​What kinds of symptoms do patients experience before receiving treatment?

The most common symptom is swelling, a lump or a bulge in the affected area. The bulge, lump or swelling will be more pronounced when standing up, bending down or coughing and can disappear when lying down. Some patients also experience pain or discomfort at the site of the hernia. Overtime, pain can increase at the site of the bulge, especially while doing certain activities such as lifting objects. The bulge can also increase in size over time. Patients can also experience a sudden and severe pain at the site of their hernia.

​What is the impact on patients’ lives of living with these conditions?

Over time, a hernia can grow larger and more painful. Due to the symptoms of the hernia, adult patients may have difficulty caring for their families and completing day-to-day chores. They may miss work or lose their jobs altogether, resulting in a decrease in income for their families. Children can miss school or drop out, resulting in a lower quality of life in the future. Untreated, hernias can cause life-threatening complications. Complications of an untreated hernia include strangulation, where a part of the intestine becomes trapped between abdominal tissue, which cuts off blood supply to that area of the intestine. The patient may experience nausea, vomiting, acute pain, bloody stool and a fever.

What cultural or regional factors affect the treatment of these conditions?

Many adult patients with inguinal hernias, especially male patients, feel too embarrassed to seek medical attention due to the fact that inguinal hernias affect their groin, an area of the body still considered taboo to talk about in our local cultures. Because of this, they will usually only seek treatment when their condition is severe and they are in a lot of pain. Due to the severity of their condition, they will usually need to undergo urgent surgery. Additionally, hernia patients from low-income households will delay seeking medical care because of financial difficulties paying for treatment and travel to a hospital. Migrant patients may not know how to go about accessing care in a local hospital, and may refrain from seeking help because they do not speak Thai.

What does the treatment process look like?

The patient undergoes a blood test and an ultrasound scan if the doctor thinks it is necessary to confirm a diagnosis. For adult patients without any underlying conditions, hernia repair surgery can be performed quickly. However, if the patient has underlying conditions such as high blood pressure or diabetes, their underlying condition must be managed before they receive surgery. A patient usually spends about 2-3 days in the hospital.

What is the impact of this treatment on the patient’s life?

After the surgery, the patient will no longer experience pain and will be able to resume normal daily activities. Any other symptoms caused by the hernia such as nausea or vomiting will be alleviated.

What potential side effects or risks come with this treatment?

Potential risks of undergoing surgery for hernia repair includes a wound hematoma, bladder injury, an infection at the site of the surgery and allergic reactions to anesthesia. In addition to this, a hernia can reoccur after surgery, pain from undergoing abdominal surgery may not diminish and digestive complications can arise if a section of the intestine needs to be removed. In male patients undergoing inguinal hernia repair, the testicles could be harmed if connecting blood vessels are damaged. Additionally there could be nerve damage or damage to nearby organs.

How accessible is treatment in the area? What is the typical journey like for a patient to receive care?

Hernia repair is available at most district hospitals in Thailand. However, since most migrant and refugee patients have to pay out of pocket, most cannot afford to pay for it. Additionally, the language barrier keeps many patients away. Therefore, many migrant patients will go through a number of clinics before they are referred to Burma Children Medical Fund. BCMF works with partners who have staff assisting non-Thai speakers in the hospital with navigating appointments and translation.

What are the alternatives to this treatment?

Hernias can only be treated through surgery and rarely get better on their own. Laparoscopic surgery is an alternative type of surgery for hernia patients. This type of surgery is less invasive and leaves smaller scars than open surgery. Because of this, recovery time is faster. However, most hospital in Thailand do not use this method of treatment.