The medical profession is held in high regard. Being a doctor, for many, means good pay, an honourable career and a life of comfort.
But life as a doctor doesn't necessarily mean all this -- especially for those working at state hospitals. Pictures of state healthcare providers overloaded with patients are a familiar sight. With inadequate staff and facilities, many of these hospitals often face complaints of long waits and inattentive care.
Video by Jetjaras Na Ranong and Melalin Mahavongtrakul
Last month, news went viral when a state doctor in Chiang Rai submitted a resignation letter stating that he found Thailand's bureaucratic system unbearable. He'd had enough with the workload after attending almost a hundred patients a day in a small local hospital where only three doctors are available, not to mention conflicts with patients and emotional breakdowns.
Recently, a 15-year-old boy died at a state hospital in Phetchaburi after a long wait with severe stomach pain. It was found that he suffered from a rare disease and an artery in his stomach had ruptured.
Dr Jaras Wacharaprapapong, chief of neurosurgery at Buddhachinaraj Hospital. Jetjaras Na Ranong
What is life actually like as a doctor working for state hospitals these days? Dr Warin Yuyangket, 39, neurosurgeon at Buddhachinaraj Hospital in Phitsanulok, said things can get pretty busy in her neurosurgery unit -- a place she's been working for the past seven years.
The data from 2013-2015, as provided by fellow neurosurgeon Dr Visithi Sathienvantanee, shows that the neurosurgery unit at Buddhachinaraj Hospital cares for over 4,700 outpatients a year, while also handling about 1,500 operations, 2,700 in-patients and 200 emergency patients. The team consists of only four neurosurgeons, who treat everything: accidents, strokes, brain tumours, broken spines, etc.
In the waiting areas and hallways of the hospital, patients clamour, along with family of all ages, with some sitting in wheelchairs or lying in beds waiting to see a doctor.
As a regional hospital in the lower northern part of Thailand, Buddhachinaraj Hospital is responsible for patients in Phitsanulok, Phetchabun, Sukhothai, Uttaradit and Tak, as well as other nearby provinces.
For Dr Warin, work starts around 8am each day when she checks on patients -- around 50, in her unit. Later in the day, she will meet other patients at the OPD.
At night, if she's due for a night shift -- seven or eight days per month for each neurosurgeon -- she will stay to care for patients outside of office hours. Her work concludes around 8am the next day, bringing it to a 24-hour shift. Additionally, she may have to give periodical lessons to medical students, or complete paperwork pertaining to patient data.
"I try to spend time with my patients, like five minutes for each of them in OPD. Some came really far from other provinces, leaving their houses at 3 or 4am and waiting until 10am before they see a doctor. It won't do to give them thirty seconds just to say hi and prescribe medicine.
"We do get some rest," Dr Warin said. "But let's say we're about to eat and our phone rings. Then everything else is dropped. We save our patients first. And on days when we have surgery, we could go from morning to night with no time to eat."
Dr Warin is only one example of a state doctor who handles an overload of patients on a daily basis. Of course, situations at other state hospitals, especially small ones, can get worse. Based on 2015 figures from the Ministry of Public Health, doctors in Thailand are inadequate. The doctor-to-patient ratio in Bangkok is 1:720. In the northern provinces, it's approximately 1:2,300. Worst is in the Northeast -- 1:3,200.
Neurosurgeon Dr Warin Yuyangket explains a brain scan to a patient who has had a brain tumour. Jetjaras Na Ranong
There are around 18,000 doctors registered with the Public Health Ministry, but only 57% work in state hospitals, including regional and community hospitals. The rest are in private hospitals and other places.
That perhaps explains why Dr Warin only gets about two days off per month. Her total monthly income is around 80,000 baht. For the same job, she said she could make about 500,000 baht at a private hospital.
She added that there are only about 40 new graduates in neurosurgery a year. Half of them choose to work in Bangkok; most of the rest head to private hospitals, with only a few coming to state hospitals.
As a Phitsanulok native, Dr Warin chose to stay close to home. She added that while money matters, it is not the answer to everything.
"I have great mentors -- other doctors who set an example that, even though they're not local here, still choose to stay and care for our patients. We have both local patients and those coming from other provinces. Some are very poor. They have no other options. If we choose to go elsewhere, the patients will have a hard time."
A patient's smile, and the realisation that her hands make them better, are some of the best rewards of a medical career, said Dr Warin with pride. At the same time, negative reactions from patients and family are something that really wears her down. Still, she insists she'll continue to stay at her current workplace.
A hospital's corridor filled with patients in beds. Jetjaras Na Ranong
Addressing the issue of doctors quitting state hospitals, Dr Jaras Wacharaprapapong, chief of neurosurgery at Buddhachinaraj, said that doctors do have a high turnover rate at state hospitals. This is part of an unfortunate cycle, with the insufficient number of doctors making it hard to cope with ever-increasing patients.
From his three decades working at the Phitsanulok hospital, the 58-year-old said it's crucial for the three parties -- the government, the doctors and the patients -- to work together to solve this problem.
"We really need to take a look at our system and how we are spreading out our doctors to rural areas. The budget also needs to be sorted out, with additional support going to smaller, local hospitals so they will be able to treat more patients and more conditions on their own. This would, in turn, reduce the burden put on bigger hospitals that have to take in referred cases," he suggested.
While we wait for the state to better manage the country's healthcare system, Dr Jaras believes it's equally important for doctors and patients to show courtesy and understanding towards one another, to improve the survival chance of all patients, not just one's own relatives.
He suggested that medical practitioners need to consider the family's feelings, too, not just approach each case from a medical point of view. At the same time, from the patients' side, everyone should at least possess enough basic medical knowledge to take care of their own health and prevent general sicknesses. Also, it would be highly beneficial for people to recognise whether their conditions really require urgent treatment.
"We've had people coming in at 2am after they finish partying because they weren't free during the daytime. Some had just a slight headache. Some demanded to see a specialist even when their conditions could be treated by general practitioners at any hospital near them.
"When this happens, the people who really suffer aren't just us, but the patients who are in actual critical, life-threatening situations," he added. "They may receive less care and attention than they should be getting as we have to divide our time among other patients, too."
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