Reflection

This rotation has taught me an incredible amount about the differences and similarities in pharmacy/healthcare practice in other countries, as well as the cultural differences. It was an experience to see health care in action for a country that operates under a universal healthcare coverage system. Patients are able to go to the doctors for a mere $1 under this coverage system, something almost unheard of in the US. This seems to have such a dramatic impact on access to HIV/AIDs care, TB treatment, and much more. The Thai government also encourages the use of herbal and traditional medicines alongside western medicine, recognizing how beneficial massage and acupuncture can be in disease state treatment. Community pharmacies are also allowed to sell many medications over the counter such as antibiotics, blood pressure, and cholesterol medications without a prescription. This poses problems just as we would expect, patient's taking multiple medications that could interact, having incomplete medication lists, etc. Above all, the Thai people are so welcoming and there was never a place we visited that we weren't warmly welcomed. It was such an eye opening experience to see people give all that they had, even if they had so little themselves. Even our bus drivers did everything they could for us without being asked, from bringing cold water after a hot day, to playing music and DVDs on long rides. After our month long journey in Thailand, I hope that I am at least able to pay forward the kindness and love that everyone showed us along the way. I am also honored to walk away with so many new friendships that I know will last a lifetime.

Thanks!
Tiffany

  

Final thoughts on an amazing experience

In a blink of an eye, 4 weeks in Thailand has finally come to an end...

A bitter-sweet feeling as we are headed back home to reunite with family and loved ones, but also leaving behind a new learned culture, new friends, and new experiences.

We will all take different things away from the past 4 weeks we’ve been abroad, but these are some of the most meaningful to me.

Life is busy in Thailand. Normal hustle and bustle here is far busier than anything I’ve experienced before and the fast moving pace and busy streets are definitely a highlight of this country.

Hospitals and clinics follow the same pattern. Public hospitals are constantly packed and pharmacies are packed full of pharmacists and technicians with their own systems and processes that allow them to keep up with the high volume. It was remarkable to see the sheer number of waiting patients in their waiting area, and the ability of the pharmacy to produce the prescriptions quickly.

Probably my favorite experience of the trip was our days with the elephants. This was my first time seeing this beautiful animal in person, and it was truly an experience I️ will never forget. Being able to get up as close as I️ wanted and play with the elephants was an amazing experience, and it was nice to see how well taken care of they were.

As a fan of spicy food, my taste for Thai dishes quickly developed during the trip. We were fortunate enough to take a cooking class where I️ was able to learn how to prepare my favorite Thai dish: Khao soi. I’m happy to be able to take the ability to make this dish home with me so I️ can prepare it for my own family.

Through hot and humid climates, a lot of walking, learning and being in awe of temples, animals and beaches; it’s certainly disappointing to be going home and leaving behind such an amazing experience and place. These past 4 weeks were filled with so many good times that I️ will never forget, and I️ look forward to re-experience them through this blog and tons of photos that we’ve taken.

Thank you to the faculty, staff, and classmates who were a pleasure to be with, and helped to make the rotation so fun and educational.

A special thanks to Brittany, Chelsea, and Peter, the closest friends I️ had along the way-who without being with, the trip could not have been nearly as special.

Signing off one last time from Thailand

- Tom Spring

A Trip I'll Never Forget

Sadly, our trip to Thailand has come to an end. Sitting here with a whole month to reflect on is humbling. This opportunity has provided me with not only with academic experiences, but overall life experience as well. Throughout our trip we were able to compare and contrast our healthcare system with theirs as well as the role of pharmacy specifically in this country. Although there are many differences, it is clear that the priority lies in the actual care and comfort of the patient as a human. The respect the Thai people show each other is genuine and unmatched. I'd love to see more healthcare professionals look at patients as people rather than disease states. Their courtesy for others didn't dissipate upon leaving their professional roles, all those we came in contact with showed genuine interest in our trip and were willing to give advice on where to go and what to see. These led to cultural experiences such as the elephant camp, and what a day that was! Spending time with these gentle giants was astounding and you can truly tell how much the keepers love them. Someone please let my mom know that I decided to bring an elephant home rather than my luggage. All jokes aside this trip has enlightened me in so many ways. I got here and decided to go into every single thing completely open-minded, and that truly allows me to take home so much more than just souvenirs. I'm leaving here with some unbreakable bonds, a newfound love for Thai food and cooking in general, the ability to speak with others without being so shy, and a weird new obsession with some koala snack crackers. I want to continue to take full advantage of different opportunities and new things when I get back to the states, and I urge everyone else to do so as well. So, eat the bugs, try the scorpion, run around with elephants, just stay open-minded. What I really learned is that you can never guess how much you'll gain from an experience without jumping in headfirst and I'm so happy I did.

"Oh the Days of Thailand, They Are Gone

And the time has come for moving on ...
So we'll think back onto these times, and lean on what we learned. For we'll all face life, everyone in his own turn."

While these may be the words to the alma mater of the summer camp I worked at for a few years (with a small change from "summer" to "Thailand" up in the title) it still seems apt as this incredible journey sadly wraps up.  Our time here in Thailand is rapidly drawing to a close, and its time for us to move on to Mid-Year, the holidays and our next rotations. But even as we move on past our expedition, the lessons we have learned will prove to be invaluable. Even beyond the obvious pharmacy knowledge that we gained and discussed, this rotation gave us the chance to learn about travel, humility, policy, cultural differences, flexibility, understanding, self-care and patience, particurally as well tried to navigate traffic in Bangkok. This knowledge will serve to make us better pharmacists, but it is also broadly applicable to all other areas of our lives. There are an incredible number of things that can't be learned or taught in a classroom, and can only be gained by experience, and what better way to gain experience then heading to a foreign country and traveling through it for a month? The days spent in Thai hospitals, the nights spent exploring the cities, the hours spent in the vans, the many moments of laughing, chatting, singing, dancing and snacking with friends, both new and old have made this a once in a lifetime opportunity and experience that has taught me more than I could ever imagine. For a small town girl who had never left the country, save for a 3 day conference in Montreal, a trip halfway around the world has proved to be just what I needed to gain a better understanding of myself.

It doesn't hurt that I also gained a better understanding of elephants along the way...

I will finish out this final blog with many more photos, and after hearing great response to my first set of things I learned, I will include another list of more "educational tidbits."

Signing off,
Amanda


Amanda's Extra Eleven Elucidations from Experiences in (South)East Asia

1) The Thai people are increadibly friendly, welcoming and generous. There wasn't a place we went where we weren't greeted with a smile, a sawadeeka, and most of the time a snack. Even when we visiting villages with very little in the way of possessions, the people were always trying to share food and drink and make use feel welcome.

2) Many (Most?) Thai people have great veneration for the US. There is a long history between the States and Thailand that I was really unaware of before this trip. Everywhere we went people asked where we were from, and upon telling them the US they were very eager to talk about our country and hear what things are like there. I think that in many cases our hosts had more questions for us than we had for them (which was still a lot...)

3) A squaty potty in Thailand is not even close to the squaty potty in the US with the rainbow unicorn ads that people love to share on Facebook.

4) Thai people have their full given name, but they also all have a nickname, also given by their parents. Sometimes these nicknames make sense, like the woman we met who's nickname was Song, Thai for second, since she was her parent's second daughter. Other times there is no connection at all, like the pharmacist we met whose nickname was Pooh, or the one whose nickname was Act.

5) Never underestimate the importance of a travel buddy, or a good relationship with the guys who drive your vans.

6) A Thanksgiving dinner will never taste quite as good when eaten out of the country, away from family, no matter how fancy the hotel serving it is.

7) In many ways, the health system in Thailand exceeds our own. Their hospitals may be crowded and busy, but they can perform the same kind of services we have in the States, and at a cheaper price, even for foreigners without Thai insurance who pay cash. Pharmacists can get paid for screening, home visit and clinic services directly, without needing something like a practice agreement, or a location within a Dr. office. While pharmacy in Thailand is still growing, evolving and finding it's exact role pharmacists essentially already have provider status, and they are fighting for more.

8) Pharmacy residency in Thailand takes 4+years to complete, and instead of getting paid, you have to pay for it. This is because when they decided to start residencies here, the government wasn't sure what that meant or equated to, so they didn't know how to recognize them. What they did understand was PhD programs, so Thailand modeled their residency system to equate to a PhD program in terms of length and research expectations. A resident spends 2 years in one hospital, a year in a different hospital, and at least a year doing research, earning the end of their fellowship only after they have their research accepted for publishing.

9) Watching Cartoon Network dubbed into Thai is one of the most amusing ways to spend a quiet evening in. (Just an FYI, there are also many channels that broadcast shows and movies from the States in English as well.)

10) Thai massage is not for the faint of heart. They certainly know which pressure points to hit, but it feels so good after. (Side note: The Thai government wants to preserve past traditions while also becoming more modern. As such, traditional Thai medicine is promoted, often used along side Western medicine, and is paid for under the universal coverage scheme. This means if your Dr says you need massage to treat your ailment, it is covered!)

11) The country of Thailand is an amazing place, full of amazing people, places and experiences. It is fairly accessible to foreigners who don't speak the language, and it has enough to fill an entire semester of travel. I am increadibly greatful to have come here and experienced this all for myself, and it hurts a little bit to be leaving. I can't want to plan a trip back!

Thai Language Lesson:

The Thai word for Thank you is "kob kuhn ka": An increadibly important phrase, as in "Thank you for such an amazing trip Thailand, Am, Noi, UNE and WNE!"

The word for good bye is "La gon ka": As in goodbye Thailand.

Also the ending of all of my greetings has been Ka. This is because I am female. If I were male, it would be Krab. Kind of like how other languages use different forms of words to indicate male vs. female.

That is pretty much the extent of my Thai knowledge, but I'm eager to learn more!

And now for the photos...

Where can I get one of these trays for my pharmacy?!

Mom of Dragons. Denarys, is that you?

One of the many adorable puppy we saw.

Intricate carvings at the temple

A little paw size comparison between a newborn and a giant

I'm not a cat person, but even I loved this guy

A methadone clinic at the hospital

Souvenir dolls made by HIV patients to help them earn an income.

We made a new friend at the orphanage, and Tom even coordinated their outfits ahead of time.

The 4th, 5th and 6th graders were all to happy to see us

Our chicken dancing kindergarten friends

Every girl should know how to accessorize!

I had no bananas, so the elephant tried to eat my shoe...

Weighing things out the old fashioned way at the Thai Traditional pharmacy

The fire show was too hot to handle, especially sitting right next to the stage.

The end of an amazing adventure

Hello to all my family, friends, and faculty that have following along during our great adventure! 4 weeks have flown by in a blink of an eye and sadly it’s time to head home.

Thailand has been an experience of a lifetime. I have gotten more out of this experience then I ever thought I would. I learned about Thailand’s healthcare system as well as their culture, but I have learned so much about myself. Being a somewhat “picky eater” I have tried more new foods here than I ever would have imagined. The best part about it was that I liked a lot of new things that I never would have thought I would. This has shown me that going outside of my comfort zone can lead to great things. In some ways Thailand has made me realize how privileged we really are. In other ways it has also opened up my eyes to how kind and humble people are in other parts of the world. I have seen more people in thailand who volunteer out of the goodness of their heart and because they love their country and their country’s people. Even though they do not have everything we have in the US, they are so happy and so grateful for what they do have, which is very admirable. It Along this adventure I have met so many new people and established relationships that I will cherish forever. It was amazing to be able to have this experience with 6 students from my class and 7 students from WNE. I have built stronger bonds with my own classmates and was able to establish new bonds with students from WNE. Thailand is a trip that we will all remember forever and be able to reflect on years down the road. The 3 years I spent looking forward to this APPE has exceeded my expectations and I could not be anymore grateful to have been given this opportunity. 

There and Back Again: A Reflection

From the hills of Chiang Mai to the back alleys of Bangkok, these have been some of the greatest four weeks of my life. As this is an educational trip I'll start first with the essentials. Engaging with the pharmacists, doctors, and faculty at the hospitals we visited helped us gain much more of an appreciation for Thailand than had we just been another group of American tourists. Eager to learn about America as much as we were about Thailand, our conversations covered all walks of life. From the utter confusion of American health insurance to the increased role of hospital pharmacy in Thailand, we covered a lot. The Thai people are curious, engaging, and always polite.

What we learned on this trip is so much more than the purely academic, however. Learning how to communicate with those who often speak only broken English was both frustrating and rewarding at times, but is a skill that can be molded to many an occasion. It takes a lot to live in a totally foreign world for so long, from navigating a city of eight million to finding food that won't set your mouth on fire to bartering at the market much like your grandmother used to do when she'd drag you to the yard sales. I know for all of us that we've made great friends along the way and would go back in a heartbeat.

Until next time Thailand,

Peter

Final thoughts. I have learned so much from this experience both on a professional and personal level. I've learned about Thailands healthcare system and how much it differs from ours back home, but I also learned about the Thai people on a cultural level which is an experience that could never be replaced. They are so happy with their lives even though to us, they appear to have so little. I have never been exposed to a more welcoming and accepting culture which will forever change how I deal with foreigners in my pharmacy. I also got to connect with all of the amazing fellow students on this trip and have made relationships that I could never be replaced. This has by far been the most enriching APPE experience I think any student could have. I look forward to the day I can come back to Thailand to experience it all again.

Final thoughts

Choosing to do the Thailand APPE was not an easy decision for me. It was a big commitment to make, and I was concerned it would put me at a disadvantage as compared to my peers. Now, at the end of the rotation, I can say it was one of the best experiences I could have gotten.  While the rotation may not focus on drugs used in America, I gained so much knowledge about how a different healthcare system works, methods of infection control, and the humbling experience of how it feels to be a minority.

I’m also very impressed with the pharmacists in Thailand. Their available technology is still years behind America, but they work with what they have and continue to push the boundary of pharmacy services. I’m particularly impressed with their home visits and continuous inventions to get their patients to take their medications. The interaction between pharmacist and patient during the home visits was something I was envious of - it allowed for one on one interaction and fostered a trusting relationship which revealed drug related issues that might have otherwise been missed. As I get ready to return home, I hope to take back some of the lessons I learned. I want to push the boundaries of what pharmacists are expected to do in the setting of ambulatory care, just as they do here in Thailand.

-Jenny

The Final Countdown

Hello everyone! What an amazing experience. I truly don't believe everything we have learned or received from this trip has set in yet. I don't believe it will for awhile. All the hospitals, all of the people we have come in contact with, have made an indescribable impact on myself and many others. One aspect that has made the most impact on me has been the traditional herbal medicine benefits. In the U.S. we are not necessarily taught to believe in herbal medicine based off of the lack of evidence. However, I now believe the benefits of such medications have been proven in many ways by the Thai culture and the United States may just be influenced by a different way of thinking. We tend to shy away from herbal medicine when really we need to be expanding our knowledge as some of our own patients will be using such remedies. My favorite day? The elephant camp. Favorite food? anything spicy! Most difficult aspect? The language barrier. I am extremely lucky to have had the opportunity to go on this trip. Wouldn't trade it for the world!

Chelsea Kuzio

What I learned in Boating School is...

First off, I want to say that this experience has surpassed anything I could have ever imagined. When you think of doing a rotation in Thailand, you imagine seeing some herbal medicine and having a ton of fun. Yes, that did happen but it was so much more than that.

I specifically requested the November trip to get the opportunity to meet other students from another program, but I didn’t realize I would end up developing such wonderful relationships with such amazing individuals. These past four weeks, I have laughed, cried, and enjoyed the beautiful country of Thailand with some of the most extraordinary people I have ever met. I have had the chance to get to know some of my classmates who I hadn’t really spent that much time with and share some amazing moments with a few of my closest friends. I wholeheartedly believe that this trip was as amazing as it was because of the people on this trip.

As for the rest of the trip, seeing another healthcare system has made me realize how lucky I have it, and learned several techniques to better serve my future patients. I realized how America does some things exactly the same way as other countries, some things we are more advanced on, and several things that we are behind on. It was extremely interesting to see how each of the different hospitals did processes differently, and how they make up for what they lack in ways such as funding and technology. Learning about universal healthcare here opened my eyes to issues that I didn’t really notice at home, yet also made me appreciate different aspects of our healthcare system I have always taken for granted, such as choosing which hospital and doctors office you want to go to. Lastly, learning about the alternative medicine and seeing the research that is going into it makes me feel more competent in recommending certain techniques to patients who may benefit from it.

Overall, I would say choosing to do an APPE in Thailand was one of the best decisions of my life and I would choose to do it all over again.

That's a Wrap!

Hello All!  This APPE rotation has been the experience of a lifetime, not only for my personal life but also for my career.  It has opened my eyes to the many ways pharmacists can help treat their patients in a medical way as well as in an emotional way.  Seeing how traditional medicines can help a patient along with Western treatments to make to overall patient better, not just their disease state was an amazing thing.  Many times during my experiences in the US I have shied away from herbal treatments, but now I see that doing a little research to ensure quality and preventing adverse reactions many patients can benefit from alternative therapies.  I am glad to have been given the opportunity to see all these places and been allowed to tour many hospitals and meet their patients.  Even though we could not directly communicate with each other I felt that each patient knew that by allowing us to visit with them we were improving the next generation of healthcare practitioners.  Not only were they helping us take our knowledge back to the US but they were helping the 6^th year pharmacy students from Thailand.  Having the time to discuss the differences in our schooling and the rotation experiences we had was great, along with learning that if they want to have a residency they may have to go for an additional four years where as ours in only a year or two.  I was very surprised in how almost everything in a pharmacy is in English, but it makes sense with how many medications are developed in the US and other English speaking countries.  The only difference I could see was that the government supplies many medications and they have reproduced them with different names for marketing purposes to make them affordable for the universal healthcare program.  Without out this APPE I would not have been very open to a discussion with a patient for herbal medications but I think in my future I will advocate for patients that want to incorporate it in their care.  I am so thankful for my parents to support my decision to apply for this rotation and thankful to my friends that made this trip the best memory of pharmacy school.  See you soon America! 

อขอบคุณ or as we say Thank you,

Miranda