Life Lessons from the Clinic

As our first week in the clinics came to an end, we began to feel more comfortable working with the patients and students in Thailand. We have all gained significant life experiences from working in the rural villages and greatly appreciate all that we have learned in such a short period of time.

As a group, we have collectively noticed an influx of patients who present with multiple different symptoms that all can be traced back to the massive amount of flooding that has occurred in the area. During home visits, we have noticed roughly 6-12 inches of stagnant water under and around some houses. There are many areas where the water level has climbed too high for motor vehicles to safely cross, and even some spots where there are "mini-rapids" where there is even an undertow. We have all encountered children who complain of stomach aches and pains, nausea and vomiting, and other vague symptoms that result from playing/swimming in the contaminated water. Other illness (eg: types of diarrhea and skin disorders, fever) that we rarely see in the United States have presented through some of our patients in the clinic, once again due to the flood waters. These unfamiliar illnesses have been interesting cases for us to work with since we rarely encounter them at home.

Unfortunately, with flooding waters comes the potential for dangerous situations. During the middle of a busy clinic morning, we saw a man driving a motorcycle flying into the clinic. Startled, we made our way toward him and noticed that he was carrying a child over his shoulders, and shouting for help in Thai. We could tell immediately that this was an emergent situation and the child was in dire need of our help. We had learned that child was playing in the flood water and was pulled under and drowned. A group of villagers saw the tragic event happen, and joined together, linked arms to form a line, and starting walking through the rapids to find the missing child.

In a room full of chaos, we, as nurses, did what we do best by immediately reacting to the scene and jumping in head first to help in any way possible. We knew that time was of the essence, and being exposed to similar situations through work and past clinical experiences back home in the states, we were prepared with knowledge and skill to help save a life. Working as a team with members of the clinic, we were able to transport the child through the jungle to meet the ambulance (in a truck shared by the community), and transfer him to the appropriate level of care at the local tertiary care hospital.

The experience was nothing short of traumatic, yet as in all situations, there is something to be learned. When we take a step back and reflect on the situation, a major difference presents with the lack of resources and equipment that were available at our rural clinical site. Inadequate oxygen supply, lack of airway equipment, and no ambulance present for transportation (our clinic only has a single ambulance that was already in use) are a few of the key elements noticed to be missing from the scene in a time of need. We were happy to be informed the next day that the patient made it safely to the hospital and received appropriate care.

We were invited to participate in the discussions with the clinic, local staff and faculty, and community about the event. We reviewed the case and the situation with the clinic and our hosts.  Several things complicated the situation.  Primarily, the clinic was underprepared for an emergent situation.  In retrospect, there is now discussion to have double or triple supplies at the clinic for potential emergencies or other natural disasters.  Next, the clinic is in the process of relocating, further complicating things by supplies being in both locations.  We were able to identify some key resources that should be present in the clinic at all times, as well as discuss with health officers useful resources to have for potential use at the clinic.

Although this was a sad and challenging situation, it alerted us to the reality of the hardships of healthcare in rural and poverty-stricken areas. It reminds us of how we sometimes take for granted that we typically have the necessary resources to provide appropriate and comprehensive care back home. Finally, although this was a difficult situation, it was impressive to see how the community jumped into action and worked together.  While they may not have what we consider to be "necessary" supplies, they have a close knit community network that provides support without being asked.  It is now clear why they refer to each other as grandmother/grandfather/sister/brother.  They are truly family and linked in a way that so much more than the word "community" implies.

The Michigan Difference in Thailand

Not only have we made a significant difference in the weight of our suitcases due to the vast number of scarves bought at the silk shop, we have also started to reflect on the effect of our presence here in Thailand.

Playing peek-a-boo with a small child through the window, relieving the pain from a stye in an eye, and putting a smile on the "Smoothie Man's" face, who anticipates our daily arrival, we sport our Michigan Maize and Blue colors with pride in Thailand.

While small effects are great, we are even more excited at the cultural intra-professionalism occurring. Not only have we learned all the Thai student's names we are working with and them ours, the students are now asking various questions and having us confirm their assessment skills.  The language barrier is still one of the greatest barriers encountered, but through charades and an incredible effort from the students, understanding of chief complaint and history is obtained.  Working together, we are able to collaborate with those in the clinic to devise a plan for patients.

Evidence of the full circle of healthcare and the importance of Community Health Nursing is evident in our adventures. This week, we did a home visit, a home that did not resemble anything we have experienced as a place of dwelling before. The patient had not sought healthcare services in an extended period of time, yet had several things that were of concern. Education was provided at the time about coming to the clinic to receive a referral to see a physician about these ailments, yet we all left feeling questionable about the reality of this plan.

As we walked into the clinic today, we were met with a familiar figure. The patient from the home visit came to the clinic today to receive our full assessment and referral! If we had never ventured to that home, a place of discomfort for most clinicians as it is outside of the normal clinic routine, it is uncertain if or when the patient would have sought healthcare.  Now we are aware of and involved in the steps that have been taken toward follow up.

All of these small gestures, interactions, and learning experiences have allowed each one us to grow in a significant way. We are proud and fortunate that the people we meet positively impact our lives, and that we in turn do the same. Through our strong educational foundation and tradition of excellence instilled at Michigan, we are doing our small part to make a difference in this corner of the world. Go Blue.

Leave Your Shoes at the Front Door JCAHO

Dressed in navy scrubs and ready to change the world we travel in vans through flooded lands to our small village of 300 people.  Take off your shoes and step over the stray dog at the door because you are in the Tajalung Clinic.  No HIPAA here.  Patient histories are taken within earshot of the lobby and no Purell to be found.  But do not get the impression that the health care here is substandard. The 4th year nursing students from SUT have already personally delivered 3-5 babies and are so dedicated to their learning that they live at the clinic for 4 weeks.  The villagers will cook and bring them food in appreciation of the services they provide while there.  Not only do we see the patients that come to the clinic for a range of services from illness to antenatal care, we also visit patients in their homes.

Today's home visit is one that has opened our eyes to the luxuries we have in America, but also the undeniable need for community health nursing.  Our patient had not been seen in the clinic in 2 years and had several chronic conditions. Had we not traveedl to this home who knows when care would have been sought out by this individual. It is through these experiences we are learning just how important we are to the community and how big of an impact we can really have.

"The higher the technology, the greater the need for human touch"

After some amazing first experiences with Thai Culture in Bangkok, the clinical group traveled by van (largest van we have ever been in) to Nakhon Ratchasima (or as we like to call it, NR for short). Thailand recently had some large rain falls- which led to significant flooding along the preferred route of travel to NR, leading us to take an alternate route. We traveled through lush green areas and winding mountain roads that had breathtaking views of the jungle. Our travel time was stretched when we came across heavy traffic- everyone had taken the "back roads" to avoid the huge floods, and we soon saw that the backup was related to a semi truck that had flipped over on the wet hilly roads and left its cargo laying across the entire stretch.

Along the way, we stopped at a very authentic Thai restaurant for lunch. The views were once again beautiful and surreal. Our Thai clinical leader, Nar (a graduate from the University of Michigan- GO BLUE) ordered us lunch and helped us gain more insight to Thai culture and cuisine. We ate a variety of new foods- including a full fried fish with head and eyes still intact.

SUT (Suranaree University of Technology) became our new home away from home for the next two weeks. After settling into our rooms and getting tour of the campus, we prepared for our first clinical experience with the Nursing Students at SUT. Meeting the students was a wonderful experience. The students and faculty were extremely welcoming and interesting in learning about us and our purpose for travel. Each UofM student was assigned a group of 4th year SUT nursing students to teach and review clinical health assessment. This was a fun and educational experience for both sides, leaving everyone with new ideas about clinical health and wellness. We were also able to connect with the students on a personal level and develop friendships, leading to multiple new Facebook friend requests.

The rest of our day in NR was spent exploring our new surroundings. We traveled to the city center and explored the NR mall (which could give mall of America a run for its money). Everyone in the group took the time to stop for an hour-long ($6.00!!!!) Thai massage that stretched our bodies in ways that we didn't know were possible.

Our day ended with a group trip to the local market. Upon arriving, we were met with a vibrant atmosphere- full of food vendors and small shops. We all explored the area and enjoyed authentic thai cuisine as we sat outside and watched the SUT nightlife at full pace. Tomorrow we all begin our first clinical experiences at the community health care sites. We are all eager to jump in and help those in need by providing primary care through the SUT Nursing motto- the higher the technology, the greater the need for human touch.

Jumping In

Wednesday we set off on the long trip from DTW to BKK for the first global clinical experience in the adult/gero and family nurse practitioner programs at the University of Michigan.  Five graduate students. Two faculty. Twenty four hours of travel time. Piece of cake.

Our trip started with a bang. After about five hours on the plane, a women seated a few rows behind the students became difficult to arouse, had a pulse of only 39, and was diaphoretic.  The students switched into nurse practitioner mode and got their first glimpse of a true global clinical experience. They had to work with family members and flight attendants to act as translators, had to adjust their treatment plan based on the patient's cultural preferences, and had limited resources to gather data and provide treatments.

Ultimately we will end up in Nakhon Ratchasima working with students and faculty from Suranaree University of Technology. In this pilot experience we will pair a University of Michigan nurse practitioner student with a student from SUT. We will work in dyads to provide health care and community assessments in a smaller town outside of the university.

Today we whet our appetite for Thai food and culture. On four hours of sleep we jumped in and explored the city by public transit and took a cooking class. Tomorrow we load into vans to make the three hour trip north to move into our new "home" for the next two weeks.

We are excited to immerse ourselves in Thai culture and learn as much as we can about the people, healthcare, and ourselves!