Friday, November 18, 2016

Primary Care in the School Setting

School assessment and health education in Thailand is quite similar but also different in interesting ways than how it occurs in the United States.  It was really fun to be able to teach the kids little songs and dances to remember proper hand-washing and teeth-brushing, as I’m sure many people remember these fun songs from their childhood.  I was impressed that the Thai preschoolers learned a lot of the songs in English!  It was also impressive to see that the kids were learning another language at such a young age.  Some interesting differences arose in the process of the physical assessments.  For example, EVERY child in the school came out of class and sat patiently while they waited to see the nurse. During the health screening, the University of Michigan and Thai students were able to do a number of assessments on each child: skin, teeth, hair, heart and lungs, and scoliosis checks.  Many of us have limited experience working with children, so it was very helpful to get the opportunity to do SO MANY child assessments in a row.  We were able to evaluate many normal assessments as well as identify potential health issues, such as dental caries.  Although this appears to be a more common problem in Thailand than in the United States, free fluoride and dental work are provided to children at the community health promotion hospital.  This is an interesting difference from the United States as many people cannot afford dental insurance and forgo treatment of dental issues.  When we compared the assessments of dental hygiene in younger children versus the older children, it was clear that the kids here are participating in the dental care that they need as they age.    

With the help of our Thai brothers and sisters, we were able to identify a severe heart murmur in a 15-year-old student. More history revealed that it was a new murmur, and while the student reported feeling well, his heart rate was significantly elevated. Our Thai colleagues were able to identify the abnormal finding and, with our help in history taking, elicit more details. It was a first time for us to hear a murmur this pronounced and palpate a thrill, but it was a valuable learning experience for all of us, Thai students included. We were also able to educate and reassure the student while ensuring that he would follow up with the local hospital the next morning, although in the US this probably would have bought him an E.D. visit. Since the health promotion hospital works very closely with the school, we learned a couple of days later that he was admitted to the larger hospital and would be having surgery the next day. The school health assessment was invaluable in identifying and coordinating treatment for this young man, particularly because he was not symptomatic. We were impressed by the collaboration within the community, the Michigan students and the SUT students to follow up with his care.

At the end of the day, we were able to observe a small Loi Krathong ceremony put on by the school children. This festival thanks the river for providing life to the fields and forests and asks for forgiveness for the polluting ways of the humans. Beautiful handmade boats, made of banana leaves, flowers, and candles, were placed into the river by the students. It was a perfect end to a unique and insightful couple of days.  This entire day was a great reminder of the valuable experience that we have gained thus far while in Thailand, gaining knowledge about another culture while also furthering our skills as future nurse practitioners.

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