Law Regarding Infectious Diseases In Thailand?

[Neole]

My friend with a foreign passport is admitted in a hospital in Korat with tuberculosis. He is fit to leave hospital but hospital says he is still infectious so they dont want to let him go. They say if he going to a hotel they will have to inform the hotel ( which might mean the hotel wont permit him to stay ) and he cant go on standard flight to his country.

They are running up a big bill everyday and say it might take a month to be non infectious.

Does anyone know the law regarding this? If he cant afford to pay the hospital are they obliged to keep him till he is non infectious?

[ExpatJ]

They cant legally force him to stay. so once he's out of the hospital he can stay in a rented house or in a hotel. He will not be able to fly if the airlines know plus he should not fly- if he infects others on a flight while knowingly having infectious TB he would likely be traced and then be screwed through criminal and civil lawsuits.

[afarang]

T.B. Is a serious problem in Thailand. I live near the border with Cambodia. It is rife here. The Amphur where I live has over 200 cases ,at any one time.. I have just recovered from T.B.. They found it only because I had Pneumonia. Is your friend in a Government hospital or a private hospital? If in a private ,get him out PRONTO. They can charge like wounded bulls. So, I was admitted to a Govt. Hosp. ,It took 6 days for me to recover from Pneumonia. I was discharged then. No mention of my staying any longer, because of T.B.. However , the treatment program is of 6 MONTHS duration,ALCOHOL free,I might add). The first 2 months ,are a collection of 4 drugs in 1 HORSE PILL. Huge ,they were .Difficult to swallow, I can tell you-awful. Then it is 4 months of capsules ,which slide down real easy.At the end you must have an X-ray + submit sputum(phlegm) samples ,collected over 3 days for lab analysis. To prove you are cured. My 6 day stay in the hospital cost me about B 12,000 ,which included everything - bed, food, drugs, x-rays, lab tests ,doctors ,nursing. etc.. Best wishes ,to your friend. Been there ,Done that!!! Tell you what , that first beer went down real well.

[jimbeam1]

Not a nice position to be in. Has he tried contacting his ever caring Embassy. Probably wont want to know, but might help?

I am also sure that the Monks do have rooms at the Temples where those that can't afford medical treatment can stay. They were once pointed out to me by a Thai. Although I would only try that as a last resort. Best of luck to him.

jb1

[afarang]

Not a nice position to be in. Has he tried contacting his ever caring Embassy. Probably wont want to know, but might help?

I am also sure that the Monks do have rooms at the Temples where those that can't afford medical treatment can stay. They were once pointed out to me by a Thai. Although I would only try that as a last resort. Best of luck to him.

jb1

It is a "minor " medical problem .Embassies will be of absolutely no use. And why should they be?.He doesn't need any help from the monks. The treatment provided through the Govt. hospital system is excellent, and very cheap.It does take time, to completely rid yourself of the disease- 6 months. Sorry ,you did not comment on my post ,as one who has been through the mill

Edited September 21, 2011 by afarang

[Mario2008]

Moved to health forum.

[Mario2008]

T.B. Is a serious problem in Thailand. I live near the border with Cambodia. It is rife here. The Amphur where I live has over 200 cases ,at any one time.. I have just recovered from T.B.. They found it only because I had Pneumonia. Is your friend in a Government hospital or a private hospital? If in a private ,get him out PRONTO. They can charge like wounded bulls. So, I was admitted to a Govt. Hosp. ,It took 6 days for me to recover from Pneumonia. I was discharged then. No mention of my staying any longer, because of T.B.. However , the treatment program is of 6 MONTHS duration,ALCOHOL free,I might add). The first 2 months ,are a collection of 4 drugs in 1 HORSE PILL. Huge ,they were .Difficult to swallow, I can tell you-awful. Then it is 4 months of capsules ,which slide down real easy.At the end you must have an X-ray + submit sputum(phlegm) samples ,collected over 3 days for lab analysis. To prove you are cured. My 6 day stay in the hospital cost me about B 12,000 ,which included everything - bed, food, drugs, x-rays, lab tests ,doctors ,nursing. etc.. Best wishes ,to your friend. Been there ,Done that!!! Tell you what , that first beer went down real well.

There is open and closed TB. Not everyone with TB is automatically infectious. Obviously the OP is and needs to take precautions. If he is fit to leave the hospital but can't travel, a stay at atemple is indeed an option. many temples care for people who are well enough to be released from hospital, but still need some extra care,.

Of course their first line of inquiry would be with their travel insurence/health provider, but it seems they don't have one.

[Neole]

T.B. Is a serious problem in Thailand. I live near the border with Cambodia. It is rife here. The Amphur where I live has over 200 cases ,at any one time.. I have just recovered from T.B.. They found it only because I had Pneumonia. Is your friend in a Government hospital or a private hospital? If in a private ,get him out PRONTO. They can charge like wounded bulls. So, I was admitted to a Govt. Hosp. ,It took 6 days for me to recover from Pneumonia. I was discharged then. No mention of my staying any longer, because of T.B.. However , the treatment program is of 6 MONTHS duration,ALCOHOL free,I might add). The first 2 months ,are a collection of 4 drugs in 1 HORSE PILL. Huge ,they were .Difficult to swallow, I can tell you-awful. Then it is 4 months of capsules ,which slide down real easy.At the end you must have an X-ray + submit sputum(phlegm) samples ,collected over 3 days for lab analysis. To prove you are cured. My 6 day stay in the hospital cost me about B 12,000 ,which included everything - bed, food, drugs, x-rays, lab tests ,doctors ,nursing. etc.. Best wishes ,to your friend. Been there ,Done that!!! Tell you what , that first beer went down real well.

Thanks for the response! 12000 baht?? Here my friend has been billed over a million baht for 30 days stay and the are still not leaving him! I have to say his condition was quite severe for the first week. But i think they made it worse by bronchoscopy and trachel intubation.

Also they keep telling him if they discharge him they have to inform the hotel. My advise to him was to say he will stay at a friends house and then check into a hotel. Should that be ok you think?

[Neole]

T.B. Is a serious problem in Thailand. I live near the border with Cambodia. It is rife here. The Amphur where I live has over 200 cases ,at any one time.. I have just recovered from T.B.. They found it only because I had Pneumonia. Is your friend in a Government hospital or a private hospital? If in a private ,get him out PRONTO. They can charge like wounded bulls. So, I was admitted to a Govt. Hosp. ,It took 6 days for me to recover from Pneumonia. I was discharged then. No mention of my staying any longer, because of T.B.. However , the treatment program is of 6 MONTHS duration,ALCOHOL free,I might add). The first 2 months ,are a collection of 4 drugs in 1 HORSE PILL. Huge ,they were .Difficult to swallow, I can tell you-awful. Then it is 4 months of capsules ,which slide down real easy.At the end you must have an X-ray + submit sputum(phlegm) samples ,collected over 3 days for lab analysis. To prove you are cured. My 6 day stay in the hospital cost me about B 12,000 ,which included everything - bed, food, drugs, x-rays, lab tests ,doctors ,nursing. etc.. Best wishes ,to your friend. Been there ,Done that!!! Tell you what , that first beer went down real well.

There is open and closed TB. Not everyone with TB is automatically infectious. Obviously the OP is and needs to take precautions. If he is fit to leave the hospital but can't travel, a stay at atemple is indeed an option. many temples care for people who are well enough to be released from hospital, but still need some extra care,.

Of course their first line of inquiry would be with their travel insurence/health provider, but it seems they don't have one.

The insurance is handling his bills though partially.

Still my main question is, is there a law prohibiting a person with open tuberculosis to go out in public with a mask?

And what are hotels viewpoints regarding this, would they allow a person with mask to stay?

[Mario2008]

I'm not sure if Thailand has laws to commit someone who spreads a contagious decease, they probaly have, but they do have laws to arrrest and deport a foreigner who is a risk to public safety. (With deportation at ones own expenses).

Your question is formost medical one, as it must be ensured that no other persons are/can be infected and which precautions must be taken to prevent that. Get expert medical advise regarding that.

[zzaa09]

They cant legally force him to stay. so once he's out of the hospital he can stay in a rented house or in a hotel. He will not be able to fly if the airlines know plus he should not fly- if he infects others on a flight while knowingly having infectious TB he would likely be traced and then be screwed through criminal and civil lawsuits.

I'm really surprise that a mandatory quarantine isn't in order, in this case.

As contemporary TB strains have mutated and highly airborne infectious.

The health authorities are acting incredibly criminal.

[Soutpeel]

The insurance is handling his bills though partially.

Still my main question is, is there a law prohibiting a person with open tuberculosis to go out in public with a mask?

And what are hotels viewpoints regarding this, would they allow a person with mask to stay?

Yes there are laws in place and it will be a hospital/doctor who decides what a person can or cannot do

[afarang]

Neole,your friend is obviously in a private hospital. GET HIM OUT of there , and into a Government hospital .Or at least ,get an opinion from a Government hospital. Everything I quoted in my original post was a FACT, Personal experience. When I came out of hospital ,NO demands were made on me . I did , personally decide to wear a mask, when out in public.The doctors did say I was infectious ,when released from hospital. They were not concerned. I don't know how infectious. I was. I suspect that once the treatment starts the level of possibly infecting others drops quite markedly. What drugs is your friend on? Is he taking Rifinah?I think the hospital he is in, is playing a con game.I was discharged ,as soon as i was fit and well enough. Remember, I was NOT in hospital ,because of T.B. I was admitted ,because of Pneumonia. As soon as my Pneumonia was cured -OUTSKI ,after paying . As I said 6 days of treatment , my bill was B 12,000, approx. .I doubt the hospital is being honest with you. As I said, in the Amphur , in which I live ,there is in excess of 200 T.B. patients, They actually have a special T.B.room, with a designated nurse, whose sole job is to supervise T.B.sufferers. The total number of T.B. sufferers in Thailand? I have no idea. If they were all forced to stay in hospital, there would be no room for any other patients. As an aside, Diabetes type 2 is deadly serious, In this very rural Amphur , bordering Cambodia, there are over 800 Diabetes type 2 sufferers.

Edited September 22, 2011 by afarang

[Sheryl]

It does take a month of treatment or more to become noninfectious. Sputum tests will indicate when he no longer is.

If he leaves the hospital while still infectious it is a serious public health threat and the authorities would be well within their rights to take measures accordingly. He would be putting others at risk...most especially if he were to fly.

If he is in a private hospital (as I assume he must be given the reported large bill) they are not under any obligation to treat him without payment. His best option is to transfer to a less expensive hospital. Government hospitals can manage this disease quite well, and even with a private room ("hong piset") are not that expensive.

[Neole]

Thanks for the advise everyone.

The doctor treating him says he can go stay in a hotel and does not even need to wear a mask. She says though hes not completely non infective, tb is common in thailand and thai people have natural immunity to tb and after a month of tb treatment the patient is practically not a threat of infection to anyone.

Yes he is taking Rifinah. I dont think it is a con game as the treatment was essentially for pnumonia and he was quite bad off initially. Even now he needs oxygen.

But right now the hospital supervisor, not the doctor, mentions the infection and that they must inform the hotel if the patient is asking for discharge. Its good that the supervisor does not say that they have to inform thai authorities or immigration authorities.

My friend would love to leave the couuntry but the doctor says though he can leave the hospital, it is entirely unsafe to travel for long distances and she wont allow him to take a flight.

Anyway, tb being so common here, i doubt there is forced quarantine for tb. I would think a mask is all that is required ( and the hospital supervisor also says the same thing ) except for the fact that they must inform the hotel. I have my doubts a hotel would give out a room if a hospital informs them the person is suffering from an infectious disease.

I will ask my friend to follow afarang's advise, as a government hospital would surely know of government rules and follow them. A private hospital cannot be trusted.

Edited September 22, 2011 by Neole

[afarang]

It does take a month of treatment or more to become noninfectious. Sputum tests will indicate when he no longer is.

If he leaves the hospital while still infectious it is a serious public health threat and the authorities would be well within their rights to take measures accordingly. He would be putting others at risk...most especially if he were to fly.

If he is in a private hospital (as I assume he must be given the reported large bill) they are not under any obligation to treat him without payment. His best option is to transfer to a less expensive hospital. Government hospitals can manage this disease quite well, and even with a private room ("hong piset") are not that expensive.

Do you not read other posts? .I was admitted as a Pneumonia patient. Then they discovered I had T.B.as well. I was given Rifinah ,intra venously for 1 week. Then I was discharged.Then I was on the horse pill stage, to complete the first 2 months of Rifinah,at home. Given the huge number of T.B. patients in Thailand, they could NOT keep them all in hospital for 1 month.Your comment starting "If he leaves" is quite incorrect. After his Pneumonia is cured ,if that is what he had, which should take about 6 days,as mine did,he should be discharged, as I was.With pneumonia ,you cannot have a private room( Hong Phiset), as you need to be under nurse supervision 24 hours a day.Especially for the first 3 days ,when the lungs are attempting to get rid of huge amounts of "fluid".The doctors did NOT require me to submit Sputum tests ,until my 4th month of treatment.,Which takes 6 months.As I explained in an earlier post. In my Amphur, there are over 200 T.B. patients ,at any one time. If ALL T.B. patients were required to spend 1 month in hospital ,the hospitals would be "up s**t creek .Too many!!!.Govt.hospitals are superbly placed to treat T.B.They are well-versed in the treatment regimes, which I must say is ,actually very simple. Might I add that I have lived in Thailand ,since 1989 and have NEVER been to a private hospital. I have ONLY used Government hospitals and Clinics.And I am still ALIVE to tell the tale, even though I am now 72 years of age.!!!!!!

[smedly]

is there a vaccine for TB ?

oooops it was the BCG i got when young, so is this now ineffective or are most of the people getting TB these days not vaccinated ? or is this a new strain that make previous vaccination useless.

Edited October 11, 2011 by smedly

[Mario2008]

It is more effective for children than for adults.

http://en.wikipedia.org/wiki/Tuberculosis#Vaccines

In general, most vaccines require booster shots every once in a while in order to keep their protection.

[Sheryl]

BCG has some partial effectiveness in preventing extra-pulmonary TB in children. That's about it, but worth getting for that purpose if one lives in an area with high rates of TB. It will not prevent you from subsequently getting pulmonary TB and it is not advantageous if given after infancy. It does not require a booster.

[thaifamilyguy]

SITUATION we have a Philipina helper that I am rather certain will be diagnosed with Pulmonary TB shorlty, it most likely a reoccurance due to failing to take her drugs years ago. We only came aware of any of this when sent her to Dr after two days of her feeling bad. Luckily she is on an Education visa and not need to leave the country until August so has a window of opportunity here to get started and stablized without that added crisis. FIRST LESSON - Anyone hiring domestic help, ask about potential and demand a chest xray as part of hire!

We are paying for her to be diagnosed at a small international hospital and they appear to be following the proper approach, with confirmation of whether she has it and how bad soon.

I don't know whether to start a new thread or just respond to this one, but I appreciate the moderator being knowledgeable on this and perhaps has new information from when this discussion began. Feel free to edit/move etc. ALL REPLIES COMMENTS APPRECIATED

MY QUESTIONS -

1. It woudl appear the most efficient approach here is that she acccess the public health providers here vs. private hospitals as they are competant to give her the necessary care at this stage. Anyone have experience about this beyond the above discussion that woudl like to share on do's and don'ts?

2. Does anyone know any risks she takes in accessing public system as a foreignor?

3. IS Hospitalization for active TB required, I note the discussion above that people were presenting for other things, but nobody seems to know if its just a bad case of active TB, there would be hospitalization. It would seem to me that it necessary if drugs need to be given by IV, etc.

4. I assume her next obvious step will be to return to the Philipines where TB program is extensive and free to her. HOWEVER - I want to be absolutely sure we have all the information on her condition before she disappears and also all additional tests that the public system may not do (both for her and for us). Does anybody know if the public system goes that far?

COMMENT - I greatly appreciate that point abou the private hospital grabbing ahold of somebody and not letting them go, I am not at all surprised and I am certain that if the guy DIDN'T have the right insurance, he would have been out in a week. Our helper presented herself at an int'l hospital, no insurance adn they have had her coming in each day to give samples and just told her to avoid people, but xray and history/symptoms sceam TB. I am now better prepared for the diagnosis confirmation and "what next"

An entirely separate discussion is on my family's treatment plan as a result of her having TB and for that I feel we have plenty of professional & international resources to sort out. We will be accessing the Int'l hosptial but luckily none of us show any signs of being active, the children all had the vaccine at birth, but we also well aware of the recomendated treatment regimines which we will be following. We also will get further specialized advice outstde of Thailand.

CONSENSUS - children with member of household exposure to active Pulmonary TB person should go on profolactic antibiotic treatment, just accept it, the vaccine not effective against pulmonary and negative skin tests too often false, children under 5 simply not have immune system to fight it as well as older persons. So its not the false postives that are the issue, its the false negatives, particularly in this sort of situation. It sucks, really sucks but especially with the resistant strains around here, TB is a killer.

The SECOND CONSENSUS - appears to be to ensure that the EXACT strain of the TB is identified and this will take MONTHS of cultures (one for ea. avail drug, I believe), the reason being that up to 90% of people never show symptoms of having contracted until a major health event, so could very easily take a drug for 6 months, stop and it not tell you anything. My scenario I am going to run at various experts is, latent TB so take x drug for, hell , a year if nec., but then get result that the TB exposed to is highly resistent to the drug just took. No TB symptoms, gee great, but that not because of any treatment, just lucky on the odds. Then goes active later, THEN tests done, and gee sorry about that, the drug we had you take for a year lulled you into thinking you fine.

[Sheryl]

First of all, has she been coughing? If she has not had a productive cough the risk of infection for the family is much less than if she had.

Secondly, how old are your children? Chemoprophylaxis of asymptomatic contacts is only recommended for children under the age of 5 and people who are immunocompromised.

The only drug which has been tested and approved for prophylaxis is INH, with or without rifampin. If the strain of TB she has is resistant to it then indeed there is no point in taking it.

With or without chemoprophylaxis, all family members need to be screened for TB with rescreening at intervals esp for the children.

In terms of being sure to get the culture done (assuming active smear positive TB is confirmed) in a timely manner with access to the results, I think you'd do better to take her to a private hospital infectious disease specialist.

Unless she is critically ill, there is no need for her to be admitted at as an inpatient at any point in all this.

Cultures do take time but usually not many months, more like 4-8 weeks. And multiple cultures, a single specimen if it contains the bacterium is adequate to test against all the antibiotics.

There is a newer test called GeneXPert which can rapidly detect both the presence of TB and whether it is resistant to rifampin (in which case it will usually also be resistant to INH). . Results same day. Another advantage to seeing a private doc. While the public hospitals may have access to it, owing to its cost they are going to limit its use to patients who show clear signs of multidrug resistance.

[thaifamilyguy]

Many thanks for your information, yes my concern is because there very much an active cough, children are under 5 etc., my concern about the strain is also very much on the issue of resistence. Again, on the medical treatment front we have been on a steep and continuous learning curve.

I have confirmed that the International hosptial we use has series of tests they can do and have actually prepared already for her to do one more sputum sample for the whole range of tests. After reading this thread I decided to just make an appointment for myself and go in and grill the Dr: they treat on outpatient basis, have the tests, etc., So will use them not the public hospital unless it reaches level that she needs hospitalization, etc.

Its possible the problem the guy was having with the hospital was not that he was going to leave, but that he wanted to go to a hotel, vs., own apartment, etc. Though I can also see the point about insurance. The Dr. I talked to was adamant about the person being isolated for 2 weeks and testing, but the idea in own apartment is fine. Makes sense as really casual contact out an dabout is not the risk.

More as this proceeds.

[thaifamilyguy]

Wonder if should start new thread on this as title is not really the topic but I not khow how to do.

The Update is that contrary to the experiences above, our helper was treated very much as an outpatient from the start, I now realize they would never have admitted her anyway as they not want to deal with HP infection if she has it.

That meant that she was given containers to do samples over three days, first thing in the morning, and then bring into the Hospital, on day 4 she met with the DR who said the tests were all negative but given her other symptoms and history, she should go get a second opinion. I now know from my own education that the samples should have been brought in w/in an hour of being done. The helper decided that after coughing up into the container each morning, she needed to eat breakfast, nap, and then go in, so 2-3 hours later. I did NOT bother figuring out whether they told her 1 hour or she forgot/didn't listen, but a real education on the public health challenge in dealing with this and the value of being in-patient/controlled environment.

I immediately took her to our international hospital but the next step is getting new sputum samples done, which I now will pick up and deliver.

For all my controlling behavior over this, incompetance still found a way! Given her other symptoms and history, I did get the first Dr. to tell me she thinks she has TB, but the sputum test is what they do, its done, now she is refered onward. I am sure that was all that was gong to happen regardless, which raises the question of why the referral wasn't made in the first place.

The poor woman has now gone a week without any real treatment at all and feeling terrible, we may need to go ahead and get her into the public hospital tomorrow so that she can at least get care and rest. Though I continue to expect worse-case.

[Sheryl]

Should specifically ask the private hospital if they can do a geneXpert test. In addition to being quicker it is much more sensitive.

[thaifamilyguy]

yes was going to but will now go in and jump up an down tomorrow to say that is what I want done, other tests are secondary! Thanks. Unfortunately, since we had to wait for the serum to come in from Bangkok for the skin tests, I bet they do but only back in Bangkok as I know the equip for same is not cheap so they would want much bigger volume coming through to do it. Ayway, yes will ask and let you know!

[Sheryl]

Oh, you are upcountry. that's a dfrawback. They indeed will probably have to send to Bkk for this.