Nakhon Si Thammarat, Thailand
On the final day of our visit to the dam in Khao Sok NP, Nickiy developed a headache. It had been pretty hot that day and we had sweated our buckets off climbing uphill in the jungle, so we were probably dehydrated. During the night she’d seemed pretty hot but didn’t seem to have any shivers or sweats. Really it was just a sharp headache behind the eyes that was troubling her, as well as some aching in the hands. So, as planned, we set off across country to a large coastal town 260km away. Apart from having not much sleep, leaving late and the immobiliser cutting out the engine randomly, we had a fairly uneventful day heading to the east coast.
When we got into town we found a pretty good hotel with gigantic rooms for not much money. Apparently no tourists visit Nakhon Si Thammarat ever, so we were definitely a novelty as were the low prices of things we bought. There were a few reasons we had chosen to visit this town. One was its unpopularity but the main reason was its geography. We were about to begin our trip north, planning to steadily work our way through the narrow, one-road neck section of Thailand. It would take us about a week to travel on this motorway as we would stop off at coastal towns on the way. However the Thai new year celebrations (Songkran) were about to begin and according to friendly locals we spoke to, this was definitely NOT the time to be on the roads.
Songkran is a traditional buddhist festival which involves the rare treat of pouring water over buddha statues to purify one’s spirit. Additionally chalk is used by monks to mark their blessings. The festival also involves pouring water over the hands of one’s elders and subsequently many people return to their homelands during this period. This all sounds very tranquil and respectful.
In reality, Songkran deteriorates into a drenched mess of splattered youngsters covered in luminous coloured paste. Utes laden with kids in hawaiian shirts cruise the streets throwing buckets of water over everyone and everything they pass. Gangs of kids with pump-action super-soakers battle it out on closed roads. People come up and slap paint on your face. It is totally random and (as long as you don’t have anything not waterproof or valuable on you) great fun. Plus you manage to stay cool in the summer heat.
The drinking also starts early and the 3 official holidays are stretched by most families to 7 days of not working much and partying a lot. Mostly in their cars and on their mopeds. During this 7-day period it became clear to us how vital it was to not be travelling anywhere. A few years ago per head of population, Thailand was the most dangerous country in the world in which to drive. It has recently been knocked off the top spot by war-torn Libya. Thailand has about the same population as the UK. Here are the Thai stats for the WEEK we spent in Nakhon Si Thammarat:
A truly astonishing set of numbers. Much safer to stay put in and around the hotel. But that wasn’t good enough for Nickiy, oh no. She had to be somewhere safer still, didn’t she?
We had spent our first morning in town experiencing the festival properly. We were soaked through, our clothes were stained and stretched and our eyes itched. Nickiy had done some pretty big sweating overnight but once her headache was treated with paracetemol she was keen to get out and about. It was a good thing we did because that was the last we saw of Songkran. She was pretty tired and so we thought we’d better consider some self-diagnosis and a visit to a doctor.
She contacted the insurers with her symptoms and asked them to provide a good local doctor. “How do you spell that town?” So they didn’t know of any approved doctors we could go to. We knew none of them would be open anyway as they were all in other parts of the country and getting covered in water.
Next up were the symptoms. Mild fever, headache, aching joints in the hands. Pretty nondescript. She wasn’t sensitive to light. She didn’t have any rashes. What about exposure to known vectors? In the previous few weeks we had been in contact with beaches used by cats and dogs (hook worm), warm still freshwater (ameobic meningitis), bats, monkeys, dogs, cats (rabies), floodwater (sewage), river water (leptospirosis), mosquitoes (malaria, dengue, zika, japanese encephalitis), untreated drinking water, freshwater fish (parasites), etc, etc. It was a long scary list with the realisation that tropical diseases are all around us, all the time!
So we tried to narrow this down to a realistic shortlist and the subsequent levels of treatment required. Of course she may have just picked up a little bug from someone on the trip to the lake. It might not be anything tropical at all! The most likely candidates were malaria, dengue, meningitis, leptospirosis and chikungunya (whatever that is). Most of these could be tested for in a blood sample. Most were treatable. Dengue and chikungunya are not.
Nickiy slept. The next morning we had a quick breakfast then jumped on the bike and headed to the largest private hospital in town. For some reason we were quickly ushered into the VIP wing and Nickiy was registered efficiently by hundreds of neatly dressed ladies. They took her passport, blood pressure, temperature and told her to wait. About 15 minutes later we went in to see the (female) doctor. She asked all the sensible questions then got a nurse to take some blood. Blood went into the vacuum tube and off upstairs to the lab. 10 minutes later the results were back. Low platelet count, low white blood count. The doctor said “this is probably dengue and we should keep you in hospital for a few days to monitor you”. From arrival to being admitted to hospital had taken just over an hour.
So where safer to stay during Songkran than in the best hospital in town? With room-service food 3 times a day and room-service temperature measurements 4 times a day and room-service blood tests once a day! She got the 5 star air-conditioned condo for $300 a night and I stayed in the $14 a night cheap seats!
There isn’t a lot that can be done when you get dengue. Physicians treat the symptoms; some muscle relaxant, some pain-killers, some anti-emetic and a lot of hydration. Nickiy got a drip straight away and a close eye was kept on her urine…any blood anywhere it shouldn’t be, basically. Because the clot-inducing platelets become diminished, internal bleeding is a pretty bad possible outcome. I was amazed at how predictably the disease followed the lovely Wikipedia graph day-by-day. We reckon she’d been admitted on the third day (taking first day as day 0) and her platelets were already below normal levels. These continued to drop over the next day or so then started to slow. They were only happy to release her once these platelets picked up a bit.
In addition to the excellent service we were getting from the Thai ladies (I only saw one medical male the whole time we were there), the insurers medical team in NZ were following closely and advising where necessary. Apart from being tired and having no books or english TV to interrupt the boredom, Nickiy faired very well. Dengue is particularly common in Thailand at this time, so she just became one of 140,000 people annually to contract the disease. Ignoring weekly variations, catching dengue was still LESS likely than being injured on the roads that week. So whilst unlucky, I think catching dengue was a pretty good outcome in that respect.
So the good news is that Nickiy survived her encounter with dengue, in fact she could probably have easily survived it in the hotel. The bad news is that because there are 4 serotypes of dengue, and this confuses the immune system in case of re-infection, the next time Nickiy gets dengue she will definitely need to be in a good hospital. So if we hated mosquitoes before, we really hate them now. We’ll have to carry more DEET than ever before and treat everything we own with permethrin regularly. We might even buy one of those electrocuting tennis racquets to carry on the bike!