Health for Wealth Day 2 - BCNB & Bumrungrad

Boromarajonani College of Nursing, Bangkok

Victory Monument

Following a quick walk down to Victory Monument (we arrived at the college very early) we were greeted by Chanpen Ninwatcharamanee (DNS, RN), the Deputy Director for Academic Affairs at 9am. The presentation conveyed information about the college and its nursing education and accreditation.

2/1 Phayathai Road, Rajthevee, Bangkok 10400

In 1946, the BCNB was first established to help solve the problem of a nursing shortage following World War II. BCNB was originally named the School of Nursing, Midwifery and Public Health, and was later named "Boromarajonani" in honour of Her Royal Highness, the King's Mother. As well as being nationally recognised for its high standards of education, it was the first nursing college under the jurisdiction of the Ministry of Public Health.

Programs provided by the college are:

• Bachelor of Nursing Science, 4 years
• Teaching and learning in Nursing, 4 months
• Primary Care Nursing Practitioner, 4 months
• Emergency Nursing, 4 months

International Short Course Programs offered, also 4 months in duration:

• Critical Care Nursing: Adult, Paediatric and Neonatal
• Clinical teaching in nursing
• Midwifery
• Orthopaedic nursing

The curriculum of the Bachelor of Nursing Science encompasses holistic care to both the health and sick and establishing comprehensive health care service models. The degree is bound by a conceptual framework based on caring, teaching and learning, and environmental factors, with the aim of producing nurses that respect the rights and dignity of their patients, and nurses who commit to lifelong learning. For course completion, students must complete 144 subject credits over at least 8 semesters, and hold a GPA of at least 2.00.

Yearly competencies

1st year:

• Understand individual differences and adapt to various situations
• Admire and respect all
• Demonstrate self-care ability
• Face problems and deal with conflicts appropriately
• Demonstrate responsibility, virtue and ethics
• Demonstrate communicating in English in daily life
• Seek knowledge using technology
• Demonstrate and develop an understanding of human nature

2nd year:

• As above, plus
• Promote health and prevent illness
• Demonstrate continuing self-development to accomplish goals
• Provide holistic nursing care through practice experience

3rd year:

• As above, plus
• Introduction to Midwifery
• Develop a nursing report and nursing articles using the English language

4th year:

• As above, plus
• Demonstrate clinical judgement and creative thinking
• Demonstrate emotional maturity
• Work as a team leader and in-charge nursing
• Demonstrate leadership skills

Once students have graduate from the college, they are required to work within the government sector for a minimum of 4 years, before having the freedom to move around within the nursing profession and work for the private sector.

Kainapa Kaewjuntra (RN), Deputy Director for Student Affairs, then gave a brief presentation that provided insight about how the students of the college are supported during their studies. The college appears to take every measure to ensure a comfortable, safe and healthy lifestyle for their students.

Accommodation

• Accommodation is provided for the duration of their studies, and students are required to stay in dormitories on site
• A curfew of 7pm is enforced for the students' safety, which is enhanced with 24/7 security
• 6 buildings in total - one housing 150 female students, with another housing only 50 male students
• Housekeepers attend to the dormitory sites and clean bathrooms and common areas
• Each dormitory room houses 3 or 4 students, and shared bathrooms are located at one each of each level

Service and Facilities

• 3 meals are provided per day at the cafeteria for a small fee
• Meals are served within certain times, during which students may come as it suits their schedule
• Counselling and student advisory services
• Library and campus-wide computer facilites
• Laundry
• Student clubs, societies and activities
• Gymnasium and swimming pool

Dormitory living

Awarding academic performance

• Scholarships are provided for outstanding academic performance
• Exchange programs are also offered for a very small number of students with the aim of broadening world views, experiencing new cultures, and developing leadership and communication skills
• The STIKES Bali Exchange Program has been their most recent project

What I loved about the college is that its students appear to be really taken care of through a structured and nuturing environment. Efforts are made to ensure that students have time for visitors, as well as being able to provide care to other students and participate in extracurricular activities. The students are also very happy and warm, and quickly greet you once in their presence, making us feel part of the family.

Fourth-year students showing us around the campus

I found that the course structure really focuses on a few key points: holistic care, learning about the whole person, and understanding how different factors affect health and health promotion. In contrast to the Bachelor of Nursing in Australia, the Bachelor of Nursing Science offers Midwifery (so jealous of this - midwifery is offered as a post-graduate degree following one year of clinical work as an RN), a more in-depth theoretical and practical experience, and has a huge focus on leadership and communication (particularly in the fourth year of study), thus producing well-equipped and more confident nurses. There is also the mandatory summer semester when studying nursing in Thailand, whereas the summer semester is voluntary in Australia. Also noteworthy is the fact that UTS Nursing students are currently unable to attend exchange programs as part of their degree - the only way this is possible is by undertaking the double degree, Bachelor of Nursing and International Studies. I hope that one day Australia can adopt programs similar to those offered in Thailand to offer their students such an amazing and educational experience that I believe will contribute greatly to their personal and career development.

It was definitely eye-opening experiencing a glimpse of dormitory life and seeing how four students squeeze into a tiny room. I cannot imagine living like that during the course of my studies! I also wish we had uniforms half as many as theirs look, with the first year uniform differing slightly from the second, third and fourth year students.

Nursing uniforms - college, community, hospital, and graduation

Such beautiful, hospitable, and empowering women

On the road to our next visit...

The Poor while the Rich looms in the background: on the way to Bumrungrad Hospital

Bumrungrad International Hospital

33 Sukhumvit Soi 3, Wattana, Bangkok 10110

So being my first introduction to the private sector, I was completely overwhelmed by what I experienced at Bumrungrad Hospital (pronounced bahm-roong-raht, meaning 'care for the people'). The vibe of the hospital was something different in itself; the foyer and lobby feeling more like an airport or five-star hotel, filled with foreigners that I had not passed in my travels through Bangkok so far. While waiting for the lift, it was impossible to miss the immaculately presented and cheerful staff.

On the 21st floor, we stepped into a large meeting room and took our position around the table. Big leather chairs, coffee and pastries; I was content. Mack Banner, the CEO, greeted us and begun his presentation about the hospital and its financial successes as a result of the influx of the "international market". This was not the presentation we were expecting. I was hoping to learn about how the rise of medical tourism has impacted Thailand… however, I pressed on.

The care provided by the hospital is considered first-class, with adequate staffing, boutique stores, and luxurious hotel style rooms to boot. To further influence the upper-class international market, the hospital provides Visa extension services and is in partnership with Thai Airways, accepting frequent flyer mileage as payment for checkups.

Hospital history

• A 200-bed facility was opened in September 1980
• In 1989 the hospital was listed on the Stock Exchange of Thailand
• The main hospital building was opened in January 1997, costing 110 million USD, with a 500 bed capacity
• 2001 saw an influx of 12,000 Middle Eastern patients as a result of tighter Visa restrictions in the US
• The US TV program, 60 Minutes, featured the hospital in April 2005, and compared medical expenses between the US and Thailand
• Focused on a cardiac patient whose bypass surgery would have cost $100,000 (USD) in the US, vs only $12,000 in Thailand
• The newest outpatient clinic building was opened in May 2008
• Not long after, the hospital experienced financial uncertainties for 3-4 years during the global financial crisis
• Achieved voluntary US accreditation

Finance

• Bumrungrad Hospital is a public company traded on the Stock Exchange of Thailand
• The majority of shareholders are Bangkok Insurance Public Company Limited and the Sophonpanich family (one of Thailand's most respected business families)
• 70% of patients are self-paying
• Net profit = 15.1% in 2012
• Margin (EBITDA) = 25.3% in 2012
• Most business from Australia comes from plastic surgeries

Hospital information

Capacity:

• Over 1.1 million in- and out- patients treated per year
• 538 inpatient beds
• 473 Medical/Surgical/OB/Paediatrics
• 37 Adult Intensive Care
• 14 Cardiac Care
• 9 Paediatric Intensive Care
• 6,000 outpatient capacity per day
• 1st July, 2013 saw 3,700 outpatients treated
• 270 examination suites
• 24-hour emergency care, and ambulance and mobile critical care fleet
• 21 floors
• 10 floors for clinic rooms
• 2 floors for imaging equipment
• Technology
• 64-slice CT scanner
• Automated lab onsite
• Nuclear medicine

Services:

• Communication
• International referral offices in major cities (Australia, Bahrain, Bangladesh, Cambodia, Ethiopia, Hong Kong, Indonesia, Mongolia, Myanmar, Nepal, Oman, Russia and Vietnam). These offices promote the hospital and its health personnel, organise travel arrangements for patients, and also obtain a 10% commission from the initial patient fee
• Contact centre that handles 300-500 emails per day
• Over 150 interpreters
• User-friendly website that allows potential patients to research doctors, procedures, costs, and book appointments
• Comfort
• International patient lounges and segregation. There are separate check-in desks for Thai locals and foreigners
• Cultural amenities and prayer rooms
• Restaurants and shops
• Hospital wide wifi and bed-side laptop rental

Ironic: McDonalds

Staffing:

• Over 4,700 employees
• Doctors - over 1,300; 300 full-time (working in over 50 specialties and sub-specialties)
• Nurses - 1,000; with 60% of staff under the age of 30
• 5,000 THB per month in public sector, vs 16,000 THB for a new graduate
• Pharmacy on every outpatient department floor
• Swisslog pharmacy robot - enabling electronic medication ordering and dispensing

Basically, I feel very uncomfortable about a lot of the information I learnt at this presentation. Don't get me wrong, I can see where such a hospital fits in and caters for elective surgeries and provides care for those who cannot afford healthcare in their own country (or afford health insurance). Something that wasn't mentioned in the presentation was The Bumrungrad Hospital Foundation that was established in 1990, and is dedicated to providing healthcare to underprivileged Thais. The Foundation has provided over 100,000 Thais with free services ranging from check-up programs to life-saving surgery for children with defective hearts. But is this enough for the disadvantaged populations? And who decides who gets what treatment? 

No doubt, the hospital is an attractive workplace; providing higher pay rates for nurses and roster flexibility. The fact that private hospitals are selective about the patients admitted and treated means there is less stress (I have never seen such warm and happy nurses), minimal waiting times, greater infection control (well, there really is NO infection) and no acute mental illness. It hardly felt like a hospital, especially when standing in a huge hotel-style room that is the size of my apartment, overlooking run-down tin-roofed shacks below.

At the end of the day I guess it all comes down to money making. The hospital has not only created a greater number of jobs, but also helps stimulate the Thai economy through increased tourism. BUT, why is there no focus on health promotion and illness prevention? And what else is being done to help the local Thai population that cannot afford care?

The view from the 16th floor

To top of a busy day, a few of us checked out Jim Thompson's House - Thanon Rama I, Wang Mai, Pathum Wan, Bangkok 10400 (in short, very close to Ibis Siam and down a small alley way). Entry was only 50 THB for people under 25 years of age, and there are guided tours provided during the day. Unfortunately photography is not permitted inside the house. The restaurant there is also very reasonably priced, and the food was amazing! Not every day you can say you ate dinner out of a pineapple ;)

A boat charging through the canal at the back of Jim Thompson's House

Spirit House - to protect the property from evil spirits

Precious artifacts collected by Jim

Jim Thompson's House

For more information and the story of Jim Thompson, check out http://www.jimthompsonhouse.com