My experience in Thailand, Bangkok has been incredible so far. We had the opportunity to visit a few temples and learn about Buddhism. There is a lot of overlap with my own religion (Hinduism) which gave me a chance to reflect on my own practices. One of the best feelings was taking that first step into the temples and hearing nothing but silence.
Visiting Bamrasnaradura, the infectious disease institute, was our first academic visit. After meeting various people throughout the day including doctors, nurses, and pharmacist (of course) we learned much about their system and services. Pharmacist Thiranon Kladphuang (image below, right) was truly inspirational. She manages parts of the TB clinic and has worked really hard on motivating her patient. Adherence is an issue in these patients because the regimen includes multiple drugs and can be as long as 9 months. Many of these patients also have HIV creating an extensive medication list. In order to track adherence she implemented a program where she'd offer her patients eggs if they came for a visit and brought all their medications with them. It was successful! She stressed the importance of teaching her patients about the drugs instead of just 'telling' them they need them to get better.
The past few days I've learned so much about the challenges that we face vs what Thailand faces. The way they choose what medications is on their national list sometimes limits what's available for patients. They choose one preferred medication per indication. A preferred medication is paid for by the government when a nonpreferred is not. For example there's only one type of integrase inhibitor for HIV treatment which limits treatment options for those that have issues with this drug. Considering the limited choice of drugs, treatment guidelines vary. For example, first line HIV treatment in the states includes two NRTI's and one integrase inhibitor when here it's two NRTI's and one NNRTI. Integrase inhibitors have less side effects. Other challenges seen in Thailand include limited treatment options for TB treatment. They often have to remove patients from these medications and rechallenge them due to hepatotoxicity risks. Multidrug resistant TB is a challenge because of low adherence and wide use/access of antibiotics. We don't face these issues because TB is rare in the states.
Until next time !!
Purvi
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