Posts
Sunday, September 20, 2009
Someone Bought the Book
Today I was checking on my first book and was surprised as well as pleased that some one has purchased a copy of "A Year In Thailand, The Beginning of a New Life".
Thank You.
I hope that the book meets your expectations.
My first book which chronicles a very important period in my life while I was working in Thailand. The book captures many of the sights as well as people that I encountered here. I wanted to share as best as I could and ended up with a 160 page 11 inch by 13 inch book that ended up costing more than I had expected. Despite it's cost, I am pleased with it and have a copy here in Thailand and I have sent copies to my parents and one of my aunts.
I am currently working on a second book which will be a compilation of photographs and narratives related to living in Isaan. It will focus on the Lao Loum people, their culture, and my experiences with both. Recognizing the perhaps prohibitive cost of the first book I am targeting the next book to be 200 pages 10 inches by 8 inches and sell for $61.95 + S&H.
The creation of the second book is going well, and I anticipate that it will be available within the next two months.
Saturday, September 19, 2009
Snake Oil Salesman - Health Care
No, this blog is not about anyone in America and it has nothing to do with any individual involved in the Health Care debate in America. This blog is definitely not racist or about racism either.
This blog is about a event that I unexpectedly witnessed this afternoon in Tahsang Village here in Isaan. Ironically, it does involve health care but health care as is related to Isaan.
Lately I have written about health care both public and private here in Isaan. This was due to family developments as well as events both on cable television and on the Internet.
Today, Duang wanted to drive out to Tahsang Village to visit her 7 month old grandson, Peelawat, AKA "Pee - A - Lot". Duang is doing very well from her surgery on both of her ears. However she is sleeping a great deal which I suspect is due to some of the medication that she was given and instructed to take. It has been my observation, that Isaan people expect to take medicine for any and all maladies no matter the seriousness. I can sneeze twice in a row due to the bright sun and Duang will suggest that I go see a doctor or take some medicine. I believe that the doctors in Isaan cater somewhat to this mind set by over prescribing medication. Every time that we see a doctor, Duang ends up with 5 to 7 different kinds of pills no matter what her diagnosis is and they have ranged from common colds, ear infections, UTI, pulled muscles, etc. I try to determine what each medication is but often I am unable to identify them over the Internet. I can usually can identify the Tylenol type medication, and the antibiotics but the others are mysteries. I suspect that they are antihistamines and relaxants.
As I always do when travelling the highways and back roads of Isaan, I brought along my backpack containing my camera gear. There always seems to be something or some one interesting, at least to me, to photograph. Today was no exception.
The fields are flooded and the rice crop is thriving. All the rice planting has been completed and the farmers are anticipating a good harvest late next month and the following month. The sugar cane is growing well and does not require any attention for the time being. Peanuts have been harvested and finding a roadside stand to buy fresh boiled hot peanuts has become difficult. With the relative lull in farming activities, the local people have focused on fishing. The lowlands have flooded and all the rickety bamboo fishing platforms on the way to Tahsang Village were manned. The people were dipping large square mono filament nets into the flood waters in hopes of catching some small fish. In consideration of Duang's condition I did not stop and pressed on to the village.
We were not at the village long when we heard Isaan music blaring from a pick up truck that was crawling through the village. This is a common occurrence. Trucks selling vegetables, fish, clothing, prepared foods, household goods, or snack foods ply the narrow village lanes. Sometimes these vehicles are soliciting people's support for a particular politician or political party. But today was different, the truck was announcing the arrival of a "Snake Show".
The truck stopped alongside of the street across from Duang's parent's house. A man, his wife, and his 7 year old son got out of the truck. The man held a microphone and made some type of announcement. Since most people are outside of their or their neighbor's house during the day and because it was Saturday, a small group of villagers assembled almost instantly.
The man carried a good sized wood box out of the back of the truck and placed it on the bare ground. There was a hinged door that cover half of the box's top. The door was secured shut with a metal hasp and a bent u-shaped wire. He carefully removed the "lock". He backed off a little from the box and used a thin bamboo rod that had a 4 centimeter branch cantilevered from the pole to open the door. It looked like Isaan's native answer to the metal snake hooks that we see on "Animal Planet" and "National Geographic Channel" shows. Skillfully he used the rod to coax a large snake out of the box. The snake was about 4 meters (12 feet) long. It was dark green and black with a yellowish under belly. It was a cobra! In all honesty it was a very well behaved snake. It did not lash out and try to strike any of the audience, the two village mongrels that were cautiously curious, or even the two scrawny chickens that were wandering around. I believe that the snake had eaten recently. The man was very good in handling the snake - not reckless and showing a definite respect for what the reptile could do. It was a treat for me to see the reaction of the children to the snake. They were not terrified of it but they too were cautious. I asked Duang if it was the same type of cobra that had crawled into the bathroom that was occupied by her daughter a couple of months ago. Duang indicated that it wasn't.
The man seemed to be telling people about the snake and answered some questions. He used the stick to keep the snake's movements away from the children and tried to a limited success to get the snake to flare its hood. The snake moved with a calm and deliberate demeanor almost like the swagger of the town bully knowing that he was the biggest and "Baddest" MF in town. After awhile the man coaxed the snake back to the vicinity of the box and using a combination of his hand and snake stick got it back into the box. He closed the top and set the hasp with the bamboo rod before placing the bent wire with his bare hand.
After putting the box back into the back of the truck, he brought out a similar sized wood box. Using the same equipment and techniques, he eventually had a 6 foot python on the ground. This snake was not so polite. It was hissing very loudly. The snake through its movements clearly demonstrated the power contained in its body. Again the man seemed to be lecturing about the snake. His wife also came forward with a woven wood basket in her hand and started working the crowd. Inside the basket were small plastic bags of stuff - it looked like wood shavings and snakeskin. There were other bags that contained large white tablets.
It turned out that this man and his family were selling medicine. Much like the snake oil salesmen of the American west in the 1880's they put on a little show, in this case showing the snakes, to attract a crowd to extol the power and benefits of their medicine which they were selling. Their pitch was not falling upon deaf ears. I saw several villagers reaching into their pockets to pay for some of the bags of "medicine" Duang told me that the medicine was from China. The wood chips with snake skin was very good to make a tea out of for women who had just had a baby. The other medicine was good for taking care of headaches. This type of medicine is traditional in Isaan especially out in the countryside.
The show ended with a third box being opened to reveal two turtles. The little villagers came closer for a better look at them. The man also placed a small plastic crocodile next to the turtles and would press the back of the toy with his bamboo rod causing it to squeak. Everyone got a good laugh when a couple of the small children jumped back in surprise at the squeaks.
After about 30 minutes the "snake oil" salesman left Tahsang Village headed to the next village with their answer to health care for the Lao Loum people.
This blog is about a event that I unexpectedly witnessed this afternoon in Tahsang Village here in Isaan. Ironically, it does involve health care but health care as is related to Isaan.
Lately I have written about health care both public and private here in Isaan. This was due to family developments as well as events both on cable television and on the Internet.
Today, Duang wanted to drive out to Tahsang Village to visit her 7 month old grandson, Peelawat, AKA "Pee - A - Lot". Duang is doing very well from her surgery on both of her ears. However she is sleeping a great deal which I suspect is due to some of the medication that she was given and instructed to take. It has been my observation, that Isaan people expect to take medicine for any and all maladies no matter the seriousness. I can sneeze twice in a row due to the bright sun and Duang will suggest that I go see a doctor or take some medicine. I believe that the doctors in Isaan cater somewhat to this mind set by over prescribing medication. Every time that we see a doctor, Duang ends up with 5 to 7 different kinds of pills no matter what her diagnosis is and they have ranged from common colds, ear infections, UTI, pulled muscles, etc. I try to determine what each medication is but often I am unable to identify them over the Internet. I can usually can identify the Tylenol type medication, and the antibiotics but the others are mysteries. I suspect that they are antihistamines and relaxants.
As I always do when travelling the highways and back roads of Isaan, I brought along my backpack containing my camera gear. There always seems to be something or some one interesting, at least to me, to photograph. Today was no exception.
The fields are flooded and the rice crop is thriving. All the rice planting has been completed and the farmers are anticipating a good harvest late next month and the following month. The sugar cane is growing well and does not require any attention for the time being. Peanuts have been harvested and finding a roadside stand to buy fresh boiled hot peanuts has become difficult. With the relative lull in farming activities, the local people have focused on fishing. The lowlands have flooded and all the rickety bamboo fishing platforms on the way to Tahsang Village were manned. The people were dipping large square mono filament nets into the flood waters in hopes of catching some small fish. In consideration of Duang's condition I did not stop and pressed on to the village.
We were not at the village long when we heard Isaan music blaring from a pick up truck that was crawling through the village. This is a common occurrence. Trucks selling vegetables, fish, clothing, prepared foods, household goods, or snack foods ply the narrow village lanes. Sometimes these vehicles are soliciting people's support for a particular politician or political party. But today was different, the truck was announcing the arrival of a "Snake Show".
The truck stopped alongside of the street across from Duang's parent's house. A man, his wife, and his 7 year old son got out of the truck. The man held a microphone and made some type of announcement. Since most people are outside of their or their neighbor's house during the day and because it was Saturday, a small group of villagers assembled almost instantly.
The man carried a good sized wood box out of the back of the truck and placed it on the bare ground. There was a hinged door that cover half of the box's top. The door was secured shut with a metal hasp and a bent u-shaped wire. He carefully removed the "lock". He backed off a little from the box and used a thin bamboo rod that had a 4 centimeter branch cantilevered from the pole to open the door. It looked like Isaan's native answer to the metal snake hooks that we see on "Animal Planet" and "National Geographic Channel" shows. Skillfully he used the rod to coax a large snake out of the box. The snake was about 4 meters (12 feet) long. It was dark green and black with a yellowish under belly. It was a cobra! In all honesty it was a very well behaved snake. It did not lash out and try to strike any of the audience, the two village mongrels that were cautiously curious, or even the two scrawny chickens that were wandering around. I believe that the snake had eaten recently. The man was very good in handling the snake - not reckless and showing a definite respect for what the reptile could do. It was a treat for me to see the reaction of the children to the snake. They were not terrified of it but they too were cautious. I asked Duang if it was the same type of cobra that had crawled into the bathroom that was occupied by her daughter a couple of months ago. Duang indicated that it wasn't.
The man seemed to be telling people about the snake and answered some questions. He used the stick to keep the snake's movements away from the children and tried to a limited success to get the snake to flare its hood. The snake moved with a calm and deliberate demeanor almost like the swagger of the town bully knowing that he was the biggest and "Baddest" MF in town. After awhile the man coaxed the snake back to the vicinity of the box and using a combination of his hand and snake stick got it back into the box. He closed the top and set the hasp with the bamboo rod before placing the bent wire with his bare hand.
After putting the box back into the back of the truck, he brought out a similar sized wood box. Using the same equipment and techniques, he eventually had a 6 foot python on the ground. This snake was not so polite. It was hissing very loudly. The snake through its movements clearly demonstrated the power contained in its body. Again the man seemed to be lecturing about the snake. His wife also came forward with a woven wood basket in her hand and started working the crowd. Inside the basket were small plastic bags of stuff - it looked like wood shavings and snakeskin. There were other bags that contained large white tablets.
It turned out that this man and his family were selling medicine. Much like the snake oil salesmen of the American west in the 1880's they put on a little show, in this case showing the snakes, to attract a crowd to extol the power and benefits of their medicine which they were selling. Their pitch was not falling upon deaf ears. I saw several villagers reaching into their pockets to pay for some of the bags of "medicine" Duang told me that the medicine was from China. The wood chips with snake skin was very good to make a tea out of for women who had just had a baby. The other medicine was good for taking care of headaches. This type of medicine is traditional in Isaan especially out in the countryside.
The show ended with a third box being opened to reveal two turtles. The little villagers came closer for a better look at them. The man also placed a small plastic crocodile next to the turtles and would press the back of the toy with his bamboo rod causing it to squeak. Everyone got a good laugh when a couple of the small children jumped back in surprise at the squeaks.
After about 30 minutes the "snake oil" salesman left Tahsang Village headed to the next village with their answer to health care for the Lao Loum people.
Friday, September 18, 2009
Private Health Care - A Thai Experience
In the interest of what Fox News Network describes to be "Fair & Balanced" reporting, I am writing about yesterday's experience at a private hospital in Udonthani, Thailand. I have written a few blogs on the public health care available to the people of Isaan - the maternity ward in Khumpahawapi, the emergency room in Udonthani, the birthing experience in Kumphawapi, Duang's brother's emergency surgery, and a couple visits to relatives. These were public facilities and as it turns out very different from the private facilities and experience.
When she was a young child, my wife, Duangchan, had both of her ear drums perforated in an incident of domestic violence. Being poor without the funds for medical care, the ear drums were never attended to. Perforated ear drums are more susceptible to ear infections and Duang was no exception to this statistic. Over the years of ear infections and lack of proper medical car, she had lost an appreciable amount of hearing acuity as well as the remnants of the perforated ear drums.
In the past year, she has had five ear infections. She has gone to the number 1 Ear, Nose, and Throat doctor in Udonthani. I have written about at least two of our visits to his clinic in previous blogs. We had been talking about how at some point in the near future he would operate and repair Duang's ears. The last ear infection did it for her. She had been afraid to be operated on but finally agreed to go forward with the operation rather than suffer from so many infections as well as loss of hearing. Yesterday was the day of her scheduled operation.
The previous day we went to the specialist for the third time regarding the last infection. On our first visit I wrote how we paid 400 baht for the visit as well a six filled prescriptions. We did not have to pay for the subsequent last two visits. The last visit was to ensure that the infection had cleared up and that there was no impediment to proceeding with the procedures.
We arrived at one of the private hospitals in Udonthani at the scheduled 8:30 A. M. time. The doorman smiled at us and directed us to the Information Desk as he opened the door for us. The interior of this part of the hospital was very nice - much like that of a three or four star hotel in the big city. I had been to the Bangkok-Pattaya Hospital in Pattaya, another private hospital, a couple of times for dental work and had a similar experience although that hospital was more like a 5 Star hotel. That hospital actually had a wing donated by the Royal Saudi family so little expense was spared.
We entered the hospital and were greeted by several prim and properly attired female personnel. They were wearing blue uniforms and small hats that reminded me of Eastern Airline stewardesses from the 1960's. One of them escorted us to the information desk and had us sit down similar to registering at a hotel. Duang submitted a paper to them that the doctor had given her the day before. They looked it over and started discussing it in Thai. In a couple of minutes a very well dressed man came up to me and introduced himself in excellent English. He was the hospital's "Manager of International Services". He explained the process to me and escorted us through the various steps up to the point where Duang was in her room to start waiting for the surgery. This was very comforting as well as very reassuring since I had no idea what was going on. Although Duang speaks Lao as well as Thai, she does not have experiences with being admitted to hospitals let alone private hospitals.
From the Information/ Admissions Desk, I went to the counter next to it, and again it was more like checking into a hotel than a hospital. The young women working in this section were just as well coiffed, dressed and made up as the greeters but did not wear hats. I was given an estimate of the costs for the surgery as well as the room.
The previous day the doctor had told me that it would be around 55,000 to 60,000 baht ($1,618 to $1,765 U S dollars). This was a good deal. I found out from Duang that he had recently done a similar procedure for the wife of a foreigner and the price was 200,000 baht. Duang had told the doctor that I am retired and that we didn't have medical insurance - all true. He told her that he knew she was Lao (Lao Loum) so he would take care of her for 55,000 to 60,000. The room was not include in his estimate. He wanted to use this hospital because they had a new microscope surgery piece of equipment in their operating room.
Part of the checking in procedure was to select the type of room we wanted. I selected the "Duluxe" room for 2,700 baht a day ($79.41 a day) which included food, and nursing care. The "Duluxe" room had a couch in it where I could and I was encouraged to spend the night. The cheapest room was a shared "Twin" for ($34.41 a day). The most expensive room was "VIP 1" for $161.76 a day.
Our "Duluxe" room was fine. It had a small color TV set with international cable channels, a small refrigerator stocked with water and soft drinks, two wood chairs, and the couch. The room had a small screened balcony over looking a school across the street. It was comparable to standard Motel 6 room in the USA.
Unlike the public hospital, the corridors and grounds of the hospital were quiet and we saw very few people. Unlike the public hospitals patients were not exposed to the open air either on their way to or from surgery.
I did read some literature on the costs for some of the hospital's procedures. The one at the top struck out like a sore thumb - "Sex Change" - $1,865 - I assumed that it was for a man to become a "woman" and I doubt if it included the room. Breast augmentation I believe was around $1,200. Prices like that are driving the Medical Tourism Industry here in Thailand, Malaysia, and India.
Perhaps a more realistic solution for the 47,000,000 Americans without health insurance would be to buy those people round trip economy air fares (about $700) to Thailand and pay for their treatment in Thailand than the outrageously expensive plans being currently argued about. I know that when I was in the USA without a job, my COBRA extension of my previous health insurance was $1,500 a month to cover myself and my wife. At that rate - $8,400 a year per person - it would have been cheaper for me to fly to Thailand and stay in a hospital every time that I needed to see a doctor in a year! Hell some one could have had two sex changes a year in Thailand for just the cost of my insurance.
Having decided on our room, and with Duang signing once on one piece of paper, I was asked to place a down payment on the estimated cost of services. I had gone to the bank the day before and withdrawn 60,000 baht for the operation so I put down 55,000baht. I was given a receipt and we were then escorted up to the room.
A nurse came in and had Duang change for the second time into hospital garments. She had changed into a more traditional hospital gown downstairs for her admission examination but for waiting in the room she had a one size fits all pair of Chinese styled cotton pajamas. We were set to go by 10:00 A.M.
We knew the doctor had clinic hours until 1:00 P.M. so we anticipated surgery would be 2:00 P.M. We were told that it would last three hours and Duang would be in the Intensive Care Unit for two hours before returning to the room. So we were prepared to do a great deal of waiting.
Around 11:00 a couple of nurses came in to take blood and hook Duang up to an IV. It was very interesting - neither nurse wore gloves or face shields for either drawing blood or setting up the IV. Drawing blood was not to easy. Duang had been told and had not eaten or drank anything since 7:00 P. M. the night before. Her blood was rather sluggish but they got enough apparently. A very small speck fell on the bed's comforter - they either didn't notice or didn't care. I washed it up when they left. They had some trouble setting up the IV but the third time and the other arm was the charm.
We bided our time watching movies and talking to Duang's son and his girlfriend. Around 1:00 P.M. the Operating Room Head Nurse stopped by to speak to Duang and inform her what to expect. She seemed to be explaining things well and in detail though it was all in Thai so I am not certain. Duang seemed to be remaining calm and was happy so it went well. Duang was then assisted into another traditional type hospital gown for surgery.
At 2:30 an orderly came by. Three nurses assisted Duang to transfer to the transport gurney. We took the elevator down to the lower floor where the operating room and ICU was. I was allowed to go up to the yellow line on the corridor floor where Duang was transferred to an operating room gurney.
I returned to the room to watch TV, stare out off of the balcony and pace the floor. At around 5:00 P.M. the Manager of International Services stopped by to see how I was doing. I told him that Duang was scheduled to be out of surgery at 5:30. He took me to the nurse's station and had then use their walkie-talkie to check on her status. Word came back that she was still in surgery. He told me that when she was out of surgery, the nurses would let me know so that I could join her in the Intensive Care Unit for her two hours of monitoring before she went back to the room.
Around 6:10 the nurse came to tell us that Duang was in the ICU. We went to the ICU and had to remove our shoes and put on slippers before entering the area. Duang was in a small room, I believe she was the only patient in the ICU. Duang was lying on the gurney bundled up as if she were sleeping outside in Northern Alberta during a winter night. She had an oxygen mask on and her vital signs were being monitored on a small HP machine on a counter next to her gurney. Outside her room, two nurses manned the desk.
After awhile the nurse took the chair from the corner of the room and had me sit down. By then Duang's son and his girlfriend had seen enough and left to get dinner.
I was fascinated. First of all I had never visited any one in an ICU before. Secondly Duang was like a zombie. Her eyes were half open but no one was home - I know because I checked her reaction (none) to my fingers crossing and headed towards her eyes. This state last for an hour and one-half interrupted only twice - once when she managed to get one finger out from under all the covers to wipe moisture from the corner of one eye, and once when she appeared to be letting me know she was OK with her finger movements and facial expression. Both times did not last long and it appeared that she had not regained full consciousness. After 1-1/2 hours almost as if she heard an alarm clock, she woke up and was fully conscious. The nurses monitored her conscious state for half an hour and we then went back to the room.
I spent the night and helped her once. After a fitful night on what had to be the hardest couch in all Udonthani, I got up a 5:00 A. M. Duang's son picked me up at 6:00 and brought me back to the house to get cleaned up. Two hours later she called to tell me her son was on his way back. The doctor had seen her and was releasing her this morning. I got back to the hospital and there was some confusion about getting released. I took a couple of trips up and down the elevator and then took the step son's girlfriend to the nurses station with me - she would tell them, get their answer in Thai and then tell Duang in Thai so that Duang could tell me in English. I didn't get to see how well this was going to work because my old friend "Manager ..." was at the door. We told him the situation. He talked to the nurses and made a couple phone calls - everything was squared away. Once the IV was removed Duang had already changed into her clothes, didn't want to shower there, didn't want to eat breakfast there, she only wanted to be back home.
An orderly came with a wheelchair and brought us all down to the second floor where they cut off her ID bracelet, I paid the balance on the bill and she got 6 prescriptions to take home.
The orderly along with one of the nurses wheeled her out the front door and we went home.
Duang was fine and has been recovering all day. The total bill was 64,696 baht ($1,902 USD)
I don't think that we could have received any better care anywhere else in the world. I know for a fact that we could not have gotten any where near that amount of care (3 hours surgery, 2 hours ICU, one night hospital room )for that amount of money in the USA.
This experience has reinforced my belief that good and adequate private medical care is available and most importantly affordable for us here in Thailand
When she was a young child, my wife, Duangchan, had both of her ear drums perforated in an incident of domestic violence. Being poor without the funds for medical care, the ear drums were never attended to. Perforated ear drums are more susceptible to ear infections and Duang was no exception to this statistic. Over the years of ear infections and lack of proper medical car, she had lost an appreciable amount of hearing acuity as well as the remnants of the perforated ear drums.
In the past year, she has had five ear infections. She has gone to the number 1 Ear, Nose, and Throat doctor in Udonthani. I have written about at least two of our visits to his clinic in previous blogs. We had been talking about how at some point in the near future he would operate and repair Duang's ears. The last ear infection did it for her. She had been afraid to be operated on but finally agreed to go forward with the operation rather than suffer from so many infections as well as loss of hearing. Yesterday was the day of her scheduled operation.
The previous day we went to the specialist for the third time regarding the last infection. On our first visit I wrote how we paid 400 baht for the visit as well a six filled prescriptions. We did not have to pay for the subsequent last two visits. The last visit was to ensure that the infection had cleared up and that there was no impediment to proceeding with the procedures.
We arrived at one of the private hospitals in Udonthani at the scheduled 8:30 A. M. time. The doorman smiled at us and directed us to the Information Desk as he opened the door for us. The interior of this part of the hospital was very nice - much like that of a three or four star hotel in the big city. I had been to the Bangkok-Pattaya Hospital in Pattaya, another private hospital, a couple of times for dental work and had a similar experience although that hospital was more like a 5 Star hotel. That hospital actually had a wing donated by the Royal Saudi family so little expense was spared.
We entered the hospital and were greeted by several prim and properly attired female personnel. They were wearing blue uniforms and small hats that reminded me of Eastern Airline stewardesses from the 1960's. One of them escorted us to the information desk and had us sit down similar to registering at a hotel. Duang submitted a paper to them that the doctor had given her the day before. They looked it over and started discussing it in Thai. In a couple of minutes a very well dressed man came up to me and introduced himself in excellent English. He was the hospital's "Manager of International Services". He explained the process to me and escorted us through the various steps up to the point where Duang was in her room to start waiting for the surgery. This was very comforting as well as very reassuring since I had no idea what was going on. Although Duang speaks Lao as well as Thai, she does not have experiences with being admitted to hospitals let alone private hospitals.From the Information/ Admissions Desk, I went to the counter next to it, and again it was more like checking into a hotel than a hospital. The young women working in this section were just as well coiffed, dressed and made up as the greeters but did not wear hats. I was given an estimate of the costs for the surgery as well as the room.
The previous day the doctor had told me that it would be around 55,000 to 60,000 baht ($1,618 to $1,765 U S dollars). This was a good deal. I found out from Duang that he had recently done a similar procedure for the wife of a foreigner and the price was 200,000 baht. Duang had told the doctor that I am retired and that we didn't have medical insurance - all true. He told her that he knew she was Lao (Lao Loum) so he would take care of her for 55,000 to 60,000. The room was not include in his estimate. He wanted to use this hospital because they had a new microscope surgery piece of equipment in their operating room.
Part of the checking in procedure was to select the type of room we wanted. I selected the "Duluxe" room for 2,700 baht a day ($79.41 a day) which included food, and nursing care. The "Duluxe" room had a couch in it where I could and I was encouraged to spend the night. The cheapest room was a shared "Twin" for ($34.41 a day). The most expensive room was "VIP 1" for $161.76 a day.
Our "Duluxe" room was fine. It had a small color TV set with international cable channels, a small refrigerator stocked with water and soft drinks, two wood chairs, and the couch. The room had a small screened balcony over looking a school across the street. It was comparable to standard Motel 6 room in the USA.
Unlike the public hospital, the corridors and grounds of the hospital were quiet and we saw very few people. Unlike the public hospitals patients were not exposed to the open air either on their way to or from surgery.
I did read some literature on the costs for some of the hospital's procedures. The one at the top struck out like a sore thumb - "Sex Change" - $1,865 - I assumed that it was for a man to become a "woman" and I doubt if it included the room. Breast augmentation I believe was around $1,200. Prices like that are driving the Medical Tourism Industry here in Thailand, Malaysia, and India.
Perhaps a more realistic solution for the 47,000,000 Americans without health insurance would be to buy those people round trip economy air fares (about $700) to Thailand and pay for their treatment in Thailand than the outrageously expensive plans being currently argued about. I know that when I was in the USA without a job, my COBRA extension of my previous health insurance was $1,500 a month to cover myself and my wife. At that rate - $8,400 a year per person - it would have been cheaper for me to fly to Thailand and stay in a hospital every time that I needed to see a doctor in a year! Hell some one could have had two sex changes a year in Thailand for just the cost of my insurance.
Having decided on our room, and with Duang signing once on one piece of paper, I was asked to place a down payment on the estimated cost of services. I had gone to the bank the day before and withdrawn 60,000 baht for the operation so I put down 55,000baht. I was given a receipt and we were then escorted up to the room.
A nurse came in and had Duang change for the second time into hospital garments. She had changed into a more traditional hospital gown downstairs for her admission examination but for waiting in the room she had a one size fits all pair of Chinese styled cotton pajamas. We were set to go by 10:00 A.M.We knew the doctor had clinic hours until 1:00 P.M. so we anticipated surgery would be 2:00 P.M. We were told that it would last three hours and Duang would be in the Intensive Care Unit for two hours before returning to the room. So we were prepared to do a great deal of waiting.
Around 11:00 a couple of nurses came in to take blood and hook Duang up to an IV. It was very interesting - neither nurse wore gloves or face shields for either drawing blood or setting up the IV. Drawing blood was not to easy. Duang had been told and had not eaten or drank anything since 7:00 P. M. the night before. Her blood was rather sluggish but they got enough apparently. A very small speck fell on the bed's comforter - they either didn't notice or didn't care. I washed it up when they left. They had some trouble setting up the IV but the third time and the other arm was the charm.We bided our time watching movies and talking to Duang's son and his girlfriend. Around 1:00 P.M. the Operating Room Head Nurse stopped by to speak to Duang and inform her what to expect. She seemed to be explaining things well and in detail though it was all in Thai so I am not certain. Duang seemed to be remaining calm and was happy so it went well. Duang was then assisted into another traditional type hospital gown for surgery.
At 2:30 an orderly came by. Three nurses assisted Duang to transfer to the transport gurney. We took the elevator down to the lower floor where the operating room and ICU was. I was allowed to go up to the yellow line on the corridor floor where Duang was transferred to an operating room gurney.I returned to the room to watch TV, stare out off of the balcony and pace the floor. At around 5:00 P.M. the Manager of International Services stopped by to see how I was doing. I told him that Duang was scheduled to be out of surgery at 5:30. He took me to the nurse's station and had then use their walkie-talkie to check on her status. Word came back that she was still in surgery. He told me that when she was out of surgery, the nurses would let me know so that I could join her in the Intensive Care Unit for her two hours of monitoring before she went back to the room.
Around 6:10 the nurse came to tell us that Duang was in the ICU. We went to the ICU and had to remove our shoes and put on slippers before entering the area. Duang was in a small room, I believe she was the only patient in the ICU. Duang was lying on the gurney bundled up as if she were sleeping outside in Northern Alberta during a winter night. She had an oxygen mask on and her vital signs were being monitored on a small HP machine on a counter next to her gurney. Outside her room, two nurses manned the desk.
After awhile the nurse took the chair from the corner of the room and had me sit down. By then Duang's son and his girlfriend had seen enough and left to get dinner.
I was fascinated. First of all I had never visited any one in an ICU before. Secondly Duang was like a zombie. Her eyes were half open but no one was home - I know because I checked her reaction (none) to my fingers crossing and headed towards her eyes. This state last for an hour and one-half interrupted only twice - once when she managed to get one finger out from under all the covers to wipe moisture from the corner of one eye, and once when she appeared to be letting me know she was OK with her finger movements and facial expression. Both times did not last long and it appeared that she had not regained full consciousness. After 1-1/2 hours almost as if she heard an alarm clock, she woke up and was fully conscious. The nurses monitored her conscious state for half an hour and we then went back to the room.
I spent the night and helped her once. After a fitful night on what had to be the hardest couch in all Udonthani, I got up a 5:00 A. M. Duang's son picked me up at 6:00 and brought me back to the house to get cleaned up. Two hours later she called to tell me her son was on his way back. The doctor had seen her and was releasing her this morning. I got back to the hospital and there was some confusion about getting released. I took a couple of trips up and down the elevator and then took the step son's girlfriend to the nurses station with me - she would tell them, get their answer in Thai and then tell Duang in Thai so that Duang could tell me in English. I didn't get to see how well this was going to work because my old friend "Manager ..." was at the door. We told him the situation. He talked to the nurses and made a couple phone calls - everything was squared away. Once the IV was removed Duang had already changed into her clothes, didn't want to shower there, didn't want to eat breakfast there, she only wanted to be back home.
An orderly came with a wheelchair and brought us all down to the second floor where they cut off her ID bracelet, I paid the balance on the bill and she got 6 prescriptions to take home.
The orderly along with one of the nurses wheeled her out the front door and we went home.
Duang was fine and has been recovering all day. The total bill was 64,696 baht ($1,902 USD)
I don't think that we could have received any better care anywhere else in the world. I know for a fact that we could not have gotten any where near that amount of care (3 hours surgery, 2 hours ICU, one night hospital room )for that amount of money in the USA.
This experience has reinforced my belief that good and adequate private medical care is available and most importantly affordable for us here in Thailand
Sunday, September 13, 2009
Saturday In Isaan - Dealing With Police
Yesterday, which was Saturday here in Isaan, we took a ride up to Nong Khai which is the border crossing with Laos. Apparently Duang's mother who has been caring for "Brother, #4" after his surgery at his home in Udonthani had cabin fever. She had never been to Nong Khai or Laos and wanted to check it out. "Brother, #4"'s girlfriend would drive up to Nong Khai and invited us to join them.
One half the way to Nong Khai, "Momma" realized that she did not bring her Thai National ID card so going into Laos was off the agenda. I would not go into Laos on this trip anyhow. I would have to pay $35 for a Lao Visa to enter be it for 1 minute or 30 days. I will wait and pay when we take another holiday in Laos. Thai people who live in Isaan, typically the Lao Loum but not restricted to only them, can enter into Laos without paying or even getting a Visa. There are some restrictions as to length of stay and how far from the border Thais can travel without a Visa but during last year's week long trip to Luang Prabang, we had no problems with Duang not having a Visa - perhaps we were lucky.
Many expats bring their wife or girlfriend to the border crossing at Nong Khai so that the Thais can cross into Laos and shop at the Border Duty Free Shop in Laos. Laos has excellent prices on articles such as whiskey, rum, wine, beer ... In Laos clothing and textiles are also very cheap. In Nong Khai at the market along the Mekong River, you can buy beautiful children's clothing made in Laos for $3 to $6 U. S. dollars - the same clothing that in the USA would cost $20 to $40. The little girl's outfits were exceptionally cute.
Our trip up to Nong Khai was interrupted by a Police checkpoint. On average we encounter Police checkpoints 4 times a week. Inside of populated areas, the checkpoints are focused on checking documentation of motorcyclists (typically the young female university or high school students) and giving out fines for not wearing helmets. All people 6 years or older on a motorcycle are supposed to wear a helmet. The fine is 200 baht ($5.88) if you get caught without wearing one. It is like shooting fish in a barrel. Easy and quick money for the police - I can't believe how many people ignore the law. The babies, toddlers, and young children who ride the motorcycles squeezed between older people or standing on the motor scooter running board in front of the driver are exempt from the law. I know that it is only a matter of time before we encounter an accident involving a small child. We have seen many victims and some fatalities involving motorbikes but fortunately none involving small children.
Outside of the populated areas, police checkpoints target truckers who have a reputation of using "yaba" amphetamines, speeders, and spot check of documentation such as driver's licence, vehicle registration and vehicle insurance. Yesterday's random checkpoint was for documentation. Duang's brother's girl friend had an one month expired vehicle registration. She had to go over to the tent that had a desk, chairs and officials to pay a 500 baht fine. She has 10 days to correct the problem or she will be subject to fines once again. She has a receipt, "stay out of jail card" for yesterday's fine to avoid having to pay again within the next 10 day period.
Along the way up to Nong Khai, we passed an Immigration Police Roadblock on the other side of the road heading back to Udonthani. We teased Momma about getting arrested because she didn't have her National Identity card with her. We told her that the Police would think that she was an illegal Lao in Thailand. She started to practice singing the Thai National Anthem so that she would be able to convince the Police if we were stopped. She was joking and we all had a good laugh. Humor is a big part of Isaan culture and Dunag's family is no exception.
We parked the car at a local Wat near the market. Often Wats will rent out parking on their property. As we got out of the car, the Abbott spotted me and started speaking some English. We went into the uboth so that the family could make merit. Part of the merit making was to be sprinkled with water by the Monk. He included me as well as my camera in his blessing. No problem - I had a cloth to quickly wipe it dry. We enjoyed a massive lunch in a market restaurant along the walkway bordering the Mekong River. The river was high due to the rains of the past two months and was running very fast. The boats that were crossing between Laos and Thailand were just about running all out to make progress against the current. After lunch we did some shopping but had to leave early because Duang's brother was feeling some discomfort from his recent stomach surgery. I was ready to go too - too much heat, too much humidity, too many people - I was glad that he flinched first.
On the return to Udonthani, there was no excitement due to road blocks or checkpoints. Duang's brother invited me to join him on a road trip in two months. He will be chartering a bus and the band along with the dancers are going to Chiang Rai to perform. He said that I would be able to take many photographs. I readily agreed - sounds interesting -perhaps I could do a story about it for Rolling Stone magazine - I doubt if anyone has written about a Mahlam Lao/Mahlam Morlam road trip yet.
We got back to Lon's place, Yes he does have a name although few people use it, and we were greeted by some of the other performers who live on the street. They were finishing their lunch and in the middle of drinking their whiskey. I had a "quee", a round Pan Pipe type musical instrument central to Lao music, and gave them some samples of how I was teaching myself to play it. That was all it took. Although I initially declined to join them in drinking, they were persistent and my resolve was weak. I joined them and quickly had a nice cold whiskey and water in my hand. I had met three of the guys before and they knew that I was Lon's falang (foreign) brother-in-law. Two of the other men were introduced as policemen. They were not wearing the top of their uniforms but had their radios, guns and other police items around their waist. Apparently their were on a long "lunch break" and did not want to be conspicuous sitting at the sidewalk cafe drinking while on duty. There were two young girls about 18 years old at the table next to us - obviously new dancers from the neighborhood. The men asked me in English if I liked the young girls. I responded in Thai "Sorry, but I have a Lao wife" they roared with laughter. They were very interested in where I was from, how much money I made when I was in America, did I like Thailand ... It worked out very well - their limited English, my limited Thai and even more limited Lao and the free flowing whiskey. The young dancers seemed entertained by our antics. This definitely made the Police happy. We were soon joined by a motorcycle policeman who had also removed his shirt. He admitted that he was interested in the pretty girls. Time for another toast - I gave it in Lao to their surprise. Duang joined us after awhile and did some translating and let me know that I had to finish my drink because we were leaving.
The guys invited me to join them again someday soon.
It was a nice way to finish a Saturday here in Isaan. they were the type of policemen that I can and actually enjoy dealing with.
One half the way to Nong Khai, "Momma" realized that she did not bring her Thai National ID card so going into Laos was off the agenda. I would not go into Laos on this trip anyhow. I would have to pay $35 for a Lao Visa to enter be it for 1 minute or 30 days. I will wait and pay when we take another holiday in Laos. Thai people who live in Isaan, typically the Lao Loum but not restricted to only them, can enter into Laos without paying or even getting a Visa. There are some restrictions as to length of stay and how far from the border Thais can travel without a Visa but during last year's week long trip to Luang Prabang, we had no problems with Duang not having a Visa - perhaps we were lucky.
Many expats bring their wife or girlfriend to the border crossing at Nong Khai so that the Thais can cross into Laos and shop at the Border Duty Free Shop in Laos. Laos has excellent prices on articles such as whiskey, rum, wine, beer ... In Laos clothing and textiles are also very cheap. In Nong Khai at the market along the Mekong River, you can buy beautiful children's clothing made in Laos for $3 to $6 U. S. dollars - the same clothing that in the USA would cost $20 to $40. The little girl's outfits were exceptionally cute.
Our trip up to Nong Khai was interrupted by a Police checkpoint. On average we encounter Police checkpoints 4 times a week. Inside of populated areas, the checkpoints are focused on checking documentation of motorcyclists (typically the young female university or high school students) and giving out fines for not wearing helmets. All people 6 years or older on a motorcycle are supposed to wear a helmet. The fine is 200 baht ($5.88) if you get caught without wearing one. It is like shooting fish in a barrel. Easy and quick money for the police - I can't believe how many people ignore the law. The babies, toddlers, and young children who ride the motorcycles squeezed between older people or standing on the motor scooter running board in front of the driver are exempt from the law. I know that it is only a matter of time before we encounter an accident involving a small child. We have seen many victims and some fatalities involving motorbikes but fortunately none involving small children.
Outside of the populated areas, police checkpoints target truckers who have a reputation of using "yaba" amphetamines, speeders, and spot check of documentation such as driver's licence, vehicle registration and vehicle insurance. Yesterday's random checkpoint was for documentation. Duang's brother's girl friend had an one month expired vehicle registration. She had to go over to the tent that had a desk, chairs and officials to pay a 500 baht fine. She has 10 days to correct the problem or she will be subject to fines once again. She has a receipt, "stay out of jail card" for yesterday's fine to avoid having to pay again within the next 10 day period.
Along the way up to Nong Khai, we passed an Immigration Police Roadblock on the other side of the road heading back to Udonthani. We teased Momma about getting arrested because she didn't have her National Identity card with her. We told her that the Police would think that she was an illegal Lao in Thailand. She started to practice singing the Thai National Anthem so that she would be able to convince the Police if we were stopped. She was joking and we all had a good laugh. Humor is a big part of Isaan culture and Dunag's family is no exception.
We parked the car at a local Wat near the market. Often Wats will rent out parking on their property. As we got out of the car, the Abbott spotted me and started speaking some English. We went into the uboth so that the family could make merit. Part of the merit making was to be sprinkled with water by the Monk. He included me as well as my camera in his blessing. No problem - I had a cloth to quickly wipe it dry. We enjoyed a massive lunch in a market restaurant along the walkway bordering the Mekong River. The river was high due to the rains of the past two months and was running very fast. The boats that were crossing between Laos and Thailand were just about running all out to make progress against the current. After lunch we did some shopping but had to leave early because Duang's brother was feeling some discomfort from his recent stomach surgery. I was ready to go too - too much heat, too much humidity, too many people - I was glad that he flinched first.On the return to Udonthani, there was no excitement due to road blocks or checkpoints. Duang's brother invited me to join him on a road trip in two months. He will be chartering a bus and the band along with the dancers are going to Chiang Rai to perform. He said that I would be able to take many photographs. I readily agreed - sounds interesting -perhaps I could do a story about it for Rolling Stone magazine - I doubt if anyone has written about a Mahlam Lao/Mahlam Morlam road trip yet.
We got back to Lon's place, Yes he does have a name although few people use it, and we were greeted by some of the other performers who live on the street. They were finishing their lunch and in the middle of drinking their whiskey. I had a "quee", a round Pan Pipe type musical instrument central to Lao music, and gave them some samples of how I was teaching myself to play it. That was all it took. Although I initially declined to join them in drinking, they were persistent and my resolve was weak. I joined them and quickly had a nice cold whiskey and water in my hand. I had met three of the guys before and they knew that I was Lon's falang (foreign) brother-in-law. Two of the other men were introduced as policemen. They were not wearing the top of their uniforms but had their radios, guns and other police items around their waist. Apparently their were on a long "lunch break" and did not want to be conspicuous sitting at the sidewalk cafe drinking while on duty. There were two young girls about 18 years old at the table next to us - obviously new dancers from the neighborhood. The men asked me in English if I liked the young girls. I responded in Thai "Sorry, but I have a Lao wife" they roared with laughter. They were very interested in where I was from, how much money I made when I was in America, did I like Thailand ... It worked out very well - their limited English, my limited Thai and even more limited Lao and the free flowing whiskey. The young dancers seemed entertained by our antics. This definitely made the Police happy. We were soon joined by a motorcycle policeman who had also removed his shirt. He admitted that he was interested in the pretty girls. Time for another toast - I gave it in Lao to their surprise. Duang joined us after awhile and did some translating and let me know that I had to finish my drink because we were leaving.
The guys invited me to join them again someday soon.
It was a nice way to finish a Saturday here in Isaan. they were the type of policemen that I can and actually enjoy dealing with.
Wednesday, September 9, 2009
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.
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.
Saturday, September 5, 2009
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.
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.
Wednesday, September 2, 2009
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.
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.
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