Reasssessing the Notion of a "Brain Drain"
I’ve struggled with how best to say this without being offensive, but, the idea of that the Nigerian government has and continues to lose out on its investment into the training its healthcare force, is, quite simply, laughable. Investment, ke? When overall health infrastructure spending falls at a paltry 4% of a nation’s total budget, one can only imagine that how much less is “invested” into training the healthcare force – in terms of financial assistance for education and future career support. For the overwhelming majority of Nigerian physicians practicing both in Nigeria and abroad, the heavy lifting of such support primarily rested on self, family, benevolent communities and non-governmental organizations. Furthermore, the American Medical Association reports that more than half of African born physicians practicing in the United States spent a significant portion of their educational careers at American universities and hospitals.
While doctors and nurses play an irreplaceably essential role in a nation’s overall healthcare, one must remember that the success of any national healthcare system depends on far much more than its healthcare workers. The World Health Organization identifies a number of key components of an effective healthcare system, of which, interestingly, health care staff play a merely supporting role. Of chief importance are, again, good governance and financing, but also functioning information systems, diligent public health surveillance and access (to be distinguished from availability) to essential drugs and technologies. While the desire to return home and practice medicine in Nigeria remains a strong desire for many a Nigerian physician in the US, packing up and re-inserting oneself into a virtually non-existent health system may prove frustrating to both healthcare provider and patient. It goes without saying that organizations such as ANPA have and continue to contribute to the welfare of Nigerian patients and some Nigerian physicians in America, have in small groups, given back to their homelands, whether in financial assistance, educational support, or short-term projects. Though not yet quantifiable, doctors in the West may be contributing far more than they could have while in Nigeria and a mass exodus back to Nigeria, may prove counterproductive, particularly in the absence of policies and structures. It is critical, therefore, to reassess what is actually being drained and what the consequences are of haphazardly reversing that process.
Where's the Funding: Rural Health Care
Our taxes are meant to provide everyone with REAL access to doctors, home care, hospitals and long term care services so that we can get the right level of care at the right time.
So why are people who live in Rural Saskatchewan being asked to pay an additional tax to get the same access that people in Urban areas receive?
The excuses from government are un-ending.
But there is no real plan in order to save our health care and keep it in good shape for our children.
It’s time to tell your MLA and the Health Minister of Saskatchewan that you won’t accept a two-tiered health plan.
Help put a stop to the under-funding of health care in this province.
Add your voice by sending an email now.
Budgetary Allocation to Health: Shame of a Nation
The lack of commitment on the part of the federal government of Nigeria to increasing the budgetary allocation needed to improve the health of Nigerians remains a disturbing one. Recently, it was reported that Nigeria earmarks 3.5 per cent of its national budget to the health sector. With the well documented intrigues surrounding the release of budgetary allocations, no one is even sure if all the earmarked funds are ever gets released, and if released what percent is spent on services or lining pockets. With this level of allocation, Nigeria ranks just above Burundi in Africa in budgetary allocation to health. It is shameful that a nation that ten years ago hosted African Heads of State and Government at a conference in Abuja and led in the pledge for governments to allocate at least 15 per cent of their national budgets to health does not even allocate a paltry 5 percent of its budget to care for the health of its citizens. According to Ademola Olajire, a Nigerian and the Director at the Social Affairs Department at the African Union Commission, only six countries have achieved the target set in Abuja. It sure must break Mr. Olajire’s heart to provide such information that gives Nigeria a black eye. The six countries, namely Rwanda, Botswana, Republic of Niger, Malawi, Zambia and Burkina Faso that have passed the 15 per cent mark are all less endowed than Nigeria. Leader of Africa, who are you leading.
Did someone say “Cry my beloved country”, oh no I am the one who said it. As a healthcare professional, the healthcare infrastructure in Nigeria breaks my heart every time I think of it. As one of my colleagues said “because we all have parents and relatives in Nigeria who depend on this healthcare system and cannot afford to fly them out to countries with better facilities every time they fall ill, we cannot fold our hands and watch without doing anything.” The q
uestion is what can we do as non-politicians to force the hand of the government to allocate more resources to delivery of healthcare services to Nigerians? At a National Association of Resident Doctors’ roundtable in 1987, Nigerian physicians were called out for forgetting the “Hippocratic Oath” and not insisting on receiving needed resources when they become commissioners or ministers of health. It will be recalled that the late Professor Olikoye Ransome-Kuti extracted a committment from Babangida before he accepted the position of Minister of Health that the resources needed by the ministry will be provided to ensure that programs are implemented. He remains the only minister in recent memory to have done this. He got most of what he wanted albeit during a military regime.
In an interview with The Guardian after delivering a speech at the on-going Conference of African Ministers responsible for Finance, Economy, Planning and Economic Development in Addis Ababa, Ethiopia, Nigeria’s Minister of Health Professor Onyebuchi Chukwu said “funds allocated to security and the electoral system, among other competing needs in Nigeria, might have robbed the health sector of much-needed higher allocation in the budget.” The minister’s statement does not provide any succor to many Nigerians who still rely on government provided healthcare. In addition, the minister’s assertion that government's per capita expenditure on health was rising steadily and it's about $20 contradicts independent sources including the Africa Public Health Info which puts the figure at $10.
This is not surprising as anyone following the political debates and campaigns in Nigeria would have noticed that none of the candidates at the local, state, or national levels including the presidential candidates have mentioned or articulated any strategies to improve the health of Nigerians or arrest the decay that is the Nigerian health infrastructure. As the elections are conducted, winners announced, and executive councils formed, it is time for the Nigeria Medical Association that have done a good job of insisting on physicians running the ministry of health to go a step further to insist on improved allocation to the health sector and preventing its members from accepting health commissioner and minister positions as a form of protest if government allocation is not increased. Professor Olikoye did it and it still can be done if the focus is on the overall interest of Nigerians and not on holding a political position. When it is all said and done, physicians are going to be reminded that they presided over the decay of the Nigerian healthcare system.
Did someone say “Cry my beloved country”, oh no I am the one who said it. As a healthcare professional, the healthcare infrastructure in Nigeria breaks my heart every time I think of it. As one of my colleagues said “because we all have parents and relatives in Nigeria who depend on this healthcare system and cannot afford to fly them out to countries with better facilities every time they fall ill, we cannot fold our hands and watch without doing anything.” The q
uestion is what can we do as non-politicians to force the hand of the government to allocate more resources to delivery of healthcare services to Nigerians? At a National Association of Resident Doctors’ roundtable in 1987, Nigerian physicians were called out for forgetting the “Hippocratic Oath” and not insisting on receiving needed resources when they become commissioners or ministers of health. It will be recalled that the late Professor Olikoye Ransome-Kuti extracted a committment from Babangida before he accepted the position of Minister of Health that the resources needed by the ministry will be provided to ensure that programs are implemented. He remains the only minister in recent memory to have done this. He got most of what he wanted albeit during a military regime. In an interview with The Guardian after delivering a speech at the on-going Conference of African Ministers responsible for Finance, Economy, Planning and Economic Development in Addis Ababa, Ethiopia, Nigeria’s Minister of Health Professor Onyebuchi Chukwu said “funds allocated to security and the electoral system, among other competing needs in Nigeria, might have robbed the health sector of much-needed higher allocation in the budget.” The minister’s statement does not provide any succor to many Nigerians who still rely on government provided healthcare. In addition, the minister’s assertion that government's per capita expenditure on health was rising steadily and it's about $20 contradicts independent sources including the Africa Public Health Info which puts the figure at $10.
This is not surprising as anyone following the political debates and campaigns in Nigeria would have noticed that none of the candidates at the local, state, or national levels including the presidential candidates have mentioned or articulated any strategies to improve the health of Nigerians or arrest the decay that is the Nigerian health infrastructure. As the elections are conducted, winners announced, and executive councils formed, it is time for the Nigeria Medical Association that have done a good job of insisting on physicians running the ministry of health to go a step further to insist on improved allocation to the health sector and preventing its members from accepting health commissioner and minister positions as a form of protest if government allocation is not increased. Professor Olikoye did it and it still can be done if the focus is on the overall interest of Nigerians and not on holding a political position. When it is all said and done, physicians are going to be reminded that they presided over the decay of the Nigerian healthcare system.
Dr. Stephen R. Keister : Health Care and the Congress from Bedlam
The Congress from Bedlam:
Health care and American priorities
By Dr. Stephen R. Keister / The Rag Blog / March 30, 2011
"I know of no country in which there is so little independence of mind and real freedom of discussion as in America." -- Alexis de Tocqueville.One might conclude that the current Republican Congress was spawned in Bedlam.
The nation faces what could become the worst financial crisis since the creation of the republic, and a health care crisis second to none. Yet the legislative goals of the Republican Congress, encouraged by the fundamentalist Christian Right and the Tea Party movement, appear to be (1) abolishing Obama’s health care program, (2) curtailing abortion rights, (3) defunding Planned Parenthood, (4) defunding NPR, and (5) declaring English as America's official language.
I find the attack on the health care law beyond comprehension since it was negotiated in secret between the Obama administration and two of the industries that are financial keystones for the Republican Party -- the health insurance cartel and the pharmaceutical industry.
Not only does the legislation guarantee greatly increased profits to these corporate entities, but the entire plan is modeled on the Mitt Romney program under which the Commonwealth of Massachusetts still suffers from higher health costs and no decrease in the number of personal bankruptcies for those unable to pay their medical bills.
Recent information indicates that the insurance companies nationwide have been able to increase their rates by 20-60 percent since passage of the legislation. Little improvement has been made in providing coverage for those with pre-existing conditions because of excessive premium costs, while 50 million Americans are still uninsured and thousands still die from lack of health care.
What is it that creates such fury in Republicans that they wish to do away with the legislation? One might think we had enacted a low cost, inclusive, all-encompassing health care plan like those in most of the nations of the free world.
The near total failure of this legislation is discussed in detail by Kevin Zeese in a Truthout article entitled "One-Year Anniversary: The Incredible Shrinking Obama Health Care Law."
Our Republican friends should also gain great satisfaction in the fact that the personal physician, the traditional family doctor, will soon be replaced by hospital-based doctors, thus increasing the cost to the average citizen and concurrently increasing profits to the hospital industry.
For instance, a stress test may well increase in cost from $170 to $240, a study for sleep apnea will increase from $780 to $1,140, and a Caesarean Section from $2,700 to $3,420.
In my home, Erie, Pennsylvania, we have been watching the evolution of this phenomenon for some years. Here, most medical practices are now under the aegis of two traditional hospitals. As the older practitioners die or retire, options will be increasingly restricted.
This is pushing us further into a corporate structure that idealizes profits rather than professional medicine. This process is discussed in detail in an article at Smart Money, in entitled "Say Farewell to the Family Doctor."
The one bright spot on the horizon is the passage of a universal health care bill by the Vermont House -- The Vermont Health Care Authority -- by a vote of 89-47. The Governor has expressed his approval for the legislation, which still must pass the Senate. The law has been contested by all of the corporate interests that one would anticipate.
Much work is yet to be done, but there is cause for encouragement. The physicians are pleased as punch, and many other doctors may look to Vermont as a good site to move their practices.
Unhappily one can anticipate little movement from the American public in the direction of intelligent economic or health care policies. The average American, sadly, has little knowledge of the state of national affairs and the workings of government -- or what is really in his or her own interest.
Newsweek recently published a survey where 1,000 Americans were given the U.S. Citizenship test, a test taken by new immigrants at the time of naturalization, and 38 percent of current citizens failed it. European tourists with whom I talk know more about current affairs in the United States than do many of my neighbors.
One other bit of encouragement is Rep. Anthony Weiner's move to attach a "public option" to the current federal law. I feel that Rep.Weiner is one of a handful of honest elected representatives in Washington, and I admire his diligence and honor; however, I greatly fear that he is talking to the sea. The organization, Physicians for a National Health Program, continues its efforts and I would encourage those who can donate to do so. Hopefully, one day, it will be more than a voice in the wilderness.
Another positive note is the slowly increasing public attitude favoring the legalization of cannabis. A number of states have approved use of the plant for medical purposes, and many far-sighted individuals are beginning to see a bright side to decriminalization – like increased tax revenue in the billions of dollars, and the elimination of the tremendous expense of incarcerating those convicted for possession. Three more states, New Hampshire, Rhode Island, and Vermont, are close to arriving at rational decisions.
I tend to support the legalization course, as well as national laws permitting prescription cannabis, though I have never experienced the drug personally. Patients, and relatives of patients, have told me repeatedly that smoking a joint gives much more relief from pain caused by chronic or terminal illness, than prescription opiates.
My underlying fear is that the pharmaceutical industry will get on board the prescription cannabis train and at the same time lobby against legal, government-regulated, individual use of pot, leading to “prescriptions for profit” while individual use continues to be a felony.
I fear, as well, that the lobbies for the liquor industry will do their best to prevent sale of a drug much less physically and psychologically harmful than most alcoholic beverages. I would urge that all who have a rational Congressperson contact him/her and encourage the movement for national legalization.
[Dr. Stephen R. Keister lives in Erie, Pennsylvania. He is a retired physician who is active in health care reform and is a regular contributor to The Rag Blog.]
Dr. Kevin Patterson on Western Diets and Health
A few readers have pointed me to an interesting NPR interview with the Canadian physician Kevin Patterson (link). He describes his medical work in Afghanistan and the Canadian arctic treating cultures with various degrees of industrialization. He discusses the "epidemiological transition", the idea that cultures experience predictable changes in their health as they go from hunter-gatherer, to agricultural, to industrial. I think he has an uncommonly good perspective on the effects of industrialization on human health, which tends to be true of people who have witnessed the effects of the industrial diet and lifestyle on diverse cultures.
A central concept behind my thinking is that it's possible to benefit simultaneously from both:
The sanitation, medical technology, safety technology, law enforcement and lower warfare-related mortality that have increased our life expectancy dramatically relative to our distant ancestors.
The very low incidence of obesity, diabetes, coronary heart disease and other non-infectious chronic diseases afforded by a diet and lifestyle roughly consistent with our non-industrial heritage.
But it requires discipline, because going with the flow means becoming unhealthy.
A central concept behind my thinking is that it's possible to benefit simultaneously from both:
The sanitation, medical technology, safety technology, law enforcement and lower warfare-related mortality that have increased our life expectancy dramatically relative to our distant ancestors.
The very low incidence of obesity, diabetes, coronary heart disease and other non-infectious chronic diseases afforded by a diet and lifestyle roughly consistent with our non-industrial heritage.
But it requires discipline, because going with the flow means becoming unhealthy.
Top doctor says health care needs to move off of the election waiting list
CALGARY - The president of the Canadian Medical Association wants health care moved from the waiting list to the top of the agenda in the federal election campaign.
Dr. Jeff Turnbull told a Calgary audience that Canada's health-care system is at a crossroads and the federal government needs to expand its role.
"That's why, in this newly launched federal election campaign, Canada's doctors will be pressing to put health care on the agenda," Turnbull said Wednesday in a speech to the Calgary Chamber of Commerce.
"Canadians have identified health care as their priority and I would like to see our elected officials now starting to have that debate and I'd like to see a much greater conversation about how we're going to transform health care for future generations."
So far, says Turnbull, the federal parties are offering nothing more than "piecemeal initiatives" instead of a picture of what the system should be in the future.
The system as it stands now is inefficient, he said, and it should be run more like a business so that the money saved from any efficiencies can be funnelled back into the system.
The current federal-provincial health accord is set to expire in 2014 and Ottawa needs to take a bigger role, he said.
"Some people want you to believe that the federal role is just as a funder. It is absolutely not. The federal government is the custodian of the Canada Health Act," Turnbull added.
"It delivers services to military, RCMP, First Nations and Inuit. It should be responsible for facilitating the best health care within your jurisdiction, for your communities. I do believe there is a role for the federal government in ensuring medicare is pan-Canadian, rather than 14 separate systems."
The Canadian Medical Association has been consulting with Canadians about the future of health care for more than three months through its website. What it's heard so far from 50,000 respondents has not been good.
"They're having trouble getting access to primary care, congested emergency departments, cancelled surgery, trouble getting into home-based care or long-term care," Turnbull said.
"Canadians are expressing to us on an ongoing basis and the Canadian doctors who are charged with the responsibility of giving effective care and serving their communities — they're coming to us and saying please fix this health-care system."
He's not suggesting one giant superboard overseeing all the provinces and territories but he said there should be national standards to make sure everyone receives good health care.
Alberta Premier Ed Stelmach said he supports the idea of a more universal approach to health care.
"That's fine. Stand shoulder-to-shoulder across Canada and bring about changes. We can't do this province-by-province nor can we follow the same process we did in the past," said Stelmach.
"When the Canada Health Act was passed in Ottawa it was a 50-50 split on health care. Today as an Alberta taxpayer you are providing more than 80 per cent of health-care costs. Other provinces are in similar situations."
Dr. Jeff Turnbull told a Calgary audience that Canada's health-care system is at a crossroads and the federal government needs to expand its role.
"That's why, in this newly launched federal election campaign, Canada's doctors will be pressing to put health care on the agenda," Turnbull said Wednesday in a speech to the Calgary Chamber of Commerce.
"Canadians have identified health care as their priority and I would like to see our elected officials now starting to have that debate and I'd like to see a much greater conversation about how we're going to transform health care for future generations."
So far, says Turnbull, the federal parties are offering nothing more than "piecemeal initiatives" instead of a picture of what the system should be in the future.
The system as it stands now is inefficient, he said, and it should be run more like a business so that the money saved from any efficiencies can be funnelled back into the system.
The current federal-provincial health accord is set to expire in 2014 and Ottawa needs to take a bigger role, he said.
"Some people want you to believe that the federal role is just as a funder. It is absolutely not. The federal government is the custodian of the Canada Health Act," Turnbull added.
"It delivers services to military, RCMP, First Nations and Inuit. It should be responsible for facilitating the best health care within your jurisdiction, for your communities. I do believe there is a role for the federal government in ensuring medicare is pan-Canadian, rather than 14 separate systems."
The Canadian Medical Association has been consulting with Canadians about the future of health care for more than three months through its website. What it's heard so far from 50,000 respondents has not been good.
"They're having trouble getting access to primary care, congested emergency departments, cancelled surgery, trouble getting into home-based care or long-term care," Turnbull said.
"Canadians are expressing to us on an ongoing basis and the Canadian doctors who are charged with the responsibility of giving effective care and serving their communities — they're coming to us and saying please fix this health-care system."
He's not suggesting one giant superboard overseeing all the provinces and territories but he said there should be national standards to make sure everyone receives good health care.
Alberta Premier Ed Stelmach said he supports the idea of a more universal approach to health care.
"That's fine. Stand shoulder-to-shoulder across Canada and bring about changes. We can't do this province-by-province nor can we follow the same process we did in the past," said Stelmach.
"When the Canada Health Act was passed in Ottawa it was a 50-50 split on health care. Today as an Alberta taxpayer you are providing more than 80 per cent of health-care costs. Other provinces are in similar situations."
Mental health concerns mount as Japan tsunami realities sink in
Via Reuters: Mental health concerns mount as Japan tsunami realities sink in. Excerpt:
Japanese tsunami survivors mourning lost loved ones and struggling to replace shattered homes and workplaces also face daunting mental health concerns, experts warn.
Three weeks after a March 11 earthquake and tsunami left more than 27,500 people dead or missing, shock and awe at sheer destruction can give way to despondency and depression as the gravity of the survivors' loss sets in.
"For a lot of people who up until this point have been able to ignore reality and what actually happened, as they get back on their feet they realise that, for instance, their house is gone, or their children are dead, and they're being forced to confront these facts," said volunteer doctor Toru Hosada.
"A lot of them are extremely uncertain as to what they can do," he said during rounds at a shelter in the shattered port city of Yamada in Iwate prefecture.
A tour of some 150 km (90 miles) of the devastated coast of northern Japan showed brisk efforts to house, feed and bathe thousands of people made homeless by the wave -- but worries that "kokoro no care" (mental health treatment) was coming too slowly.
"Many people cannot sleep well at night as they are afraid of earthquakes. They have lost many things so they are psychologically hurt," doctor Keiichiro Kubota told Reuters at a makeshift clinic in Kesennuma.
The difficulty of comforting survivors is compounded by the more than 350 aftershocks recorded since March 11.
"I am sleeping with my regular clothes on. I am always feeling an earthquake. Even when a car passes by, I think it's an earthquake," said Toshie Fukuda, 64, a survivor in Rikuzentakata, one of the cities hit hardest by the tsunami.
At the main disaster evacuee center in Rikuzentakata, a junior high school, the psychological counseling center is a curtained-off 4 square metre (36 sq ft) corner of a classroom.
"Do you suffer from headaches, stomach aches, diarrhea? Are you easily agitated and unable to sleep? Do you have no appetite, suffer nightmares about the disaster, or lack your normal energy? Are you irritated by the smallest sound, unable to stop crying and unable to relax?" reads a clinic poster.
"These feelings are not at all unusual -- they are the normal reaction of people who have received a severe shock," the poster said. "Talk to a specialist to lighten your burden."
Japanese tsunami survivors mourning lost loved ones and struggling to replace shattered homes and workplaces also face daunting mental health concerns, experts warn.
Three weeks after a March 11 earthquake and tsunami left more than 27,500 people dead or missing, shock and awe at sheer destruction can give way to despondency and depression as the gravity of the survivors' loss sets in.
"For a lot of people who up until this point have been able to ignore reality and what actually happened, as they get back on their feet they realise that, for instance, their house is gone, or their children are dead, and they're being forced to confront these facts," said volunteer doctor Toru Hosada.
"A lot of them are extremely uncertain as to what they can do," he said during rounds at a shelter in the shattered port city of Yamada in Iwate prefecture.
A tour of some 150 km (90 miles) of the devastated coast of northern Japan showed brisk efforts to house, feed and bathe thousands of people made homeless by the wave -- but worries that "kokoro no care" (mental health treatment) was coming too slowly.
"Many people cannot sleep well at night as they are afraid of earthquakes. They have lost many things so they are psychologically hurt," doctor Keiichiro Kubota told Reuters at a makeshift clinic in Kesennuma.
The difficulty of comforting survivors is compounded by the more than 350 aftershocks recorded since March 11.
"I am sleeping with my regular clothes on. I am always feeling an earthquake. Even when a car passes by, I think it's an earthquake," said Toshie Fukuda, 64, a survivor in Rikuzentakata, one of the cities hit hardest by the tsunami.
At the main disaster evacuee center in Rikuzentakata, a junior high school, the psychological counseling center is a curtained-off 4 square metre (36 sq ft) corner of a classroom.
"Do you suffer from headaches, stomach aches, diarrhea? Are you easily agitated and unable to sleep? Do you have no appetite, suffer nightmares about the disaster, or lack your normal energy? Are you irritated by the smallest sound, unable to stop crying and unable to relax?" reads a clinic poster.
"These feelings are not at all unusual -- they are the normal reaction of people who have received a severe shock," the poster said. "Talk to a specialist to lighten your burden."
Public health caravan dispatched to help southern victims
BANGKOK, 31 March 2011 – The Ministry of Public Health has dispatched a caravan carrying consumer supplies and 30,000 sets of medical kits in an urgent effort to aid flood victims in the southern region.
Public Health Minister Jurin Laksanawisit stated that the public health caravan is bringing the necessities to eight southern provinces currently suffering from serious flooding. The provinces are Nakhon Si Thammarat, Phatthalung, Surat Thani, Trang, Chumphon, Phang Nga, Songkhla and Krabi.
Mr Jurin also reported that 7,237 flood victims have so far received medical treatment from the mobile unit. Most of them came with flu, tinea pedis and small fresh wounds.
The minister reported further that the death toll from the disaster currently stands at 20 while 44 villagers have reportedly been injured from the recent landslides in Krabi. A group of eight medical staff members from Vachira Phuket Hospital has been sent to take care of the patients.
According to Mr Jurin, 77 hospitals have been devastated by the severe flooding thus far. Out of that number, three are seriously hit with high flood water that nearly submerges their one-floor buildings. Those hospital are Po Daeng Hospital in Chumphon, Sai Thong and Song Phraek Hospitals in Surat Thani.
Public Health Minister Jurin Laksanawisit stated that the public health caravan is bringing the necessities to eight southern provinces currently suffering from serious flooding. The provinces are Nakhon Si Thammarat, Phatthalung, Surat Thani, Trang, Chumphon, Phang Nga, Songkhla and Krabi.
Mr Jurin also reported that 7,237 flood victims have so far received medical treatment from the mobile unit. Most of them came with flu, tinea pedis and small fresh wounds.
The minister reported further that the death toll from the disaster currently stands at 20 while 44 villagers have reportedly been injured from the recent landslides in Krabi. A group of eight medical staff members from Vachira Phuket Hospital has been sent to take care of the patients.
According to Mr Jurin, 77 hospitals have been devastated by the severe flooding thus far. Out of that number, three are seriously hit with high flood water that nearly submerges their one-floor buildings. Those hospital are Po Daeng Hospital in Chumphon, Sai Thong and Song Phraek Hospitals in Surat Thani.
