The Challenges of Staying Healthy in Thailand

Moving to a new country doesn’t come without challenges and Thailand is no exception. Although we pride ourselves in adjusting to life’s curveballs and successfully building a life here, we’ve had our fair share of ups and downs when it comes to staying healthy in the country we now call home.

We thought to write a post about our experience because we were recently interviewed by Aetna International. We talk about how we keep up a healthy lifestyle abroad, both mentally and physically, as well as our experiences with Thailand’s health care system.

Writing that article really got us thinking about our physical and mental health and what we do as expats to stay healthy in Thailand. Below, we’ve addressed our biggest challenges to date and how we stay on top of them. We touch on adjusting to the climate, eating a healthy diet, exercising, integrating into the expat community, and getting medical treatment. Hopefully, by shedding some light on our experiences, you can gain a better understanding of what life can be like abroad, the good and the bad.

Adapting to a hotter, smoggier climate

One of the reasons why we chose to move to Thailand was its year-round tropical climate. If you’ve ever been to the Mid-Atlantic in America and experienced the bleak, damp days of fall and the frigid, miserably dark and wet days of winters, you’ll understand why.

In hindsight, we thought we were ready for Thailand’s heat and humidity. Chris spent half his life abroad, which included summers in Bahrain’s hot deserts and Sicily’s scorching beaches. I grew up with Maryland’s uncomfortably muggy summers, which my grandfather matter-of-factly described the air like “breathing a bowl of pea soup.”

But Thailand maintains a disturbingly high level of heat and humidity that we took forever to get used to. Just after we moved, we felt zapped of our energy and enthusiasm and rarely wanted to be outside. And this was even during non-peak hours when the sun wasn’t blazing. With time, and we’re talking a few years, we’ve acclimated to Thailand’s climate that’s far different from the 20°C temperature of our old offices!

One of the best bits of advice we tell newbie expats is to never use the air conditioning like you did before you moved to Thailand. Not only will you never want to step foot outside due to the 10+°C degree temperature swing, but your electric bill will be outrageous. Although Chris and I still fight over the thermostat levels (he likes it at 25°C while I like it at 27°C), our bodies have definitely adjusted to Thailand’s warmer climate. We are much more comfortable at open-air restaurants, parks, markets, and other areas with outdoor gatherings than when we first moved here.

On a more serious matter, we had no idea prior to moving to Thailand that harmful smog blankets the entire northern half of the country for nearly six months. Beginning as early as late November and stretching into May (with the absolute worst in March and April), yellow smoke-filled skies are the norm. This is Thailand’s smoky season.

Many expats and Thai authorities dismiss the smoke from vehicles and burning farmlands as merely a visual inconvenience. Uninformed locals call it fog! However, the microscopic smog particles (size PM 2.5 and smaller) are extremely unhealthy. These teeny tiny particles have been known to negatively affect the cardiovascular and respiratory systems.

With growing frustration, we watched and smelled the burning season start earlier and last longer, year after year. We wore N95 face masks when we went outside. We placed filters in our AC units and bought an air purifier with a HEPA filter.

Even so, breathing in Chiang Mai’s polluted air hurt us. With PM levels going into the “very unhealthy” 200s (and possibly higher), we experienced several side effects. They extended far beyond an inconvenient runny nose or an itchy cough. They were debilitating at times and had us really concerned, too. Let’s not forget, we got cabin fever because we were stuck inside our house for months at a time, too!

Eating a healthy diet

One of the reasons we chose Thailand over other countries to move to is that we really like the taste of Thai food. We love that it’s full of herbs and spices, raw salads, grilled meats, and a range of fresh, tropical fruit and vegetables. Years back, when we were deciding on which country we wanted to live abroad in, it was important to us that we liked the local cuisine. A huge part of what makes us happy is eating out and experiencing new foods as well as sharing good food and drink with friends.

Eating Healthy in Thailand

What we weren’t prepared for after we moved to Thailand was the prominent use of syrups and salty bouillon in drinks, sauces, and broths. Sometimes, we’re frustrated with the meager protein portions and low fiber content in the average Thai stir-fry or curry. And the few glugs of palm oil added to every dish? No thank you.

To be fair, food high in salt, sugar, and oil is commonplace when eating out no matter which country you live in. These are what make restaurant and store-bought food taste so good!

After our first year eating almost exclusively Thai food, the excitement of dining on 30- to 60-baht meals from food stalls and our neighborhood Thai restaurants wore off. We re-evaluated our eating habits after gaining weight and feeling sluggish. Now, we eat out occasionally and cook most of our meals at home.

When we do eat out, it’s seldom and we are more choosy with where we eat. We are happy to see a growth of restaurants offering menus with sustainably grown, vegan, vegetarian, organic, raw, and whole foods. Although this wasn’t like that in Chiang Mai when we first moved there in 2013, the number of health-conscious businesses have grown in response to customers’ demands. It’s awesome! We’ve also seen them or heard about them in other major expat-friendly towns such as Phuket, Bangkok, Pattaya, and Koh Samui.

Exercising

Back in the US, we were adamant gymgoers. We regularly, if not religiously, tackled free weight, machines, and the occasional intense group class. It was a way to release energy after sitting at our office desks all day.

When we moved to Chiang Mai, all of that changed. After spending a lot of time trying to find gyms (back in 2013 when only a few were listed in English and the rest were in Thai), we were disappointed. The gyms’ weights and machines were dated and needed repair, reupholstering, or just a good ol‘ scrub-down.

In the past year or two, gyms have really popped up in part to foreigners’ demands. It’s been an incredible transformation in Chiang Mai, although we’re sure that larger expat-friendly cities are already years ahead of the game. Now, there are several high-end gym options complete with classes and good quality machines and weights. We joined two different gyms over the span of four years and we’ve been happy getting back into our workout routine.

In between gym memberships, we started doing more outdoor activities. Chiang Mai has an impressive selection of things to do outside, both in the city and the surrounding countryside. Over the years, we’ve played badminton, did yoga, walked, ran, swam, rock climbed, and hiked. We also had friends who did tai chi, self-defense, as well as danced, played hockey, bicycled, and kayaked, among other activities. Many clubs can be found online and meet regularly.

Unfortunately, Thailand’s smoky season put a damper on our exercise routine. We knew we were compromising our health if we did any outdoor activities between February and May. What we didn’t know until early 2018 was that the PM 2.5 levels indoors are nearly as high as those that are outdoors! Unless the gym’s windows and doors are properly sealed and the room is equipped with air purifiers (which is highly unlikely – we’ve not once seen or heard of a gym with one), you’re harming your heart and lungs with the exact pollutants you’re trying to avoid.

Being part of a community

The effects of living far away from home, in a country whose culture is starkly different from where we grew up, are two-fold. There are the effects caused by leaving behind one community as well as effects when integrating with a new community.

As many new expats are, we were thrilled with the prospect of living abroad. And that lasted quite a long time because it took several years for us to began to miss our families and friends. Luckily, it’s easy to keep in touch. We make it a point to stay up to date with friends and family over email, Facebook, and the occasional phone call or video chat. We also look forward to taking our trips to the US and make our rounds seeing as many people as we can.

Chiang Mai has a very large expat community, which has grown considerably even in the five years since we moved there. You can find expats that are retirees, teachers, non-teaching workers, digital nomads, spouses of Thai citizens, missionaries, brick-and-mortar business owners, and a few others. Most people can settle down into one or two of the groups and develop lasting friendships.

Our unique situation made it a little difficult for us to fit into any group. Plus, Chiang Mai is a very transient city, and many people don’t stay for more than a year or two. Without going into specifics (we’ll save that for another post), it’s been difficult for us to make and keep friends, but not impossible. However, we think that most people are able to quickly settle into communities, especially in the expat-friendly towns.

Getting medical treatment

We love that Thailand provides medical treatment for a fraction of what it used to cost us back home. There are loads of stories online where people have flown to Thailand, had surgeries, stayed a week, and flew back for less than the price of what’s they’d pay in their home country. For us Americans, Thailand’s prices are between 15% and 25% of US prices! Here’s a little comparison chart.

Note: Prices in Thailand paid in Thai baht (1 USD = 33 THB)
Item Price in the USA Price in Thailand
Hormone Injection 78 USD (medication)
100 USD (consultation fee)
25 USD (administer fee)
12 USD (medication)
3 USD (administer fee)
20g 0.025% Retin A Cream 148 USD 4 USD
Routine Teeth Cleaning 100 USD 12 to 14 USD

Another thing we like about Thailand is that we don’t have to have a prescription for some items back home. For example, we can buy Retin A from the pharmacy and contact lenses from the optometrist without a prescription in hand. We love the convenience!

Regarding health insurance, signing up it is a personal decision. If you do choose to have health insurance, there are many local and international companies to choose from. You can also use traveler’s insurance to cover you during the first few months of settling into your new home. However, Thailand’s medical prices are fantastic for people who prefer paying out-of-pocket.

However, not all medical treatments are available in Thailand. There are life-saving or life-changing medications, namely narcotics and psychotropic drugs, that are strictly regulated or downright forbidden in Thailand. We are fortunate that we do not depend on these drugs, but others are not so fortunate. Just last month we had a reader email us about her struggle to find Low Dose Naltrexone (LDN) and T3, a thyroid medication. Unless she flies back to her home country or manages to have the medication shipped to her from overseas, she can’t get what she needs.

For anyone who is interested in alternative medicine, there are communities practicing these healing methods all over Thailand. In fact, since living in Chiang Mai, we’ve learned a lot about crystal healing, reiki, acupuncture, vegan and raw diets, applications of essential oils, yoga, meditation, and Ayurveda, among others. We had heard very little, if anything, about these while we were living in Northern Virginia. It’s definitely very eye-opening.

For a more comprehensive wellness overview, check Aetna International’s Wellness Survey 2018. It interviews more than 30 families from across the globe and provides a broader perspective outside of living in Thailand. It’s interesting to read about others’ experiences. At the end of the day, there seems to be a general consensus about wellness, regardless of where you choose to live.

Disclosure: This post is brought to you by Aetna International. We shared an honest recap of our challenges so that you can make an informed decision about living in Thailand as an expat.

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