She thought she could manage it. A retired American nurse with few savings but a small US government pension. Her pension barely kept her above the poverty line in America and she was estranged from her one remaining son, and so she made the choice to move to Thailand alone, where retirement was easy, cheap and the weather was much better. For a while, it was a great move.
As so often happens in "expat" locations, friends moved on, died, moved to Costa Rica and Ecuador. Her world grew smaller.
Slowly the cheap, cheap lifestyle of 15 years ago evaporated as Chiang Mai is rapidly becoming the "Go To" new Asian city. Prices relatively have doubled in the last 10 years while her already small pension has stayed the same. And meanwhile the requirements to remain here have become considerably more restrictive and expensive, forcing her to purchase a "grey" visa where a bit of "tea money" under the table enables a visa to be issued by a mildly corrupt but pragmatic immigration official without the requisite funds being held on deposit in the bank.
She managed to balance it for the 15 years I have known her....
Image by Arek Socha from Pixabay
and then this week it all fell apart.
It started for my now 76 year old friend with what she thought was indigestion; after 3 days the pain became so unbearable she ended up at the emergency room of the cheapest (missionary run) private hospital we have. She had a strangualted bowel and an already very substantial abdominal infection which required major surgery.
She has no health insurance.
The christians put the money issue first, didn't treat her and transferred her to the cheapest Thai government hospital we have: the Nakorn Ping Hospital which has a designated IDP wing for refugee people, displaced people and for people with no money. Here - unlike in the US or the christian missionary hospital - you are still treated first and the bill managed (somehow) later.
It's not a glamourous hospital by any means and she was placed in a large ward of 60 female surgical patients - the beds 1 meter apart, little privacy and a decor reminiscent of 1962. The nursing staff speak little English and my friend had never bothered to learn Thai. But it was clean, her infection was treated immediately with IV drugs and she had major surgery removing 3 feet of damaged bowel.
And then the "fun" started.
- The US Embassy officially doesn't help US citizens staying here, other than arranging repatriation for them to the US with a "low cost" loan which DOES have to be repaid from that still-the-same pension. No where to go back to, and no money to start over with rental deposits etc, not to mention the new repatriation loan repayments? Not their problem - they will asign you a welfare worker. That's it.
- The local US-centric Expat Care Group has a new policy of only assisting those more financally stable people who have a squeaky clean 100% white visa;
- The bill for the surgery and immediate 2 days of post surgical care came to USD $3,200 - a HUGE amount relative to local salaries (equal to 6 months of local median working class wages) and her non-existant ability to repay.
Living only 10 minutes from the hospital which I know well through my refugee work and knowing that this lady doesn't speak Thai, I popped in to see if I could assist. And thus became the official translator, financial negotiator and quasi social worker.
It's been a confronting few days.
I managed to get her discharged from the hospital with only a small percentage of her hospital bill paid (around 30%) with a written contract for monthly repayments;
She (unfortunately and solely for cost containment reasons) chose to be discharged far earlier than I think was wise, and still had seepage from her very large abdominal wound;
Together with a retired lawyer friend of hers who normally also lives here but is currently stranded in the UK, we did an urgent global crowd funding. In 4 days we have raised MORE than the hospital bill - we have enough to cover the daily wound dressing and transport costs to the clinic for that, and a little extra for her follow up xrays and stitch removal.
Tonight, in between blogging and being a solo mom, I'm making barley & vegetable soup for her, and a quiche, since she can barely stand and is needing to eat very bland, not spicy food.
In between it all these last days, I have vascilated between an elated "we got her this time, and she will be OK!!" and a very despondent "oh crap - this is the beginning of a slippery slope towards a less than easy death."
On the way home from the hospital, we spoke frankly about her wishes if she died in the night and how much the cheapest possible funeral here would cost. She knows I can and will arrange it for her. At least I'm clear that she'd be OK to share her cremation with the local deceased dogs and cats if it made the process cheaper. 😆
For now, she has what she needs, mostly. She's in a lot of pain and the take-home pain meds are not as good as the IV morphine, for sure. But she has her cat and her little garden and some sense of a decent, modest life that she has chosen herself.
I can't help but think about SO MANY PEOPLE I know, working "in the system" who think it will all be easy when they stop working becasue they have a pension coming.
I have news for you: it's unlikely to be enough for even a basic life. If you ever get a pension.
We who choose to exit the maze and step of that ratty, wonky treadmill need to be prepared; to have serious contingency plans and also be prepared to go without surgeries and the expected western health treatments. We need to be healthy, strong and working towards alternate social and health care models. We need damn fine friends, and we need to cultivate, treasure and support them. We need community, and care options for people who are frail or sick. Our homes need to be designed with a spare room for an aging auntie or uncle in need. We need to be prepared to give to a seemingly endless stream of incoming crowd funding asks, for people like my friend.
I didn't have cash to support my friend this week, but I translated, cooked, drove, organized and haggled the hospital bill and discharge for her in Thai. I don't count this lady as a particularly close friend - in the last 2 years I have seen her socially only twice. But I am tonight having a renewed sense of what it means to have taken the red pill and what that might mean for so many of us in the years to come.
I can only say this:
- don't rely on the idea of a pension, from anywhere;
- build alternate, autonomous revenue sources that will still deliver when you are much older;
- make your health a serious priority, and not an afterthought;
- build community wherever you can, because you will need it.
Creating space and time to care for someone you're not very close to, and don't even particularly like? It's a commitment to the idea of community, and to the idea of One Love - that we are all fragments of the same whole, and that we are all just walking each other home.
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