Living & Ageing in Isan: Worries?

I’ve got a few questions, if not quite worries, about living in Isan particularly, that I’d like to pose to those of you who have been here for a while, and who are now “getting on a bit”, as they say. Of course, younger lads’ comments and thoughts are most welcome as well, but I’m frankly more interested in the older gentlemen’s responses, the long-timers, since I know that one begins to view things quite a bit differently when one passes 50, or 60, or 70, etc.

This is obviously a personal topic; still, it’s definitely an important one – one that I, and I’m sure many others, would very much appreciate having some thoughtful reflections on (together here in one place) - since I know these topics have been explored elsewhere in this increasingly comprehensive and extremely useful forum.

A few of the things that I’ve been thinking and wondering about, that might serve as a rough guide – or even better, a starting point – to forthcoming forumites in their responses, are as follows:

1) Is the health care up to scratch? I’ve lived in Bangkok and Chiang Mai, where I have been more than satisfied with the quality – and especially the price! – of the health care offered. However… I cannot say the same about my limited experiences here in Isan, where I’ve only lived for several years.

Since I live between Udon and Nong Khai, I’ve checked out the hospitals (and dentists) in both cities: all 3 hospitals in Nong Khai, and what I’ve been led to believe is the best in Udon: Aek Udon – please correct me if I’m wrong about this. I’d love to know that there are better ones around than Aek, which seems to me to be the “go to” hospital of choice for many.

For some things, smaller problems and concerns, the NK hospitals are fine, and there are a couple good dentists (and some bad ones) but it is certainly not a place I’d consider having anything major done, nor would I want to spend any extended in-patient time there.

NK Hospital has the most facilities, being the government hospital, but also the most patients, since that’s where Thais go to use their government-funded health scheme. Hence, it’s often a somewhat crowded, chaotic affair, but still tolerable in my experience; for example, I really have no complaints about the way they handled the birth of my son there – and at no cost I should add. I’d do it again, if I were to do it again – which I’m not!

As for Aek Udon, it’s really a mixed bag as far as I can tell, and judging from others’ experiences in this forum. There are some good doctors, and the facilities are perfectly adequate; nonetheless, you’re never quite sure if the specialist you need is really up to snuff, or up-to-date in their field. I’ve been pawned off on GP’s just to move me through the system, when I needed a reference to a specialist. And I’ve heard plenty of complaints about the dental care there, though my experiences have been satisfactory in that regard. What do you think?

2) Will visa regulations get tighter? They certainly have been, especially in the past 5 years or so for some reason, with the last few years seeing changes we never saw coming. My single friends, and my older friends without a great deal of money, are finding things more and more difficult. Proof of THB 800,000 total annual income to retire here is a not insignificant amount of money to some people, though you might argue that one should have at least that much in order to retire. But we’re also talking about letting a good chunk of cash simply sit in the bank for at least 3 months before every annual visa renewal.

Some close friends of mine, long-term residents of Thailand, gifted teachers no less, recently packed up and moved to southern Cambodia, because they were very anxious about whether they could continue renewing their visas. These were two brilliant individuals, an American and a Vietnamese, who were contributing a great deal to Thailand, but opted for neighboring Cambodia because it is so easy to get visas there, and Westerners feel relatively welcomed, which isn’t saying much after here, I know.

But as we are all well aware, government bureaucracies and their agents are not known for looking at individual cases, and making decisions based on the merits of respective cases. If anything, they seem intent on driving many Westerners away, or at least seriously discouraging us from settling here.

I’m curious if anyone might know more about this issue, this attitude? And also if you’re personally concerned about it affecting your ability to stay here or not?

Which leads me to my third and final quick question at this time…

3) Do you have a contingency plan? As my best friend in America keeps asking me, do you have a “go bag” at the ready in case (for whatever reason) you might need to up and leave quickly?

He’s gone so far as to advise me to make a plan to cross Laos and then he’d go so far as to meet me personally in Hue or Danang, Vietnam! One can laugh at this now, but he who laughs last, right?

The latter may admittedly be a bit extreme, but having a contingency or backup plan(s) seems to me to be basic common sense. There’s any number of reasons why one might want or need to move on, or “back”, without much notice.

So how many of you have actual plans in place? I for one feel I should, but don’t yet. Is making such a plan alarmist thinking, or just being wise and sensible?

I look forward to your responses.

Hi,
You do not need to keep 800,000B tied up in a Thai bank for three months.
Got a letter from British Embassy stating my yearly pensions, which amounted to approx 830,000B. You would not beleive it but the lady at immigration asked me what the exchange rate was as it was in stirling, Since then I got married to the lady I was living with for the last 6 years. If you are married you only require 400,000B income. TIT.
No trouble getting a yearly visa last month, once I knew the ropes, In and out within a hour with 12 months stamp in passport. Next year will go for supporting a family, who are Thai citizens, way.
I think the government is trying to stop people that do border runs every month, and abuse the system, now you only get a couple of weeks stamp in your passport, not 30 days, from adjoining countries, and are only allowed so many. Every thing else seems the same.
As for dentists. Used one in what used to be called the Paolo Hospital, now called Panyavejinter Hospital, had tooth ache, they took a x-ray said I had a abscess on the root and it had to be cleared before they would do anything with it. Got 2 fillings in my front teeth while there. Went back after a week and they pulled the tooth out. The service was very good and cost just under 1,000B including medicine and x-rays.
Fell and broke my wrist and hurt my back, a few years ago. Called ambulance and they took me to the military hospital. Very good service and costs 6,500B for everything. Have not been to AEK so cannot comment.
Cheers Doug.

older gentlemen’s responses............................one passes 50, or 60, or 70.........................this increasingly comprehensive and extremely useful forum.

yo................older, i'm still in early 50's, well for few more weeks, now 60/70, that's old, very old. also, excellent kiss up.

health issues......agree with you, udon hosp are not up to par, i prefer Panyavenjinter hosp, though if anything life threatening, trauma, or high tech, i personal wouldn't get my hopes to high on surviving, or full recovery. so if already have serious health issues, i would recommend to people not to retire here, stay close to real hospital, or home country. KK has better hospitals, i believe, never used, but teaching hospital and the RAM is well reguarded there, but again, emergency/trauma, at least an hour from udon, possibly 2 for you, so, i wouldn't get my hopes up.

immigration.............basically, just what you already stated, they make no effort to make it easy, not that it's extremely hard, but they could ease up a bit. don't think they will make any more hoops for us to jump threw, though i expect a couple new twist when i renew in feb, as udon office seems to want everything you can think of, and so far, won't accept the yellow book for proof of residence, which will make things a bit inconvenient for me. but will manage. it would be nice if the rules were applied uniformly, every day, every office, but we know that's not going to happen. the only change to concern about, especially if brit or yank, is our declining home currency, and sure to get worst before better, so a game of meeting the numbers for many. or simply adjust visa. i could cut the amount in half and get married maybe not, or do the tourist visa thing every so many months till they tighten that up, even more. but actually don't expect or think i would need to change from a retirement visa, unless something very drastic happen, i which case leads us to 3rd question.

contingency plan.................for me, i would check out cambodia/vietnam and possibly others on an extended vacation, just so i wouldn't be missing any opportunities. though i'm not very optimistic about that, but if that didn't work, i would simply return to states and have no problem setting up there in smallsville. though hopefully i'll never need to do that. but wouldn't be a complete negative, as i would go married and she would get citizenship and my soc sec/gov't retirement scheme when i move on to the next level. leaving her sitting mighty pretty. i have no plan, as i don't think it would really be necessary, i can't see the gov't saying, 'all farangs have one week to leave', that just isn't going to happen. but it does make me constantly change my mind about building another house, or continue to rent. so far, i'm in the renting mentality, as a plan i have, doesn't seem to be going to work, due to thai time and lack of initiative, as waiting to buy a parcel of land i would consider building on, but the principles can't seem to be in one place at the same time, or something isn't right, and nobody wants to fess up, thus the decision to build will be made up without my input, very soon. if not purchased before march, it won't be and no time to build before i need to rerent something else.

not a whole lot of help, but my thoughts on probably what you already think.

question for you, have you stayed in contact with the 2 in cambodia, if so, how long have they been there, where, and what is their opinion now, if been there a while. still like it, or honeymoon starting to where off. my concern is the infrastructure and even more corruption, possibly crime, though they do seem to be little more immigration friendly, along with couple other regional countries. but i've never visited any in asia, except here.

Do you have a contingency plan? WTF

Come on this ain't some communist regime and even with the political climate I don't believe there's any reason to worry about getting the feck out of dodge most leow leow. Unless of course you're doing something naughty

As for TB's post, I think he nailed it

I haven't got rid of my suitcase

At 71,I feel no immediate threat to my residency here in the near future,so I have no contingency plans!I see nothing that would make me think the rest of my lifetime will not be spent here!

If circumstance were to suddenly change where I felt I needed to make a plan,Cambodia or Laos would probably be my first options!Probably Cambodia,as my wife might be comfortable there as she speaks the lingo,although I don't think I would enjoy moving there,never been there though!The third option would be returning to the USA,but only if my family were able to go!


My biggest concern is the medical one!I am a bit of a fatalist,I have no confidence in the system at all!Emergency care,whatever happens,I will just accept, except for ''milking''my families assets!I have no interest in prolonging my life for a year or less or even longer, w/o quality.I guess you could call me one of the guys that is in ''The Pill Club''

Many thanks so far, especially to TB (who did nail it!), and LA, BK, Doo, etc.

To LA re Cambodia: My friends moved to Kep, southern Cambodia, which they like well enough. They've travelled the world for about 50 years so they're not the honeymooning types; however, I've heard no major complaints, and they're very happy with the ease of the visa situation, #1!

They live in a bungalow overlooking the river, and quite unusually for them, even (also) rent a small flat over a bookshop in town, which just tells me just how cheap it is. They bicycle back and forth regularly.

Many, if not most, things not as readily available as here, but they're not the complaining types - they're happy enough there. And never a word about corruption, crime, or downsides. They just keep studying, writing poetry (Vietnamese), and getting by. Emailing me as normal also, so not really off the grid.

Thanks again. Very useful & interesting for me (to kiss up some more!) - and hopefully to others as well. (I'll check back again later.)

You touched on 3 things that I think about because I've decided to live in Udon and have been here off and mostly on since 2002, and continuously since April 2007. I'm 64. My biggest concern is emergency medical services, then civil war, and lastly immigration problems.

MEDICAL CARE -
I have personal experience with emergency care for two problems: Heart disease and stroke. The emergency care at AEK Udon for the angina I had was well done, properly tested and diagnosed, and I was in Bangkok within a couple of days where I had bypass surgery.

The stroke was mismanaged. I'm just lucky it was minor. The ER doctor at AEK said I didn't have a stroke. I insisted I had and requested another doctor. He concurred with me and I went for an MRI transporting myself to the military hospital for it and then returning a couple hours later for the results and a return visit to AEK where they then decided to admit me. After a night in the hospital I signed out and bought a ticket to Bangkok where I went to Bumrungrad and received state of the art care. Luckily I was not disabled or unable to travel.

Had the stroke been serious I probably would have suffered more permanent damage than I did. The first 3 hours are the most critical in stroke care, and here you'd be lucky to see a competent neurologist within 3 hours. The first neurologist I saw was nearly 12 hours after the event and she didn't speak enough English to communicate with me, although she did follow an appropriate protocol for caring for someone so late in the game.

All in all, emergency care in Udon is better than 7 years ago, but still quite primitive when compared to EMS in the US. Staff on emergency response vehicles have little or no EMS training and they are often responding simply to get paid for the service. I don't know of a trauma center in Udon, although I'm told the military hospital on Thahan Rd has a physician present 24/7. I don't think AEK Udon and the other private hospitals do. I'm not sure about Udon Hospital.

I have visited friends and family who have been admitted at AEK Udon, Wattana, and Udon Hospital. None of them would be accredited in the US.

My wife and I use Bumrungrad in Bangkok for medical care other than minor complaints or initial consults.

We have a dentist in town that we like and have used her for several years. I did have some work done at AEK Udon; their sterile technique was sloppy and they basically tried to sell me up on every possible thing. I haven't been back.

IMMIGRATION -
The past few years it seems that immigration policies have changed in such a way as to try to exclude those who are staying here illegally or in violation of the intent of the law. I applaud them and wish them every success in keeping those people out.

Since you have a kid, I'm assuming you're married. A marriage visa only requires 400,000THB in the bank or monthly income of 40,000THB. I suggest using the marriage extension rather than the retirement extension.

The USD is likely to lose more value and it may become increasingly difficult to qualify for the higher reserves or income associated with a retirement extension. Also, in the past immigration has grandfathered people in at the rates that were in effect when they started getting their extensions. Consequently, there are guys staying here on less than 200,000THB in the bank and or income under 20,000 per month.

I don't worry about immigration policies becoming a problem for me.

CONTINGENCY PLAN -
I've been thinking more about this as the monarch's health has become more frail. There is a possibility of civil war in Thailand when he passes. I maintain enough cash to get out of the Thailand and out of Laos. Keeping a reentry permit active will help me return when things settle down, if they do so before my visa expires. If not, I'd have to get a new one.

Because borders are sometime shut down during national emergencies I've also considered the costs and risks with illegally crossing into Laos to escape.

I don't see an easy way to protect my assets here. I'd try to get a family member to occupy my house in our absence. I'm not counting on being able to access my Thai bank accounts when out of the country. Civil war often causes banking systems to lock down or collapse.

Immigrations...........won't accept the yellow book for proof of residence

I sit corrected, new update of someone renewing, yellow book was accepted as proof of residence.

To correct a few points:
The yearly stamp obtained in the immigration centres here in Thailand is an EXTENSION to the VISA you obtained OUTSIDE of Thailand.

The 800,000 has to remain in the bank untouched for 3 months on the second extension application. I believe they will allow only 60 days in the bank untouched for the first extension. This cannot go lower than this amount during this 'untouchable' period and therefore you will need more than this for living expenses to ensure you do not dip below the 800,000 benchmark.

The applications for extension based on retirement are done locally and providing all the boxes are ticked, are apparently not too difficult. Extensions based on marriage, whilst being 'cheaper' at a minimum of 400,000 in the bank for 3 months are somewhat more difficult and are sent away for processing in Bangkok and can take months to return with an answer, especially on your first extension. Tales of nightmare scenarios are not uncommon and applicants have been asked to provide maps to their home, photographs to prove the relationship and even past proof of correspondence or co-habitation. I have even heard of some Thai wives being asked some extremely personal questions.

Its more of a pain in the ass rather than difficult, as long as you have the correct documents.
The ones they are (successfully) weeding out are the long term 'tourists' who live here and those without correct documents, work permits or income.

At the end of the day it is quite strict here with many hoops to jump through to be 'allowed' to stay, but it IS possible providing you show you have a reason to be here and can support yourself as there are no benefits given to foreigners.
Many complain bitterly about it - yet wish their own countries adopted the same hard-line policies, and then perhaps wouldn't have felt compelled to 'move out and make room' for the ethnic minorities (or majorities in some cases).

Just when I decided to go for a Marriage Visa this time i/o renewing my Retirement Visa!

Hmmmm...good to know - cheers.

Has anyone gotten a Marriage Visa without too much hassle?

And if I'm thinking of working, perhaps I should brave the Marriage Visa hoops nonetheless?!?

Do they give you some kind of temporary extension on your visa while you're waiting for the approval from BKK?

Marriage visa is a pain in the buttocks.

Can't wait until I turn 50 so I'll be allowed to "retire."