Friday, November 15, 2013

Nursing Across the World

During our time in Thailand,we have been working hand in hand with nursing students from Suranaree University of Technology (SUT).  Not only have these girls worked so hard and taught us so much over the past weeks, but they have also been instrumental in our understanding of the differences in nursing education around the world.

For starters, we have learned that nurses in Thailand have a different scope of practice than we do in the United States.  For example, as an undergraduate prepared nurse, one can prescribe some medications, suture, and function as a midwife.  We learned that each student from SUT had currently delivered 6-7 babies as a part of their clinical time! At the clinics in which we have been working, there is no doctor on site daily.  The clinic is run by assistants, nurses, and nurse practitioners.  This different scope of practice was eye opening.

Currently, the Thai nursing students are completing their community health clinical rotation and are in the final year of their undergraduate nursing program.  This rotation requires them to immerse themselves in the community, uncover current health disparities, and create community interventions that will be beneficial to the people in the village.  While this is similar to the community health nursing class taken by all undergraduates at the University of Michigan, there are some stark differences.

The students here in Thailand must LIVE in the village they aim to serve for the entire 4 weeks of their community clinical rotation. They live in a small, two room cabin that is on the property of the health clinic. The rooms have no air conditioning and have only enough room for the students' sleeping bags.  Their program is intensive and requires them to interview 80-100 families from the community while also seeing patients in the clinic.  During home visits, students enter community members' homes, greeted with open arms, to conduct very comprehensive surveys including: demographic information, thorough health histories, and comprehensive physical exams.  After gathering community information, the data is analyzed using online systems, and a presentation with results of significant health disparities for community members is compiled.  At the open presentation, people from the community are invited to attend and the health priorities of the village members are determined in order to decide what interventions (also implemented by the students) will be most beneficial.  Furthermore, we noticed the students working 10-14 hour days seven days a week. The students opened the clinic as early as 6:00am and finished their last home visits as late as 9:00pm.

This intensity and passion put forth by the nursing students is remarkable.  The dedication that they have not only to their nursing program, but also to enhancing the well being of a community population is very clear.  Not one student complains, not one student seems disengaged.  Each student participates as an equal member and furthermore, each student makes an unbelievable effort to make us feel involved, understood, and respected. Taking some of these lessons back to our own life as we complete our Nurse Practitioner programs is integral for success.  In Thailand, we saw a willingness by the students to be their best and to put forward their best efforts.  These students understand that hard work, passion, and dedication is not just a means to an end, but a way to live life.  From these girls, we learned the importance of giving the world the best.  Heading into our last semester, and future practice, we hope to bring the continual passion to provide, with open minds, dedication, and humble hearts, to those that we serve!

Friday, November 1, 2013

The Essence of Health Care

Our group of seven from Michigan has been split between two clinics here in Nakhon Ratchasima. Our two previous posts have come from half of our group working in a more rural clinic in the village of Keetun. The other half of us have been working at the clinic in the village of Dan Kwiean. Our village is considered more urban, in part because of the vibrant pottery industry that brings in shoppers from all over the world. Although more urban by local standards, at home we would compare our village to small rural town. Our clinic serves an area of ten villages with a total population of about 1,700. We have a check in area, a dental room, two consultation rooms where we see patients, a room for IV infusions, and a small procedures/emergency area with one bed.

For the most part, the chief complaints of the patients we have seen have not differed drastically from those of patients seen at the rural clinic, or even from those of patients at home. One of our first mornings here we were able to help with a diabetes and hypertension clinic. Almost 200 patients showed up for blood pressure and blood sugar readings, education, and consultations. We have treated upper respiratory infections, a plethora of eye complaints, gastroesophageal reflux, and occupational complaints such as pulled muscles from factory work or bad burns from pottery irons. On occasion, we encounter diagnoses we rarely see in the United States though, such as leptospirosis and dengue fever.

Things that have surprised us or are different:
Patients come to the clinic with extensive bruising and wounds which require dressing changes then they jump back onto their motorcycles with only flip flops on and drive away.
The use of lots of herbs and multiple prescriptions for diagnoses we often wouldn't treat with prescriptions back home.
The consistent stoic response to pain and discomfort we see with all of our patients. Even patients with acute eye injuries, extensive dressing changes, or wound suturing display minimal physical or verbal response to pain.
Many times multiple patients are seen within the same consultation room. Patient privacy does not seem to be priority concern.
Our clinic does not treat mental health disorders, instead we refer out to a tertiary care center for psychiatric evaluation and treatment. This has meant that for acute mood disorder cases, we may be able to prescribe a day or two of Valium but won't otherwise treat a patient while they wait to get in to see a psychiatrist.
We have three dogs that call the clinic home. During the busiest part of the morning, they are not allowed in the clinic, but as the day winds down we often see them wandering in and out. These dogs also escort us around town as we walk to do our home visits and guard us from other territorial dogs in the area.
There is only one sink in the entire patient care area of the clinic, we are used to seeing a sink in every room in our clinics at home. It is the same with gloves, we have a single box of gloves out in the entire patient care area.
We notice some other vital supplies low or missing such as a full oxygen tank or defibrillator.
The willingness of patients to allow us, and the Thai nursing students, to walk right into their homes, sit on the floor, open their cupboards and refrigerators to assess their food choices, etc.
The way that generations live together in homes or compounds. We have visited homes with up to 4 generations together under one roof.

As our two weeks come to a close, however, we realize the essence of our health care mission is the same in Thailand as it is at home. We are all working toward the common goal of improving the health of our patients using a compassionate and holistic approach. It has been amazing to immerse ourselves in a different health care culture and to understand the differences, but more importantly, the similarities of our systems.