January 9th — Day Four in Thailand

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I think I’m going to actually sleep well on the airplane on the way home. I’m exhausted! We started off today with morning ceremony, but quickly traveled over the hospital. My day was better than expected other than my bodies reaction to drinking to much condensed milk in my morning chocolate coffee (which my preceptor kindly bought for us). The trauma ward was pretty much what I had anticipated after our tour yesterday. All of the patients we saw had head injuries, a result of motorcycle accidents. The neuro surgeon spent about 20 minutes showing us the CT scans of a few patients, stating the cause and results. He explained that many patients were in from new years eve/day because they had been riding a motorcycle drunk after a long night of partying. I was able to dress and clean some head wounds, prepare and administer IV push and drip medications, as well as prepare and administer NG tube feedings. I was reminded of how grateful I am for nutrition and pharmacy back in the United States because it was time consuming to mix feedings as well as IV solutions.



I was also stretched in skills I do not practice often such as using ampules for medication administration. There were often parts of our care that I struggled with because I felt that not enough precaution was taken. We didn’t filter medication drawn from the ampules. We didn't flush the NG tube or IVs before administration. We interacted with patients with pneumonia without masks and wore gowns for contact patients though there was no separation between them and the patient next him or her, often sharing medical equipment. I know that we often have to do what we can with what we have and so therefore grace is extended, but it is difficult to watch these practices if they could be easily changed to help protect the patients.



I did appreciate the way the nurses broke up patient care. They split into three teams, and therefore require a lot of teamwork which was actually very productive. The ward was much calmer than a hospital floor in the states. Nurses took lots of breaks and often sat down during the shift, something I rarely get to experience at work as a nurse aide. I can’t imagine the “burnout” rate is as bad since nurses are given more of a leisurely laid back work environment. But, then again, just a few days in the hospital does not show the whole picture of what it is really like to work in this setting.



To end my day at the hospital, I was able to shadow the third year students and preceptor/professor on the pediatric unit, my favorite! It was tough to watch and to dal with because I felt like proper treatment was not being given. Infants with respiratory infections were placed in the same unit as “critical patients” with no precautions. Intubated patients and tracheostomy patients presented with contractures due to no PT or movement. Infants with febrile seizures were getting treated for the seizures, symptoms, rather than the fever, the cause. This was very frustrating for me, especially in a population I am passionate about helping and assisting. During my experience with third world medicine, I am usually not frustrated by these differences. People get better and culture is not good or bad just different. So now I must learn how to process these thoughts and why my mindset has changed. Is it because I know more now? Is it because I care more? Or am I less sensitive? I guess I will have to ponder these things and take them to the Lord. What are His thoughts? What are His ways?

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