The day I wore red eye shadow.

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January 9th:

I promised in this blog I would describe the hospital more thoroughly, but first I know you all are wondering what I had for breakfast.

Today's breakfast of champions was garlic fried chicken with rice and a sautéed vegetable that looked like seaweed. I actually enjoyed the seaweed because it reminded me of spinach. I realized that I may need to start eating fried chicken for breakfast back home.

As we did yesterday, we started the day with our Thai buddies doing the morning ceremony and then headed to Nakornping Hospital. We were all placed in our various wards for the day, so I was dropped off at Neuro ICU. There, I met my preceptor named Peanut, (do not know actual spelling) pronounced Pea-knot. The Neuro ICU is located on the other side of the neurosurgical ward and contains only 8 beds. It is important to note that unlike hospitals in the US, there are no private rooms. There is only one large room with about 2-3 feet between each bed. So, there were four beds lined up next to each other per side. While each bed did have curtains, I only saw a curtain used once for privacy. In most of the general wards in this hospital, the normal nurse to patient ratio is around 1:6 or 1:8 but in the Neuro ICU it is 1:2. It is also important to note that while we had patients that were considered critical, the male/female medical wards had patients that we would consider critical in the US. In the male medical ward, there are 45 patients, 9 of which are on ventilators, 2 of which are septic and will likely die over the next few days. Because Nakornping is a public hospital, people are diagnosed and there is a specific care plan that is used depending on the diagnosis. For example, if a patient has pneumonia they will receive the same care as the next person with pneumonia. If they get better, great. If not, then they die. You can pay extra for special treatment, but people are often far too poor to do so. Another barrier for proper care is religion. I was told by my friends in the female medical ward that a woman with severe gangrene on both lower extremities was told by the doctor that in order to live she must get her feet amputated. She refused because she believes that if she gets them amputated she will not have feet once she is reincarnated. The doctor called a monk to come in and attempt to change her mind. She still refused after the visit with the monk, so she is now septic and will likely die in the next day or so. I would say that my first overall impression of the patients in this hospital is that more patients than not are in critical condition and are very very sick. Sorry for getting distracted. Now onto how my day went in the Neuro ICU.

Once on the floor, our preceptor introduced me and my friend Katie to a nurse who immediately put us to work. The nurse we were paired with told us we were doing a bed bath for a man who looked to be around 75 years old and about 90 pounds. Almost all the patients in the Neuro ICU seem drowsy and only able to be aroused by pain. We filled a basin and started soaking him and adding soap. Unlike bed baths in the US, this seemed like we were actually giving him a bath in his bed. We were not afraid of getting the sheets soaked and washed him thoroughly. After we were done we changed the sheets which were not fitted, so the nurses tie knots at the corners. We also changed the pillow cases which were over top of wool blankets instead of actual pillows. We then finished with mouth care and suctioning and let him rest. Our nurse then told us we were going to do two wound dressings. My friend let me do them (not by choice), as she and I both had never changed a dressing near the jugular. The nurse talked me through it step by step. A major difference in dressing changes from how we do it in the US is that their sterile field is a sterile cloth, and they use all metal utensils. We used sterile forceps to gather our instruments and then used tweezers to clean the wound and place the gauze. In the US we often use betadine to clean the wounds, but in this hospital they use sterile water. After the first dressing was complete, I changed a head dressing where this patient must have had brain surgery. A lot of the patients in the Neuro ICU are admitted for motorcycle accidents or alcohol-related incidents.

Around 10 am they told us we were to take a break (they are so nice in Thailand, you almost can't resist when they tell you to do something). Our preceptor sat down with us and we talked about various experiences. She discussed her experience when she visited Pennsylvania with my professor and a few other Thai friends last year. She loved Hershey's chocolate factory as well as the Amish. She couldn't believe that the Amish rarely went to the hospital or that women often chose to give birth at home. The break ended and we headed back to work.

We switched up nurses and got paired with a nurse named, Mint. Mint was a new nurse only working at Nakornping Hospital for 6 months. In fact, she graduated from BCNC and had her own American buddy four years ago. She was so so sweet and eagerly wanted to practice her English with us. She showed us how to suction with an ET tube as well as how to humidify oxygen. None of the ventilators give humidified oxygen so nurses need to occasionally attach a tube with water to allow for some humidification around every 2 hours. All of the patients but two were on ventilators (no tracheostomies, all ET-tubes). None of these patients were sedated and Mint told us that unless they are severely agitated they do not sedate patients. Mint then went to take care of her last patient who we were told not to get near. This particular patient had E. coli positive ESBL. We were told not to get near him because another huge difference between this hospital and our hospitals at home are there isolation precautions. This patient's bed was at the end of the room, gloves and masks were used, but other than that, no other protective measures were taken. We did see a patient with MRSA in the men's medical ward that had three sheets of plastic clipped above his bed area to help isolate, but that was the most protective measure that we saw.

Until lunch, Katie and I researched about one of the patients who had a severe intraventricular hemorrhage and needed to have a craniotomy/ventriculostomy. For about an hour we looked at his paper chart and were able to read almost all of his information because doctor's are required to write in English.

Mint then took us to lunch at the outdoor cafeteria where I got shrimp Pad Thai. It was so so good. It was also 90 degrees out, the hottest day we would see for the next week. I was sweating through my uniform and I knew I needed a cold drink. We asked Mint and she took us to the cheapest place to buy drinks at the hospital. I tried some more Thai tea with bubbles (large balls of Tapioca) and it was just the refreshment that I needed. My entire lunch and drink for the day cost me 80 baht (just under $3), I know crazy right?!

The rest of the day consisted of helping change the position of patients, more mouth care, and suctioning. There were not a lot of medications given but we did see Mint reconstitute a medication and place it in an IV bag to give. In simpler terms, the nurses do what pharmacy does for nurses in the US. There are less IV drips and more IV push medications given in this particular ICU. Once 3:30 pm came around we said goodbye to Mint and our preceptor and drove back to BCNC.

We all quickly showered as we prepared for our Thai buddies to come to our rooms. Tonight for dinner we would be going to KhumKantoke Restaurant with the nursing faculty of BCNC and our hospital preceptors. We would all be dressed in traditional Thai outfits so we needed help from our buddies to look appropriate. We head a knock at 4:00 and all 5 of our Thai buddies came through with flowers for our hair, makeup, and our Thai outfits all washed and ironed. My skirt was black with orange and red flowers, paired with a red mid-length sleeved shirt. The skirt had to be wrapped around and tied in the front. Mean did my makeup and gave me red eye shadow which at first was something I was not used to. But to the Thai people this look is very beautiful. My look was completed with a low bun that had orchids in it along with a stick with a silver elephant at the end. We took plenty of pictures with our buddies and then thanked them for helping us look beautiful. Unfortunately, our Thai buddies did not get to come with us to dinner but they enjoyed making us look pretty.

When we got to the restaurant, we walked in and were greeted by women dressed in traditional Thai costumes. We took pictures of these women as they were sitting carving out beautiful patterns into melons. We walked further into the restaurant (an outdoor restaurant) and there were three large sections of tables. The far right and left sections had low-set tables that made it look as if we were going to be sitting on the floor to eat. When we got to our table though, there was a lower section for you to place your feet. The large middle section had tables that actually required people to sit on the floor. Towards the front of the area was a giant stage where people would be performing later in the night. Dinner was family-style and contained sticky rice, fried pork, fried tamarinds, fried chicken wings, oven-baked pork, lots of veggies, and various sauces. I tried everything and was not disappointed. They even brought our fried bananas and fresh pineapple/watermelon for dessert 😊

An hour into dinner, the performance started. There were different routines with Thai ladies dancing/singing, men playing the drums, and even two men dressed as money-eating (tips) llamas. Don't worry, I have pictures of all of this. The last number of the performance invited the audience to get up and come to the center to try a traditional Thai dance. This dance was simple (I thought) as the only thing you needed to do was walk in a circle and change hand positions. Thais grow up practicing make their hands bend backwards so for all of us Americans, this was a challenge. Even so, we all tried our best even if our fingers were straight up and not bent back. We thanked our teachers and Thai friends for the lovely dinner and then ventured back to BCNC.

I received a message from Mean who told me she wanted to drop off oranges for me and my friends and so I took that time to gift her with an air plant in order to properly thank her for helping me get ready for dinner. She is always so surprised by my gifts and if there wasn't such a language barrier I would tell her that no amount of gifts could thank her for everything she has already done for me.

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