Gut Check.
It
was a few days before Christmas in Hanoi. I had been working abroad
in
Vietnam and couldn’t
wait to see
my wife and daughters in southern Thailand. I flew from Hanoi to
Bangkok, then hopped a southbound
train.
Trains takes a bit longer, but
planes emit 3 to 7 times the carbon as trains.
i
It
smacks of stupidity to choose an option that helps leave a
ruined planet for my kids.
 |
| Trains in the Bangkok depot preparing to depart. |
It’s
annoying that you cannot buy train
tickets electronically. This
means
I usually get stuck in a train
car
without air conditioning. That also
means
keeping
the windows down and, depending on the breeze, some
diesel exhaust from the train engine blowing in
your face. Stepping into one takes you back in time to when Thailand
was
just starting to break into the modern industrial era. These
train cars must date back to the 1970’s or before. I didn’t
even care, though. As a dad, I love the excitement and wonder in my
girls’ faces during
this magical
season.
Watching them play
within
their innocent
imaginations
are moments
too
precious to
miss.
I
purchased a
ticket and
went to the 7-Eleven
across the street to get some food. (You
can’t swing a dead cat without hitting a 7-Eleven here. One
school I worked
at had
two main entry gates a couple hundred yards* apart, and there was a
7-Eleven on the other side of the road from each gate!)
A lot of
people like the street food in
Thailand. Honestly, I do too, but 7-Eleven
has their own line of pre-made meals that
they make in
line with modern food safety practices.
They are like our frozen meals back
home,
but only refrigerated because
they sell so fast.
I don’t like
the extra plastic waste, but street
food vendors don’t always follow good
food safety practices; this is a safer option.
My belly was beginning to feel a little off;
I must have been quite hungry.
The
train left
a few minutes after I boarded,
sometime around 5:00. I
had food,
internet
data,
earbuds, and dozens of books on my tablet. It wouldn’t
be the most comfortable ride, but I
was
set. I planned
to read a research article or
two,
maybe catch up on the news; it was
all good. The Pad Kapow (Thai spicy stir fried pork with holy basil)
was still steaming as I began to eat. Salty, spicy, savory, spicy –
it’s Thai, so you have to mention spicy at least twice, – and
delicious. I kicked
back to read a bit, but
my eyes grew heavy.
I dozed
off with a nice, happy belly
and thoughts of seeing my lovely wife and girls.
I
woke around 7:00. It wasn’t a dream or sudden stop that awoke
me. It
was a brick sitting in my stomach. I felt half the brick's weight physically. The other half was the feeling of deep dread that just
sucks your body into the chair with its own dark, dire void.
I
had felt this before after eating some bad street-food barbecue in
Hanoi. I knew what was coming. If I was lucky, I would just have a
really crappy night.
If
I was lucky . . .
A
minute
later my stomach began
swirling
and churning
– warning
me that we would
not be
that lucky.
I’ve
had touches of bad food back home in
America
before.
At most, I
would have
an uncomfortable tummy for a few hours. I never had really
bad food poisoning until I came to Southeast
Asia. With
the bad barbecue,
I could not eat for 30 hours because both ends of my
gastrointestinal tract were trying to discharge, projectile-style,
the entire tract's contents simultaneously. (The
gastrointestinal, or GI tract, for the
non-geeks, begins where food enters the body; it ends where the food
exits.) I chose
to avoid street food for
that reason,
despite its deliciousness. (It is really
good.
There is a trend of restaurants that specialize in street food
cuisine in a sit-down atmosphere because it is that good.) But no
good deed nor health conscious decision
would go unpunished this
day. . . .
And
then my gut felt as though it had punched itself. “If only we
could
be that lucky,” my belly gurgled, doubling me over in the chair. Nope. Food poisoning is when you get bad bacteria inside the GI
tract. This would turn out to be enteritis: food
poisoning’s evil, psychopathic twin.
Somehow, some of those nasty
little buggers
went from inside the
intestines into the intestinal
wall.
I imagined
that is what it would feel like to be stabbed with a spear, just
without the extra
pain of cutting through
flesh.
It was enough to make me lose my balance and have to squat down
while
my guts writhed and twisted themselves about like
a python squeezing the life from its unfortunate prey. On
a pain scale of 1 to 10, this was a take-me-out-back-and-shoot-me.
This
already
made
food poisoning feel like a walk in the park.
Around
7:30 or so – I
lost track
of time as
the world spun and swirled – I made my first mad dash to the toilet. First
came the vomiting. That
was a
temporary relief at
least.
Later
rounds would include diarrhea too as my body tried to exorcise the
evil
residing
within.
When
expecting multiple
rounds
of
vomiting,
you
need some
food in
the belly.
It’s
easier letting the stomach vomit something up than sitting there for 5
minutes in a fit of the dry heaves. It’s
amazing how
vomiting causes
all your
internal muscles to create so much havoc. It’s like an entire gym
workout in a matter of moments, complete
with
pain
and
exhaustion. I wiped the dripping sweat from my face and returned
to my seat. I ate
a cookie and drank
water in preparation
for the next round. Just
a single cookie, though. I could tell this bout
was
going
beyond the standard 15 rounds.
The
toilet was only a few rows away – maybe
10 yards* or so.
(*Meters, for my international friends.)
I lost track of how many times I stumble-ran
between the two. I couldn’t make it the entire way a few times
because of the cramps. It’s tough to walk with your intestines clawing their way out from inside your own belly. The cramps also
make you feel like you're having a constant diarrhea attack too,
causing
the
GI tract to attempt
to
evacuate from both ends at once. Fortunately,
I was able to withhold
the
vomiting
until I reached the toilet.
Even
more fortunately,
the sink in the tiny bathroom was close enough to the toilet that I
didn’t have to puke on the floor when
the other end of the
GI tract decided to join the fun.
 |
| Stepping into one of these train cars is like being transported back to a time when Thailand was just starting to industrialize. |
After
the millionth trip or so to the toilet (I’m
rounding down
here for sake of convenience),
I was exhausted. I lost count of how many times I
vomited;
there were several times that I had multiple vomiting bouts in a
single trip. You know how, after you puke, you feel like you’ve
just done a total ab workout at the gym? This felt like a
dozen of those workouts back to back. Finally,
thankful
for exhaustion, I made my way back to my seat and collapsed
for a nap.
I
caught a few needed winks when my heaving stomach lurched me awake
and
doubled me over.
There was no time. With a quick check outside to
ensure
there were no overhanging tree limbs,
I stuck
my head out the window
while
my stomach shot
what little was in my belly out like a cannon.
 |
| Kinda like this, except with projectile vomiting. |
And
on it went through the night: cramps, puking,
diarrhea,
and occasional short naps of relief. You
know how, when there is nothing in your stomach, that you dry heave
when you vomit? I found out that night that the intestines will do
the same thing when
trying to disgorge something evil.
Lucky me - I had the privilege of experiencing the dry heaves and dry diarrhea simultaneously.
Finally,
around 3:30 AM, I was done. Not
done being sick. That was still hours away. I had reached my pain
threshold
though.
Barely able to walk and
exhausted,
I gathered my bags
and decided to crawl off the train at the next stop where there was a
local hospital.
That
took a couple more stops though.
I think it was between 4:30-5:00
when I finally got to an appropriate stop. It’s
hard to remember for sure though; time flies when your stomach
contents are
flying
too.
So, there I was, nearly crippled from pain and exhaustion in a land where I barely spoke the language and had not spoken it for months, in some tiny little hamlet town of rural Thailand. This town was too small to have a car taxi service, but there was a scooter taxi.
My
Thai words were escaping me. Something
about feeling like you might
die tends to interfere with remembering foreign languages.
Luckily,
my tablet could
translate a request for
help to
grab a taxi
to the hospital. A
Thai gentleman kindly helped me to flag a scooter and gave
instructions to the driver to take me to the hospital. The driver
listened, looked at my exhausted, ill foreigner
face, and promptly took me directly to the local high school. Yeah,
because where else would a saltine-cracker
white
guy like me go in Thailand, except to a school to teach English?
I
was able remember
how to
say, in Thai, that I was sick and wanted to go to the hospital now.
So, after repeating again, the driver gestured
me to
climb back
on the bike, and off we went. As we finally began heading
to the hospital, I realized my
vulnerability.
I
was even cold! Back in Michigan, I used to walk barefoot in the snow
for fun. I start wearing shorts at 40°.
(That’s Fahrenheit
for my international friends; about 4° C.)
For me to feel cold told me that I was in much
worse
shape than I realized. If
this guy wanted to mug me, there was
no way I could have
fought
back in that
condition. Like
most Thai citizens, though, the driver was a decent, kind person.
By
the time we reached
the hospital, my ears were ringing from the pain. I was shivering
from cold and too
dizzy to walk. Man, this was turning out to be a sucky vacation. Worse yet, I forgot to buy insurance before this trip. At that
point, though,
it
didn’t matter.
I needed the pain to stop. In
America, many think of
healthcare
like a heated seats option from a car dealer instead of the life and
death issue that it truly is.
Fortunately,
the doctors in Thailand all know English. Thai medical schools
follow an accelerated 6 year program. Thai students that want to
study medicine must not only score well on science and math exams,
but English as well because every textbook they use is from either an
American or British publisher. (The med students I used to teach
told me that most are from America. Why? That’s because, despite
the MAGA crowd’s inane, idiotic ideas, America always was and still
is great.)
While
Thai doctors know how to use the language in written format, many of
them
have had little opportunity to practice speaking the language. I
have taught medical English. It is amazing to see these brilliant young minds
that
can
fluently
compose
a written
sentence,
often
with better grammar and vocabulary than people who grew up speaking
the language,
but still
struggle
to put that into speech. My doctor was one of those folks, so we had to write some
messages back and forth.
Make
no mistake, though, she was smart. I worked in healthcare for a
decade back
home
and am very familiar with medical terminology, different
medications, and a lot of basic protocol.
She understood
my questions and responses as long as the morphine wasn’t slurring
my words.
(So,
if
you ever come to Thailand,
don’t worry, the docs here are well-trained professionals.) When
my English-fluent
wife
arrived
later she helped translate, but she doesn’t have a
medical background. This
created
an interesting circular,
instead
of a back and forth, conversation.
But
there was no doubt that this doctor
knew what she was doing.
For
those of you familiar with medical costs,
go
ahead and
take out a
calculator . . .
They
did the ER thing: vitals, x-rays, blood draw, intake questions, etc.
The
first shot of morphine came
while
we
were awaiting
blood test
results. The morphine didn’t so much take the pain away, but made
me tired enough that I could pass
out
for a while. Thank
goodness.
It’s
amazing how thankful we become for little things like sleep when
accosted by a constant, stabbing pain. Or
how we count ourselves lucky when
the sink is close enough to vomit into
from the toilet.
I
didn’t
contact
my wife until
later in the morning, just
before the
train was scheduled to arrive in her home province. My poor wife.
My
head was swimming from morphine
so I gave
the
phone to the doctor to explain. My
ears were ringing so
loudly that I could barely hear.
I’ve had a touch of tinnitus for years, but I could not
even
make out the words she said on the phone. I could text back and
forth, though. Come to find out, the pain had spiked my blood
pressure and the medical staff wanted to know if I had a history of
high blood pressure. After
clarifying,
they
gave me something to bring my blood pressure down. The
ringing subsided enough to hear again. The IV antibiotics were
beginning to work too. It still hurt like hell, but at least I could
stand up and walk if
I needed to use the restroom.
This
happened on a Saturday morning, and this small town hospital’s
cafeteria was closed. One
of the nurses found some ramen for
me. I asked if they had any bananas, as they are about the mildest
food to put in your tummy when you know they
won’t
stay
there long.
Bananas commonly
grow
wild here, but they didn’t have any. So another nurse went to the
local market and brought some back for me. (This is typical of the
kindness you see from Thai people, by the way.)
I
went through a round of x-rays, blood labs, a bag of saline, IV antibiotics,
blood pressure medicine, and 3 rounds of morphine. I was in the ER
for close to 16 hours, taking space in one of their beds.
For
those of you with calculators, do you have a tally for what that ER
bill would be in America yet? Oh, . . . . but wait – there’s
more!
The
doctors in the ER treated the enteritis professionally
and
kindly,
but my ears still rang
constantly and made
me
dizzy. I knew it was tinnitus, which is tough to treat, but have
never seen a doctor for it. Now, though, I was having episodes where
I was too dizzy to walk. Crud, that meant more doctor’s bills.
My
wife took me to the local hospital for a referral to a university
teaching hospital in the provincial capital, and
we went a couple days later. (Yes,
I
was
uninsured and still able to get a specialist appointment in 2 days.)
While there, they conducted a hearing exam in a sound-proof box
before
I saw the
specialist. There’s not a whole lot one can do for tinnitus, but
he gave me a prescription for a Thai manufactured medicine made from
ginkgo biloba. The medicine didn’t eliminate the ringing
completely, but it made
it
barely noticeable. That’s pretty darn
good
for tinnitus.
I
had a follow-up a few days later, with another sound-proof box test
and a hearing specialist consultation. He prescribed more of the
gingko biloba medicine. That medicine is fairly expensive by Thai
standards. It’s about $30 for a month’s supply if you don’t
have insurance.
So
here’s a second and
third round
of unplanned and uninsured healthcare expenses I was
gifted with last Christmas.
Care to posit a guess at the costs if that were in America?
The
Thai healthcare system, by the way, is a universal
healthcare
system that
also allows
private
hospitals and practices. Private
health insurance is
available,
and
it’s
one of
the world's top
medical tourism destinations. ii
There are many doctors and dentists running
private clinics, though most work through the government system. At
the public hospitals, family usually come to watch over the sick
person, and they do pay for a
few things
out of pocket, but hospital stays
are
covered for Thai citizens and
those enrolled in the social insurance program.
Foreigners
working
in the public schools are automatically enrolled in the social
insurance program
and
the cost, limited to no more more than 750 baht, is deducted from
one’s salary. 750 Thai baht is about $23 US.
iii
Per
month. That’s less than $300
US per year for
comprehensive health insurance.
While
American hospitals were charging $2 per Tylenol
back when my dad was injured in 1988,
Tylenol
from the hospital here costs the same as you would pay over the
counter. It
is
a little less than 3 cents per tablet. That
is, unless you are in the social insurance program – then it’s
covered.
Plus hospitals
throughout SE Asia, all developing nations, have access to the modern
pharmacopoeia of medicines in addition to traditional herbal
remedies.
Ready
with those prices?
Translated
to US currency, the ER visit was a little under $40. That included
reimbursing
the nurses for the ramen and bananas. Seeing the hearing specialist
twice was under $175 for both appointments
and the medicine. And
the
quality of care was excellent. On
top of it all, even
though their cafeteria was closed, one of those nurses even went out
to find bananas for a sick patient with a bad tummy.
If
a developing third-world country can provide healthcare of this
quality at this cost, why do we tolerate the out-of-control costs in
America? Why do we tolerate a system that is designed to profit by
refusing to treat people who pay hard-earned money for their
insurance? Why is it acceptable to tell some of our fellow Americans
that it is better for them to suffer and possibly die in pain than to
get the treatment they need that allows them to get well and return
to work? Why do we tolerate healthcare CEO’s raking in millions
while their customers all-too-often suffer and die because the
companies refuse to provide the coverage we were led to believe that
we bargained for?
Thank you for reading. If you need a break from lock-down boredom, I've linked some satire pieces below to give you a laugh. If you want to see something that will make you further scratch your head about the American system, check out the video I made of a Vietnamese grocery store below. I made this video when there were empty store shelves back home in the USA. (Apologies for the video quality. I don't do videos often. I was also wearing a heavy mask that was tough to breathe through, so my breathing is kinda heavy here.)
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