's daughter was in the labor ward along with three other pregnant women. The ward is very spartan - a sort of first aid type facility for a large industrial plant. The room had concrete walls covered with a sort of plastic paneling riveted on to it. There was a completely exposed nurse's station consisting of two desks, two chairs and one computer set in the ward by the entrance.

There were 10 beds in the labor ward. The beds were rather spartan as well - metal frames with a plywood base with a 3 inch thick foam mattress on top. There were two air conditioning units in the ward that cooled and heated the room. Since it is now cold (63F) at night the units warmed the room. The room also had a single fetal monitoring machine which was being used for one of the other patients.

At one end of the labor room was the birthing suite(?). The birthing suite was a large room that to me resembled a cross between the autopsy rooms shown on TV and a barber shop. The room had three chairs with stirrups in a row - side by side. The room was drab without any semblence of decoration or sense of high technology. I was a little concerned that there were four women in the labor room and only three birthing stations.

Duang's daughter was not in labor and after about two hours she was released with some antacid and some pills.

We returned home and about two hours later received a call that Duang's daughter was back at the hospital. We went back to the hospital with Duang's son and son's girlfriend.

Since it was now night time, people were setting up for the night. Just like Udonthani General Hospital, patient's families camp out at the hospital. Duang's son-in-law and his mother had claimed one of the concrete benches along the outside open aired corridors to spend the night. They had brought some sahts, blankets, and plastic bags with clothes and food for the night. Other people were setting up their spots throughout the complex. This hospital was different from Udonthani General in that there were hospital cats wandering the area.

There were three other women in the labor room. One was hooked up to a fetal monitor machine. Another patient was in advanced labor and was tended by her mother and husband. She was in pain but kept her suffering in silence.

The third patient was in labor and was tended only by her mother. She was in very much pain but like the second patient was fairly quiet.

After awhile, the woman with the fetal monitor was discharged - so now there were three women for three birthing stations. I was more at ease.

We stayed there and gave support to Duang's daughter. She was going to spend the night in the hospital but was not in labor yet. In no time at all we knew the conditions of the other patients and they knew about Duang's daughter. I am continually amazed at the openness and resulting lack of privacy of Isaan society. The people love to talk, chat, and gossip and there are few topics not up for discussion.

We returned to the hospital this morning. Duang's daughter was still in pain but not in labor. She will spend two more days in the hospital.

The biggest news was that the two other women had their babies. We went over to the neo-natal unit to check them out. One woman had a little girl. Since she was a cesarean birth, the baby was not birth molded at all although she was in an incubator. The mother was in a bed about fifteen feet from the incubator which was in the aisle way from the ward entrance across form the nurse's station. The proud grandmother and father were also visiting so Duang got into an involved conversation about the birth.

The other baby was more serious - he was born with a heart defect and had already been transferred some 40 miles south to a specialty hospital. We found all this out from the Grandmother. After awhile the new mother walked out carrying two bags of clothing with her husband. Isaan women are definitely tough. They were going down to see their son at the new hospital.

It is eye opening to see the medical facilities that are available to so many people in the world.

It is also a revelation to see how little care is available to people.

Here in Isaan there is no air of mysticism or invulnerability associated with medicine or medical care. Healing, birthing, and dying are not hidden behind doors in pastel walled, brilliantly lit rooms in the company of strangers.

Injured patients and post operative patients are wheeled along outside aisle ways filled with children, toddlers, and adults of all ages. Doctors, nurses, and cleaning personnel are indistinguishable in their uniforms. Each one has a job to do. Each job being just as important as the other.

Some of this may be attributable to the Buddhist attitude towards life and death ... "The Buddhist spends their entire life preparing for the moment that they know will come - the moment of their death."

In the Wast, many of us spend all our life trying to avoid or deny the moment that will come for all of us. Our faith in our percieved medical capabilities and facilities helps support our efforts.

7 Juanuary 2009, Busted Up In Isaan

Busted Up In Isaan
7 January 2009

This is my second attempt to write this blog. On Sunday, I spent a couple of hours composing the blog only to lose all my work on MySpace by hitting an incorrect key - Grrrrr!

I will now try resurrecting it from memory and first write it in Word so that all I have to do is paste it into MySpace.

We had to go into Udonthani Sunday morning for a family emergency. Duang had gotten a phone call that one of her relatives had been in an accident and was now hospitalized. I have written before about the number of her relatives. Here in Isaan it seems that just about everyone is an aunt, uncle, cousin or “cousin of my cousin”.

In Isaan, one’s family extends beyond what we typically define as immediate family in the USA. For me family was made up of aunts, uncles, nephews, nieces, and their children. I am not even familiar with the term for the “cousin of my cousin”. But this is Thailand and things are different.

In preparing to rewrite this blog after a day of sulking or perhaps mourning over my lost original work, I sat down with Duang to get a better understanding of just how many relatives that she has. I restricted my questioning to just aunts, uncles and cousins. I was shocked but developed a better appreciation for how so many people seem to be family for her. Duang has 7 uncles, 9 aunts, and 92 cousins. Now I understand – a little bit.

Duang has difficulty with possessive pronouns – your, my, his, her, our, and their. This leads to some interesting but interesting conversations. Sunday was one of them. She informed me, if I remember correctly, that “cousin of you uncle of my sister” have accident last night.

She assured me that I knew the victim and that he had “taken care of me the other day at party”. “Take care” of someone means to say hello to them. Since half of the village was at the party, I am certain that the victim had spoken to me but I had no idea who he was. I decide to just wait and find out once we were at the hospital.

Her relative, “cousin of you uncle of my sister”, was at Udonthani General Hospital. Udonthani General Hospital is similar to a county hospital in the United States. The farmers of Isaan go to that hospital because they do not have good medical insurance. When their condition can not be adequately handled at the more local facilities such as the Kumphawapi Hospital (Maternity Ward Blog) or the outlying clinic that I had previously described where Duang and her aunts had enjoyed a medicinal sauna, the patient is transferred to a facility in Udonthani.

Udonthani has five hospitals – one Army, three private, and one public. Udonthani General hospital is the public hospital.

Udonthani General Hospital is located across from the park in central Udonthani. The hospital is located on one of the main 4 lane divided streets in the city. The far side of the street is bordered by the park, a sidewalk, and a lane of pull up parking. The sidewalk is mostly taken up with sidewalk vendors and sidewalk restaurants as well pedestrians weaving their way through the gauntlet. The one row of pull up parking is no where adequate for area so people park in a single row perpendicular to the parked pull up spaces. This only uses about one-half lane of the street so there are one and one half lanes of vehicle street traffic. The Thais have a system for parking that seems to work rather well. People park behind other parked cars leaving their locked vehicle in neutral. If your vehicle is blocked, you just go up to the offending vehicle and push it out of your way – no problem, no emotion, no anger – it’s just the way it is here. Can you imagine this happening in the USA – blocking half lane of street traffic, blocking another car, and putting your hands on someone else’s vehicle? I think not – not in our lifetimes!

Duang’s son parked the truck in the single remaining pull up parking space a short distance up from the hospital. As we left I started to think about how difficult it would be to remove a blocking vehicle behind the truck if the offending vehicle was one of 4 or more parked bumper to bumper. When we eventually returned to the space, we were blocked. Maybe we were just lucky but there was room beyond the offending vehicle so we only had to push one car out of our way. Perhaps there is an unwritten code to park so that someone only has to push two cars to free up their vehicle. I’ll keep an eye out to understand what the system is – if there is one.

The other side of the divided street is similarly congested. The sidewalk is cluttered with street vendors, sidewalk restaurants, and pedestrians. There is no car parking on this side of the street but one half lane is occupied by parked somlaws (three wheeled passenger carrying motorcycles). The numerous somlaw drivers are scattered about hustling potential customers, eating, drinking, smoking, gossiping, or napping. Neighborhood and street dogs wander in and about the masses of people making their way to and from the hospital. It is quite a congested sight.

Udonthani General Hospital is a large complex of three story concrete structures reminiscent of 1960’s era urban school architecture in the United States. It is apparent that there was little advance planning in developing the hospital site. Buildings were shoe horned into the restricted sight as their need was identified. Each building is connected to others through a maze of open sided covered walkways. The combination of walkways and cantilevered balconies of each building creates many sheltered areas at ground level. Some of the sheltered areas have been turned into gardens with plants and benches along the edges. The other sheltered areas have been paved over with concrete.

The paved sheltered areas were occupied by many people. The people of Isaan who use Udonthani General Hospital are typically poor people from the outlying farming regions. There is no Ronald McDonald House for relatives of patients to stay at while their loved one is being treated. Transportation to and from the hospital is difficult and not convenient - pickup truck – up to 10 people per vehicle. No problem. The people of Isaan spend much of their time outdoors. So it is at the hospital. In the sheltered area families set up their sahts (woven reed mats) and camp out for the duration of their loved one’s stay. Atop the sahts, they place their woven baskets of sticky rice, plastic bags of other Lao food, plastic bottles of water, plastic bags of clothing, and plastic bags stuffed with blankets.

Typically the grandparents sort of hold down the fort at the sahts while watching over the grandchildren who are running all about trying to amuse themselves all the while annoying others and being nuisances. The children are so cute and precocious that they are easily tolerated.

There were not any elevators in the hospital. Access to the upper levels is by stairs or ramps. Since the ramps were congested with patients being transferred in wheelchairs or gurneys, we used the stairs.

Duang’s relative was in a typical 24 bed open ward. We were not the first ones to arrive at his bedside. With our arrival, he had 12 family members hovering around his bed. I had expected to see an older man before me and was surprised to see a 12 year old boy in the bed. He was hit by a pickup truck with no headlights on while driving his motorcycle across the road to visit his uncle. Twelve years old! Driving a motorcycle on a public road! No problem – this is Thailand. There were no arrests, no charges and the pickup driver will make restitution after the boy is discharged from the hospital.

We were not the only people in the hospital ward. The ward was about 1/3 filled with patients. Patients ranged in age from about 6 years old to 70 years old. Some were on machines to assist their breathing. Privacy was at a premium. Although there were curtains that could be drawn to isolate a bed, no one was using them. Each patient had about 8 family members tending to them. Family members perform many tasks that nurses do in the USA. Family members wipe brows, feed patients, and assist them with going to the bathroom.

Visitors brought their own food and drink for their consumption while visiting. Children of all ages visited along with their older relatives. It was all very free and open as well as somewhat chaotic. Once again the sense of family and community was very prevalent.

Thai people have a fascination with pain and suffering that at times I find rather disconcerting. On television news broadcasts it is common to see up close and intimate filming of accident or victims of crime. I have seen broadcasts where the film crew followed the victim into the ambulance focusing on the victim’s anguished face or injuries. At ambulance facilities they have display boards with photographs of the victims that they have assisted or those that they just ended up picking up off of the road. The photographs are very vivid and leave little to the imagination. They are also very popular. I always feel like an intruder when confronted with these types of displays. In fact, upon leaving the hospital, Duang, her son and his girlfriend made a point of looking at each and every photograph on the “Don’t Drink and Drive” display in the hospital lobby.

Duang’s family is no exception to morbid curiosity. When we arrived, a point was made to show us each and every injury that the boy had endured. The blood stain on the hospital bed was pointed out and hospital gown was adjusted as needed for full viewing as well as for the convenience of the onlookers. The boy had an injured knee and would be operated upon in about two hours. His other injuries amounted to scrapes, and some cuts that required stitches.

After our visit we went off for awhile and returned later to give some family members a ride back to Tahsang Village. If you have a vehicle in Isaan, you are often called upon or expected to provide transportation for family members. When we were walking towards the boy’s ward we were called up by Duang’s sister to the second floor of a different building. This building was apparently the surgery building. The second floor had a door that indicated that it was an Operating Room. The exterior of the Operating Room resembled the exterior of a 60’s era high school classroom – metal, and glass curtain wall within concrete structure. Access to it was by way of open air covered ramps. Abandoned gurneys and wheel chairs cluttered the walkways outside of the room. In a corner a large bin was overflowing with used hospital linen. The boy’s family was congregating on the second floor outdoor hallway outside of the operating room. There was no nurse’s station or any other sign of life around the room. The windows to the room were heavily tinted so I had no idea what was on the other side. After surgery the patients are wheeled outside to their ward.

We gathered up the clan and I drove them back to Tahsang Village – about 40 miles. The boy did fine and will be released from the hospital tomorrow.