Monday, November 23, 2015

When opportunity knocks...

There are three types of people that you encounter as a traveler: missionaries, mercenaries, and misfits. I’m not sure where nurses fall in this spectrum. For a good portion of this month I have had the honor of participating in a program that pairs advanced practice nursing students with bachelor level Thai nursing students through a collaboration between the
Sometimes travel is a leap of faith.
University of Michigan (U of M) and the Institute of Nursing at Suranaree University of Technology (SUT).
The SUT students are completing a community health course, which entails completing a through assessment of the health status and history of nearly every individual, family, and village serviced by the district clinic. They are doing a proper assessment; they are placed in a foreign community and spending nearly six weeks living and working in these communities. Additionally they have been taking on the role of medical interpreter as we conduct physical and psychosocial assessments in both clinical and home settings.
            Although we are students ourselves we have been assigned the role of expert clinician, a role that we have been prepared for. Our program has taught not only the importance of clinical assessment skills, but also the importance of considering our patients as people. We look at their needs and desires, assets and barriers to health care. We are trained not to only diagnose and treat illness, but also to promote health and help in eliminating the barriers to health. We have been gifted a skill set that transcends borders and language barriers.
Other times it is PowerPoint longing for coffee in a bag, as our Thai Sisters demonstrate.
            Our Thai brothers and sisters as well as the communities we served have welcomed us graciously. Huay Tai, a small village about 45 minutes south of Nakhon Ratchasima, (or Korat) has been our base of operations. We’ll call it Village 11, as there are 15 villages that are served by the clinic… and I usually spell and pronounce the names incorrectly, and confuse them with the province, district and each other. Village 11 is amazing. The health problems that we encountered are pretty standard, the same kinds of illnesses that you’d see in any clinic or home visit the world over, but they have just been managed a bit differently. Of course there are a couple of region specific problems that we don’t really come across in the States – dengue fever, typhoid fever, betel nut related complications, and healthy food choices in Buddhist monks, to list a few.
            The team dedicated to Village 11 consisted of three U of M NP students, whose specialties include adult/gerontology primary care, pediatrics, midwifery, occupational health, and international health (we like school, what can I say?) and seven Thai students, who are finishing their BSN degrees. Like all teams that matter it took awhile for everyone to work well together but in the end we were a solid team that worked well together in increasing our own knowledge as well as assessing and assisting our community. A community that embraced us from the beginning; I’ve lost count of the number of new grandmothers that have claimed us as their own.
I told you it was a left at the Mango tree next to the chicken, not the duck.
  A home visit in rural Thailand isn’t quite the same as a house visit in the US. In the US visits are planned well in advance (usually), have specific billing criteria, and tend to focus on a specific problem: post discharge follow up, acute care, wellness visits, medication review. Here we show up sometimes without a formal appointment. There is of course more to it than that but essentially we knock doors and people welcome us in (usually) they are open to share their stories, just like in the States people will talk if you give them freedom to do so and just like in the States you kind of have to keep them on track or a 20 minute visit lasts two hours. Our patients here give us access to there medicine, log book (each provider encounter is summarized and noted in little note book that the patient keeps with them and brings to each encounter – America I’m looking at you for this as it beats a eMAR any day), the even let us roam around their homes and look in their food (a great way to measure sodium intake). The patient’s here are open to suggestions (and just like the States knowledge doesn’t equal action). That’s the beauty of this program, the Thai students gain a bit more knowledge of assessment and the types of questions to ask from us and then they have another month to follow up with the patients.
            As our time in Thailand comes to an end I feel like I’m grieving. The community threw us a party, complete with locally sourced food.
Noodles first, we'll address that burn after lunch.
There was a mom and pop noodle factory that I assessed and have been trying to sample for the last two weeks, high risk for thermal injury but world-class noodles. We had a early celebration of Loi Krathong, the annual river festival where decorated baskets are placed in the river and wishes are made as the basket floats away. Our group was blessed by a traditional healer and received Sai Sin, or blessed string bracelets, from the village elders (we did health assessments at two different temples and I can tell you that performing a health assessment on a monk with an audience of ten or more requires a new level of cultural competence. That and monks tend to be stoic so don’t take offence if your jokes are met with silence). And there was a three-way dance off between the community, the Thai nursing students, and the U of M nursing students. While it wasn’t a contest, they watched us Whip and Nae Nae. We nailed it.
...and that is how the Thai Family Functioning Scale was validated.
            I’m sad to leave but the community is in good hands. Nursing is hard to define, just sit through one of our theory courses and you’ll understand, or actually not understand. We enter the profession for various personal reasons (we hate the ‘Why did you become a nurse?’ question) and soon realize that it’s a hard job that’s rewarding spiritually, and every once in a while financially. Nursing takes us places if we are willing to step through the doors that it opens. So yes the next time you are out in the world and trying to decide if that quirky person with the dark sense of humor is a missionary, mercenary, or a misfit… maybe they are all three because they just might be a nurse.

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