Couple random:
- At the hospital I am treated like a VIP, it is really like
nothing I have experienced. Everyone
seems to know me, as if there was alert about my arrival. Many nurses and staff know my name! They have a nice little cafeteria with a set
lunch menu that is 30 baht every day!
The food is actually amazing. I
see the nice cooking ladies on the main floor feverishly creating the dishes
for the day when I walk by in the morning.
My first lunch, I sat down and the pharmacist assistants helped me order
and pay. And then this huge spread of
food showed up! I mean, beef brisket
with vegetables, egg omelet, curry soup with fish balls, rice, and others.
This was one of many VIP lunches I received. It seemed I always received way more food
than others! Haha, the women always
seemed to have an extra glow on their faces when they brought my food out
=D. I tried to tip one of the ladies and
she gave me an emphatic “no,” and then “no no no” and smiled. Must be policy.
-I was speaking to one of the interns and they mentioned
that many people become sick during songkran festival. It seems they have diseases of Songkran,
including heat exhaustion, trauma from motorbikes, acute alcohol intoxication,
and water borne diseases like leptospirosis and acute gastroenteritis from the
some of the water that is thrown (maybe even river water!). It is hard to keep out of your mouth. We have on the wards one guy who is 27 who
developed fevers, cough, after songkran and developed a significant lobar
pneumonia with a rapidly formed pleural effusion a week later. It seems like a typical strep pneumonia with
parapneumonic effusion but who knows, its Thailand! They sent studies and seemed like exudative
with predominantly wbc’s but 88% lymphs.
ADA was pending. I am just really
suspicious of a young healthy guy with no history showing up with a
pneumonia. But maybe songkran partying
for a week was enough to impact his immunity.
-The Thai people respect their elders very much. The Doctors refer to their colleagues if they
are older by adding “P-“ and younger sometime with “nong.” So Cheer, the students of chines medicine,
calls Dr. Mai “P-mai.” Very interesting.
-Thai massage hive story:
I was at the Thai massage clinic and one of the masseuse grabbed
me. She had a pruritus rash on her arms
that clearly were hives. They looked
quite uncomfortable. I wasn’t sure how
things worked in the pharmacy, but I said give me a second. Walked to the main hospital and into the
pharmacy to look for steroid cream and Benadryl. They luckily had an equivalent 1st
generation anti histamine and mild steroid cream. So easy, just walked off with it and gave it
to the masseuse. I checked on her the
next day and it had all resolved.
-They have a major issue with malpractice brewing in the
country… The government does not provide
malpractice insurance… Craziness. This apparently is a major issue. Dr. Tip knows of a surgeon who performed an
appendectomy, and there was an unexpected complication. The family went to the police, and they
arrested him right from the hospital!
They pressed criminal charges, despite no negligence. The family was claiming he should have
transferred to larger hospital. It was
so traumatic and costly for the doctor that they retired!! Unbelievable.
This trend of litigation is increasing per Dr. Tip. She said that there is a high level of
paranoia because of this but they have not been able to catalyze change at the
national level for protection. The
interns tell me some patients at larger hospitals will say “I need a CT scan,”
and if the doctor disagrees the patients says “well then I will get a
lawyer.” I am just speechless from
learning this. How is a government not
protecting such an important commodity as their governmental physician workforce???
***** UPDATE****** I found otop products at LAX-c the thai costsco style store in Los Angeles.
-Many patients with asthma are treated with
theophylline. It is very interesting
because we obviously do not use this medication because of side effects and
better alternatives. We even had one woman
come to asthma clinic with afib with RVR who was on theophylline. Dr. Kim and I had a little laugh when we
looked at her med list and both looked at each other.
- Laboratory services are limited during the evening and
especially weekends. Blood cultures for
example cannot be sent during the weekend.
They currently do not have a microbiology lab and have to send to the
larger hospital.
- Long white coats are actually reserved for medical
students. The interns and head doctors
all wore polyester formal button up shirts with the hospital logo. I think because of the temperature (reaching
as high as 110 F while I was there), you are rewarded by wearing less and
having dry fit material! =D. Poor med students, they must be so hot. It is funny how we have it reversed in the
US.
- In the primary care unit visit to a small clinic a patient
presented with depression. They only
have amitryptiline, unfortunately SSRIs are not readily available. They also have limited counseling for anxiety
and depression, although they have it for alcohol and drug dependence. It is interesting because SSRIs are often
very cheap. I am not sure why they are
not on formulary with the government small hospitals.
- Common complaint in clinic was palpitations. Also, fatigue is common. In the ED they also see this symptom during
the summer months. Patients get
dehydrated and they show up for IVF therapy.
- They PCU doctors
told me that they do a community diabetes screening. They tell me it is well attended. It definitely keeps the PCU diabetes and
hypertension clinic busy!
- Also at the PCU we visited they have a specialized dental
RN that does a lot! She does
extractions, cavity filling, cleaning.
The dental RN I met said her name was “Lu mu, which means, little pig.
Because I’m fat.” =D Thai people seem to like to make fun of
themselves without being shy about it.
Being fat seems to be quite rare here.
- While in the asthma clinic a man in Monk garb told us that
he has a history of cocaine use. This is
so interesting to me. I did not realize
that anyone can enter a temple and monkhood if they desire and are approved by
the Wat (temple). So people can use it
as a rehabilitation and move toward a more pure and clean life. In the asthma clinic they like to trend the
CAT score. We don’t use that score to my
knowledge.
- I asked one of the pulmonary nurses if they use Incentive
spirometry on the wards to reduce post-op pneumonias and atelectasis. She grabbed a tissue, held it up like a sheet
and then acted like a patient. She said,
“we don’t have incentive spirometry, this is Thai version. And blew on
it.” Haha, they certainly have a sense
of humor at this governmental hospital.
-blood culture on weekend, unfortunately is not available at the hospital... Major issue.
-communal rounds. All the patients listen in during rounds on the other patients. Leads to some amusing experiences.
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