Thailand Confidential

by Jerry Hopkins

  Others were actually working. Graham Greene wrote numerous novels placed in the region—his most famous, The Quiet American, is centered in Vietnam—and actually wrote a letter following one of his visits (framed and hanging in the suite), calling the hotel a place where “almost anything may happen and one may meet almost anybody, from a mere author to an international crook on his way elsewhere.” While Barbara Cartland—whose suite is pink, her favorite color—began writing a novel based in Thailand at the turn of the new century, a romance, Journey to a Star .

  As vastly different as the writers were, the hotel was a part of their Thailand experience. Over the years, Maugham enjoyed telling how he almost got kicked out of the Oriental and when he returned to Bangkok many years later, perhaps remembering that early visit, he elected to stay somewhere else.

  The Backpackers

  Backpackers are the low-riders of tourism: youthful pilgrims in search of themselves under the guise of seeking experience and enlightenment (but for many, in fact, just getting out of the house and school), the holiday-on-the-cheap hordes who’ve been there and done that twice and along the way made Bangkok’s Khao San Road infamous, while throwing enough money at Tony and Maureen Wheeler to allow them to fly Business Class for the rest of their lives (they own the Lonely Planet publishing empire).

  In the 1960s, the “straight” world called such people “hip-pies.” But backpackers are a different breed. They’ve partied in Goa and spent a week in an ashram and they wear the same parachute pants from Kathmandu and even take some of the same drugs, but the tie-dyed, long-haired swarm of the 1960s and early 1970s actually stood for something, or tried to, while their clones-gone-astray in the 1990s, as ubiquitous as self-indulgence and sloth, may be rebels without a cause save hanging out (or merely “hanging,” as the current vernacular has it).

  The differences between the generations may be understood by comparing books written about them. The first was Jack Kerouac’s On the Road, a novel deemed unpublishable when the author’s agent sent it around in the 1950s, a manic word-grenade typed in a single burst on a single roll of teletype paper, whose hero was Dean Moriarty (based on the real-life Neal Cassidy), a “sideburned hero of the snowy west” whose energy gave Keouac’s creation a rush like amphetamine. He was one of Kerouac’s “mad ones, the ones who are mad to live, mad to talk, mad to be saved, desirous of everything at the same time, the ones who never yawn or say a commonplace thing, but burn, burn, burn like fabulous yellow roman candles exploding like spiders across the stars and in the middle you see the blue center-light pop and everybody goes ‘Awww!” Thus, the Beat Generation was defined; the “Beat” stood for beatitude, by the way.

  Arguably, Kerouac was the father of the hippies— On the Road was the book that Jim Morrison and Janis Joplin and many others claimed most influential—and so it was no surprise when the same Neal Cassidy reappeared in 1964 as the driver of the painted bus that carried a group of novelist Ken Kesey’s friends the Merry Pranksters from California to the New York World’s Fair. The bus was called Intrepid and on the front there was a sign that warned three thousand miles of small towns, “We Have Come for Your Daughters!” In the refrigerator was a pitcher of LSD-spiked lemonade. The journey was documented in Tom Wolfe’s 1968 account, The Electric Kool-Aid Acid Test, setting the tone for much of what followed throughout the western world.

  In the 1970s, the hippies disappeared, at least in the media, elbowed aside by Saturday Night Fever and the Me Generation and then the Babyboomers, enfatuated first with raising their consciousness (becoming by their own boast “estholes”) and then with making a million bucks buying and selling futures and bonds, and blowing it all on cocaine. No wonder that Quaalude, a horse tranquilizer that tended to make you fall down, was another drug of choice.

  In the 1980s came the X Generation and Heavy Metal and Techno and Rap, and the drugs of choice now were manifestations of cocaine in its vilest forms: ice and crack. And to come down, a taste of heroin.

  Meanwhile, backpackers spread like crab grass. The old hippie trail to India, Nepal and Tibet was revived, providing new blood for the communes and beach parties along the way; orgies in Goa followed by a month cleaning up in a meditation class in Varanasi.

  And then they discovered Thailand, led by the nose by the Wheelers, whose second book was a patchwork guide to Southeast Asia on the cheap. Finally, in 1996, the backpackers’ bible—their answer to On the Road —was published. This was The Beach, a first novel by British writer Alex Garland. As I write this, I’m looking at the back cover copy of the paperback edition: “Bangkok—the first stop on the backpacker trail. On Richard’s first night in a hostel a mysterious traveler slits his own wrists, leaving Richard a map to ‘the Beach.’ The Beach is a legend among young travelers in Thailand: a secret island Paradise where a select community lives in blissful isolation...”

  It sounded like the hippies all over again, with the comforts that a quarter century brings. On the first page of his book, Garland called Khao San Road “backpacker land. Almost all the buildings had been converted into guest-houses”—he wrote— “there were long distance telephone booths with air-con, the cafes showed brand-new Hollywood films on video, and you couldn’t walk ten feet without passing a bootleg-tape stall. The main function of the street was a decompression chamber for those about to leave or enter Thailand, a halfway house between East and West.”

  Garland and his novel and the inevitable movie released in 2000—starring Leonardo DiCaprio, a yuppie wannabe pretending to be a backpacker; at first I thought the casting was wrong, but then I realized it was bang-on—did for the backpackers what the previous texts did for the beatniks and the hippies. Made them cliches in their own time. Except, this time around there was no substance to subvert.

  Where the beats and their long-haired spawn staged a siege on society’s constraints, rebelling against conformity, protesting against Vietnam and for marijuana, against Lyndon Johnson and for dancing, against hypocrisy and for ecstasy (the emotion, not the drug), against police and for sex, expanding on the vocabulary of exploration, actually trying to put their heads (as they said) into a different space, the only questions backpackers seemed to ask concerned cheap train tickets and where they could find the best banana pancakes.

  These cultural flotsam and jetsam are found in greatest number in Thailand not just in the three-dollar-a-night guest houses in Bangkok’s Banglampoo district (of which Khao San Road is the main drag), but during the full moon of every month in communion with their peers in ecstasy (the drug, not the emotion) on a beach on an island named Koh Pha-ngan, where, following directions found on the Internet, on the full moon of every month, an estimated eight thousand to ten thousand backpackers worship Dionysus, the ancient Greek god of partying.

  (In fact, when someone pointed out that days when the moon is full are religious holidays for those who bow to the lunar calendar, the party was moved ahead one night.)

  The old fishing huts on Pha-ngan are gone now, replaced by small cabins and rooms and restaurants that sell fried rice and burgers. Internet cafes, without which no backpacker could survive, sit next to shops selling black-light posters of psychedelic mushrooms and body-piercing parlors with photos on display showing all the intimate places a stud or ring can be affixed. (Bring your own anesthetic.)

  Beachside bars crank up the volume and the resonant bass of techno muscles in on the natural rhythms of the heart, as the chemicals ingested go zooming to the brain, abetted by unlimited quantities of alcohol and caffeine-rich drinks called Red Bull and Caribao, the latter named for a popular local rock band. By midnight, the surf has become a toilet for partygoers disinclined to line up for the club lavatories or pay twenty-five cents for the private, beachside stalls. By two o’clock, most are drunk or stoned and those still on their feet are dancing in the sand. The last body is usually dragged away to one of the small clinics by noon.

  Back in Bangkok, the veterans compare notes with new arrivals. “What wa
s it like?” “I don’t remember, mate.” “Oh, man, that sounds way cool! What’s the best way to get there— train or bus?”

  It wasn’t planned this way. Time magazine opined that when backpackers first hit the road in the 1970s, they were seen as “an antidote to sterile package tours, a return to travel as exploration and adventure,” where anyone could be Marco Polo, travel close to the ground and get to know the “locals” and their divergent cultures. Rather than give their money to international hotel chains, they’d give their money directly to guest house owners, mom-and-pop restaurants, and street vendors. As tourists, they insisted, they were “green.”

  There was some truth to that. Contrast the average backpacker who remained in Thailand for the full month allowed on his or her entrance visa with the wealthy tourist who stayed at an international hotel.

  This hippie redux dream was dashed quickly. Backpackers traveled like migrating herds on a predictable path, connecting beaches in India (Goa), the Philippines (Boracay), Bali (Kuta) and southern Thailand, and as true environmentalists discovered, the herds inevitably trampled the landscape flat. “They tend to be like sheep, all going to the same places,” Tony Wheeler told Time. “That is a negative.”

  Bangkok Heart Attack

  When I told my kids back in the United States that I’d decided to have open heart surgery in Bangkok, they thought I needed my head examined. Was I crazy?

  I assured them I was not, said they had to trust their dear old dad, even if he was falling apart. I said my Thai cardiothoracic surgeon was London-trained and had participated in over a thousand such operations, while the cardiologist who’d been supervising my coronary health the past year, was schooled in the U.S. and practiced there for twenty years before returning to Thailand, and that Bumrungrad Hospital probably was the best in the region, including those in Singapore.

  Coincidentally, I’d interviewed the CEO of Bumrungrad recently for a story about Bangkok’s emergence as an Asian health care center, and was impressed even more than I’d been during my six years of residence—during which time I’d visited the hospital’s dermatology, EENT and internal medicine departments, where I always got excellent care. I also talked with the resident doc at the U.S. Embassy, who told me he could send expat heart patients home and used Bumrungrad instead.

  Before getting on with what happened to me in surgery, here is a part of the story I wrote following that interview with the CEO and sent to my kids, making it clearer (I hoped) why they were concerned and perhaps why they didn’t have to be.

  • • •

  Countries are a bit like entertainers: they want to be the center of attraction and make a nice living by being so. They also want to be taken seriously. Certainly this is true in Southeast Asia, where nations compete eagerly to be a regional center for this or that, or in the current business parlance, a “hub.”

  Thus, Hong Kong and Singapore battle it out for pre-eminence as financial centers and telecommunications and import-export hubs, while Shanghai threatens to overtake Hong Kong by merging its stock exchange with that of Shenzhen. At the same time, Hong Kong, Singapore, and Bangkok are in a three-way contest as transportation links, and Kuala Lumpur has staked a claim as THE software manufacturing center to be reckoned with...as Myanmar and Cambodia haggle over which produces the most and best quality gems, and Thailand, Indonesia, and the Philippines all say they have the best beaches. We won’t even touch the subject of where the best shopping is, nor where the most beautiful women reside.

  As the members of ASEAN, and southern China (arguably a part of Southeast Asia, at least economically and culturally), scramble for control of various markets, some of them make an occasional, amusing stretch. When the Love Bug devastated computers around the world in 2001 and the culprit or culprits were said to be young hackers in Manila, for instance, then President Joseph Estrada, a onetime film actor, said his country should strive to become a center for developing anti-virus software. It sounded like a bad movie plot.

  So, too, did a plastic surgeon’s call in Thailand when he said Bangkok could become the world’s center for sex-change operations. In fact, the doctor, himself one of a number of physicians active in waving his magic scalpel to turn one sex into another (mostly men into women), actually was on the right track. He was just taking too narrow a view.

  Others in Thailand already had tried to promote the country as a destination for foreign retirees, without any notable success.

  But one of the things offered to such retired persons did seem, by itself, reasonably exploitable—and that was the recognition given the country’s new levels of medical proficiency.

  Not long ago, if you needed medical assistance in Southeast Asia, conventional wisdom said the best—only!—places to go were Hong Kong and Singapore. I remember a half-dozen years ago asking Andrew Toth, the American consul in Bali, what his biggest problem was. He said it was trying to convince foreign visitors to the island that just because they were staying in a five-star hotel, they could not get five-star medical treatment.

  “I told them that if they had anything more serious than a broken leg,” he told me, “they should somehow get to Singapore. Because the hospitals in Bali didn’t even provide medicine or food.”

  It was for this reason that many expatriates in Indonesia, and elsewhere in the region, had clauses in their medical insurance policies that covered “med-evac” (airlift) service to Singapore or Hong Kong.

  Happily, medical treatment has improved in Indonesia and elsewhere in Southeast Asia in recent years, but it’s still pretty shaky in much of the region. In most Southeast Asian countries, even the capital cities don’t have much to brag about when it comes to modern medicine.

  Of all the countries, Thailand may have improved the most, and there is no better place to start than in the office of Curtis Schroeder, the American CEO of Bumrungrad Hospital in Bangkok. He believes that Thailand’s medical services now are as good as those offered in Singapore and that with prices one-half to one-third of those in that city-state, Singapore no longer can compete.

  The shift began, he said, in 1997, when Bumrungrad opened its new building and six months later the baht was devalued. The Singapore dollar subsequently lost only a little of its value, but this led to its losing most of its Indonesian patients when the rupiah dropped to less than a third of its previous value, making Bangkok the more attractive destination for health care.

  Schroeder also credited Bangkok’s location, within quick and easy reach of numerous countries that don’t offer much modern medical treatment—from Nepal and Bangladesh to Myanmar, Laos, Cambodia and Vietnam.

  “These fundamentals are not specific to our hospital,” Schroeder said, “—they apply to everyone in Bangkok.” He also recognized that eight other hospitals (in Chiang Mai and Hat Yai as well as in the capitol) have been certified by the Swiss-based International Standards Organization (ISO), which evaluates and guarantees work systems but not services quality. However, so far, he said, Bumrungrad was (at the time of my interview in 2000) the only one with Hospital Accreditation (HA), the approval given by a non-governmental Bangkok organization that judges actual hospital care by American and Canadian standards.

  To win this international acceptance and patient base, Bumrungrad sent marketing teams to meet doctors throughout the region, from Kunming to Jakarta to Bhutan, and opened fulltime offices in Dacca, Ho Chi Minh City and Yangon (staffed by a physician, who makes references), and representative offices in Phnom Penh, Colombo and Kathmandu. The hospital also began hosting medical teams from throughout the region and introduced a web page that attracted over three thousand hits a month.

  “Our forms are now in Thai, English, Japanese and Mandarin,” he went on, “and we have a staff of interpreters, including seven who speak Japanese. Many of our physicians are internationally trained. Our nurses receive cultural sensitivity training. For instance, Thai patients take the pills they’re given without question, but Americans and Australians want to kno
w what they’re swallowing, so our nurses have to know. For our Muslim patients, they also know where Mecca is and prayer rugs are available.

  “In addition, we’ve tried to create an international feel to the place. Much of the hospital signage is in English and Japanese as well as Thai. We offer vegetarian, western, Japanese and Oriental [Chinese and Thai] dishes on our menu and employ guest chefs from leading local hotels who create healthy gourmet lunches. We have Japanese and Thai restaurants in the hospital, along with a McDonald’s and a Starbucks, and soon will have two Cybernet cafes for our patients.”

  The chain restaurants have drawn some criticism, with one Bangkok journalist writing “fill up now on fatty hamburgers downstairs and when your arteries are clogged come upstairs and we’ll replace them.” Schroeder shrugged and said they were a “way to create a world ambiance. Our lobby doesn’t look or smell like a hospital. It’s less intimidating. We believe this creates a better environment for healing.”

  This setting further includes fully-serviced apartments for friends and family members. When a man comes from Japan for heart surgery, say, he’s admitted to the new hospital building and his family checks into the old one, converted to comfortable oneand two-bedroom flats.

  What has been the result? In 1996, there were forty thousand international patients, including resident expatriates and foreign travelers and in 1999, there were 162,000, the largest number from the Japanese expat community, followed by Americans and British. This business, Shroeder said, represented thirty percent of the hospital revenue and it made Bumrungrad the “largest international health care provider in Southeast Asia.”