Wednesday, November 23, 2016

Thailand through a Pediatric Lens

Two out of ten of us on the trip are Pediatric Nurse Practitioner students. Similar to the United States, the majority of the people that seek healthcare in Thailand are the elderly. This created a bit of a challenge for the two of us, as our population was a bit harder to find. Luckily, we also had some unique benefits that made our experience different than anyone else’s. For example, we were both very fluid with our clinic placements. We followed the children, and if they went to one clinic but not the other, we would, too. This was very special to us because we got to see the differences between each clinic, and all of the care that each encompassed.

In Thailand, they set aside certain days to perform developmental assessments and vaccines for the children. The first day assessment day in which we participated was for babies up to 9 months old and was held at the Dan Kwian clinic. The patients were assigned a number upon arrival and used this to transition from different rooms to accommodate registration and measurement, developmental assessments, and vaccines. During the second week that we were there, we got to repeat the process with toddlers, ages 9-24 months. We were very impressed by the organization of the process. All of the toys were separated into cloth bags, and were labeled with the age group with whom they belonged. For example, in the 2 month-old bag, you can find a rattle, in order to test the baby’s gross motor movement. Each child was accompanied by a booklet that contained details about growth, vaccines, variations of normal, any health conditions, and medications given. The booklet always came to the clinic with the child, whether for a sick or well visit, and everything was easily recorded and congruent.

There were many familiar elements of this assessment day- the developmental screenings were done using milestones we have learned in our programs, the growth is charted to ensure adequate nutrition and screen for possible metabolic concerns, and many of the vaccinations we also administer in the United States (one exception is a three dose series of the Japanese Encephalitis vaccine). Adjusting to technique and supplies differences was initially challenging, but we had the support of the nurse practitioners in the clinic to guide our learning. We were extremely impressed by the strength the children demonstrated when getting vaccinations- tears and screams were rare.

Schools were frequently used to provide assessments and support pediatric patients in the community. Kids of all grades were familiar with the 10-point evaluation used to screen for signs of abuse, skin concerns, dental caries, lice, conjunctivitis and other ophthalmologic issues, musculoskeletal and bone deformities, and deviations from normal gait. Vision screening and growth measurements were also included in each assessment day separate from the 10-point evaluation, and a heart and lung assessment was added by the SUT students. During one school visit, two dentists and a dental student were present to assess the oral cavity for caries, administer an injection of local anesthetic, and remove diseased baby teeth. This was a remarkable process to witness, both for its efficiency and for the incredible bravery each child demonstrated. We were again able to see the strength of this population.

In the community, we were able to participate in the assessment of a jaundice newborn who had just returned home from a 24-hour hospital stay under bilirubin lights. The baby was three days old when we met him and he could not have been more adorable! We asked about the number of wet diapers, sleep, and postpartum depression and found that both mom and baby were doing really well. The multigenerational household standard was clearly beneficial from the standpoint of childcare, as this newborn had multiple caregivers and mom was able to rest and recover.

We were so grateful to have had this cultural experience. We saw many differences as well as many similarities in pediatric health care delivery between Thailand and the United States. There were many things to be learned from the Thai population and their methods of healthcare delivery, and we will take some of these lessons home with us to be implemented in our careers.

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