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In a large pot over medium, heat the oil until shimmering.
Add the onion and ginger; cook, stirring often, until the onion is translucent, 5 to 7 minutes. Add the chicken and fish sauce, turning the thighs to coat, then stir in the coconut water, broth and ¼ teaspoon pepper.
Bring to a boil over medium-high. Add the lemon grass, then cover, reduce to medium-low and cook, stirring occasionally, until a skewer inserted into the chicken meets just a little resistance, 18 to 22 minutes.
Stir in the chayote and coconut. Cover, increase to medium and return to a simmer. Continue to cook, stirring occasionally and adjusting the heat as needed to maintain a gentle simmer, until the chayote is tender-crisp, 8 to 10 minutes.
Remove and discard the lemon grass. Add the spinach and stir until just wilted. Remove the pot from the heat, then taste and season with salt and pepper. Serve garnished with the sliced chilies and with lime wedges on the side.