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Photo: The superb Bangkok private hospital in Hat Yai What's On This Page?
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Thailand - Health
Looking through the Lonely Planet section about health in Thailand would be enough to put off a lot of people from visiting and I read recently that the Elephantiasis parasite is still a problem in certain border regions. Great. Have a holiday in Thailand and end up looking like the Elephant Man a few months later. Most of the nasty diseases are only potential problems in remote, rural areas and not a problem in towns or tourist areas. Tummy problems are to be expected and are not necessarily due to spicy food although a bowl of very spicy tom yum goong won't help matters. The bacteria in our stomachs forms an important part of the digestive system for breaking down food and it differs slightly from country to country. After eating and drinking in another country an upset tummy is not unusual and normally results in a few emergency toilet calls. It's nothing to worry about normally but continued diarrhoea or painful stomach cramps could be a more serious problem so if it gets bad see a doctor. On average I suffer from food poisoning incidents in Thailand about once every six months to a year and they aren't much fun. These aren't just hurried toilet visits with diarrhoea but excruciating abdominal pains that normally require hospital treatment. A friend of mine (a dive buddy from my 1996 stay in Thailand) had a friend who came to Thailand in 2004, got a bad case of food poisoning in Bangkok, was admitted to hospital there and died. A big health safety campaign was launched in 2004 but not a lot actually happened. A lot of lip service was paid and some impressive looking advertising material was created but I never actually saw any evidence that anything had changed or that government inspectors had started clamping down on hygiene standards. What is impossible is being able to tell where problems exist. On one occasion a sandwich bought in a fairly upmarket shopping mall made me ill yet the place looked spotless. I've eaten at local style rice and noodle restaurants hundreds of times which, to be honest, often look disgusting but I've never had a problem. In 2006 a botulism outbreak was reported in Nan province which affected over 150 people. Botulism can bring on respiratory problems which can in turn cause death. This particular outbreak was cause by fermented bamboo shoots. Dehydration is something to watch out for in tropical climates. In the past I have suffered in tropical countries with fatigue and lethargy and just put it down to the heat. Years later, after reading more about the subject, I think I may have been mildly dehydrated. We all need to drink a lot of water to replace lost fluid wherever we are but this is even more important in hot, humid climates where body fluid is lost through perspiration. It's important to drink even if you don't feel thirsty. In fact, if you start to feel thirsty you have left it too late. Every morning I force at least half a litre of bottled water down myself and then drink regularly throughout the day. A minimum of two litres of pure drinking water should be consumed each day. People have told me to stop drinking coffee but I am too addicted. Drinking coffee and other diuretics though, especially alcohol, means drinking extra water to compensate for the additional fluid loss.
I've heard it said that tap water in Thailand is drinkable but it's a risk I'm not prepared to take, especially when bottled water is so cheap anyway. Water running from a tap looks fine but if you fill a sink or other container you will notice that the water normally has a strange brown hue to it. I only ever drink bottled water and I don't keep water in my fridge as I have been reliably informed that water at room temperature is better for the body. At restaurants I prefer bottled water but it is common to be given water from a jug. This should be fine. I try to avoid ice. Ice cold drinks going into a hot body can upset the system, the water source of the ice can be suspicious and I have seen a few ice-making facilities in Thailand. Huge blocks of ice are dragged across filthy pavements before being cut up or fed into machines to produce ice-shavings. I don't like getting bitten by mosquitoes. The bites irritate and there are some very nasty mosquito-borne diseases. Malaria is still a big killer in the world today killing an African child every 30 seconds (see also this report on the BBC web site which voices particular concern about the disease in South and Southeast Asia) and Dengue Fever can be very unpleasant. A recurrence of Dengue can result in Dengue Haemorrhaging Fever which can be fatal. Try to find out beforehand if these diseases are present in the place you are going to. Mosquitoes carrying malaria bite at dusk and dawn but the Aedes mosquito that carries Dengue bites during the day. If you thought that Dengue is something that exists only in remote jungle regions that isn't true. In the Bangkok area between 1st January and 21st March 2005 a total of 667 people were infected with Dengue. Most lived in the Bang Kho Laem, Chatuchak, Lat Phrao, Yannawa, Chom Thong, Rat Burana, Nong Chok and Bang Khen districts (source 'The Nation' 23rd March 2005). The article went on to say that trials of a new vaccine are being carried out in Thailand where research is quite advanced but a full vaccine is not expected until 2008 - 2010. It's a serious problem. If you notice mosquitoes cover up and use repellents containing Deet to prevent bites. Prevention is better than cure. 7-Eleven stores in Thailand sell small sachets that contain a cloth impregnated with Deet mosquito repellent. They are cheap (Bt5) and convenient. Instead of carry a bottle of repellent around you just wipe the cloth over your skin and throw it away. 7-Eleven stores can be found absolutely everywhere in Thailand. Thai doctors and hospitals are very good from my experience - see below. Some people ('health tourists' is the term that has been coined) come to Thailand specifically for surgery and operations because of the relative low prices and great service. Doctors here are more familiar with local diseases than doctors in the West where these diseases are rare so if you think you may have contracted something nasty it may be better to consult a Thai doctor rather than wait until you get home. Hepatitis is a problem in Thailand. An American down-and-out bum I ran into on the streets of Bangkok who was scrounging money from foreign tourists told me this and provided me with some invaluable (and unforgettable) advice. "Don't eat any bad pussy," he told me. Depending on the type of Hepatitis, it can be contracted in different ways. It's easy to take care of your own personal hygiene but not so easy to ensure the personal hygiene of the guy cooking your lunch. Be aware of what you eat and where you are eating. Rabies is endemic in Southeast Asia. I declined rabies shots before I left England as I didn't anticipate a problem with rabid dogs but then got bitten by a monkey in Langkawi. I lived to tell the tale but it's something else to watch out for. Vaccinations are available for most of these diseases either in your home country or once in Thailand. Elsewhere on this site is information on some travel related diseases. Sexual health in Thailand is so obvious that I won't insult anyone's intelligence with regard to what can be contracted and how to avoid problems.
Last updated: 30th January 2007
Unlike the system in the United States, which is primarily concerned about making profits for various private companies involved in drugs, insurance and healthcare, the Thai system exists, and is run, for the right reasons. Most things that are good in Thailand have considerable amounts of royal backing and the healthcare system is no exception. Early Kings in the present Chakri dynasty were responsible for bringing traditional medical care practices into Buddhist temples where people were taught about diseases and how to cure them. 1828 was the first year in which Western medicine began to play a role in Thailand. The system now is a holistic approach using the best of Eastern and Western medicine. The newest faculty at the university where I teach is for Thai traditional medicine and this coexists alongside faculties teaching Western medicine. During King Rama V's reign a sanitation law was enacted (1870) to clean up rivers and canals and Siriraj hospital was opened. This hospital has lots of royal connections and contains some of the most amazing medical museums which all visitors to Bangkok should make an effort to visit. In 1888 a Nursing Department was established at Siriraj. During the reign of King Rama VI a Public Health Department was established (1918). In 1942, during the reign of King Rama VIII, the Ministry of Public Health was set up. One of the key individuals responsible for many reforms and improvements to the health system was the King's father, His Royal Highness Prince Madidol Adulyadej of Songkhla (the 69th son of King Chulalongkorn - King Rama V). In 1992, on the occasion of the 100th anniversary of his birth, royal permission was sought to rename him to Prince Madihol 'the Father of Thai Public Health.' Several individuals within Thailand's royal family continue to be very active supporting healthcare initiatives in Thailand. Good healthcare is a right of the Thai people and has been written into the Thai constitution, "The state shall thoroughly provide and promote standard and efficient public health services." Thailand is a wonderful example to the world of what can be achieved when a healthcare system is set up for the right reasons and not purely as a profit-generating business.
Generally I have the utmost respect for the BBC and how they report news but their reporting of the Bird Flu virus makes even the tackiest of gutter tabloids look sombre and respectable. News should be based on fact and kept in context. Sensationalism, scaremongering and speculation are not things I expect from reputable news agencies. Every single case of a Bird Flu death anywhere in the world becomes the BBC's top on-line news story. They talk about the deaths triggering a panic but fail to take any responsibility themselves for causing panic situations as a result of their sensationalist reporting. They admit that the dreaded pandemic scenario may never actually occur but continue to scaremonger and spread panic. In the same way that worldwide doom and gloom was predicted for the year 2000, exactly the same thing is happening now with Bird Flu. Just as we all woke up on January 1st 2000 and realised that nothing had changed before starting to wonder what all the fuss was about, I expect that eventually the Bird Flu panic will become another damp squib and we will look back wondering what all the panic was about. We are being told that such a huge percentage of the population will be wiped out when the pandemic hits that it will destroy our infrastructure and threaten the existence of everyone else. The shops will run out of food and what food remains will not be able to be distributed because there will be no transport infrastructure. As a boy, I remember a BBC TV series called Survivors (circa 1975). It was about a deadly virus that escaped from a Chinese laboratory and wiped out 95% of the world's population. The show followed the adventures of the few remaining survivors. This theme is a BBC favourite and now they are trying to recreate an actual event to follow the purely fictional account seen in Survivors. Let's look at a few facts before getting carried away with all the scaremongering. The virus was discovered some time in 2003 and by the end of 2005 a total of 22 people in Thailand had contracted it. Of those, 14 had died. In order to contract it, people must have close contact with live infected birds. These deaths pale into insignificance when looking at how many people are killed on Thailand's roads each day and how many are killed by other bacterial, viral, fungal and parasitical infections. To make such a big story about Bird Flu and to be completely unbothered about deaths caused by other means is irresponsible and hypocritical. The fear is all based on speculation IF the virus mutates to a point where it can directly affect humans. Of course, we should all be very aware of the potential danger and IF the worst case scenario occurs then our media will play a vital role but to cause panic at this stage is bordering on criminality. I have complained formally to the BBC but they defend their reporting and tell me it is their responsibility to report such stories because they are being told to do so. I wonder if they would feel the same way if people told them the world was about to be hit by a huge asteroid and everyone was in grave danger? Would they report that? Bird Flu is great for the scaremongerers because, being spread by birds, they tell us there is no way we can control it. In Thailand you have more chance of winning the lottery than contracting Bird Flu. At the time of writing - early 2006 - Bird Flu should be the very least of your concerns if contemplating a trip to Thailand. Worry about malaria, worry about dengue fever, worry about nasty bacteria and fungi that live in the country, worry about STDs if you are a single male, worry about the increasing amount of robberies and muggings, worry about food poisoning, worry whenever you travel by road in Thailand, but don't worry about getting Bird Flu. On the other hand, worrying about things only makes you old before your time and causes health problems so actually it's best not to worry about anything at all.
Any form of insurance which isn't mandatory can be considered a gamble. You buy a policy and it may save you money or you may have a trouble-free year and not make a claim, in which case it might possible seem unnecessary. My first comment on the matter concerns the peace of mind medical insurance brings and it is difficult to put a price on peace of mind. Secondly, even though you may be extremely healthy in your own country, Thailand - a tropical, developing country - presents more health risks than developed, temperate countries. The constant hot and humid climate is a perfect breeding environment for bacteria, viruses and fungi. Apparently the fungus that grows in some khlongs (canals) can be fatal if ingested. I now have a permanent scar on my cornea as a result of a fungal infection contracted in Thailand through a contaminated contact lens. I was told I was lucky not to have lost my eye. Prior to living to Thailand I had never had an eye infection despite wearing contact lenses for many years. There are a lot of road accidents and there is no real sense of personal liability. Charcoal burners are set up on the streets to cook food, cavernous holes are left in pavements and steel poles jut out at eye level. Even a casual activity like walking around the streets and crossing roads can be risky. Rabies is endemic and there are millions of stray dogs, not to mention dangerous dog breeds kept as pets and not always controlled very well. Mosquito-borne diseases are a major problem in some areas and avoiding mosquito bites completely is difficult, if not impossible. Both malaria and dengue fever can kill. Food hygiene standards are pretty poor and a walk around any Thai wet market will illustrate what I mean. Meat is left unrefrigerated and exposed to swarms of flies. I have suffered three bouts of food poisoning in Thailand and it really isn't fun. I'm not just talking about a few hurried toilet trips, I am talking about severe intestinal pains and a friend of a friend (an American) died of food poisoning after contracting it in Thailand in 2004. In the sea are a number of poisonous creatures and coral cuts can be particularly nasty. Several poisonous snake species are native to Thailand and although I have never personally seen a snake here I have seen a person in the emergency room at a hospital who had been bitten and the bite wasn't pretty. This is not meant to scare people but just to let them know that the health risks in Thailand are different to farang countries and this is why I believe it is important to have medical insurance in Thailand even if you don't consider it important back home. If you are in Thailand for a short time a travel insurance policy purchased from your home country will suffice. I used to buy yearly policies which covered any single trip up to 90 days. However, if you are in the country for longer you need to look at other types of policy. The first problem I had trying to get medical insurance in Thailand is that most Thais don't recognise the concept of buying an insurance policy that just covers medical expenses. Most Thais I know have life insurance (more accurately, death insurance) policies which also include medical insurance. Life insurance is more important in Thailand than developed countries because generally employers don't offer any benefits to dependents in the event of an employee's death whereas many companies in the developed world do. When I first made enquiries about buying medical insurance at local agents they tried to sell me a life insurance policy which I wasn't interested in. In Thailand it is necessary to go to one of the large foreign insurance companies operating in Thailand such as AXA, AIA or Bupa to buy medical insurance. Policy prices are based on a combination of age and benefits. People aged 10-19 are considered the lowest health risk and those aged 61-65 the highest. I'm not sure if they will consider insuring anyone older than 65. Here are the various annual premiums for different age groups for the AXA SmartCare Executive policy published on 15 November 2005. This is just a rough guide and you will need to get the details from AXA if you are interested. To give you a very quick idea of the difference between the plans, the daily hospital room allowance for Plan 1 is Bt1,500 and for Plan 5 it is Bt6,000. The premiums in the first table are for hospitalisation only and do not include outpatient benefit.
And here are the premiums for varying levels of outpatient benefits. There is a maximum limit of one visit per day and 30 visits per year.
For my policy a medical check was not required but there was a form to fill out and failure to disclose previous conditions will void the policy. One more thing to mention is that I was asked for a copy of my work permit by the insurance company. I'm not sure why. I can't understand why they wanted to see a work permit and I don't know what the response would have been if I didn't have one.
I mentioned the disease Elephantiasis above and shortly after I had heard it was a problem in some parts of Thailand I started seeing a beggar who had been infected in one leg. I am a bit squeamish and sometimes I have to walk past him as he always sits begging on a narrow pedestrian bridge. I am normally compassionate to beggars who are in a bad way but I can't bring myself to look at him. The disease is caused is caused by a parasite that enters the body. On 27th April 2005 The Nation published one of those stories that is guaranteed to give people nightmares. An 84 year-old man went to the Vachira Phuket Hospital complaining that his ears were itching. When the doctor examined him he found 50 maggots living inside the man's ears. The doctor removed them of course but was amazed that anyone could withstand living with so many fly larvae hatching in their ears. It makes you wonder what state his ears were in before the maggots arrived.
Recommended Adult Immunisations For Thailand The Nation (Thailand's best newspaper) published an excellent article about immunisation for adults in their 17th November 2004 edition. The following information is taken directly from that article. This information should only be used as a guide. Always consult a professional for up to date medical advice. The gist of the article is that we are all aware immunising our children is important but have we neglected to keep our own shots up to date? It was written by staff from the Queen Saovabha Memorial Institute on Rama IV Road in Bangkok and is specifically for Thailand. Generally everything on my web site has been written by myself but this was so good, and I'm sure the advice will be appreciated by others, it seemed a shame just to keep the newspaper article in my desk drawer and not make the information more widely available. Measles: A viral disease present in Asia, infection is via the air. If you are uncertain whether you received a full course of live measles vaccine as a child and are travelling extensively or are a healthcare worker, teacher or social worker, consider getting a booster dose. Mumps: Endemic worldwide. The indications for a booster dose are the same as measles. German Measles (Rubella): This relatively mild disease , spread by respiratory secretions, can cause severe foetal malformations during pregnancy. All young women should review their childhood vaccine history and make sure they have immunity prior to getting pregnant. If in doubt, get a booster dose before planning pregnancy. Polio: Thailand has been polio free for many years but imported cases do occur. A booster dose should be considered when travelling to endemic countries (India, Nepal, Africa). There is an injectable polio vaccine which can be safely given during pregnancy. Tetanus and diphtheria: Tetanus bacteria are found in the soil worldwide. The current tetanus vaccine induces long-lasting immunity but you should have a booster dose at 10-year intervals. Diphtheria is spread via inhalation. It can be deadly and a vaccine is given in a joint product with tetanus called TD. Thailand has only occasional cases of diphtheria but outbreaks have occurred in central Asian countries. Hepatitis A: This form of acute liver inflammation is spread by contaminated water and food as well as by some sexual activities. It is still common throughout Asia. Hepatitis A vaccine is available in Thailand. Hepatitis B: This is spread by blood, body fluids, dirty syringes, from mother to infant and by sexual activities. It is endemic in Asia and can become chronic with severe liver damage, including cancer. It is preventable by vaccines that are now routinely given to all infants in Thailand. Hepatitis C and E: Hepatitis C is common worldwide. It is spread like B. There is no vaccine for this disease, which can become chronic. Hepatitis E is food and water spread, relatively uncommon in Thailand and similar to A, but can be dangerous in pregnancy. There is as yet no vaccine. Influenza: Influenza is transmitted by air and is present worldwide. It can be a fatal disease in small children, the aged, persons with immune deficiency and chronic lung diseases. The virus causing influenza is capable of rapidly changing its "mantle" and protection requires a newly-made vaccine every year. Chicken Pox: Chicken pox or varicella is widespread in Asia and is usually serious in adults. Once infected, it remains with the person and may later reactivate and cause shingles. This is a reason why vaccination is a good idea. Pneumococcal vaccine: This vaccine decreases the risk of pneumonia and meningitis due to streprococcus pneumonia. It is a deadly disease spread by inhalation in the very young and aged. The vaccine is now recommended for individuals over 65 years and those with chronic disease. Meningococcus meningitis: This type of meningitis (inflammation of the brain cover) is spread by inhalation and is not common in Thailand. Routine immunisation is not recommended. It is, however, endemic in northern India, Nepal and much of Africa. Pilgrims going to Mecca are required to take the vaccine. Japanese encephalitis: This disease is spread by mosquitoes. The natural hosts are pigs and birds. It is common throughout Asia and parts of northern Australia. The virus starts with mild flu-like symptoms in most but can cause a severe, often fatal, form of brain inflammation. Vaccination is recommended for children living in rural Thailand and consists of two doses, two to four weeks apart with a booster a year later. Adults without prior vaccination should be given three injections, one week apart. Rabies: Rabies in Thailand is predominantly a disease transmitted by dogs and cats. Human rabies is fatal but can be prevented by pre- and post-exposure vaccination. These vaccines are available in Thailand. It is important to remember that any mammal bite can transmit rabies. Immediate washing of the wound with water and evaluation at a hospital are essential preventive measures. Tuberculosis vaccine (BCG): This vaccine is given to all infants born in Thailand but it does not prevent the disease later on in life. Other vaccines: Yellow fever vaccine is mandatory only for travellers to parts of Africa and South America. The disease is not present in Asia. The vaccine is available at several WHO-certified government facilities in Bangkok, Chiang Mai and Songkhla. Moderately effective typhoid fever vaccines are locally available and should be considered by travellers to countries with poor food hygiene. Cholera vaccines are available and may be considered by travellers to Saudi Arabia, Bangladesh, India and Africa. They are of only transient value and cholera is best prevented by attention to food hygiene. Tick-borne typhus vaccine is recommended for travellers to parts of central and eastern Europe and the central Asian countries if they plan extensive outdoor activities. It is not available in Thailand but can be obtained in Europe and Russia. Plague and anthrax vaccines are of marginal efficacy and indicated only in special situations (occupational exposure or under the threat of bio warfare). We do not yet have any vaccines against dengue fever, malaria, leptospirosis, scrub and murine typhus, liver flukes, fillarisis, meliodosis and HIV/Aids. Much research is going on but only a dengue and perhaps malaria vaccine looks promising so far. Adverse effects of vaccination: Any vaccine, like antibiotics and most drugs, can cause side effects. Discomfort, swelling and redness at injection sites as well as a mild fever, headache and muscle pains are among such reactions. They are almost always transient. If you have had such a reaction before, mention it when reporting for immunisation. Start by asking your doctor to review your immunisation status and determine your special needs. Check the following web sites for more information:
Vaccines are available at most hospitals. Several private hospitals in Thailand maintain specialised travel and immunisation clinics. The Queen Saovabha Memorial Institute of the Thai Red Cross Society on Rama IV Road provides most vaccines and specialises in managing animal bites. Yellow fever vaccine is available at the Immigration Department on Sathorn Road (Tel. 02 286 5114) and the Bureau of Communicable Disease, Ministry of Public Health on Tiwanon Road in Nonthaburi (Tel. 02 591 8393).
I don't regard my health as bad but I've spent more time in Thai hospitals than I would have liked to. On my first ever visit in the 80's I contracted food poisoning from eating a dodgy crab but a local doctor diagnosed the problem in about 30 seconds and gave me two types of pill which cured me completely in no time at all. Seventeen years and several visits later I have experienced another couple of bouts of food poisoning after eating bad food and have been hospitalised as a result. When I wander around some of the wet markets, where many of the local restaurants buy their food, I am surprised that food poisoning isn't a bigger problem. Meat is kept unrefrigerated while a million flies land on it. Where ice is used it is often from large blocks that have been dragged over the ground. The people selling food generally don't have much money so I can't believe they throw away unsold produce at the end of the day. It is probably stored overnight and sold the next day - or later. The trouble with contaminated food is that it is so hard to spot. I have eaten the most basic street food and not had any problems but sandwiches from Western style restaurants in upmarket malls have made me sick. I've eaten at restaurants regularly over many months and never had a problem but then on one visit the food has made me ill. When I have got ill I have often eaten the same food as Thai people with me but they are OK. Regardless of how careful you are I think that if you spend enough time in Thailand a few bouts of food poisoning is inevitable. The government began a campaign for better food hygiene some time in 2004. The thing about Thailand though is that when they do these things nothing much changes. There is a lot of advertising but nothing changes because there is no incentive to change. If there were armies of food inspectors touring the country shutting down restaurants who are not complying with hygiene regulations something might change but in Thailand laws are very rarely enforced. A couple of years ago I picked up a fungal infection between my toes (athlete's foot) from a none-too-clean bungalow on Koh Tao and it took ages to clear up, I think it took a long time to get better because of the heat and humidity. Fungal infections thrive in the climate here. My ears always play up when I am in Thailand. This also has something to do with the heat and humidity but another factor is that in Thailand I shower a lot more often than usual. They get itchy and because I keep scratching them I have picked up a couple of ear infections. I get a lot of wax build-up and at times (while trying to remove it) I have pushed it farther inside and clogged up my ear. When this happens it is necessary to see the ear doctor in order to get the kee huu (ear shit) sucked out. The last doctor I saw told me to try to prevent water getting in my ears. Since then I plug my ears with cotton wool before showering and this has certainly helped.
Everything I've mentioned so far has been fairly minor, not affecting me for very long, but the exception was an eye infection I picked up while wearing contact lenses. The first indication that anything was wrong was a sore eye and the feeling I had something - a foreign body - in my eye. The initial diagnosis was a bacterial infection and the doctor seemed 99% confident it would be OK when I came back a couple of days later after using some antibiotic drops. It wasn't. After the antibiotic drops had no effect the problem became 'complicated' according to the doctors. It's a long story but to keep the details brief I saw seven doctors (five in Thailand and two in Singapore). At various stages the infection was diagnosed as bacterial or fungal. At other times it was suspected of being a virus or Acanthamoeba. The latter is particularly nasty and potentially blinding. I had four of the worst months of my life with blurred vision, an almost constant feeling that a large grain of sand was in my eye and extreme sensitivity to light. Going outside was not an option for many months so I was confined to my own darkened room like a virtual prisoner. The medication was hardly any better, especially the anti-fungal drops which stung like hell. At one point with none of the medication working the doctor mentioned that a corneal transplant might be necessary. This news gave me anxiety fears on top of the physical pain. My condition reached a stage where the medication was making things worse rather than better. Putting toxic anti-fungal drops in my eye every hour during the day and every two hours at night was doing me no good at all. The doctor told me to stop the medication and slowly things started to improve. My eye got better but it was never the same. The infection left a big scar on my cornea and as the healing process began it started to change the shape of my cornea. This, in turn, caused bad astigmatism. I now have to wear new glasses to correct the astigmatism and I no longer have the perfect near-sight I used to have for reading and computer work. The moral of this story, I suppose, is that if you wear contact lenses be especially vigilant about cleaning them. If you wear weekly or monthly disposable lenses change them on time. Although it works out more expensive, one day lenses which are just thrown away at the end of the day are a safer bet. Do not shower or swim wearing contact lenses. Acanthamoeba lives quite happily in sea and tap water. If the parasite gets trapped behind a contact lens it can then enter your eye. Make sure you always clean your hands before handling lenses and follow the lens cleaning solution manufacturer's instructions to the letter. After wearing lenses for a long time I had got a bit complacent after never having a problem. However, in the year-round heat and humidity of Thailand, bacteria, viruses, fungus, parasites and other micro organisms thrive. If you are a lens wearer be very careful. One of doctors I saw in Singapore recommended that I never wear lenses again. At first I was upset about this but now I am happy just to wear glasses. I never want to go through anything like that ever again.
During a particularly rainy period in December 2005 which caused a lot of flooding in southern Thailand I went down to Singapore for a few days. When I returned, I found fungus over the surfaces of most the wooden furniture in my room. (The picture is just of a small section, taken with a macro lens.) I also found it on leather belts hanging in my wardrobe and all over the leatherette carrying case for my camera. It's horrible stuff and, like all fungi, it just appears from nowhere. I am not exactly happy about the damage to my cornea but I was told I was lucky not to lose my eye as this is what happens to most Thais who contract fungal infections in their eyes. However, the story is a lot worse if a fungal infection manages to get inside your brain. There are some very nasty fungi living in Thailand's filthy canals and these can be deadly. The most publicised case was when a singer from one of Thailand's boy bands drove his car into a Bangkok klong. Apichet Kittikorncharoen, aka 'Big' from the band D2B was rescued from the filthy water but didn't escape the deadly fungus which got into his brain and turned him into a vegetable. The younger sister of a colleague of my girlfriend's died from a fungal infection on her brain five years after coming into contact with flood water in Hat Yai. According to some information I found on-line, people with HIV infections who have a compromised immune system are particularly vulnerable to the fungus that causes brain-swelling and death. Because of high HIV rates and a perfect natural environment for fungi to flourish, the problem is particularly acute in certain parts of Thailand. The id21 web site says that in north-east Thailand, cryptococcal meningitis is second only to tuberculosis in causing the deaths of people whose immune systems have been damaged by AIDS. The locals, of course, are fully aware of the dangers of fungus. Thai friends have told me to be very careful with certain foodstuffs on which fungus likes to grow. In particular they have mentioned bread and packets of instant noodles, such as MaMa, which are very popular in Thailand. These foods should be stored properly and expiry dates strictly observed.
Is It Necessary To Bring Lots Of Medication? Obviously if you need special prescription drugs you should bring those. Otherwise, it's whatever makes you feel most comfortable. If you feel better about having a well-stocked medicine kit in your bag bring it. Personally, I wouldn't bother unless going into a very remote area. There are pharmacies everywhere in Thailand, many with excellent pharmacists. I have never found it a problem getting a good diagnosis and suitable medication for any problem I've had in Thailand. Local pharmacists understand local ailments and are well equipped to deal with the things that are likely to be a problem in Thailand. Medication is cheaper in Thailand compared to the West and there are products that are not available in the West. Let's take prickly heat rash, for example. In the West the pharmacist would probably describe some kind of calamine lotion. In Thailand there is something called 'Srichand Complexion Powder' which is mixed with water to form a pink paste. It works really well, is easily available and costs only Bt17. St. Luke's Prickly Heat powder is another very cheap, easily available product that works well after showering to cool the body down.
As in other countries there is a definite two-tier hospital system in Thailand. The public hospitals are similar to NHS hospitals in the UK and the private hospitals are like private UK hospitals. I would say though that both are better in Thailand than the UK equivalents and I have experienced them all. Thai public hospitals, like UK NHS hospitals, can be manic places. There are far too many patients and all the staff appear to be far too busy but you have to admire the way the doctors and nurses set about their work even though you can guarantee they won't be earning very much. I had been seeing a doctor at a private hospital but a test he wanted carried out could only be done at a public hospital where there was a research lab. When I attended I had to pay a very small registration fee (Bt20 I think) and there was a charge of about Bt700 for the procedure I underwent. I waited for a while in a very crowded waiting area and when I was attended to there were other patients being attended to in the same room. As I had the top layer of my cornea scraped off to provide a test sample a young girl on the next bed screamed at full volume while four adults held her down as she had an insect removed from her eye. Thai private hospitals are very, very different. They employ 'meet-and-greet' staff who are invariably very attractive, high-class females. It is said that first impressions count and first impressions at a Thai private hospital certainly make you feel good. I have only attended one private hospital, one in the Bangkok hospital group, but I have been there many times. I should mention that it is not necessary to be referred to a private hospital in Thailand as it is in the UK. They have A&E and outpatient departments and anyone can walk in to be seen. Here are a few impressions of the private hospital I have attended. The hospital building itself is more like a 5 star hotel than a hospital - new, spotlessly clean and lacking that hospital 'smell' I was familiar with in UK hospitals. The level of service and professionalism is first class from the time you enter until you leave. I have never had to wait more than about 15 minutes, even for minor complaints. This is quite unlike anything I ever experienced in UK hospital where it is not unusual to have to wait in A&E for four hours or more before seeing a doctor. The hospitals are very well equipped including an MRI facility at the one I went to. The nurses and doctors who have attended to me have always been extremely courteous and professional. Weight and blood pressure are measured as a matter of course on arrival. When I spent a day in the hospital suffering from food poisoning nurses checked up on me regularly and of course all of them had that famous Thai smile. I have been impressed with the skill of Thai doctors I have seen and have trusted them completely. You will find that all Thai doctors speak English (some better than others) and most have worked or studied abroad at some stage. They keep up with recent developments in the international medical community and have access to the best equipment. I truly believe that if I had been a member of the British royal family being treated at the Princess Grace or another private hospital in London I would not have received better treatment than I have in Thailand. Without a shadow of a doubt my best hospital experiences (if there are such things) have been in Thailand. What's more, for the fantastic service, it is not that expensive. When I was admitted for an overnight stay for food poisoning the cost was around Bt6,000 which included a private room, meals, several doctors consultations, constant nursing care, a saline drip and lots of other medication. The visit for an ear infection which included a consultation for the diagnosis, antibiotics and ear drops came to Bt500. The doctor's fee was only Bt200. It seems crazy that a doctor who has studied for years and is equipped with all the latest equipment charges only £3. In London this would be closer to £100. The only thing to remember about the private hospitals is that they are first and foremost businesses. Everything they do is very efficient, especially tracking charges and billing patients. If what you require is going to be quite expensive you will probably need to release your credit card details before anyone will see you. Every swab and aspirin will appear on your bill. There are standard charges that appear on the bills too. I used to ignore 'Packaged Medical Charges', 'Other Medical Charges', 'Drugs and Parenteral Nutrition' until I went to pick up a repeat prescription one day. All I did was go straight to the pharmacy inside the hospital to get more eye drops. When all these other charges appeared in addition to the charge for the drops I started to question why. Maybe this is me being cynical but I have felt at times the doctor was trying to get me to stay in overnight when it wasn't entirely necessary. The reasons given are the nurses can administer drugs better and it will be easier for the doctors to observe you but for certain problems I haven't considered an overnight stay to be essential. Could it be that in-patients generate more revenue by filling empty rooms? If you do have to stay in there is a separate department selling rooms. This operation is more like a hotel than a hospital. They will show you colour brochures of the different rooms available and give details of the facilities in each room. What you will find is that doctors working in the private hospitals will often work in several other places including public hospitals, other private hospitals and clinics. It took me a while to discover that my regular eye doctor has his own clinic. It is located a lot nearer to where I live and seeing him there is cheaper than seeing him at the hospital. There aren't lots of pretty girls to greet me when I go to the clinic but I can live without that. Obviously, while I was seeing him at the hospital he wasn't allowed to tell me he had a clinic. Finding his clinic was pure chance.
Thailand has a large Chinese population and there are lots of pharmacies and doctors specialising in Chinese medicine. The pharmacies are easily recognised by the strange items they stock - roots, herbs, tree bark, animal parts, etc. The smell inside a Chinese pharmacy is actually very pleasant. I have watched fascinated as the pharmacist prepares prescriptions using a set of scales to mix weird and wonderful ingredients before wrapping them up in pieces of plain paper. My view of Eastern medicine is that it definitely has a place alongside Western medicine. Western medicine is quite destructive. Doctors make a diagnosis and then prescribe something to kill the problem but what else does the medicine destroy? Eastern medicine takes a more holistic approach where balance is very important and the whole body is looked at. Something out of balance in one part of the body may be causing problems elsewhere. As a visitor to this site wrote and told me, Chinese medicine has been around for 6,000 years so they must know a thing or two by now. I once went to a Chinese pharmacy in Penang to get something for an excruciatingly painful sore throat. I was hoping I would get a strange 6,000 year old remedy consisting of weird ingredients. Instead the pharmacist sold me a pack of Strepsils. In desperation I went to see a Chinese doctor about my eye infection (see above). It was a strange experience. I was told by the pharmacist who recommended him not to say anything. I wasn't to ask any questions or start giving him the history of my eye problem. His shop was unlike any doctor's surgery I had ever been to. There was no reception desk - no other staff in fact, it was just him. The place was filthy, his desk was cluttered, he chain-smoked throughout my consultation and occasionally used a spittoon on the floor to his right. He asked me a few basic questions - where I came from and what I did for a living - but didn't speak much. His entire diagnosis was performed just by feeling the pulse on both of my wrists. From this he is apparently able to determine any problem in the body. He wrote out my prescription using an old-fashioned ink pen and a pot of black ink. It was all in Chinese characters of course. I went back to the pharmacy to have it made up. The cost rather startled me. The prescription was for six days and he had included double doses of Ginseng each day which doesn't come cheap. Each morning I had to boil the herbs up like tea and drink the resulting liquid. The Ginseng was soaked in the 'tea', chewed and swallowed. I had to keep the herbs and later in the evening added three more cups of water to repeat the process. Did it work, then? I'm afraid I can't answer that question. My eye definitely started to improve but I think this had more to do with the fact I stopped putting toxic drops into my eye at the same time I started taking the Chinese medicine. The Chinese medicine was designed to give my nervous and immune systems a boost and I'm sure it didn't do me any harm but how much actual good it did me I cannot be sure.
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