SN Kluay transferring a severe head injury patient
SN Kurn suturing a wound
SN JJ with a burn contracture postop patient
SN Kurn performing tonometry
SN Ying suturing a laceration in the ER
OR Manager Sriwilai and AN Taweelit
AN Nit with SN Ying and visiting SN Hannah resuscitating an infant
SN Kulap and SN Onn on the wards
I’m told that the very beginnings of medical care in the Sangkhlaburi area started with nurses. And even after the doctors came, there have been times when there were no doctors in Kwai River Clinic/Hospital. But our nurses have been there throughout our hospital’s history…. with the baton passed from one generation to the next.
Lea Lindero caring for a baby in the incubator
Matthew 25:40 … Anything you do for one of the least of these brothers and sisters of mine, you did for me.
Construction progressing on the “new” Kwai River Christian Hospital in Huay Malai, approximately 1983-1985. These photos were taken from the water tower of the mission compound.
“What if we built something ‘bambooish’ to start with?” I remember Dr. Lois Visscher saying something like this around 1982 during one of our discussions about the uncertain future of the Kwai River Christian Hospital.
The Electrical Generating Authority of Thailand was in the process of constructing a dam that would result in flooding of the valley of the Khwae Noi River (often called the Kwai River in English). Detailed surveying by EGAT had shown that the Kwai River Christian Hospital at its original site would be flooded out along with several villages. Time was running out for us. The reservoir would start filling in June, 1984. We had to decide whether to rebuild or close down.
Front entrance of the original hospital building, probably mid to late 1970’s. The hospital site was only about one kilometer from the bed of the long abandoned “Death Railway”. The objects in the foreground are railway wheels which Dr. John Freeman hired elephants to drag in as a memorial to the thousands of Asian coolies and Allied POW’s who died laboring on that infamous railway project.
The Kwai River Christian Hospital as it appeared about 1980. At this point the building had served the community over 15 years. It was doomed to be swallowed up by the reservoir in 5 more. The front entrance to the hospital is on our right behind the coconut trees; the operating room and delivery room are at the near end of the hospital.
Map of the Sangkhlaburi and Thongphaphum areas of western Thailand depicting roughly the area flooded by the reservoir that backed up behind the Vajiralongkorn Dam, also known as the Khao Laem Dam. The note at the bottom of the page about travel times by car or boat was true in 1984 but no longer apply. There is now a paved road all the way from south of the dam to the new town of Sangklaburi. That distance can be covered in about an hour.
Map of original location of the Kwai River Christian Mission. This was drawn up by “Uncle Billy” roughly around 1982. Please disregard the circled numbers. The buildings have now been labeled directly on the map. [Left click once on the map to enlarge it.]
The mobile clinic team was able to travel by boat to some of the villages on the circuit. Here Olivia, who headed up the mobile clinic program, secures the cargo. The original Kwai River Christian Hospital was built near the bank of the Ranti River, one of the tributaries of the River Kwai. The mission boat landing was in front of the doctor’s house.
When roads became impassable in the rainy season, patients were still able to get to the hospital at the original site [Lainam] by boat.
By “bambooish”, Dr. Visscher meant a structure that used inexpensive, locally available building materials such as bamboo. Dr. Visscher had been a missionary in India for about 40 years before she aged out according to the rules of her mission board. She then came to help at the Kwai River Christian Hospital! She was used to economizing from her days in India.
But why rebuild the Kwai River Christian Hospital with cheap materials? It’s because some were asking, “Why rebuild the Kwai River Christian Hospital at all?” The KRCH had been in operation since 1963 (and had operated as a small clinic in a wooden shed for a year or two before that). In those twenty years of operation, the hospital had served thousands of patients, but there had been frequent problems staffing the hospital, especially with doctors and nurses. Twice the hospital had closed for lack of staff. Some said, “Maybe it would be better to just close the hospital, and eliminate these headaches!”
Another force dampening enthusiasm for building a new hospital, robust from end to end, was uncertainty as to whether the villagers would actually move to the relocation sites assigned to them: “What if the hospital moves to its assigned relocation site but the villagers don’t move to theirs? The hospital might end up serving a very sparse population.”
The Electrical Generating Authority of Thailand did provide some compensation for villagers and institutions. However, the compensation for the hospital was not sufficient to rebuild the hospital with all new robust materials from one end to the other. We decided to build one end of the hospital robust and the other end “bambooish”, with the intent of gradually upgrading the cheaply built end if the hospital was well utilized. The service and support area of the hospital (operating room, delivery room, x-ray, pharmacy, and central supply) was built robustly. This allowed medicines and equipment to be stored in locked rooms. The inpatient and outpatient areas of the hospital had a concrete floor but woven bamboo walls.
Ben and Doris Dickerson, long time missionaries among the Karen people, were assigned to the Kwai River Christian Mission, arriving in June, 1982. Ben was put in charge of moving the Kwai River Christian Mission, including the hospital. He was assisted by Jit Yawan. Doris was assigned to the evangelism department of the Kwai River Christian Mission.
Jit Yawan (far left) was Ben Dickerson’s foreman during relocation. Here he poses with his bride-to-be, Jan Vertigan, his parents, and her parents. Jit’s Dad was village head man of Nithe Village during the 1950’s when missionaries were exploring the area. He was in favor of the missionaries setting up a hospital and school. Ultimately, a plot of land just west of Nithe was granted (in the Lainam jurisdiction, where Kamnan Thun Sa was headman). At the time this photograph was taken, Jan was head nurse at the Kwai River Christian Hospital. This not only carried the usual responsibilities of head nurse but many additional duties related to relocation as well.
Loes deVos, missionary pharmacist from Australia, was responsible for packing up the medicines and supplies for the move to Huay Malai. At one point, the operating room and the delivery room at the “new” hospital were not available for operations and deliveries because they were filled with medicines and supplies. This, because they were the only rooms at that point that could be locked.
Woven bamboo walls divided examining rooms in the outpatient department.
Patient, nurse, and relatives in the large open ward on the “bambooish” end of the hospital. Note the bamboo latticework for a wall behind the patient: one of many measures taken to try to keep construction costs down in the “bambooish” end of the hospital.
Missionary nurse Lea Lindero checks on a patient in the open ward of the “new” hospital in Huay Malai. Note the woven bamboo “walls”. When it became clear that the hospital would be well utilized, the bamboo was gradually replaced with concrete blocks. Also the large open ward was partitioned into two medium sized wards and two semi-private rooms. The man on the left is Don Cross, volunteer electrician from Australia, who helped with the wiring of the new building.
Dr. Edwin McDaniel standing in front of the Khao Laem Dam while still under construction, about 1983. This is the dam that flooded out several villages and the Kwai River Christian Hospital.
The shell of the original Kwai River Christian Hospital building: forlorn but still standing. Note that the roofing, door frames, window frames, glass louvers, shelves, and cupboards had all been salvaged for use in the “new” hospital in Huay Malai about 10 miles away. Even the trusses that held up the roof of the original building were re-used. For that reason the “new” hospital had to be built the same width as the original. This photo was taken shortly before the reservoir filled: probably about 1984.
Two man sawpit: The builders hired to move the mission compound (hospital, school, boarding house, workers’ houses, and more) salvaged as much wood as they could from the buildings at the old site, but there was still a need for more. This was due in part to some of the old wood being dry rotted, termite-eaten, or otherwise unusable. The demand for new wood was also driven by the increased number of buildings at the new site.
Watch your toes! Many large trees stood on the old mission compound. They were going to be flooded out if not harvested first. It made no sense to buy wood on the outside when we could hire sawyers to saw the wood on the old compound into planks that could be used on the new. The endurance and skill of these men was impressive. This is dangerous work!
Driver applies chains to one of the back wheels of the “six wheel” truck bought for the relocation project. During relocation, trucks carrying building materials salvaged from the old site to the new site sometimes had to use mud chains to make it through. Muddy conditions prevailed during each rainy season, about June through September.
This is what the road looked like in front of the hospital in the rainy season about 1984.
Original site of the Kwai River Christian Hospital, now covered by the waters of the reservoir. Note the coconut trees at “half mast”, the water level having crept half-way up their trunks. About 1985.
Visiting all that remained of the duplex housing for single missionary ladies at the old site (about 1985). Flooring, siding, roofing, windows, and doors had all been transported to the relocation site for use in buildings there. Note the rising waters of the reservoir in the background. To our left is the boatman hired for this trip. In the center with back to camera is Linette McDaniel. On the right, pointing to the “ruins”, is Jan Stretton, missionary nurse, who used to live in this building.
As a cost saving measure, long slices of bamboo were used in place of steel reinforcing rods. This was not my idea, but I did not oppose it. I wish I had. The workmen used wooden stakes to hold the latticework of bamboo off of the dirt surface below before pouring the cement. Later, we had a big termite problem!
Pouring cement floor for what was to become the large open inpatient ward. Note the bamboo “reinforcing bars” underneath.
This wooden guest house, moved from the original hospital site, was used as temporary pharmacy, lab, outpatient examining room, and operating room while the new hospital building (behind us) was being built at the Huay Malai site. Note the outhouse in the background.
Morning worship. Same building as on left but from the inside looking out. Staff members have left their shoes at the entrance in order to keep the floor clean. In the background is the Huey Malai hospital under construction. Note the two colors of roofing. The darker colored roofing was salvaged from the old hospital building; the light colored roofing was bought new.
Same building, here being used for the Under 5’s clinic, a health maintenance program for young children.
Same building as in the photos above and left, but a year or two later. At this point in the building’s history it was back to being used as a guest house for patients’ relatives and for long term patients, the way it had been used at the original site. Note the laundry hanging out to dry!
New hospital in Huey Malai under construction about 1984. Note use of woven bamboo for the wall on the near end of the building and, in the background, the use of old roofing salvaged from the original hospital building.
Brick and mortar section of the hospital under construction even as patients check in and check out.
Inpatients and outpatients receive care even as the hospital is being built around them.
Same area as above but 1-2 years later
The land in front of the “new” Huay Malai hospital before it was cleared by a bulldozer.
Same building. This was taken shortly after the land in front of the hospital had been leveled by a bulldozer.
The “new” hospital in Huay Malai turned out to be well utilized, serving two refugee camps along the Thai-Myanmar border as well as the villages near Huay Malai, the new town of Sangklaburi and points beyond. The “bambooish” end of the hospital was upgraded by degrees, until it began to look like a real hospital. At no time did patient care cease. It was available either at the old site or the new and for a brief time at both. To bring this about was a bit of a challenge as a major amount of construction material was being salvaged from the old hospital to use in the construction of the new. After the carpenters removed the roofing and support structures from half of the hospital at the old site, there was nothing to keep the rain from falling into the unroofed hallway and making its way to the part of the hospital which still had a roof. We had to chisel a small diversion channel so that the rainwater would run out the side of the hospital rather than continuing into the pharmacy and x-ray area.
KRCH (Huey Malai) at time of completion of main building. L to R: Front entrance of the Kwai River Christian Hospital; banana plantation in the hospital compound, water buffaloes grazing outside the hospital fence, road to Sangklaburi. In the background is the village of Huay Malai. Probably mid to late 1980’s.
We are standing in the front entrance of the Kwai River Christian Hospital looking out, Huay Malai, about 2000.
In 19– a new wing was added to the Huay Malai hospital. In the 1980’s and 1990’s the Kwai River Christian Hospital and the Armed Forces Research Institute for Medical Sciences (US division) collaborated on several research projects.
Front entrance to KRCH. Huay Malai about 1990’s.
Front entrance to KRCH, probably on an “Under-5’s Day” in the 1980’s
Nurse Sabaithip at hospital entrance, 1980’s or early 1990’s
The changing face of KRCH, Huay Malai
Over the years it has become more and more difficult to meet the building codes of the Ministry of Public Heath at the Huay Malai facility. The parts of the Huay Malai structure that were salvaged from the original (1963) building are now 55 years old. Construction is already underway for relocating the hospital once again. With financial assistance from Overbrook Hospital in Chiang Rai, USAID, and Church World Service, this new building will be up to date and ample in size. The building is going up in Sangklaburi Christian Center in the town of Sangklaburi, the transportation hub for the district of Sangklaburi.
Second relocation: the next big move (still pending at the time of this post). Artist’s conception of the new Kwai River Christian Hospital building due to be completed in late 2019 or early 2020.
Over the years a great deal of time, effort and money has gone into building, relocating, upgrading and remodeling. When the new building (at Sangklaburi Christian Center) is complete, the Kwai River Christian Hospital will be able to move into the largest and best equipped facility in its history. However, the most important asset of the hospital will still be its staff. My hope and prayer is that the doctors, nurses, aids, pharmacists, cashiers, and cleaners will always feel genuine compassion for the sick and suffering and that “Caring for the weakest on behalf of God Almighty” may be a daily practice, not just a motto.
From the 1960s through the 1980s the hospital was still quite remote. Budget was tight. Much of the equipment had been donated and was quite old. To keep expenses low we made do with the materials and equipment we had.
With no regular electricity available during the day, we had to either start a “back-up” generator to provide power for, say, surgery or x-rays, or we had to schedule procedures for a time in the night when we expected that there would be electricity.
This 15 kVA 2-cylinder diesel generator was run from dusk to about 10 PM each night in the mid 1980s to supply the mission compound with power the first part of each night. Outside of these regular hours, it was used for urgent electric power needs at the hospital such as x-rays or surgery. After the arrival of government power in the late 1980s, it became a backup generator used during the frequent power outages.
Nurse Eiam providing the air pressure required for a nebulizer treatment for an asthma patient, using a bicycle pump.
Another asthma patient getting a nebulizer treatment powered by air pressure from a bicycle pump.
This man had been gored in the chest by a wild ox and had a collapsed lung on the right with some bloody fluid in his chest. I put in a chest tube to drain the fluid and help re-expand the lung. The only suction machine we had at the time was this hand-operated vacuum cylinder. It was not very efficient. Staff were encouraged to stop and give a few pulls on the vacuum pump each time they passed by the room. The patient made a gradual recovery. In fact, he is the happy fellow returning home by boat with his family in my “Boats, Carts and Elephants” post.
This spotlight, powered by a motorcycle battery, was primarily used by the night watchmen for the hospital and mission compound. It was also useful by day to search for termite entry points. When the electricity went off in the middle of an operation, it came in very handy as an emergency light source.
In the 60’s and 70’s there was no electric cast saw. Casts had to be removed by small crescent-shaped hand saws. This was a tedious task assigned, in this case, to the hospital gardener. Sometimes it was assigned to a friend or relative of the patient or even the patient himself!
In the early days of the hospital, patients came and went using multiple means of transportation. The method used in a given case depended upon distance to travel, the season, the patient’s resources, what types of vehicles could get through, and how ill the patient was.
At the original hospital site [now under water due to a hydroelectric project], patients were sometimes brought by boat. See boat in foreground, patient in a hammock suspended from a bamboo pole in the background. (early 1980’s)This patient [the man behind the mahout] arrived at the hospital on elephant back. As I recall, his reason for coming to the hospital was giddiness. Given that elephants lurch and sway when they walk, this was a curious choice for means of transportation.
Oxcart pulling up to the front of the hospital (probably in the late 1980’s or early 1990’s).Patient suspended from a bamboo pole approaching the rear entrance of the “new” hospital in Huey Malai. [This picture, taken by my dad, Dr. Ed McDaniel, during one of his volunteer stints, was actually staged following the recovery of the patient!] Note that the patient is suspended from the pole by sarongs, the same type of garment worn by the bearers of the pole. Patients who arrived at the hospital this way were usually in bad shape: incapacitated by a land mine injury, a gunshot wound, a stroke, cerebral malaria, cholera, or snake bite. (mid 1980s, rainy season; hospital staff houses in the background)Two patients slung from hammocks in the back of a pickup truck. (probably late 1980’s or early 1990’s)Patients often come and go from the hospital in taxi-buses: pickup trucks with two long benches in the back. (1990’s)These passengers boarded this “long tail” boat at the boat landing in front of the doctor’s house at the original hospital site. It was taking the mobile clinic team to one of the villages it regularly visited and was also returning a patient and his family to their home. (early 1980’s)Many patients came to the hospital on motorcycles: usually just 1-3 per motorcycle, but sometimes more! Hopefully this family has now heard about family planning. (early 1980’s)Patient and family heading home after hospital discharge (early 1980’s).Patient, improved, returning home with family (early 1980’s).
Volunteers from many countries have donated their time and talents to further the work of the Kwai River Christian Hospital and benefit the community. They have generally paid their own way to get to the Kwai River Christian Hospital and paid for their own room and board while there. Some volunteers have been repeaters, giving of their time and talents again and again. A few volunteers are pictured below. I hope to add more photos as they get digitized.
Bruce Mills trying to keep his boots dry by pole vaulting across the stream. Bruce came with Phil Blackman and son Andrew Blackman to put in a gravity-fed water system for the Village of Yakadee.
Phil Blackman and Bruce Mills. When I asked Phil whether he thought he could improve the function of our rickety old operating table [this table swayed a bit from side to side and also slowly sank under the weight of the patient during operations], he said, “Not a problem. It works just like a piece of farm machinery!” At that time Phil Blackman was managing a farm owned by a specialist surgeon in Australia and Bruce Mills was running a sheep ranch.
Bruce, Phil, and Gideon give the operating table a test ride after their overhaul job done in the hospital’s back yard.
Dr. Ed McDaniel covered the KRCH many times. The first time was in the early 1960s when he covered the hospital for a week or two for Dr. Doug Corpron. At that time, son Philip was still in high school. In this photo, probably from the late 1980’s, Dr. Ed is examining a patient recovering from a coma. Patient is lying on a mattress on the floor. I think this is because the beds were all full. However it also could have been a precaution against falling out of bed due to a seizure or disorientation.
Dr. and Mrs. Curry (Frank and Beryl) in Washington State, USA, where Phil McDaniel went to visit them in July, 2004. Frank and Phil’s dad, Dr. Ed McDaniel, together covered the KRCH for about one year (1987/1988) while Phil was on furlough in the USA. Frank and my dad both turned 70 in 1987. Their birthdays were just four days apart. They referred to themselves as “the two old men manning the fort”.
Dr. Keith Dahlberg and nurse Satja, round on a patient in the big ward. Dr. Dahlberg took turns with Dr. Bina Sawyer and Dr. Ed McDaniel to cover the hospital part of the time during the two year gap between Dr. John Freeman and Dr. Phil McDaniel. In later years, Dr. Keith returned from the States 2-3 times to cover the KRCH so Dr. Phil could go to a conference or go on vacation. Dr. Keith has been listed in some accounts of the hospital’s history as one of the former directors. However, he was never officially the hospital director at KRCH. He was director at Maesariang Christian Hospital.
Dr. Akira Koga from Japan [back row, center, flanked by Dr. Phil McDaniel and nurse Ebra Sanba] with cataract patients in the mid 1980’s. Dr. Koga came twice, sending expensive donated equipment ahead of his first visit.
Dr. Koga testing visual acuity of a patient following cataract surgery.
Improved vision following cataract surgery. Note that this was in the mid 1980s. We were still using an old method involving removal of the entire lens (intracapsular cataract extraction) and no placement of an artificial intraocular lens. This was in the days when post cataract surgery patients had to wear thick glasses.
The staff called visiting dentist, Dr. Phil Horton, “Dr. Phil Tooth” to distinguish him from Dr. Phil McDaniel.
Dr. Phil Horton works on a student while curious schoolmates look on.
Dentist Phil Horton with translator and assistant Kalay (left) and gardener-turned-denture-maker Moung Oo (right).
Dr. Mathew Clark came for a volunteer stint in the 1980’s. Here he is aspirating a liver abscess. We located this clinically [no ultrasound or CT scan at KRCH in those days!]. Patient felt much improved after aspiration.
Forest Daugherty, family practice doctor from Columbus, Ohio made two trips to KRCH with his wife, Marsha. Their enthusiasm was infections.
Marsha Daugherty accompanied her husband, Dr. Forest Daugherty on two volunteer trips to KRCH. While Forest saw patients, Marsha led a charge to dust and wash glass louvers as well as scrub walls and clean shelves. When Forest was not examining patients, he and Marsha worked together to sand and varnish some of the woodwork in staff housing.
Don (electrician) and Jeanette Cross from Western Australia. Don came to KRCH two or three times. He did extensive wiring jobs and over-saw the installation of a hospital-wide suction system.
Dr. Jim Smith, ear, nose and throat specialist from Oregon, USA, evaluates a patient with a large goiter (enlarged thyroid gland). We later removed this under local anesthesia.
Dr. Smith made a side trip to KRCH following a medical conference in Malaysia, which we had both attended. Here Dr. Smith is operating to remove the large goiter pictured above (Phil assisting).
Dr. Steve Parker came to KRCH for an elective rotation as a medical student. Later he returned as a resident and still later, while he was an attending physician at Oregon Health and Sciences University. The white streaks on his face are from the application of a cooling slurry of water and mentholated powder. This was applied by someone on the hospital staff as a gesture of goodwill and compassion during one of the hottest days of the hot season. In his hands Steve is holding a generous helping of mangoes and sticky rice.
Dr. Veeraphan evaluating a possible candidate for eye surgery at KRCH
Dr. Veeraphan working on an eye patient in the operating room at the Kwai River Christian Hospital. Most of his visits were in the 1990’s. He performed extracapsular cataract extractions with intraocular lens placement.
Dr. Veeraphan, eye surgeon, and his team came every three months for several years. The vehicle they used was donated by CBM.
This man had particularly dense cataracts. His grandson (center) had been his guide, leading him around with a stick. After cataract surgery he was able to walk independently. He was pleased with that and also very pleased that he was now able to see his grandson for the first time!
Cataract patient being led by grandson before his cataract surgery. The look of anxiety on his face was soon to be replaced with a big smile!
Dr. Phil McDaniel consults with Dr. Doug Walsh (left) and Dr. Scott Miller (both connected with AFRIMS) on the day of the official opening of the AFRIMS-KRCH Clinical Research Building
Friday the 20th started with an innocent pitter-patter of raindrops, as almost every morning does during the rainy season. By late morning it was clear the drainage ditch bringing water under the road in front of the hospital was in trouble. It had been about 5 years since the last flash flood had swamped the hospital, but immediately, the hospital staff went into high-gear to move all the equipment and medications to the higher ground of the inpatient annex and above the level of the flood waters. The Saha Christian School next-door closed classes early, and sent us their older students to help sandbag off and seal the front and rear entrances to the building. Unfortunately while they were battling at those fronts, the floodwaters came up rising up through the sewers and the toilets.
Sand bag barricades
Setting up a water pump
Flooding down to the OR, X Ray room, Pharmacy and Medical Records
The little army of volunteers barricaded the CT room with plastic liners and sandbags, and scooped with anything that could hold water, while water pumps were set up. After a couple hours of valiantly battling the rising tide of murky water, it began to recede towards the OR and labour and delivery rooms, where the waters were deepest.
Setting up a water pump
Kru (“teacher”) Lindsey even sent her brothers to help
By the end of the day, with much sweat and elbow-grease, we had mopped up the outpatient area, the ER and OR. The CT room only had 2 cm of water sneak in, and after a quick check, we left the CT room sandbagged overnight for safekeeping.
Ajarn Maniwan our evangelist
Our pharmacist
Sweeping water out of the OR
Kru (“teacher”) Lindsey even sent her brothers to help
Head nurse Tik weeping water out of the OR
Nurse Kulap at work
Nearly everything is functional again, except a non-portable x-ray machine, and we are waiting for the electronics for the server portion of the CT machine to dry out a bit more before the technicians inspect it and we risk turning the power back on.
Our rainy season lasts until the end of October, so we are praying that this does not happen again. We will be ready though, and it was such a blessing to see everyone working together in the smelly water to get the hospital cleaned up and running again!
Join us to give thanks to God for the provision of light enough for each step on the journey, as well as the camaraderie and gracious assistance of many who have helped to lighten the load of the full-time team serving at KRCH.
Please do pray along with us to use our resources wisely to serve the community entrusted to us, and those who have trusted us for their care.
Pray for healing and wholeness for the physical, emotional and spiritual health of our staff, especially for some who have gone through loss and sorrow. May our Lord be their comfort and source of strength.
