Mae Sot Day 1 + MTC week 1

So I've been in Mae Sot for about a week and now I've finally got the hang of things I'm going to catch you guys up from the start, since all I've been talking about for ages is my plans for my medical elective at the Mae Tao Clinic (MTC). 

Yep that's right 19 degrees is 'cool' and people actually wear puffy jackets + beanies
If you guys haven't already figured it out, I like to plan things. Not in a drill sergeant type of way, but I like to read and research as much as possible and then narrow down my possibilities so I know when I make a choice I'm choosing out of the best available options. Before I started my etsy shops I researched the competition, the prices, the types of items the wording of the descriptions so I knew what my niche was and how to tweak it to be different. When I was asked to make a bag with free reign on the design as long as it zipped up and fitted a passport I sketched pages of ideas until I just took out the fabric and cut. 

So it should come as no surprise that I researched my elective at the Mae Tao Clinic with the same kind of enthusiasium that I do most things. I plotted the different guesthouses on a google maps which was kind of hard, given that you can't search most things in Mae Sot in English as well as you can in Thai, so I overlayed the gueshouse's thai google map image with the satellite view to find it. And the thing with google maps is that you can make different icons and paste pictures and notes about the different locations, so that once I had added in all my info I just had to click to check it out. Still no amount of planning can counter my horrible sense of direction which led me the wrong way basically the whole of the first day.

I spent my first week in the adult outpatient department which is always the busiest on Mondays, but that's basically the rule for all clinics everywhere after a weekend. But add to this that Monday at the MTC is immunisation day for the children, it makes for scores of people ambling about. And it took me at least until the second day to work my way around the sprawl of buildings at the MTC to find the most direct path to the toilets. 

One of my research readings was a thesis by an Australian midwife on the fertility management of Burmese migrants in Thailand, and she described the MTC as a 'home, school, temple, church, welfare agency, public relationship department and a unique model of refugee-led primary healthcare'. The MTC is that and so much more they have teach children basic hyigene like handwashing to prevent disease transmission and they have an onsite laboratory, prosthetic workshop, private HIV counselling rooms, acupuncture and vision testing in addition to their adult, childrens' and reproductive health outpatient and inpatient departments.They also provide two meals a day to their patients. It's an amazing community setting with families involved in the care of their loved ones and the ones in the beds beside them. 

Outdoor eye testing for glasses and referral to the visiting eye surgeon
So Monday being the busiest day I was placed with Loisa an amazing medic who helped me as I fumbled through my first week. It was just like being in a clinic in Australia, except Loisa was happy to be the translator as she observed by history and examination skills. It seems normal to me now after a week, but on my first day some of the differential diagnoses and treatments were completely left field. And for the meddies of us playing at home, did you know that aluminium is an antacid? and that the top differential to rule out in developing countries when a patient presents with epigastric pain is worm infection? But even the simpler things make you realise that medicine is region specific. In Australia we treat headaches with paracetamol not aspirin, aspirin is used as a blood thinner rarely as an analgesia but I'm pretty sure that some weird Australian thing. 

The entrance to the Adult Outpatient Department (OPD) 
Th adult OPD is basically like a GP clinic. The key difference would be the limitation and differences in investigations that you can order and the types of illness that are seen. The most commonly ordered tests are urine tests and haemoglobin levels as well as a malaraia test for all patients presenting with a fever. The best thing is that the patient goes to the lab for the test and come back with their results, same day return. The first time the medic ordered a urine test and handed the patient the slip and a plastic bag I was so grateful that I did not have to perform the urine dipstick test in the clinic. 

The other key difference is of course in the patient demographic. In what is essentially a GP clinic I saw one person with a history of diabetes in a week! In Melbourne, every couple of patients has diabetes or some other type of cardiovascular risk factor obesity, high cholesterol high BP and so the list goes on.
The backs of all the clinical rooms open onto a shared hallway with medics and trainees passing by and popping in and out to borrow equipment
The patient logbook that each medic has to note name, age, sex, clinic registration number, diagnosis and treatment. Similar to the logbook I had to keep during my GP rotation in Melbourne.
The clinic room next door. You can see the wall dividing us in the right hand corner, but rooms next to each other are only used when there is a medic supervising two separate trainees. Otherwise every third room is used instead for privacy. The paper stuck on the wall are little drug cheat sheets for dosages and such, though only the students seem to need to refer to those, the medics know it off by heart. And the books under the interview table have all kinds of hidden gems including the oxford handbook of clinical medicine and more randomly some really graphic dermatology textbooks.
Just to the left of the waiting area for the adult OPD is the pharamacy. The medication which has been prescribed is dispensed from those massive bottles into to little resealable plastic bags for the patients. Fun fact ibuprofen is hot pink.  

The most interesting cases of the week were beri-beri (B1 deficiency) which is rare in Australia, bowel obstruction case which we admitted to the in patient department (where I am now, and we referred him on to the Mae Sot General hospital for more complex treatment today), nephritic syndrome guy, the chain smoking monk and abdominal TB patient.

Interesting parallel was the case of a stressed out high school student with headaches, unsurprising with her 6 hours of sleep a night, who requested a CT scan. I can think of many aspiring (neurotic) med students who likely presented to their GPs in the same way.

And just a quick thanks to all my friends + family whose hungry stomachs and the lure of this banana crepe cake at my fundraising brunch resulted in a donation of $1200AUD to the clinic! 

mel@all.wrapped.up Web Developer

The indecisive crafter

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