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.

Buying A Truck In Thailand

Earlier I had written about the experience of purchasing a home in Thailand. In that blog I had pointed out that the actual process of buying the house took less time than the time required to change the responsible person on the water bill.

Two days ago we embarked upon the adventure of purchasing a new pick up truck. When I first moved to Isaan, a year ago, we started looking at buying a truck. We did not buy one because of other priorities. During the past year, I researched and learned about buying vehicles in Thailand.

Buying vehicles in Thailand is a great deal simpler than in the USA. First of all, the price is the price. There is no great deal of negotiation. Every dealer charges the same price for a vehicle in a given area. Apparently prices are relatively cheaper in Bangkok, around $800 less on a $24,000 vehicle. However Bangkok is 6 hours drive away or 8-1/2 hour bus trip away. Two round trips would be required with at least one overnight stay.

The other simplification to purchasing vehicles is the lack of choices. In Thailand, unlike the USA, there is not many accessories, trim options, customization items or upgrades available for the consumer to consider. The choice of colors is also very restricted.

We had decided upon a double cab pickup truck and after researching selected Toyota.

Having decided upon a Toyota double cab pickup truck, we were faced with 11 models. Choosing 2 wheel drive rather than 4 wheel drive vehicles, reduced the selection down to 8models. Since we only wanted manual transmission, our choices were pared down to two models with the difference between them being the size of the diesel engine (no option for gasoline engine - only diesel). One model has a 2.5L engine and the other has a 3.0L engine. The difference in price is about $1200 for the larger engine in addition to Anti-lock Braking System so we went with the larger engine model.

We were now faced with deciding on a color - 5 choices were available. We went with the Silver Metalic - just like most people in Isaan who choose the same model.

There was no choices available for the vehicle sound system - you get the standard system.

There was no choice for interior colors, textures, or fabrics - you get the standard.

There was no choice for seating options - you get the standard.

We had decided to go with the Toyota dealership closest to our house - about one mile away. Besides the advantage of it's location, one of Duang's 93 cousins is a salesman there. I had written that the price is the price but there are some things that dealerships do to sweeten the deal for customers if required to close the deal.

A month ago we visited the dealership and met with her cousin. We found out that there was a new version of the model that we wanted coming out soon and they did not have any details on it. I told them that when they had the new brochure and knew the price, to call me or rather call Duang.

The information was finally available earlier this week. Duang's cousin drove over to the house to go over everything with us. I knew that we would have to order the vehicle and would not have it for two weeks. He came by to place the order. Since he is a relative we got the "Freebies" - bed liner, floor mats, one year of class 1 insurance, window wind deflectors, and vehicle registration without having to negotiate, bluster or beg for them. Window tinting was also available but I did not want it - even for free. The roads of Isaan are not illuminated very well. Many times at night I roll down the window of Duang's son's truck to better see when turning at night.

He filled out a form, reviewed my passport to ensure that I had the proper Visa, and inspected my "Yellow Book" (House Registration for a Foreigner Occupant. I gave him 10,000 baht (about $340)as a down payment. Just before the truck is ready he will call us and give us the information so that I can arrange for my bank to electronically transfer the remaining funds to the dealership. The entire process was completed in fifteen minutes.

Our truck will cost $23,740 USD which isn't too bad compared to a comparable vehicle in the USA. However the price of sedans in Thailand is much greater than comparable models in the USA. An entry level Toyota Camry in Thailand costs $37,323 with the top model running $52,323 USD. It is no wonder that Thailand ranks number 2 behind the United states in the number of registered pickup trucks.

Giving Back - Thanks For The Votes

Yesterday was a very busy day for us.

Peelawat, our 6 month old grandson dropped by with his parents to return the pickup truck that they had borrowed for three days. We loaded their motorbike into the back and we all headed back to Tahsang Village - to drop them off back home as well as to offload the bike.

They had borrowed the truck to take care of family business and to bring Peelawat to the doctor for his 6 month check-up. The poor little guy had had a rough day. He received his second haircut and apparently did not like the noise or feel of the clippers. At his checkup, he got another shot. He was already running a slight fever by the time they got to our house. Despite his problems, he was still in a good mood without any crying. He was just a little subdued for him and he went to sleep in the truck as I held him during the trip out to the village.

We had gotten a call from Duang's cousin earlier in the morning. She wanted to let us know that there was going to be a Mahlam Lao show in a nearby village that afternoon. I have written about these shows before and how they mark various celebrations throughout Isaan. Well yesterday I learned of another reason to have a show - politics!

After settling Peelawat into his home and having something to eat, Duang, her cousin, another village woman and I headed out to see the show. The justification as well as the responsibility for the celebration was the election of a new Village Headman. He was recently elected and was giving back to the community by arranging as well as sponsoring the show. Village Headman are important men or women in Thailand. When we went to get my "Yellow Book" (House Occupant Book for a Foreigner), we had to take our Village Headman, actually a woman, to the Provincial Offices to have her testify and sign that I am actually living in the house. In Tahsang Village when one of the local young women ran off and abandoned her baby to live with a crazy man in a distant village, it was the Village Headman that called the other village to arrange for her return. He also accompanied the relatives to the other village to retrieve her.

We arrived after the celebration had started - perhaps not too long but long enough for just about everyone to be well on their way to being drunk. The show was a typical village Mahlam Lao event. There were a couple canopies set up to protect people from the sun. Underneath the canopies plastic chairs and tables were set up for people to eat and drink. Additional tables and chairs were set up underneath the elevated houses that surrounded the area where the show was going on.

The people were all very friendly. The show was going on full tilt. We were welcomed by some old friends of Duangs from the village. We were immediately introduced to the Village Headman as well as the local Police official. They insisted that we join them for eating and drinking.

We had previously eaten so we got away with not eating anything. However my desire to not drink anything was countered with the argument that I had to wish everyone good luck and happiness which could only be properly done with alcohol. I relinquished and had a couple glasses of beer with ice. Here in Isaan, people drink beer out of glasses with ice cubes.

Duang's friend dragged her out on to the dance area and kept trying to get her to dance. One of the village woman dragged me out to dance and I was a more willing dance partner. Everyone was enjoying themselves.

I took several photographs. The young men were congregating in front of the stage doing their thing like they do at all of these occasions. The performers were keeping everyone entertained.

As time went by, Duang's friend became more and more persistent. Her friend then kept trying to speak to me however due to her condition and the loudness of the show, I had no idea what she was saying or even trying to say. In a short while an altercation broke out on the perimeter of the crowd between some young men. This happens at just about every one of this celebrations usually in front of the stage. The heavy drinking, testosterone levels, hot sun, and the Lao Loum sensitivity to not losing face all combine into combat. Since everyone is related and there is a strong village identity, fights between two men frequently escalate into potential bigger scenes. After a couple of blows, or due to their inebriated state the first wild swings, the sides form up. By this time, the mothers head into the area along with their sisters to yell at their son as well as the other participant. Sometimes uncles head into the fray but in their efforts to break up any pending violence often lead to them squaring off amongst themselves. By this time the show has stopped with the singer pleading with everyone to behave themselves. The Police move in followed by the Village Headman. The Police are often ignored but some how their presence distracts everyone so tensions subside. The Village Headman makes some statements and peace is restored if only temporarily. Usually there will be one or two more flare ups before the show is shut down. As they say "A good time was had by all"

Years ago when I attended the company family picnic, we would always stay until a fight broke out. Once the fight broke out I knew that we had seen all there was to see so we could go home. Nothing has changed. We took our cue and left - safe and definitely not sorry.

When we got home to Udonthani, Duang's cousin (one out of 93) came over and we bought a new Toyota pick up truck - but that is the subject of tomorrow's blog.

Mother's Day - Thailand

Yesterday, Wednesday 12 August, was the Queen's birthday. It was also Mother's day in Thailand. Mother's Day has coincided with the Queen's Birthday since the early 1950s.

Since it was the Queen's Birthday, the Royal flags along the streets and roads had been changed to blue with the Queen's logo. Each day of the week has a color associated with it. Duang and I were both born on Thursday so our color is orange. The Queen was born on Friday so her color is blue. Since the King was born on a Monday, his color is yellow. Many Thais dress according to this color scheme. On Mondays especially you will see many people wearing yellow shirts in honor of the King. There were many large pictures of the Queen prominently displayed alongside the roads, public buildings and businesses. At the Mall there was a large display dedicated to her along with a book where you could write birthday greetings to her. I was a little confused for awhile. She was born in 1930, but many of the formal portraits were of a young woman - I thought that they were of her daughter. It turns out that the photos were actually of the Queen when she was younger.

I guess that it is similar to some of the obituaries that I see in US newspapers. There will be a picture of a handsome young man or beautiful woman in their mid-thirties. When you read the obituary, you determine that they were 85 years old at the time of their death! I don't know if the disparity is due to a lack of a more recent photography or is how people wanted others to remember the departed.

For Mother's day, children are expected to visit their mother as well as favorite older Aunts and pay their respects to them. The day before, Duang and I had gone to the Mall to pay a bill. There was a craft fair being held in the parking lot across from the Mall. We ended up buying two blouses for Duang's mother and a blouse for one of her Aunts. The blouses were $3.00 each.

We drove out to Tahsang Village to pay our respects to Duang's mother. As we have been doing lately, I drove from our home to just past Kumphawapi while Duang drove the remainder of the way to the village. She recently got her driver's license and developing more confidence in driving. Confidence was definitely needed yesterday. The roads were very busy with people travelling to visit their mothers. There was more crazy driving then is normal - perhaps due to "celebrating".

We arrived at the village and waited for Duang's older sister to arrive before presenting the gifts. I occupied my time playing with Peelawat - our 6 month old grandson. When Duang's sister arrived, both daughters put their gifts on a plate. They supplicated themselves (krab) on the floor at their Mother's feet and offered their plates to her. They said something along the lines of "I love you. I am very happy that you are a good Mother. You took care of me for a long time. I wish that you live a very long time." Their Mother put her hand on the plate while it was being offered and said things along the line of "Good Luck for you. I wish you a long life. You take care of Mother and Father. When Mother and father die, you take care of sister, brother, grandson. You love your husband. Buddha will take care of you." She then accepted the gifts. After taking care of her mother, Duang repeated the ritual with her Aunt who is blind.

I was suffering from a sore foot that Duang had massaged and put "Tiger Balm" on prior to leaving the house. Duang's aunt was known to be an expert in massage therapy so I was encouraged to see what she could do for me. She was very old and appeared to be frail however her fingers were like rods of steel! She commenced to massage my sore foot. My flinches and gasps were all quite entertaining to Peelawat as I held him. He smiled and laughed every time I gasped in pain and flinched my body. I told her that I thought she worked as an interrogator for the police and that I was ready to confess. If I had not been holding Peelawat, the flinching would have been much greater. The old woman worked me over for a very long time. She seemed to know exactly where it hurt the most. After a very long time she was finally done. I wiped the moisture from my eyes and refocused on playing with Peelawat. Today the foot is better but that may only be due to the endorphines brought on by her strong fingers.

Duang's old aunt disappeared. Soon I heard Duang's father yelling and moaning from outside. He lays on a raised platform outside the house under the shade of the roof overhang, smoking, and listening to the radio. Today he was getting a massage. I felt much better listening to his agony and made sure that everyone knew that he was making much more noise as well as fuss as I had.

Duang's brothers came and paid their respects to their mother. As is traditional they gave her garlands of jasmine and some cash.

As Duang did her family thing and got caught up on the village gossip, I played with Peelawat. Today he crawled for the first time. Things are going to change quickly now. In the first 5 minutes of being able to crawl, he had gotten into trouble three times.

Peelawat is also working very hard at "talking". He and I ended up having a 10 minute conversation. Every sound that he made, I repeated or at least tried to repeat. He enjoyed it and smiled a great deal.



Later that night, Duang's son came to our home with his girl friend and another girl. They brought two pretty garlands and a bag of eggs. They had Duang sit on the couch and then had me sit next to her. They gave Duang the jasmine garland and gave me the garland that had two orchids. I protested and said that I was not a mother but they insisted that I was to be included in the ritual. They bowed to our feet and wished us luck, happiness and a long life. Duang had me give them our blessing and best wishes.

It was a very nice way to end a special day here in Isaan.

The Wonder Of It All

Nine days ago Peelawat became 6 months old. He is doing very well.

He has been living in Tahsang Village for about two months now. He spends most of his hours inside the family's small market in the village. If he is not awake, he is sleeping in his homemade hammock at the back of the market. When he is awake he is either being held by someone or motoring around in his walker.

Peelawat's life is typical for a baby in an Isaan village. His world is filled with many care givers. Relatives and neighbors ensure that there is always someone holding, playing, or talking to him whenever he is awake. Although babies and children in Isaan do not have many toys they are exposed to a great deal of mental stimulation through interaction with adults and other children. Grandmothers and aunts in Isaan ensure that there is always a pair of arms and a smiling face to care for the little ones. People talk to and joke with babies a great deal. In addition village children of all ages manage to stop by to talk to and entertain babies several times a day.

The children play and amuse themselves with whatever is available. For Peelawat a cardboard box, a plastic bag, bags of snacks, a blanket, a plastic bottle of talcum powder, my foot inside a sock, and a small Winnie The Poo stuffed doll are enough to keep in busy while awake. Sometimes he is satisfied to just scratch and grab my face or pull the hair on my arms. For Kwan, who is 1-1/2 years old, her days are spent playing in the sand with a broken bowl and a plastic plate. When she is bored with filling and emptying things with sand she walks around to Duang's mother's house to check up on Peelawat. Older children in the village play with balls and bicycles. There is not much television watching available for the children.

Peelawat has learned to motor around in his walker and keeps himself occupied playing with the bags of snacks displayed in a metal rack in the market portion of the room. He is constantly exploring his world by either scratching things or bringing items up to his mouth for analysis. I did not think that it was a good idea for Peelawat to be playing with merchandise or chewing on a metal rack so I grabbed his walker with one hand and attempted to pull him away by turning my wrist. No luck. Peelawat hung on with all his might and silently resisted my effort to move him away. It was quite comical. After awhile of playing tug of war I used both my hands to pry his fingers from the rack and relocated him to another part of the room.

Yesterday, he started to crawl for the first time. In five minutes he had managed to tip over his basket of lotions and medicines, grabbed a bag of boiled peanuts, and made a good run at getting to the electrical receptacle at the end of the extension cord.

The other day when he visited us at our house, he was fascinated by the stereo system. He was aware of the music coming out of the speakers but kept looking as if to find the people singing. He is curious about everything.

He sleeps in the same bed as his mother and father. He is the first one awake and starts each day off by slapping his mother on the leg two or three times before scratching her with one hand. He then does the same to his father.

Whenever Peelawat encounters a new object, he first checks it out by slapping it two to three times and then giving it some detailed scrutiny by scratching at it with his thumb and fingers. He is constantly probing and investigating his environment.

Although he does not have many toys, he is getting a great deal of stimulation from direct communication and contact with people. The television does not substitute as a care giver for him or for many children in Isaan.

People in Isaan make do with what is available to them. Peelawat is learning at an early age to adapt. So far, he seems to be enjoying it very much - the wonder of it all.

Thailand Swine Flu Precautions

Yesterday, while shopping and performing personal errands, we were able to observe some of the precautions that Thailand is taking in regards to the Swine Flu pandemic.

As of last week there have been 65 deaths attributable to Swine Flu with 21 just last week. To date there have been 8,877 cases of the disease up from 6,776 cases the previous week.

Upon my return to Thailand earlier in the month, I and all other arriving international passengers were "thermal scanned". We had to remove hats and eyeglasses as we looked into what looked like a movie camera as we walked towards the Immigration area. The area where the thermal scanning devices were located was staffed with medical personnel.

In a different area along the route to Immigration there was a medical receiving area for tourists staffed by medical staff.

There were also medical pamphlets ready available related to "Influenza A (H1N1)". The pamphlet gives some tips regarding the "Prevention of Infection". These tips are fairly typical - wash hand, avoid sharing the same glasses, get plenty of sleep, drink plenty of water and wear a mask if you are caring for ill patients. However there is one recommendation that we will not be following "Use common spoon when eating with other persons"

In Isaan, people eat using a common spoon in each serving bowl of food. If the dish is soup, everyone eats the soup out of a common large bowl or pot using a single spoon. Besides being a traditional way of dining, this practice is sometimes necessitated due to a lack of bowls and utensils. It also dramatically cuts down on the amount of things to be washed after the meal.

I suspect that the pamphlet meant to advise "Do not use common spoon ..." but the intended intent got lost in translation.

As we approached the entrance to the shopping mall, the door was opened by a security guard wearing gloves and a surgical mask. He and other guards performed this duty for all people entering and leaving the facility. Using guards to open and close the doors meant that patrons did not have to touch doors that could be sources of infection.

Upon passing through the doors into the mall there was a table and a bottle of alcohol gel for hand cleaning. There was a sign in Thai advising people to sanitize their hands to avoid infection.

We needed to go into the bank branch inside the mall and as is customary and typical, a security guard manned the door so there was no need for a customer to touch the door. Inside the bank on the table where you fill out your deposit or withdrawal documents, there was now an alcohol hand washing station. All but two of the bank personnel were wearing surgical masks.

Most of the stores inside of the mall had bottles of alcohol based hand sanitizers available for people's use. About 2% of the customers were walking around with surgical masks covering their nose and mouth.

This is all very interesting. In a normal year, 30,000 to 40,000 Americans die due to Influenza. The A (H1N1)strain this year is difficult to ascertain just how much a threat or danger that it is. When it first started out in Mexico the mortality rate seemed rather high. Now it seems that the mortality rate has settled down to a more typical rate for seasonal influenza. This is reassuring as long as the virus does not mutate to a more lethal strain.

New Gallery Available to View

A gallery of photographs related to my July 22 "Isaan Rice Planting" and July 17 "Planting Rice, Listening to Gossip" blogs is now available for viewing at my photography website.

The weather continues to be hot, humid, and wet - great weather for getting caught up on all kinds of tasks such as blog writing, editing photos, correspondence, and writing my next book.