Welcome back folks. We've had a great year of fundraising and are in the last planning phases for this year's trip. We are having a fundraiser cocktail party in Bangkok March 1st. Our clerkship group leaves Feb 26 and the spring break group arrives March 6th.

We will provide exam updates, vaccines and dental care. We also hope to make a trip to the villages in the mountains. We hope you'll follow our adventure here on our blogg and we will also post daily to our facebook page PROJECT THAILAND.

More pics from the CGT, clinics and Play therapy

Clinic at CGT

The children line up and can't help looking through the windows to see the doctors at work. The are very patient but curious and tend to push to the front. While working the students have big crowds watching them.

Here are some more photos from our clinics and other activities. They are registered and a paper chart completed, then they enter this into a electronic database once clinic is closed. With such a system, next year will be much more efficient and we should be able to track their progress and medical issues along the way. The students will be able to see these charts before they leave and we should be able to prepare, and purchase supplies more efficiently. This will improve overall resource utilization and save the center money and our teams a lot of time.

Hard work pays off! Time for some fun

The team has been hard at work for 3 days now. First clinic was Sunday evening. We went full tilt Monday and had vaccine clinic for evening. We did 300 Japanese encephalitis, and hundreds more polio, and hepatitis B vaccines. We have found a great online EHR that was simple, intuitive and most importantly FREE!! We spent most of today entering the exams and vaccine records into this database. We will be able to access this later via the internet and this will permit us to follow and better plan for future trips. The team will go up into the mountain villages tomorrow to see the Akha families of these children. This will be more of an acute care setting but they have no other access to any care.I did a video interview today of David Stevenson and hope to use it in presentations back home. They plan to build a school here and we are discussing making some rooms dual use as a medical clinic as well. The center has grown significantly since my first visit including chicken coop, food and fruit gardens, playground, and volunteer housing.

I am grateful for the enthusiastic help and support I have received from the students, fellow faculty, Drs. Jennifer Light, Mobeen Rathore, and Rich Petrik, the Emergency Department and the College of Medicine.

We are making a big difference to the Akha kids, not just protecting them from sex-slavery and pedophiles but also providing a true future with training in sustainable farming, and education that can be the foundation for higher education. Indeed, 2 of the CGT graduates are now studying at Universities in Thailand; the first Akha to do so EVER!

We are winding down the clinical phase and will begin to focus on art and play therapy. Tonight is American Movie night. We will be showing Fantasia 2000 and popping popcorn and we have ordered ice cream for all the children.

After tomorrow's village clinic we will be handing out more of the toys we purchased and Thursday we will take 2 children each for elephant rides, and lunch in the mountains. Thursday night we will be leaving to return to Bangkok where we will have 2 days of shopping and R&R. Saturday night we'll return to the airport for our late night flight home. We should be back in G'ville Sunday evening.

From Tourist Central to Northern Villages

Touch down at Chiang Rai airport and it was off to start another adventure. We were greeted at the airport by David, the founder of the orphanage, and a few excited smiling faces. Dr. Petrik, Dr. Light, Dr. Rathore and William Light on board, we were ready to see some patients! About twenty of us jumped into a large pick-up truck and we raced to the store to pick out toys for the 100's of children.

After seeing the kids jumping all around to greet us at the orphanage, we were energized to start clinic. Impetigo, tinea versicolor, lice, cough, and the occasional heart murmur were some of the clinical pearls of the day. With no labs or imaging to guide us, the skin became important again and stethanie regained her glory. Mosquito nets in place, we slept soundly.

5 AM.

The sound of little running feet and children laughing began to amplify from all corners of the complex culminating at a central location with beautiful songs and hymns. After their morning assembly, the children went straight to their tasks-cleaning, preparing lunch, getting ready for school, and helping the younger ones.

More much needed high-school children were available to translate in clinic. As the sun set, we prepared the vaccines. 100's of children received vaccination for Japanese Encephalitis, and we came together as a group to make some tough ethical decisions regarding the allocation of limited polio vaccines.

We started to understand our limitations here as we learned more about the immigrational status of these children and the political climate in this region. Nevertheless, we managed to do what we came here to do by way of medical care. Perhaps our most important contribution this year, we are spending much of our day today compiling medical records for teams to use in the future. We haven't presented the toys yet, so much more to come!!

Week 1, Part 2

Sawasdee (Hello) from Thailand, blog-followers!

A few nights ago, we had the pleasure of dining in a Thai home in Bangkok. Helen, a woman who grew up in the "mountain villages" of Burma, actually had a liver transplant at UF/Shands about five years ago. She saw an article about Project Thailand on the Gainesville Sun website, and invited us to an authentic Thai dinner in her beautiful home. From her 16th floor condo, we had a gorgeous view of Bangkok's night skyline. Dinner was absolutely delicious - especially the spicy Tom Yum Goon soup with fresh shrimp. Conversation was equally delicious. By the end, we had all fallen in love with Helen's infectious laugh and positive spirit! Her friends, Sumitmai and Flo, graciously transported us to and from the dinner, and shared lots of entertaining stories as well. We thank Helen for inviting us into her home, and we hope to see her again before we leave next weekend.

Since arriving in Phuket, we have visited the Vachira Hospital and Tacuapa Hospital, where we were moved by stories and images of the tsunami that struck 5 years ago. The healthcare workers there are true heros!

Other highlights include the Acupunture lecture and demonstration on Quincy (!), the Muay Thai boxing match, and lunch at the highest point on Phuket island with an amazing view of the mountains, jungles, and beach. Stay tuned for more photos & updates!

We've arrived in Bangkok!

We finally arrived in Bangkok, after our long, >24 hour trek across the globe! We got into town close to midnight on Sunday night, and everyone was wide awake due to the time change. Thankfully, Khao San Rd (where we're staying) never seems to sleep so we got to catch part of the US-Canada hockey game with some ice cold Chang Beer!

Monday, we were introduced to the Emergency Department at Ramathibodi Hospital Mahidol University. Over the next 2 days, we received lectures about tropical

diseases in SE Asia, advanced airway and RSI, and Thailand's EMS system. We also got to join in on rounds in the emergency room and check out their ambulances. Over the next day, we will learn more about toxicology, pediatrics, and Chinese acupuncture!

Of course, most of us have gone for a Thai massage in the last few days which is quite different from our massages. Let's just say its good to be flexible and its a little more painful! One of the nurse's husband does Thai massage and invited us over to give us a demonstration in its healing properties. Amr was the lucky victim and it was quite entertaining!

ER triage board

Our lab group with Thai students and faculty




Learning about tropical diseases and checking out flukes, worms and parasites

Gmail address

Project Thailand now has a GMAIL address. If you have supplies to donate, or wish to be a sponsor to support our group you can now contact us at
UFProjectThailand@gmail.com.
Supplies we particularly need are pediatric Singulair, and oral medications that don't require refrigeration. Cash donations can be made by check to UF Foundation with Project Thailand in the memo section.
Due to Pharma conflict of interest rules we cannot accept donations from the pharmaceutical companies but healthcare professionals such as physicians, pharmacists, and nurses can contribute.
Thanks,
Project Thailand

Gainesville Sun article on this year's trip

http://www.gainesville.com/article/20100215/ARTICLES/2151008/1002/NEWS01?Title=UF-professor-med-students-to-help-kids-in-Thailand-

Sign-up here for our upcoming Project Thailand Golf Tournament!

When: Saturday, January 30, 12:00 PM start

Where: Haile Plantation Golf and Country Club

Registration: click here

Would you like to be a sponsor? Learn more about how you can help. Sponsorship packages are listed here.

Project Thailand 2010

This past spring a group of doctors, nurses and medical students at the University of Florida traveled to Chiang Rai, Thailand to provide care to orphaned children of the Akha tribe. As students at the University of Florida College of Medicine, we are excited for the chance to return once more to provide medical care to the people of Chiang Rai. We expect this year’s trip to be bigger and better than last year’s as we will be increasing the number of students and faculty who will be making the trek.

This coming March, we will be providing health care to 400 orphaned children of Akha ethnicity. These Akha children are stateless refugees, as they are not recognized as Thai or Chinese citizens. Their only medical care comes from visiting groups. This year will be the fifth year UF physicians have made this volunteer trip, and the second time medical students will join the effort. We will set up clinic, where we will provide free basic medical care, including physicals, immunizations, vitamins, and medications. Last year we were able to create an electronic medical record for each of the children and we will be expanding upon this record during our upcoming trip.

We will also be setting up clinics in the surrounding villages of Chiang Rai and providing care for others within the community. This will require more supplies and organization but will provide us with the opportunity to expand our area of outreach.

Like the UF physicians, we medical students are providing our own funds to travel to Thailand. We are also responsible for raising enough money to assist in covering the cost of supplies, immunizations, and medications. As you can imagine, we have a great challenge ahead of us to raise enough funds to support the plans we have for this year’s trip. We have fundraising projects planned but we also wanted to reach out to our friends and loved ones and open the door for you to support us as well.

Project Thailand represents a tremendous opportunity to serve some underserved children of Thailand. It also provides an unparalleled educational experience for us as medical students interested in international community medicine. To see photos from previous years, please visit http://emergency.med.ufl.edu/community_service.shtml or scroll through last year's blog posts.

Finale

On our last night we were treated to the kids performing traditional Akha dances in their native dress.
This banner was unfurled at the end of the first dance....

Epilog

We are all home safe and sound. We are planning a picture swapping party and will begin the process of organizing our group and preparing for next year. We have to complete the medical records and I have sent David & Asa growth charts and they will enter the immunization records. We have several potential projects, buying immunizations, establishing sustainable protein with chicken coops, and of course planning the next mission. I have secured space at the upcoming Alachua County Medical Society's Product show and we'll sell some of the Akha art items we brought back. I am donating some black star sapphires to a silent auction and we may have a few other special items for auction.

I have played with a logo design for tagging our equipment and adding to T-shirts and other items we can use for fund raising. Hope you like it but input and suggestions are appreciated.

Elephant rides & Ice cream. The CGT kids have fun

Each team member treated 2 of the children ( who am I kidding we had fun too) to a day or elephant rides, lunch, cokes and ice cream.

Last Day in Bangkok

This overcast, windy day propelled many of us to spend a few hours shopping at the Chatuchak Weekend Market, a labyrinth of stalls selling fisherman pants, bright flowy dresses, silk pillowcases, silver jewelry, wares featuring elephants, orchids, lotus bulbs, green mango salad, fresh cut watermelon, and coconut juice right out of the coconut, among other things. One vendor/performer attracted customers by spinning around and around while he was pouring tandem cups of Thai iced tea. After weaving through the crowds, customers could get some reprieve with an hourlong Thai massage for 250 baht (about US$7). Since it was nearly impossible to navigate our way back to the Sky Train station, we bargained with a taxi driver for fare back to the hotel.

All 17 of us met up for one last dinner in Bangkok, this time with two of the Thai Emergency Medicine residents in their first and second year of their three-year program. We dined on the patio and ate family style to sample whole sea bass, tom yum soup, prawns, morning glories, and chilies in nearly every bite. On our way back to the hotel, we walked through aisles of night market stalls and came across the occasional baby elephant, leashed to be fed or ridden at a price. We caught three of the brightly-colored taxi cabs—hot pink, half-yellow half-green, lime green, royal purple, depending on the company—and flew down the highway toward the Suvarnabhumi Airport.

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.

Mission Accomplished!

By Tuesday we had seen nearly all the children and a couple of adults. The vast majority were well child exams but there were several with irregularities that needed follow up, such as tachycardia, mild hypertension, stool guiac needed etc. There were about 50-60 that required some intervention, ear infections and fungal skin infestations and most of the younger ones have head lice; there were also some that reported worms in the stool and a couple wheezers. We also discovered several with physical findings that will require more evaluation. Tuesday we each treated 2 children to elephant rides done by the Karan Hill tribe. This was the highlight of the trip so far afterwards we had lunch and ice cream and browsed the Karan shops before heading back to the Akha training center. That night they treated us! After dinner I received the best pro-fee imaginable. The children donned their native Akha costumes and performed several traditional dances and some contemporary Christian music too. The Akha are Christian and have been for centuries, but the blend of native costumes and dance to hymns was quite impressive. At the end of their first dance they held up a hand painted “Thank you Gators” banner. After concluding the dance they called us up to thank us one-by-one and each student was given an hand sewn handbag with exquisite needlepoint decoration. Once that was done each of us got about 400 hugs as each child mobbed us on the stage screaming, “Thank you” and “I love you”. It is as close as I’ll ever come to being a rock star. I took photos and video of the evening events but I took some time to just soak up the atmosphere. It was all very moving. We learned their special “handshake” and there were plenty of American high 5’s too. I was gratified to see several of the children for the 3rd time and one who is enrolled in the local university. This is an exceptional accomplishment as it is nearly unheard of for the Akha. She is studying international business and finance. The Training center is supporting her tuition but she works 3 part-time jobs to meet her living expenses.
Wednesday, we tied up some loose ends, some of the kids had slipped by but we had a mini-clinic and quickly completed the charts. There are still charts to be entered into the databank but this will be done by their staff as they are the essentially normal ones. After more hugs and high 5’s it was time to leave our friends and begin our journey home. This was the toughest part of the mission as many bonds have been forged. We piled our stuff and ourselves into the back of the pick-up one last time and left for the airport to a chorus of good-byes from scores of happy faces.
We are now in Bangkok and settled into our hotels. Tomorrow, I have arranged for the students with EM interests to spend some time in the Emergency Department of Ramathibodi Hospital and after lunch we’ll tour the Grand Palace. We are pouring over the tour books and will plan our R&R for Friday and Saturday. Most of us leave late Saturday night, actually 0135 Sunday. There are many places to shop and many sites to see, no doubt we’ll leave with many still on the list.
The main point though is the Mission went well.

Flight of the Flatus

With great relief that no ants had drilled their way into my ear drums last night, I woke up with residual excitement from the festivities from the night before and a brand-spankin' new energy to see the kids. Our last day at clinic was jam-packed with more visits (including a case of congenital cataracts!) and education about immunizations and catch-up immunization schedules. Time flew by so unbelievable fast! Just as the faces were becoming more and more familiar, and putting names to them as well, we had to say our goodbyes. Crowds of children began smothering each of us, wishing us goodbye and saying "you come visit again!"

We could still smell the lemongrass from the (in)famous "meatloaf patties" on our skin as we boarded the plane to Bangkok. It was during this flight where I began to appreciate what I learned in physics. I'm not sure if it was the dried bananas, coconut juice, meat-on-a-stick, the grass jelly drink, or just plain genetics, but I was farting like crazy on the plane. Thank God it was only an hour-long flight, 'cuz by the end of the flight, the monstrous toots started to smell oozing out of the seat cushion, which had so courageously secured them. After trying to pinpoint the culprit, I realized (with the support of resident physicist Ivan), that the reason I was farting so much was because at that cruising altitude, my intestinal pressure was much higher than the surrounding pressure, causing that oh-so-pleasant odor that Quincy and Kristen could not get enough of.

Elephant Rides

March 10

A late post due to technical difficulties....

The children at the Akha training center wake up at 5 am and begin their morning devotion time at 5:15 am. It is an incredible experience to have 400 singing children serve as your wake up call. Our day begins early as well. Many of the children will receive medicine for several days after we leave. Our nursing team, Kathy and Amanda, organized a medication administration record to help the training center staff administer the medication properly. In addition, Kathy collected the urine of a few children to test for urinary tract infections. We identified one infection, and this child will receive an antibiotic.

We purchased a multi-vitamin with iron for one of the older girls. We suspected that she had a significant iron-deficiency anemia based on her history and physical exam. Dr. Ferguson taught us to exam a patient's palms when looking for anemia. If the creases of the palms still have color, it is a good sign. If the creases lack color, "Get on the phone and call the blood bank. Now!"

Later this morning, we took a group of about 30 children into a local market area. There were many local crafts created by the Akha people. We walked around the various stalls and shared ice cream with the children. One shop was home to several large snakes. One weighed 120 kilograms. That is about 264 pounds! For a small fee, you could hold the snake with your friends and take pictures. The children were very excited about the opportunity to have their picture taken with the snake!
After a hot, dusty ride back to the training center, we shared our last evening with the children. Dressed in traditional attire, they performed a tribal dance for our group. They thanked us for coming and offered us many, many hugs. It was like the last night of summer camp. Many children asked if we would return. We are eager to return, and we look forward to seeing how much the children will grow and change over the next year.

We are off to Bangkok tomorrow. The adventure continues!

---Jenn

Morning Routine

So cute!

Pre-school morning stretches before class

Bus ride to school

Pre-schoolers brushing their teeth

Cleaning their dining area after breakfast

Laundry Time