Tube Feeding in Thailand- excellent system and support for Alzheimer’s/dementia

Health

Thailand has an excellent robust system available to assist patients who need to go on tube feeding. I have enormous gratitude towards the Thai healthcare system for providing support to my mother who is now on tube feeding as she developed dysphagia from end stage Alzheimer’s.

When my mother could not longer take in sufficient fluids and nutrients on her own, the specialists from two different hospitals all recommended that my mother be placed on nose tube feeding (nasogastric tube).

She may pull out the tube. Well, no worries, there are hand restraints in place. The hand restraints are not inhumane and it does not distress the person. There is a company in Thailand called Maysa Medical that designs hand restraints and covered mittens that have ventilation and can be worn long term without any discomfort. We bought 2 pairs and she has been using it for 3 months. It prevented her from pulling out the tube.

The healthcare support has been tremendous. When my mother was hospitalized in a common ward in a government hospital for one week, the nurses took the time to teach and get me familiarized with the tube feeding, bed bath and diapers change process. Despite it was a busy ward and the nurses were very busy but they still make time to teach. That is just ‘informal’ lessons.

Formally, the hospital will assign a teaching nurse to explain about tube feeding. She taught in detail, for about an hour and patiently answer any questions or concerns we may have.

In most countries, when it comes to the food required, one would think of using formulas like Ensure or Enercal which is very expensive. You need 8 scoops each time to be given 4 times a day in order to meet the dietary requirements.

But in Thailand, hospitals provide detailed guidance and some even supply these food that are made fresh daily. The preparation of these food are done in a separate kitchen from the main kitchen and the conditions are very hygienic.

At first we thought of preparing the meals ourselves and we were enrolled in a free class taught by the dietician on how to prepare the meals. But later we decided since the hospital also supplies food for tube feeding, we would order the food instead of preparing.

This is because a lot of care is required to prepare the food. One need to allocate separate set of cooking equipment, blender and utensils just for this preparation to avoid contamination. Also time and resource is needed to prepare and cook the food. The nurses in the ward had told me that if careful precautions were not taken during the preparation, some patients get readmitted back due to diarrhea and other digestive issues as their stomach is very sensitive.

The tube feeding food is prepared fresh daily and comes in 4 enteral bags for 4 separate meals as prescribed to the tube feeding patient. Each morning, we drive to the hospital to collect the 4 bags. Food for later meals are stored in the fridge and reheated before being given to the person. The pricing is very reasonable, 100 baht per day for the 4 enteral bags. When my mother’s blood sugar was a little high, they even have the diabetic version.

After consuming the food from the hospital, my mom has regained her health. For an end stage Alzheimer’s patient, usually only the swallowing reflex is not working. Their digestion is still working perfectly. Hence it really does not make sense to follow advice from ‘experts’ in developed countries that is against tube feeding. It is literally starving the person to death and is unacceptable in Thai healthcare system and culture that cares for the elderly.

The nose tube would have to be changed once a month. We do not even need to go to the hospital to do that. We were told a nurse can come to our place to change it once a month. And it is done for free without charges as it is linked up to the government hospital.

It is very fortunate we are staying in Thailand. My family and my mom’s friends (who are all former nurses) all agreed that my mom would not have survived had she not been in Thailand. The support is amazing.

In Thailand, it is just a natural process to place a person on tube feeding if they develop dysphagia due to neurological disorders, Alzheimer’s, dementia, stroke or other illnesses. No one would look at your loved one weirdly if she goes to the hospital with a nose tube and her hands being restrained. Because they understand. And in fact, people around would be helpful.

In Thai hospitals, be it private or government, the priority is always to save life first. If the patient needs to be restrained, so be it. Better restrain them and administer the necessary treatment to save them than to let them die. But they would not do it in an inhumane manner. The hospital I went to even sew their own hand restraints from recycled bedsheets and patients’ clothings. Care is taken to make the restraints soft and not uncomfortable for the patients.

However, the line is drawn at invasive treatment. Like intubation and resuscitation. When my mom was first admitted to the ER, the doctors told me her vitals were very low. She was in fact dying. The recommended treatment was tube feeding and IV drips but they were at first not sure if she could make it. They asked if I want to sign a DNR (do not resuscitate). Because according to the doctors, they will do their best to save her. But if she were to collapse, lose consciousness and slip into a coma, they asked if I would want resuscitation on her.  They said they would do it if I want but they also told me it would cause her a lot of suffering. And once reach that stage, chances of recovery is very very slim.

The doctors consider tube feeding to enable the person to receive nutrition and to be comfortable. Recently through YouTube, I have discovered tonnes of videos produced by various Thai hospitals, professionals and caregivers that taught many things on how to care for a bed bound person, prepare tube feeding food, oral care, diapers change and even how to make hand mittens to restraint someone from trying to pull out the nose tube.

The demonstration of how tube feeding food is prepared, cooked, sieved and stored were produced by a few hospitals from Thailand. In Thailand, it is seldom that people send the elderly to homes. They usually care for their aged parents themselves. So a lot of videos are also make for a single caregiver in mind, ie single person lifting and doing physio for their loved ones.

The wealth of information available is simply AMAZING. Unfortunately, these videos are all in Thai language with no English translation. That is when I realized how to expect caregivers from other countries to know how to look after or prepare the tube feeding food if there are no guidance and support from videos or the healthcare system?

What I would do is I would attempt to have some of these videos translated into English. For example, I attempted to translate the tube feeding preparation by the Saraburi Hospital in this post. I have created a section in my Health Blog on  Alzheimer’s/Dementia Tube Feeding Resource page.

I would be updating the section above with my experience and translations from useful videos that I could not find any equivalent in English. I am blessed to be staying in Thailand where the healthcare system and support enable me to fulfill my duty to my mother whom I love dearly. I know there are others out there like me, who is caring for loved ones who have dementia or Alzheimer’s and is feeling very lost. I hope I would be able to help.

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