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ROBERT SIEGEL, host:

From NPR News, this is ALL THINGS CONSIDERED. I'm Robert Siegel.

MELISSA BLOCK, host:

And I'm Melissa Block.

Millions of people travel to Bangkok for medical care. They get everything, from facelifts to heart bypass operations. These medical tourists have helped boost the Thai economy, but there's a downside. Doctors in Thailand have become so busy with foreigners that Thai patients are having trouble getting care.

As part of our series on the international business of medicine, NPR's Jon Hamilton visited a hospital in Bangkok that's doing something about this problem.

JON HAMILTON: When medical tourists come to Bangkok, they usually go to places like Bumrungrad Hospital. It's a private facility, downtown, near the fancy hotels. There's a sushi bar, interpreters who speak Arabic and Mandarin, and VIP suites with marble bathrooms. Most Thais can't afford it. They're more likely to go to Siriraj Hospital. It's way across town, along the banks of the Chao Phraya River.

Siriraj was founded by the royal family more than a century ago to provide free care to the Thai people. It treats more than two million patients a year.

HAMILTON: The outpatient waiting room looks a bit like Grand Central Station, on a very hot day, with no air conditioning. Hundreds of patients are squeezed onto old wooden benches. Many more are slumped in wheelchairs or lying on gurneys.

Ms. MALAI KAMPACHUR: (Speaking in foreign language)

HAMILTON: Malai Kampachur says she has come in from the district of Phetchaburi because she feels sick and her legs hurt. She also has hepatitis.

Ms. KAMPACHUR: (Through translator) I got here about 6 o'clock in the morning.

HAMILTON: And what time did you leave home this morning then?

Ms. KAMPACHUR: (Through translator) I left at 3 in the morning.

HAMILTON: She'll probably wait several more hours to get two or three minutes with a doctor. Then she'll wait some more for test results or a prescription. Malai says she won't be home until at least 9 tonight.

(Soundbite of hospital advisory)

HAMILTON: A taped message asks for patience. It's a constant reminder that Siriraj doesn't have nearly enough doctors, and neither do other hospitals that accept people covered by Thailand's basic health plan. The problem is money. Doctors don't get paid much for working at public hospitals, so many won't. And the ones who do tend to moonlight at private facilities.

Dr. Suwit Wibulpolprasert is an adviser to the Thai Ministry of Health. He says even public doctors depend on private patients.

Dr. SUWIT WIBULPOLPRASERT (Adviser, Thai Ministry of Health): Like my wife, she is a radiologist. She works five days a week at a medical school and on Saturday she works at a five-star private hospital. And what she earns in one day per week is about almost three times than what she earns from five days at the public medical school. So we survive.

(Soundbite of laughter)

Dr. WIBULPOLPRASERT: We serve the public at the same time we serve the private.

HAMILTON: Suwit's wife is trying to follow the teachings of Thailand's Prince Mahidol. Back in the 1920s, the prince called on Thai doctors to treat the poor as they would their own families. But Suwit says many young doctors don't feel this obligation.

After medical school, most of them have to work in a provincial hospital for at least a couple of years. But Suwit says once that's done, they tend to head for the private sector.

Dr. WIBULPOLPRASERT: And this is the so-called river of no return. They never go back.

HAMILTON: The doctor shortage isn't a new problem for Thailand. During the Vietnam War, Thai doctors left in droves to work for the U.S. military. Then they started leaving for other countries, where they could earn more money. And the shortage gets worse every time a doctor leaves the public sector to take care of medical tourists.

(Soundbite of chattering)

HAMILTON: The river of no return is flowing swiftly at Siriraj.

Dr. Damras Tresukosol is a cardiologist here. He says the doctors that leave are often the most skilled.

Dr. DAMRAS TRESUKOSOL (Cardiologist, Siriraj Hospital): I just heard that one of my colleagues resigned from this hospital. He is one of the best cardiac surgeons who can perform congenital heart operations.

HAMILTON: Damras slumps a bit as he tells the story, then he looks around the small meeting room.

Dr. TRESUKOSOL: I'm very afraid that if we do not change anything, good doctors will leave and work for private.

HAMILTON: So Damras is trying a radical experiment just outside this room.

Dr. TRESUKOSOL: This is the lobby of critical care unit.

HAMILTON: High above the teeming outpatient department, Damras has created a new center for cardiac care.

Dr. TRESUKOSOL: On the fifth floor is a critical care unit.

HAMILTON: And when you step out of the elevator, it feels like you've wandered into one of those swanky private hospitals downtown.

Dr. TRESUKOSOL: This is the television. They have a refrigerator, a sofa, or the entertainment area for their relatives.

HAMILTON: It's very private, it's very modern, it's very home-like. It's like an apartment.

Dr. TRESUKOSOL: So that's the idea.

HAMILTON: There's even a marketing slogan.

Dr. TRESUKOSOL: We provide good hands and better hearts.

(Soundbite of laughter)

HAMILTON: The idea is simple: Attract some private patients to Siriraj, so doctors here can earn more money without leaving for another hospital. Siriraj isn't focusing on medical tourists. The cardiac unit hopes to get Thai people willing to pay a bit extra for special care and no waiting, or expats who want more amenities and privacy than they'd get in a typical public hospital.

It's a big leap for a hospital with a royal mandate to care for the common person. But Damras says the new unit will help fulfill that mandate.

Dr. TRESUKOSOL: The motto belongs to the king's father, king's father is Prince Mahidol. His motto is to treat the poor as ourselves. But to survive in this globalization, we have to look forward and try to bring in more patients to this unit, to give us some revenue to treat the poor.

HAMILTON: It's too soon to know whether the cardiac unit will make money or keep doctors at Siriraj. But it has brought some new patients.

Mr. ROBERT MORRIS (Siriraj Hospital Patient): Well my full name is Robert Morris, but I prefer to be called Bob. That's what I've been known all my life.

HAMILTON: Bob and his wife retired to Thailand a few years ago. When he began having heart problems, he came to Siriraj.

Mr. MORRIS: Right now, I'm a post-pacemaker implantation patient. It was done yesterday at 1 o'clock in the afternoon.

HAMILTON: Bob is not exactly your typical patient. He used to run a big VA hospital in Denver, and he knows a lot about Siriraj.

Mr. MORRIS: This is the facility where the king would come. I think that if it's - if the king can come here, I certainly can come here.

HAMILTON: Even with more patients like Bob, Siriraj will never be able to pay doctors as much as places like Bumrungrad. But Damras says private patients will make it easier for doctors to follow the lead of Prince Mahidol. The prince left Thailand to get an M.D. at Harvard. Then, he came back to spend his life caring for the poor.

Jon Hamilton, NPR News.

BLOCK: And if you're considering surgery abroad, you can find a checklist of what you need to know at npr.org.

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