Mahidol University and the Grand Palace

It felt familiar this morning when I staggered out of bed onto the street in my scrubs and ate breakfast on the run. Adam, Angela, Courtney, India and I rode the skytrain to meet Dr. Ferguson on our way to the local teaching hospital. At the hospital, we met up with faculty of their emergency department and were able to chat with medical students and emergency medicine residents of the university, see their facilities and learn about how their department operates.

Patients are triaged based on vital signs and chief complaint into one of three acuity levels. We were told that the lowest acuity patients will wait about 2 hours to be seen in Bangkok. All patients are seen, regardless of their ability to pay, however patients are sometimes transferred after stabilization if they hold insurance with another hospital.

We were shown to the resuscitation bay, were we were amused to see a resident caring for a patient by holding a paper bag over the patient’s face (he was having hypocalcemic tetany exacerbated by hyperventilation). The resuscitation bay had a wall with all of the incubation gear laid out on hangers. Each patient care room had a statue of the Buddha. Adam learned the hard way not disrespect the Buddha by pointing a finger at the Buddha statues.

Throughout our tour of the facilities, we had an engaging discussion with faculty about the differences between our respective hospitals. This included systems issues like overcrowding and admission hold overs, as well as specific disease management issues, such as stroke treatment and tropical diseases. It was interesting to hear that physicians radio orders to the ambulance en route to the hospital in contrast to the more protocol driven system independent of physicians at home. Also, overcrowding in the Thailand ED was addressed through the use of an intermediate holding area between the emergency department and the ward floor.

Resident life seemed to be similar to the US in more ways than not, including the use of a simulation lab, sharing one cluttered resident lounge and having test anxiety (we happened to visit on a resident test day). Medical students and residents read textbooks and journal articles in English and receive lectures and discuss information with teachers in Thai. Their bookshelves had the same favorites as we do back home, including Tintinalli’s emergency medicine, William’s hematology and Nelson’s pediatrics.

We had lunch at the Mahidol University cafeteria, were we sampled various Thai dishes and fruit juices. We were astonished by how food could be so cheap but so good, and wondered how our lives might be different if we had access to the Thai cafeteria everyday back home instead of the Shand’s hospital food. Outside of the cafeteria, a poster session was being held for the various scientific disciplines at the university. The program for it included both English and Thai versions of the abstracts.

In the afternoon, we rode a boat bus down to visit the Grand Palace, were we learned about the traditions of the county and gawked at the beauty of sites like the Chapel of the Emerald Buddha. In the evening, the whole project group met up for dinner and ate Thai food before heading out to haggle at a night market.