May in Thailand

Published 09/08/2022 in Scholar Travel Stipend

Written by Linda Chan | 09/08/2022

For two weeks in the beginning of May 2022, I had the privilege of traveling abroad to Thailand for a course focused on comparing healthcare systems between the United State and Thailand. As a nursing student, I was not only attracted to this course due to its traveling component, but also because it would provide me with the opportunity to learn more about the healthcare system of a foreign country.

Here in the United States, we have private insurance programs, Medicare, and Medicaid. These three systems are meant to provide coverage for most American citizens, with Medicaid providing coverage for those who cannot afford to purchase private insurance. Similarly, Thailand has private health insurance as an option for their people, but to ensure healthcare access for all their citizens, they also have a Universal Health Coverage program that provides free basic healthcare to all. This program used to be known as the 30-baht coverage scheme, where all participants only have to pay 30-baht (~$0.82 USD) copay for each medical encounter. However, this copay has been removed since 2006, meaning that all who use Universal Health Coverage won’t have to pay for their medical visits and treatment. In terms of limitations, this program is only accepted in public hospitals funded by the government. Furthermore, in making healthcare more accessible to Thai citizens, pharmaceutical products are predominantly produced within Thailand and regulated by the government, making it affordable for most people.

In Thailand, there are few primary care clinics, but they do utilize public health centers retired medical staff as volunteers in rural communities and villages to provide health checkups for Thai citizens. Many of these public health centers are led by nurse practitioners and nurses with at least one rotating doctor from a city hospital due to the lack of incentive for most doctors to work in rural communities. These public health officials and nurses would also recruit volunteers from small towns, educating them about preventative care and first aid, so that they can be the first line of care for their community. This method of using people from the community takes into consideration the importance of a trusting relationship between patients and providers and ensures that the community’s medical needs are understood as well as addressed.

During our stay in Thailand, our class visited Siriraj Hospital, Hua Hin hospital, and traditional medicine clinics. At both hospitals, I had the opportunity to shadow at the trauma emergency department and also under the surgery department, observing their facility and how they operate. I was surprised to see that at both hospitals, they didn’t have accommodations for bariatric patients, and they didn’t use electronic health records, but rather handwrote all patient information and status. One interesting thing I learned at Siriraj hospital, was that they had a subsidiary hospital that operated like a private hospital, but in terms of costs, it was cheaper than private hospitals. Despite being a part of the largest public hospital system, Siriraj Piyamaharajkarun Hospital only accepts cash payments or private insurance, with all proceeds supporting the public hospital departments and supplementing treatment costs for those using the Universal Health Coverage program. Their fair pricing for quality care aims to set the standard for the pricing of medical treatment for private hospitals in Thailand, which I hope to see in the United States one day. In terms of my traditional Thai medicine experience, I had the privilege of receiving two Thai massages, which I learned is considered as medical treatment in Thailand and can be billed through insurance. 

Aside from visiting hospitals, clinics, and the Ministry of Public Health, we also had some time to learn more about Thai culture through various excursions such as floating markets, temple visits, and Chinatown. These excursions were a great way for me to learn more about Thai culture and observe daily life and public health in Thailand. Prior to arriving in Thailand, Penn’s student health and my professors had warned us multiple times to not drink tap water, beware of food stalls, and to only eat cooked food. These are common warnings for tourists traveling to unfamiliar areas, but now I understand why this warning is something to be taken seriously especially in Thailand. What concerned me the most was that there seems to be no regulations with food safety amongst food stalls. While exploring the area, I noticed that many of the food stalls were open to air with mosquitoes, insects, and flies swarming over all the food. As was mentioned by the Ministry of Public Health, most Thai citizens drink bottled water and avoid tap water because while tap water is safe, the pipes that tap water flow through are often corroded, contaminating the water itself. However, majority of the food stalls I passed by use tap water to make ice and prep food such as washing fruits and vegetables. Likewise, while riding along the floating markets, I saw multiple food-selling boats that had cut up fruits open to air with river water splashing over it. Moving further along the river, I noticed how polluted the river was with food wrappers, water bottles, and other plastics, but also saw local residents of the floating market washing their clothes and dishes using the same water. This trip to a floating market not only revealed environmental concerns, but also health concerns considering that the use of these dishes would contaminate the food residents consume.

In visiting multiple temples and talking to Buddhist monks, I also learned about how religion plays a big part in the health of Thai residents. As more than 90% of Thai people identify as Buddhists, many seek guidance and blessings from monks and buddhas regarding their health. Our tour guide told us that some people would rather seek help from monks and rely on amulets/talismans than to seek medical help when they are ill. At Wat Pho, we also saw inscriptions on stone tablets of Traditional Thai medicine contents including massage, pressure points, and herbal medicine. As a result, it is understandable why so many people trust the ability of monks for healing, but this can be an issue if this delays people from seeking life-saving treatment.  

Overall, this trip was an eye-opening experience where I not only had the opportunity to have fun and travel abroad during a pandemic, but also allowed me to learn more about healthcare system outside of the United States. I was impressed by how well integrated alternative medicine and western medicine is within the hospital system and how accessible it is to its people. In ensuring that people can have a meaningful life, taking into consideration their health and well-being, I hope to take what I have learned and observed in Thailand and apply it to my role as a nurse. This course has emphasized the importance of recognizing social determinants of health and understanding how culture plays in a person’s willingness to seek medical treatment and their approach to health, something I will keep in mind as I care for others.