We recently spent ten days in the huge Srinagarind Hospital, which is the main teaching hospital for the Faculty of Medicine at Khon Kaen University in the north east of Thailand. I thought I would share my impressions of the experience, not as a comprehensive guide to the Thai medical system but as a personal insight into one brief involvement (thank goodness). Having said that I am sure there are aspects I will write about that can be applied to being on the wards of most public hospitals here.
I will also throw in some information about the hotel we used, in the unlikely event anybody reading this follows in our footsteps.
I am not going to share too much about the medical background to our situation, as that is of limited interest to outsiders and is personal, but I will give a brief background to provide some context. My stepdaughter Peng is seventeen and she has had mobility problems since very early childhood. An operation to lengthen the tendons in her legs was performed when she was five years old at this same hospital. Having reached adulthood further lengthening was required to corrected problems she has had in straightening her legs combined with weakness, which has made walking increasingly difficult.
The decision to have surgery was taken last year but due to operating theatre renovations it had to be delayed until June this year. The original plan was for more extensive surgery involving some knee reconstruction and on one leg only before repeating the procedure six months later on the other. The final operation in reality involved both legs and there was no knee work involved, which lessened the impact.
My first observation is that you need a great deal of patience is dealing with the hospital system if you are a drop-in or even have an appointment. This is a large facility and there are literally hundreds of people sitting around in open rooms and corridors waiting for attention.
We have been here many times for Peng as she has a six monthly check-up plus there were a few visits leading up to the operation. Although in theory you have an appointment time we have never got to see the doctor in under four hours. Seven hours was the record. Combine that with a two hour drive each way and it ends up being a full day. On the up side most medical treatment for Thais only costs 30 baht or A$1.20, which may explain why every medical centre I have been to is so busy. I believe some specialist services may not be included in this base fee and for major treatment there may also be an upper limit after which the patient has to fund the difference. Getting definitive information on this is difficult. I know of people in the village who have had to sell land to pay medical bills so there must be some situations the government doesn’t cover.
All the public areas in Srinagarind are open to the outside so it can get very hot and although there are plenty of fans around it is a huge space and hard to find a chair let alone one under a fan. Like public hospital systems the world over the medical system eventually gets the job done. If you take the time, and waiting around comes naturally to Thais, then you will be treated at some stage. If you find yourself committed to a hospital visit then my recommendation is bring a good book or make sure your mobile internet is paid up!
We were booked into the hospital on the Saturday before a Tuesday operation date. I doubt that a western hospital would consider such a long lead time and I am not sure why that’s the case here and if this is standard. The previous time we were booked in for what ended up being a postponed operation date admission was on the Sunday, when the public part of the hospital is closed, which made it a breeze. Even this time despite plenty of people it only took a few minutes. Your medical records are provided at admission and you take these with you to the ward.
I have to say that the administrative side of things seems to work pretty efficiently. The book-in process was quick, the ward was expecting us and the transition from normal person to hospital patient was all smoothly arranged.
I was prepared to pay for a private room for Peng, at a cost of 1,200 baht a night (A$48.00) but her surgeon wanted her to be in the public ward after the operation so we went with that. We ended up in the specialised orthopedic ward, which has 30 beds grouped in rows of five. The ward had a mix of male and female as well as all ages however the children were grouped together at one end. Because this hospital takes on the situations other lesser public hospitals can’t handle it tends to have more specialised cases (my observation) rather than “just’ fixing broken bones. A lot of the children were in for corrective bone surgery due to birth defects rather than as the result of accidents. When Peng started to have problems when very young Peng was referred up the line of hospitals from our local one in Si Bun Ruang, to the one in our provincial capital of Nong Bua Lamphu, then to the major one in the city of Udon Thani and finally to the teaching hospital in Khon Kaen. You can’t just jump straight to the end of the queue.
In the case of Srinagarind Hospital if you do find yourself there you need to realise that it is a teaching hospital for Khon Kaen university so several times a day the wards are full of students following one of the doctors around. I didn’t find them intrusive in Peng’s situation but for other patients it was a closed curtain session with an audience!
In this ward the beds are spaced a metre apart and this area becomes the supporting family member’s home for the duration of the stay, which includes them sleeping on the floor next to the bed. Thais hate being alone and hospitals are no different. Almost every bed had a mum, grandmother or other relative in attendance and they literally live there to do most of the non-medical work that would normally fall to nurses to do in our western medical system. Feeding, washing, bed pans, changing clothes, all of this is done by the carer not hospital staff. I guess if you didn’t have anyone then the nurses would step in but they certainly did like staying in their air conditioned part of the ward – more on this later.
The ward is not air conditioned and every other bed had an overhead fan. Why not every bed who knows. Because of this every second bed has a portable floor fan. The windows are open so the internal air temperature is the same as outside, which when we were there was in the low 30’s. I would plan my stay outside the hot season in March/April when it can get to over 40 degrees for several weeks. Not only were the windows open but most of the insect screens were too! I know that many Thais believe the screens block air flow but this seems an odd attitude allowed by a supposedly highly educated staff. I had someone tell me that their theory about why Thais never put on their car lights until total darkness is that they think by doing so they are using more power and therefore using more fuel. This is the same sort of ignorant thinking in evidence. By having the windows open to the outside we often had sparrows hopping around looking for food and it is an open invitation for mosquitoes too although I never saw one.
The beds themselves were modern electric, which could be raised and lowered as well as options for various mattress configurations. The bedding was all clean and refreshed regularly but no towels were provided so make sure you bring your own. A lady came around every day with fresh hospital gowns – large sizes for the kids so rubber hair bands were in big demand to tie up trousers 🙂 Each bed had privacy curtains and a supply of plastic visitor chairs was available in each section. An old CRT TV was available to be shared in each five bed row, but in an age of internet phones most people seem to do their own thing.
The wards were obviously well used and not the most modern but everything seemed to work and it was kept very clean. Cleaners came around twice a day to sweep and mop. Each bed had a small wastebin and a supply of fitted plastic liners were available, which sounds very minor but in my mind shows that this is not a third world medical scenario if small things like this are thought of.
Three meals a day were provided being breakfast at 8:00 am, lunch at midday and the evening meal at 4:00 pm. The food was totally Thai, no surprise there, and pretty basic but I guess if you didn’t mind losing some weight it would do the job. The meals themselves were usually two main dishes plus steamed rice (of course) and a dessert. Because this is Isaan and sticky rice is the main accompaniment to any meal people who did bring in sticky rice shared it with neighbours!
For visitors and those wanting to supplement meals there are two farang style cafes in the hospital, a Black Canyon and an Amazon, as well as a few small speciality shops. There is a bigger supermarket but that was being renovated while we were there. The main public food area is to the right hand side of the entrance on an upper level behind the cafes. For someone like me who gets the farang munchies there is nowhere in or outside the immediate hospital grounds that can help.
When it came the day for Peng’s operation the whole pre-arrangements were again very efficiently handled. Various people arrived to check on the procedure and she was hooked up to a drip. The preoperative antiseptic wash liquid was just delivered and it was up to Peng and Gaun to apply. A wardsman arrived with a roller bed and four nurses helped with the transfer. One nurse walked with Peng to the theatre and she was transferred to a bed there. This was done at 2:00 pm, she went into theatre at 4:00 and was the second last to leave post-op just on midnight! How do surgeons work at this concentrated level for these sort hours?
I was concerned about what would be available for pain relief post-op. For Peng’s first major operation aged five it was just pills and Gaun tells me she cried a lot poor girl. Thankfully times have moved on and Peng was hooked up to a self administered morphine drip and that got her through the first two days. She was off it by day three and despite having had eleven incisions on her legs, apart from a few instances she has been pretty pain free since.
Back to nurses. From what I observed their main function was mainly to administer the more specialised medical side of patient management. They made regular rounds to check vitals and to distribute medication but despite there being up to ten nurses for a 30 bed ward they didn’t have a lot of contact with the patients. They were certainly there if you needed their attention but it was all a pretty hands off role for all the day to day matter of attending to patient’s needs. There was a time twice a day when the whole group would do a massed exit from the air conditioned room to formally walk around the ward. I have never had much to do with the hospital system in Australia but I suspect the nurses there have a broader range of responsibilities, many of which they probably would prefer not to do!
The people I do admire are the doctors especially the two who do most of the specialised surgery. There’s a lady who is the head of the orthopedic unit and did Peng’s original operation twelve years ago and a younger Chinese/Thai guy who was the surgeon for this one. They both had a real affinity with the children (more so than with their parents it seemed!) always taking time to chat and crouching down to be on the child’s level if talking to them. I doubt they have families of their own because Gaun tells me that they were in at six in the morning and often were doing rounds at eight in the evening, seven days a week. They must have time off but when?
The other thing I noticed after spending so much time on the ward is the sense of family that builds over time with others in your section. Not just the patients but the supporting carers too. This is especially true in a Thai situation because unlike me, who finished up early evening and went back to my hotel, these family members looking after the patients were in living in the ward, sleeping, eating and hanging out. We got to know the people passing through pretty well and Peng has heard from the girl in the next bed since we returned home. News was swapped, food shared and the “old timers” helped out new arrivals. Thais are less inhibited than us westerners about things medical and they just come up and ask what the situation is almost as soon as people arrive and then tell them their problems. It was hard not to get involved even for an outsider like me.
The girl to the left of Buck in the background was in because she got her skirt caught in the rear wheel of her motorbike and it broke her thigh bone. The local hospital set it only to end up with one leg shorter than the other. She was referred to Khon Kaen and they had to re-set the bone as the previous attempt had them overlapping!!!! That’s Yuan and Lud on the right, Gaun’s younger sister and brother-in-law, plus another sister Paed out of picture who made the trip down to see Peng.
We were cleared to check out on day eleven and once again this was a smooth administrative experience. The nurses prepared a financial statement, which ran to four A4 pages detailing every single item used down to the last pill literally. The total cost? 66,000 baht or A$2,500. Amazingly cheap for ten days in hospital, a major operation and all medication. Peng has a disability card and because of this she not only gets a very small payment every month (700 baht I think) but she doesn’t even pay the 30 baht base medical charge and there’s no upper limit on what the government will cover. Try that in Australia or the States! It also shows that although super inexpensive if you are financially in a very tight situation medical does not necessarily fit into a “Thailand on $10.00 a Day” sort of budget. I have private medical cover and you can read about that HERE.
To get us out of the hospital a wardsman arrived with a roller bed and took Peng to the main entrance, helped get her into our pick-up and then we were finally free and connected to the real world again. Home has never seemed so good.
That wheelchair is a loan from the local medical centre in Si Bun Ruang. All we did was turn up explain what was needed and they took a copy of Peng’s ID card, Gaun signed a handwritten note and we were off with the chair in ten minutes. No medical records, Peng was still at home and it was all done by word of mouth.
We head back to Khon Kaen on the 17th of July to have the plaster casts removed and for an assessment of what physio is required. The conclusion of this operation is unknown but we pray for a positive outcome for Peng, who is one of life’s sunny characters like her mum.
Enough medical – let’s do a side trip if you are interested. If you are local and find yourself on an overnighter at Srinagarind Hospital and don’t want to sleep on the floor as Guan did then I recommend U Inn, which is a new place just across highway 2. It is a ten minute walk to the hospital and there’s a pedestrian skywalk over the twelve lane highway, which makes access easy. You can find U Inn on Agoda HERE.
I had a burst of creative writing and left a review of the place on Agoda and Google Maps, which reads as follows:
The U Inn is a hotel built and located for a purpose – to provide accommodation for visitors to the the giant Srinagarind hospital across the road not as a general tourist destination. As such it is a pretty bland and uninteresting place to stay situated in an area that offers very little unless you are connected to the hospital. We spent ten days there recently and U Inn does the job at a daily rate of 790 baht.
The location for access to the hospital is great – a ten minute walk with the option of a pedestrian overpass across highway 2 during busy times, which is a 12 lane road at this point.
The rooms are small but adequate. The bed is Thai style firm but not uncomfortable. Linens are good quality and changed daily. The air con controller is fixed so you can’t access it so you can turn it on and off and adjust the temperature but nothing else. It was set on high fan speed, which was noisy. The bathroom work well for a Thai place. They have an exhaust fan and the shower is in a separate enclosure so that you don’t flood the entire bathroom with water like so many Thai hotels and resorts. Water pressure was low but you could adjust the shower head to make it look as if there was more! The walls and floors are thin so if you had noisy neighbours you would certainly hear them. The views are of typical Thai city ugliness as you can see from the photos and we never bothered to open the curtains. The penthouse has limited appeal in Thailand. The curtains are not blockout so you will certainly know when morning has arrived.
The major downside was that there is no coffee/tea making option in the room. I have been to many hotels across Thailand and I think this is the first to miss out on this pretty standard option.
The limited room service meals on offer for 55 baht are actually microwaved from a packet so don’t get too excited. The one I had was inedible.
Wifi worked all the time we were there at around 10 mbps download speed. There are two modern lifts so getting to any of the seven floors is easy. The staff have a little English but wouldn’t be able to cope with more complex enquiries.
Breakfast was adequate with a rice soup and a main course with rice for the Thais as well as eggs (they have fixed the warmer a complaint in previous reviews so the eggs are warm), toast, jams, cereal, coffee, tea and juice. The emphasis is on Thai guests and as the vast majority of people staying there are locals it is no use complaining that they don’t do more western choices.
The immediate area is a wasteland of empty shops on the whole. There’s an Isaan restaurant immediately in front of the hotel, which was well frequented by locals but I didn’t think the food was special. Maybe a kilometer down the road heading into Khon Kaen is a place called the T Bone Steakhouse and it’s the closest farang food place. All you can eat steaks and sides for 219 baht. Good value. Open 6:00 – 10:00 pm.
If you are into massage there’s an excellent place just behind the hotel run by a farang and his wife. Clean with air con she does an excellent mixed Thai/oil massage – one hour 250 baht.
All in all U Inn did the job providing a clean, and mostly comfortable place to stay. If you are a tourist there are better choices. If you are in Khon Kaen because of the hospital this is one of the best options.
I hope you have found our medical adventure interesting. Maybe this post has given you a realistic insight into what spending time in a Thai public hospital might look like. You probably never will but it is another story that takes you beyond the elephant rides and zip lining that takes up so much blog space.
Thanks for reading