Ramathibodi Hospital

Warm greetings from Thailand! My name is Natalie Underdown and I am fourth year student pharmacist at the University of New England College of Pharmacy. From the beginning of my studies at UNE, I have been looking forward to the opportunity to travel internationally and I cannot fully express my gratitude for being in Thailand advancing my pharmacy practice and immersing myself into the beautiful culture of Thailand.

On Wednesday (10/31) and Thursday (11/01) of this week, I spent my day with the clinical pharmacists and pharmacy students at the Ramathibodi Hospital, in conjunction with Mahidol University, in Bangkok. With four separate centers, this hospital is known to be among the top public hospitals in Bangkok, being categorized as a teaching hospital, having over 18 separate inpatient wards equipped with clinical specialists, employing over 11,000 healthcare providers, including over 200 pharmacists, and averaging about 1,200 in patients per day about about 6,000 out patients per day.

Over the course of two days, we visited many sites within the hospital related to pharmacy practice. From the drug compounding center, outpatient centers, drug supply management, as well as their hemodialysis clinic, oncology clinic, and various acute care medical wards. A highlight from this experience was spending time with the critical care pharmacist in the Intensive Care Unit.

While in the ICU, we had reviewed all the major conditions and topics that are relevant to critically ill patients. From sedation, pain, agitation, delirium, respiratory distress, intubation, sepsis treatment, ECMO, and other topics, we discussed the major treatment approaches for these conditions and the roles of pharmacists in Thailand. Although most first line agents are similar in the United States as in Thailand, a common theme that I noticed was that there is not nearly the same diversity in treatments in Thailand and that cost dictates a patient's treatment more so than what is seen in the United States. One example is that the sedative dexmedetomidine is used quite commonly in the United States and is often first line for various conditions in guidelines, however, in Thailand the high cost prevents its use and Doctors have to obtain approval for only special circumstances.

What made this experience particularly valuable was how we were welcomed with open arms. In every conversation, we enjoyed comparing the differences and similarities between healthcare practice in Thailand and in the United States. There was so much for each of us to learn. Additionally, the pride that the pharmacists and hospital staff had in their profession was immensely tangible; their excitement and joy in sharing their workplace with us made our visit with them that much more enjoyable and I am thankful to have met such wonderful pharmacists, students, and doctors.

Thank you for such an incredible learning experience, Ramathibodi Hospital!

Best,

Natalie