May 9th, 2016 by Taylor Veh
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My last few days in Thailand were certainly eventful! Between getting ready to travel home and getting into the full swing of seeing patients really on my own, I’ve been on the go most of every day!

The hospital continues to see patients with several of the same complaints. There is gastroenteritis running rampant through this village, and we are admitting about a child a day due to concerns for dehydration. The littlest ones start crying once their IV goes in, and they don’t stop crying until they finally fall asleep!

I had one 18-year-old who allowed me to experience my first real cultural difference in medical treatment. He suffered from abdominal cramps (and diarrhea) so I continued to watch him while he received fluids. While I was repeatedly told about the pain, and I constantly reassessed the pain, nothing seemed to indicate we needed to be concerned. However, his mother complained to the hospital that I wasn’t treating his cramps, and I was finally told that the hospital almost always treats discomfort, even the discomfort we’d allow people to tolerate in the United States. I felt dumb and horrible for making the hospital look poorly to the patient, but given that he left the next day, I was reassured that I at least had not put him in any serious danger.

The outpatient department has started to see some more complicated cases. I really think the holiday weighed over our community the first half of my visit, and we are starting to see more than simple acute complaints. I was able to put my gynecologic interest to work with one patient, and I was so grateful to do so! We also helped care for a very young man with new onset atrial fibrillation. You never know what will walk through those doors!

Leaving Kwai River Christian Hospital was more difficult than I expected it to be. I have very rarely experienced the kindness that I have experienced from the people at KRCH (let alone from a working environment like a hospital!) As we lined up for pictures, and added a few people on Facebook, you start to understand how supportive these communities are to everyone, and that’s what makes it such a wonderful experience. I realized that I may be another wheel in the machine that is their revolving door of volunteers, but you can never take the experience from me and separate it from the person and physician I will become.

For your comic enjoyment, I have to relay part of the story of my journey back to Wichita. There are two buses that travel between Bangkok and Sangkhlaburi every day. I had a suspicion that something would go wrong when I left, and sure enough the 9:30 bus I had intended on taking had been cancelled. Through cell phones and a little game of telephone, we were able to get me on a minibus to Kanchanaburi, with a continued passing message of getting me to Bangkok. Once I got to Bangkok, I couldn’t get a cab to take me to my hotel, so I took the train to the airport, which is the closest train stop to my hotel. After a 40 minute wait, I got to the hotel about 10 hours after leaving KRCH. If you want to summarize a true international experience, it’s taking a little extra time for something to work out just a little differently than you expected.

April 24th, 2016 by Taylor Veh
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We have finally hit a little cooling spell here in Huai Malai, which means I have been using my blanket in the early morning hours! It is a very nice change from the heat. I went to the market this week and picked up some food and goods. I saw a patient from the hospital (young boy) who smiled and looked away when we realized we knew each other! The kids are so shy, and even more so when I catch them staring.

We have had a good week of outpatient experiences. I have seen patients every morning this week. Because I worked OPD all of last week, I am seeing several follow-up patients. The new ID fellow lets me handle seeing my return patients, which is nice, especially since they all have been fully recovered from their likely viral illness, and require about 3 minutes of my time! A highlight for me was a young man, my age, with Down syndrome. Much to the surprise of his family, he has lived for a very long time with (what sounds like) a very large congenital heart defect.

This week for me has really been about honing my history interpretation. That may sound odd, but when your question sometimes goes through three languages before you can piece it together, you have to get pretty good at figuring out the gist of what your patient is saying. I’ve learned that short, direct questions and answers seem to be the most helpful. One of our interpreters knows the questions I ask all our kids with fever and headache, so he asks most of them before I get the chance to!

Outside of OPD, we have been rocking the OR or theater all week. I got to have all of my obstetrical joy with a C-section for twins (girls!) who were both over 6lbs each! You have to wonder sometimes how all of these patients are able to do all that they do without all the miracles of “modern medicine.” We also were able to do an open nephrolithotomy, hernia repair, and vagotomy, antrectomy and Bilroth II anastomosis. I mean, come on, this is the stuff that surgeons dream of. I can’t even begin to describe how amazing it is to have a surgeon talk through all of these procedures with our patients awake, and squeezing your hand sometimes with anxiety.

I know that my time in Huai Malai will soon be ending. Like most 4 week rotations, I find myself just hitting my stride, realizing that today is Sunday, and I leave Saturday. I have found a couple of people who speak English and always say that my last day here will be my last day, “For now, but you will come back.” We’ll just have to see I guess.

***PSA: I will be posting a blog about my last week. I will also then post an essentially photo-only entry, and then a post with all the fun medical things I’ve learned about, that most of you won’t want to read.***

April 18th, 2016 by Taylor Veh
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Hello! I may have joked about needing fans last week in the heat, but we have moved past jokes. It is hot. Like too hot. Like July and August in Kansas hot, with very few places to catch an air-conditioned break. I have relied on naps and the kindness of the visiting physician and his family to share icy drinks to stay cool and ignore the oppressive 100+ degree days.

This week was the Thai New Year, Songkran, meaning that normal activities were suspended toward the end of the week. People in Thailand traditionally travel to their hometowns, where water fights and family gatherings reign supreme. The surgeon of our hospital took his family on vacation south to the beaches, so we had a different surgeon come with his family for the week.

This family has three little girls, and I must say they liven up our quiet neighborhood around the hospital! They run around in the heat, calling for “Auntie” (despite their mother’s best attempts to make them call me “Miss”) to come play. They opened their home to my roommate and I almost every day for treats and games. On Thursday they had a party for a birthday, and we had a large feast! Traditional Thai food is delicious, usually an assortment of grilled meats and “salads” which are sometimes too spicy for the American palates. My roommate and I baked a cake, and I have to say it turned out well considering our limitations.

The time off also left time for my American roommate and I to go crazy about the small gecko lizards living in our apartment. We had enough of them one day after one posted up in my bedroom. After chasing it out with a towel and bug spray I had to admit defeat there would be some somewhere, just not in my room. We have one that has taken permanent residence under the microwave…

Time does pass quickly. Having inpatient rounds and outpatient clinic makes the mornings fly. A full emergency department does the same. Empty hotter afternoons are a different story, especially now that all my roommates have left and I have the place to myself. I take refuge in my Spotify playlists and books. Another American arrives tomorrow.

Despite the holidays, there was still work to be done in the hospital. We round in the hospital as a team every morning. There has been a large outbreak of gastroenteritis, leading us to have several small children on the ward most days who are unable to maintain hydration with their vomiting and diarrhea. To make us Americans feel more at home, we also have an asthma exacerbation and newly recognized atrial fibrillation with heart failure.

Monday and Tuesday we were able to hold outpatient clinic, seeing some illnesses that we are less familiar with. It is a rarity to see chicken pox in the US these days, but I was still able to spot its beginnings on a three year old from across the room. There are more complicated cases seen by the staff physicians. A man with a large parotid tumor causing facial nerve paralysis came for a second opinion. We told him to go back to his first doctor! On Saturday I was able to have my own clinic, supervised 100% by the attending, but will have some returning this week! I’m starting to get used to the different medications and dosing, especially in pediatric cases.

Unfortunately the holiday also encourages lots of alcohol consumption and vehicle accidents. If you have been watching the global news, you may have seen this. We had multiple patients come in one afternoon. Thankfully while only 1 is seriously hurt, they are all largely well. The same can be said for the accidental gunshot who came in just hours before the motorcycle accident victims. Lots of trauma experience to be had!

These larger cases give the surgeons the opportunity to operate (and us Americans to seek refuge in the air conditioned operating room). Watching patients be operated on with a spinal seems miraculous, until you realize C-sections are performed this way every day at home. Regardless, watching surgeons operate in a low resource setting is amazing every time. Most baby deliveries have happened at night, but I was able to finally watch one! They have nurses who can handle uncomplicated deliveries, and they handle them very similarly to US deliveries.

I am so surprised by how similar some aspects of healthcare are to the situation in the States. The other American and I discussed how we see outpatients maybe (maybe!) twice and never again. I suppose I am used to this from student clinics, or just student rotations. Patients are lost to follow up. Access is an issue. Transportation is an issue. Cost is an issue. We are all so much more alike than we are different.

April 9th, 2016 by Taylor Veh
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As I am typing this, I am lying under a ceiling fan. Ceiling fans keep the people of Huai Malai from going stir-crazy in the exceptional heat of the hot season in Thailand. Thankfully there is plenty of cool water for showers when you need them. Drinking water must be carefully obtained, however. I have found this to be one of the aspects of traveling I am less used to.

All this being said, I feel I have adjusted very well to my home for the month of April! The people of the Kwai River Christian Hospital are very hospitable and kind. Learning a proper greeting and “thank you” has helped me and the other American visitor feel less rude to those showing us their best smiles.

I have spent the week with a visiting team from Taiwan. They come every 6 months to do outreach clinics in areas just too far from the hospital for regular visits. As our hosts tell us, these villages are very “primitive.” This usually means holes in the ground for toilets and no electricity. However there always seems to be someone in these villages with a cell phone…

The team from Taiwan is an efficient machine; they have surgeons, ER physicians, a pediatrician, dentist, Chinese medicine, and a host of nurses! They know exactly how to set up our clinics every day. I was worried that I would be unable to keep up with the doctors and diseases, but it turns out certain things are universal: children get colds and older persons have body aches. The children do not love their fluoride treatments, but theirs are not strawberry flavored.

The clinics go quickly. Some days we only see 60 patients or so. Other days we see over a 100! The Chinese medicine is very popular for patients and our volunteers alike! Many try acupuncture and cupping for their backs and shoulders. The children carry around their pharmacy bags filled with anti-parasite treatments and multivitamins like trophies, which was great because it encourages more people to come to see us.

Some days we set up our clinics outside, and others we use clinics or churches. One day we used a Buddhist temple, which was very beautiful on the inside. In traditional Thai culture, we do not wear shoes while indoors, which I am convinced cools you as well. A few patients that stood out from the week include a middle-aged man with a large (20cm x 8cm) mass who did not follow-up in the hospital, and a small girl born covered in dark plaques, which her mother also had. These left the whole teams questioning the causes, and provoked photos from nearly every person to send home for advice.

Evenings and mealtimes were often in fellowship with the Taiwan team and people who work in the hospital. Some drive us to Sangkhlaburi (the town) for meals, and others host us in their home. I cannot emphasize enough how kind and welcoming everyone has been. It makes being away from home so much easier.

As we head into the weekend, we are preparing for a guest physician to come while the surgeon is away on holiday. This next week is the Thai New Year, which is celebrated with throwing water around, and people traveling to their home villages. Unfortunately they say this is a time with frequent accidents, so we will hope for a safe New Year for all our Thai friends!

Until next time,

Taylor

March 19th, 2016 by INMED
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Hello! My name is Taylor Veh. I am a medical student at Kansas University, and I’m starting my INMED service-learning experience at Kwai River Christian Hospital in Thailand beginning in April 2016.