Thursday, September 6, 2012

Universal Healthcare: Is the Chaos Worth the Cause?

Fact: According the the World Bank, 99.5% of Thailand's population is covered under their medical system.
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Due to my apparently weakened immune system, I've fallen victim of trivial illnesses far too often in the past few months. Multiple times I found myself at the dreaded Sappasit Prasong Hospital in search of an English-speaking doctor to cure my ailments.

My very first week in Ubon, plagued by a recurring sore throat, I braved the government hospital in all its language barriers on my own. Back then, this was an intimidating task considering the challenge of navigating the numerous steps and employees without a lick of English language. Having sinceforth been back with the aid of a Thai teacher, Bhinya, I definitely waited a couple hours too long on my own. Four months in Ubon and one too many visits later, I could comfortably navigate that place now being deaf and blind.

Sappasit is a government hospital. So in all it's glory, there is a lot of waiting to be done, allowing for a lot of  time to analyze the intricacies unfolding before my eyes. During what I pray was my last visit to that godforsaken establishment, I found my eyes wandering from the half-naked old man in the stretcher, the child retrieving intravenous treatment in the hallway and the birds doing a little dance on the permanently dirt-colored floor - all taking place in the stifling hot open air waiting room. I watched the nurse, dressed in an uniform straight from the '60s conduct preliminary examinations of patients publicly, recording the results on stacks of papers (an uncommon sight nowadays in America with computerized medical charts). 

With my developed Thai goggles, there isn't much I find shocking anymore, including this typical hospital scene. With time to kill, I forced myself to look longer and harder at my surroundings - until I recognized just how foreign this hospital atmosphere in rural Thailand was from the immaculate, orderly hospital and doctor offices I grew up in - and just how far away I was from home.

1. Treasure Hunt
The process of a government hospital in Thailand reminds me of a treasure hunt, with the doctor being the highly sought-after treasure. There are about 5-10 steps that must be completed before getting to the prize - filling out various forms in different corriders throughout the building. The illogical sequence is even mapped out like a treasure hunt - sending you on a wild goose chase up and down from one building to the next to complete the tasks. It's as if they want to make sure you're functioning with a little warm up before you get to the doctor.  If you don't speak or read Thai, you basically need a personal escort to figure out where the hell to go next. I've been lucky to have caring Teacher Bhinya assist me on numerous hospital visits. When you finally reach the tiny air-conditioned room alone with the doctor - it really is like a pot of gold! 

2. First Come, First Serve - Kind of
When I say I've gone to the hospital, this is just the location in which one goes to see the doctor. There are also medical clinics, but the hospital is usually the most reliable choice. There is no such thing as appointments. Instead, you take your little piece of paper as received during the treasure hunt, place it in a basket and hope it doesn't get moved out of order until the nurse calls your name. And it probably will get moved out of order. And people will probably butt in front you, interrupt the nurse during your two-minute allotment with her or straight up sneak ahead of you in line. This isn't necessarily distinctive of the hospital scene per say, but the lack of rigid lines in Thailand. If I wasn't already aware of this little societal quirk, some lady may have gotten punched last weekend. From what I gather, the greater concept in the hospital resembles first come, first serve - but put your game face on.

3. No Privacy, No Shame
Back in January, I had my first government hospital experience in Sriracha to retrieve a medical certificate. I remember feeling uncomfortable at the amount of people on stretchers in the waiting area and treatment dispersed in arbitrary locations. Privacy, I suppose, would require space, and space requires money, and that defeats the purpose of a government hospital. During my most recent intravenous antibiotic treatment, my student and his family happened to be in the same room. Across the room I hear a little boy squeak, "Teacher Andrea!" and I wave from the hospital bed with a needle flopping out of my arm. Awkward.

4. Implausibly Cheap
My company provides health insurance for longer hospital stays, but luckily I haven't needed it (though my friend did have her appendix procedure completely covered). Every time I go to the doctor, I leave with heaps of prescriptions - they love to load you up with "just in case" medications. Even though I know from experience the bill is going to be inexpensive, I still always half-expect to see appalling US prices. My recent doctor visit included six prescriptions, one of which was an antibiotic that had to be injected at the hospital for three consecutive days - all for the measly cost of $6. This price also included a 50 baht ($1.50) surcharge for seeing the kind doctor who went to the trouble of calling me two days later to check on my health. Bhinya assured me that the surcharge goes to the government, who in turn pays the doctor what is considered a good salary in Thailand, though certainly more modest than in my country. Teacher Bhinya also refilled a couple prescriptions for herself at no cost, as all government employees receive free medical care.

I'm lucky. If I wanted to, I could have skipped out on half of the hassle for a private hospital in Ubon for a bit more money. (Why didn't I? It's further, Bhinya suggested Sappasit, I'm on a budget, and frankly, I enjoyed learning about the health care system through experience). If there was a serious medical issue, I could have probably flown to an international renowned hospital in Bangkok that looks exactly like hospitals do in America.

But not everyone has that luxury.

Despite the frustrations, inconveniences and public chaos in government hospitals, everyone receives  treatment they need, which to me, says a lot more about the success of a system than the zoo-like appearance. Coming from a place where healthcare is not a basic human right, my heart is unequivocally warmed by witnessing a system that gives fair opportunity of treatment for all people. 

If it means that I have to wait a little bit longer, and go through a little bit more hassle to see a doctor, but that the school janitor can also afford medical care for his family, so be it.

How can any human see a problem with that?

1 comment:

Ellie said...

Haha, i thought i time traveled when i first went to a hospital in Thailand - straight outta 1960! I do agree though, so amazing that even a country like Thailand can afford to give all its citizens healthcare. Step up America! Great post!!