My husband and I just returned from a two-week trip to Thailand, where we visited good friends who are living in Bangkok. Dimitri is an epidemiologist, working on HIV/AIDS prevention in Asia. Julia - also an epidemiologist - is not working in Thailand now, since she is nearly eight months pregnant.

Thailand has long been a tourist destination. Travelers visit this Southeast Asian country to enjoy the ancient Buddhist culture, the fabulous food, the gentle people, the modern liveliness of Bangkok, the forests of the north and the tropical beaches of the south. Thailand is an inexpensive, safe and fascinating country to visit.

For many years, "sex tourism" has drawn Europeans, North Americans and other travelers to Thailand. A few areas of Bangkok and some coastal resorts are known as centers of prostitution. Hundreds of thousands of women and children perform in sex shows and work as prostitutes; many of them come to cities from rural areas in desperate need of money to send back to their poor families.

But now, in an attempt to get away from sex tourism, the Tourism Authority of Thailand is promoting "health tourism." Spas, clinics and hospitals provide services at a fraction of the cost we would pay in the United States or Europe. However, most Thai people cannot afford this level of health care.

Some "health tourists" visit spas for massage, herbal medicine, aromatherapy and other alternative treatments. But many come for serious medical diagnostic tests and surgical procedures.

The quality of health care available in Thailand is very high. Many hospitals in Bangkok have a reputation for providing excellent medical, surgical and nursing care. Nurses and doctors usually speak English, and many have trained in the United States or Europe.

We visited Bumrungrad Hospital in Bangkok, where Dimitri and Julia attended a childbirth preparation class and will go to deliver their baby. The bustling lobby - complete with a Starbucks, McDonald's and many gift shops - looked like a luxury hotel. The hospital is immaculate, modern and well-designed.

Although the medical and nursing staff of Bumrungrad Hospital is mostly Thai, the clientele is international. The lobby was filled with people from the Middle East, Japan, Australia, Europe and North America.

Most were there for elective medical care, ranging from plastic surgery, corrective eye surgery and liposuction to gall bladder surgery, hip replacement, cardiovascular surgery, sex change operations and fertility treatments. Diagnostic tests, such as colonoscopy, coronary angiography and gynecological laparoscopy are offered at a fraction of the cost one would pay in developed countries.

Health tourists are attracted to Thailand by the promise of "First World quality medical care at Third World prices." On the surface, this seems to be good for the Thai economy and good for foreigners who receive low-cost, high-quality care. But, there certainly are problems with this system.

Thai doctors are increasingly inclined to specialize in fields such as plastic surgery and cardiovascular surgery, catering to foreigners and receiving high salaries. These doctors usually work in private specialty hospitals in big cities.

Meanwhile, doctors willing to do public health work with poorer Thai people in rural areas for lower wages will be fewer and farther between. Public health in Thailand will suffer as a result.

Similar concerns about the rise of health tourism at the expense of public health are emerging in countries such as India, Malaysia, South Africa and Costa Rica.

Countries where health tourism is on the rise must make a commitment to provide quality public health services to all their citizens, not just wealthier foreigners, or the overall health of the world will suffer.

Kathryn B. Brown is a family nurse practitioner with a master's degree in nursing from OHSU. Is there a health topic you would like to read about? Send ideas to kbbrown@eastoregonian.com. You can find more local health news and information in the Health section at www.bluemountaineagle.info.

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