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Medical emergencies - Is it still necessary to go to Bangkok?

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starkmonster
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Medical emergencies - Is it still necessary to go to Bangkok?

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Post by starkmonster » Fri Dec 23, 2016 1:42 pm

There is some expat advice in this country that just gets handed down from expat to expat without ever stopping to access whether it's still correct. One of the big ones is medical treatment.

The old advice was get to Bangkok ASAP, and this is the advice that I always used to give people. I did some real world research back in the early 2000's with lengthy stays in both Calmette and Bumrumgrad in Bangkok. Back then Calmette was a horror show and Bumrumgrad was like the medical bay on the Starship Enterprise in comparison.

My wife also delivered our two children by c-section here in the mid 2000's, she had no interest in going to Bangkok and being away from family. Both times the experience was acceptable, but not great.

Anyway to cut to the chase, a few weeks back my wife complained of stomach pains after lunch and went to bed, she woke up a couple of hours later in severe pain and wanted to go to the doctors. I wasn't too panicked as like most Khmer women she doesn't have a very high pain threshold and stiff upper lip is an alien concept.

So we get in the car and start driving to SOS which is where we've always gone. On the way there though it was clear to see this wasn't regular Khmer melodrama and she was in fact in writhing pain, as it was Saturday afternoon which at SOS is classed as out of hours I decided to call ahead to check that there was a doctor on standby and ask advice.

The doctor on the other end asked a series of questions and once it was established there was no fever, no diarrhea and no vomiting she advised me to go directly to a hospital with a CT scanner. She recommended either Royal Phnom Penh near the airport or Khema in BKK1, and to choose whichever was closer. Khema was closer so I headed there.

As soon as I pull up quickly at the entrance properly dressed nursing staff rushed out without being prompted and had my wife in a wheelchair and into a very modern looking emergency room before I had even had chance to say a word. An older Khmer doctor immediately began examining my wife and asked the exact series of questions the doctor at SOS has asked, whilst also giving me commentary in English.

He said he suspects it's an appendicitis, which as we all know isn't serious as long as it's dealt with promptly, but will need to do an ultrasound to confirm and possibly a CT scan if the ultrasound is inconclusive. They drew blood and started asking the standard pre-surgery questions, when did you last eat, any allergies etc and drew blood to do pre-surgery tests.

She's then taken to what looked like an absolute state of the art ultra-sound room, where the operator was already powered up and ready to go the second we arrived. He wasted no time in confirming the appendicitis diagnosis and said there was no need for a CT scan. My wife was then taken back down to ER where the previous doctor was already looking at the ultrasound pictures on a flat panel on the wall.

He said it was an acute appendicitis, and talked me through what we were looking at on the ultrasound scan. He said she needed surgery immediately. Someone from the office then came to give me pricing information, everything was already in packages and the appendicitis package was about $3k which included everything, including three nights stay for observation. They automatically gave a 20% discount as I was paying myself.

I did a quick crosscheck on the pricing by calling Royal Phnom Penh and asking what their package costs. They said $2.3k with two nights included and additional nights charged at $350. I did this because despite the high level or professionalism I'd seen so far, I still had that feeling of wanting to search for the catch, a feeling that I think comes with living in this country too long. Especially when it comes to medical stuff.

They prepped her for surgery. and the surgeon, an older slightly eccentric Khmer gentleman, arrived about thirty minutes later. I later found out that he has 25 years of experience, most of which was in France.

And interestingly he is independent of the hospital. When chatting with him near the end of the stay and talking healthcare in Cambodia and Royal Phnom Penh he jokingly told me later whether I had of gone there it still would have been him performing the operation, as he is the first choice as both hospitals for this procedure.

He had a bedside manor and way with the ER staff that was very calm but also firm, exactly what you see from doctors at home and that instilled confidence. He did a good job of calming my wife down and talked her through the procedure as well as giving her the option to make the incision via an existing c-section scar.

She only had a spinal anesthetic, so the whole thing was done within an hour or so and she was back in the room. I won't bother describing the room, you can see for yourself:

Main room:
Image

Private dining room:
Image

Image

Bathroom:

Image

Image

There was a nurse station as the end of the corridor of rooms that had at two or three nurses in it 24/7. The nursing care was very attentive, and anytime my wife hit the call buzzer someone would come immediately. She had some nausea and pain, both of which were treated promptly.

The room and the entire hospital come to that mater was completely spotless. A cleaning crew were in the room twice a day everyday. The surgeon also came back once each day to check on her progress.

On day three she was discharged, looking great and in very high spirits all things considered. The entire process from start to finish was faultless, which is not something I often say.

I know this was just a single visit and maybe I got lucky. But I don't think that was the case, everything was so regimented that there were quite clearly strict processes and practices in place and those things don't come from luck.

Just one example is that every member of staff cleaned their hands with sanitizer when they entered the room and did the same again on the way out without fail. There were also constantly completing the checklists posted everywhere that covered everything from the room cleaning schedules to inventory checks.

I also saw a Singaporean doctor giving a Khmer accountant a very firm dressing down in front of everyone at the front desk for preparing an invoice document before he has signed the patients discharge papers.

The staff all seemed to be highly experienced and highly qualified. The doctor we first met in ER and the surgeon both trained and worked as doctors in France for long periods of time, two of the senior nurses on the nursing team were Singaporean. There were also signs advertising two heart specialists from a Singaporean hospital that are currently posted there.

Anyway, make of it what you will. But I know that I for one am not anywhere as apprehensive about medical emergencies in Cambodia as I used to be and think that these new hospitals are more than capable of handling most common medical emergencies with a high level of competence.
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Post by Playboy » Fri Dec 23, 2016 1:54 pm

Thanks for the update on medical facilities SM, always useful to know here.

Also glad Mrs SM is feeling better, was following her progress in FB - all the best to her
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Ot Mean Loi
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Post by Ot Mean Loi » Fri Dec 23, 2016 1:56 pm

Thanks, Starkmonster, for this first hand account of a medical crisis within your family and its professional resolution.
Thanks, also, for the quality of your posting. Such a change from the usual puerile/infantile/non-sensical drivel that the forums accepts as its daily diet.

Oh that we had more postings of your quality and relevance.

OML
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Post by salvajeuno » Fri Dec 23, 2016 2:01 pm

Thanks starkmonster!

I had a similar experience at Royal Phnom Penh in December of 2014 although I didn't have surgery. The doctor they assigned to me had gone through med school in the U.S. and practiced there for 35 years before returning to Cambodia with his family. It was my first experience in a hospital in Cambodia and I was impressed with everything.
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Post by Biltong » Fri Dec 23, 2016 2:25 pm

Is Khema not in Toul Kork?
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Post by Zillah » Fri Dec 23, 2016 2:28 pm

Thank you so much for this post! :bravo:

I've heard several people say that it's now possible to get reasonably good medical care here in Phnom Penh, if you know where to go for what sort of problem. It sounds like Khema did a great job, and certainly flying to Bangkok would have been a much worse option for Mrs. Starkmonster. Will keep Khema in mind for my next emergency.
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Post by Abou-Gor » Fri Dec 23, 2016 2:35 pm

Useful post. Can I ask if you were covered by medical insurance? If so, what company and what sort of annual premium do you pay?
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Post by Stramash » Fri Dec 23, 2016 2:39 pm

The Sunrise Japanese hospital also seems to be getting good reports recently.

I had heard cases of great care at RPP but some padding of the bill.

I think evac to Thailand now would only be an idea in extreme cases such as cardio- or neurosurgery.

I had cancer treatment at Sen Sok and found the care very good. Though there were a few general hygiene issues I noticed in the building as whole (but not in the actual rooms)
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Post by billythekid » Fri Dec 23, 2016 3:43 pm

The first Khema clinic opened in Tuol Kork some years ago, the new one is located in BKK. I had my right Kidney removed at Khema TK back in march this year. A CT Scan as well as Ultrasound showed that the kidney had to be removed because of a large tumor. The whole procedure was very professional done, including the doctors in the operation room, the diagnosis, the nurses, the room etc. etc. Same good experience than "starkmonster" explained with the surgery of his wife's health problem.
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Post by Khmerhamster » Fri Dec 23, 2016 4:09 pm

Generally agree what is being said however a couple of caveats.
1. Small local clinics are unpredictable, can be reckless and undertake unnecessary surgery.
2. Last month a friend of mine had a fractured pelvis and Royal PP was unable to diagnose it. She was sent to Bangkok and the doctors there couldn't understand why it wasn't diagnosed locally. They had all the kit, X-rays and scans done but couldn't diagnose what was a n apparently obvious issue.
Insurance companies still seem to be keen to seek treatment in Thailand for certain issues - this speaks volumes. These guys don't want to waste money.
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Post by Khmerhamster » Fri Dec 23, 2016 4:10 pm

But of course exceptions don't prove anything.
I'm just not sure if my friends experience was the exception or starkmonsters experience was the exception.
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Post by Abou-Gor » Fri Dec 23, 2016 5:03 pm

And we'll never know unless more people post their experiences.
Along with medical insurance, it's as if some people don't want to let others know. It seems odd. Maybe it's all on Facebook somewhere.
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Post by Kachang » Fri Dec 23, 2016 6:00 pm

Khmerhamster wrote:Generally agree what is being said however a couple of caveats.
1. Small local clinics are unpredictable, can be reckless and undertake unnecessary surgery.
2. Last month a friend of mine had a fractured pelvis and Royal PP was unable to diagnose it. She was sent to Bangkok and the doctors there couldn't understand why it wasn't diagnosed locally. They had all the kit, X-rays and scans done but couldn't diagnose what was a n apparently obvious issue.
Insurance companies still seem to be keen to seek treatment in Thailand for certain issues - this speaks volumes. These guys don't want to waste money.
It all comes down to the person doing the job. You can equip a monkey with a CT-scan, but....

I've seen them perform an echography @ Royal Phnom Penh (45 USD), really bad. Just a quick rub over the belly, nothing thorough. I trust all the radiologists I've experienced at Aurore clinic (15 USD) more than the radiologist I've seen at work at Royal Phnom Penh.

Also experienced a radiologist at Bumrumgrad once - that was the most thorough one of all. So according to my experience, it can be a hit and miss, depending on the doc you meet, and the hospital you visit.
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Post by ali baba » Fri Dec 23, 2016 6:49 pm

Do any of these clinics have addresses?
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