Reflections: A.J.

My favorite part of traveling is the tangible evidence that paradigms are just that. Doing something because it’s the way we’ve always done it doesn’t make it the only or the only right way. Food, healthcare, family structures, mores and aesthetics are social constructs and sometimes, you have to view them from a different perspective to realize it. 

Four weeks abroad seemed like a long time, but it went in a flash. I feel like I’ve only begun to scratch the surface of Thailand, but I have made many enduring memories from the experiences of the past month. Our hosts and guides have been gracious, warm and welcoming. They are the greater part of the highlights, above the places and activities. 

Our coordinator Noi always went the extra mile. She was our conduit into not just healthcare in Thailand, but many of its prominent cultural features as well. She wouldn’t just order new Thai dishes to try, she’d explain the culinary process, show us the component ingredients, and discuss when it was typically eaten and by whom. She patiently answered sensitive questions about Buddhism, politics, the monarchy, and the everyday life of Thai people. She and Nu, our driver, were the touchstones through the entire trip - consistent and dependable in each new situation we found ourselves in.

Every hospital, community pharmacy, and university we visited put visible effort into making us comfortable and providing a valuable learning opportunity - the Thai reputation for hospitality is well deserved. I am thankful for all the people we met along the way.

For a middle income country with limited resources, Thailand does an admirable job taking care of it’s people. By way of comparison, the United States spends ~17% of its considerably larger GDP on healthcare - Thailand spends 4%, but yet, it provides universal coverage to every one of its citizens. This care is not entirely free, and it comes with some drawbacks, but any Thai national can receive some basic level of services, affordably delivered. Many of the talking points used to rally against universal healthcare in the United States are found here; long waits and limited choice. Patients may spend a whole day in the process of seeing a doctor and picking up medications, and those UC medications come from a limited national formulary. Some of the preferred medications, like for HIV anti-retroviral therapy, are considered third-line choices in the US. This is not precision medicine. Still, I’ve seen American patients with wildly uncontrolled chronic diseases due to economic barriers, and I feel strongly that some care is better than none, no matter how “cookie cutter” it is. 

There is no prescription opioid crisis in Thailand. Acetaminophen is the king of analgesia here and non-pharmacological measures are routinely offered as first line treatments in chronic pain. There is a cultural difference in attitude toward pain here, too. Buddhism is the most common religion. I suspect its precepts and practices about the inevitability of suffering and the tools to rise above it, including meditation, encourage the acceptance of this treatment plan. Massage is also a large component of traditional Thai medicine, which is encouraged even in western medicine for the treatment of musculoskeletal pain. I hope that, armed with the knowledge we have now about opioids, America can shift to a similar culture in the area of medicine, and do a better job with integrative treatment. 

As you might expect, there were some experiences that were less than comfortable. There is a different emphasis on outward appearance here that feels more pressured than in the United States. All of our professional hosts were well made up and neatly attired, which felt impossible for me, in the heat and humidity. I felt sloppy, sweaty and awkward. Pointed comments about body image and weight were made toward our diverse-looking group, even by some health professionals. At the elephant hospital, we were mobbed by tourists, who all wanted to take pictures with us, and it felt like we were on constant display. 

We also saw many levels of care, from very posh private hospitals to rural health centers, The gap in resources between the highest and the lowest were very broad indeed. In a regional psychiatric facility, I was shaken by the difference in standards of treatment from what I’ve seen the U.S. When our pharmacist guide asked us whether the ward was like ours, I had no idea what to say. 

I think that with discomfort, comes growth. I used these experiences to re-examine what was at the base of the feeling, whether it was a personal insecurity or a closely held bias or belief. I appreciate when I am valued for the quality or effort of my work, more than the way I look, but I also know that appearance plays a significant role in human interaction. I believe in patient-centered care, that takes into account the autonomy of the patient, but I can also acknowledge the difficulty of this in low health-literacy populations.

For all the differences I observed, I also found that at the core of their work, Thai healthcare providers were in medicine for the same reasons I am; they are driven to help people achieve healthy, meaningful lives. Pharmacists in Thailand are fighting for a place at the table in hospitals, clinics and the community, in the same way American pharmacists did in the not so distant past. I don’t speak much Thai, but meeting with pharmacy students and residents, I realized we shared a universal language, connecting through our passion for the profession.

Thanks for reading,
A.J.