A Traditional But Not Your Everyday Clinic Visit

Lek, one of Jip’s nursing school classmates, lives near me. I check in with her now and then because she has the same disease Jip had, which is quite rare in Thailand. Recently Lek asked if I would accompany her to the traditional medicine clinic in the neighboring district of Saraphi.

Many such clinics, built and run with Ministry of Public Health funds, are attached to public hospitals in this country. Government officials recognize that for most people here the first line of defense against illness is Thai traditional medicine. Western treatment often gets used a last resort, only after herbs, massage, and spiritual techniques haven’t worked.

The two of us drove in circles through beautiful fruit orchards until we finally found the cozy little building. We didn’t have an appointment but didn’t need one. The clinic sees about 20 patients a day, most on a walk-in basis. Lek wanted to know what its staff would say about her symptoms. She expected the massage therapists would be helpful.

In the large open reception area, Lek registered and went through the clinic’s initial exam. First, a nurse asked if Lek could clasp her hands together near her shoulder blades. Later I heard that in yoga circles this maneuver is called the Cow Face Pose. You raise one arm, then bend it so your elbow points towards the ceiling and your hand drops behind your upper back. The other arm’s bent elbow points at the ground while its hand comes up near the shoulder blades. Lek couldn’t do it.

All the conversations at the clinic between patients and nurses were public. There was no curtain. After giving up on the Cow Face Pose, Lek laughed. The rest of us in the room joined in.

Even after living here for many years, I’m not always sure how to interpret laughter in Thailand. Sometimes it means exactly what it means in the West. Other times, Thais laugh because they’re embarrassed. Or angry. Or because the situation is so uncomfortable that they don’t know what else to do.

The spirit of laughter at this clinic seemed to be, “What did you expect? People come here because they want to get better, not because they can already do everything healthy people can do.” A few of the staff had unusual health conditions, but nobody acted shy about it.

The next measurement concerned Lek’s “wind.” I pricked up my ears. Jip’s grandmother used to battle wind problems.  For Grandma it was a catchall complaint about breathing difficulties, occasionally involving dizziness, chest pain, stomach gas, or fever. Both fainting and sunstroke could also fall into her definition of wind illness. Its causes varied widely: from bad odors to stress to karma. Sometimes Grandma would suddenly develop what everyone learned to call a “wind attack,” which left her weak, dizzy, and needing immediate attention.

At the Saraphi clinic, they check wind by tapping on the abdomen in four places while the patient is lying down. Lek’s nurse shouted a wind score across the room so that everybody could hear it. Again we all laughed. I didn’t know what criteria they used to assign a number, or what they considered average or acceptable, but I learned low scores were better than high ones. Partly based on Lek’s wind number, they recommended she receive a specific kind of herbal massage. That was the whole of her exam. No blood pressure cuff, no bathroom scale, no thermometer.

When Jip worked as a health researcher with refugee women in Seattle, many Western docs asked her to explain “wind illness” in detail. They were confused by the wide spectrum of symptoms that their immigrant patients assigned to this term. Newly arrived from Asia or sometimes East Africa, very few of the women could speak English. Their translators didn’t offer a more precise English phrase for wind, maybe because like Jip they had grown up hearing about it from many of their older relatives. Jip eventually did a study on it, and published the results.

I ended up getting a massage too. My first plan had been to happily sit with a book and wait for Lek. But she said, “As long as we’re here…,” and I thought, Who needs a reason to get a massage? Besides, the others in the room looked like they wanted to watch the foreigner do the Cow Face Pose and to know my wind score.  Soon they led me off to see the chiropractor for “general maintenance.”

My session finished first. I returned to the lobby and saw the staff had set up a screen and projector. It looked like they were expecting a big audience. I guessed it was some kind of community event. A bus pulled up in front. Out poured a dozen foreigners on a study tour—Americans, Europeans, and Mexicans—accompanied by a professor from Chiang Mai University. The head nurse welcomed them with a short history of the clinic, while the professor translated. I stayed in the back row and waited for Lek.

One visitor asked why Saraphi staff didn’t wear uniforms. The nurse’s answer suggested that everyone at the clinic felt more comfortable without them. The professor said in English that no uniforms made the patients more relaxed. I whispered “and staff, too” to the visitor, remembering how Jip disliked wearing a white outfit and a starched hat. The professor noticed my whisper—she laughed and asked if I wanted to help translate. I was pretty sure she was just joking, so I only smiled. I didn’t want to make her mad. Anyway, her English was much better than my Thai.

A few minutes later, the questions turned to the clinic’s initial exam. The nurse demonstrated the Cow Face Pose and explained about the wind check. The visitors looked confused. When the professor struggled to clarify wind illness in English, I smiled again—of all the topics they could have raised, it was the only one I felt qualified to talk about!

So I slowly raised my hand and volunteered to say a little more, based on the information I remembered from Jip’s study. This time the professor seemed genuinely grateful for my extra words. Perhaps now many of the study tour participants will expect to encounter it in their Asian patients when they return home.

Lek showed up just before my words got me in too much trouble. She and I gracefully exited before anyone asked either of us to do any more translating. We both felt great.