Yesterday was another busy as well as interesting day here in Isaan.

Duang woke up with an ear infection. She has a propensity towards ear infections due to perforated ear drums caused as a child by her father and years of not being able to afford medical treatment. I drove her to the Ear, Nose, and Throat Specialist in downtown Udonthani. It was not necessary to schedule an appointment - Isaan is very informal. We arrived at his clinic at 8:25 A. M. and we were the second patient waiting on the sidewalk for his clinic to open at 8:30. The clinic opened on time and we waited until 9:00 A. M. for the doctor to arrive.

The doctor's office is a small and narrow room with stucco covered brick walls. The walls are a dingy pale cream color and could use repainting or at least a good cleaning. The front third of the space is a combination of wooden benches and plastic chairs for patients. There is a water cooler on the left hand side of the room with three plastic glasses sitting in a tray atop the water bottle. People in Isaan accept and are accustomed to sharing - I have a ways to go in that department.

There is a receptionist desk and medication storage area facing the patient waiting area. Behind the receptionist station there is a 6 foot high partition which is one of the walls to the examining room. There is a sliding window in the partition which allows the receptionist to get change from the doctor when a patient pays their bill. Credit card payment is not an option.

On the walls there are two medical posters showing detail cut aways of the anatomies of nose, ears, and throat. There is a large picture of the King of Thailand near the receptionist' station. All businesses and every private home that I have been to have pictures of the King, King and Queen, or other members of the Royal Family prominently displayed.

There is one other large poster on the wall in the patient waiting area - a large advertisement for a huge industrial HEPA vacuum cleaner - think in terms of a shop vac. The poster displays all the hoses as well as nozzles available with the machine. I always have a silent chuckle when I look at it and think about some poor patient going to the doctor for the first time and seeing that device.

The doctor's "shop vac" is much smaller and definitely very much older. To clean out ears, he has a vacuum pump device. There is a vacuum pump that looks like it was made in the 1950's with a exposed belt and 12 inch diameter wheel with a large glass bottle that appears to be straight out of 1960's high school science lab.

There is a 1950's era dental work station for the patient to sit in. Instead of a xray camera, the work station has a microscope/camera device. Magnified images are displayed on a 13 inch color TV from the early 1970's. The office is completed with an old metal desk, old and somewhat corroded metal bookcase of paraphernalia and medicines, an examining table, and two plastic chairs for visitors. There is no door for the doorway into the area and the area has 6 foot high partitions in a building with 12 foot high ceiling, but if you have read many of my blogs you already understand that privacy in Isaan is not high consideration.

The doctor took care of Duang and she needs to go back in 3 days. The cost for his care and 7 prescriptions which were filled by his receptionist was 400 Baht - $11.76 U. S. Dollars.

After returning home, we addressed a home repair issue. The shower from the upstairs guest bathroom has been leaking on to, into, and out of the dining room ceiling. Our house is three years old and we are not the original owners so I expected correctly to have to pay for the repairs. Duang talked to the developer's office people (houses are still being completed) and within 1/2 hour we had a man over to the house. The man and his female assistant worked from 10:00 A. M. until 4:30 P. M. removing ceiling, tiles, and concrete. We bought new tiles and a new drain fitting for $13.23 U. S dollars. The man and his partner replaced the drain and tiles. Another man returned today to patch and paint the ceiling. Total price for the labor - $58.82. In addition to affordable (by U S standards) health care, Isaan also has affordable home repair pricing.

I am learning, very slowly, to speak some Thai. Duang's command of English far exceeds my attempts at Thai or Lao so we communicate mainly in English. Often there are mis-communication which end up with both of us laughing. Yesterday was another example. Duang got a phone call. During the phone call she told me that it was her cousin. She has 93 cousins. Duang also uses the term "cousin" to include nieces and nephews. I do not know how many nieces and nephews that she has. Anyhow - the way that I heard it was that her cousin wanted to know if I wanted to give 2,500 now or get 3,000 in one month, cousin says 2,500 now , wait one month, give me 3,000. I assumed, wrongly in the end, that her niece was calling to borrow 2,500 baht now and would pay me back 3,000 baht in a month. Falangs are perceived by local people to be rich, and compared to the local villagers, we are. Due to our status a foreigners and relative wealth, Isaan people believe and it is actually part of their culture to ask us for favors such as to borrow money. In return as part of the Isaan culture, we as a "higher" status are entitled to ask them to do things for us. To be fair to everyone, I do not loan money.

Duang kept talking to her cousin and asking me about 2,500 and 3,000. I replied that I was not a bank. I do not loan money. If I were to loan 2,500 baht, I would not want to get 3,000 baht back - only the 2,500 baht. I reaffirmed my position to not loan the money. Duang looked perplexed and I was becoming impatient. The phone call ended with Duang telling me that her cousin would call again. I said I didn't know what good that would do - I said "No" and I will say "No" again! Duang then started rummaging through the magazines and papers on our cocktail table and pulled out the Toyota Truck brochure. It then started to dawn on me what may have been going on. The person that she was speaking with was her cousin the car dealer - the man we are buying and ordered our truck from. Through hand gestures and pantomime, I now understood that he was saying we could have a truck with a 2.5 Liter (2,500 cc) engine now or wait for a month to get it with the 3.0 Liter (3,000 cc) engine that we had wanted. We decided to wait for what we wanted and ordered to begin with. Duang and I had a good laugh and teased each other the rest of the day about our lack of communication.

We ended up going to the OTOP Festival at 5:00 P. M. We had gone last year and enjoyed it very much. This year it was better and it was worse. It was better this year in that it was comprised of several large interconnected AIR CONDITIONED tents. It was worse in that there was no large outdoor stage with free stage shows. We toured one area and bought some handicrafts and left.

The restaurant that we used to eat at frequently last year near our hotel is closed so Duang's son took us to a different place. We were going to eat "mauk ka tah" (Thai BBQ). The open air restaurant that we ended up at was alongside the fence of the airport fairly close to the runway. Heavy vegetation concealed an open view but a couple times you could partially view and definitely hear planes completing their landing run out at the airport. The restaurant is mostly for Thais - just what I like. There was a large open sided structure that contained a large stage and some tables for diners. There were three sections of open sided structures that had tables or shelves with uncooked foods such as marinated beef, marinated chicken, marinated pork, squid, vegetables, noodles, leaves, greens, etc. Another section was where you could get "pauk pauk" - green papaya salad and another where you could get some grilled food.

You sat in plastic chairs at a wood table that has a large hole in it. A heavy and thick refractory lined bucket with a charcoal fire is placed in the hole of your table. A thin metal, hubcap type, pot is placed over the fire. The pot has a trough around the perimeter in which water is kept. A slotted cone rises out of the trough. Food is boiled in the water and food is grilled on the slotted cone. The cost for this "all you can eat" extravaganza was $2.91 each plus drinks.

I know why the restaurant from last year was out of business. People from Isaan can pack away the food. I was the first to get full and stop eating followed by my step-son. His girlfriend who is about 5'5" tall and about 110 pounds was third. My wife who is 5'0'' tall and 94 pounds (before eating last night!) was the last to finish - 20 minutes after I did. There was no problem there was a man playing guitar and singing for entertainment. It was a nice finish to a busy and definitely interesting day here in Isaan.

Being Informed - The Price of Freedom

The other day we ended up consulting with a doctor regarding an aspect of Duang's health. I accompanied her into the doctor's office. I ended up having a fairly good technical conversation with the doctor and the doctor asked me if I was a doctor. No - I am not a doctor. Unlike the commercial, I didn't sleep at the Holiday Inn Express the night before.

This was not the first time that I had been asked if I was a professional outside of my career as a Mechanical Engineer. I was once asked by a lawyer if I was a lawyer.

On another occasion, during a review of my investment portfolio, a professional "investment counsellor" for a large US firm remarked that he had nothing to recommend to me and complimented me on the portfolio that I had created using Quicken software and performing my own research over the Internet.

These incidents are not due to random chance. I have always strove to be informed on all aspects of my life to be able to make informed decisions as well as to be capable of evaluating the advice given to me by "experts".

Having worked overseas, I have been exposed to a myriad of medical standards and conditions. In Curitiba, Brasil I had two impacted wisdom teeth removed at the dentist's office under conditions that most likely exceeded most facilities in the United States. The office, surgery, and even the elevator were immaculate. An oral surgeon trained at Northwestern University, a regular dentist, dental assistant and anesthesiologist all worked together on the operation. I am certain that my after care exceeded US standard practise - I received three laser treatments to accelerate and facilitate healing. The surgeon gave me his home phone number as well as his cell phone number. While he was away at a convention the following week, he called me three times to check on my recovery.

In Arzew, Algeria our medical facility was basically a clinic set up in a 20 year old house trailer in the resident camp staffed by an Algerian doctor who had been trained in Belgium. When my wife first met him, he was seated at a table reading the "Merck Medical Manual" - the same book she had brought to Algeria with her. The facility was very basic and handled the medical needs for the camp's 5,000 residents. Medical waste such as syringes was used by some of the local children as playthings - even during the age of AIDS. Medical emergencies such as ex-patriot's broken limbs required medical evacuation to either Spain or France.

In between these two extremes I was exposed to various degrees of medical facilities and capabilities including treatment for Cholera in my home in Vietnam with the bedroom coat rack serving as support for the IV drip. These experiences have lead me to some different perspectives regarding medical care and treatment.

I have found and learned that most of the time our aches, pains, and sickness do not require the high tech but expensive facilities so often available throughout the USA and in large part expected by patients. In the places where I have lived overseas lawsuits and charges of malpractice are rare.

Doctors are not responsible for our health. We are responsible for health. Poor choices that we make affect our life and we are eventually accountable for those choices. Doctors can help alleviate some of the damages that we cause ourselves.

Having seen medicine practiced under various conditions, I view doctors as people with some specific training and experience but they are not miracle workers. They, based upon their training and experience, diagnose our ailments. It is our good fortune that for most of our life our ailments are relatively common place and predictable. Colds, flu, sprains, cuts, broken bones, childhood diseases and blood pressure ailments are easily treated without requiring the latest technology or world class facilities.

To be truly free, we need to be able to make informed decisions and not blindly trust or rely upon others. To enjoy and maintain freedom requires diligence and hard work.

During the early years of our life, many of us were encouraged to question and challenge authority.

Now that we are advancing into the later years of our life it is ironic how willingly some of us are to blindly accept and trust our governments in matters that affect so much of our daily life.

A cost of being free is to take the necessary steps to ensure that we are fully informed. If it can't be explained or if you can not understand it, it most likely is not a good idea or the truth to begin with. The problem is not with you. The problem is with the presenter or proponent but it very well could become your problem if you blindly buy into it or accept it be it investments, personal finances, relationships, foreign policy, law or health care.

Selling Human Organs - I Don't Understand

Today in Isaan, during the Andserson Cooper 360 segment on CNN International, there was a story about trafficking in human organs - specifically kidneys.

In the report it was stated that it is believed that up to 10% of the kidney transplants in the world come from the illegal sale of kidneys. These kidneys rather than coming from a genuine donor actually are procured from people for around $10,000 U. S. dollars. These purchased kidneys are then brokered for up to $100,000 U. S. dollars to patients who need a transplant to survive.

A big part of the story dealt with an alleged ring in New York, where Jewish people were buying kidneys from poor Jews out of Eastern Europe for transplantation into Jews in New York City, Boston, and Philadelphia.

I am opposed to harvesting organs from executed people or from people who have not signed a proper organ donor card. However I am confused in regards to the illegality of willingly selling one or a piece of one of your organs in the United States.

A couple of the justifications regarding the Supreme Court decision of Roe v Wade 1973 that ruled abortion was a fundamental right under the United States Constitution were the Due Process Clause of the 14th Amendment and the right to privacy.

So how is that it is legal to have an abortion which ends up ending a life but it is illegal to sell one of your organs which will end up saving a life?

Do not the same arguments that the Supreme Court used to define a woman's abortion rights not apply to anyone's rights regarding their decision to sell a part of their body?

If a woman's body is her own personal property and she is free to make her own decisions regarding the use of her body, is it not also true that our, men and women, body is our personal property and we, men and women, are free to make our own decisions regarding the use of our body even if it entails willingly selling parts of it?

The Supreme Court has found support for right to and of "privacy" in the Bill of Rights as well as the 14th Amendment to the Constitution although the right or freedom to "privacy" is not specifically stated or written in the Constitution.

I strongly believe in this "right" and "freedom" which along with the Freedom of Speech is so frequently attacked and compromised. However, I do not understand how privacy and the "freedom of contract" can be used to allow abortions and not used to allow for the selling of one's organs.

In selling of one's organs, assuming that it is fully informed and consensual, no one's rights or freedoms are abridged or violated. The most likely result of this private contract and transaction between the donor and recipient or broker is the saving of a life. We are all brought up to believe that saving a human life is a good thing. The world's major religions all support the concept of helping our fellow man as well as saving a human life.

So why is selling one of your organs illegal - other than that is what the law says now?

I don't understand.

Is it because selling organs is not politically correct - yet?

Is it because it is not part of a major political party's agenda or strategy?

Is it because the basis for defining abortion rights is fundamentally flawed and therefore can not be used to define the right to sell your body parts?

I don't understand.

Local Shopping - Shopping for Locals

We do our food shopping at a combination of locations here in Udonthani. For most of our household needs and "kao falang" (foreign food), we shop at Udonthani's newest supermarket, "Carrefour". Carrefour is a French international superstore. Besides food, Carrefour sells appliances, clothing, household goods, electronics, and many other items. In Udonthani there is also a similar British international supermarket - "Lotus - Tesco" that we occasionally shop at. There is one other similar superstore named "Big C" that we used to shop at while living in Vietnam but we avoid it here.

For fruits, vegetables, and "Kao Lao" (Lao food), Duang goes to a local market to shop. Local markets are located throughout the city. The biggest and best market is located in the neighborhood where her brother lives. At the local markets, just about anything can be purchased - clothing, hardware, prepared foods, flowers, plants, DVDs, CDs, meat, seafood, turtles, eels, snakes, frogs - basically if it is alive or was once alive, it is for sale. Local people and people from outlying villages shop at these local markets.

In all villages there are small, very small, markets where villagers can buy certain necessities such as cooking oil, sauces, soap, shampoo, canned mackerel, soda, beer, whiskey, snack foods and sometimes eggs and a few vegetables. These markets supplement villager's shopping trips to the local markets.

Local markets are located throughout towns and cities in Isaan. In rural areas, there are markets set up alongside the road where people gather to sell and buy. Some of the markets are temporary setups on specified evenings of the week (night markets).

Local markets are a combination of indoor permanent facilities and temporary outside facilities. The indoor facilities are large dark buildings or a series of connected buildings with corrugated sheet metal roofs. Inside there are rows and rows of fixed raised tables where the vendors set out their goods to sell. Outside facilities consist of a low raised wood rough platform typically covered with a plastic tablecloth upon which the merchandise is displayed along with a small spring scale to weigh the goods. A large umbrella protects the goods and vendor from the elements. Sometimes there is a small plastic chair or aluminum lawn chair for the vendor but quite often they sit atop the platform along with the goods. During harvest season, we often see Duang's sister and her husband there selling vegetables from their farm.

Saturday, we went shopping at the markets in Kumphawapi for food to celebrate the visit of one of Duang's friends who was visiting Tahsang Village along with her family. Eleven people had piled into a pickup truck to travel from their village to Tahsang Village. It is a typical sight on the roads of Isaan to see a pickup truck chugging along with 12 or more people representing 3 or 4 generations.
We were shopping at the local markets because the food is cheaper than at the big international stores, and most importantly of all the selection of the types of foods that the Lao Loum people eat is much greater there.

Shopping in the local markets is not just the matter of going in, grabbing what you need, paying for it and getting out. These local markets in Isaan also are centers of gossip and social interaction. People end up meeting their friends and relatives at the market so they stop and talk. The vendors also join in and ask questions about family matters. The simple task of selecting vegetables to buy also requires an involved conversation - to ensure the best quality, best price and most likely most importantly of all be perceived as a "kuhn jai dai" - a good person, someone with a good heart.

Scattered throughout the interior of the indoor portion of the Kumphawapi market there are large charcoal grills where fish and meat are cooked. Large metal ducts take the smoke and fumes up and out through the sheet metal roof. Cooked products are lined along the counter for sale. In other areas people use gas burners to cook sweets. The sweets are typically corn or rice with coconut as well as sugar added. I particularly enjoy the corn kernel- shredded coconut waffles fresh out of the waffle iron.












Inside the market the aisles are very narrow as well as crowded. You need to be careful walking because the concrete floors are not level, have abrupt changes in elevation, and are in various states of disrepair. Lighting levels are low inside the market with illumination provided by a small number of exposed fluorescent tubes and bare light bulbs. Interestingly, many of the bare light bulbs are now the eco-friendly fluorescent type. An occasional cat or street dog will also wander by to further complicate navigating through the market. On this trip, someone had placed newspaper along portions of the aisle to soak up some of the rain that had entered through the roof from an earlier rain shower.

Some of the vendors, typically those who are selling canned goods have updated their booths with small TVs or stereos. This provides some entertainment and distraction for their children or grandchildren who accompany the vendors. Between the sights, sounds, and smells, a stop at the local market is always entertaining as well as interesting.

From the Kumphawapi market we drove to the meat market - not a club or drinking establishment but a place where beef is sold. We had purchased beef there before and have never been disappointed. The freshly butchered meat hangs in the open air from metal hooks. Besides meat, the shop sells various beef products such as stomach, liver, blood, and very small plastic bags of what appears to me to be urine. I discussed this with Duang and it apparently it is urine from inside the cattle. Apparently older people like it but young don't - I guess that qualifies me as still being young.

The meat is definitely fresh - I smelled it as it hung in the open air. One thing about the lack of refrigeration - it may not prevent spoilage but it also can not hide it. If anything is less than fresh, it is obvious.Surprisingly there were hardly any flies hovering around the meat. Today unlike other visits to the meat booth, there were not any "ready reserves" tethered to the sturdy fence along side of the shop. Usually there at least two cattle tied to the fence awaiting their fate. The shop is run by a Muslim family which is fairly rare here in Isaan. There was a sign at the front of the booth written in Arabic which tipped me off that they were Muslim and that their beef was "halal" - good to Muslim standards.

We bought one kilogram of beef for 130 baht ($1.73 lb). We pointed out the portion on the hanging leg that we wanted. The female vendor took her large knife out and carved it off of the hanging chunk of meat. We had selected a more expensive cut of beef so it was 130 baht a kilogram. At the Kumphawapi market, less than a mile away, the same cut of beef is $2.00 a pound. Less expensive cuts from the leg cost 100 baht a kilogram.

Having completed our "local shopping" we completed our trip out to Tahsang Village. Everyone enjoyed the large meal and a good time was had by everyone

New Gallery Available to View - Foz do Igaucu

Over the past two days, I have continued to work on reviewing as well as editing scanned slides of the past 33 years.

I have created a new gallery at my photography website for a visit that I made in April 2001 to Foz do Iguacu. The following is a link to the gallery;

//http://www.hale-worldphotography.com/Other/Brasil-Foz-do-Iguacu/9402662_vvHg4/1/630911715_9szt9

Foz do Igaucu is one of the natural wonders of the world. It is a series of spectacular waterfalls created by the Parana River in the Tri Border Region of Brasil, Argentina, and Paraguay. On July 13, 2009 I wrote a blog about the area.

Today I am writing about a portion of my first visit to the falls - "Moises Bertoni Museum".

As part of tour packages in the Foz do Igaucu area, you can book a tour of the "Moises Bertoni Museum". The tour involves a boat cruise on the Parana River to get to the museum which is located in Paraguay. The tour lasts approximately four hours with either a morning or afternoon departure.

We took the afternoon departure and enjoyed a very pleasant cruise along the river on a large double decked boat. There was a fairly large group of Brasilians on board celebrating something so besides the great scenery, we also had some quality "people watching" opportunities. Our fellow passengers were seasoned party people - they had brought aboard picnic jugs of cairpirinhas (a strong alcohol drink - the national drink of Brasil). They were having a good time and by the late afternoon they were having a great time.

After about a one and one-half hour voyage, we arrived at the location of the Museum Moises Bertoni. It seemed to me to be an island in the river but subsequent Internet research leads me to believe that it is actually a peninsula. The area is known as Porto Bertoni and is part of Paraguay.

The museum is the former home and research center for a Swiss immigrant named Moises Bertoni. He was a larger than life man in a time when many men and some women rose above their peers in their quest for adventure, knowledge, and pursuit of their ideals.

Moises Bertoni was born in Switzerland in 1857. He was very intelligent and ended up speaking several languages. By the time of his death he had published 362 books, speeches, articles, maps, booklets, and pamphlets regarding zoology, botany, and ethnology. He was knowledgeable in such diverse sciences as meteorology and anthropology.

In the late 19th century, he and 40 other people left Switzerland to look for a place that was "territory still virgin". Somewhat like some of the hippies of the late 1960's, he was seeking a place where he could apply and experiment with what he had learned of science, politics, sociology and Utopian lifestyles. By this time he had five children and believed that he could not continue his studies, research, and raise the family in the confines of Switzerland and Swiss society.

He left Switzerland and arrived in Argentina. He and his group were initially welcomed there. But as time went on, like most idealists, they wore out their welcome. Bertoni's ideals were in conflict with the ongoing exploitation and destruction of the land as well as people's in his area. His views invited persecution from powerful people. Despite these difficulties Bertoni continued to collect plants, animals, insects, and seeds. He was preparing to publish what he had found when his fifth child accidentally died. With this family tragedy in 1890, he decided to move to Paraguay. He settled in the jungle in the Yaguarazapa region. Some years later he moved once again to the area where the museum is located.

Alongside the Parana River he continued his studies of a wide ranging area of topics. He was greatly assisted in his work by the local indigenous people the Guarani. From them he learned about and was able to study many different types of plants and animals. He also studied the Guarani culture and society while raising his 13 children with his wife. Part of his research and work involved planting many rare plants around his home. The progeny of these plants thrive today around the museum. Some of his work involved researching malaria. Ironically Bertoni died in 1929 due to malaria - two weeks after his wife had died of the same disease.

After docking, we left the boat and hiked about one-half mile up a hill through the hot and humid jungle along a narrow muddy trail to get to the museum. Inside of the museum, which is his actual home and research center, we were able to see Bertoni's collections, books, furnishings, and scientific instruments. Outside, Mbaya people with their babies were selling handicrafts.

The Mbaya people are descended from the Guarani people and are well known now for their handicrafts - necklaces, baskets, and carvings. I ended up taking a couple of photographs of the Mbaya people but I was limited by the film that I had. Shooting in the jungle requires a higher speed film to keep exposure times reasonable to avoid blurring. Interestingly, I now look back at these photographs as the beginning of my focus on people rather landscapes and animals in my work.

New Gallery Available to View - Lapa, Brazil

Duang's brother is doing well in the Udonthani Public Hospital. He will be released on Friday after his stitches are removed. I am impressed with the success of his treatment. Just as in the delivery of Peelawat, it appears that although the Isaan medical facilities do not compare with USA hospitals, they are fit for purpose. It would make for an interesting discussion or debate regarding how much technology, staffing, modern facilities, etc are actually required to provide adequate medical services. It is a discussion and debate that I am not qualified to participate. I have only shared my observations and experiences related to medical services in Isaan.

Today we drove to the Mall in central Udonthani to take care of some banking, pay a bill, post some letters, and buy some razor blades. Duang also suggested that we have lunch at the Pizza Company. There is a desk at the Province Office inside the Mall where a postman is available to determine postage and mail letters and packages - very convenient with services available 7 days a week. At the Bank office in the Mall you can pay bills seven days a week as well as do your banking. I had two Thai checks to cash and found out that I could only deposit them to my account with the money being available in 7 days - not so convenient but not a problem - thankfully.

The remainder of the day was spent editing and reviewing scanned slides. Recently I recieved two DVDs of scans of approximately 2,000 35 mm slides from a 33 year span. I had boxed the slides and sent them to the San Francisco Bay Area where they were added to others and shipped to India for processing. From India the slides as well as the DVDs of electronic files of the scans were sent to my parents house (the company does not ship to overseas locations). My parents then shipped the DVDs to Thailand with them arriving a month later.

Over the course of time I will be adding selected photos to my website. I recently added new photos to my "China 2004" gallery and today I created a new gallery.

My new gallery is from the June 2001 celebration of the Feast of Corpus Christi in Lapa, Parana Brazil. The following is a link to the gallery: http://www.hale-worldphotography.com/Other/Brasil-Lapa-Corpus-Christi/9388713_gsiqu/1/628777107_EpxjY

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.