Good OB-GYN in Surin?

[Lorry]

27 y.o. gave birth (first time) 7 months ago,  had an infection afterwards that needed operation (done at Surin Hospital).  Now, when she passes stool part of the stool comes out of the vagina (so there is a fistula).

She will need another operation and I was asked if I can recommend a good doctor. But I have no idea. 

I don't know her personally, but the major private hospitals in Bangkok or Korat are no option.

[Sheryl]

She probably needs a colorectal surgeon, not an OB-Gyn. Rectovaginal fistula repair is rather complicated.

 

To have this done free under the government health system she needs to have it done at either Surin Hospital (which is presumably where she has been told she needs the surgery) or another hospital they refer her to. (This is assuming she is registered at Surin Hospital under either Social Security or the so-called "gold card"/"30 baht" scheme.) Odds are they woudl refer her given the complexity of the matter.

 

I cannot give the name of any doctors at Surin Hospital but it is a Regional level facility which means they have some senior doctors on staff. Most government hospitals have an :"after hours" option whereby one can directly see a senior doctor.  She could try showing up around 3 PM and asking to see an OB-GYN acharn through the "clinic nawk wela". When doing this she has to pay for the consultation (usually about 250 baht) and may have to pay something for the surgery as well but just what is additional to what government system covers.

 

Or, for the very best care, she could go directly to Siriraj Hospital in Bangkok (leading government teaching hospital). Unless she goes through the costly private channel she won't have a choice of doctor, bu there are several there (in the Surgery dept, not OB-GYB)  in supervisory capacity with expertise in repair of recto-vaginal fistula, including Prof. Vahrut Lohsiriwat  and Prof. Romyen Jitmungngan.

 

It sometimes works to get a letter from the tertiary hospital willing and able to do the repair addressed to the hospital which needs to refer her, to get a referral letter issued.  In other words, she might go to Siriraj first, then once she has seen doctors able to do the repair (again, she should anticipate being sent doctor to doctor first) and gotten a cost estimate for self-pay, see if they would be willing ti send a letter to her home hospital asking them to refer.

 

The complexity of the repair will depend on how high up the fistula is.

 

If there is any infection present that has to be treated first.

[Lorry]

Thanks a lot for the explanations. 

Can she just show up at the non-private arm of Siriraj as an outpatient?

Her house registration is in Surin - would she be refused treatment or made to pay?

I remember Thais whose house registration was upcountry going to Chula, it didn't cost much if anything at all.  But that was 10 - 15 years ago.

[Sheryl]

43 minutes ago, Lorry said:

Thanks a lot for the explanations. 

Can she just show up at the non-private arm of Siriraj as an outpatient?

Her house registration is in Surin - would she be refused treatment or made to pay?

I remember Thais whose house registration was upcountry going to Chula, it didn't cost much if anything at all.  But that was 10 - 15 years ago.

She can just show up at the outpatient surgery clinic . Should arrive early to get in the queue.

 

As explained, unless she has a referral from Surin she will have to pay full fee. Costs are not high especially for outpatient care. She'll get an estimate on cost if surgery. My suggestion is that she try to get a referral from Surin. If it proves hard to get initially could then try to see if Siriraj would send a letter  asking them to refer. 

[Lorry]

Thank you,  i explained it to their family

[Sheryl]

12 hours ago, Lorry said:

Thank you,  i explained it to their family

I should add that this type of repair is a bit complicated and the skill of the surgeon counts for quite a lot in terms of outcome, which she will live with for the rest of her life. 

 

Unlike say an appendectomy, this is not something I would personally want to have at even a regional level hospital in the provinces -- the doctors performing it (who will include interns in training) will just not have had much experience, in fact for some it may be their first such repair.

 

It is worth taking trouble/travelling to get the best.

[Lorry]

8 hours ago, Sheryl said:

I should add that this type of repair is a bit complicated and the skill of the surgeon counts for quite a lot in terms of outcome, which she will live with for the rest of her life. 

 

Unlike say an appendectomy, this is not something I would personally want to have at even a regional level hospital in the provinces -- the doctors performing it (who will include interns in training) will just not have had much experience, in fact for some it may be their first such repair.

 

It is worth taking trouble/travelling to get the best.

I agree and nudged them into this direction. 

She just finished covid (pretty much everyone in their village is having covid) and will see the doctor next week.

It won't be easy for her to go to Bangkok because of her 7-months old child, but i think it can be done. 

[Lorry]

Update: she was referred to the surgeon in Surin Hospital, they did a CT or MRI (I forgot), and then the surgeon told her he couldn't see anything in the pictures. All of this took many weeks.

She was then referred to the university hospital in Khonkaen and got an appointment last week.

The surgeon in Khonkaen scolded her, why the surgeon in Surin made the appointment in Khonkaen so late?

Then the surgeon in Khonkaen gave her a new appointment next year (not kidding).

 

Vagina is getting itchy, but even her friends who are farmers tell her that cleaning or medicating the vagina won't help much. She needs to have the fistula operated. 

 

I keep suggesting going to Bangkok,  but I am just a friend of friends

 

 

[Sheryl]

There are long waits now in goivt hospitals for everything but emergency surgery due to backlogs from COVID (all non-emergency surgeries were deferred for quite some time).  It might not be any quicker in Bangkok unless she went to a private hospital and that would be quite costly.

 

KKU Hospital is a good facility.

[Lorry]

34 minutes ago, Sheryl said:

KKU Hospital is a good facility

I know but was shocked about the delay.

The backlog from covid explains it.