Community hospitals ailing due to dearth of specialists

An unprecedented health crisis is unfolding as smaller facilities are forced to send patients to provincial centres due to a shortage of specially trained surgeons

Kongjian Phusatan looks anxious as he waits to see a doctor at Chiangkhong Crown Prince hospital in Chiang Rai, not far from the border with Laos.

LOSING PATIENCE: Somdet Prayannasungworn community hospital in Chiang Rai’s Wiang Chai district has resumed hernia and cataract surgeries after launching a project to share medical specialists with nearby Chiang Rai Prachanukroh provincial hospital.

The 53-year-old farmer suffers from an infected wound on his left foot. Diabetes has led to poor blood circulation and nerve damage in his feet, and the prognosis looks grim.

"I still don't know whether my left foot has to be amputated or not," Mr Kongjian said. "But if it has to be amputated, I would prefer to have the operation done here rather than at another hospital."

Due to a severe shortage of medical specialists nationwide, that is unlikely to happen. Mr Khongjian is among thousands of farmers and villagers who regularly visit Chiangkhong Crown Prince Hospital.

But it is one of 700 community hospitals nationwide that is facing a critical shortage of medical specialists, the Public Health Ministry said. Surgeons, anaesthetists and gynaecologists, among others, are in short supply, and in most cases, they are not available outside major provincial centres.

If a doctor decides that Mr Khongjian's foot must be amputated, he will have to be transferred to a provincial hospital more than 100km away.

His wife Somkid, 52, said she wants her husband to receive treatment at the community hospital, which is close to their home and the rest of their family.

"We need more medical specialists in our community," she said. Representatives from the National Health Security Office last week toured community hospitals in Chiang Rai to assess the extent of the skills shortage in a bid to formulate a strategy to resolve it.

According to data from the Medical Council of Thailand, 682 general surgeons and 612 anaesthetists received professional certificates from the council between 2003 and 2012.

There are 2,390 surgeons and 1,299 anaesthetists practising nationwide. Of those, most work mainly in private hospitals, leaving government hospitals without the personnel needed to deal with a high caseload of complex surgeries, the council says.

The Public Health Ministry said almost 1,000 patients requiring appendectomies are admitted to community hospitals around the country every year. But due to the shortage of specialists in those hospitals, the patients are forced to go elsewhere for the relatively routine procedure.

Operating rooms in most community hospitals have been abandoned or are now used only for childbirth and providing vasectomies.

Dr Somprat Munjit, the director of Chiangkhong Crown Prince Hospital, said his small hospital had to care for Thais as well as Lao nationals who crossed the Mekong river in search of better quality medical services.

He said almost all patients who require surgery are forced to seek treatment at the provincial hospital.

But even the provincial hospital is struggling to cope, as it is being overloaded with cases sent from struggling community hospitals. Waiting lists commonly extend beyond one year.

A scholarship programme is in place enabling doctors who have recently graduated to be trained as specialists in return for pledging to work at community hospitals once their training is complete.

However, most of the scholarship recipients pay money back to the grantors after graduation to escape their community hospital commitment, Dr Somprat said.

At Somdet Prayannasungworn community hospital in Chiang Rai's Wiang Chai district, administrators are trying to solve the problem by sharing specialists with nearby Chiangrai Prachanukroh provincial hospital.

Dr Tawatchai Jaikawang, director of Somdet Prayannasungworn, said the deal meant his hospital was able to reopen its operating room and start offering hernia and cataract surgeries in 2010.

He said he now plans to expand services to offer appendectomies soon, though he is still waiting for a budget allotment to purchase a new anaesthetic machine.

"Good cooperation and having a humanitarian heart are the keys," Dr Tawatchai said.

Several surgeons from Chiangrai Prachanukroh provincial hospital regularly donate their time and expertise to perform surgeries at the community hospital, he said.

One of those surgeons, Dr Pichai Phongmanjit, said more than 300 locals had surgeries since the reopening of the operating room three years ago.

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Writer: Paritta Wangkiat