Home Visit

We found ourselves in a tiny, rural farming community, surrounded by mountains. The patient was a 60 year old female, being seen following a discharge from a community hospital, for kidney stones. Her previous medical history was significant for recurrent UTI, chronic kidney disease, lower back pain and atrial fibrillation. 

The pharmacy student reviewed her current medication usage, including diclofenac, acetaminophen, doxazosin and a completed course of flouroquinolone antibiotics. She noted that the patient had two medication packages from different hospitals for the same medication and asked more questions to ensure the patient was only taking the medication once. She asked the patient about her health conditions, noting that she said her back pain was acting up. The patient admitted to smoking, but not as much as some people, she joked. She also took note of the patient's home environment, particularly the toys scattered from a nephew living with her, & expressed her concern about the potential for falls.

Any of these elements could have belonged to a home visit I've participated in, in Bangor, Maine, but here are a few additional details:

The patient’s occupation was seamstress, doing beautiful embroidery work that requires long hours bent over a work table. She showed us a table linen she had recently completed, a whole day's work, for which she received 30 baht, the equivalent of one US dollar.

Chickens and a vegetable garden supply her with food year round. On top of all this, she cooks for the village events. 

She has no health insurance, but medications are covered under the universal coverage, provided she seeks treatment at her Primary Care Unit, the service the pharmacy student was operating under. A point of confusion for many villagers, the patient instead got treatment at a hospital clinic where she was required to pay for the services. 

The patient smokes, but the amount was not measured in cigarettes or packs per day, but rather in length on the forearm, as “keeoh” a handrolled cigar, is the tobacco form of choice. 

She takes a supplement in addition to her medications, for stomach ache, which contains menthol, anise and simethicone. We found many empty bottles of this liquid product. The student pharmacist and health volunteer, a trained villager, were warmly welcomed by the patient and neither were sparing with physical affection, patting her on the knee or arm, as we all sat, barefoot, on the floor of her home. 

Rural healthcare appears to be a community affair, with the health volunteers supplying education and preventative care to their neighbors, helping them to not just access services like the primary care unit, but also know when they can and should reach out to a medical professional. 

Whether in Maine or Thailand, the challenges of rural healthcare delivery are the same. A shortage of healthcare personnel, resources & infrastructure require implementing innovative strategies to care for our patients. Pharmacists have so much to offer in this need!

The pharmacy students are being trained to care for these patients in the same way that we are and are responsible for documentation and presentation of their cases to their peers and faculty. On our way back to the primary care unit, we made a necessary stop and found another universal student pharmacist trait: 

The name of this cafe is, appropriately, ‘Need Coffee.’ 

The students from Chiang Mai University were so welcoming and we are all looking forward to working with them throughout the week!