After a lot of consideration about our healthcare whilst travelling, I’d decided that alongside the free travel vaccinations offered by the NHS for those going overseas, we would book in to get further travel advice and any other necessary medications once we arrived in Asia. I’d read fairly widely about the subject and heard from several sources that local knowledge can differ from the advice given back home. As we were planning to travel long-term, as opposed to a 2-week summer holiday, I felt that we could afford to wait until reaching Asia before commencing any further treatments. After doing some research, I booked our family an appointment at the Thai Travel Clinic, based at The Hospital for Tropical Diseases, Mahidol University, Thailand. The booking process was easy – all done online via their simple choose and book system. You choose the time slot that best suits your schedule, fill in some personal identification details, tick which services you require – e.g. vaccinations, pre-travel advice, antimalarials, or healthcare if you’re feeling unwell, etc. You are then emailed an appointment confirmation, with instructions and maps to find the clinic easily. You can further complete the necessary patient information registration form online, if so wished; or you are advised that this can be done in person on attendance. On arriving via SkyTrain, the whole area of the Victory Monument stop closest to the hospital, has a medical feel to it. There are several hospitals in the area – the main Rajavithi Hospital, the National Cancer Institute, the Royal Neurological Institute, a hospital for injured veterans and also the Royal Thai Army Nursing School. The Travel clinic is based on the 3rd floor of the busy, modern Hospital for Tropical Diseases building. On checking in, the clinic already had our pre-printed forms that we had partly completed online. They took a photocopy of our passports for ID and we completed the rest of our registration forms whilst waiting to see the doctor.
On calling us through, Dr. Peyawadeeook took a thorough history of our general health, our previous travel vaccinations, our on-going travel plans and asked what information we wanted to know. Her English language was excellent and I noticed that a few of her many medical qualification certificates on the wall were gained the UK. On considering our plans, she advised that we should all have a Japanese Encephalitis vaccination. I explained that we had considered rabies vaccination for the kids, but had decided against this on the rationale that I thought our risk of rabies was low- we felt that the kids were old enough to understand not to touch unknown animals, thus reducing their risk of being bitten. After laughing out loud at my ignorance of rabies, she kindly corrected my understanding by explaining that rabid animals will run at humans (or anything moving!) and attack without warning; leaving very little time to decide whether or not to give said animal a gentle pat or stroke. I have since realised that one of the doctors at the clinic was the lead researcher on a 2012 paper that assessed traveller risk of acquiring rabies and traveller attitudes and practices related to reducing this risk. This paper concluded that most travellers were inadequately informed and unprepared for this life-threatening risk! I think we can add our family to the numbers on this subject! The main recommendation of the paper was to ensure that a rabies risk discussion is included as part of all travel health consultations.
We were advised that our main risk area would be if we were to travel through jungle in Cambodia: mainly because Cambodia as a country does not stock rabies immunogloblin, which is the treatment should a person be at risk of a rabies bite. Aaron and I agreed there and then that we would not be taking the kids trekking through Cambodian jungle. We were informed that if we did experience a bite or a lick from a potentially rabid animal in Cambodia, we would need to fly immediately out of the country, ideally straight to Bangkok, to get the correct hospital treatment. Finally, we discussed the issue I have been most anxious about – antimalarial treatments. Dr. Peyawadee advised that antimalarial prophylaxis was not highly recommended for the areas we were planning to visit, as the risks of malaria were low. The main risk area in South East Asia is the Laos border area close to Cambodia and Thailand. However, it was explained that an option for travellers like ourselves, is to consider taking a ‘just-in-case’ standby course of emergency treatment of malaria (SBET). This is taken ASAP by a person who becomes unwell with malarial symptoms, even if they have visited a low-prevalence area, before they are able to reach qualified medical help. This seemed like a good compromise. I was reluctant for us to take antimalarials unless absolutely necessary; however my nursing training tells me that this is not something you take risks with. I have been surprised that out of all the other long-term travellers we have met, no-one has considered malaria a particular risk and no-one has taken prophylactic medication of any kind. After our consultation, we had to go off to pay the hospital fees, before receiving our planned injections (one each!) and collecting the anti-malarial SBET. We were offered the full range of antimalarial treatments for our SBET kit and had the pros and cons of each one explained. I had already checked out the vaccination list and noted that the drugs used by the clinic were mostly identical to those used by the NHS in the UK. The bill for our family, to include the medical consultation, cost of and administration of drugs, came to a grand total of £166. The service was spectacular. The injection technique was perfect 😉 The nurses took a particular shine to the kids, especially Rosie with her blonde hair. Niracha, the nurse who had given us our injections, even wanted a photo with the kids. She was mortified that Rosie had cried on receiving hers and wanted to make sure she left feeling happy!