Saturday, October 25, 2014

Beyond The Comfort Zone

"Creativity involves breaking out of established patterns in order to look at things in a different way." Edward de Bono

After a full three days of clinic that got us quickly acquainted to the ins-and-outs of the Thai way of life, we were ready for some debriefing!  Procedures in clinic, diagnoses, and interesting home visit stories were experienced by all and needed to be shared! So we decided to do our debriefing over an American!  This was a nice change from the market cart food that we have all become accustomed to eating.  Although quite different in taste then what we are used to back home, it was a welcomed treat.

Sausage Pizza
Diagnoses we've covered in clinic and out at home visits so far have included A LOT of uncontrolled hypertension, many ulcers, cuts, abrasions, and bites that all require daily dressing changes, upper respiratory infections, dyslipidemia, allergies, rashes, previously undiagnosed diabetes, fungal infections, and parasites.  While these seem like common diagnoses, just like in America, treatment is often complicated by lack of resources, access to care, and/or patient compliance.

At times things are challenging simply because our approach to care would be different in the US.  For example, dressing changes have used only alcohol, saline, betadine, gauze, tape, and kerlix. At home, some of these wounds would comprise more involved wound care (eg: more frequent dressing changes, wound vacs, prescription ointments, etc).  It has been quite impressive, in fact, to see the creativity of the providers in managing complex patients.

A syringe barrel used as an external fixator
Like some clinics in the US, we also have limited medications that are readily available in clinic for treatment. At times there may be a medication or treatment option available, but no nurse or prescriber available to administer a treatment or medication.  This is evidence that resources, access, and scope of practice impact patient care across borders.  At home we may have many more options depending on patient's insurance and clinic locale. This clinical experience been an eye opening and challenging one for all of us, especially for those of us who have not had the opportunity to work in an underserved clinic in the US.  The skills we have learned from using what is readily available will help us all greatly in our future practice and is a good reminder that a little creativity can go a long way!

Thursday we had a rare day off from clinic because of a national holiday!  We took the opportunity to sleep in (though most of us were up by 6 or 7 AM) and spent the morning catching up on laundry, work-outs, and getting in touch with family. We were excited to explore more of Korat, by visiting the local zoo.  We traveled by "open air" taxi, which was a new experience for everyone.  We definitely didn't mind the wind blowing in our hair, given that it was incredibly hot and humid despite the partly cloudy sky.  Unlike in the States, animals in Thailand are allowed to be in much more open habitats that are much closer to guests, which allowed for us to not only get a close up look, but also to feed most animals. Some group favorites were the hippos and monkeys that seemed to love having an audience.

Tomorrow we will be back at our villages to wrap up the week. Our free time this weekend was filled with adventures, so stay tuned!

Katrina feeds a pigmy hippo

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