The Laotian Affair

When you have travelled around Laos for a while, one thing you notice is that there is always an ATM at the entrance to a hospital. Now I know why.

Hospitals are a cash-based society in Laos. If you need an x-ray, or a bandage, or some drugs, you need first to hand over a large chunk of cash to the sister (the one I dealt with refused to smile, despite my best efforts). And when I mean chunks of cash, there are 26,000 Laotian Kip to the GBP. If you don’t have the cash at the time, the sister (who could have easily been cast as the guard in a concentration camp) will hand you a chit with a list of undecipherable words, and send you with it to the pharmacy in order to replace the stocks that your incapacitated wife has just consumed.

The hospital in Luang Prabang was built with Chinese money; most Laotian infrastructure is - roads, railways, dams, bridges etc. But it doesn’t mean that the Laotians have the cash to run them. And I don’t think there’s a national health service. The hospital was basic to say the least, and Alix’s room was not the cleanest to put it politely.

The odd stray dog roamed the corridors. The families of the inmates set up barbecues on the grass outside the windows to provide catering services. And lines of drying washing were strung between the occasional trees. We were the only white, Westerners on site. I did bump into a middle-aged Aussie doctor in the children’s ward doing his good deeds, pro bono no doubt? I think he assumed, at first, that I was also working there.

I think of China as some huge fungus with its mycelium stretching far and deep into the rest of Asia, Africa and indeed around the globe, simply to feed its enormous population of increasingly demanding mouths. Everywhere you go in Laos, China is there, even though we didn’t see many Chinese, as Laos still perceived the travelling Chinese as a Covid-19 risk.

The biggest and most pervasive effect of a hungry China is on Laotian agriculture. Vast tracts of native forest have been clear-felled, roots grubbed-up and then planted with monoculture crops of banana, watermelon, pineapple. All this produce is then shipped north on Chinese trucks out of the country. The Chinese lease the land off the locals and pay them a wage to tend the crops. This tends to be popular locally as it lifts the population out of subsistence, slash-and-burn farming. And it brings the locals down from the hill tops thus providing some respite the wildlife that clings onto existence up there. In fact the Government is encouraging it for that reason (at least that is the spin on it)

But there are environmental downsides too. Big ones. Whereas native vegetation regenerates after slash-and-burn, the grubbing-up of rootstock has basically eradicated the native flora for good. And the Chinese insist that the locals use lots of fertiliser, insecticides and pesticides that are trucked-in from China. Much of this is bad for local flora and fauna and also ends up in the rivers and water table. It’s quite depressing really, until you realise that that is exactly what England did, especially after WWII. I suppose it’s best not to be a preacher and a hypocrite, but it’s such a shame that developing countries haven’t been able to avoid – or leapfrog past – the well-known problems that first-world countries experienced.

Even as I write this sitting in the cockpit of Missy Bear, I am gazing over a landscape, devoid of much of its trees and supporting only the smallest and spiniest of shrubs that the wandering goats either can’t or won’t eat.

Anyway, I digress. We were grateful there was a hospital in Luang Prabang at all. Alix’s x-rays proved the obvious and the local doctors tried to set her right leg straight in some bandages. Even to my untrained eye, I could see that they hadn’t done a great job (her leg was wonky!)

I contacted the travel insurance (Nationwide, underwritten by UK Insurance) to explain the situation and to make a claim. Ivan (our hotel manager's husband) was a great comfort; even as the local insurance agent was telling me that there was another Chinese hospital in town that fancied “having a go” at the necessary operation, Ivan assured me that all the ex-pats made sure that their family and staff were sent to Thailand as soon as possible for treatment. I made this case strongly to the insurance team and waited.

I spent two nights with Alix as full-time carer, feeding, cleaning up and emptying the catheter bag etc. There was one nice young nurse call ‘Huk’, who I befriended. She wanted to improve her English. I even gave her a subscription to DuoLingo. I think Alix was suspicious, though, especially the ongoing WhatsApp messages from Huk when we were back in England :-)

I slept for the two nights on a table in Alix’s room - not the comfiest nights’ sleep I’ve ever had. But good news eventually came that Alix would be flown by air-ambulance to Bangkok. There was some toing and froing as to which hospital, but they all seemed to be high-quality from a basic Google inquiry.

When the time came, a whole troop of medics and helpers, dressed like Ghostbusters, rushed into the hospital room, assessed Alix, put her onto a posh trolley and wheeled her out into a waiting ambulance. I gathered the cases, said goodbye to Ivan and Huk, and followed behind in a taxi.

The ambulance had the “blues and twos” going, and the taxi had a job to keep up. The many cyclists and moped riders were having to take evasive action.

The ambulance drove straight through a gate in the perimeter fence and onto the tarmac. I, however, had to clear passport control and customs, while frantically trying to get the local SIM card (that Ivan had lent to me) out of my phone, along with passing instructions to the girl at passport control to please hand the SIM to an English gentleman who was probably arriving right behind me (Ivan had had no chance to keep up with us in the heavy two-wheeled traffic.)

And so, the seven of us (we two, plus two pilots, and three medics from the Bangkok International Hospital’s air ambulance team) took off and headed south to Thailand and to a hospital so amazingly first-rate that the juxtaposition between the two hospitals was barely credible.

The flying patient

Touchdown in Bangkok

As soon as we touched-down in Bangkok, we were whisked away to the hospital (opened in 2019, and hardly used since due to Covid-19 restrictions) and Alix immediately had MRI scans and x-rays in spotless, new theatres almost devoid of other patients. Her suite of rooms was comparable to a very good hotel (ensuite, lounge, kitchen area, large Plasma TV…) and there was a constant line of consultants, nurses and hospitality staff making sure that Alix was thoroughly checked-over and doing well.

She had a 5-hour operation within a day or so on a Sunday afternoon/evening. To quell my anxiety, I went for a trip downtown, and had a sundowner beer overlooking the Chao Phraya River.

The physios had her out of bed and walking (with support obviously) on the Wednesday and she was well enough to fly home two-weeks later. Quite remarkable.

Learning to walk again

If you ever need an operation and the NHS waiting list is a tad too long, you might consider flying business class to Bangkok and having it done there instead. Even the doctors back in England were extremely complimentary about the quality of their Thai colleagues’ leading-edge work.

And that is partly why Alix has been able to get back out onto Missy Bear at all in 2023. The season has been much shorter than planned, and we have taken it easy. But we are very grateful to have got here at all.