Reflection: Maddie

Hello for the last time!

I can't believe that four weeks have already gone by and this is our last day in Thailand. I have learned so much from being in this country and I know that there is so much more to discover. I truly feel like a better person because of this trip and I know I will be encouraging future students to take part in this once in a lifetime opportunity.

In terms of personal growth, I definitely learned more about cultural appropriation and awareness. This is a constant learning process for everyone but every time I travel abroad, I definitely gain a new found understanding. One example is that with Buddhism, Buddha is to be respected and they do not want people using it as a decoration in their homes. They have billboards throughout the country saying just that and as a visitor, I need to respect that and encourage others to do so. It's important to respect all people and embrace the differences that exist in the world both in my role as a pharmacist but also in my day to day life. 

Another aspect of the Thai culture that I will take home with me is the humility and friendliness that I have seen and experienced while here. Thai people are constantly looking to better themselves and often they look towards Western countries, such as the US, as a way to improve upon their current practices. This is something we all can learn from, especially because we often lose sight of that in the US. They also practice humility in their daily routines with such respect for Buddha and although I do not practice that religion, I have definitely benefited from seeing this type of respect. Thai people are also extremely friendly and they constantly greet us in a respectful manner and are always thankful of our presence. This constant friendliness is infectious and I know that I will bring this back to the US with me because I think many Americans could use that positivity in their lives even if for only a few minutes. 

In the pharmacy world, one of the biggest take aways from this trip for me is that the US has a lot of room for growth with patient care. Although Thailand doesn't have the funding for a lot of modern technologies, they far surpass the US in terms of patient education. The pharmacists at various hospitals have developed so many helpful and informative tools for patient education that have inspired me to help spark that change wherever I practice in the future and potentially on my last 2 APPEs. Another tool Thailand has developed is an application available on mobile phones that provide patients with education about their own medication.

With these tools, we could improve health literacy of our nation and avoid potential medication errors. 

The pharmacists in Thailand also have a completely different attitude about their jobs than most people in the US workplace. They thoroughly enjoy their jobs and gain satisfaction in helping patients, and this includes the new graduate pharmacists as well. I want to adopt the same attitude upon graduation because I know it will make the difference not only for myself, but for the patients and co-workers that might be feeling the effects of burnout. 

It's hard to list all of the things I will miss about Thailand because it feels like I am saying goodbye. For starters, I will definitely miss the delicious food, as I haven't had a bad meal here, friendly atmosphere, the people, and so much more. I have felt safe here and it has become my home away from home for a month, which means it will always hold a special place in my heart. I do hope to come back one day to visit the friends I have made and to see more of the beautiful country I have come to love. Thank you readers for tuning in and feel free to reach out to hear more details about my trip! 

Sawadee ka!

Maddie Pryor

Chao Phya Abhaibhubejhr Hospital, the Center for Excellence in Traditional and Herbal Medicine

This past week we visited the Chao Phya Abhaibhubejhr Hospital, the Center for Excellence in Traditional and Herbal Medicine.

What stood out about this hospital was that it manufactured, on an extremely large scale, their own herbal preparations. We got to tour some of their manufacturing facility and after passing through several air locks and were gowned to protect the sterility of their process, we got to see rooms where herbs are boiled, analyzed, mixed, and packaged. Additionally, this hospital is a major research facility and has numerous ongoing clinical trials for herbal products.

Although this facility prides itself in their expertise in herbal medicine, they offer modern, non-herbal medical services to patients as well. Only about twenty percent of the patients that visit this hospital choose to receive herbal therapy, however their medical staff interview the patients and refer them to specific services that they believe would treat them best.

The Center for Herbal Medicine is housed in a beautiful building that was once a palace to the royal family. They converted parts of the hospital to a museum that has ancient documents surrounding herbal remedies, as well as old containers, devices, and preserved herbal products from over time.

This visit was extremely interesting and it was neat to see two completely different medical practices seamlessly used together alongside modern research and manufacturing.

-Natalie

How to Access Healthcare Services in Thailand

Sawasdee ka from the land of smiles!

It is hard to believe but this rotation has almost come to a close. Thailand has given us all an amazing educational opportunity to learn from both our own healthcare in America and theirs. Being here has allowed us the opportunity to learn from a different, newer healthcare system while reflecting on our own back in the states.

Many times myself and the other students have discussed the Thai universal healthcare system but what happens to people when they become ill? Well, if you are living in Bangkok then you go right to the hospital when you are sick. In Bangkok there aren't primary care doctors offices, only the doctors in the hospitals. If you go to the hospital then you anticipate waiting for numerous hours in the waiting room before you can be seen. If you have a chronic illness such as tuberculosis or HIV then on certain days of the week you will go to a clinic held at the hospital. These clinics are a one stop service, meaning you will see a nurse, doctor, dietitian, and a pharmacists all on the same day in the same office. It is important to note that patients are assigned a specific hospital that they should go to. It is this hospital that they pay a minimum yearly payment to so then if they do go to the hospital it is free.

However, if you are living anywhere outside of Bangkok then your process is a little different. This stepwise process begins with first seeing your local healthcare volunteer to discuss your sickness. If they think you need more medical attention then you can go to the local clinic that is run by nurses. From there you can then be referred to the district hospital to see a doctor. However, these hospitals do not have a lot of resources available to them so sometimes you can then be brought to a provincial hospital.

It is important to note that for any patient who would prefer to pay more they can be seen at private hospitals, which are not covered by the Thai UC. But these private hospitals are generally used by tourists and foreigners. Even with a healthcare system that seems easier to understand than that in the states there are many patients who do not know what to do when they are sick or if they require more frequent care.

Learning about these different health systems it makes me wonder what I would do if I were traveling abroad in a foreign country and required medical attention. In these cases you worry not only about not knowing the health system but also about the potential language barrier. Since most of the hospitals in Thailand are public they do not necessarily have the resources for translation and not everyone speaks English. Many people love to travel abroad but looking into healthcare isnt exactly the firs thing on someone's mind when planning a vacation.

These are things that I know I will ne concerned about in the future, not only because of my interest in healthcare but also for my own safety. Thankfully, the students and myself did not require medical attention further than a short discussion with a local pharmacists.

Thank you for reading! Until next time,

Casey

Home Visit

We got to go on a home visit with Thai students from Chiang Mai University. We visited a man in his 60s who was diagnosed with COPD. We were able to look at his medications which included theophylline, tiotropium, and budesonide. He is very compliant with his medications which has significantly helped his COPD. He was a former smoker who quit shortly after his diagnosis but his wife still smokes knowing the harm it can cause.

He told us during the home visit that he tried a gecko to help with his COPD exacerbations. He got this idea from his doctor who mentioned that he gives it to his wife to help with her exacerbations. Because they live in the village access to a doctor at times is difficult. There was a point where he didnt want to go to the doctors for treatment even if that meant he would die. Now that he sees how much of a difference it has made in his life, he no longer has an issue with seeking help when its needed. These pharmacy students are another means to check up on the villagers. They are assessing the patients medications, health, and the quality of their home and life.

The students were volunteers to help with a center that focuses on basic health needs. This is where the villagers could get their dental care, as well as get treatment for smaller injuries like cuts. They have a system where they seperate the patient files by the 11 different villages they care to. A long with this, one file would include health information from a family's household. Which was pretty interesting to see because I have not heard of that before. It was a great opportunity to be able to work with the Thai pharmacy students and observe them on their home visit. 

Thank you,
Desiree

Loy Krathong

Thursday November 22nd marked Thailand's holiday, Loy Krathong. On this day you can witness festivals around the country where thousands of lanterns are lit and sent up into the night sky and floral arrangements with incense and candles and released down rivers.

We were a few days short with our stay in Chiang Mai to witness the lanterns, however, we were able to participate in the floral ceremony alongside a river.

The purpose behind floating these beautiful hand crafted pieces down the river is to honor and pay respect to the water goddess in Thailand, however there is also other spiritial meaning behind this that makes this holiday meaningful to a lot of people, even tourists who follow different belief systems.

What was interesting to me was that the releasing of these flowers signifies the release of things in your life that you no longer want to carry with you. Whether its circumstances, emotions, habits, mindsets, relationships, or anything negative that is weighing down on you, sending off flowers is meant to be a way for you to release the bad in your life and invite better things into it for the future.

As I have noticed time and time again, participating in the rich culture of Thailand has blessed me with extremely beautiful experiences and memories that I will hold onto. I am thankful to have been a part of this ceremony and to have had the time to reflect on releasing the negative and inviting the positive into my life and in those around me.

-Natalie

Being Prepared for the Bathroom

Hello there!

Though it may seem like an interesting blog post title, I think using the bathroom here is so different and I wish that someone had warned me before coming to Thailand about this. The biggest difference between here and the US is the lack of toilet paper. Most public toilets in Thailand do not have toilet paper or a sufficient amount for all of the traffic they receive throughout the day. This may be due to a lack of resources. Every business must supply their bathrooms with both toilet paper and soap and those products can become costly over time. Additionally, if they do have toilet paper, many of them encourage guests to throw it in the trash. One theory behind this is that many toilets here do not flush at the same speed as toilets in the US and it becomes clogged easily. In order to save themselves time and money on more expensive toilets, the Thai people ask guests to throw the toilet paper in the trash can. 

Another major difference is the type of toilets that they have here. Although many bathrooms have the traditional toilets we are used to seeing, some of them are on the ground. They have a toilet seat with no elevation from the ground, which makes the first experience very interesting. In order to compensate, these toilets often have a hose device in each stall to clean up after usage. This somewhat replaces the need for toilet paper in their minds and is less wasteful.  

Some advice I have for visitors to Thailand would be to always pack toilet paper in your bag/purse and hand sanitizer because many bathrooms do not have soap either. Experiences such as these remind me of how lucky I am in the US to depend on simple products such as soap and toilet paper and to not take the little things for granted in the future. I think it's also important to realize that embracing a different culture and way of life can be as simple adjusting to a different bathroom. 

Thanks for reading!

Maddie Pryor

See below a photo of one of the types of toilets I was referring to that I found on the internet:

Process of Learning and Understanding the Thai Healthcare System

Sawadee ka,

I believe it was our second academic day in Thailand when we met Dr. Surakit Nathisuwan, aka “Kit.” Kit was a pharmacist who went to pharmacy school in Florida and was now practicing as a professor at Mahidol University Faculty of Pharmacy, one of the top pharmacy schools in Thailand. What then seemed like an interesting lecture on Thai healthcare and the process of becoming a pharmacist, turned out to be one of the best lectures we received while in Thailand.

It was so important to have that basic understanding of what universal healthcare looked like in their country before we immersed ourselves into their hospitals, clinics, and homes. This lecture was given at the perfect time during our trip and I hope others are as lucky as we were. Kit taught us the basics of healthcare in Thailand, including statistics, access, and the role of pharmacists in the care of Thai people. All of this information made it easier to understand the following lectures throughout our visit. It also helped us build on that knowledge by asking more personalized questions about others’ healthcare experiences in Thailand.

Even though I was somewhat aware of the universal healthcare offered in Thailand, I did not expect to have learned nearly as much as I did. I have been able to compare public and private hospitals, observe specialty clinics for diseases such as dengue and TB, and visit a psychiatric hospital and orphanage.

But overall, I don’t think I would have gotten as much out of the experience as I had without that first lecture from Kit, as the succeeding lectures had the expectation of our general understanding of universal coverage.

Thanks for reading,
Sara