A Day in Chiangdao

สวัสดี or Hello to the blogosphere. Today on our Thailand adventures, we are all still buzzing about our time with the tiger and elephant encounters the past weekend on the van ride to Chiangdao Hospital. We started in the conference room where we met Kudchaporn Intravong, MD the Director in the hospital where she introduced us to the Chiangdao District that the hospital serves.

The District of Chiangdao with the hospital being the small cross towards the bottom, and all the tribal groups that are served in this district surround the map

The hospital has a 60 bed capacity with 11 doctors, 64 nurses, and 5 pharmacists with a focus on HIV/AIDS and TB patients. They work with patients to promote adherence to drug regimens and educate the community to prevent the spread of infections, they also provide coordination between Sue Kwan Doi Luang a PHA group, or people living with HIV/AIDS. The hospital works closely with the Sue Kwan Doi Luang as they have a main office on the hospital grounds where they have monthly meetings with healthcare volunteers and patients, children and adults.  This group helps patients by making monthly packages for their medications, like this one for a TB patient as they will take their medications once a day, usually at night, and the pharmacy packages up a days’ worth of medications in a baggie to be placed in each days pouch.

A month calendar for TB patients treatment

We also learned of the work that Sue Kwan Doi Luang does for patients to help cover the cost of services and medications for migrant workers from neighboring Myanmar.  Patients can work at the mushroom farm or making candles for Loy Kra Tong festivals, that we attended earlier on our trip, for Sue Kwan Doi Luang and sell the products for money to be put to use for medications as well as community education visits and in some cases healthcare volunteer rides to far away patients.  With the help of PHA’s migrant workers are able to receive the same care as all Thai people covered by Universal Coverage as well as the same education on diseases, but we learned that it is harder to keep track of some workers as they don’t stay in the district to follow-up for care.  Then we spoke to the lead pharmacist for the hospital where we learned that the pharmacy has a smaller stock inventory than some of the university hospitals that we have seen in the past.  We did find in this pharmacy liquid anti-retroviral (ARV) treatments for children and Efavirenz in 200mg that they use for low weight patients as the regular 600mg tablet would cause too many side effects for them.  

Main treatment options for ARV supplied by the government

Liquid ARV Options

The pharmacist also mentioned that her first counseling session with an HIV patient is usually around 30 minutes but as a patient continues treatment and needs to change therapies and will need counseling on adherence they can last for an hour or so because the doctors are barely spending 10 minutes with them.  Pharmacists can also be responsible for ensuring that HIV patients are closely monitored for creatinine levels when they are taking Tenofovir, by requesting the lab to get blood work.  After touring the pharmacy we got to see the Sue Kwan Doi Luang office and meet a few volunteers, who have TB which makes communicating concerns and questions easier between the patient and doctors as these volunteers have the disease and can better relate and give advice.  These volunteers go out into the community for HIV patients starting ARV every few days to help them with the treatment and any concerns they may have, but will have to go every day for 2 weeks for TB patients to watch them take their medications and make sure they are in a safe place in the home.  From there we went to the area of the hospital that provides Thai massage, acupuncture, saunas, and hot pots for mothers having contractions.  

Charts for Traditional Medicines at the building for massage and acupuncture, and our guiding doctor

We then went to the PT and OT buildings where patients, in the hospital and in the community, can come for electrical and physical stimulation like ultrasound, and physical stretching to help numbness, muscular problems or any condition that a physician believes can benefit from therapy.  OT deals mainly with developmentally delayed children, like those with ADD, Downs Syndrome, Cerebral Palsy, and Autism to help them flourish as well as train parents how to best help their children at home and will do home visits with them.  The facility itself does a lot of screening tests for children to determine their diagnosis.  From there we went on a walk to the ER and main hospital floors where we saw many people waiting to be seen by doctors and learned that only 3 to 4 doctors work per day and about 300 patients come in for care, about 70-100 of those patients are considered for the ER.  The ER medications are kept in what looked like a hutch cabinet that a pharmacist will check on every 8 hours to make sure they have the medications they need in the event of an emergency.  From there we went to the third floor that had the labor room, where we saw the medication buckets for labor, here are photos of the lids that list the medications, some medication though is kept in the floor refrigerator like atropine.  Approximately 700 labors occur per year in this ward of 5 beds, with no OB or anesthetist so if there are any complications women must be sent to the Providence hospital which is about an hour away, but they are hoping to have an OB in a year.  These patients cannot have a C-section or an epidural so they have massage, hot pots, and herbals to help mothers through labor pains.  

The High Alert medication box on the labor ward

The General Medication box on the labor floor

After that we headed down for a tasty lunch that the hospital provided and went a few kilometers down the road to the Ban Mitrathon orphanage and school.  We got to meet some of the head nuns of the orphanage like Sister Agnes that came all the way from Bangkok to meet us, and take us around the orphanage that takes in children with HIV or children that have been abandoned by HIV infected parents.  They showed us their medication room where children come and get their weeks’ worth of medication at a time, their play rooms, and a few of the bedrooms. 

The new ARV treatment regimens for children to see what they need based on their records

They brought us to the baby building where we got to see 3 babies under the age of 2 years even though we woke them up from their afternoon nap they perked up to see us.  Lastly they brought us to the school where the 2^nd through 6^th graders sang and danced for us in the stage area of the school and got to ask us questions like our names and where we were from.  Then we went to a kindergarten class that we sang the “Hello” song with and danced the chicken dance with for a bit before their parent teacher conferences.  Overall it was a great day in the mountains of Chiangdao and I can’t wait to see what our last week in Thailand brings!