Hapatite C, what hospital?

[Captor]

Hello,

My girlfriend has got hepatite C. Probably from making eyebrow tattoo´s. That is not the point here from what.

The point is what hospital to go in Bangkok among the goverements hospitals? We found out this when she gave blood. We then visited Vichaiyut and the doctor there suggested we should go to a governmental hospital. For exampel the one were he are working in workingdays, Rajavithi. Or maybe Siriraj.

So I wonder if someone has any idea of which one to chose? Siriraj is closer for us to drive. But in the other hand the doctor is working at Rajavithi.

So we are confused. We want to have quick treatment so I understand that we have to pay for that even if she is thai. Is it same price or is one more expensive?

Any comment regarding this issue is appretiated. We will go as soon as tomorrow morning. Thanks.

[Captor]

Sorry, I should mention that we are living in Nong Kheam. And we are open for other hospitals as well other then the mentioned before.

[Captor]

I have heard today that the doctors at Siriraj are more worth than other people in their own eyes?

That sounds not so nice. Does someone have experienced something like that?

[Sheryl]

Siriraj is excellent, so is Chulalongkorn but frankly any of the large govt hospitals can handle this. Given that you live in Nong Kheam Siriraj is probably the most convenient.

 

As to doctor attitudes it depends entirely on the individual doctor, not the hospital.

 

Your  big problem will be cost, the drugs are very expensive and local generic not yet available.  You can, however, get lower cost generic in India and may be able to order by mail. See these threads:

 

https://www.thaivisa.com/forum/topic/988817-harvoni/

(last post)

 

https://www.thaivisa.com/forum/topic/1025422-hepatitis-treatment-in-thailand-costs-and-havoni/

 

[Captor]

Dear Sherry,

Sorry for not reply for some days. It has been 3 days of hospital runs..

Now, the situation is that my girlfriends hospital is Param2 (for 30 THB) not during insurance. I was not aware that thai people can use private hospitals and still only pay 30 THB. But that appears so. So we have started in the wrong end. We should not go to Rajawithi at all. But the doctor at Vichaiyut told us there are not many hospitals that have the Plasma thing. The same doctor at Vichaiyut/Rajawithi told us to go to Parom2 and ask them to be sent to Rajawithi because they have the Plasma thing and more resources than Param2. In order to get the medicine cheap for 30 THB. He said that they for sure want to do that. So we tried that today. But they told us at Param2 that they not can do that and they said they have the resources needed and want to send my gf to a Hiso hospital that we never heard about name "Mali" or something like that. They have this Plasma scanner. And they also have a excellent doctor specialised in Hepatite C. So that is where we are standing now. We have an appointment for plasma scanning on 25 at Rajawithi and then a new appointment to the doctor at Rajawithi on 26. And gf have already given blood samples and also genotype check from a private company via Rajawithi that not have that themselves. That we have payed for and is outside the 30 THB sceme because we wanted that quick. But the medicine we want to try to get within the 30 THB scheme. And the doctor at Rajawithi said us how to do in order to arrange that. We will get all answers on the Hepatite C status on the 26:th when we will meet the doctor there again. 

But now came this new issue up about Param2 and the Hiso hospital they want to send us to. And they not want to send us to Rajawithi.

Probably the doctor at Rajawithi will give us all the results to bring to another hospital so no money is wasted. But it feels like to many cooks now.. Feels like we would like to have the doctor at Rajawithi (which we like and seems to have a very good reputation!) and having him doing it all. But now we are not able to do that because of the Param2 hospital where she is written as "her" hospital.

Is there a hospital named Mali in Bangkok and is it OK? When I google I find a hospital which are working mostll about beauty!

And the Param2 recenlty got very bad reputation about the woman that died on the way to another hospital.

[Sheryl]

Yes, Praram2 has had bad press and there is talk of shutting it down.

 

I have never heard of a private hospital being under the "30 baht scheme" much less this one.  Are you sure it is the "30 baht" scheme and not Social Security? (it would be SS if she had a job in the formal sector). If it is SS  then she can change her hospital registration to another hospital in the area and she should contact the SS office to do so. It will take some time as the change can only be made at certain times of the year but is well worth doing.

 

When you say it is "written" that Praram2 is her hospital that sounds like the SS scheme, where the hospital is indicated on the SS benefit card. The hospital one is covered at under the "30 baht" scheme is not usually "written" anywhere. It is just based on your tabian ban listing.

 

I had never heard of Mali  hospital before and I am not sure it is licensed by the Ministry of Public health as a general hospital; does nto appear on any list I have seen. From its website it indeed seems to be a beauty/"anti aging" clinic which is not where one would optimally go for treatment of Hep C. Further, on the list of doctors I do not see a single GI or infectious disease specialist which is what she needs.

 

This business of the "plasma scanner" as reason to go to one hospital over another is nonsense.  (and that is not the correct terminology - there is no "scanner" machin involved, it is just a lab test but a complex one involving many steps and needing highly trained staff and secial reagencts)).  It is true that only a few laboratories places - mostly located in large government teaching hospitals - have the capacity to measure Hep C viral load and do virus genotyping, which is probably what is under discussion, but other hospitals can and do just send the samples out to them. It is not necessary to be treated at the place that has the lab that does this.

 

I suggest you (1) clarify if your gf is under SS or the 30 baht scheme and then (2) call either the NHSO (if 30 baht scheme) or local SS office and explain the problems she is having with Praram2  and ask them to run interference in enabling her to be treated at, if not Rajawithi, then at least some government hospital. If it is SS she should ask how to get her hospital selection changed. If it is the "30 baht" scheme she should tell them where she is listed in a tabian ban and ask if she can be treated at the government hospital that covers that geographical area, I will be very surprised if the answer is no. Normally to be treated at a government hospital under the 30 baht scheme all you need to do is go there and show your tabian ban. Now where you may get issues is, she may be listed in a tabian ban in a home province somewhere upcountry. In which case you and she should look into getting her tabian ban listing changed.

 

NHSO:  https://www.nhso.go.th/eng/FrontEnd/index.aspx

Hotline is 1330. But I doubt she is actually under the 40 baht scheme from the way all this is described, it sounds more like SS.

 

SS Offices for Bangkok area:  https://www.sso.go.th/wpr/

[mogandave]

I had my Hepatitis C treated at Chula by Dr. Piyawat. The treatment took six-months and cost of the medication was about US$35,000.

 

It is worth noting that Hep C is not an emergency. It takes years to build up a significant viral load, and only has a negative effect on about 50% of people infected. I had it for 30 years without knowing, and only found out because I was diagnosed with low platelets and fatty liver.

 

It is not very contagious either. I was married 10 years before I found out I had it, but my wife was never infected. That said, you should wear a condom to be safe. 

 

Sheryl, please do not hesitate to correct anything I may have gotten wrong.

[Captor]

Sheryl, here comes some update:

My gf talked to the doctors nurse at Rajavithi ovef phone and she too have never heard anything like this. She said that she will talk to the doctor and he will probably write a letter to Praram2 so they "let her go" to him at Rajavithi.

 

Yes I am sure it is the "30 bath" we are talking about with Praram2. Also there were other people there at the same time and that was the 30 bath scheme with them as well. We know about the social secure scheme you are mention and it is not that. It is the 30 bath scheme for thais. She has a hair salon and is not working at a government. And she don´t have the insurance needed for that social security if working in a factory for example.

The Rajavithi is now full and they do not take more patients in the 30 bath scheme so my guess is that the government hospitals all are full or close to so the government has open up for private hospitals. But I don´t know.

 

My gf comes from Roi Et and was written there for long time. Recently, maybe 6 months ago, she was written to Praram2 when she was visiting a clinic (name: Param1) when she had problem with her eye. So it was that clinic that arranged this Praram2 register. My gf that time was not aware of that Praram2 is a private hospital. She had never heard of it. Then she would have ask more about this.

 

I think now we will wait until the scheduled visit with the doctor at Rajavithi on 26. And then talk more about this with him. Also we have the appointment at Praram2 for ultrasound on 24. They forced that appoinment. They really want to earn a buck. I dont know if we should go to that? We also have an ultrasound appointment at Rajavithi on 3 Januar.

The plasma scan will be at Rajavithi too on 25.

Very confusing everything on what we should do.

Maybe we also call to NHSO as you kindly suggested for guideline is this "soup".

[Captor]

Mogandave, thanks for the information. Good to know some facts of the decease. We think my gf not have had this for so long. She is working mainly with womens hair but also sometimes she makes tattoo of eyebrow and it may be that way she got it. Or 1 tattoo she has by herself. Or maybe when she got pedicure. She said it sometimes comes blood. And if this happen to other customers as well and the pedicurist not clean the tools enough maybe it can come that way too.

[Sheryl]

42 minutes ago, Captor said:

Sheryl, here comes some update:

My gf talked to the doctors nurse at Rajavithi ovef phone and she too have never heard anything like this. She said that she will talk to the doctor and he will probably write a letter to Praram2 so they "let her go" to him at Rajavithi.

 

Yes I am sure it is the "30 bath" we are talking about with Praram2. Also there were other people there at the same time and that was the 30 bath scheme with them as well. We know about the social secure scheme you are mention and it is not that. It is the 30 bath scheme for thais. She has a hair salon and is not working at a government. And she don´t have the insurance needed for that social security if working in a factory for example.

The Rajavithi is now full and they do not take more patients in the 30 bath scheme so my guess is that the government hospitals all are full or close to so the government has open up for private hospitals. But I don´t know.

 

My gf comes from Roi Et and was written there for long time. Recently, maybe 6 months ago, she was written to Praram2 when she was visiting a clinic (name: Param1) when she had problem with her eye. So it was that clinic that arranged this Praram2 register. My gf that time was not aware of that Praram2 is a private hospital. She had never heard of it. Then she would have ask more about this.

 

I think now we will wait until the scheduled visit with the doctor at Rajavithi on 26. And then talk more about this with him. Also we have the appointment at Praram2 for ultrasound on 24. They forced that appoinment. They really want to earn a buck. I dont know if we should go to that? We also have an ultrasound appointment at Rajavithi on 3 Januar.

The plasma scan will be at Rajavithi too on 25.

Very confusing everything on what we should do.

Maybe we also call to NHSO as you kindly suggested for guideline is this "soup".

YES. Call the NHSO.

 

Unless there is something unusual in the arrangement Praram2 has with the NHSO (and maybe there is as this seems to be a very unique situation, I've never heard of a private hospital enrolling people under the "30 baht" scheme) they do nto make more money by doing an ultrasound. they get a flat amount per year per patient that is enrolled regardless of what if any treatment they provide. It is a capitation system nto a fee for service system.

 

But it is pointless to have the ultrasound twice.

 

Call the NHSO, explain the situation and that Praram2 is refusing to refer her to a government hospital and instead trying to refer her to a private beauty clinic which does nto have appropriate specialist. Whiel she has them on the line she should explain where she lives (per tabian ban) and ask how she can get care under the scheme at a government hospital. As mentioned that might entail changing tabian ban listing.

 

I should warn that the preferred medication (sofosbuvir) is not covered by the 30 baht scheme. She will instead receive a different, less desirable, regimen.

 

this may change in a year or so, studies on cost benefit of including it are underway.

 

 

[GLewis]

On 12/10/2018 at 3:43 PM, Captor said:

I have heard today that the doctors at Siriraj are more worth than other people in their own eyes?

That sounds not so nice. Does someone have experienced something like that?

Please dont post when you dont have a clue. Siriraj is a fine government hospital. You will have to wait and queue in the early morning, but some on Thailands best doctors do have rounds there.  If money is a factor then take the time to use it. All the Royal family use Siriraj.  I really get angry at posters who dont have a clue who voice opinions. 

[mogandave]

Mogandave, thanks for the information. Good to know some facts of the decease. We think my gf not have had this for so long. She is working mainly with womens hair but also sometimes she makes tattoo of eyebrow and it may be that way she got it. Or 1 tattoo she has by herself. Or maybe when she got pedicure. She said it sometimes comes blood. And if this happen to other customers as well and the pedicurist not clean the tools enough maybe it can come that way too.

As I understand it, it has to be blood to blood for infection, so dirty tattoo equipment is a likely cause.

Unfortunately, Hep C is a hearty virus and (again as I understand it) can survive up to 48 hours outside of the host.

[mogandave]

Double

[Captor]

1 hour ago, GLewis said:

Please dont post when you dont have a clue. Siriraj is a fine government hospital. You will have to wait and queue in the early morning, but some on Thailands best doctors do have rounds there.  If money is a factor then take the time to use it. All the Royal family use Siriraj.  I really get angry at posters who dont have a clue who voice opinions. 

Dear GLewis

Please don´t criticize if you haven´t read the post correctly. A hint: there is a question mark after the sentence...?

[Captor]

Sheryl, Yes we will do that.

So the most desireble medicine is still not in the 30 bath scheme? OK, so what you think about getting the medicine cheaper from India? I have read that many people do that. Maybe dangerous?

 

Also you say Sofosbuvir is the best. Is that not same as Sovaldi?

Then there are a hole bunch of medicines: Hepcvir, resof, Sofovir, Sovihep, Twinvir, Harvoni....

Are those older medicines?

Very confusing...

[Captor]

1 hour ago, mogandave said:

Double

Yes blood to blood that is what I was thinking too. Yes we think it is very likely it comes from that or maybe the pedicure. Not easy to know.  But no more pedicure now. And tattoo´s she only have one. And regarding the eyebrow tattoo she do it is maybe better to stop with that so no one get Hep C from her. Or at least be very, very protected with gloves and glasses and so on. I think she will stop it at all.

[Sheryl]

4 hours ago, Captor said:

Sheryl, Yes we will do that.

So the most desireble medicine is still not in the 30 bath scheme? OK, so what you think about getting the medicine cheaper from India? I have read that many people do that. Maybe dangerous?

 

Also you say Sofosbuvir is the best. Is that not same as Sovaldi?

Then there are a hole bunch of medicines: Hepcvir, resof, Sofovir, Sovihep, Twinvir, Harvoni....

Are those older medicines?

Very confusing...

 

Sovaldi and Sofovir are both Sofosbuvir. Sofosbuvir is the chemical (generic) name, Sovaldi and Sofovir are brand names.

 

Sofosbuvir is recommended to be taken in combination with one of these: ribavirin, peginterferon-alfa, simeprevir, ledipasvir, daclatasvir, or velpatasvir. Which one will depend on the genotype of Hep C.

 

Harvoni,  Hepcvir and Twinvir are all brands of   Sofosbuvir combined with Ledipasvir. Hepcvir is made in India and Twinvir is made in Bangladesh.  Of the two I would recommend the former (Hepcvir), the company which makes it (Cipla) is very reputable.

 

 

Sofosbuvir combined with Ledipasvir is the preferred teratment for  Hep C genotypes 1, 4, 5 and 6.   If she has genotyoes 2 or 3 treatment will differ somewhat. The doctor at Rajawithi (or any other competant GI specialist or ID specialist) will be able to advise the optimal treatment once her genotype is known.

 

 

 

 

 

[Captor]

Sheryl, a short update: We have called NHSO now and they confirmed that all the government hospitals are full so they have open up for private hospitals as well. As soon as there is a free hospital close to Nong Kheam my gf will apply for that instead. First of all we must use the closest to the address according to tabian ban (as you said) but if there is no one close she can also apply for Siriraj for example which is reasonable close to Nong Kheam. Or wait for another closer government hospital to open up.

 

There is a webpage to look what hospitals are open for new patients and what is not. We will look there every week. So in the meantime it is Praram2. We can of course change to another private but better wait until a government will be free and open up.

 

Webpage: https://bkk.nhso.go.th/main/

 

About the issue with Praram2 and their deny to send my gf to a BIG government hospital instead of that beauty clinic they said that we can demand that anyway if we think that gf not get the best treatment for her decease. And also they NHSO can check up Param2 closely if we get problem with the healthcare there. So far she have not meet a doctor there. she have to go there on an appointment that she has on the 28:th. Who know, maybe that doctor is more reasonable then the administration there at Praram2. And also who knows if the administration know what they talk about when they say that they have this Plasma scan examination. I think that we need to go the the appointments that we have got and then see what will come out of that from there.

 

24:th - Blood samples and ultra sound at Praram2

25:th - Plasma scan at Rajawithi

26:th - Meeting the doctor (professor actually) at Rajawithi for all the test results done before this date

28:th - Meet the doctor at Mali

3:rd - Ultra sound at Rajawithi (we cancel this if getting Ultra sound at Praram2)

 

Already done at Rajawithi: Blood sample for checking Hep C again + Geno test

 

 

 

[Sheryl]

14 hours ago, Captor said:

..... We can of course change to another private but better wait until a government will be free and open up.

 

 

IMO it would likely be worth changing even to another private hospital while waiting for an opening at a govt hospital top open up. Can you post here what the options are? The link is all in Thai.

 

I see no point at all in keeping the appointment at Mali. GF should tell doctor at Praram2 that she has spoken with NHSO and been told she has the right to insist on referral to a hospital with appropriate specialists. Knowing that she is in touch with NHSO will help.

[Captor]

Dear Sheryl,

Yes we agree but we will talk to the doctor at Rajawithi what we can do. We believe that he will send a letter to Praram2/Mali that we bring to Mali on 28:th.

We can be sure how to do after the 26:th how we shall proceed.

 

She has to go to the hospital where she is registered and they have already sent her to Mali for meeting a doctor there. At Mali (the last hospital in the chain) she can talk to the doctor and they can send her to another hospital or clinic. If they not have the resources to take care of Hep C. However, our doctor at Rajawithi want to take care of this. He has no confidence in the private hospitals. But now that we are in the loop it is not sure that we can come out of it the way we want. I think we have to wait and see what will happen on the 26:th. And also my girlfriend can start talking with the people at Praram on 24:th and mention NHSO. Not sure that she will meet a doctor there.

And I am not sure if I should go with here because if they see a foreigner then maybe they smell the send of money and that makes it more difficult.

 

About the hospitals on the webpage there are now 5 private hospitals and no government hospitals in Nong Kheam:

Laparam1 > Param2

Anunputthana > Anunputthana2

Phutthrakcha > Samutsakhon

Bangkhuntean > Param2

Bangboon > Suksawat

 

The left are clinics that send the patients to the hospitals to the right. Need to go trough the clinics.

 

 

[Sheryl]

Samut Sakhon Hospital is a government hospital and looks to be the best bet on that list.

[Captor]

Is it? We thought that was private. OK then we will go for that as soon we can do that. Thanks!

Sent from my SM-G960F using Thailand Forum - Thaivisa mobile app

[rumak]

On 12/14/2018 at 3:51 PM, Captor said:

Sheryl, Yes we will do that.

So the most desireble medicine is still not in the 30 bath scheme? OK, so what you think about getting the medicine cheaper from India? I have read that many people do that. Maybe dangerous?

 

Also you say Sofosbuvir is the best. Is that not same as Sovaldi?

Then there are a hole bunch of medicines: Hepcvir, resof, Sofovir, Sovihep, Twinvir, Harvoni....

Are those older medicines?

Very confusing...

There are a few newer meds now available for hep c .  The one that was the "breakthrough" is Harvoni.

which costs a fortune (like 100k dollars).   There is now a generic licenced by the original company called Ledifos. This is made in India.  It works !   The drug is  Ledipasvir 90mg combined with Sofosbuvir400mg.

It is almost 100 % effective.... a tablet a day for 90 days... and very few side effects if any.

Going to India to the pharmacy directly is one way....Cost for 3 bottles (30 pills each) is total approx 1500 dollars.     Because of the pharmaceutical control of profits it is not available in Thailand.  Any Dr here recommending interferon based treatments is WAY behind the curve.   Do not do it !

Try whatever you can to get harvoni or equivalent.   BTW:  what is her viral load?    after 30 days of harvoni ( or generic) viral load should be non detectable ! 

Harvoni is a new medication used to treat hepatitis C. It is a combination pill containing sofosbuvir (sold separately as Sovaldi) plus ledipasvir. It was approved in Europe in November 2014 for treatment of adults with genotype 1 or 4 chronic hepatitis C, and for some people with genotype 3.

[Captor]

Dear Rumak,

Thanks for answering. We still don´t know about the viral load or genotype. I hope after the 26:th when we visit the doctor again we get to know that.

You mean that Harvoni or Hepcinat LP (which both are Ledipasvir 90mg combined with Sofosbuvir 400mg I think) are not available in Thailand?

I have searched in India and there it seems to be easy to get that.

But I wonder if a prescription from a Thai doctor is needed for order that? And what about the custom?

Is it illegal to order from India?

[rumak]

3 hours ago, Captor said:

Dear Rumak,

Thanks for answering. We still don´t know about the viral load or genotype. I hope after the 26:th when we visit the doctor again we get to know that.

You mean that Harvoni or Hepcinat LP (which both are Ledipasvir 90mg combined with Sofosbuvir 400mg I think) are not available in Thailand?

I have searched in India and there it seems to be easy to get that.

But I wonder if a prescription from a Thai doctor is needed for order that? And what about the custom?

Is it illegal to order from India?

you can get it by going to India .   I am not sure what you would need , best to contact the Indian company directly or if you feel an emergency just go there !   

Anything from a thai doctor would not have any impact at all !   Maybe you would need an Indian doctor

to prescribe but i am not sure.

If your GF is not sick (no symptoms) then there is no emergency.... it is terrifying to know you have it but

as another poster says it takes  years and years to have symptoms.   The important factors are her liver enzyme levels  ( alt and alp ).  If VERY elevated not good.  And genotype and viral load are MOST important.  Read what is considered  low, med, high as to the viral load.  

Trying to order drugs from India or elsewhere is fraught with danger.   getting ripped off or fake meds,

Read real life experiences (on google) to learn of ways that some have gotten the medication by going to the manufacturer,

SORRY:  a few years ago the meds were not available in Thailand.  period.  And as far as i know nothing has changed.   If available then a major hospital would of course have them.  Sometimes their "liver specialists"  don't even know that they exist !

[Sheryl]

Harvoni is available here, but extremely, extremely  expensive. The less expensive generics are not yet available here.

 

It is technically illegal to import any pharmaceutical by mail though in practice customs will usually let through small quantities if sent by regular mail (not courier).  But I can't say re reliability of various order by mail companies in India.

 

Flying to India and back to buy the generic will still be much cheaper than buying Harvoni here.

 

you can also purchase by mail through a nonprofit foundation started by an Australian physician

 

https://fixhepc.com/what-is-fixhepc.html

 

 

[rumak]

i looked at the link from Sheryl.    I am not familiar with them BUT  i do know Greg Jeffrys 

Greg Jefferys was the first patient to come out publicly about his Hep C generic treatment journey and continues to assist patients years after he himself was cured. You will find Greg Jefferys' Homepage here, his blog here, and his Facebook group at Hepatitis C Treatment Without Borders. This is a closed group so you will need to apply to join.

 

He is definitely one of the people you can trust !  

[rumak]

On 12/14/2018 at 1:47 PM, Sheryl said:

I should warn that the preferred medication (sofosbuvir) is not covered by the 30 baht scheme. She will instead receive a different, less desirable, regimen

To the OP :   I am not a doctor ,,,,and Sheryl knows a lot more about care in thailand than i do ,

Having said that, my opinion is that sometimes people take the word of some doctors or hospitals

and follow incorrect  advice or do unnecessaray procedures.   Often the Cat scans or MRI that hospitals

steer one into doing are useless.  And the one reading it is often not really up to the task.  Worst of all

would be a biopsy for your gf if she shows no signs of illness.    

Put your efforts into getting the generic Harvoni....    it works and is available.  Try contacting that group

in Australia.   Eat well,  stay healthy,  take the meds.   Hep C is curable.  And the liver is a very tough

organ and will recuperate unless there is serious damage .

[Captor]

Hello both, thank you for your very appretiated comments. I have emailed about 10 different Indian pharmacies and they all have Hepcinat LP, Ledifos, Ledciclear, Twinvir or My Heplvir on stock. The prices vary between 150 USD until 275 USD for 1 bottle = 28 tablets. And they all claims that they are delivering by EMS to Thailand and that there is no prescription needed and no problem with the Thai custom. I don´t know. I feels not so good.

Then I think the australian guy feels more safe. I will contact him and see what he has to say. Thank you very much again both Sheryl and Rumak.

Also there is an Indian gay named Gupta or something like that I have read about earlier in links from Sheryl. Look like several people at TV has used him with good result. But I have not been able to reach him. I have sent email to he´s pharmacy but no answer.

 

Another alternative is this Dr. Theea at Samitivej who I have read has a clinic somewere in Sukhumvit. He seems to help Hep C patients but has a long waiting list. I have read.

I have not tried to reach him yet.

[Sheryl]

in any case you'll need to verify genotype first.