Let’s Talk About Sex (Education and Health)!

We were immediately intrigued when asked to give a school-based sexual health presentation to adolescents in Thailand. As Nurse Practitioner students, we recognize the importance of sexual education and prevention in this age group and were more than happy to share our knowledge and expertise. After touring the school and meeting with faculty, we sat down with our Thai sisters to plan our school health day.

The presentation was to be about one hour in length for a group of twenty 12-15 year olds. We were given limited direction on what topics to cover, we just knew that we would have to demonstrate the right way to apply a condom. After some discussion, we decided to discuss healthy relationships and consent, common sexually transmitted infections (STI) and prevention, condom storage and use, contraceptive methods, including cost and effectiveness, teen pregnancy statistics and prevention, and overall sexual risk reduction. We also developed a pre- and post-tests to assess baseline knowledge and knowledge gained after the presentation. It was a lot of material to cover in 1 hour and we had 24 hours to prepare, so we got to work!

We had the prior knowledge of Thailand having universal health coverage but had many questions regarding trends, standards, and access to care involving sexual health: for this information, we consulted with our Thai sisters coupled with some internet surfing. We came to find out that the cultural expectation in Thailand is that adolescents remain abstinent until marriage. Also, sexual health education is not standardized in the Thai school system. Similar to many other countries, teen pregnancy rates have been on the rise in Thailand. According to the United Nations Population Fund, more than one million babies were born to teen mothers in Thailand over the last 15 years, increasing 31% from 2000 to 2014. Contraception, condoms and STI testing are widely available through local Primary Care Units (PCU), but require a parental consent for anyone under the age of 18. Local pharmacies also offer over-the-counter oral contraceptives and condoms for those of any age at a cost. It was eye opening to learn about organization and access of the Thai healthcare system in relation to sexual health.

We were struck by both the similarities and differences of sexual education between Thailand and the United States. Unlike the United States, where sexual education standards are decided at the state level, the schools and communities have more flexibility with delivery of content. One thing that we found out was pretty universal is that teens will be teens, and sex can be silly and uncomfortable to talk about. The students seemed curious and receptive to the information we were providing, but they also had their moments of uncomfortable giggles. However, we believe the students learned essential information that will help them stay healthy for years to come.

Thanksgiving-Thai Style

Spending a holiday away from family is never easy, but our Thai family gave us a Thanksgiving we will never forget. The evening began with a group effort to prepare a feast consisting of regional Thai cuisine and improvised Thanksgiving favorites. We had pad-mi, curry, and green papaya salad alongside sweet potato fries, Thai pumpkin, and even a few turkeys. 

The overwhelming amount of food matched the generosity and hospitality of the village. Dressed in traditional Thai clothing provided by our SUT brothers and sisters, we were honored with a blessing ceremony led by the village elders. As we sat in one communal circle, the village elders slowly approached each one of us to tie white strings on our wrists, bestowing upon us wishes of good luck, health, safe travels, and future success. We did not need to understand their language to feel their well-wishes as they tied each string, blessing us as if we were their own family.

After we overindulged in the delicious feast, we exchanged performances with our SUT brothers and sisters. The SUT students performed beautiful traditional Thai dances, while we brought some American flair via the Cha Cha Slide and the Michigan Fight Song. We also discussed the history of Thanksgiving and in the true spirit of the holiday, gave our heartfelt thanks to everyone who contributed to our success over the last two weeks.

We are thankful for our SUT brothers and sisters; for their kindness, encouragement, and their much-appreciated translation skills.

We are thankful for our faculty members who helped guide our interactions with patients and each other.

We are thankful for our clinic workers, who provided us with a new perspective in health care delivery.

We are thankful for the village residents, who welcomed us into their homes and hearts without blinking an eye.

The story of Thanksgiving emphasizes blending of traditions and gratitude for each other. Our gathering was the perfect farewell to our incredible cross-cultural experience.

Embracing Culture

We have been in Thailand for a little over a week now and what a life changing experience it has been so far. The impact that culture has on health and wellness is no surprise to us as nurses. The link between culture and individual/community health has been embedded into our brains since the very beginning of our careers as nurses; and when I say the beginning of our careers, I’m talking first day of school, NURSING 101 and every year after. Throughout our careers as nurses, we are taught about ethnocentrism and how to be culturally sensitive while trying to see the world through our patient’s unique cultural lens. We are asked about cultural sensitivity in every interview we have for any nursing position and take great pride when we are able to help our patients embrace their cultural norms while supporting their health and healing. So, as we packed our bags and headed to Thailand for our clinical immersion experience, being culturally sensitive and adapting to the way of life and health care in a new land was not something we were necessarily worried about.  Instead, we were busy wondering if we really should have packed that second bottle of SPF 50, and how many packets of Kleenex was appropriate amount to bring for a 2 week stay in Thailand (getting stuck without toilet paper is not a situation you want to find yourself in), and if we really should have gotten that Japanese encephalitis vaccine that was recommended, but not required.

Well, as well versed in cultural sensitivity as we thought we were, I think that letting go of our own cultural norms and embracing those of a completely foreign culture was a lot more challenging than any of us would have anticipated. Now, that is not to say that every part of this foreign culture was difficult to embrace. We quickly became accustomed to taking our shoes off before we entered any building, bowing as a greeting instead of waving, and taking a second to just slowdown from our fast-paced lives in America. The people of Thailand value time differently than we do. I think for most of us, this was a very refreshing change of pace.

Over the last week I have witnessed amazing things in Thailand health care. I have witnessed nursing students completely immerse themselves in their community health clinical experience. Packing up their lives for 6 weeks to live in their assigned village, making daily home visits on their bikes, and tailoring nursing interventions to improve the overall health of the community. I have witnessed community health clinic filled up with 150 patients all by 8:30 AM. Some patients waiting as long as 3 hours to speak with the doctor. People sat outside in the 90-degree heat, others sat on the floor, and a handful arrived early enough to snag a chair inside near a fan. All without one complaint. Yet, the most profound moment for me was witnessing the interdisciplinary care rounds that occurred IN the patient’s home and lasted over an hour and half. When it comes to their patients, it is evident just how much these health care providers truly care for their patients. From the nurses and physicians to the community health volunteers, these people go above and beyond for their patients.

This experience has given me an opportunity to reflect on our own health care system in America, resource utilization and what cultural sensitivity really means to me. As challenging as self-reflection can be, it is an opportunity that I will be forever grateful for! 

Below from top to bottom: Our clinic with 150 patients on community health day, our nursing students working on their community map, and finally the interdisciplinary, in home care rounds.

The Thai Approach

Graduating from the U of M BSN program 4 years ago and working on multiple units in the hospital as well as currently working in a clinic setting 16 hrs a day / 7 days a week might lead one to believe that their nursing skills are nothing short of impressive. In 2 days my fellow colleagues and I have watched that view slowly wither as we learn a different approach to care.

Working in the clinic and out in a rural community is a reminder that NURSES are able to adapt and do things with limited space and resources. We do not always need the monitors or advanced technology. We can do dressing changes in the back of a vehicle exposed to the environment and elements and still protect a patient’s privacy and maintain their dignity. NURSES can find humor in peddling a bicycle in 90 degree weather, in the middle of a banana plant farm, wearing backpacks and full nursing gear, during a torrential downpour as they make their way to see a patient.

Nursing is a dynamic and complex profession that can sometimes leave us feeling helpless when we want to do more but empowered when we can make even a small impact on a patient. Each day will bring a new challenge, a new adventure and a new friend. Each day our hearts will be filled with sadness, pain, joy and laughter. I look forward to every minute of watching, teaching, and learning with a Thai approach.

GO BLUE!

Year 5: Bigger and Better

University of Michigan School of Nursing primary care nurse practitioner students arrived to Korat, Thailand on Saturday and immediately got to work. We met our SUT colleagues and planned our activities for the next several weeks.  With our largest group ever, we have the opportunity to engage with more villages and have some exciting health promotion activities and interventions planned.

This year we were able to bring back one of our alumni, Tracy, to work as faculty and facilitate an additional clinical group.  We are so excited to see what 2017 brings and cannot wait to watch our students explore, learn, and grow from this unique opportunity.  Thank you to SUT for hosting us and allowing us to go on this journey with your students!

#BestClinicalEver #BestInstructorsEver #UMSUTDreamTeam

Storytellers

Traveling-it leaves you speechless, then turns you into a storyteller. Ibn Battuta

The reentry process is never easy.  Anyone who has traveled will talk of playing catch up with sleep, with current events, with friends and family, and with work/school.  At first it can seem overwhelming.  But being in a foreign country for a period of time offers a sense of protection, a buffer, that cannot be fully appreciated until one is home.  Upon return, it is easy to notice the NOISE.  We are no longer protected from the ever-present chatter as we hear and understand the words and interactions around us.

Less tangible, however, is the impact the experience has had on our personal values, our outlook, our sense of self. Henry Miller said "One's destination is never a place, but a new way of seeing things." The Thai culture and people are full of values that not only had an influence on our time there, but will continue to influence our lives and interactions as we move forward.

Tradition.

Respect.

Honor.

Strength.

Warmth.

As we adjust to the eastern time zone and our domestic responsibilities, we can share our experience with the climate, the food, and the clinical experience.  Even more, though, we will become storytellers: the perseverance, the support of the community and nation, the overwhelming kindness of our hosts and communities.  We will notice subtle changes in our approach to patients, to families, and to life.

A huge heart-felt thank you to SUT, our communities, and our Thai faculty and hosts.  Your hard work and time is so appreciated.  Until next time, Thailand!!

A journey is best measured in friends, rather than miles.
--Tim Cahill

The Eyes of a Foreigner

       Travel, among all things is truly something that excites the soul. Quite honestly, the natural discovery of both tangible and intangible ways of life has a keen ability to satiate otherwise famished visions and perceptions.

       Prior to setting out, normalcy and taboos of the Thai culture, villages, and clinics were explained to us. Information such as the death of King Bhumibol, shoe removal prior to entering rooms, and cultural cuisine expectations were each addressed. Despite this knowledge, nothing could have prepared us for what we experienced by actually being present in the country. 

       With respect to the death of King Bhumibol, never has a  more powerful sorrow been felt. The ENTIRE country was mourning the death of King Bhumibol Adulyadej who reigned from June 1946 to October of 2016. Signs, posters, pictures, and banners of him were posted and acknowledged throughout the country. Every home we visited had a beautiful, grandiose shrine of this honorable man surrounded by other significant figures including other family members and because most people are Buddhist, Buddha. When we visited The Grand Palace, everyone was wearing black. Little black ribbons were provided for the attachment to our scrubs as we worked through the villages and clinics so we could also show our respect for the King. 

Something about living through such an entirely, highly regarded respect one has for another human being is simply beautiful. As this resonates, because it continues to, I will always be conscientious of the admirable qualities, achievements, or abilities one possesses, being sure to honor these characteristics with subduing respect. 

       In addition to respect, consideration for others was also consistent throughout the community without fail. A core part of our experience in Thailand involved partnering with our Thai sisters from SUT, and performing home visits throughout the village.  Before beginning this experience, this was the single most stressful idea to me!  Having had community health clinical experiences in the US as an undergraduate student, I expected that there would be resistance and lack of enthusiasm by the villagers to having a group of students enter their homes, and that they may perceive the discussion of their health as an invasion of privacy.  I was so wrong!  Starting from the first home we visited, I felt welcomed and appreciated, despite speaking a different language than everyone around me.  

(Making home visits by bicycle in the village)

       
       The villagers were overwhelmingly enthusiastic about seeing us; they welcomed us into their homes and stores, were engaged in conversation with our group, and would ensure our comfort, whether that meant offering us water and fruit, or offering us all a place to sit.  Many village residents were overwhelmingly excited to show us their yards and homes, and their friendliness and kindness permeated every interaction.  Many people even made an effort to talk with me in English when they could, and used their gestures to express hospitality and gratitude when we couldn't communicate with each other verbally.  While life in a Thai village is incredibly different from life in an American suburb, there were lessons I learned about being respectful toward others, providing comfort toward those who enter my home, and being fully present in every moment.

       Lets talk food! The Thai diet is much different from the familiar westernized cuisine consumed in America. It consists of broth based soups, various types deliciously prepared curry atop rice with fried eggs, grilled meats, seafood, fish sauce and spicy chilies. Dishes are served family style as opposed to in courses and mixes of spicy, mild, and sweet foods are served together as to neutralize the palate. Native herbs and spices such as the kaffir lime, Thai basil, lemongrass, and dried red chilies produce mouth-watering flavor combinations. Also, the Thai way consists of eating only when hungry and avoids placing emphasis on "3 meals a day" or "small meals every 2-3 hours." This contributes to fostering a being present in the moment type of dining experience. In addition, the cuisine lacks the added fats, oils, sugars, and caloric sweeteners that goes into the preparation of westernized foods-- and also, cheese! Remarkably, cardiovascular disease is much less prevalent in Thailand than it is here suggesting diet really does play a strong role in disease.

(Various vegetables and herbs we gathered at a market prior to learning how to prepare a 5 course meal at Silom Thai Cooking School!)

       
       Lastly, as mentioned in a previous blog post, the work ethic of the Thai people is quite impressive. We witnessed a sweating, diligent, hard-working gentleman turning a pottery bowl. Later, we learned the amount of money earned for completing such a cumbersome, repetitive task for a consecutive 8 hours! An amount that through foreign eyes could be viewed as potentially inhumane. This has made me appreciate things I may sometimes take for granted. 

"Certainly, travel is more than the seeing of sights; it is a change that goes on, deep and permanent, in the ideas of living" -Mary Ritter Beard

With Love, 

Julia and Lizzi