Traveling- when things don't go as planned

Alternative title #1:

Heading to sunny places with a sun allergy: decisions from my 20’s

Alternative title #2:

Medical Tourism in Thailand

I guess that mostly speaks for itself.

First off, thank you to my friends who check this blog for updates and remind me to add new posts. I really didn’t think anyone was actually checking (I suppose I could have looked up my Google Analytics), but that means a lot. I feel very grateful, and so this update is dedicated to you.

What’s been happening

So the original plan was to spend 2 months traveling in Thailand, and then 1 month in Taipei. Instead, I ended up spending 1 month in Thailand and am currently half-way through month #1 of 2 in Taipei. I made the difficult and costly decision to leave Thailand early because I realized it would be nearly impossible for me to return to a healthy state and remain so for the duration of my trip.

My medical history

About 7 years ago, I was diagnosed with cutaneous lupus. Lupus is a condition in which your immune system attacks healthy cells, and cutaneous implies it only affects the skin. This diagnosis comes with the realization that I am photosensitive, or quite frankly, allergic to the sun. I have been told by numerous doctors to wear copious amounts of sun screen, or better yet, stay out of the sun completely. My understanding is that the sun (among other factors including stress) can aggravate my condition which will trigger a ‘flare’, an intermittent and nagging reminder from my immune system that I need to take better care of myself.

I’m grateful that I have a mild case of this (more severe sufferers are affected by this disease on a daily basis). I know this because my doctor tells me I shouldn’t need to take a daily dose of medicine, and also because I have been going to Coachella every year for the past 4 years which is, to anyone who’s ever attended, probably the hottest and sunniest weekend in America, and I have never experienced a flare from this.

So in my blissful ignorance and self-analysis, I decided that 2 months in Thailand during the beginning of the hottest season would be just fine.

This would be the first of many instances in which I was painfully wrong.

The arrival of an unwanted travel companion

It started with this dry spot on my cheek which slowly grew to a weird rash I’d never seen before, and unfortunately I have experienced my fair share of skin rashes. Truthfully, it was inconvenient for this to be something that would require medical attention because I had a traveling plan to abide by that would take me further and further away from urban centers, where the dermatologists would presumably be. Somehow, I suddenly became an expert in skin conditions and decided that with my basic “medical” kit of aloe vera, hydrocortisone cream, and skin moisturizer, I could handle this on my own.

As I moved from hostel to hostel, city to city, every day would be a new diagnosis. One time, I skipped out on going to the Khao Yai National Park (which I was super excited for!) because that day, I decided it was sweat that was trapping microbes and making my rash worse. I stayed in all day that day and thought the rash was diminishing until I woke up the next morning only to find it back in full force.

I even tried to think or meditate away the rash, thinking back to that one podcast episode about this lady who imagined her brain tumor did not exist and subsequently went on to live a long life.

For the next week, I settled on it being heat rash– I landed on this after researching every possible skin condition given my symptoms and situation. I tried my hardest to stay out of the sun and to keep my skin dry and to not sweat in Thailand, which is about the equivalent of not stepping on every crunchy leaf at the onset of autumn as a child.

Finally, things got really bad. I was at least 400 miles away from Bangkok staying in a small village when I finally realized I had to go see a doctor. It had got to a point where I probably hadn’t smiled or laughed in 2 or more days because the rash had taken over such a large area of my cheek, making it extremely difficult and a bit painful to show any facial expression. For the first time, I admitted to myself that I had no idea what was wrong and I was actually scared. I also felt like I was tired every day and I was afraid that this was my lupus affecting me beyond just my skin. I ended up taking a 5 hour trip from the farm to Bumrungrad International Hospital in Bangkok, supposedly a top international hospital in the field of medical tourism.

Hospital Visit #1: Bumrungrad International, Bangkok

Bumrungrad International Hospital in Bangkok is the 5-star hotel equivalent in healthcare. I actually think I saw a bellhop in the lobby. It is well-known as the best, and thus most expensive, private hospital in Thailand.

Upon entering, I was greeted right away by a friendly worker who asked me if I was a new patient. I confirmed, and she asked me what type of doctor I’d like to see, as if these medical specialists who had spent almost a decade to get to where they are, were casually at my disposal. I said dermatologist and she instructed me to go to the next building and take the elevator up to the 14th floor, where the new patient registration was. The facility was spotless and the service was impeccable. On my way over, I noticed many booths each donning a different flag and I realized they were offering an interpretation service for each major nation. Very cool.

After registering, I was lead to the floor above where the skin clinic was located. I checked in and sat down. 10 minutes later, I was called into the office. When I walked in, the doctor was already inside, sitting at her desk. Between walking into the hospital unannounced and seeing the doctor, the time elapsed was less than 30 minutes. Incredible.

The dermatologist was a young and professional lady who was very empathetic and spoke very good English. I told her my medical history and she gave me her insight, assuring me that it was not in fact a lupus-related flare, but a superficial skin infection which was definitely treatable.

She wrote my prescription, pressed a big red button next to her desk and the same nurse that escorted me in quickly came back to escort me out. She brought me down the hall to the cashier, which was conveniently located next to the pharmacy. 1800 baht was my damage– equivalent to about 57 USD. The itemized receipt listed: getting my vitals checked (10USD) seeing the doctor (30USD), 1 prescription cream (10USD), and 1 prescription face wash (7USD).

Back to normal… not

I left the hospital with a renewed sense of life and purpose. I would heal this damn thing off my face and continue to have an amazing time in Thailand. I returned to the farm in the small village and diligently followed the daily ritual prescribed by my doctor. I stayed there for a bit longer, having felt like it was the best place for me to rest and heal. After about a week, I left the farm for the second and last time.

Still smiling and having a good time on one of the better days of my skin rash

I traveled east (Bangkok is west of where I was) and spent time in a city called Ubon Ratchathani, and then a small village of 2000 called Phana. The total span of this part of my trip lasted about 10 days. Afterwards, I flew to Phitsanulok, a city between Bangkok and Chiang Mai.

But something felt really off. It was extremely hot in Phitsanulok. I was feeling miserable and sluggish. I felt like anything I did, I would sweat. My face was constantly throbbing from the heat and I felt like my rash was getting worse. I also ran out of the original prescription cream I received and I was not yet healed.

On top of that, I started developing new symptoms. The worrying returned. I left my hostel as I was not feeling very social and opted for a private hotel room instead.

I decided to pay a visit to the closest private hospital– Bangkok Hospital which is a chain hospital. Its location was not far from my hotel, although a 15 minute walk there in the blazing sun felt like I was walking through an urban desert of fumes and exhaust.

Hospital Visit #2-4: Bangkok Hospital, Phitsanulok

Bangkok Hospital is a well-known chain of private hospitals in Thailand, though not as well-revered as Bumrungrad. When I was asking my hosts or hostel for their recommendation, Bangkok Hospital was brought up with slight caution that I may encounter some difficulties communicating in English.

Bangkok Hospital in Phitsanulok was much smaller than Bumrungrad– it is only one building and it seemed as though they have a limited number of doctors on duty with specialists being available on an irregular schedule. They also had what seemed like at least 2 dozen nurses on duty. Thankfully, I had an English interpreter with me for what would be the first of three visits.

I had to wait nearly an hour and a half to see a general practitioner. But really, I didn’t mind at all. I didn’t have much interest in exploring Phitsanulok and as it was the middle of the afternoon, I was very much enjoying being in an air-conditioned space with my Kindle. I could have waited there all day, which is what I kept trying to tell the apologetic nurses who often looked at me with sympathetic eyes.

The interpreter followed me into the doctor’s office and it became apparent that the doctor, who had no specialty in dermatology, wasn’t sure what was going on with me. His best guess was that I was allergic to something. He gave me a recommendation to see the dermatologist and I had an appointment for the next day. Time in the hospital: 3 hours. Cost for the day: $0.

The next day, I returned to see the dermatologist. She spoke very good English and had the same level of expertise and empathy as the one I saw at Bumrungrad. She diagnosed me quite quickly and gave me a very concerning look when I told her I was going to be in Thailand for another month. I asked her point blank if she thought that was a good idea, and similar to the other doctors I asked, she gave me a very indirect answer. It was as if they were not comfortable making recommendations like this. It is either an attribute of Thai culture (which is known for being overly polite, afraid to be overstepping boundaries, etc), or maybe a fear of being held accountable of a tourist’s bad time in Thailand. She prescribed me some new cream and I was on my way. Total cost for the visit and prescription: 22.40USD.

Creams, creams, and more creams.

Later, I decided I wanted to do a full blood panel and urine test. I’m supposed to get one done annually for having lupus, but stopped about 2 years ago after a number of consecutive panels came back with no issues and my rheumatologist back in California told me it was not necessary to keep doing these. I figured it would be cheaper to do it in Thailand. Also, it would put my mind at ease, which had at this point been running laps non-stop for the past few days.

I returned the third day and saw a doctor who agreed to send me off to do the blood and urine tests associated with my condition. He warned me that the results for this particular blood panel would take longer than usual to come back. I had no rush to head off to my next destination and was planning to stay in Phitsanulok for about 5 days anyways, so I wasn’t too worried. I asked him how long it would take. He said one hour.

So, I had my blood drawn and I peed in a cup. I went across the street to have some delicious Khao Soi, and returned to the hospital shortly after. I got my results back in an hour as promised, and everything looked healthy. What a relief. Total cost for blood test, urine test, and doctor’s interpretation: 25USD.

Silver lining: ate the best khao soi of my life across the street from the hospital!

Leaving Thailand

Although my results came back healthy, I realized that being in Thailand was not conducive to a healing environment. From my second hospital visit, I found out that the original skin infection had indeed cleared up, only to reveal the lupus flare that was present the whole time. This was the first time in over 5 years that I have experienced a lupus flare, so it was quite concerning to me (the last one I had was traumatizing). In the end, it was obvious my condition and allergy to the sun would be preventing me from fully enjoying being in Thailand and it was in my best interest to cut the trip short in order to heal fully in a more promotive environment.

Reflections and learnings

I think I’ve put off writing this post, rather, I didn’t want to write this post because I didn’t want to face how my travels ended so abruptly. At first, I felt a complicated mixture of failure, disappointment, and an uncertain opinion of my self-reliance. My string of self-diagnosis failed me and I was blinded by my overconfidence. Despite my boyfriend telling me to see a medical professional much sooner than I did, I refused to and, for no good reason, prioritized other more trivial matters over my health.

Dealing with the unexpected is not a new lesson for anyone. It is a simple fact of life, one I admittedly often forget. Further, it is a gentle reminder that no matter how much planning you do or foresight you may have, you cannot be prepared for every possible outcome, and sometimes the luck of the draw will put you in the disadvantaged position. The right way to learn from this is not simply to add a line to your personal “if this then that” guidebook to life (e.g. if I encounter a mystery rash, then I’ll see a doctor sooner rather than later), but also to build resilience, a reliable one-size-fits-most tool for your low days. Resilience is a muscle, and traveling, especially long-term and solo, is the exercise of choice for me right now.

Historically, I’ve always been a planner of the worrying variety. A worrier has a much more difficult time dealing with the unexpected. Their minds become clouded with what-ifs and while they may eventually overcome the situation, a lot of emotional and mental energy is wasted building up irrational monsters in their own heads along the way. At 21, I had a vision for myself at 23, and at 23, a vision for 30. Spoiler alert: none of it came true and presently, at 27 with no fixed address, I am far from where I thought I’d be even just last year. I am learning to be more present and appreciate where I am currently in life even if where I am was not where I planned to be. Worriers are wasting the present, and I do not want to waste my year off.

Current Status

I have been in Taipei with Justin for a little over a month now. I am more-or-less fully healed from my flare. Taipei is hot, but mostly hazy. I am wearing sunscreen (almost) every day and I am making the most of my time here. I spend my days exploring new coffee shops, improving my mandarin, working on some programming projects, meeting up with locals for language exchange, working on my yoga practice, working towards my goal of reading 50 books this year, exploring Taipei and surrounding cities, and spending lots of quality time with Justin. I feel in full control of how my day starts and ends, and everything in between.

The 2 months of downtime between traveling (I am headed off to Europe for 5 months at the beginning of May) also gives me a lot of time to reflect on my year so far as well as what I want out of my trip to Europe. This, I’m realizing more and more everyday, is extremely valuable. Rest assured all this extra time is not going towards a combination of planning and worrying, but rather, building excitement for the unpredictable and gaining confidence in the uncertainty.

Final thoughts

Although I often joke about how I did more medical tourism in Thailand than normal tourism, I had a great time in Thailand. In my one month there, I feel I have explored a lot of small villages and towns. I’ve gotten to know a lot of local people and experience their culture. Though I got a bit more than I bargained for, this is exactly what I wanted out of my trip.

Lastly, I am forever grateful for my host family on the farm and all the international travelers whose stay there overlapped with mine. The farm was truly my sanctuary and the perfect judgment-free place for me to heal. In any other place, I would have felt self-conscious or embarrassed of the giant red blotches on my face and would have wanted to cover up with a face mask. Everybody was understanding without being patronizing and sympathetic sans pity. I was relieved to have been able to continue working and contributing to the farm through indoor work. One of the most touching moments was when my host parents made a curry dish for dinner containing bamboo, seen as an inflammatory food in Chinese culture and thus hindering to my healing. My Thai mom pulled me aside to let me know that there was enough leftovers for me because she had remembered I mentioned once that my mom cautioned me against bamboo. They were truly my family away from home.