wilcopops

Part of the confusion is that when people talk about blood tests for dengue they refer to more than one thing.

Anyone with dengue-like symptoms will have a complete blood count which measures the red and white cells and platlets. Among other things, this is necessary to rule out a bacterial infection.

In dengue, despite high fever, the white count is not elevated and in fact is usually a little low. The platlets may also be on the low side of normal initially. So a CBC with a slightly low WBC and platlets is typical of dengue and together with the clinical picture (and if necessary a negative malaria test -- needed only if the person has been in an endemic area) are sufficient to diagnose probable dengue and this is in fact all that is usually done. Then thereafter the platlet count is monitored as it may drop to a dangerous level.

Any laboratory can do the above, and the results will directly guide clinical management.

The other type of testing is serology, checking for antibodies to the various strains of dengue. Not all laboratories have this capability, and the antibodies take time to form. While some people will have measurable antibodies earlier, it is usually 5-7 days before they are detectable, hence a negative result in the first week doesn't mean anything and the test would need to be repeated later. The test is thus of no real help in the clinical management of an individual patient, which together with the fact that not all labs have the capacity to do it, is why it is not always done.

There are in existence other tests which measure the actual presence of the virus and thus are both more accurate and positive earlier but these are extremely expensive and very few labs have the ability to do them.

"Any laboratory can do the above, and the results will directly guide clinical management."

THere is a chain here and my contention is that the chain is only as strong as its weakest link.

first the Doc has to decide to do the right test at the right time and carry out the blood sample or whatever.

THen the sample has to be stored and transported correctly to where it has to be handled and tested appropriately.

Then the results - if they are correct and unadulterated have to be returned to the Doc in question (or may be a colleague on duty) who then has to decide the correct clinical management.

my impression is that in Thailand this chain has an unacceptable number of weak links.

so drunk driver.....what about the boat? Parked where "on the beach"? or was it o the road with no lights on it?

Sorry deleted this post - something is wrong with the reply window.........

So how knowledgeable are Thai doctors about Dengue?

There has been a lot of research into all aspects of Dengue in the last 2 decades so Thai doctors should know about it - but most of them don’t, why? The answer is quite simple.......

For any doctor to keep up to date he has to read IN DEPTH the medical journals and papers published therein....something that very few doctors do in any country, let alone Thailand.

This is a problem that affects not just Dengue but ALL ASPECTS of the Thai medical industry......

The majority of these papers wherever they originate (even Thailand) are published in ENGLISH; the problem for a Thai doctor (alone in his surgery) is that no matter how "good" his conversational English may be, it isn't on average good enough to read the original papers.

So he can do what most doctors do; the medical journals often have summaries or reviews of research posted for doctors and other scientists to get a quick idea of the latest developments - which the doctors can then follow up any aspect that interests them (do you think they often do this?) but of course these articles are, in the vast majority of cases, published in English and are difficult enough to understand even for a native English speaker. So the next step is to read the Thai translation of the English review of the original paper............and anyone who has seen an English into Thai translation of anything will know what sort of standard to expect there!

....and in reality, most doctors don’t even bother to do this - but eve if they do it is unlikely that they will get the whole picture. Information in hospitals and clinics is too often just dispersed by word of mouth (gossip) or picked up from the public media which is notoriously bad at understanding scientific issues surrounding any topic.

Doctors don’t leave the training hospital with an encyclopedic knowledge of all things medical, primarily they have the tools to deal with medical situations as and when they arise - critical thinking to research and understand; their careers should be a constant learning and evolving process.....but sadly it is far to easy for a largely unsupervised doctor to sit back (alone) and take it easy and let the world of medical science slowly leave him behind....especially in Thailand where everything a doctor does or says is regarded as gospel.So how knowledgeable are Thai doctors about Dengue?

There has been a lot of research into all aspects of Dengue in the last 2 decades so Thai doctors should know about it - but most of them don’t, why? The answer is quite simple.......

For any doctor to keep up to date he has to read IN DEPTH the medical journals and papers published therein....something that very few doctors do in any country, let alone Thailand.

This is a problem that affects not just Dengue but ALL ASPECTS of the Thai medical industry......

The majority of these papers wherever they originate (even Thailand) are published in ENGLISH; the problem for a Thai doctor (alone in his surgery) is that no matter how "good" his conversational English may be, it isn't on average good enough to read the original papers.

So he can do what most doctors do; the medical journals often have summaries or reviews of research posted for doctors and other scientists to get a quick idea of the latest developments - which the doctors can then follow up any aspect that interests them (do you think they often do this?) but of course these articles are, in the vast majority of cases, published in English and are difficult enough to understand even for a native English speaker. So the next step is to read the Thai translation of the English review of the original paper............and anyone who has seen an English into Thai translation of anything will know what sort of standard to expect there!

....and in reality, most doctors don’t even bother to do this - but eve if they do it is unlikely that they will get the whole picture. Information in hospitals and clinics is too often just dispersed by word of mouth (gossip) or picked up from the public media which is notoriously bad at understanding scientific issues surrounding any topic.

Doctors don’t leave the training hospital with an encyclopedic knowledge of all things medical, primarily they have the tools to deal with medical situations as and when they arise - critical thinking to research and understand; their careers should be a constant learning and evolving process.....but sadly it is far to easy for a largely unsupervised doctor to sit back (alone) and take it easy and let the world of medical science slowly leave him behind....especially in Thailand where everything a doctor does or says is regarded as gospel.

Dengue doesn't show up in test till after 2 days I believe. They can do a simple tournique test, cut/limit the blood flow for 5 minutes, to see if you will show red spots, which would indicate dengue. That can be done in an earlier stage.

I"m reliably told that the period is in fact 4 days and there is more than one test for Dengue. But 4 days after WHAT?? - first signs, the bite itself? I'm not clear on this. As I'm not the tester it isn't important for me to know, but for the doctor, it is and frequently they simply don't know.

BUT - this isn't the point I'm trying to make - the point is that doctors and technicians cannot be relied on to carry out the tests correctly and then diagnose the results- also test results are usually given a Percentage" to indicate the likelihood of accuracy......

We alreadty have one example of someone who was tested and told they DIDN"T have the disease...because the type of test was carried out too rely - a later test showed the person did in fact have Dengue. (As I said this kind of basic incompetence is not restricted to Dengue alone)

I have great reservations about testing , especially in Thailand as it seems to be largely a hit or miss affair - especially the "multiple testing" where things are treated like a sausage factory and the results can be wrong, inaccurate and finally misinterpreted.

I'd recommend if you need a blood test you chose a test for a specific thing (e.g. Dengue) and closely monitor where it goes and what sort of tests are made and by who.) If you are not completely convinced go to a completely different place and get a second opinion - making sure they aren't using the same lab service.

It's not just Dengue testing that is carried out incorrectly - some of the mistakes I've come across quite frankly defy belief, they are so elementary.

Thailand's version of English is only available , understood (maybe) and taught in Thailand, outside of the Kingdom the disciples of this form of English will be found wanting. Thai English teachers dont understand it or how to teach it effectively, like many of the foreign teachers, they try try to teach a version to Thai standards.

What they dont understand is that to teach English you first have to teach English English and you have to think like an English person to understand it, applying the Thai culture to English does not work which is why there will be a big surprise in the new year when Asean kicks off.

What do you mean by "English English"????? there are many sub-strains of the English language

Can someone tell me what they mean by "bloodwork"?

Today I was diagnosed with DF. It's really strange because I first came down with the flu like symptoms on Wednesday, by Sunday the fever had gone and on Monday I was able to go out again,.

Then on Monday night it all blew up again, high fever this time with large blotches all over my body and aching eyeballs, so my wife took me to hospital. They conducted blood tests which showed the presence of DF, but in a mild form, thus I was not admitted for now, just given meds and sent on my way,

What really surprised me was the fact that it seemed to go away and then come back...really weird.

When you say "diagnosed" - what do they mean "mild form"?....only a small presence of antibodies? this was a blood test done at the right time?

Graphs, figures, stats - lots of people who know everything but understand nothing.

is it OK to press the "like" button on TV?...or is that illegal too?

...if everyone sent an email to the policeman saying they liked him at rthe same time, what effect would that have on his inbox/website?

Silly me! Here I was thinking that Neanderthal were a thing of the past.

Or perhaps the Missing Link isn't really missing after all, but living, breathing and (very scary thought), breeding in Thailand.

We don't have to go back nearly as far -- this is Stalinism or the teachings of Chairman Moa or [even closer to home & present time] the Khmer Rouge. Now it really is becoming scary!!

Pleae - don't insult Neanderthals!

So if he "accepted" a a seditious that means he approves of its content?? How about a suspicious parcel? - them seems to be a flaw in this logic.

Yes if she was a bar-girl...or no, if she was a cashier, funny how many were cashiers.....or of course like Lez Dawson they were overwhelmed by your good looks and married for lust........

now on to next stupid question..................

Pretty fit guy - well done!

Guide to good health read the "alternative" posts - do the opposite.

UPDATE:

According to a taxi driver, who served in the Royal Thai Navy and speaks perfect English(!), the seafood in BKK comes from south Thailand. He said for BKK seafood, nothing to worry about.

However, for Chonburi and Pattaya, he said a big part of the seafood comes from Rayong area.

Now you know (at least a little more than you did yesterday).

Now we know what a taxidriver is REPORTED to have said to a TV member...............

It's amazing that Thais escape world wide coverage of this devastating and global scale environmental damage and risk. Given that Thai seafood is a big export it is bewildering that there is little if any coverage of high probability of Thai shrimp and tuna contamination. The US and Europe should be watching this and stop Thai imports of seafood for a year.

Thais were all ecstatic when Katrina brought New Orleans shrimping to a standstill. It was touted as a boom for Thai shrimp. Now we'll see what goes around comes around. It's a certainty that the Japanese won't be importing too much Thai shrimp for a while. The Japanese watch these contamination issues closely.

The overwhelming majority of Thai shrimp exports is from farmed product. The oil incident is irrelevant to exported product.

THe entire coast of Rayong has some forms of fish industry - whether it is inshore farming or offshore fishing...rayong has a large fishing fleet and there are fish processing and fish sauce plants all along many beaches - i would be very surprised if the impact isn't felt there.......if the farms are using pumped seawater then there will be problems.....not just for the locals but for the reputation of Thai seafood in general.

Ditto for every other part of Thailand too?

In most countries they don't notify, they ask permission and are frequently told to s-off.

Consumers advised to cook seafood thoroughly at a high temperature

Cook seafood 'thoroughly' ?!

Cooking will kill bacteria, but I doubt if the heat of cooking will radically change any other contaminents.

Relax alt=thumbsup.gif width=25 height=19> , I included disclaimer early on. ~Line 6.

That's based on what I read, I don't really know <deleted> I'm talking about re: local salaries.

I know private school and university wages in .au from family, but it's like comparing a hose to a donut.

I work in a completely different industry, so I just know what I people tell me, or I read about.

RE: Comparing favourably

http://www.seek.com.au/

so ~$40-50 - 70-100 AUD / hour for English tuition/training.

1000 - 3000 baht / hour.

A basic teaching job, at 30kaud/year = 70k baht/month.

What are the rates here like ?

My understanding was that 30 - 60k/month was average for full time teacher.

I would also have to disagree with your self assessment of your communication abilities if the image of Thailand that you describe above is the one you intended.

Noted.

Interested to hear what image I've described that you take issue with, as , criticism aside, it's fundamentally positive.

That's why I live here

I'm afraid your perceptions are wrong - You don't seem to understand the difference between a curriculum trained teacher and TEFL - you're comparing apples and oranges.

I have business with schools in Europe , Oz and Asia and at the rates offered TEFL teachers are remarkably the same. In Oz a state licenced/trained teacher may command a higher wage - there is in fact little or no market for non-australian teachers in Oz except gap-year candidates. Many countries such as US, India etc have enough native English speaking teachers. I UK - private schools employ TEFL teachers at about the same rates as Thailand. Spain and Italy, Eastern Europe are the same - they rely largely on young graduates who want a job for a year or two. If people turn the job into a career then the wages increase.

Comparing and hourly wage and monthly wage is of course just daft. Some teachers in TEFL are paid by the hour others receive a salary and benefits. (Thailand is very poor for offering foreign teachers benefits outside the govt school system). Hourly rates vary on where and who they teach. However if you just look at the number of lessons a teacher takes at a school the hours a full-time teacher is actually teaching are very low.

in sme countries in mainstream teaching the unions over the years have carved out some vey good deals - whereby a teacher eve if paid by the hour receives a monthly salary that reflects the real time spent at the school in preparing lessons and admin etc. TEFL teachers outside government systems are rarely covered by these sort of agreements.

THere is also the cost of living to take into account. many countries that employ TEFL teachers have a relatively low cost of living and teachers can actually save money once they have established themselves.

I'd also question whether salaries offered are the deciding factor in those seeking employment -many teachers give up much higher paid jobs for the opportunity to live in a different country, climate or culture.

English in any country is not just taught at government schools - in fact I know of no country that doesn't also have a TEFL industry that is outside the regular school system - in country those wishing to learn English will go to a private Language School - as a product it has to be one of the US and UK's biggest invisible exports.

thailand's BIG problem is that it's laws governing those wishing either to teach or set up a school here are FAR TOO RESTRICTIVE or just absurd. Having more rational regulations in place will not open the floodgates to "bad teachers" but will allow those expert in TEFL to set up profitable schools that employ high quality teachers - and to judge by the level of TEFL salaries worldwide without any significant change in cost to the customer.

+1 on large classes not helping.

Ideal class size is ~18, 30 maximum.

I doubt the crap wages and long hours would attract good overseas talent.

$2-3k/month? That's a low wage for teacher by any standard.

Private schools in Aus pay 60-80 for top level teachers, I'd imagine 40? for someone fairly fresh.

That's based on what I read, I don't really know <deleted> I'm talking about re: local salaries.

The inability to affect the teaching environment, course materials etc, would be very frustrating too.

Teaching types generally give a shit, and really do want to help their students.

Years ago, I tutored my Japanese housemate, so he could pass TOEFL and get Aussie visa. Took us about 5 months.

Being Japanese, He would listen to lessons on his ipod all day in the kitchen, then come home and we'd talk for a while.

Actually wanting to learn the language is the most important thing. A lot of time is probably wasted on students who could be learning something

they'll put to use, than borked pigeon anglish.

Thais aren't inherently stupid or unable to learn the language. I think it's just a limited world view, and no incentive.

It's hard to blame people for having a limited world view when that's all they've been taught or exposed to.

Look at television.. Westen movies are completely dubbed, complete with stupid comedy noises.

Why not subtitles?????????? (and why the same 2 guys for everything 55555)

(many) Thais aren't very good at communication, period. I've traveled the world and been able to communicate with people I didn't share a language with, so I'm not sure what the malfunction is here.

That being said... there is a conspiracy among taxi drivers here to get me where I want to go... it's awesome.

If hordes of eloquent migrants start taking Thai jobs, I think the standard of English will improve quite quickly.

That, or they'll execute them for spreading rumors about colonialism and causing the yaba problem

Here is somone voicing opinions without knowing the facts - TEFL teachers are employed all over the world and Thailand's wages actually compare quite favourably. They are not to be confused with general curriculum teachers in other countries.

I would also have to disagree with your self assessment of your communication abilities if the image of Thailand that you describe above is the one you intended.