Stickman Readers' Submissions July 9th, 2013

Vaccinations in Thailand

I read the interesting submission on Hepatitis B. I agree that for some procedures better hospitals are superior to off-brand clinics. Immunizations are important for disease prevention and making sure you have them from a legitimate source is vital.

I recently had a possible exposure to rabies in Pattaya. The odds were slim but getting bitten by any dog you cannot quarantine later is high risk. I was advised 8% of street dogs in Bangkok have rabies. They don't live long but they are infectious while they are alive. I went to one of the private hospitals in Pattaya for treatment. Compared to the West the cost is (relatively) small and they are far better equipped to treat people immediately. In North America and I presume, the EU, rabies from domesticated animals e.g. cats and dogs, is very rare.

He Clinic Bangkok

The protocol was pretty straightforward. For immediate protection you are given immune globulin (IG) which is made from horses infected with rabies but which are immune. Their plasma is used to provide already active antibodies from the horse serum to the human patient. There is a human made version also which is very expensive and even if you can afford it, they test your reaction to the horse IG first and if you are not allergic, you get the horse serum and not the other, even if you can pay for it, due to its scarcity. The nurse calculated the dosage and from that the cost. Apart from fairly minor doctor and hospital fees (around 2,000 Baht), the serum was 8,800 Baht. When I paid cash, it dropped to 7,000 Baht. Cash is king. The only problem is that the amount given is huge. 20 cc from two syringes suitable for injecting farm animals in my hand and buttocks was unpleasant indeed. There is not a lot of room in your hand for this much liquid so things are pretty puffy.

In addition to the IG you are given vaccine, for a total of 5 injections. The first while at the hospital, the second at day 3, the third at day 7, the fourth at 14 and the last at 28. Subsequent injections are much less expensive as there is no consultation fee, just a fee for the shot and vaccine. They do that between patients so you can be in and out in 20 minutes. Only 900 Baht or so for the vaccination alone. You get a little rabies card and carry that from hospital to hospital where they stamp each visit. Unlike a supermarket you don't get a prize when the card is full.

I had to go to Bangkok for the time that would be covered for the third and fourth vaccinations, so I had to find a spot for that. I assumed that since I stay on Soi 11 Sukhumvit, I'd walk to Bumrungrad Hospital (and pay dearly). So to the internet.

CBD bangkok

I found a traveler's medicine clinic at Mahidol University Hospital. They have a web site in English with directions that even included photos of what you will encounter en route from the Victory Monument BTS to the hospital. And you can book online and get immediate e-mail confirmation of your appointment. From the BTS it is 10 minutes walk and unless you stay in the same area the BTS is the only sensible way to go. Forget a taxi or moto.

Nurses and doctors both speak English very well. You get a proper medical interview and the treatment cost is less than Pattaya by half. Very professional operation and on top of rabies they will vaccinate for just about anything, including a novel Japanese Encephalitis vaccine that needs only a single dose, and costs literally 1/30th of the cost in North America ($20 vs. $600). They decided I would receive that as well. The rabies vaccine with all fees was only about 540 Baht per treatment. Where I live the three vaccinations (pre-exposure) cost over $600. Three vaccinations at Mahidol cost about $50 in total. Obviously for me, the post-exposure treatment was critical at any cost and my cost was covered by travel insurance but tourists and ex-pats can benefit greatly from preventative vaccinations, including Hepatitis, given competently. If I lived in Thailand I would get the pre-exposure vaccination for rabies.

Mahidol Travel Clinic has moved to a very modern new building on the same campus. No more see the nurse, go to window 1 at the pharmacy, then the cashier then the window 2 at the pharmacy then the nurse, then down the hall for the injection. It is all on one floor. And air conditioned. I was the first patient of the clinic (farang or Thai) on the day they moved and the president of the university personally escorted me from the lobby to the clinic in a new elevator. I had my photo taken and I am sure it is there somewhere now.

Good English, proper professional service and understanding of pre and post exposure regimens. Tourists or residents alike could not do better than the clinic. There is a website
with a price list and booking service. There's no need to be timid about it being a Thai run hospital. They are totally competent to communicate and treat in English. Attending there is almost worth it when you read this part of their mandate, to
me a unique attitude in Thailand:

wonderland clinic

(From their FAQ) Apart from that (buying in bulk lowers the price), our clinic and our hospital are not-for-profit organization. Our mission is to provide an excellent medical services to all, regardless Thai or foreigners. So we do not set another vaccine/medication pricing for foreigners. Everyone attends our clinic will pay the same vaccine price.

I had the final vaccination back at home. Because it was post-exposure it was part of the public health system and was free. Testing now shows that my level of protection is 9 times the minimum level that is considered fully protected so this is evidence of the Thai treatments being totally effective. The little dog that bit me is still alive and as snappy and miserable as ever but not rabid.

Stickman's thoughts:

Mahidol is one of the best universities in Thailand so I would expect the medical facility to be top notch – and it's great that that was exactly your experience!

nana plaza