Health care values compared
Make it better Accept with grace
Control over nature Balance/Harmony with
Do something nature
Intervene now Wait and See
Strong Measures Cautious Deliberation
Plan Ahead-Recent is Gentle Approach
better Take life as it comes-
Standardize-treat ”time honored”
everyone the same Individualize-recognize
Money Group orientation
Privacy Surrounded by family
Independence and friends
Individualism Defers decision making
Expects others to take
total care of them
during sick phase.
Many will avoid saying ”No” Many have not had formal
because they consider it education, so careful
impolite. explanation on what is
Food, illness, and meds are happening is important.
classified, according to the Traditional belief is that ill
perceived effects on the health may be the result
body-“hot”/”cold” of the soul wandering
Many take on a sick role, from the body and unable
when ill or pregnant, in to find its way home.
which they depend heavily A soul calling ceremony may
on others for assistance. be required to cure the
views and their
impact on health care.
Healthcare in Thailand-Strengths
• Competent-Many of the doctors have
• Doctors’ English generally good
• Inexpensive by Western standards
• Relatively quick
Thailand is at the
moment becoming a
destination for health
Healthcare in Thailand-some challenges
1) “There is no established primary
health care system”
• “Doctors in Thailand are mostly specialists,
so you will not find a good reliable all
around physician at the corner of your
street for your minor ailments.”
• Dr. Greer, Family Medicine MD
13th floor Sriphat 9 – 12 M,W,F
053-946700 (English speaking)
Doctors practicing family medicine
• Dr. Kriengsak, Pediatrics
Kriengsak clinic, on Changkran Rd.
cell phone 089-554-1624
• Dr. Sharin, people use as family practice
but his speciality is cardiology.
Sharin/Savitri clinic - close to DK bookstore
on East outside moat road.
2) “Most Thai doctors working in
hospitals do not do so fulltime”
• “Physicians and surgeons have working schedules
in different hospitals and go from one place to
another to do their clinics and perform medical
procedures (like surgery).”
• “Besides working in hospitals, they are also likely
to have a private clinic somewhere. They work
long hours, often into the evening.”
• “Another result is that you will not see your doctor
that often while you stay in the hospital, and he or
she will turn up at unusual hours, after doing his
clinics (at various places).”
3) “There are no adequate emergency
• “Very few hospitals run a good
emergency service. You will have to
get to the emergency room by
yourself if possible.”
• “Cars do not even give way easily, if
you happen to be transported by an
4) “Money is very important”
• “Fortunately, most Westerners will have
obligatory insurance, or will be assumed to
have a medical insurance.”
• “Still, you better have the cash or credit card
ready, or at least pertinent medical insurance
• It is advisable during a hospital stay to inquire
about your bill so that you can verify charges
and know how much money you will need to
pay when released.
5) Language Issues
• “While some of the well known hospitals clearly have a
policy of catering to foreigners, and Thailand is actually
promoting itself as a place to go for reasonably priced
medical treatment, this remains an important issue.”
• “When you have to communicate properly, because you
are incapacitated and need to be moved around in a
certain way, it is very difficult to have things done
properly, because most of the nursing staff has only
basic English command.”
• “Even communicating with doctors can be a drag,
possibly also because they are 'busy', and do not really
take a lot of time to have a little chat with their
6)”Pitfalls of being assertive:”
• “Possibly because you are a foreigner, the staff
tends to take your objections and opinions too
much into account. That is, if you do not want a
certain medicine for whatever reason, they will
not give it to you. You can almost bargain the
whole time how you want to be treated. This
attitude is not always beneficial to the patient.”
• “The staff at Thai hospitals may just give in to
your wishes, just because you are a foreigner,
and they apparently want to please you this
way. Medically speaking, this is not always
• “Whereas doctors in the West will only prescribe
the medications you cannot obtain over the
counter, doctors in Thailand will prescribe
everything you might need, including Tylenol,
Ibuprofen and antacids. If you don’t ask about
the prescription before going to the cashier you
will find yourself with several medications you
probably already own.”
• Ask the doctor the names and reasons for the
drugs. Some people end up taking too much
paracetamol or other anti inflammatory meds
because they didn’t know the pill was already a
part of their pills prescribed by the doctor.
8. “Tendency to have limited nursing staff and
reliance on family assistance for patients.”
• “It is very common for Thai patients, and
also apparently for Middle Eastern patients,
to have one or more family members stay
overnight to help out.”
• “If necessary, services are available to hire
a nurse for the night (at a high fee) and the
hospital can probably arrange for that.”
9. Medical Reports
• “Some major hospitals are computerized
and have reports available showing your
history at that hospital but many are not.”
• “Overall written health reports are rare
because the Thai system doesn’t utilize a
primary health system with a family doctor
or general practice MD.”
• Keep detailed records yourself and ask for
copies from different doctors so that you
can have some health history available for
doctors who ask for it.
Tips on going to the doctor
• Ask friends for recommendations
• Educate yourself before going
– CDC.org, WebMD, Mayo Clinic website,
• Don’t be afraid to ask questions. If you find
the doctor seems unwilling or frustrated with
your questions – go somewhere else.
• Be sure to get full information on
prescriptions: when to take it, how long to
take it, how many times per day, how many
milligrams, side effects, etc.
Tips on going to the pharmacy
• Many medicines are over the counter here.
• If you have a routine prescription med from
home, write the name (generic), dosage and
number of pills, etc that you need on a piece of
paper and give it to the person at the pharmacy.
• Dara Pharmacy across from Dara School and
down from McCormick Hospital is
• Almost all chain pharmacies have pharmacists
who speak English and are helpful. Prices vary
and are generally more expensive in the
• Most of the time, writing down what you want
whether medicine or equipment will result in
getting the item more quickly.
Chiangmai Ram 1
Chiangmai Ram 1
• Chiangmai Ram 1 is located right next to
Central on the moat.
• Many chose this hospital for quick care of
minor emergencies i.e. stitches, x-rays for
possible broken bones, etc.
• In-house dental clinic, lab, MRI, X-ray &
• Centrally located
Chiangmai Ram 1 - Shortcomings
• Not all the doctors at CM Ram are the best,
though most are competent
• Tends to be on the higher end of cost
• Doctors are quick to admit and prescribe
Seeking medical care at CMR1
• DO NOT go to the Emergency Department
unless it is a true emergency.
• Check in before seeking the doctor or clinic
• Registration staff will direct you to the
• The closest hospital to Grace Int’l School
• Klaimor Hospital has a convenient clinic for
obtaining health certificates
• People report dried blood and lack of
cleanliness in general.
Special Medical Service Center
• Where most CM Univ. professors practice
• 13th floor clinic 8am-8pm 053-946-905
• Car park several blocks down from hospital
• Head nurse of Mother/Baby unit at Sriphat
is Australian trained and is very supportive
• The hospital that many Thais use
• Quite cheap, yet has a decent reputation
• Quite busy, you may find yourself waiting
• Some unpleasant reports from patients
• The place to use if you’re very short on cash
• Birth packages about 10% more than Ram1
• Most foreigners who use this hospital go for
Dr. Udom, an OB.
• Dr. Sompong at Pediatric Expertise
– Monday/Thursday evenings from 5-8
– Saturday/Sunday 9-12
– Does consulting at CM Ram 1
• Dr. Watcharee at Pediatric Expertise
– Works out of Suan Dok/Sriphat
– Monday/Wednesday evenings from 5-8
– Saturday/Sunday 9-12
• Dr. Supreeya
• Located at a row of hongtaews on the
Superhighway just before Airport Plaza
and at Kullapant Clinic not far from Lanna
• M-W-F 5:30-7:30/Thurs 5:30-7:30
• Practices at Sriphat and at CM Ram 1
• Practices everyday at Lanna Hospital
• Lack of accountability structures
• Low-tech/questions about ultrasound
• Lanna is not the place to go for any
• Some have reported that nurses speak
limited English or not at all
• Dr. Sudhee
• Very experienced
• Excellent surgeon
• Private Clinic – 053-214-139
• M, T, Th 5 pm/ Sundays 9 am
• Ram – Dr. Wachiraporn, 4th floor
• Sirphat – pediatric dermatologist available
Other specialties at CM Ram 1
• Ophthalmology • Rheumatology
• Allergy & Chest • Ped. Cardiology
• Cardiology • Ped. Endocrinology
• Dermatology • Ped. Hematology
• Endocrinology • Neonatology
• Gastroenterology • Ped. Nephrology
• Hematology • Neurosurgery
• Nephrology • Surgery
• Neurology • Plastic Surgery
• Internal Medicine • Urology
Special Medical Service Center
• Faculty of Medicine CMU
•Pediatric Allergy •Ped. Orthopedics
•Infectious Diseases •Ped. Pulmonology
•Cardiology •Colorectal Surgery
•Dermatology •Ped. Surgery
•Chest/Heart Surgery •Neonatology
For a JCIA hospital…
Bumrungrad Hospital, Bangkok
A handful of BKK hospitals have JCIA.
• Be up-to-date on all the usual vaccines
• For information visit
• The CDC website also has numerous fact
sheets about individual vaccinations
Typhoid: inj–every 3 yrs; oral-every 5 yrs
Hep A: booster may be needed
Hep B: booster may be needed
Tetnus: every 10 years
MMR: You should have had a booster in your
Japanese Encephalitis: up to 4 shots/2 shots
Rabies: every time bitten by a unvaccinated*
dog/cat, some shots are given.
Special Vaccines for Thailand
• Transmission of hepatitis A virus can occur
through direct person-to-person contact;
through exposure to contaminated water,
ice, or shellfish harvested in contaminated
water; or from fruits, vegetables, or other
foods that are eaten uncooked and that
were contaminated during harvesting or
– Highly recommended
• Hepatitis B vaccine is now recommended for all
infants. It is recommended for all people living in
• Hepatitis B is endemic in Southeast Asia and many
are carriers and have no idea that they can
• The virus is virulent and can last at least 7 days in
dried blood or body discharges.
• Some people require boosters to keep immunity.
Check blood tests – Anti-HBs
– highly recommended
• This is a routine immunization for people
who live in Chiang Mai.
• A series of 3 shots with a possible 4th
booster; it is available in most clinics and at
• A new 2 shot series is available now.
• Sriphat is reported to have less expensive
vaccines (4 shot series) than Ram.
• Typhoid fever can be contracted through
contaminated drinking water or food, or by
eating food or drinking beverages that have been
handled by a person who is infected. Large
outbreaks are most often related to fecal
contamination of water supplies or foods sold by
• Oral pills (5 yrs) are available from McCormick.
• The injection (2-3 yrs) is available at most
• If you might have extensive unprotected
outdoor exposure in rural areas, such as
might occur during camping, hiking, or
bicycling, or engaging in certain
• If you can get to a hospital within 1 hour of
being bitten, there is no need for a rabies
• Resistant forms of malaria exist along the
borders with Laos and Burma.
• Malaria prophylaxis offers little or no
protection in these areas.
• Malaria is not a problem in Chiang Mai.
Leptospirosis & Schistosomias
• Usually caught by wading or swimming in fresh
water. The latter is carried by water snails and
the former is transferred by the urine of wild &
domesticated animals. If you have to wade
through water, wearing boots will prevent these
• Leptospirosis can also be transferred through soil
because of pets. Pets should be vaccinated. This
has been on the rise in Thailand.
• TB is endemic here and will continue to be a
problem because of the number of people
• It is recommended that you have a yearly
skin test to catch and treat latent infections
which can cause many serious problems.
• Dr. Kriengsak will do testing. PPD skin tests
are not part of routine care for most Thais.
• Dengue Fever is transmitted by the bite of a
day biting mosquito.
• Only Tylenol/paracetamol should be used
for Dengue pain relief so use Tylenol for
fevers of unknown cause.
• The number of people with Dengue
dramatically increased this past rainy
season throughout Asia.
• This is a parasite you get from
inadequately cooked pork.
• Pork should not be pink when you eat it.
• Chiang Mai has the highest number of cases
in all of Thailand!
• Spread through dirt primarily from pets, etc but
also through sheets, shared bath water, bath
towels, blankets, etc.
• S/S: Difficulty sleeping, huge appetite, girls:
bladder control problems, itching around anal
• Mebendazole – for children 2 years and up.
Use no more than 2 x’s/yr. 100 mg followed by
100mg 2 weeks later. Only available in
200/400 mg tablets here.
• Benedryl is useful to help the child and the
worms sleep. Thick diaper ointment or vaseline
can also help relieve the itching.
general health topics
• Due to pottery glazes or the lack thereof
• Ask about FDA approval for export.
• Take it easy – this is the tropics!
• Drink lots of fluids. If you feel like you are
dehydrated drink electrolyte fluid-readily
• Stay out of the sun, or at least wear a hat. The
sun is the most dangerous from 10 – 4pm.
• If you succumb to heatstroke, you may have
trouble with heat in the future.
• Macular Degeneration is very common now –
wear approved eye protection.
• Use sunscreen, protective clothing, hats, and
sunglasses to protect yourself against the effects
of the tropical sun!
• Latest research seems to show that sunscreen
doesn’t protect against melanoma. Clothes with
dense fibers are the best protection.
• If a person has a blistering sunburn before the
age of 19, their risk of skin cancer is dramatically
• You can even get burned while under a shade
tree here in Asia if you are fair skinned.
• No leash laws mean that dogs roam free and are
• You may want to take a stick/doggy treats with
you when walking out of your “territory”.
• If you are bitten, try to contact the owner to find
out if the dog has been vaccinated against rabies.
*3 -5% of Thai dogs vaccinated still get rabies!
• Each time bitten, you will have to have some
Cuts & Scratches
• Cuts, scratches, and bug bites tend to be
more easily infected here in Thailand.
• Wash immediately with drinking water and
soap. Use betadine for puncture wounds.
• Apply antibiotic cream/ointment
• Have deep wounds stitched
• Cat bites/scratches almost always need to
be treated with oral antibiotics.
Cuts and Scratches cont.
• Peroxide should not be used because it prevents
the white blood cells from coming to the wound.
• Stitches are recommended for facial wounds
after they have been cleaned thoroughly.
• A puncture wound, minor foot and hand
wounds, and wounds with care delayed
beyond 12 hours, cat/human bite wounds, and
wounds of people with compromised immune
systems should not be stitched because of
• Deep wounds which involve tendons, joints,
deep layers or blood vessels should be stitched
by a plastic surgeon.
• Remember always use drinking water/sterile
water to wash or soak a wound in.
Food & Water
• Food is generally clean
• Always drink bottled or filtered water – several
companies provide water delivery
• Market veggies tend to be high on pesticides
• Imboom vegetables are reputed to be organic –
Khun Jantip 053-823-223
• Doi Kam veggies are available at most grocery
• Meat from Northern Farm products thought to be
• Mango allergy possible if allergic to poison
Case Study #1
Jane was riding on a motorcycle with her
friend and accidentally touched the tail
pipe. She has a large burn on her right
• Immediately put in cold water for 15 min.
for 1st and 2nd degree burns. (If a large portion of a
person is burned do not put in water.) Or apply cold
compresses or towels. Use large quantities of drinking
water to cool the area.
• Take off the clothes, jewelry, etc on or around the
wound. (If clothes are burned on the skin, do not
remove. Take immediately to the hospital.)
• Apply antibiotic cream or burn ointment with a nonstick
sterile gauze dressing. Do not apply ointment if you
have a large burn and need to go to the doctor.
• Daily clean the area with drinking water and mild liquid
soap; apply cold compresses several times/day to
relieve pain; do not break the blister; cover with a non
stick sterile dressing.
• Healing takes between 3-6 days(1st) to 2-3 weeks(2nd)
• Make sure that you are up-to-date on Td
• Do not apply butter, oil, ice or ice water on the
• Check the burn every day for signs of infection,
such as increased pain, redness, swelling or pus.
Draw around the outer edge of the redness with a
permanent pen to help you distinguish if the
redness is spreading from day to day. Go to the
doctor if any of the above symptoms occur.
• Dermazin crèam has been recommended for burns
Case Study #2
Your child was swinging and fell off the
swing. She hit her head and is crying.
You are able to calm her but now she
appears to be dazed and not her normal
The following require immediate medical care if they occur after a
– Loss of consciousness, confusion, or drowsiness
– Low breathing rate or drop in blood pressure
– Fracture in the skull or face, facial bruising, swelling at the site of the
injury, or scalp wound
– Fluid drainage from nose, mouth, or ears (may be clear or bloody)
– Severe headache
– Initial improvement followed by worsening symptoms
– Irritability (especially in children), personality changes, or unusual
– Restlessness, clumsiness, lack of coordination
– Slurred speech or blurred vision
– Inability to move one or more limbs
– Stiff neck or vomiting
– Pupil changes
– Inability to hear, see, taste, or smell
• Apply ice to area for 20 min every 2-3 hrs.
• Watch for signs of a serious head injury.
• If a child throws up more than once, continues
to “act abnormal”, complain of a severe
headache, or have any of the problems listed in
the previous slide – Take to the hospital.
• If a child starts to go about normal activities but
wants to sleep – wake every 3 hours and ask
• Paracetamol/tylenol are fine to give a child with
a headache. Do not give aspirin.
Case Study #3
Ken has climbed a ladder to pick a
papaya from the tree. The ladder
collapses and he falls to the ground on
his back – about 5 feet.
• Ask if they are okay and if they hurt anywhere.
• If they are conscious and respond to you, allow
them to move if they want to but monitor them
closely and give them assistance.
• If they cannot move on their own: Stabilize
their body by holding their head and neck in
line with their body. Move as you would a log
only if necessary for safety. Call for help.
• Look for any signs of bleeding or broken bones
after you have made sure they are conscious
and breathing. Stabilize a broken limb with a
splint. Elevate a bleeding limb and apply
pressure with a clean bandage or cloth.
Case Study #4
Andrew, 5 years, has a fever and
vomiting and diarrhea for the past few
days. He will only drink liquids and lays
around on the couch most of the day with
naps throughout the day. He vomits
almost any liquid a few minutes after he
• High Fevers (102/38.89 – 105/40.56) cause dehydration
in a small child quickly. Treat with paracetamol/tylenol
10 – 15 mg/kg of body weight every 4 hours. Use tepid
baths and cool compresses.
• Diarrhea: more than 7 stools/day in a child/adult. If
diarrhea is bloody, has mucus or pus, or is foul
smelling, go to the doctor. Provide sports drinks –
watered down or other forms of electrolytes to replace
• Vomiting: Use ice chips for chewing on. Keep trying to
take small amounts of watered down electrolytes or
sports drinks. If a child wants to eat, allow them to eat
what they are hungry for but also encourage toast,
pretzels, crackers, clear soup, rice, etc to help their
• The behavior is normal for a child with these
symptoms– but must be monitored carefully because
dehydration can occur quickly in a small child.
Diarrhea in adults without fever; blood, mucus or
pus in their stool can be treated with immodium
for up to 3 days.
Pepto bismal is also useful. It has been reported
to have an antibiotic property which helps kill
the problem bug. This shouldn’t be used in
those under 18 years of age because of Reye’s
Lactobacillus after a case of diarrhea may help
your body restore the normal bacterial flora of
your gut. Active culture yogurt is available at
Rim Ping and the pills are available at most
Case Study #5
Juanita is returning late at night after
teaching an evening class for new parents.
One of the class participants is catching a
ride home with her. As they come around a
curve in the middle of the canal road,
Juanita has to swerve to miss a motorbike
crashed in the middle of the road. The
road has few lights but the lady with her
said that she saw a body on the right side
of the road. The road is quiet and no one
else seems to be around.
Some things to think about…
• Be prepared if you want to be able to stop and help people.
Gloves, etc to protect against blood and body discharges are
• Be aware that if you stop and help, you could be blamed for the
problem and held liable for the costs. Sometimes the police just
take your driver’s license while they work on it. Remember our
cultural understanding of justice is much different than what is
• If there are other people there and available vehicles, most
likely your help is not needed.
• If you do plan to stop, park your car where it is obviously not a
part of the wreck. But still be prepared to defend yourself in
case someone starts blaming you.
• Always have on your person, emergency phone numbers of those
who can help you or of people that could be called if you
yourself are in an emergency. We don’t always have our cell
phones, etc but we should always have some sort of ID and
numbers so that people can be reached in times of emergency.