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Chapter 4Select DestinationsAsia

Thailand

Gabrielle A. Benenson

DESTINATION OVERVIEW

Thailand, known as “the Land of Smiles” is a popular travel destination because of its warm and welcoming reception of tourists and expatriates, beautiful beaches, delicious cuisine, excellent shopping, fabulous golf courses, exciting nightlife, and exotic adventure opportunities. Many travelers also visit Thailand for business, and the country is quickly becoming a regional business hub. The Thai language is a melodic, tonal language that can be difficult to learn. Luckily, most popular destinations in Thailand feature Thai people who speak English and road signs, maps, and tourist guides that provide information in English and Thai.

With close to 67 million people, divided into 76 political provinces, Thailand is a geographically diverse country a little smaller than the state of Texas. Thailand’s geography includes:

  • Sandy beaches and rocky shores along its 2,000-mile coastline and >1,400 islands
  • Central plains made up of extensive rice fields along the Chao Phraya River
  • Mountainous areas in northern, western, and eastern Thailand
  • The dry Khorat Plateau in northeastern Thailand.

Because Thailand is so close to the equator, the climate is tropical and often hot and humid. Flooding is always a possibility in Thailand, and various regions are prone to flash floods. Monsoon rains fall from May through July and can last until cooler, drier weather comes in November, making the North American winter a popular time of year to visit Thailand. Thailand’s central location and major international airport in Bangkok make it an easy access point for other destinations in Asia.

Approximately 9.5 million people live in the capital city of Bangkok, a major metropolis and center of commerce. Bangkok is a mix of old and new— skyscrapers and waterways, bustling city streets full of people, vendors, dogs, uneven sidewalks, and lots of traffic, in contrast to the fast, quiet, and cool modern monorail and subway systems. Tourists visit historic sites of glittering grandeur such as the Grand Palace to catch a glimpse of the Emerald Buddha or one of Bangkok’s 400 Buddhist temples. The main artery of Bangkok is the Chao Phraya River and its canals, which provide access to tourist sites, boat tours, the floating market, and restaurants and lend justification to Bangkok’s nickname, “Venice of the East.” Bangkok is a paradise of culinary delights, from local fare at a sidewalk noodle stand to a fancy 4-star meal in a restaurant. Rounding off a visit to Bangkok, many tourists will enjoy the pleasures of Thai nightlife, which includes a variety of bars and pubs, dance clubs, drag shows, and the famous red light districts of Soi Cowboy and Patpong.

Visitors to Thailand will also likely visit Chiang Mai, in northern Thailand. The city, surrounded by a moat and defensive wall, has >300 temples, a popular night bazaar for great shopping, and easy access to the handicraft villages, elephant nature parks, and outdoor adventures that are popular in the region.

A popular reason to visit Thailand is for rest and relaxation on sandy beaches along the coast or on one of the many islands. Beach destinations include plenty of opportunities for snorkeling, scuba diving, windsurfing, sailing, swimming, and dining on fresh seafood. A growing number of tourists seek out such relaxation opportunities as part of their recovery from medical or dental procedures. Over the years, medical tourism to Thailand has increased, as the costs for treatment are much lower and the quality of care is good (see Chapter 2, Medical Tourism). In 2005, an estimated 1 million foreigners were treated in Thailand. Thailand’s Bumrungrad Hospital charges only $16,000 for a heart bypass operation performed by a US-trained, board-certified physician. The same operation costs >$56,000 in the United States.

Thailand has a large expatriate community and has also become a popular destination for Western retirees. In 2008, over 98,000 Westerners were estimated to be living in Thailand. The warm climate and low cost of living make Thailand an attractive place to live.

Map 4-13. Thailand destination map

Map 4-13. Thailand destination map

View Larger Map  PDF Version (printable)

HEALTH ISSUES

Immunizations

All travelers should be up-to-date on their routine vaccinations. In addition, most travelers to Thailand should also be vaccinated against hepatitis A and hepatitis B. Typhoid vaccine should be considered.

Japanese Encephalitis Vaccine

Japanese encephalitis (JE) is endemic throughout Thailand. Transmission occurs year-round, with seasonal epidemics from May through October in the northern provinces. JE vaccine is recommended for travelers who plan to visit Thailand for ≥1 month and should be considered for those visiting for a shorter period but who have an increased risk of JE virus exposure due to their itineraries or activities. The highest rates of human disease have been reported from the Chiang Mai Valley. Several cases have recently been reported among travelers who visited resort or coastal areas of southern Thailand.

Rabies Vaccine

Despite government-sponsored mass vaccination campaigns for dogs and cats, rabies is still a risk in Thailand, particularly in Bangkok, where community dogs roam the streets. Preexposure vaccination is only recommended for travelers who have an occupation that puts them at risk for exposure (such as veterinarians), will be traveling for long periods of time, or are expatriates. Hospitals and clinics in Bangkok cater to the expatriate community and medical tourists, and rabies vaccine is readily available for preexposure and postexposure prophylaxis, although not all hospitals in Thailand carry human rabies immune globulin.

Malaria

Malaria is endemic in specific areas of Thailand, particularly the rural, forested areas that border Burma (Myanmar), Cambodia, and Laos, as well as the rural, forested areas of Phang Nga and Phuket. Prophylaxis is recommended for travelers visiting any of these areas (see Chapter 3, Malaria). Transmission in Thailand occurs year-round, and most cases are due to Plasmodium falciparum, with the rest due to P. vivax or mixed infection. Atovaquone-proguanil or doxycycline are the recommended antimalarial drugs for travelers in Thailand.

Dengue

Dengue is endemic throughout Thailand with large epidemics that occur every several years. Peak transmission occurs during the rainy season, although cases occur year-round even in non-epidemic years. Travelers to Thailand should take measures to protect themselves from daytime mosquito bites to prevent dengue (see Chapter 2, Protection against Mosquitoes, Ticks, & Other Insects & Arthropods).

Travelers’ Diarrhea

Although the Thai Government and several nongovernmental organizations are leading projects to provide clean water across Thailand, and some hotels use their own filtration systems, water and food still contain harmful bacteria and other contaminants. Travelers should practice food and water precautions and bring an antibiotic for self-treatment. Because fluoroquinolone resistance is widespread in Thailand and other areas of Southeast Asia, azithromycin may be preferred (see Chapter 2, Travelers’ Diarrhea).

Water and Soil Diseases

Melioidosis is highly endemic in northeast Thailand, and leptospirosis is reemerging primarily in the north and northeast regions of the country. For both diseases, most cases occur during the rainy season. Travelers who visit endemic areas should avoid contact with soil and water that could be contaminated and ensure that any open wounds are covered to prevent exposure. When contact cannot be avoided, travelers should wear protective clothing and footwear to reduce the risk of exposure. Skin lacerations, abrasions, or burns that have been contaminated with soil or surface water should be immediately and thoroughly cleaned.

Other Health and Safety Risks

Sexually Transmitted Diseases and HIV/AIDS

Thailand is a popular destination for sex tourism (see Chapter 3, Perspectives: Sex & Tourism), and although illegal, sex work is practiced openly across the country. A 100% condom program with sex workers helped slow the spread of HIV and other sexually transmitted diseases; however, approximately 530,000 people are living with HIV/AIDS in Thailand. Travelers should be aware of these risks and always use condoms during sex.

Safety and Security

Approximately 12,000 people are killed on the roads in Thailand each year, and a substantial proportion (82% in 2002) are killed while riding motorcycles. Motorcycles are a cheap, easy, and popular mode of transportation in Thailand, but they are also the most vulnerable vehicle on the road. If at all possible, travelers should avoid riding motorcycles and ride only if they wear a helmet.

In recent years, Thailand experienced a great deal of political unrest. With a new prime minister in office, the country remains divided but calm. Travelers should pay attention to the local news and monitor the US embassy websites and social media outlets to find out if and where protests and demonstrations will occur. Travelers should avoid these locations, since no one can predict whether protests will stay peaceful or turn violent.

BIBLIOGRAPHY

  1. Bundhamcharoen K, Odton P, Phulkerd S, Tangcharoensathien V. Burden of disease in Thailand: changes in health gap between 1999 and 2004. BMC Public Health. 2011;11:53.
  2. Chongsuvivatwong V, Chariyalertsak S, McNeil E, Aiyarak S, Hutamai S, Dupont HL, et al. Epidemiology of travelers’ diarrhea in Thailand. J Travel Med. 2009 May–Jun;16(3):179–85.
  3. Coker RJ, Hunter BM, Rudge JW, Liverani M, Hanvoravongchai P. Emerging infectious diseases in southeast Asia: regional challenges to control. Lancet. 2011 Feb 12;377(9765):599–609.
  4. Howard RW. Western retirees in Thailand: motives, experiences, wellbeing, assimilation and future needs. Ageing Soc. 2008;28(2):145–63.
  5. Kasempimolporn S, Sichanasai B, Saengseesom W, Puempumpanich S, Sitprija V. Stray dogs in Bangkok, Thailand: rabies virus infection and rabies antibody prevalence. Dev Biol. 2008;131:137–43.
  6. Kositprapa C, Wimalratna O, Chomchey P, Chareonwai S, Benjavongkulchai M, Khawplod P, et al. Problems with rabies postexposure management: a survey of 499 public hospitals in Thailand. J Travel Med. 1998 Mar;5(1):30–2.
  7. Tanaboriboon Y, Satiennam T. Traffic accidents in Thailand. IATSS Res. 2005;29(1):88–100.
  8. US Agency for International Development. Thailand: HIV/AIDS health profile. Washington, DC: US Agency for International Development; 2010 [cited 2012 Sep 26]. Available from: http://library.cphs.chula.ac.th/Ebooks/HIV-AIDS/Health%20Profile_Thailand_HIV-AID.pdf.
  9. Wichmann O, Yoon IK, Vong S, Limkittikul K, Gibbons RV, Mammen MP, et al. Dengue in Thailand and Cambodia: an assessment of the degree of underrecognized disease burden based on reported cases. PLoS Negl Trop Dis. 2011;5(3):e996.
  10. Wiwanitkit V. Rate of malarial infection among foreigners in a tertiary hospital of Thailand: change of epidemiology and importance of travel medicine (1996–2005). J Vector Borne Dis. 2007 Sep;44(3):219–22.
  11. Wuthiekanun V, Sirisukkarn N, Daengsupa P, Sakaraserane P, Sangkakam A, Chierakul W, et al. Clinical diagnosis and geographic distribution of leptospirosis, Thailand. Emerg Infect Dis. 2007 Jan;13(1):124–6.
 
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