Friday, February 16, 2018

Too posh to push? Hospital shopping in Thailand...

We started looking at hospital options many months ago, back when it started to become clear that we were not going to have as much time to do research on location as we'd planned. We don't have health insurance, so though cost is not the main issue, we have a keen interest in getting value for money. After Ravi's birth being difficult resulting in an emergency cesarian section we knew we wanted a hospital with good facilities on standby in case something might go wrong again.

We started by looking up a few birth stories on expat websites. These were mainly centered in capital cities; Kuala Lumpur, Bangkok and Singapore, none of which we wanted to anchor at. We then looked at the maps and charts to find possible hospitals with sensible anchorages nearby. Then with a long list of hospitals we sent emails to them all giving a little information about ourselves and asking about the services they offer and possible prices.

The response was disappointing, we only got about four replies from around fifteen requests, one saying they do not have facilities to treat foreigners at present. We tried a bit harder calling and emailing a selection of preferred choices and in the end had a list of options as we sailed up the coast having left it all very late.

As it happened we had excellent conditions sailing north from Indonesia. For the first time in ages we had a lovely time sailing day and night. The current seemed to be with us much of the time, making sailing into the light to moderate north easterlies close hauled fast and pleasant. With the breeze being offshore the water was mostly pretty flat allowing us to make 7 to 10 knots much of the time. In the few patches of windless hours we motored happily on in calm water.

Our most favoured destinations had become Penang in Malaysia or Phuket in Thailand. Both heavily touristy busy islands; well populated with both private and government hospitals. The anchorages in Penang are not ideal and prices for cesarians were more so we decided to press on for Thailand where we dreamed of beautiful beaches and clear water in which to wait for the new babies passport.

Malaysia is very welcoming to yachts, clearance being totally free, the boat can stay indefinitely and we were given a 90 day visa as a matter of course. Thailand is a little trickier so we applied for our 60 day visa in Penang which can be extended once by a further 30 days which took two visits to the embassy and a small chunk of money.

So here we arrived in Phuket on Saturday and unwound our tightly coiled springs over the weekend at a nice Beach before clearing in and looking at hospitals on Monday. The first we stopped at could not help us; they either did not have a childbirth unit or possibly could not offer childbirth for foreigners. Our Thai is non existent so communication was tricky but they advertised obs and gynae services on the bill board outside so we're not sure.

The next was our first and most promising reply from back when we first started researching; the Siriroj international (private) hospital. We knew all the prices and details of their facilities and so were happy to have a check up and talk with the obstetrician. We didn't tell them that we were merely researching at that time; our due date being only 9 days hence at this point.

After a quick once over the upshot was that he would strongly recommend a c section. Not only because we'd had one last time only 16 months ago, but also because his ultrasound showed the baby to be on the big side and with its back to my back (as Ravi had been, though his main problem was a twisted head). We had expected this. Thailand in general and private hospitals in particular prefer cesarian births.

We had already decided that if it was recommended we'd go with that. When researching we found out that if we'd been at home in Bath (UK) they would have supported a trial of labour with close supervision but that if we'd given birth in Australia they would have strongly encouraged a cesarian due to the risk of rupture. So we left having paid for the consultation and with a date booked. (We were offered the next day but chose a little more time, it's wierd picking your kids birthday).

We knew we were happy with the place and thought the set price package to be reasonable. However thrifty to the end, I felt uncomfortable having not researched thoroughly every option. We looked down our list. The other private hospital was significantly dearer and since we were happy with this one we saw no point in visiting that. But there were two more government options. We'd already spent twenty five pounds on taxis, it was getting late and we were tired so we went home.

Duncan was very happy with our choice but I couldn't let it rest in my mind, so after we'd taken the boat back to a quieter much more protected anchorage I took myself off with Ravi into town on the bus. My reasoning was two fold. I wanted to find out the bus route and timings (there are no bus timetables in Phuket, supposedly to keep the tourists in the taxis) and I thought I'd take a look at the last hospital. By then I'd found out that one of the government hospitals would be a similar price to the Siriroj if we needed a cesarian due to rules about making foreigners pay so ruled that out.

The bus took hours! I went for it before 10am but didn't get to town until well after midday. The driver drove in first or second gear for the first half of the way, he only sped up once he'd picked up a few more passengers. It was a mile from the bus route end to the Vachira hospital so by the time we got there Ravi and I were hot and hungry. I bought him some rambutans of which he promptly scoffed the whole kilo. Again communication was a problem but I was able to speak to someone on the phone in English who gave me some estimated costs and said I would need to see the doctor in the private clinic at 5pm to see if they felt I needed a cesarian or I could just turn up when I'm in labour and take my chances.

The place appeared clean and well looked after. But it was also very busy and quite noisy with lots of old people being wheeled around in rusty wheelchairs and children getting underfoot. It's funny that in Fiji we'd liked that frenetic feeling in the hospital but there, they spoke English. Here it seemed a little intimidating and weighing it up I didn't feel the price difference to be worth it.

So what does it cost?

Siriroj hospital offers all inclusive packages which we are assured are much cheaper than if you were to pay an itemised bill (even if you get a cheaper room and stay less long, allegedly)

Natural childbirth package 46,900 baht about 1,060 gbp
Cesarian package 59,900 baht about 1,360 gbp

But if you were to arrange a natural birth and then have to convert to c section like we did with Ravi they would whack on an extra 10,000 baht. Always read the small print!

Government hospitals quoted around 20,000 baht for natural and 40,000 to 50,000 baht for cesarian. These were just estimates rather than packages so we don't know if these are worst case or best case figures. The price for Thai nationals here would be much cheaper, we spoke to one lady who's sister paid 13,000 baht for her c section, I don't remember which hospital that was.

We weighed up the costs and the risks and plumped for a known cost in a nice place with much less chance of anything going wrong. If we'd have been able to have a natural birth last time we would have made a different decision, but in the end and after the last few months'trials and tribulations we decided it's time we gave ourselves a break!









Thursday, January 18, 2018

Things are getting worse... Please send chocolate...

I'm sure everyone experiences big highs and lows in their lives. Sailing is definitely always like that. For every perfect beach there is an imperfect one. For every easy check in there's a nightmare one. For every graceful easy passage there's a vomit fueled rocket ride or a slow hot humid slap about. Some days we're proud as punch of our beautiful boat but others the jobs to do are overwhelming and everywhere we look we see flaws and things that are in urgent need of attention.

At the moment we feel like our lives are more undulating than we'd like and that the lows are too much of the time. We've not had personality transplants; we still expect things to get better any minute; hopefully as soon as we get where we meant to be. However the problems have been compounding each other and it's hard to not let it get to you.

Engine troubles have always plagued us with a regular monotony. Pip was installed by us in a newly reconditioned state, but that didn't stop various peripheral parts failing or causing us trouble. Interspersed by dirty fuel and fuel bug frustrations. It's crazy to think how much trouble the engine causes when we use it relatively little.

Our sails, Aeries wind steering, rigging and hull cause us almost no trouble at all in comparison. However we're not sailing purists. We go everywhere we can whilst never turning to the noisy beast; sailing into and out of anchorages happily when we can; but we don't want to be without it. Many places we have been would have been untenable without it and we consider it a safety and comfort necessity.  Though necessity is not the correct word since each time it's failed we've had to manage without.

There were odd minor engine hiccups as we crossed the Pacific; fuel bug problems, anodes going quicker than we thought, alternator belts not cutting the muster, the prop break being temperamental etc. More recently we've had to use it more and so the problems have followed on. The temperate clime's mean less reliable winds and more danger from just drifting about waiting for wind to return.

In New Zealand it was the starter motor which had us towing the boat by rowed Avon dinghy into at least one Anchorage and having a rather nervous time around Fiordland where there were strong tides, blasts of breeze and gales and calms in equal measure. In Fiji it was the injectors. Sydney to Hobart the raw water pump. Back in Sidney the injector pump needed a total and extremely costly rebuild. At the Whitsundays the prop shaft coupling sheared requiring new coupling, adding a flex and remachining the shaft all whilst in the water.

But now takes the biscuit.


We've noticed a few grumbling concerns whilst pip has been working stoically through these islands. We were smoking a lot at idle and using a little oil. We put it down to injectors again and resolved to have them serviced once in Malaysia.

Day after day she's been rumbling on trying to help us get up wind against the strengthening contrary winds and currents. We've had some really horrible passages and even had to give up a few times and go back. Then it all got worse off the south coast of Belitung. We still thought it was the injectors but the noise and the smoke had us unable to use the engine again. Our friends on Rehua were nearby so we knew we'd be ok and managed to tack into a reasonable Anchorage by nightfall on Christmas day. Merry Christmas!


On Boxing day Rehua came to find us and offer condolences and help. The boys found very dirty fuel again and got everything they could cleaned up and filtered, the oil changed and everything that could be looked at easily checked. She seemed OK though intermittently noisy so the next day we poked our noses out again.

It was no good, the noise and smoke got worse so off the engine went but there was not enough wind to sail. The current was pushing us back so really we were just treading water with lots of rocks nearby. We gratefully accepted a tow. Had our friends not have been nearby we'd have had to sail a different way. Over the next two days Rehua got us to the fishing town of Tanjung Pandan on the island of Belitung where we've now been for over three weeks.


Tyrii, their twelve year old helping us into a safe spot in the really well protected fishing harbour of Tanjung Pandan.

The first day seemed positive; we found ourselves a brilliantly protected position tied back into the mangroves and found the town to be more developed and more friendly than many we've visited in Indonesia. Duncan got straight to it and cycled off with the injectors to be serviced. They cleaned them through and pronounced that only one was a bit sticky. Back in the boat the same afternoon the news was not good.

'Noise as bad as ever. Major problem. We'll have to rebuild it; it must be the big end bearings'.

We looked into parts but noone was open until the 2nd of January. So off we went to immigration to explain our predicament. For many hours it seemed they were insisting we must fly out of the country to reset our visas (Singapore being nearest) but we were not at all keen to loose the three days or the extra cost of staying somewhere with the boat abandoned. In the end I said we'd just have to sail on which provoked a response. An emergency Visa option was hastily rustled up. It took two more days to organise the proof and paperwork for this but at least now we're legal.

It took more time than we'd thought to get to the nub of the problem but we wanted to be sure before the parts were ordered. We're lucky our engine is a Perkins 4.108 as the parts for these are cheap and available all over the place. We had trouble communicating with the parts dealers in Jakarta who thought our engine serial number was wrong and Singapore never returned any of our calls so in the end with time ticking we made our order from the uk.




'Watson, we have found our culprit'

It's a good thing we waited until we'd checked out it all as it wasn't 'just' the bearings. The crank shaft is snapped in two places.

It is 43 years old, but the very likely cause is overtightening the alternator belt over the years to get the most out of our oversize alternator. We shall be upgrading the pulley system for this once safely in Malaysia.

It took only three days to get both parcels (new crank shaft, full engine rebuild kit and some more spare mounts) totaling around 35kg to Jakarta. During those three days we spent most of our time in the customs office trying to arrange permission for the parts to be duty free (as they should be here as a yacht in transit). However since then the only movement has been to another island (admittedly near here but there are 5 direct flights a day from Jakarta to here so who knows why they went there) and dhl say they are awaiting us to pay tax and fees. A flurry of emails and phone calls and then it was the weekend...

So this week it appears we have to pay the tax even though it shouldn't be due. We knew the rules say you must ask permission before the parts are in the country to get it tax free which is why we went to customs before the parts were ordered. However they wasted two days giving us the impression they would give permission if only we had one more document... then one more photo... then one more letter... Then no sorry, we do not have authorisation for this. Arghhh so after a bit of a cry in the customs office we forward everything we've done with them to Jakarta. They receive them the next morning just as the parts arrive too.

This all means a whopping bill of 7.7 million rupiah! The tax due is 30% on top of the price of the parts plus the shipping costs. That's shipping for 35kg! We don't mind paying tax that is due but this massive expense should not be due and it's the customs fault. They even gave us the wrong email address for Jakarta wasting us another vital few hours... So frustrating!

Yesterday I was promised if we agreed to pay cash on delivery they would deliver this morning. Today there's no movement, the parts are still on the wrong island.

Always trying to look on the bright side at least we can do the work here. We are in an extremely well protected and safe position. Our neighbours are friendly, the island is positive and safe and we've made some nice new friends.


The machinists are very competent and very cheap. Having a puller made up to remove the crank shaft pulley.


And of course we're together and all healthy.

However the big down side to being in a very protected spot is that it's really hot and humid with no wind and the mosquitoes and sandflies particularly at dusk are unbearable. Poor Ravi has terrible heat rash that flares up during the day and goes down whilst he sleeps under a fan. I'm taking him out as much as possible, whilst poor Duncan slaves away sweating and filthy in the engine room, but it never completely goes.



The tidal water we're in is plastic and sewage rich, so swimming is out of the question. At low tide we sometimes have to wade the dinghy out through the thick mud amongst the mosquitoes and sandflies. Believe me this is not glamorous living.


Not the ideal dinghy dock when you're almost 8 months pregnant!

When we can, Ravi gets a dip in the nearest hotel pool. He has developed a voracious love of rambutan and mangosteans which are available from the market and he's devouring with relish the mainly chicken, fish and rice or noodles meals that are cheap around town. But doing these things cost money and take time away from working on our poor disheveled looking boat. It's a balancing act that Duncan is not getting an even deal at.




This is just some of the plastic that washes up every day on the windy side of the peninsular, where Ravi and I go to play to get away from the heat and the biting things.

Oh and there's a rat on the boat...

Monday, January 1, 2018

Impetuous four....

Here’s an interesting and novel tale,
About a couple who loved to sail.
They bought a boat made strong and stout,
And proceeded to sail her West about.

Of course there was difficult work to do,
But that didn't phase our Impetuous two.
Sanding and filling were most of the task,
But in woodwork they found joy, even built their own mast!

Having a boat they'd rebuilt gave them confidence and style,
They had pride in her lines and basked for a while...
In frequent admiration over what they had done,
Though lining up to do all that work there'd been none.

From there to here, from here to there;
Wonderful things could be found everywhere.
Texas to Mexico, Belize, Guatemala;
Always in time, they found a safe harbour.

Working betwixt their adventures was sure…
To make them appreciate their life all the more.
They found that hard work was what could be said,
To bring about the ‘luck’ in the life that they led.

Cuba was a joy that could not be overstated,
Though seasickness all the way there; Ruth hated.
Panama beckoned; perfect islands, wondrous art.
Through the canal they traversed; frugally every part.

Late in the season, the cruisers' boat party was downhearted,
Stocked to the gunwales a few days later they departed.
The Galapagos, of course, to visit would have been nice,
‘Expensive', ‘uncomfortable', ‘over regulated’ came the advice.

So five long weeks at sea they toiled,
Two slow, three fast, faster still the seas boiled.
There many young sailors, some with startling boat failures;
Adventurous new friends, they found in the Marquesas.

Jacques Brel; Gauguin; Herman Melville found a home,
On these glorious rich islands, which truly stand alone.
Among waterfalls and mountains where dreams are fulfilled,
Pamplemousse; mangoes; breadfruit; chillies all found in the wild.

The Tuamotus and Societies could never disappoint;
Iconic and exotic, their excitement was joint.
Through the Cooks on to Tonga where whales could be seen,
They made many firm friends at that party for Halloween.

The land of the long white cloud rose out of the grey,
After a terrific New Year's party they decided to go play….
Down the bottom where only the most Impetuous go,
they found out just why when it started to snow.

Into Milford they bouldered the wind on their tail,
All computers were damaged, but they'd weathered the gale.
All around them the mountains rose out of the gloom;
They thanked their lucky stars they were graced by the moon.

The Fiords are all beautiful and thrilling in their way,
Ample fish when they ran low on food saved the day.
The weather was wild with no folks to be found,
But the scenery; untamed nature, could not fail to astound.

Foveaux straits dolphins were worried and so were they all,
When the wind was so strong, Impetuous started to stall.
In the lee of Stewart island she could heave-to in peace,
How they wished they'd found time to sew in that fourth reef.

Over the years they had sailed many atolls and isles,
And always were met with genuine smiles.
They learned much about both the lands and the sea,
And started to think that they'd like to be three.

Money had to be found to fund all of their plans,
So Impetuous; left again lonely, in far away lands.
Ruth nursed; Duncan taught, so back they could go...
With a bump in the tum; so happy they did know...

Lovely Ravi arrived in beautiful Fiji,
As mangoes dripped from the trees bright and leafy.
They were sad to move on from all the friends they had found,
But truly they loved to sail all around.

His first Christmas was spent at sea bold and breezy,
Ravi never seemed fazed as he chewed his first lychee.
The timing was perfect as round other boats they did weave.
Arriving in Sydney amongst the rockets; New Year's Eve.

They sailed on around Tasmania, to again feel the cold;
People were friendly, and there were great mountains to behold.
Then they sailed again north up the land of down under,
When the seas rose up, poor Ravi would chunder.

On and on they traversed along the Barrier Reef Great;
The Louisiades had to be postponed; they were late.
Across the Arafura sea, and into Indonesia...
With still many miles to go before the delights of Malaysia.

But now our family are having a difficult time;
The sun in Indonesia refuses to shine.
The winds are against us and the currents inclement.
Pip the engine is protesting with new problems fervent.

Delay after delay has put them at odds with the weather,
To be this far into the North West monsoon is not clever.
But sailing is what these sailors do,
Otherwise they wouldn't be Impetuous Too.

Whilst sailing onwards, we've kept a secret,
With New Year's day, we thought we might leak it...
Before too long there's going to be more;
Before too long they will be the Impetuous four.