Hospital Care

Earlier this week I decided to call my dentist and arrange for a check up. Well, I say "my dentist", but it seems that he isn't any more. I missed an appointment and as they don't send out either reminders of impending appointments or notifications of missed ones it was some time before I even realised. Then some more time passed and the result is that I have been removed from his list. I asked to be reinstated but they now only want private patients. As I've already paid for health care in my National Insurance (which for the benefit of non-UK readers is a non-optional payment that everybody in the UK pays) I have objections to being made to pay again.
Telephoning around other dentists in the area it seems to be a common problem. Nobody is accepting National Health service patients any more. I found one eventually but it was hard work.
When I've travelled around the world I've always taken out health insurance and so far never had to use it. I confess I did wonder why to visit the United States the policies are all for enormous amounts. My last one was for eight million dollars worth of cover. I can't conceive of anything that could happen to me that would cost eight million and yet not kill me, but that kind of sum is pretty standard.
Actually, in all my travelling, I have only once needed to make use of the local medical facilities and that was my own fault. It happened when I went on a hiking trip in Thailand and Laos. The first day of hiking was gentle and easy, no more than a pleasant ambling stroll. We set off through cultivated fields that were being watered with sprinkler systems that would not have been out of place in the gardens of a British Stately Home. We waded through shallow cooling rivers. We climbed gentle grassy ascents. We walked along dusty but well maintained tracks that wound through the trees. And, after no more than a couple of hours, we reached the Karen village that was to be our stopping place for the night.
The Karen are one of the hill tribes that populate much of Northern Thailand although national borders mean little to them and they are spread in greater or lesser degree throughout the whole region. The total population of such tribes is around half a million. The Karen people who are the largest of the hill tribes but nonetheless number in total fewer than 300,000 are subdivided into White Karen, Red Karen, Black Karen and Pwo Karen. Our village for the night was White Karen. It consisted of a group of about thirty wooden buildings, mostly raised by wooden pillars so that the floors were about four feet from the ground. Under some of the huts domesticated pigs were taking a siesta, under others there were ducks or dogs or cockerels. A group of women sat in the centre of the village weaving.

Children were playing with rather incongruous plastic tricycles and trucks in the dirt. After a few brief words with one of the village men Wit, out local guide, showed us to our luxury accommodation. It was a single-room hut with a bamboo floor. Wooden steps led up to the bamboo balcony which ran along one side of it. As is the custom we left our shoes outside and went in to set out our sleeping bags and mosquito nets. With that done everyone seemed to simultaneously realise that it was still only late afternoon and we all wandered around looking at people and animals and rather obtrusively pointing cameras everywhere until I felt sure that the villagers must think we were lunatics.

"Yes I have very fine pig. Every month many English take his picture. In England they do not have such pigs."
"Ha, your pig is fine but my latrine - everyone takes picture of my latrine."

With all the pig and latrine photographs out of the way we sat around drinking beer and waiting for dinner which we ate at a table outside the hut lit only by the light of a dozen small candles. The food was excellent but when we had eaten it we realised that it was still only nine O'clock. One or two people went to bed. The rest of us stood around talking until it became obvious that our increasingly eccentric conversation started to border on the manic and we too retired.
It would be untrue to claim that I slept badly for that would be to imply that I slept. My locally hired sleeping bag was tissue paper thin and would have been inadequate to even the mildest of chills. As the night was freezing it was worse than useless. Even sleeping in my clothes failed to generate enough warmth to allow me to fall asleep. If the temperature alone were not enough to keep me awake then the constant noise of the pigs and the frequent but random crowing of a host of roosters was certainly up to the task. Occasionally I would hear others tossing and turning or grumbling and for a the opaque square of one of the mosquito nets was lit by a torch as someone decided to try to read.
It was a cold miserable and uncomfortable night and as soon as they greyish light of dawn started to penetrate the cracks in the walls I struggled from my bag, climbed over the bodies and went outside onto the balcony. I pulled on my shoes and approached the steps. What happened next is a little vague. I looked down at the steps and noted their position and stepped down. At the crucial moment something must have distracted me for the next thing I knew I had missed the step and was pitching forward with my arms instinctively flailing up towards my head for protection. It did no good and even as I heard myself yelling, I felt my head hammer solidly against one of the pillars supporting the next building. Wit came rushing out to see what calamity had caused the scream which had woken the whole village. I could feel the warm stickiness of blood as it ran down the side of my cheek which was already turning cold with shock. Others emerged to see what was happening.
After some cleaning up and some running repairs to my injuries – during which I babbled incoherently – I started to pull myself together, a necessary task as I rapidly started to realise that my very limited first aid knowledge was about the best the group had and that my first aid kit was certainly the best stocked. I sent someone for it as I sat wrapped in a blanket, shivering and sipping at a cup of hot and unbearably sweet tea that Wit had pressed into my hands.

As we cleaned up my head we assessed the damage. Wit had initially said that he thought I would not need a trip to hospital it was clear that he was wrong. There were several small shallow cuts and grazes above my left ear and on the back of my head and two rather deep gashes - one immediately behind the ear and a second on the front of it which had torn down a triangular flap of skin which was hanging loose. It was this cut that was bleeding fairly profusely. We cleaned it up and dressed it. Meanwhile I was checking myself for other injuries. My left foot, which had twisted under me as I had fallen was extremely painful and starting to bruise. The toe felt broken. I immobilised it with bandage and tape and set about persuading Wit that while the others could walk I certainly needed at least a check up at the hospital.
Finally he agreed and when the truck departed I was lying in the back. Wit and our truck driver, Mr. Tah , were in the front. Every now and again one of them would ask me how I was feeling. I was feeling tired, hurt and very like a complete prat. The ride was uncomfortable and hot - about two hours in the morning sun over very bumpy dusty roads until finally we came to a main highway and fifteen minutes later arrived at the hospital.
I am not sure what I had been expecting but the reality was a pleasant surprise. The building was a single storey modern structure not much larger than a town clinic but it looked clean and fairly hygienic. There were a large number of Thai patients waiting but Wit overrode my feeble protestations and marched me to the front of the queue. Five minutes later a nurse had removed the dressing on my ear and cleaned it up again. She said something in Thai. Wit translated.
"She says you need injection."
"What for ?" I asked wondering if I would need to break out the sterile needle and syringe that I was carrying.
Wit asked.
"Tetanus." he said.
I was relieved.
"I don't need it. I had a tetanus shot only about a month ago."
He translated for her. She wasn't convinced but eventually decided that if I didn't want it she couldn't force me to have it. The ear was a different matter. It was obvious even to me that it needed stitches. Ten minutes later it was done and we could take a look at the foot. I hobbled into X-Ray and gasped in awe that a piece of equipment so old could still be operating. Nevertheless it was and the picture that was brought out barely five minutes later was certainly a foot although I couldn't swear that it was mine. The senior nurse examined it and explained to Wit that it was not broken, just badly bruised. She wrote out a prescription and I took it to the apothecary window. It turned out to be six prescriptions. One for sterile dressings and swabs, one for iodine solution, one for sterile saline solution and three for assorted drugs. Of these the one a day capsules were clearly antibiotics. I had no objection to taking those. The others were another matter. One packet contained aspirin sized fluorescent green square tablets and the other tiny bright orange oval pills. I asked what they were and Wit checked.
"Painkillers" was his uncertain reply.

I resolved to throw them down the nearest toilet and take paracetamol if I was in any pain and we climbed back onto the truck.
As we drove into town Mr. Tah tried to cheer me up. He rolled up his sleeve and showed me two scars on the front and back of his forearm. They were ragged six inch strips of dead white flesh with poor wide stitches criss-crossing them.
"I have done at same hospital." he said smiling as I looked in horrified fascination at the scars.
"What did you do ? " I asked.
The truck bounced over a rut in the road as he replied in mime, raising his arm and bringing it down towards the top of the piece of metal tubing that was securing his seat to the vehicle.
"Truck roll over !" he said with equal pleasure.
I groaned and closed my eyes.

For the next few days it was obvious that hiking was out of the question so I rode everywhere in the truck, sitting at Mr Tah's side as if riding shotgun on a stagecoach. The truck, like all the others I had seen in the area, was of an unusual design. It have no cabin and virtually no suspension although it was unbelievably robust and more like a tractor in its construction. The most unusual and unnerving feature for someone riding in the front was that part of the engine consisted of a large metal flywheel which protruded up through the floor of the footwell, spinning rapidly and dangerously centimetres from my leg.
Thanks to this royal treatment I invariable arrived at the villages hours before the rest of the party and passed the time hobbling about with my camera or sitting in the shade with my guide books. I rather wished I hadn't when, in the Lonely Planet guide, I read up about the Luang Prabang hospital in Laos where I would have to get the stitches removed. It said,
"…the availability of decent medical services is practically nil… the state run hospitals are among the worst in South East Asia in terms of hygiene, staff training, facilities and medicine"

It wasn't an experience I was looking forward to but for the moment I tried to put it out of my mind.

Whenever we drove I just relaxed and looked at the scenery, the jerking motion of the transport being too extreme for photography. It was pretty rather than beautiful and pleasant rather than spectacular but naturally when Mr. Tah asked me what I thought of his country I was a little less reserved in my praise.
Mr Tah, it turned out was quite an important man locally. One day, when we were waiting, he invited me to his house to meet his wife and son. He had been leading or assisting with treks for many years as the photographs all over the walls of his home could attest. I was getting the star guest treatment. We had about an hour before the others arrived and he showed me round proudly. Even as we had driven up it was clear that he was very prosperous by hill tribe standards. It was built on the same basic principle as the huts with the main living area off the ground and reached by steps but that was as far as the resemblance went. Instead of a bamboo construction it was built mainly of wood and whereas the huts were raised about a yard this was more than double that providing what amounted to garage and shed space beneath it. It was also about six times as large as the largest hut I had seen. He invited me in and showed me the mementoes of his years as a guide. The earliest showed him as a much younger man in a black T-shirt and sporting shoulder length hair.
"You used to be a hippy then." I commented.
He grinned.
"Yes. Hippy. That was me." he said.

A few days later we said our goodbyes at the ferry crossing that would take me into Laos and a day later we were in Luang Prabang. I had been expecting somewhere horrible but it turned out to be a very pleasant surprise and the hotel proved to be an astonishing one. Brand new and ultra modern it was a labyrinthine affair of wood and stone with a central courtyard with a lush green lawn. The rooms were stylish and comfortable and complete with en suite bath and shower, air conditioning and a fridge stocked with water and beer. It gave me hope that perhaps the guide book had it wrong about the hospital – tomorrow was the day the stitches were due to come out.
So, the following afternoon, after a morning of limping sight-seeing that had taken in the Royal Palace as well as the obligatory visits to various temples, I set off with some trepidation for the hospital.
If the Thai hospital had been a surprisingly modern and clean place the Laos one was something quite different. As usual, the Lonely Planet guide book had been right in its assessment. From a distance it doesn't look too bad but the closer you get the worse you feel. Inside it was like an abattoir designed by Edgar Allen Poe and decorated by Fungus the Bogeyman. Bleeding people lay on wooden trolleys in corridors that were open to the dusty outside. The walls looked as if they had last been painted decades ago. The nurses wore dirty and mismatched uniforms. I was led to a room where there was a doctors table that could have come from the last century. Had I been there to have stitches put in I would have fled and bled to death sooner than risk infection. As the stitches were only coming out I wasn't quite as concerned but it was still not one of the pleasanter places I have been. I sat as they snipped at the stitches and looked at the painting on the wall opposite. It was of a pale and deathly looking patient in a bed with snakes, spiders, flies, rats and cockroaches crawling on the sheets. I shuddered as much at the mind that conceive of this as hospital decoration as at the image itself.
Nevertheless the stitches were soon removed, the wound pronounced infection free and I was on my way, thankful to have escaped so lightly from my mishap.

And that, I can say with relief, was my single encounter with overseas hospitals. And the cost to my insurance? Nil. All that medical treatment had totalled almost £4, not even close to the excess on the policy.