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

Thai Traditional Medicines Hospital

The mansion that is used for a museum and Thai Traditional Medicine Dispensary at the hospital

Thursday was a pretty cool day at the Chao Phya Abhaibhubejhr Hospital, a regional hospital even though they it is the smallest facility for the region.  Regional hospitals are normally considered bigger and can offer more services than a district hospital which is mainly the hospitals that we have been seeing during our trip.  What makes this hospital unique is that it practices Thai Traditional Medicine (TTM) in the form of Thai massage and traditional Thai herbals through it’s own dispensary and manufacturing facility. 

The dispensing cabinet with the Thai Traditional Doctor assisting a group of Filipino women we were on tour with and Dean Tanzer

The display of traditional herbs and animals to display the history of Thai medication, it is very similar to old pharmacies in the US in the past with the dark wood

Wooden grinders on display in the museum

We have seen their products before at the Chiang Mai University community pharmacy as well as other community settings.  This hospital was also unique in that the hospital itself is controlled by the Ministry of Public Health but their Foundation that mainly runs the traditional medicines is privately funded.  This means that some of the services and medications must be paid out of pocket by the patients with no help from their government supplied coverage, unless the treatment has been researched and tested to provide benefit over Western therapies.  With the help of the foundation though many of the massage services are less than 100 baht per session for patients.  TTM works in many departments within the hospital like the neurology and obstetrics where they utilize massage and are continuously testing medications in controlled clinical trials.  The pharmacist that took us on our tour of the farm and of the hospital works in the clinical research department of the foundation for the hospital.  Seeing the farm where their herbals are grown was cool to try different leaves, smell bark, and look at the seeds of plants that are used as raw material for many traditional medications.  We were able to see the entire process from farming to drying to manufacturing and quality control for medication supplements that are not well controlled in the US.  They also enjoy producing the Thai herbs to keep business in the country and they don't have to import so many Chinese herbs for traditional type treatments.

Berries and leaves are used from this plant in different formulations such as suspensions and capsules 

This seed is used as a single extract to help common cold symptoms

Finished product on sale at the hospital for tea

Taking Chances

Hello friends, family and faculty!

I’ve never considered myself to be a particularly adventurous individual. Making the decision to partake in the Thailand International APPE consisted of a great deal of self contemplation and encouragement from friends and family who felt strongly that I should embrace an amazing opportunity such as this. To be completely honest, in the months leading up to my departure, I was full of dread, regret and anxiety about my decision to spend four weeks in a foreign country, especially considering that the trip would be taking place very close to a critical time in the academic year for obtaining a residency and would draw me away from time spent working on my applications.  On the day of my departure to Thailand, I certainly felt excited but also highly concerned about whether or not I had made the right decision to go. 

Having completed almost all of the experience now, it probably comes as no big surprise to readers that I strongly believe that I DID make the right decision for myself in coming to Thailand.  

Firstly, learning about the practice of healthcare in a country vastly different from where I received my own training has revealed numerous similarities and differences that have altered the way I see health achievement and maintenance. I was intrigued by the coverage options provided by the government of Thailand and the extent that they go to ensure adequate access to care. Despite challenges in affording to provide healthcare for the country, the government values this service so strongly that they do all that they can to manage the burden. 

I found it interesting how they choose to manage costs, one methodology being to promote increased use of herbal supplements and traditional Thai medicine. In the United States, medicine is only considered worthwhile if large scale randomized control trials have demonstrated non-inferiority to conventional options. In Thailand, the traditional healing options are considered to be effective because of their long term reliability, overall safety, and via efficacy evaluations of outcomes different 
from what would be evaluated in the United States. I enjoyed learning about how Traditional Thai Medicine is practiced through visualizing techniques and attending the herbal medicine farm. This experience opened up my mind to alternative treatment options and that the most appropriate therapy may not be a conventional, westernized medicine. I found this especially true for treating pain syndromes where there certainly is no room for a one size fits all approach.  

In my experiences prior to the Thailand rotation, I had many interactions with patients where a language barrier prevented ideal communication from occurring. In Thailand, a communication barrier existed in almost every conversation I had. Throughout these four weeks, I have been given the chance to continue practice in handling these encounters in which both parties do not share the same first language. Continuous interactions like this have improved my patience and given me skills in fine tuning my word choice to ensure my message is clear and concise for the person on the other side of the conversation. These skills in communication that I have gained will surely help me in understanding my patients and guaranteeing that I deliver information effectively to them when they do not speak English as a first language. Only practice and humility could have helped me in developing this skill set and this rotation provided that to me. 

One of the biggest benefits I achieved from this rotation is curiosity and confidence in traveling and experiencing new cultures. By putting myself out there to take part in the unknowns of a foreign rotation, I discovered so much more about another culture, healthcare and myself. I’m itching to come home and educate family and friends about what I was able to learn during my time here and I’m already seek out new chances to travel again. I feel that this is an important mindset to have as a student and future healthcare professional as it helps to break down boundaries between cultures and foster increased awareness of others.  

I am incredibly grateful for this opportunity and for the people who encouraged me to do something uncharacteristic. Thailand has inspired me to continue pushing my boundaries and living outside my comfort zone. 

Thank you for reading!  
Kayla Harris

Driving Around the World

On our many driving adventures of Thailand I have noticed the many differences between our country and Thailand, like for one they drive on the other side of the street.  So crossing the street has been a bit tricky to remember which direction to look first when stepping onto the street.  Even though we have been here for a month it is still my normal reaction to look left at a crosswalk, instead of right.  I have also noticed that driving on country roads it is much more common to pass all the farm work trucks rather than a tractor.  The farm trucks are pretty cool though, most are dump trucks with a matching trailer and they get painted up with all kinds of cool geometric patterns or flowers to carry dirt and other materials.  Mopeds and motor bikes are extremely common on the road, city or country side alike.  Their compact size makes for easy transportation around the buses and cars because they are allowed to ride the line and cut to the front of traffic at lights.  Yet on the long country roads they ride in the shoulder, which made it hard for them when we drove into a rain storm and many of them had to pull over because they were driving though deep puddles while being splashed on. Some tried to brave the storm with ponchos but after a while it was no match for the amount of rain we drove through.  

The rain we drove through from Chiang Mai flooded the curve and blurred the picture

On the roads further away from the cities many of the road signs for town directions do not have English translations on them unless it is specifying a resort.  At least when we drive through the city we can follow along with the English under the Thai exit ramps and mileage postings.  We learned from a waiter one night that many rural areas are not taught English in school, so they do not get a chance to practice it and there is no need for it on their signs.  As for city traffic, it is worse than in the US, people make extra lanes, so a three lane highway becomes four without any problem but they still barely move. Police sometimes cut through traffic on motor bikes to stand at the bottom of highway exit ramps to allow the traffic to leave the highway easier, but they make me nervous with how close they are to the cars.  

One of the many military bases we drove past

The ornate portraits of the King seen while driving in Bangkok towards the Grand Palace

Almost all big tour buses get decorated with the Michelin man

Almost every street sign is beautifully decorated based on the region it is in, like this one was in Old City of Chiang Mai