kelts

kelts, so good to learn that your family may have found a good outcome.  It's wonderful that the local hospital is working with your family in having a nurse come to visit Ma twice daily to administer medications and monitor her behavior.  This can work since she doesn't have a history of substance abuse and presumably will otherwise take care of herself, as in eating good meals, getting enough sleep, etc.  The price quoted is less than 300 baht per day for two daily visits, which is quite realistic for the attention of a certified nurse.  

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‘It’s my Thai translation of the information given. I’ll send the original Thai script/ language info tomorrow.


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BoonSiliployyada Nursing Home
Chiang Khan
Khun Gulaab
098-210-7846

086-965-6237


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After many trips to Loei and back, we seem to have found a solution.
We spoke to the nursing home based in Chiang Khan at length, and they needed to speak to the nurse in charge to ensure that they were equipped to deal with Ma, and her behavior. This is a standard response, but for good reason. After talking to the nurse yesterday, she was hesitant to recommend this particular nursing home, solely based on Ma’s condition and her inclination to want to go home. This nursing home offers a lot of services, but security, or preventing patients from leaving isn’t one of them. This may be helpful to others though, I will include contact details at the end of the post. The nurse indicated there may be similar services in Udon.
At the end of the day, we want what is best for Ma, and that is to be comfortable and have a chance at happiness in society. Ideally.
This may or may not workout but this afternoon we came to an arrangement with the local village hospital for support.
8000B a month for a nurse to be in charge of her medication, which includes them holding it, bringing it over twice a day, ensuring she takes it, and monitoring her behavior. This could be a great outcome for Ma, as she truly values her home and garden, mango trees, bananas, chili’s, and other vegetables I can’t pronounce or recognize.
We’ll give it a shot, it’d be amazing to see her enjoying life once again.
I’ll keep you posted, and I’ll monitor any questions on mental health or anything else I may be able to help with. I owe this forum a great debt. Thank you all for your input, especially Sheryl and Nancy, and hopefully this thread helps someone in the future. Many thanks.


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Kelts, I hope your wife's brother can come to understand that it was your mother's illness that made her act the way she did and not any personal feelings she had towards him.  Sadly, this is very difficult for family members to forgive and try to move on in rebuilding their relationship with the person undergoing treatment.  If they can, it can go a long way to reinforce the necessity for Ma to stay on her medications, for them to praise her and comment on how much better she is acting and behaving.  To smile, engage her and give her positive reinforcement.  

Thanks Nancy. Yep, you’re right. I’m sitting in a sala right now with Ma and the family. They wouldn’t let her out to see us on Saturday as they thought she might be difficult to get back in. Now that my wife’s brother and Grandad are here it’s ok for her to be out in the grounds. She seems a bit agitated today, but my wife’s brother is also acting aloof. It may take a while longer to repair some rifts I suppose. Thanks for all your help again, I’ll let you know what I can find out about the nursing home.


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Sorry for the absence, it’s been hectic! We visited Ma yesterday morning on the way back to Chaiwan, which gave us a better insight into the facility and a gauge on how Ma would receive us. It’s pretty positive. The facility seems under staffed and under pressure but not as much as Chaiwan or Udon, and I suppose this is a global problem. Ma was really happy to see us, which was a major relief after spending her first night incarcerated (for want of a better term). We only got a few minutes with her, through a small window, big enough to hold hands, not big enough to embrace. Despite the lack of time and contact, I felt it was positive, but possibly in a really sad way. I will explain. The other in-mates (again for want of a better word) seemed amazed that we had come to visit or that there were visitors at all. Ma was positively beaming at the attention and I suppose they wouldn’t get a lot of farang in these parts, and I do stand out a bit, at over 6’4”, 110 kg and long dreadlocks. Just painting the picture as most of you would be used to the unabashed staring you receive when entering a small town or village. ; )
The sad part was the other in-mates racing to the window asking us to call their relatives. Screaming ‘please help me’ in English. Yelling out phone numbers in the hope we’d call someone for them. I don’t know what I was expecting but this was disturbing and so, so sad. Nancy, I’m sure you’ve probably experienced a lot like this, and thank god for people like you! I respect this so much. [emoji1317]

So, the reunion went well, and we promised to return with Nat, (my wife’s brother) and Grandad. A 3 and a half hour drive home, and that was yesterday done.
I’d like to backtrack to some of the aforementioned pitfalls. Just because we had a referral did not mean guaranteed admittance for Ma. It depends on their occupancy at the time, and the doctors opinion on the urgency.
Because my mother in law is obviously female, and past middle age, this is seen as less of a threat to society. We did not end up engaging the police, as on the morning of departure we were able to connect with Ma enough for her to agree to come without the need.
I was regretting this when her potential admission was still up in the air, and police van after van kept arriving dropping off patients. We had a envelope with cash ready to draw at any given moment, which we did do, somewhat prematurely with the officiating nurse. Her matronly response was gold, as she looked down her nose and uttered, “it is not up to me. It’s up to the doctor.”
We never did need that envelope, and Ma is now secure for 2-4 weeks. 2 weeks is standard, 4 weeks is maximum. I’m taking my wife, Nat and Grandad back to Loei first thing in the morning to visit Ma. We’ll stay overnight in Chiangkhan, and visit her again on our way back home. There are still lots of questions and we haven’t checked out the nursing home as yet, but will certainly do so in the coming days. Thanks again for all your support, and I’ll have another update on our return to Chaiwan on Tuesday evening.



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Update:
Sorry for the short post, but I’m rooted.
However, it appears we’ve made some substantial progress. Ma is now an in-patient at Loei Psychiatric Hospital. My wife and I are now on the banks of the Mekong at Chiangkhan, which is beautiful. But not all pleasure,there is apparently a nursing home here that takes patients like Ma full time, ongoing, that we’re going to have a look at tomorrow, before going to visit Ma in the morning. I’ll have a full update tomorrow, because it’s needed. We still traversed many a pitfall today and for those reading down the track it’s worth the dialogue. Thanks.
Kelts


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kelts, I've been thinking about you today as I go about my day, much of which was involved in tasks assisting an older expat who is in the mental hospital in Chiang Mai, doing much, much better than he had been three weeks ago.
 
Please don't beat yourself up thinking that you hope she'll "forgive" you for what you're doing in the future.  You're doing the right thing for her, to help control her illness.  It's a rare mentally ill person who thinks it's a good idea for them to be treated when they're in the midst of an out-of-control experience. 
 
One of the goals of psychiatric treatment is for the patient to develop "insight" into their condition and understand why they have to continue to take their medications.  Sadly, this often doesn't happen, but when it does, it's a beautiful thing to have someone you helped who initially was very resistant to treatment return when well and thank you for being willing to intervene when they were out-of-control.   

Update:
There was a change of plans this morning. Ma is still not cooperating, basically telling us to stop talking cause she’s not going anywhere. We went to the police station and after a couple of hours and just as we were leaving to get her to take her to Khon Kaen, the police decided Loei would be better as “they’ll keep her for longer”. Therefore, another hours drive to Udon Hospital a few hours wait we get the referral to Loei Hospital. The very same referral we declined yesterday. Doh!
We rang the police on the way home and they said, quite rightly, it’s a bit late to be heading from Chaiwan to Loei and back now. If Ma is still adamant she’s not going to the hospital in the morning, we pick up 2 officers to sit next to her in the back seat whilst I drive the 3 hours to Loei. I don’t imagine this will be pleasant trip but we have to do whatever is needed to get her the help she needs. It’s really sad, and I only hope that she can forgive us in the future. Sheryl, would you have any info or insight into the facility at Loei?
Thanks so much.



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10,000 baht is probably what the hospital would ask for an initial deposit.  This is the standard request of the gov't hospital in Chiang Mai.  The hospital at KK should be very able to supply a chart of their costs.  If it's anything like the gov't hospital in Chiang Mai, it's really very reasonable for Thai people.  Sadly, Suan Prung in Chiang Mai instituted dual pricing several years ago for foreigners for their room rates, but at least the medications are still at gov't rates.  It's very possible that Ma could have very good improvement with just a couple weeks hospital stay.  There are modern antipsychotic meds that can be injected monthly for people who have a history of compliance in taking medications.   But first, she has to be treated inpatient with oral meds and observed to see what med is appropriate and at what dose.  

Hello, Kelts!
Unfortunately, I cannot give you any advice because I don't live in Thailand, but I just want to wish you lots of patience:heart_001: 
My grandmother has the same problems, so I know how hard it is. 

It's my understanding that the referring hospital pays the costs at the upper level hospital.  I could be wrong and Sheryl would have a better understanding of how this works.  But, it's fairly common for Thai people who are fed up with delays and problems in getting referrals to "self-refer" and pay for treatment at higher level hospitals, like the one associated with Chiang Mai University rather than waiting and dealing with their local hospital to make the referral, or worse yet decide they're capable of providing the service.  
 
Sometimes it's better to pay out-of-pocket to have bright, young residents under the watchful eye of professors providing the treatment at a university hospital, with skilled, mature caring nurses (who delight in teaching the young pups a thing or two) than receive treatment at a local hospital where the standards of hygiene may be sketchy, the nurses indifferent or overworked and the doctors straight out of medical school without any proper mentors.   

The medical system, especially in the north and northeast is under tremendous cost pressure.  You yourself said it in post #8 that if they gave a referral it would be taking money away from the local hospital.  They'd be the ones paying for her care in the higher level hospital if they gave a referral.  They're hoping that since there's a foreigner in the family, you'll simply give up and pay for her treatment out of your own pocket.

Well, we’re heading to KK tomorrow, as we’re out of options. I’ll look into this, and Sheryl has recommended a Dr in an earlier post that is an after hours clinic. To be honest, I’m not leaving KK until something happens. It can’t go on. My wife and I can’t fly back to Australia hoping it will fix itself. It’s already emotionally tragic, but it’s literally a disaster waiting to happen. I really appreciate the input guys.


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Thanks Nancy. I agree. In a western country we’d be crying gross negligence. However in Thailand, expats cry T.I.T. This is Thailand. Sadly, I was one of these when I lived in Samui for 5 years. But for the sake of improving the system especially for the Thai people, instances like these must be documented/reported. I’m in rural North Eastern Thailand trying to get help for my mother in law, and for the life of me I cannot see what agenda any medical professional could have that would make them do anything other than try to help.


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So, we’re back to square one. After arriving at the hospital, I went to park the car about 2 kms away. By the time I got back my wife was frantically searching for Ma. She had turned around to fill out the paperwork and Ma disappeared. We alerted security, together we went up and down the street, searching the shores of the nearby lake to no avail. After over an hour, we were advised to go to the police and report her missing. By the time we got there the hospital rang, she had been found in the temple. No damage to this one. We returned to the hospital and after a couple of hours wait Ma started kicking off, we were fast tracked to the doctor and he advised changing medication and come back in 2 months. We sat there while Ma told him she hears voices but can’t see them or find them. We explained to him the whole situation, the history, the recent arrest, her refusal to take any medication at all! By this time Ma is yelling, screaming and security are called to escort us to a different area so she can be given a sedative injection to calm her down. We are then sent home. I just endured 45 minutes of her screaming and smashing the seats and windows of the car interior until she nodded off. We are back home now and she seems calmer but is now completely uncooperative and still agitated. All we seem to have done today is turned her against us by ‘kicking the hornets nest’.
The Udon Hospital also wouldn’t give us a referral to KK, only offering a referral to Loei, which a lot further from the village, and highly impractical for relatives to be able to visit her. They told us the hospital at Khon Kaen is a different system and they could not refer us there.? We plan on heading there tomorrow regardless as we don’t have any options. We may need the police to force her to go and possibly actually take her there with us, as she is now not cooperating (the police have said they will do this if needed).
I’m not sure what we’re in for tomorrow, and again any more advice would be greatly appreciated. Thanks so much.


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Ok. Thanks Sheryl. We’re at Udon Hospital now. I’ll know more shortly. Thanks again


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Hi Sheryl,
We are in Chaiwan now. We went to the local hospital to try to get a referral to the psych hospital in KK. They flat out refused, and initially wouldn’t refer her anywhere, saying we’re taking money away from the local hospital.
It appears we will now get a referral to Udon hospital, not sure what will happen next. Any advice would be most appreciated. Thank you


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Thanks again Sheryl. I don't want to keep hassling you, and we will try to get there asap. After just talking to my wife, she remembers her mum having to spend 3 months in a mental hospital when she was about 10 years old. So, 20 years ago. And she currently doesn't take any medication or seek treatment. Hopefully, after being arrested she will agree that help is needed! I'll let you know how we go. Thank you so much

Ok. Thanks Sheryl. Would you still recommend starting with Dr. Pongsatorn Paholpak? The village is Chaiwan, about 2 hours from Khon Kaen, so it's not that much further than Udon.  But it sounds as if it may be more equipped for psychiatric issues?

Sheryl, you are an amazing human for taking the time to respond. I cannot thank you enough!

She is 54 years old. I can attest to the last 10 years of mental instability, however, it appears it started 10 years  or more before that.

My wife is 30, and she has always known her mum isn't quite right, and even mum will admit that. So, it could be 20-30 years or more. This may have always been there. There is certainly no drugs or alcohol involved. She does not drink, never has, and in a small village substance abuse would be common knowledge, if that were the case.

We will fly over in the coming days and get her down to Khon Kaen somehow, but that's another issue.

How do we get her there?

I highly doubt that she will meekly agree to a road trip to Khon Kaen. Whilst she acknowledges that she's not quite right, she vehemently refuses to seek treatment and any mention usually results in a screaming tantrum. She believes the entire family conspires against her and every movement, visit to other relatives, gestures, conversations, it's all taken as a conspiracy against her. She clearly loves and misses her kids, and she can be lovely for short periods of time but she's constantly haunted/troubled by her own thoughts. It's like self sabotage, she craves love and attention from her children/family and drives them away with crazy insecurities. I feel soooo sorry for her, this is no way for anyone to live.

Thank you so much for your advice!!! We now have somewhere to start, and I'll keep this updated as we progress.

Much love and respect,

Kelts