A Visit North Before the Journey South

Greetings from the warm half of the globe!

Our last day in Chiang Mai started out with a long, windy drive north to the Chiang Dao district. An hour and half later we arrived at the Chiangdao Hospital. We quickly learned this small 60 bed facility specializing in HIV and tuberculosis care serves a population of almost 100,000 and sees 300 outpatients per day with only two or three doctors. Wow!

We received a warm welcome from the hospital with our mid morning snack already laid out for us! Gonna miss this in a week....

Being so close to the border of Myanmar, Chiangdao hospital's patient population includes a large number of migrant workers. As you'd imagine this makes follow up very difficult, hindering efforts to treat HIV and TB both which require long and sometimes complex therapies. However, in this respect Thailand has streamlined their drug choices considerably under their universal coverage scheme. Universal coverage is free health insurance for all Thai citizens as previous bloggers have described. A patient with this insurance receives free care and medication but the essential drug list is small for this plan. During our initial presentation from the hospital they explained to us the rationale behind this limited formulary for HIV treatment. One starting regimen for all offers simplicity in a once daily, single pill combination and it harmonizes regimens across a range of comorbid conditions.

Pictured above are all the treatment options for HIV and TB under the UC scheme. Nice and streamlined.

They even have liquid medication for pediatric patients.

Putting our bubble packing to shame! Here one of the pharmacists demonstrate their version of a pill box, it has a pouch for every day of the month in which a plastic bag in placed with the day's medication.

We returned to the meeting room for a buffet style meal prepared for us by the hospital. The Thai peoples' hospitality continues to amaze me. After we were full of pineapple, green curry, and chicken wings we jumped in our vans for a short drive to the Baan Mitratorn Orphanage and Princess Ubolratana School. Known as the "Home of Caring Friends" this far north orphanage seeks to serve orphans affected by HIV/AIDS, abused children, and those afflicted by other hardships. The all girls orphanage has served up to 52 children before, but now only house about 25. The beautiful facility is nestled on a hill side with a view of the northern mountains of Thailand and several fish ponds and expansive garden.

Looking on jealously as our drivers say hi to a young puppy we were all eyeballing. Unfortunately, he wasn't lucky enough to join us for the ride home.

After playing with the toddlers and several students considering a repeat trip to the orphanage as a volunteer, we ventured over to the Princess Uboltrana School. Boy were they excited to see us! Eager to know where we were from and our names, we were escorted to the front of the open air classroom and briefly introduced ourselves. Repeating our names back to us in unison they got almost everyone's right....except mine. Maybe Pete would've been an easier syllable. Our introduction was followed with a warm welcome including both a dance and song!

The children look on intently as we introduce ourselves.

 Several renditions of "head, shoulders, knees and toes" and the "chicken dance" with the kindergartners later, we were back on the road to Chiang Mai and them to parent-teacher conferences. We drifted off in a doze, not ready to spend our final night in this amazing city, but fervently awaiting our second encounter with the elephants tomorrow.

Stay tuned,

Peter