The following is a guest opinion article from Doc Martyn. His opinions and advice are entirely his own and may not necessarily be those of The Pattaya News Company Limited. His contact information can be found at the end of the article.
1. My team arrived in Khon Kaen on October 14th 2024. The following day our Sawang Team, in conjunction with the Sawang Team from Chaiyaphum, retrieved a deceased elderly Thai man who had drowned the previous day. His body was found trapped in the tunnel leading to the sluice gates. I watched the 6 divers as they placed the deceased body onto a body board and wrapped him in white sheets. His death was an accident. I was surprised by the behaviour of the Sawang teams who treated the body with great dignity and even greater respect, see photo 1, 2, 3.
2. On our return to Pattaya, Aldente, a 72-year-old English man, was brought to see me. He had been in a local hospital overnight, the provisional diagnosis; chest infection, possibly TB. He was released the following morning, with a sample pot for TB analysis of his sputum, and penicillin antibiotics.
On arrival at the Spa, he had a fever, he was unsteady on his feet, he was unable to walk independently, he was confused and disoriented. His speech was severely impaired, with word finding difficulty and the inability to finish a sentence longer than 3 words. Neurological examination indicated that he had suffered a small right sided stroke, CVA. His cognitive dysfunction was caused by the CVA and toxic confusion. He was seriously ill and, in my opinion, should not have been released from the hospital.
3. I changed his antibiotics, managed his hypertension (212/96), slowed his tachycardia (122 beats/minute), reduced the pressure in his brain and gave him high dose Vitamin B injections. He recovered at home over the following week.
So, why did the hospital release him whilst he was critically ill?
Due to his cognitive impairment, he was unable to remember his Bangkok Bank Card password number. No number, no money. He was unable to pay the hospital medical bills, hence the early discharge.
My frustration about this case: Despite having paid for them, at discharge he was not given a medical report, nor his pathology or Xray results. I had nothing to work with and he could not afford further testing. I was left to manage this gentleman using only my clinical skills and experience.
The management of this poor gentleman was impaired by the hospital doctor(s) who failed to provide summaries of his condition. This constitutes negligent medical care. This man, whilst dying, was not afforded adequate medical attention. The hospital failed to consider his dignity. He was dying without dignity.
4. Burkhard came to see me on September 23rd 2024. This 65-year-old German retiree had significant pre-existing medical problems; including Type 2 diabetes, left Cerebrovascular accident (stroke) in 2016 and obesity. His current additional medical problems included; infected and poorly treated ulcers to his right leg, substantial heart failure with severe orthopnoea (inability to lie flat at night due to fluid in the lungs), gross distention of his abdomen from fluid retention, hyperglycaemia (BSL 189), bilateral pitting leg oedema and fatigue. He was seriously ill.
He had visited 4 local hospitals for assistance. Because his case was both serious and complicated, he was turned away by each of the 4 hospitals who “could not manage all his problems”. He was referred to one major hospital, which he could not afford.
My initial impression: Burkhard was going to die. I managed his ulcerated wounds, changed his antibiotics, and treated his heart failure. His improvement was substantial. Initially, I reviewed him alternate days and subsequently every 4 days. He called me on Saturday 5th October, his legs were painful so he cancelled his appointment. He was found deceased by a friend the following week. He died alone in his room. There was no dignity with his death, just isolation, fear and suffering.
5. On 17th August 2024, I received a request from Ria, in England, to review her grandfather’s medical care. Tony, who had been domiciled in Thailand for many years, was “terribly ill”.
Throughout my career I have seen some unusual things but Tony’s situation was a doozy. As we approached his ground floor unit the stench was overwhelming. On entry, Tony was recumbent on his bed with an old bed sheet loosely covering his private parts. The sheet was stained with diarrhoea as was his double bed mattress. Ostensibly, he had suffered intermittent explosive diarrhoea for over 2 weeks.
If he was fortunate, he would reach the toilet. But most of his diarrhoea spilt onto his mattress and the floor by his bed. His body was speckled with dry diarrhoea. There was solidified faecal material under his long finger and toenails.
Dao could not enter the room. It was a horrific scene, the likes of which she had never seen. She walked away in tears.
Whilst I managed Tony, Dao talked to the block manager. Apparently, the Thai doctors who were called to see him refused to enter the room and refused to provide treatment. Their recommendation; he needed to be admitted to hospital. Tony’s finances were limited, so he refused admission.
The unit manager was frustrated; other tenants were complaining about the stench and were requesting relocation.
6. I treated Tony’s diarrhoea with antibiotics and injected him with vitamins and steroids. I left him with electrolyte fluid replacement. Over the following two weeks, Tony’s condition improved. His diarrhoea ceased. He was able to sit up in bed and visit the toilet. I arranged for his mattress to be replaced, which Tony paid for. I advised him to leave the protective plastic cover on his new mattress. His old mattress was incinerated.
I left Pattaya to further my charity work in Chaiyaphum.
Tony’s condition deteriorated again and for some reason, best known to Tony, he had removed the protective mattress cover. The stench returned.
The manager insisted that Tony should relocate. His daughter organised a room at a home care facility in Pattaya. Because of his general condition, Tony was never given a room. He was left on a gurney in a secluded corridor. His daughter arrived from the UK. Two days later he was admitted to a local hospital where he died an undignified death.
7. The three Farangs mentioned above had similar problems. They had little or no savings to support their end-of-life experience.
Since the Thailand government deregulated both private and public hospitals, the fees for Farang medical services have snowballed, leaving those without insurance unable to afford even the most basic of care. If you are elderly and have serious potentially life-threatening medical issues with no insurance or other financial resources, consider returning to your country of origin for medical care.
8. The government does not intend to change its public health regulations to improve the welfare of Farangs who fall ill in Thailand. It is a courtesy not a right to stay in Thailand. Unless you have residential status, you are not entitled to state sponsored medical care. This is unlikely to change in the short or long term. Unless you have sufficient funds in Thailand, ‘Dying with dignity’ in the Kingdom may not be your pleasure.
Addendum: Over the past 6 years, as a retired medic living in Buriram I offered second opinions on any medical issue. I recently moved to Pattaya. As in this case, if you reside outside of Pattaya, telephone consultations are provided. For assistance; please contact me, Doc Martyn, on Facebook or call Dao on 095 414 8145.
