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.