Chulalongkorn University

Sawadee ka from Thailand!

My name is Sara and I am a fourth year pharmacy student.

Thailand has been such an amazing experience so far and we're only one week into the rotation! This is my first time visiting a country outside of North America and the differences both culturally and within their healthcare system are immensely different, as you can imagine.

On Wednesday we visited the Faculty of Pharmaceutical Sciences Chulalongkorn University, where we met sixth year pharmacy students, visited their community pharmacy, went on home visits, and on Thursday visited their university hospital and met the pharmacy residents.

Following the community pharmacy tour we took a shuttle van to the middle of a community where we stood near a temple and a funeral home, waiting for the other students to arrive for the home visit. Upon their arrival we split into two teams. Our team consisted of a nurse, a pharmacy student, and a pharmacy faculty member. We walked down the street and turned into a narrow alley way, passing a food truck. We walked over puddles from a woman washing dishes and turned the corner to arrive at our patient's home. The patient unlocked the gate and moved the plywood, which were the only things separating his home from the alley. We removed our shoes before entering the crowded 2 room apartment that housed the 84 year old patient and her son who was her caretaker.

We sat on a wooden trunk facing the frail, quiet woman sitting on her hospital bed surrounded by clothes hanging to dry and a fan blowing on her. The walls were covered with pictures of deceased relatives and above her refrigerator sat religious relics. We talked mostly to the son in Thai, while the professor translated for us. The woman's son was an amazing caretaker and went to great lengths to do so, including the neglect of his own health.

The son stays with his mother all day, helping her with her medications and trying to  convince her to drink water. After his mother insisted on taking her medications every 15 minutes, the son had to remove the minute hand from their clock that hung on the wall opposite the mother's bed. Despite the son's efforts to hydrate his mother, she will only drink about 1.5 liters of fluids every four days. She has many medical problems including heart failure and atrial fibrillation, as well as a recent fall. She takes 4 mg of lorazepam every night for sleep while the son is working as a taxi driver. He drives all the way home, across town to check on her after every customer.

Because of the way their healthcare works, they receive free healthcare at the hospital they are born at, unless they call the call center to change it which is something many Thai people are unaware of. Unfortunately for the son, his hospital is not the same as his mother's and is on the other side of the city. Every month he spends one entire day at the hospital with his mother for her check up. Going to get a check up for himself means losing a day of work and leaving his mother at home alone. With his hypertension and self medicating with losartan, his blood pressure was at 181/120. He even explained to us a time when he passed out from high blood pressure while driving his taxi! We stressed the importance of his health and what it would mean for his mother if he did not stay healthy. We tried to convince him to use primary care (which is severely underutilized in Thailand) and we informed him of the call center and how to change his hospital to the same as his mother's.

It was an eye-opening experience to see this son's relationship with his mother. Being the only child, he had an obligation to care for his mother and that is exactly what he does. He doesn't have hobbies or even a family of his own. He has so much respect for her and would go as far as choosing her health over his own.

Even though this patient was much more educated than many Thai people, his lack of understanding of the overall healthcare system was definitely evident. Universal healthcare means free healthcare for residents, but it does not mean great healthcare and it is not always easy to obtain or understand.

I am excited to continue learning about Thailand's healthcare system, as well as the culture of the Thai people!

I don't have any pictures from the home visit, but let me leave you with this beautiful picture of the floating market :)

Sawadee ka,
Sara