Today was a long and fulfilling day spent between the hospital and the university. Students were divided into small groups in the morning where each group was ushered off to various areas of the hospital to observe and participate in inpatient care. I had the opportunity to spend the morning with a lovely pharmacist in the Cardiac Care Unit. She prepped us for rounds by explaining the chief complaint, past medical history and history of present illness for each patient being cared for in the unit. After prepping us on the patients, we joined the rounding team of the attending, medical residents and nurses to discuss the hospital course and plan of therapy going forward for each patient. The team conducted rounds mostly in English for our own benefit.
As this unit serves patients with critical cardiac conditions, the patients we rounded on had recently suffered from conditions like myocardial infarction (heart attack), Takosubo’s Cardiomyopathy (“Broken Heart Syndrome”) and myocarditis (infection of the heart muscle). Most patients were on ventilators and many were requiring intaaortic balloon pumps to prevent cardiovascular collapse.
I thoroughly enjoyed this opportunity because I was able to directly compare it to my previous experiences back in the US since I have completed a rotation in the cardiac intensive care unit at a large hospital. I’m most suprised by how similar the management of care is between the US and Thailand based on what I witnessed during rounds today. They follow the same treatment algorithms and use the same drugs as we do in the therapy of these common cardiac conditions. I was able to answer questions posed by the pharmacist and follow the logic behind treatment decisions made because it so closely resembled my own experience. Rounds followed a similar dynamic in terms of presentation of the patient and discussion by the team. Pharmacists serve a similar role by providing guidance and recommendations for drug therapy just like what I took part in at the American hospital.
Most patients were elderly (older than 60 years), which is similar to the population with cardiac conditions I cared for in the US. Surprisingly, almost all of the patients in the unit were female whereas the vast majority of patients I saw on my rotation in the US were male. Additionally, because the hospitals in Thailand use paper charts it was challenging for all team members to have easily accessible knowledge about the patients labs, medications and clinical course like what we have with medical record systems in the US. One more critical difference we recognized today was in the management of multi drug resistant infections. One patient in the unit had a Vancomycin Resistant Enterococcus (VRE) bloodstream infection. The facility does not have enough space to provide this patient with their own isolated room. Therefore, the patient was quarantined off from the open floor by way of a plastic screen. With limited space and resources, the Thai hospitals work their best to isolate infectious patients as much as possible but it’s still a real challenge for these institutions to manage appropriately.
The pharmacist, attending and medical residents were incredibly inviting and excited to have us there. They took extra time to explain the patient cases to us and made sure to ask us questions to learn more about our own practices back home. I am once again grateful to the hospitality and enthusiasm demonstrated by our Thai hosts!
Chrissy, myself and the CCU pharmacist
We spent the afternoon discussing pharmacy practice in the US and Thailand with Chiang Mai University Pharmacy students
Kayla
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