Tonight We Are Thai

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Today my alarm went off at 6 am for I had to get ready for an all-day clinical. Breakfast was served at 7. Today was fried chicken, chicken broth with carrots, rice, stir-fry morning glory (one of my favorites) and fruit. We attended morning ceremony at 8 am and then headed off to Nakornping Hospital.

Students were escorted to their assigned units where they met up with their preceptors. This morning I chose to observe the Male Medical Ward. It was definitely a busy place. They had 45 patients and 9 of those patients were on ventilators. The acuity level was pretty high. The nursing model for this unit was a 2-team approach. Group A & Group B each consisted of 1 general nurse, 1 medication nurse, 1 treatment nurse and 1 helper or aide. Most of the patients were hospitalized because of complications from alcoholism, sepsis/septic shock or pulmonary infections. Myanmar (Burmese) refugees are common in north Thailand. Because they do not receive vaccinations, Thailand sees cases of diphtheria, tetanus, and pertussis unlike the USA. So, today I got to see my first tetanus patient. He was intubated through the nose because his jaw was clenched shut. My students are going to do a case study on him since this is something we rarely, if ever, see in the States. The students rounded with the physicians. The doctors were very friendly and very willing to provide a review of the patient cases for us. The students saw some clinical events that we rarely see in the US. One of the septic shock patients was on a Levophed drip to try and raise is blood pressure. This drug constricts the blood vessels in order to raise the blood pressure. He is on the highest dose possible. His blood vessels are so constricted that no blood supply is getting to his feet. He had necrosis (dying tissue) from his toes up past his ankles. His feet were black and his skin was sloughing off. Students also saw stage 4 bed sores and a new antibiotic resistant bacteria CRE. Several patients were going through alcohol withdraw and almost everyone was in 4-point restraints. One patient was even shackled to the bed but we did not see any law enforcement men in the area. Because the acuity level was so high we asked the doctor why these patients are not in ICU. He said they were not sick enough. They only had 2 problems. Those in ICU have multiple problems and are dying. 50-50% in improving from ICU.

Around 11:30 am we went to the neuro ICU. This was an 8-bed unit with modern equipment (like we would see in the USA). The preceptor in the unit is one of our Thai buddies from 4 years ago, Mint. She was great. The students in this unit oriented the students from the Male Medical Ward to the unit, protocols and patient cases. They did an excellent job.

We ate lunch at the canteen (food court). Students had a lot of food choices which made it difficult for them to decide. Some students liked their choices, some not so much. Everyone however, enjoyed the frappes and smoothies that they purchased at the joining Amazon Café. I spent the afternoon on the Medical Female Ward. This was the first time that we were on this unit. The unit was full. Half of the patients were the normal ward cases but half should have been in ICU but the ICUs are full. So, once again the patient acuity level was high. Eleven patients were on ventilators and all of these patients received tube feeding via bolus. So, my students prepared the 2 pm formula and administered medications and tube feedings via a glass syringe. They also assisted the medication nurse in drawing up saline flushes. The preceptor for this floor is the head nurse. She has been the head nurse for 25 years. She works as a nurse during the day because it is her duty and then she goes to work with her husband in the evening at their local business, a restaurant. She will retire in 4 years at the age of 60 and then she is going to be a full-time business women, which is what she really enjoys.

We arrived back at the dorm around 4 pm. Everyone had a quick shower because the buddies were arriving to prepare everyone for the Kohn Toke Dinner. Students were beautiful and were the center of attention at the restaurant. Strangers were taking their pictures. We enjoyed the traditional northern Thai style dinner served on a Kohn Toke. After we ate we sat and enjoyed a 1 hr show of various northern Thai dancing. The students enjoyed themselves and all took home a picture with them posed with northern villagers as a souvenir. The ride home was very quiet which was no surprise since we were going full force since 6 am. So, I am calling it a night. Fun dee.

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