Thailand: health guide for expats

Our Medical Director at Bupa Global, explores the health challenges for an expatriate living in Thailand.

Thailand is such a vibrant and colourful country – I love the contrast of the cosmopolitan city with the deep traditions and culture. You can’t walk far in Bangkok, for example, without coming across a peaceful temple situated moments away from the hustle and bustle of the city. As medical director for Bupa Global, I’ve met many people who have relocated to Thailand. Many of the health challenges they face are similar to other expats around the world, while others are unique to this region.

An environment of change

In the last few decades, Thailand has seen dramatic economic growth. The country has transformed from an economy borne from the land to a thriving industrialised business centre. However, a casualty in this boom has been the environment. Thailand’s air pollution in its major cities has risen correspondingly, as in many countries that have gone through an economic transition. This has had a major impact on health, resulting in more respiratory-related illnesses, such as chronic obstructive pulmonary disease.

Air pollutants from vehicles and factories have been a major contributor to the problem. This situation prompted the government to set up the pollution control department at Thailand's Ministry of Environment. The government has largely been successful in its attempts, with stricter controls on emissions. And although Thailand – and Bangkok in particular – has made great strides in the attempt to tackle air pollution with the government initiatives to improve air quality, there is still work to be done. Fine particles in Bangkok’s air have at times exceeded World Health Organisation (WHO) standards by 2.5 times, and other air pollutants are also still causing major health impacts.

If you’re an expat living in the city, you may be particularly affected. My advice is to check your local weather forecast and air quality index on a daily basis and plan your activities accordingly. On hot days when the air quality is poor, try to stay indoors as much as you can, preferably in an air-conditioned room or building. Air-filtering equipment may also help to improve the air quality in your home. If you have to go outside, choose times of the day when the air pollution is lighter, such as first thing in the morning. But most importantly, listen to your body.

The symptoms of respiratory disease can vary considerably, but the principal issues are shortness of breath, a productive cough and wheezing. The symptoms will vary from day to day, but air quality can significantly affect the severity, making the difference between having a minor niggle to even requiring treatment in hospital.

HIV/Aids is the biggest health challenge

More people die from HIV/Aids than from any other illness in Thailand, it accounted for 14% of deaths in 2006. Since the first case of Aids was reported in Thailand a quarter of a century ago, the epidemic in South-East Asia has grown massively. South-East Asia has the third highest HIV burden in the world after Sub-Saharan Africa and the Americas, accounting for 10% of all people living with HIV. Sexual transmission accounts for 83% of all reported HIV/Aids cases in Thailand. Practising safe sex is therefore vital for everyone, locals and expats alike. The risk of HIV infection is dramatically reduced by using a condom.

Thailand has successfully responded to the problem and largely controlled HIV through a strong and early national response. There are government strategies such as the ‘100% condom use programme’ as well as good monitoring and evaluation in place with research to guide public policy. Added to the government’s response are the numerous national non-government organisations, community-based organisations and academic institutions who are working to combat the further spread of this disease.

It’s also important to consider HIV/Aids if you’re a healthcare worker in Thailand due to the potential transmission through needlestick injuries. In comparison to developed countries, such as the US and UK, in Thailand, you face greater risks because of the use of certain medical equipment, such as non-retracting finger-stick lancets and glass capillary tubes to test for common tropical diseases. Although safety-engineered devices have been incorporated to help reduce needlestick injuries in the developing world, the role of such devices in developing countries remains controversial. My advice is to take extreme care and always use single-use or sterilised needles.

Bird flu risk simmers

Although swine flu now has most recently caught the attention of the world, back in 2003, bird flu was the major threat. There were outbreaks in South-East Asia, including Thailand. A total of 25 people were infected and 17 people died from the illness. The last case of a human becoming infected with the bird flu virus in Thailand was in September 2006 but with a new case in South-East Asia in Jakarta (Indonesia) this year, and in Cambodia in only December last year, it would be wise to remain cautious.

Most people have been infected with the bird flu virus from being in direct or close contact with infected poultry. Colourful vibrant food markets abound in Thailand. They are such interesting places to visit but if you take a trip to a food market in Thailand where they may be live poultry be cautious. Don’t touch the poultry, any feathers or liquid waste from it and try to avoid any areas that are heavy with poultry in poorly ventilated areas. Wash your hands after you leave the market and if you have children, take particular care to supervise them. You can safely eat poultry and eggs if they are cooked correctly as the virus is killed in the cooking process. It’s important to note that nobody has ever got bird flu from eating cooked food.

But my overall advice is that living and working in Thailand has great advantages, which should be enjoyed. The favourable climate, the naturally healthy Thai diet and the relatively relaxed pace of life are all great reasons for your health to actually improve.

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