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Saturday, 14 May 2016

Getting Prepared...am I healthy? (a costly business)

There are some things in Bangkok that you can easily throw money at, and medical tests are big business here.

I'll be honest that I've been lazy and I've had all my TTC tests done at Bumrungrad hospital. I probably should have shopped around but ease of transport, location, guaranteed spoken English, and reputation has meant that I have only ever used either Bumrungrad or Samitivej for my TTC needs (although I have used medical clinics for Visa medicals and basic pregnancy tests).

My first visit to Bumrungrad was just after we were married. As I was 36 I wanted to ensure that I had a general TTC overhaul to check there were no obvious roadblocks.

I made an appointment online with Bumrungrad. I booked a basic appointment to see a Doctor in OB/Gyn. Here's the link: https://www.bumrungrad.com/en/contact-us/request-an-appointment

Before I go on, just a word of warning for the emotional sorts (like myself). I choose to go to the hospital on my own as I figured this was a routine appointment. But as I sat in the waiting room I realised then and there that I might find out that I couldn't have children...it hit me like a wet fish and I burst into tears. I suddenly felt incredibly vulnerable and in need of a hand squeeze. As an expat, your mum or best friend cannot always be by your side, or even at end of the phone, when you need them, hubby was also unfortunately at work and I knew this was only the start of crazy arse emotions taking me hostage at inopportune moments, so I made the decision to sniff and brave it out - but you may wish to arrange to have a hand squeezer by your side.

So, I had an appointment with Dr. Suleewan Ratanachai. Her English is ok and she seemed to be a very nice lady, but this was my first experience of a doctor in Thailand and I have now come to the conclusion that they can come across as disingenuous. I don't know if the problem is that they are perfectly fluent in technical english, but lacking in colloquial english or just plain culture, but they can often come across as dismissive and uncaring, which I am sure they do not mean to be.

Dr. Suleewan assured me that my age was not a worry and that many women get pregnant at my time of life. I should not assume any problems and should start TTC naturally. But you have to press Doctors here for real information and I kept pressing for information about what could, but hopefully wouldn't, be problems in the future. At this point she suggested that I could have a Pap smear and blood tests. She explained that there are various blood tests, but that detailed analysis of my hormones etc would be expensive and she recommended just a general blood overhaul.

So here is what they tested me for:

I had a Transvaginal Ultrasound to check the size, shape, endometrial echoes and appearance of my uterus, a Pap Smear and they took blood to check for:


Non Panel Items:
  • VDRL
Hemoglobin Typing:
  • Hemoglobin Type
  • Hb A
  • Hb A 2
  • Hb E
  • Hb F
  • Hemoglobin (Hb.)
  • Hematocrit (Hct.)
  • MCV
  • Osmotic Fragility Test

  • WBC
  • Neutrophil
  • Lymphocyte
  • Monocyte
  • Eosinophil
  • Basophil
  • Neutrophilic Band form
  • Atypical Lymphocyte
  • NRBC
  • RBC
  • Hemoglobin (Hb.)
  • Hematocrit (Hct.)
  • MCV
  • MCH
  • MCHC
  • RDW
  • Anisocytosis
  • Macrocyte
  • Microcyte
  • Poikilocytosis
  • Target cells
  • Fragmented cells
  • Ovalocyte
  • Hypochromia
  • Polychromasia
  • Platelet Count

Hormones/Tumor Markers:

Non Panel Items:
  • Free T3
  • Free T4
  • TSH
  • Estradiol (E2)
  • FSH
  • Prolactin

Blood Bank: (note that you should already know this as part of your Visa medical)

Non Panel Items:
  • ABO Group
  • Rh Grouping

Immunology/Infectious Diseases:

Non Panel Items:
  • HIV Ag/Ab
  • HBsAg
  • HBsAb
  • Anti HCV
  • Rubella IgG

They had the test results back the very next day and Dr Suleewan gave me a priority appointment to see her quickly to explain them to me. They aren't very good in Thailand at giving you detailed explanations in words and phrases that you actually understand, they speak in clinical English and lack sensitivity and cultural awareness (cultural awareness of our needs and expectations as an English woman anyway) but she quickly told me that all of my results were fine (thankfully) and then bid me farewell, under advice to try naturally for 6 months and with a prescription for 6 months Folic Acid.

Now, the cost of peace of mind in Thailand does not come cheap. This is breakdown of costs:

THB 6,500   Health Screening Program
THB  1,000  Doctor's Fee
THB     100   Nursing Service
THB     200   Lab - pathologist's fee
THB  1,480   Lab - Pathology
THB  3,760   Laboratory - Clinical
THB  2,525   Ultrasound
THB     675   Ultrasound - Radiologist's fee
THB  1,080  Medicine
THB17,320  TOTAL

Do I think it is worth it, for peace of mind, absolutely, but I didn't really learn as much about myself as I was hoping for, as Thai Doctor's simply don't explain things to us in a way that we are used to in the UK. It was all clinical jargon to me and the only thing I could hold on to was the concluding phrase - no obvious signs of problems.

So, I have made a vow to translate as much of the above in the Glossary section of this blog to help all TTC women in Thailand for the future. You will note that some the test names are in italics, this is because I noticed that they checked for these items more than once. It can be common to be overcharged by medical establishments for non essential tests or doctor's time. I haven't questioned Bumrungrad about this yet, but as time goes on I will keep my eye on this happening again and let you know if there is anything we can do to save ourselves some unnecessary costs.

But for now, don't despair, if you are worried about your chances of getting pregnant and have the money, I would recommend getting these tests done for peace of mind. Of course they are not essential, we wouldn't get this service with the NHS back home, but why not avail yourself of modern technology and your highly prized position as an expat woman.

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