Public Hospital: A Good News Story

[tamesisfwp]

I too can profess to being deeply impressed by the government hospital, this one in Nakhon Phanom.

Honorary Grandmum fell from a bamboo ladder 5 weeks ago while picking her lunch, falling onto a tree stump and breaking left wrist, springing several ribs, breaking collar and scapula and a non specific bump on the head. She seemed to lay unconscious where she fell for some while before discovery. From the title Grandmum you may gather she is of very advanced years if a 61 yo refers to her in this way.

When we found out we raced to ER and found she had already had X-rays and was next in line for the scan, which took place within the hour and interpreted immediately.

There was very little prospect for her survival but the surgical team refused to give in and worked on her. After some hours she was moved to Women's surgical for observation and positioned by the nurse's station from where she was checked every 15 minutes throughout the night. Next day after further inspection of the X rays and scans she had her wrist plastered and positioned with suitable support on the bed for her to climb back to consciousness.

The nurses were amazing and I could not fault them in all their attentiveness and procedures. The young neurosurgeon monitored her regularly and when intra-cranial pressure built up he proposed Burr holes be drilled to relieve the pressure. This procedure is grim at the best of times and with a government hospital on the far reaches of empire I was very worried. However, the neurosurgeon invited me to scrub in and talk to him during the preparation about my concerns. By this time I had no concerns about him as clearly we had a very professional man working for her. However, the routine is about drilling through the skull bone and the risks are pretty obvious. As suspected he had no laser guided titanium steel gizmos just a very fine handheld drill bit and a steady hand. The operation proved to be an absolute success and she was removed to the ICU ward, where her vigil continued. Over time she showed some response and we did everything we could to stimulate her, nurses joining in some of the Glen Miller routines.

We brought her home today. She is still unconscious but can be fed and watered. All the bones are healed and it is just for her to wake up, which might be today or next week, or next month.

Throughout her stay she was treated like a Princess and nothing was too much bother. The doctors and nurses all worked for her full recovery and there was never any mention of age or debility debarring her from the best treatment.

As we were preparing her for the trip 3 incidents took place.

The neurosurgeon had personally come to help see her off and when he overheard a visitor to another patient tell someone we were (equivalent of) "taking the old biddy home to die" he went ballistic and told them she was very much going home to continue her recovery.

The second was that the ambulance men who came for her were ordered to stand aside and let the nurses transfer her to the gurney. Every nurse and student on duty participated in this action.

The third was particularly pleasing to me because while in ICU I had sung Glen Miller songs to her (she having worked at the denied USAF base at NP during the late 60s and 70s and boogied on a Saturday night at the service men's club). In the opposite bed was an unconscious young lad with the obligatory head injury (yes- fallen off a motorbike while not wearing a crash helmet) and a fretting mother and brother. It would appear the lad had come out of his coma and was found humming "Chattanooga ChooChoo" one morning by the nurse. The sister told me the mother had been looking for me for days to thank me. Strange old World!

We made many friends over the time there among staff and patients and their families. We shared a common trial and supported each other as best we could, each to our own. Language was no barrier, if anything permitting a little license on access and routines. We have a way to go but in a UK NHS hospital she would have been discounted immediately from treatment.

Sorry if some of this sounds schmaltzy.

Cost? = not a baht as I had funded her health insurance for the last 2 years. I would dread to think the real cost.

[jrtmedic]

What a wonderful story. Thank you for for sharing the tale with us.

Best wishes to Grandmum !

[gerryBScot]

Yeah that's a great story, tamesisfwp. Hope the old girl makes a full recovery.

[TerryLH]

"... but can someone please explain what the difference is between a Government hospital and a Public hospital in Thailand"

Different names for the same thing.

[kriswillems]

During the 6 years we stayed here we have been to government hospitals and private hospitals. I think both are good.

The big difference is the price. Sometimes the private hospitals were so expensive that we had to choose for an inferior treatment or an inferior check.

At the government hospital we always got fully checked and an appropriate treatment for not much money.

In case of an emergency we always go to the government hospital, because my experience is that we get better and faster service there.

I really admire the staff of the government hospitals. I even ever met a nurse that paid a new T-shirt and a new mobile phone battery for a relative that was involved in a motorcycle accident (from her own money). The T-shirt was torn up up and his battery was lost during the accident (so he couldn't contact his family). Only after asking were he got the T-shirt from, we knew who had paid for it, and we could give the money back to her. She never asked for anything.

Edited May 12, 2013 by kriswillems

[Mike45]

I've been treated at both private and a province capital cities government hospital. I have found that they have both been very good for medical treatment. The government hospital was extremely over whelmed by the number of patients and visitors. I'm wondering if all the government hospitals are like that?

[Fgis]

During the 6 years we stayed here we have been to government hospitals and private hospitals. I think both are good.

The big difference is the price. Sometimes the private hospitals were so expensive that we had to choose for an inferior treatment or an inferior check.

At the government hospital we always got fully checked and an appropriate treatment for not much money.

In case of an emergency we always go to the government hospital, because my experience is that we get better and faster service there.

I really admire the staff of the government hospitals. I even ever met a nurse that paid a new T-shirt and a new mobile phone battery for a relative that was involved in a motorcycle accident (from her own money). The T-shirt was torn up up and his battery was lost during the accident (so he couldn't contact his family). Only after asking were he got the T-shirt from, we knew who had paid for it, and we could give the money back to her. She never asked for anything.

The second main difference is the time passed at hospital.

At public hospital, especially the most famous ones, Chula, Sirijaj, etc... you have to wait and wait...

But I agree that they are good.

[kriswillems]

During the 6 years we stayed here we have been to government hospitals and private hospitals. I think both are good.

The big difference is the price. Sometimes the private hospitals were so expensive that we had to choose for an inferior treatment or an inferior check.

At the government hospital we always got fully checked and an appropriate treatment for not much money.

In case of an emergency we always go to the government hospital, because my experience is that we get better and faster service there.

I really admire the staff of the government hospitals. I even ever met a nurse that paid a new T-shirt and a new mobile phone battery for a relative that was involved in a motorcycle accident (from her own money). The T-shirt was torn up up and his battery was lost during the accident (so he couldn't contact his family). Only after asking were he got the T-shirt from, we knew who had paid for it, and we could give the money back to her. She never asked for anything.

The second main difference is the time passed at hospital.

At public hospital, especially the most famous ones, Chula, Sirijaj, etc... you have to wait and wait...

But I agree that they are good.

That is true, but in my city there are ways around that.

The doctors work also in the evenings on certain days. If you go to see a doctor in the evening, you've to pay more, it's not fully covered by the 30 Baht card or social insurance (if you're Thai), so you might pay around 200B. Because you're probably not covered as a farang anyway, the 200B will not make any difference. What is important is that the doctor will make an appointment for surgery or a new check. Once you've an appointment you'll wait much less long next time. If you don't need an appointment it would cost you around 200B, which is still much less than what you would pay in a public hospital. If you go in the evening, you've to check first which doctor works on which day. The queue is usually not longer than 15 minutes.

If you're talking about emergency cases, I think the public hospital here is actually faster than the 2 big private hospitals. The private hospitals are work in a very formal way, a receptionist has to bring you to the emergency room and then that start talking about your insurance first. In the public hospital you walk in yourself, right to the spot where they put you on an emergency bed and they help you immediately, no questions asked (This is my from personal experience).

[Sheryl]

I agree that for emergency, the higher level government hospitals are the best option (i.e. regional or national hospitals, see the pinned thread explaining the government health care system). For those living upcountry in an area far from the nearest regional hospital, best bet is either a military hospital (which is also govt) or the provincial hospital, in that order.

For routine outpatient, it really depends both on what the government hospital(s) in your area provide and also in how important time vs money is to you and how you feel about dealing with red tape, how much Thai you speak/can read and write or access to a Thai translator.

Not all government hospitals have an after hours arrangement such as the prior post describes. Where they do, in addition to being quicker, this allows you to choose your doctor and to directly see a specialist, neither of which is possible through the normal system. However, you will usually not be able to review doctor qualifications on a website so the process of selecting a doctor may be a bit difficult, and you will usually not be able to make an appointment on line or by phone, but rather have to go down in person to do so, which if you live some distance away may be a real disadvantage. Also, in many places the wait, while always much less than the normal channel, can be a lot more than in that in the town reported on above. Several hours is not unusual in Bkk and also at Sripat in CM, and it is also not unusual to have to come back another day (or week/weeks) as specialists can be booked up.

If there is not such an arrangement then you are looking at seriously long waits and possibly having to run a gauntlet of doctors, starting with a medical student or new grad, before you are approved to see a specialist (if that is what you need) which could span several days or more even, and then of course you may need to return at a later date for the actual specialist appointment Unless you have a lot more time than money and a high tolerance for red tape, it is worth it to go private in that instance.

For non-emergency things that require inpatient treatment, the trade offs are more complicated. If there is an after hours arrangement at a government hospital and you are uninsured, then that is the route worth taking. If there is no after hours clinic then you are looking at considerable waits and hoop-jumping before you get admitted (though all will be well once you are), so it boils down to how costly what you need is apt to be and how much the savings is worth to you vs hassle and time.

Also depends on what is available in your area in terms of private hospitals. Private hospitals upcountry, and especially in less populated areas, are usually best avoided. In Bkk and other major cities the situation is better, though an uninsured person would still do well to avoid for-profit private hospitals if inpatient care is involved.

[citizen33]

Also depends on what is available in your area in terms of private hospitals. Private hospitals upcountry, and especially in less populated areas, are usually best avoided. In Bkk and other major cities the situation is better, though an uninsured person would still do well to avoid for-profit private hospitals if inpatient care is involved.

Sheryl provides excellent advice here. Many expats assume that private is always better, but if you are in a small town in say the NE a small private hospital is the last place to present with a life-threatening condition. This is something well known to health professionals who can tell some real horror stories. Edited May 14, 2013 by citizen33

[oneday]

So to the OP I'd say you were lucky

Yup I was definitely lucky. Absolutely. However my condition could easily have been wrongly diagnosed too, and indeed often is. My surgeon confirmed he cultured the bacteria he removed from my body so he knew exactly what he was treating. Now that's what you are supposed to do but it isn't always done. I was seriously impressed by this young doctor and very lucky that he was on duty when I checked in. I wasn't surprised when he told me yesterday that Friday would be his last day at the hospital as he is going back to BKK for a four year course in Orthopaedics - he'll be a major asset wherever he works.

I wish your mother-in-law all the best and hope they can save her life.

Thanks for your well wishes and it does sound as if you got a very competent doctor. Very lucky.

Most people here are reporting good experiences at Government hospitals so that's good to know. After almost 3 hours of waiting at Queen Sirikit hospital in Satahip I also had a good experience for a minor ear problem.

Edited May 14, 2013 by oneday

[tamesisfwp]

And then we brought grandmum home.........................

Then, the family got stuck in - all wanting to be seen doing their bit for her when during the 5 weeks in hospital a cursory 10 minutes was all they gave her, but made sure the relatives saw them, actually walking hundreds of metres out of their way to seek out someone in the food hall just to notch their presence.

When trying to get her into a routine and to stimulate her it is right to have lots of visitors. But they all come at once and do their own thing - including dispensing medicine giving rise to 3 doses in a 40 minute period - until I hid the medicine. But the visitors came to please them and again mark they had "done their bit". When GM's nappy needed changing - but of course you know the answer already don't you boys and girls.

Be in no doubt there are many fine people in the village who have come to spend time with her and even to hold sincere prayer sessions over her. But then there are the relatives and quasi - relatives.

Even while nursing her, whether it be feeding her or prepping food, or simply giving her a cool wash, I was having to stop relatives (of both kinds) from purloining her things. Actually openly stealing her everything and not caring to be challenged by me - the word Falang was spat out many a time in just 2 weeks but they went away empty handed. There was even an attempt to open GM's safe by a quasi nephew who said he must take all her possessions into protective custody because there are thieves about. I challenged him by saying "don't you think this is the duty of the two people who hold her Power of Attorney", to which he replied they had gained this power by deception. He hated me even more when I repeated this in front of the two attorney holders, one his own brother.

Let me give you a clue. The word is out that GM has not left a will and everyone is posturing - do they not know inheritance law? - so similar to the UK when intestacy rears its ugly head. There is a will and it is very precise. Subject to prior gifts, one of which is not completed and was due to be revoked by GM because she was tired of the thieving b'ds stealing her crop to sell at market, it all goes in trust for my soon to be adoptive daughter.

I have seen fawning over and I have seen outright cruelty to GM by those "nursing" her. Where I believed they were just ignorant I trained them but quickly realised half want her dead and the other half to wake up to change her will. The statutory heirs are the ones trying to kill her as the absence of a will means it goes to them in some proportion. Those fawning are hoping for some of her land.

To say I am sick of their disgraceful behaviour. It gets worse. I have been openly threatened by the niece who may forfeit her benefice that her husband will arrange something for me. he has done 12 years for killing and in a village where the police never ever visit - see my thread on dog-knapping - so I should take this threat seriously. At the moment I have retreated to BKK for a few days to distance myself from it all and to decide if I really should get involved further.

For those interested GM is feeding well on a wide range of fruit and supplement rich foods. she can drink from a straw and I sat her out in the wheel chair the other day to get her off her sores.

I attach 2 pics - one of her last August and one sitting out the other day - of course I have to go back but must think of how to ensure my own safety - given all the many posts about Thais and their funny little murderous ways.

Watch this space - you may yet see GM wink with the other eye as well.

best wishes all and thanks for listening to my bleeting

Knacker

[jrtmedic]

Knacker

Many thanks for posting your story.

I am indeed sorry to learn about the difficulties you are experiencing with with GM's family.

Whilst I am sure you will continue to care for the old lady you must attempt to ensure your and GM's on going safety.

I would suggest you document your anxieties , make several copies and then lodge these "statements" in sealed envelopes with people known and trusted by you. Mark the envelopes "To be opened in the event of my Death/Serious Non Accidental Injury" .

Maybe the local Monk or Village Headman could assist in securing better a relationship between you and GM's relatives ?

Have you thought about the possibility of employing a nurse/carer to l reduce the stress of caring for GM ?

I am sorry about not being able to think of any other practical suggestion to make.

Perhaps others will be more forthcoming.

Best wishes

[tamesisfwp]

Hi JRTMedic

I much appreciate your encouraging words and glad to report that great minds think alike. I have spent a lot of time diarising events and in fact there was so much more that I edited out, giving only the flavour of GM's peril.

Part of my problem has been lack of local language but have just returned from getting it all translated by a University Professor I met. He sat up bolt straight when he saw my account and promised he will distribute it widely around my corner of Isaan. Given my military background he has also spoken to a General of Police he knows (some centralised department dealing with big ticket cases)and I know they have already checked me with the embassy for purposes of issuing me a personal protection weapon. He was particularly interested in the cross thread I had running about dog-knapping and the OCG involvement.

My main protection is to get the two Attorney holders to broadcast around both actual beneficiary and quasi families as to her stated wish. The revocation of the gift will be put in abeyance until GM can make her own decision. If she does not make it then the gift fails and the land will have to be sold to service the distribution around all arms of the blood relatives. She will certainly lose her land, which she has turned into a dumping ground, which is a kind of justice of its own.

Every day we saw some improvement is GM and the last leap is her arm to wake up and as you saw in the pic her left facial muscles, which have already improves since that pic. As her heart survived all this and she is a tough dear lady I have forced her recovery programme. The clan were happy to see her wallow in her own soil.

If I leave her in her familiar surroundings I am certain there is no nurse prepared to reside in what is a termite eaten hole that any health department inspector would condemn. I have half an option to remove her to my in laws' home but am not sure this will achieve the objective either.

Since beginning this the police general has called and advised he will issue me with a fire arms permit and weapon, has put a caution on the land at the Land Office and hourly patrols will now be going through the village - this is a real double edged sword as the knappers will not be happy for this attention. It will be interesting to see if a big cheese carries more weight from this distance than a local colonel on the payroll. Watch this space.

Paramount is GM's progress and on that I will focus. I am on the night bus back to NP and will show a greater presence now. I shall also go to the hospital to talk to some of the nurses about some freelance overtime - I have tonnes of rambutan and Lynchees to pay them with.

All ideas welcome.

Knacker

[gerryBScot]

Hey Knacker glad to hear GM is hanging on. Go, girl, go! I can't advise on the issues but maybe GM will continue to respond to the care she is receiving and that's clearly the best way to frustrate the vultures. Unfortunately what you describe is far from being Thai, but sadly universal - it might not happen so blatantly in other parts of the world, but I have experience sadly of this in my own community in Scotland and we do read about it. Be careful.