I could claim to be writing this as an informative comparison as to how government hospitals treat foreigners with different types, or lack thereof, of insurance. Having spent a month or more in a government hospital on three separate occasions, in three different provinces, each time with very a different financial situation, I would probably have quite a lot to add. But that's not why I'm writing this.
I could claim to be writing this as an aid to others. Perhaps a cautionary note to those of us who have weighed up what other goodies could be bought in Thailand instead of ‘wasting' it on insurance, which is almost certainly not going to be necessary; "You can get a hotel for 3 quid a night! On the beach, no less!!" was one of the many, misinformed pearls I was given before first coming out here 5 years ago. But that's not why I'm writing this.
Let me just be completely frank here. This is nothing more than a little bit of self-indulgence and a way to fill in these long summer school hours. Are we sitting comfortably? Then get a bloody cushion, I'm beginning now...
Once upon a bike
It was a beautiful, summer's day. The sun was beginning to show up over the Tha Phae Gate, the birds were just clearing their throats and all was good. Ok, Chiang Mai is a beautiful city but it could be that my mindset at the time managed to overlook the two dozen tuk-tuk drivers, (the reason, perhaps, that the birds felt it necessary to clear their throats), that had just polished off their Lao Kao ready for another day in the office. It may well be the case that I was far too high spirited to notice the girls that were still stumbling out of Spicy, hurling broken profanities at the poor guys who had respectfully declined to ‘go boom-boom.' Compared to Bangkok, Chiang Mai is a cut-out from ‘Happy House and Home' magazine, but on this particular day I swear I was looking at the pearly Tha Phae gates of heaven.
A group of guys I had met were talking about renting motorbikes and going off to do a bungee jump but it was still 6am, and I had no intention of disturbing my new best friends, so I thought it may be a good idea to get in a bit of practice on a bike (since the only thing I had ever been on was a 50cc scooter on my old school playing field). Passport in hand I went off to rent my first motorbike.
The forms that needed filling in were all pretty standard, and I don't know why I hadn't expect it, but I froze for a moment when I saw the heading "Driving License Number". Okay... although I had no idea what to put, (how many digits? Are there letters too?), I was fairly sure that neither did the shop owner so......297yg89, thank you very much. Where do I collect the keys?
It should have dawned on me then, as I stalled the thing after 10 seconds, that this might not be the best of ideas. It would not be that surprising that I had managed to stall it, since this was my first ever time on a bike, but this was a bloody semi-automatic. Surely it should not even be possible. Nevertheless, warning unheeded, off I went. And I flew. Within minutes I felt as safe as anything as I rode the gold-paved streets.
Soon I was outside the guesthouse with my crew, planning out the route we were going to take on our big adventure. There were 7 of us in total; myself, a Danish couple, an Australian couple, an English guy and an English gal (who had been paired off to ride with me). Fortunately the senses that were lacking in me were still evident in her and she politely suggested that perhaps she should sit on the other chap's bike. She had, after all, just seen me frantically thrashing my leg around, trying to find the foot brake. To try and maintain some level of pride and dignity I handed over my helmet to her as we were a helmet short between us all. I mean, really...with riding skills like I had just acquired, where was the point?
So off we went.
Worse ways to go
And off we went. It really was something out of Quadraphenia, except in colour and without any particularly annoying haircuts. Our gang. Our group of modern day mods. No real plans, just free riding (we'd stashed the map away by this point).
After we'd reached about the half-way point to our destination we stopped to get some water, check we were all ok and beam smiles at each other to signify how much fun this all was. The girl who had wisely opted not to sit on the back of my bike came over and handed me her helmet, claiming that I had been drawing the attention of the police and it would look better if each bike had at least one helmet. Looking back it was really good, and quite clever, of her to leave out that fact that I was riding like a madman and that she feared for my safety. I thanked her, accepted the helmet and we all got back on our bikes.
I was still trying to get my bike started as first one, and then a second, of our group sped off. I finally got the thing going and decided to make it my mission to catch up with the other guys, on their 250cc superbikes, and more importantly to regain some of my already dented ego. It was going to be quite a feat considering, I was on an automatic chicken chaser, but I was determined. I began leaning into all corners, assured in my mind that this would be as effective as braking, and I pushed my whole body forward in an attempt to either streamline myself or just to will the bike to go quicker. I learned, as one particularly sharp bend turned into an equally nasty s-bend, that this had not been a good idea. The bike and I, both as one unit, hit the side of the road and proceeded to perform a 720° back flip that, had it not been for the poor landing, would have surely impressed the Xtreme-games judges. I should perhaps pluralize ‘landing' as the bike seemed reluctant to give up on it's new found vocation as a jet engine and put in a few final attempts to take off.
It is true what they say about the superhuman strength your body can achieve with high levels of adrenaline. I flung the bike a good few feet away from me and began checking myself over. Starting from the top (leaving on the helmet, loosening my clothes) I looked to be in fairly good shape so I went to sit up. I'm no doctor, and a half day first-aid training is the source of the only medical knowledge I posses, but I am pretty sure that bones should not protrude out of the skin, and that legs should not resemble rare, tenderized steaks. This was quite bad.
It was about now that my Australian friends, who were the last of our group to head off, came running over with worried looks and panicked voices. Despite their evident squeamishness they came over to me and began trying to make me more comfortable. The first thing they had to do to accomplish this was to try and in some way shade me from the blazing sun. As there was no shelter around us the only way this was possible was to use their clothes and, being such a hot day, none of us had much on anyway. All the guy could spare was his shorts, leaving him standing in a pair of Y-fronts; the sort that my mother had forced me to wear as a young child, and later my PE instructor had forced me to wear to... "keep my parts in place". Having given me this protection from the sun he went on to psyche himself up for the rather unpleasant task of holding my foot in place.
His girlfriend had rested my head on her knees and was trying to feed me water and orange juice. Despite all this help the heat was still getting to me and we seemed to be forever waiting for an ambulance. She must have noticed that I was struggling with the heat as she also took off her t-shirt for extra shade. I remember thinking, as I was drifting in and out of consciousness, that there are worse ways to go than this; laying out in the sun, head resting on the knees of a beautiful, half naked woman, being fed orange juice.
Time flies when you're having fun. Well, despite the attention I was getting from two amazing people I wasn't really having fun. And time, keeping to its promise, slowed right down. Cars, trucks and buses flew past us and again the laws of the universe were obeyed; that deep, mysterious part of us which draws our eyes to anything grotesque or obscene did not falter here. I like to think that the reason people weren't stopping to help was because they were all on important business and that nobody was thinking... " it serves the dumb bastard right".
"All good things come in threes" and "when it rains it pours" are some other appropriate quotes from persons unknown as three ambulances showed up within minutes of each other, each from a different hospital/organization. I use the word ambulance quite loosely with the first as it was really just a kitted out pick-up truck from one of the volunteer groups. I should just stress that the work they do is truly amazing; they seem to get very little in the way of appreciation, and nothing in the way of funding, from the government for what they do. Nevertheless, I was a bit concerned when the first thing they did was snap off a nearby branch to make a make-shift splint. Next came the two official ambulances, both from different directions and both seeming to be in a pride-fuelled race to get to me first. I imagine they were both a bit disheartened to find that the volunteer group was already there and already half way through strapping my foot to a tree. The one driver peeled away with just a few customary words to the others and a "tut-tut" shake of the head aimed at me. And then there were two.
The relief I felt on seeing the medical professionals arrive was quickly turning into a frustrated worry as all parties left my side and went off to debate over who would take me in. Being new to the country I had no idea what they were actually saying but the raised voices and confrontational stances showed that the debate was quickly turning into an argument. I don't mind admitting that I was routing for the hospital's guys, if for no other reason than that they were much more likely be in possession of large amounts of opiates. Harsh words were exchanged, telephone calls were made and eventually the volunteer group sulked off and drove away. My inward "woop" of joy was soon justified as within a few minutes I was in the back of a sterile white ambulance, eyes rolling back with that relaxed, ‘not a care in the world' feeling that comes with a shot of morphine.
I can't say much regarding the ambulance ride, or the initial treatment I received, on account of being sedated, anesthetized and just completely exhausted. What I can talk about is first coming round in a large room with seven young, bedridden Thai guys staring at me. Let me take a moment to lay the scene a little bit. I was in a large, open room with four beds neatly lined against each wall. As you would expect in any hospital, there was a small bedside cabinet, a reading lamp and a comfortable, but sensible, chair next to each bed. Looking around the room I noticed that my little living area was quite unique in as much as that it was the only one that was completely empty; wives and sister dutifully gathered around the other beds pouring water, fluffing pillow and being generally supportive. This was the first point that the seriousness of my situation struck me and the first time that I realized how alone I really was. The young men around me were all in various states of disrepair, ranging from broken legs, bandaged arms and even one poor guy with a bolt coming from his head, staring out in a zombie like trance. It was, I would later learn, the ward put aside specifically for the hospital's regular admission of motorcycle accident patients.
Get it out
Having taken in my surroundings I focused my attention on my own injuries. My upper body was covered in scratches and scrapes but was otherwise fine. Below my waist line, however, was a different matter. My right foot had been left un-bandaged and had swollen to something akin to the classic, exaggerated, swollen thumb cartoon. It was huge. Each toe had a small amount of wire protruding from the end making my foot resemble an avant-garde sculpture made from old garden rakes. This was not the thing that was really worrying me though. What really shook me up a bit was the long, plastic tube coming from underneath my hospital pajama bottoms. A moment of calm thought would have probably told me that it is quite normal for a catheter to be inserted when a patient undergoes lengthy surgery but all that was going through my mind was "GET IT OUT!!!". I gave it a few tentative pulls hoping it would just slide out. Nothing. I tugged more forcefully, wincing at the pain. Nothing. In a fit of panic I yanked at the rubber tube for all I was worth; whatever else happened to me, this damn thing was coming out. Luckily one of the nurses saw what I was doing and came running over, waving her arms and shouting. It was only later, when the doctor came over to talk to me, that I learnt how these things are first inserted fairly easily but then filled with air to about the size of a golf ball. There is another tale which would fit the title ‘get it out' but it is perhaps a bit too crude. Let me just say that the catering staff, in their attempt to make me feel more at home, had been feeding me nothing but fried eggs and cold pizza for the first few days. Eggs are fine in moderation but being fed them morning, noon and night had a rather unpleasant effect on my digestive system.
You talkin' to me?
The next few days I had very little communication with anyone save the doctor on his daily rounds. On the first evening he explained to me what they had done during the 8 hours I was under anesthetic; every bone from the right ankle down had been broken in what he called a ‘crush injury' and so he had put in a whole framework of metal screws and wires to hold it all together; the left leg had several compound fractures which required internal and external metal work (making airport security a nightmare for me in later life). Other than that I was in pretty good shape and the cracked helmet that had been brought in with the ambulance had almost certainly saved my life.
The nurses were very friendly but could not speak a word of English. They could, however, write in a very neat, cursive script and this became our only way of communicating. Years later, at the bottom of an old rucksack, I found a slip of paper with one of my scribbled notes; "next time you are cleaning my wound can you PLEASE sedate me first?!" The role of a nurse here is slightly different to that of their western counterparts, in as much as that they are less responsible for general care (it tends to be female family members that help out with washing, eating and the like) but take a much more active role in actual medical treatments. It was the nurses who would come to scrub out my wounds twice daily, to pick out any signs of gangrene and to keep me stocked up on morphine.
It became apparent, even with the language barrier, that something was worrying the nurses and hushed conversations, aimed at me, became a regular thing. It all became clear when my doctor, on his evening round, came and very delicately broached the subject of insurance. I had travel insurance, from a pretty reputable UK company, but I had no receipt on me and all the paperwork was back in my 300 baht a night guest house. He seemed relieved that I did have insurance but there was still the question of how to contact them.
No fax no fix
After days of calling, waiting and being put on hold I finally managed to speak to someone at the insurance company who might be able to help me. My luck was in (or so it seemed) as a nice lady, sat in her London office, assured me that I would most certainly be fully covered for all medical costs, repatriation costs and anything else that might be needed. All I had to do was send her a fax, from the doctor, stating exactly what my condition was and a break down of costs to date, so I put my pen to paper an wrote out a note for one of the nurses. "I'm sorry but this hospital doesn't have a fax machine. There are many places in the city where you could send a fax but you cannot leave the hospital in your condition" was the reply handed back to me. When I called back to the insurance company, explaining the contents of the note I had just received, I was told that if I was unable to get a fax to them then they would not be able to guarantee the hospital that they would cover the costs.
When I spoke to the doctor, explaining this dilemma to him, he also apologized but said that without confirmation from the insurance company he would not be able to carry out any of the further operations, of which there may well be many. What was I to do? The next few days I was in a state of panic, completely at a loss as to what I could do. It was around this time that I saw the most welcome face pop her head around the drawn back curtains around my hospital bad. My older sister, who had been travelling around SE Asia at the same time, had heard about what had happened at had come straight to the hospital. I think this was the first time I had cried and a whole load of weights and worries were lifted off my bruised shoulders. For the rest of my stay my sister was an absolute angel. She did everything for me, from taking on the role of nurse and helping me wash and eat, to sorting out everything regarding insurance, paper work and every other little bit of red tape that got in our way. There is a chance she will read this, and I don't want to give her too much of an ego, but I can never explain how much her being there with me meant to me; never once did she make me feel like I was inconveniencing her or feel any bitterness about cutting her travels short.
Dinners and DVDs
From the moment that the insurance company had sent confirmation to the hospital we saw an immediate change in how we were treated. We were taken straight to a large private room with a place for my sister to sleep, an en suit bathroom, (again for my sister as my washing facilities were a plastic bowl and flannel, kept beside my bed), a large TV and a stack of DVDs. The nurses now spoke near perfect English and were as fun and light-hearted as they were diligent and hard working. They saw the kindness in the way my sister helped me and instantly befriended her, taking her out into the city for "time off" to go shopping, see some sights and just take a much deserved break from looking after me.
The nurses brought me a wheelchair so I could get out a bit and my sister would jump on the back as we sped down the corridors on the way for some fresh air and a smoke. The menu from the previous ward, which had consisted of cold pizza and fried eggs, was gone and I was now served large trays with an array of salads, grilled meats, exotic fruits and unusual desserts. A few times they even managed to bring me rare steak, mashed potatoes and other culinary delights which not only tasted great but also stopped me pining for home too much. Saying that, I did really want to be back home, around my family and friends, and was really hoping that the insurance company would send someone out to see me soon, and that my doctor would soon deem me fit for travel.
My sister and I had been quite cautious when telling our mum about what had happened, knowing full well that mother would take it badly and would want to be on the first flight out to see me, putting stress on me as well as herself. Over the first few days I had called home but insisted that it had been just a minor accident and I would be in hospital for just a few days. The next time I think it was sister who called home, explaining that I had broken my leg and that I would have to stay in a bit longer. It was not until about a week before I would be flying back that I told folks back home the severity of it all; over the last few weeks, despite the nurses pulling and plucking at the wounds with tweezers and soaking it in iodine, the foot had become gangrenous. First the little ‘pinkie' toe was amputated, and then two more until more than half of the foot was an open wound and I could quite easily have claimed to have been the victim of a shark attack, (which, along with a story about saving children from a burning building, would later become a way to impress any girls that I met).
Flying in comfort
After I'd been in hospital for around six weeks, and had been under anesthetic for no less than 20 hours in total, I was finally ready to go home. The insurance company sent out their own doctor, from Malaysia, to come to see and examine me, and they sent out a nurse, from the UK, to escort me on the flight back to Heathrow. We said our goodbyes to all the hospital staff, exchanged numbers and email address, and I was strapped into a stretcher for the long flight home. I don't really remember the flight from Chiang Mai to Bangkok, (perhaps because of the farewell gift of morphine I was given before heading off), but getting on to the flight at Don Muang really surprised me. I don't know why but I had expected some special airlift plane; sterile white walls and medical equipment screwed to the cabin. What I was not expecting was to be lifted on to a Thai Airways flight, over the heads of the passengers who had already boarded, and clicked into place where twelve seats would usually be. I remember thinking, glancing over at the other poor sods, all straining to see the movie showing on the plane's only screen, that this is the way to fly. No more club class for me, and you can keep your business class too. Next time I'm flying stretcher.