Monday, November 23, 2015

Adventures in Thailand

I am going to write about one of my experiences during the best clinical ever.  I had the privilege of seeing many patients in Nakhon Ratchasima, one in particular had a great impact on me.  "C", a 60 year old woman living in my assigned village.  C was recently diagnosed with stage five kidney failure.  Her physician recommended immediate dialysis however C was very reluctant.  She did not understand dialysis and was afraid.   On initial visit, the talented and dedicated Thai students and I assessed her current health status.  We found her to be doing remarkably well for a patient with advanced renal failure and not on dialysis.  C attributed her well being to the tea she drinks several times per day. This tea is made from traditional medicinal Thai herbs, a subject I plan research further in the future.
Phyllanthus amarus
Together with the Thai students, C was educated on chronic kidney disease and how important dialysis is for her health.  We explored her concerns and found she had limited knowledge about dialysis.  Additionally she was afraid about getting an infection that would cause her to die quicker than not receiving dialysis.  The Thai nursing instructors and students decided to present her case to the village elders for assistance.  Once her case was presented, it was decided that she would receive whatever assistance was necessary.  I was amazed and delighted as I watched an entire community coming together to help one of their own in need.  I guess if one member of the village is sick, they are all sick.

Renal Failure Education
The village leader arranged for C to talk with a member of the community who was already receiving dialysis.  We found ourselves there the very next day!  He described the process to her and explained he was still living a reasonably normal life.  This went a long way to assuage C’s fears, but she was still not ready to commit to treatment.   One of the Thai nursing instructors suggested we take her to the local hospital to see hemodialysis in action.  Again, the very next day we were on the dialysis unit at the district hospital.  I watched happily as one of the patients utilizing a dialysis machine assured C that this was not some horrible sentence, rather a chance at prolonging her life.  By the time we left, C had decided to proceed with hemodialysis, and a vascular surgeon consult was arranged for the following week.
Community Forum

I have been pleasantly surprised at a great number of things during my adventure here.  Wonderful food (not the same as Thai restaurants in the States!), beautiful temples, picturesque countryside views, and the most courteous and welcoming people I have ever met.  What stands out the most, for me, is the Thai peoples' ability and desire to come together and help each other when one of their community is in need.  I feel very fortunate to have been part of this experience.

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