Posts Tagged ‘Thailand’

Here is a blog post that expands on my mini tweet storm about measles becoming endemic again in the US due to a drop in children’s vaccination rates. I put the graphics and links all in one place so you don’t have to keep clicking through to other websites to see them.

This story comes from Arstechnica where they quote the researchers who point at that a drop of 5% in the MMR vaccination rate drop will triple the number of cases and be very costly in terms of public healthcare costs. The personal costs are pretty high, too. Quoting:

Measles, in particular, requires vigilant vaccination. The highly infectious virus can linger in the air for hours after a cough or sneeze. Those sickened develop high fevers, rashes, inflamed eyes, and cold-like stuffy nose and cough. But people can spread the infection days before those symptoms appear. About 30 percent develop complications, such as pneumonia, brain swelling, and blindness.

So there’s that.

Since I am originally from California I was curious about how prevalent unvaccinated kids are these days in my home state. A while ago I did an analysis of data from the California Department of Public Health on the percentage of kindergarten children who had been granted “Personal Belief Exemptions” in 2015. Here is a map of California with counties colored according to percentage of unvaccinated kids.

AntivaxxerHotspots

Note that it looks like most of the northern half of the state suffers from this risk. The county names are not listed in the graphic but the 20 with the lowest vaccination rates are shown on my Rpubs page at http://rpubs.com/markdg/AntivaxxerHotspots. Nevada county leads with 21.4% unvaccinated, followed by Mariposa county at around 15%. Amazing in this day and age, like a third world country in this respect.

Something odd I noticed when I was writing this post is that the data that I used in this analysis has been moved or removed from the CDPH website. So the link to the source on my Rpubs page is now broken. The CDPH website does have some summary data that shows vaccination rates overall are climbing back up. Here, for example they say that overall vaccination rates went from 93% in school year 2015-2016 to 96% in 2016-2017. So that’s good news, although still a little low. I haven’t spent the time to search for the raw data; perhaps it is there somewhere.

The developing country of Thailand, where I live, hasn’t lost its mind. The vaccination rate for measles has risen rapidly since 1984 and was reported at 99% in 2015. Here is a chart from World Bank based on the data they have collected.

Thailand Measles Vaccination Rates

Vaccination Rates of Children Age 12 – 23 Months in Thailand

From http://data.worldbank.org/indicator/SH.IMM.MEAS?locations=TH on 27 July 2017.

Maybe it is because so many people in Thailand can still remember the horrible days before nearly everyone received vaccinations.

There is a temple that is pretty famous in Thailand called Wat Thamkrabok. It’s where drug addicts go for rehab. The detox program is administered by monks at the temple and is quite severe. It involves a week long ritual of drinking a potent herbal concoction that induces severe vomiting and then follows by some intense herbal sauna treatments. In addition to the detox treatments the “patients” follow typical temple life which involves rising very early in the morning, doing temple chores, eating like the monks (restrictions on when they can eat) and I believe practicing meditation. “Graduates” take some vows before leaving about not falling back into the old habit.

I had heard that some foreigners go to the temple for the program. I didn’t know it was a little bit famous outside of Thailand but apparently so. Telegraph.co.uk has a photo gallery showing some westerners and Thais going through the program. The story says the temple is in Saraburi. We pass it whenever we visit my sister-in-law who lives in Lopburi. I thought it was in Lopburi, maybe it’s close to the border between the two provinces.

So I’m coining a new phrase. I’m calling this “extreme medical tourism”. Need to go to drug detox? Don’t have the money for all the pampering the stars get when they go to drug rehab? Or maybe you just like things a little more rough and raw. Wat Thamkrabok might be for you.

I previously posted some thoughts and a story about the outgoing side of medical tourism in the U.S. and the uncertainties due to the new health care reform bill. On the incoming side here in Thailand there is another source of uncertainty completely unrelated to U.S. health care reform. It’s the political unrest that has been in full swing for a month now with protesters blocking major intersections and completely disrupting access to major shopping areas and impacting nearby international hospitals. The violence and deaths that occurred have hurt Thailand’s image as a safe destination, causing many tourists to cancel their plans to visit the Kingdom.

Major international hospitals in Bangkok revealed some numbers in a recent Bangkok Post story. Bangkok Dusit Medical Services Plc (BGH), the country’s largest private hospital operator, said foreign patient visits decreased by 20% this month compared with the same period of 2009. This is the hospital group that a few years ago went through a major expansion and bought up hospitals and clinics across the country. One of their clinics is in the small town near where I live and one of their large hospitals in the one in Korat where we recently did our annual health screening.

According to Pongsak Viddayakorn, the BGH’s executive adviser, many cancellations resulted from travel warnings by European and Middle Eastern governments. Foreign patients including expatriates living in Thailand account for 35-40% of the total for BGH, so there is concern that if the political unrest continues there could be significant earnings impact.

Well known Bumrungrad Hospital said its business faced minor pressure from the protesters’ occupation of the Ratchaprasong intersection earlier this month which is not far from the hospital. Bumrungrad’s foreign patients are a large fraction of its total customers. Phyathai Hospitals estimates a 7-10% decline of international patients arriving at this month compared with last April. International patients represent only 10-12% of their total clients so the impact is not as large as for BGH and Bumrungrad.

We moved from Bangkok to a small town that is at a higher elevation with cooler and dryer weather. The weather and soil in the area make it amenable to growing grapes and there quite a number of vineyards around. I got the big idea that there might be other exotic-for-Thailand crops that might grow here. In particular, I became interested in trying to grow strawberries.

Some mountainous areas in the north of Thailand near Chiang Mai have success with strawberry cultivation. And only a couple of hours away from us there is an area that also produces strawberries. I managed to find some live plants at a farmers market and decided to give it a try.

I started with ten plants set out in the garden at the end of rainy season. They did pretty well, became quite large and lush and produced some tasty fruit, although the fruit were rather small and there weren’t many of them. Still I was encouraged so I propagated a lot of plants from those first ten, ending up with nearly 100 baby plants that I transferred to the nursery until the garden was ready for them.

The following season I put them in the ground in the garden, spent a lot of time on them, and they seemed to do pretty well. However, the fruit were small and dry in appearance – very few appetizing fruit were produced. It appeared that they were suffering from the heat. So although the weather here is cooler than at lower elevations it is still too warm too much of the time to grow strawberries the conventional way.

I have been studying the problem off and on for some time now. Published research indicates the problem in tropical climates is that the roots are too warm too much of the time. The nights just are not cool enough to cool down the soil. Some interesting research has been done in Japan wherein the plants are planted in raised troughs that have a soil cooling system integrated. The trough is comprised of a burlap sheet slung between to horizontal rods. On top of the burlap is a layer of plastic. Soil is filled on top of the plastic and the strawberry plants are planted in the soil. The burlap hangs over the outside of the horizontal rods and rests in a trough containing water. So what happens is the burlap absorbs the water, becoming wet the entire length of the trough. The under side of the burlap is exposed to the air and through evaporation it is cooled. Being in contact with the plastic and soil, it then cools the soil and plant roots.

It is a simple system to construct and would seem to be effective. There are some difficult to control variables, however. One is that high humidity will greatly diminish the evaporative cooling effect. We have “relatively” low humidity in this area but much of the hot season and rainy season is quite humid, at least for long periods during the day. Another variable is the rate of absorbtion and wicking of water by the burlap sheets. In fact, one study showed that felt type material of a particular thickness was required to achieve even cooling. Otherwise there were dry spots which resulted in local hot spots.

So the passive evaporative cooling trough approach is something that, although tempting to try out, may not be very successful. I’ve also be thinking about hydroponic cultivation of strawberries. I can’t find much written about it, however. There are some successful hydroponic lettuce growers in our area but strawberries are going to be a different challenge. And now I’m looking at an active system with pumps and filters rather than a simple passive system. So cost and maintenance could quickly become prohibitive. This remains a pending project.