Site visits
Trip Start
Oct 20, 2009
1
19
42
Trip End
Nov 29, 2009
Ban Fang, Thailand
Thursday, November 5, 2009
Our first stop was University Medical Center Hospital, an 800-bed tertiary care center in Khon Kaen. (A heart center across the street has additional beds not counted in this total). We walked through each of the outpatient wards and everywhere we went, Dr. Orasa seemed to know all the nurses. It turns out she has trained many of them in her 30 years of teaching nursing at KKU. At each ward, she encouraged me to take pictures and a number of times, she had groups of nursing staff pose for a picture with me. I felt a little funny doing this but Dr. Orasa reassured me that people love posing for pictures, especially with an American teacher. Each time we met a nurse, Dr. Orasa introduced me and explained to the nurses that I teach at the George Washington University. Either every nurse in Thailand has heard of GW or the nurses are simply extraordinarily polite - they all made oohing and aahing sounds upon hearing the name of the school.
The outpatient clinics at UMCH were very crowded, with hundreds of people waiting patiently in rows of chairs. The hospital building looked modern and sleek from the outside, but inside it was purely functional and fairly old in terms of the equipment. The nursing staff were uniformly polite, professional, and friendly, and in our travels around the hospital I never saw a health care provider that looked like they might be a physician – all I saw was a a sea of white nursing caps, busily darting around the clinics tending to patients and their families. Who knows where the doctors were – maybe in the exam rooms? – but strangely, I never saw doctors walking around elsewhere in the building.
Next we drove by a storefront, open-air clinic run by Khon Kaen Central Hospital and funded by the Ministry of Public Health. It looked empty when we drove by, but it could have been that all the patients were being seen in the exam rooms.
Our next stop was Khon Kaen Hospital, a hospital that serves as the provincial hospital. It's a tertiary care center with a 1000 bed capacity. The ER there has been recognized by the W.H.O. as a center of excellence for disaster preparedness and response. While we were there, I had the opportunity to see the ER triage center as well as a number of the wards. While we were in the ER, I spent a few minutes talking with a Thai Paramedic. He was very excited about me taking his picture – along with a close-up of his uniform patch – to show EMS folks back in the US. Khon Kaen Hospital has a special ward for monks, so we stopped for a minute to look at the statue where people leave offerings and make prayers for the health of the monks. Then we toured the wards. KKH, like UMCH, was extremely crowded. Many people were lined up waiting to be seen. Despite this, however, there was an overarching quiet calmness about the place. The throngs of people didn’t look or sound angry or inpatient about waiting. Dr. Orasa explained to me that this is very much "the Thai way." I was amused to see how they get stat lab orders from place to place in the hospital – lab techs rides bicycles through the halls of the hospital. To get patients to tests, they use segway-like scooters, with the patient sitting at the feet of the person driving the segway. Very clever….
Next we stopped at the Banfan Subdistrict Community Health Clinic. We met with several of the community health nurses over coffee and bananas, and they showed me how they chart and how they provide care in their community. They maintain paper charts for every household in the community and they maintain hand-written maps of the neighborhood showing where people have various illnesses and diseases. On the front of every patient chart, the nurses draw a detailed genogram of the patient’s family history. The clinic sees approximately 20 patients a day in the clinic itself, in addition to the home visits made by the nurses. Monday is family planning clinic, Tuesday is well-baby clinic, Wednesday is ANC clinic, Thursday is diabetes clinic, and Friday is "elderly clinic." The clinic is the only primary care clinic in the Tambon and it serves 12 communities total. Three of the nurses from the clinic came with us in the van to our next stop, the Ban Sa Kaew Elderly Club.
The Ban Sa Kaew Elderly Club was my favorite site visit today because what I saw there was so unexpected. We pulled up in front of a wood-frame building built on stilts and Dr. Orasa explained that this building is used in the community as a temple. We took our shoes off at the base of the stairs and climbed up about 12 steps to reach the building entrance. The building itself had wood floors and open-walls, and thin mats lined the floor. Hanging from the ceiling were elaborate crafts resembling origami (made from plastic drinking straws, I learned later). The room was filled with elders seated on mats, apparently waiting for our arrival. An older gentleman walked up to me and greeted me in halting English with a warm “welcome” and a huge smile. It was explained to me that he is a community health volunteer (one who was just given an award for being among the best community health volunteers in all of Thailand). He welcomed me into the building and pointed towards the front of the room, and motioned for me to sit. I followed Dr. Orasa and the community health nurses and sat down. I wasn’t entirely sure what was going on but it became clearer when a gentleman in the front row introduced himself as the head of the Ban Sa Kaew Elderly Club. He said (in Thai) that he wanted to welcome me from the bottom of his heart for coming from America, a “civilized country,” to rural Thailand to speak to his elderly club. I was deeply touched by his kind words. He then asked me to say a few words to his elderly club. I thanked him for his warm welcome and let him know that despite what he may think, Thailand is really the more civilized country in terms of how it treats its elders. America can learn a great deal about respecting and honoring older adults from groups like the Ban Sa Kaew Elderly Club in Thailand. The members of the elderly club had many questions for me – about America, about what I think about Thailand, and about my perceptions of life in Thailand. I had expected questions but what I hadn’t expected was what came next: the president of the elderly club invited me to help evaluate the work the elderly club is doing and tell them whether they are doing a good job. I was flattered by the invitation and thought he was just being polite, but he was totally serious. He and his fellow elderly club members insisted I attend a “study visit” they are hosting tomorrow for a group of outsiders to observe and evaluate the activities of the elderly club. Dr. Orasa and I graciously accepted the invitation and made plans to attend the event. Next, a woman stood up to sing me a song to honor my visit. I don’t know what the song lyrics were but it was apparently a health promotion song the members of the group all knew. After that, we took several group photos and they joked that an American visitor is like a “superstar.” This made me blush – I am so not a superstar. But it was sweet of them to say that. Towards the end of the visit, the president of the elderly club brought me towards the front of the room and motioned toward what looked like a stage. Dr. Orasa translated for him as he explained to me that the elderly club raised the funds to buy the temple decorations from Bangkok. He drew back the curtain to show me a breathtakingly beautiful Buddha. He and his fellow club members beamed with pride at the beauty of the temple they have created for the community.
Sitting with the Ban Sa Kaew Elderly Club was one of the most peaceful moments of my entire life and I’ll never forget it. When they told me about how they visit all 100 homes of their members and help them when they are sick, it struck me that growing old in Thailand is much more of a community affair than it is in Thailand. This group of elders works together to do health promotion, participates in group tours, carries out home visits to ill members, and meets regularly for social and spiritual activities. Before I left the elderly club, I told the president and the members that I just might decide to move to Thailand when I grow old since older adults seem so much better cared for here than they do in Thailand. The club members seemed really proud of being an integral part of a system of care that’s the envy of an American visitor.
After we said our goodbyes at the elderly club, we got into the van and Pon Sat, the driver, took Dr. Orasa, the community health nurses and I to Ban Fan Hospital, a 30-bed hospital in the community. When we entered the hospital, we met several nurses, then toured the dental clinic and the other sections of the hospital. Then we headed upstairs to meet with Dr. Boonchai, the Medical Director for the hospital. Dr. Boonchai was an incredibly warm and gentle man who spoke excellent English. We sat down in his office and he began to ask me questions about America. His first question was, “What do you think of Obama’s health reform plan?” We got into a great discussion about health reform, which led to a detailed discussion about the weaknesses of the current health care system in the US. Dr. Boonchai and I also discussed H1N1 and the relative merits of the nasal vs. injectable vaccine – he was very curious about both, since Thailand currently has access to neither. In total, we talked for about 40 minutes. I was extremely impressed with his strong support of nursing as a profession and of nurses individually as professionals. We took a tour of the facility with Dr. Boomchai and he showed me the private rooms (extra charge = 600 baht a night – around $20 USD) and the negative pressure room for H1N1 patients. I asked him what the plans were for handling the larger numbers of H1N1 patients they might see (since the 2nd wave hasn’t hit Khon Kaen yet). He showed me a second negative pressure room that was under construction and acknowledged that the need may end up exceeding capacity. We then toured a separate building for visiting families and for complementary therapies, and we saw the Thai massage room. I met the hospital’s physical therapist and the nurses showed me the diabetic foot care mirror contraption for patients to use in viewing the bottoms of their feet.
When we left Ban Fan Hospital, the community health nurses headed home in a separate car and Dr. Orasa and I hopped into the van. She took me to a local market on campus (The Faculty of Agriculture’s “Demonstration Farm”) to look at plants for a few minutes. Then we headed back to the dormitory, where O was waiting to meet me to see if she could figure out how to fix the internet so that I could have access in my room. (Up until now, I’ve been accessing it from a study lounge upstairs but now that I’m working much later nights, O wanted to see if she could get me access in my room). O, one of the women who work at the front desk, and a male nursing student who lives upstairs came to my room to see if they could figure out the problem. After about 10 minutes (during which they were speaking to tech support), they were able to figure out a way to get me a low-strength wi-fi connection in my room. Hooray!!! No more trudging up to the student lounge late at night to do work on the web.
Around 8, there was a knock on my door. It was O and Nan, bringing me bananas and wanting to come in to practice a little English. Nan had memorized some English phrases and wanted to try them out on "Dr. Keemberly." We practiced English for about half an hour and Nan's pronunciation got stronger the more she practiced. She told O in Thai (and O translated for me) that this is the first time in her entire life she's had more than passing contact with an English speaker. She's so happy to have the chance to learn some English while I'm here in Thailand. Nan and O are both lovely people - and such marvelous hosts - that repaying their kindness with a little English tutoring will be my pleasure.
