Tazza's Thailand Tales

Meds! meds! meds!

The medical situation in Thailand

For many, medical care in Thailand never stretches further than a visit to the drug store in Patpong, which must be the only pharmacy store to proudly display its range of condoms in the window. But bear in mind that illness can strike at any time and when it's time to visit the quack, it can be a little different to back home.

Let's cover the good stuff first. Thailand has a wide range of excellent private and international hospitals. The buildings and equipment are far better than your average English state hospital affair. The cost is usually great value and well covered by most insurance policies. Doctors are often educated abroad and speak good English.

However, there is a downside. As I type this it's 2330 and my son has finally come down from his drugged high. For the last two hours he's been zipping around the bedroom in a frenzy, while I tried (and failed) to calm him. He won't be going for counselling however, since my son is only sixteen months old and the drugs in question were supplied by local doctors.

I defy anyone, anywhere within Thailand to visit a doctor and come away without at least two forms of medication. Go ahead, try it. Visit any random medical centre and tell them you had a slightly runny nose a couple of days ago. See what happens.

Thais love their medication and in all my time here, I have never known anyone to come out of a clinic or hospital without a minimum of three types of medicine. There seems to be a two fold reason for this. First, it's an all - Asian culture trait that the second you feel unwell, you throw drugs down yourself. After all, drugs make you better so why not take plenty, just to be sure? The other reason is one that is subliminally accepted but not widely discussed in Thailand: the doctors and hospitals get kickbacks.

Thailand has only a minimal health care system built into its infrastructure. Staff salaries , standards and medication are monitored only by a very inefficient and anachronistic system. When you pay to see a doctor here, you pay not a set charge but a charge fixed by the age, rank and experience of your doctor. A GP of fifty years of age would command a far higher fee than a newly qualified twenty five year old. However, even the steeper fees are actually very reasonable, it's not where the money is made.

The real windfalls for these institutions - be they government or private - comes from the meds. Its a terribly kept secret that pharmaceutical companies pay monster kickbacks to medical centres, and that little line can only be kept going if GPs are 'liberal' with their prescriptions. Have a cold? Take this bottle for your stuffy nose, this liquid for your cough , etc. Bad stomach? Take this stuff for the stomach pain, these tablets to stop the runs, this antibiotic to kill the virus, this orange drink to replace your salts, etc. , etc.

What's more, the charge for these medicines is usually four to ten times the cost for the exact same product from the pharmacy across the street.

One of the most prevalent areas of this practice is in the paediatric section. After all,what parent wouldn't be relieved to hear the doc say: "Just take these four types of medicine home and your precious little one will be fine"? Not a bad little sales pitch is it?

I may sound horribly cynical, but there's nothing here that isn't solid fact. Don't get me wrong, the vast majority of doctors in Thailand are excellent. I must also note the doctors will usually prescribe the right kind of medicine so you will get better. There are exceptions though, I know first hand cases of overzealous hospitals and pharmacists giving antibiotics for colds and sore throats. Even a dunce like me knows that ABs don't work for colds.In fact, in England a billboard campaign has been warning about the dangerous of using such drugs when suffering from a cold. (It increases bacterial resistance to medication)

If you're single, the above shouldn't be too much of a problem. The hospital bill still feels relatively cheap, especially if you're only on holiday. And us westerners find it easy to refuse the "generous" amount of extra products. When I was single, I used to politely but firmly decline every prescription I didn't need. All the creams, salt drinks and other nonsense, I refused. If I was given a month's worth of meds for a cold, I'd just take one week's worth and visit the pharmacy with the box if I needed more later.

This tactic can save a lot of cash. A friend of mine - new to Thailand - fractured his arm playing football. He was delighted with how well the hospital treated him and bandaged him. However, when sent to the hospital desk he was presented with a bag full of creams, tablets and other goods he had no wish for that more than doubled his bill! He simply refused the extra meds and his bill was cut by more than half!

However the problem has become more serious and difficult to tackle since I wed and became a father. My lovely son has been ill a few times, and on one occasion a doctor prescribed a whopping eight forms of medication for my boy's stomach bug. I reacted angrily, telling the doctor I was well aware that too much medicine is damaging to anyone and asked if he would give so much to his own child. Justified as I may have been, it caused problems for my wife. In Thai culture it's a big loss of face to disagree with a doctor and even more to dispute what medicines you are given. Embarrassment and annoyance reigned on both sides.

So while it still makes me unhappy, I've given up trying to fight the "meds" mentality. If you have a kid, you're as likely to escape the problem as you are to escape taxes , as likely to overcome the problem as you are to overcome death.

It's also worth noting that local clinics are just as helpful as hospitals for patients with minor ailments. You'll still get the same volume and brands of medication, but the charge will be lower.

At least now - thanks to ajarnforum's Tony Dabbs - I have insurance. Remember though, most policies for children only cover inpatient costs.

So as my beloved boy recovers from bronchitis, we have to deal with the drug highs caused by his three prescribed types of medicine that are all rich in sugar and glucose, causing him to hit the roof for hours each day. As long as he recovers, I can't complain.

Tazmanian just turned thirty, and is preparing to take the head teacher's torch at a well known language centre school.


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