a picture request

In the late afternoons, if there are no more patients to see in the OPD, we conduct our own afternoon rounds of checking in on the in-patients. Kaley (our translator) has taken it upon himself to join us for these rounds so that we are able to better communicate with the patients. He is very thoughtful and gentle with the patients, and we are so blessed to have him work with us. This has become one of our favorite parts of the day.

A few days ago we were checking in on one of our young patients (more on that later) whose bed is besides this beautiful woman. In perfect english, she says "Excuse me, I want picture please." We had only heard her speak a few words in english before, so it not only surprised us but made us laugh when she requested a picture. After her request, she put on her fashionable KRCH shirt and grabbed Jessica to join her for the picture. We hope to be able to give her a copy of the picture when she returns for her follow-up visit.

This beautiful couple arrived at the hospital about the same time that we did. Each morning the wife would greet us with a big smile and "Ghaw Ler Ah Gee!" (Good morning!). Jess attempted to use some Sgaw to speak with her, with limited success. Despite the language barrier, she would chat with us each morning and afternoon. One afternoon, Kaley accompanied us to translate and the couple shared part of their story with us.
They came from Bon Dan Yang refugee camp, about 20 km up the road. Together, they run a children's home for orphans in the camp. She explained, "We are very much hoping that my husband gets better, so that we can get back to our children. There are 24 of them." This after they raised 4 children of their own! :)
Their presence was such an encouragement to us. She told us "we pray for each of you-that you will find the right medicine, and for each of the patients." Today they were discharged, but not before many, many blessings and two bags of candy "for the young girl doctors". They made us promise to send pictures for them with the next patient that is discharged back to the camp.
















This past Friday, we got to exercise the Public Health portion of our brain by accompanying the TB outreach team to Three Pagoda Pass for their monthly TB treatment day. Three Pagoda is a border town that straddles the border of Burma and Thailand. It is a very important site from a Public Health standpoint because people from the Burma side can apply for a one-day pass into Thailand to get treatment for medical conditions. The Thai government allows this on a humanitarian grounds.
Most of the patients needed refills on their TB meds, and some were there for sick visits. The first picture shows four team members sitting at the portable pharmacy. The second picture shows Pi Lea, sitting next to Amanda. She heads up many of the public health efforts (when she's not busy force-feeding us).





\Behind us are two of the three pagodas that give the town it's name. They are tiny, don't let the picture fool you. Kaley told us about the town in the 1970s, when he made the journey to Thailand. He says that the town was nothing but a few houses, a market and Three BIG pagodas.









This is the actual border crossing at Three Pagoda. Just a few miles to Yangon! :)

It appeared people were freely walking across the border, without being checked by the guards...until we got there. It turns out there is a reason the stop sign is written in English.

Sorry to disappoint Amanda's Grandma. We couldn't make it to Burma.

update on the appendicitis patient from yesterday: no pain today. hooray! (and no narcotics... amazing.)

Not quite as busy today in the OPD. Here are a few snap shots from the day.

Two of our cutest patients of the day.

Jess examining a cute little boy with the assistance of Kaley (our translator).

And one of our inpatients enjoying an afternoon snack - a cucumber.

from start to finish.

"Please take off your shoes or wipe your feet before you enter the hospital." -imaginary sign at the back and front entrances of the hospital.

It is not unusual to see bare feet throughout the halls of the hospital as most of the patients & visitors take their shoes off at the entrance. Staff customary leave their shoes on, but most of them wear sandals. I love Thailand.


Today was a very exciting day in the OPD. I believe Jess & I admitted close to 75% of the patients we saw in the outpatient department. From acute hepatitis, possible relapsed TB, bacterial meningitis to appendicitis! I must admit, that it is very satisfying to sit down with a patient and gather their history and complete the physical exam, make my diagnosis of acute appendicitis, and then assist in the operating room a few hours later when it is removed. It is incredible to see how much Dr. Phil is capable of doing. In the states, you would typically need at least three or four MDs to complete this process (ie ER doc, radiologist, anesthesiologist, surgeon). During our time here, we have seen Dr. Phil perform a c-section, pull teeth, lumbar punctures, and repair an incarcerated inguinal hernia. As we were prepping for surgery today, the electricity in the hospital went out. This has only occurred a few times since we've arrived and it usually returns in a matter of minutes. The patient had already received spinal anesthesia and we had already scrubbed so we proceeded in hopes that the electricity would return shortly. Very surreal to watch Dr. Phil make the incision and dissect through the different muscle layers with someone holding a flashlight to provide extra lighting. Half-way through the procedure, the electricity came back on and we were able to have much better lighting, suction, and air-conditioning (you would not believe how warm it was getting under the cloth gowns and mask). Tomorrow, during rounds we will check to see how our patient is doing post-appendectomy. Hopefully he is much more comfortable than today.


In solidarity with the many women around the world that must carry their water, Jess & I bought a large container of water across the road from the hospital. It took us at least 10 minutes to convince the sweet lady (without speaking the same language) that we would be able to carry it home. We are so thankful that we only need this water to drink and not for washing or bathing.






And last, but not least, our fresh laundry waiting for us when we return from the hospital. Sadly, Jess may be allergic to the soap as she has developed a mean itchy rash on the back of her knees. I sure hope this doesn't mean she has to start doing her own laundry. :)

you should see it

Saawasdee kaa :)
We arrived at KRCH (Kwai River Christian Hospital) on Monday after a long flight and a friendly overnight stay at a guesthouse in Bangkok. The hospital is situated near the border with Burma, about 15 kilometers from the famous "Three Pagoda Pass", an old trade town that straddles the border of Thailand and Burma (we'll put a map up, don't worry).

Much to our delight, the hospital is actually a whole community! There is a school which educates over 400 children. The school includes dorms for the children who come from too far away to travel. The hostel where they stay is across the path from us and they serenade us each night with their jubilant singing, drums, and yelling in Thai, Karen and Burmese. :)

There is also a sala, which is a building forTB patients,who stay here under while they get their complex 6-9 month treatment for active TB. Multi-drug resistant TB is not uncommon on the border, so as much of the TB treatment as possible is directly observed (DOT) to try to curb the spread of resistant strains from inconsistent treatment. In the sala, families can stay together while their loved ones are being treated. The sala is located between our apartment and the hospital, so each day we see some of the patients outside playing chess or sitting in the shade. The first few times we just got stares- rather intimidating, actually. But gradually both sides have warmed up. We got up the courage to make a visit today, which was a great success. More on that later. :)

There is a whole network of homes on the compound which are lived in by staff from the hospital and community members. There is also a church at the far end of the compound, which we had the pleasure of visiting today.

The view from our front door -- the brown building is a part of the school and the source of the evening music.

Within the hospital itself there is room for everybody. Families can stay with their sick loved ones during treatment, and the hospital provides large washrooms for cooking and cleaning. That is the custom here. Everyone takes care of each other. Patient beds often become family beds at night. It is not unusual to see a patient bathing outside one of the rear wings in a sarong on morning rounds.

About languages....there are many here! Although we are in Thailand, and virtually all of the staff speak Thai, many of the patients do not. We are so close to Karen state (part of Burma) that both Karen languages, Sgaw and Pwo are spoken quite often. There is also Mon and Burmese represented. Patients may speak one or any combination of those languages with significant variations in dialect, so interpretation can be challenging. Then there are the In-Ga-Lai ("English"- the general term for white folks who speak English)...Me and Amanda. The lone one-language speakers.

So far this week, most of our days have consisted of waking up early, when the fog is so thick we can't see too far out our window. We have breakfast in our rooms or at the apartment of our inherited Filipino host mom, Pi Lea. Morning worship starts at 8, at the hospital's outpatient department. All of the staff meets there shortly before 8 (we are usually late). We hear from the chaplain, Mikyai or another pastor or missionary who is passing through, sing songs and pray together. The service is conducted in some combination of Thai and Sgaw. Dr. Phil sometimes scribbles some notes in English for us, as he grew up in Chiang Rai and is fluent.

After worship we round with Dr. Phil (worked at KRCH for 30 years or so and is the former medical director), Dr. Shaw (full time physician at KRCH, educated in Burma), and David (3rd year resident from Hawaii and our part-time tour guide).

After rounds we see patients in the OPD (out patient department). We each have a translator, who not only speaks most all of the local dilects, but can give you a hint if you get stuck. Amanda and I see patients together. We decided that 2 heads rather than 1 would be a good idea, since we are PA STUDENTS and have never practiced or even studied tropical medicine! We limp along together, and grab one of the doctors when we have a question (common occurrence). We are learning quite a bit to say the least.

The man who translates for us is an older, very kind Karen gentleman named Ka-ley. He is a man of short stature and humble nature, but is a giant by way of reputation for his long years of service at KRCH. He is a community health worker in the DOT program, and has worked in many capacities at the hospital over the past several decades. He is retired now- which of course means he works full time as a translator and still goes out on health missions to TB patients. Kalay's whole family works at KRCH. His daughter is a very capable nurse, and his grandson is the self-appointed official greeter, who bows to us each day as he makes his own rounds around the hospital, checking up on patients and chatting with patients in the sala. He is 8, but very busy, you see.

After we see outpatients we usually go home for dinner, which is made for us by Karen women and ready for us at Lea's house at 6:30. We stop home to wash up on our way to Lea's, at our fully furnished apartment with electricity, wireless, and hot water. When we arrive home each evening, our freshly cleaned, dried, and ironed clothes are hanging in a basket over our door. We are VERY well taken care of here...
Our main room in our apartment - cooking area (that will probably not get much use during our stay), bathroom and bedroom off to the right.

The hospital never closes, of course. During our first week we stayed home at night and went to bed early. We recently had a crash course in after-hours care, however. More on that later...

The hospital is very well equipped- one of the best on the border, according to Dr. Phil. There is an open corridor which allows you to see clear through the building, and this opens to a big room with benches in it. This room is a sanctuary in the morning for worship, a waiting room for OPD during the day, and extra sleeping quarters for families at night.

Connected to one side of the big room is a long hallway with a radiology room, chart room, pharmacy, and 2 ORs (take off your sandals before you step over the tape, please). Connected to the front of the hospital is the ER, which is separated from the main room by a partial wall and a curtain. The ER is about the side of an average American kitchen. "Ambulances" (pick up trucks that belong to one of the refugee NGOs or paid taxis called 'song-tow') drop the patients off outside in front of the ER.

Across the big room, opposite the ER, there are 3 exam rooms which are sectioned off from the big room via a swinging door and 2 walls of plywood. This is where we see outpatients-- people coming in to the hospital who are not admitted (coughs, fever, and skin complaints are common).

Coming off the other side of the main room is another long hallway which leads to the impatient ward and the nurses' station. There are 6 large impatient rooms, each of which hold between 6 and 12 beds. There are also a couple entryways that are converted into patient rooms if need be, and can hold 4-6 beds. There are also washrooms, one for men and one for ladies. The listed capacity of the hospital is 40 beds, but there is apparently some sort of unspoken agreement with the Thai government that allows KRCH to function at several times that if necessary.

We are in the mountains, I guess. Not the Colorado mountains, mind you, but mountains none the less. :)

Picture time...

Getting geared up for the 14 hour flight from DC to Tokyo. We spent over 20 hours on a plane. It was completely worth it.


On our drive from Bangkok to the hospital last Monday, we stopped for lunch on the Kwai River.


Every Thursday morning there is a market on the main road next to the hospital. Dr. Phil said it is a cultural event not to be missed and that you can buy everything from fresh meat/fish to sandals and clothing to electronics to tools. One vendor was selling every imaginable part of a pig (the head, liver, intestine, bacon strips, etc), it was incredible!


One of the public health projects of KRCH is the Under 5 program. A few times a month, parents bring their young children to a small building adjacent to the hospital to be weighed. In addition, they may receive deworming medication and any vaccinations that they need. The child has his/her own booklet that keeps track of his/her weight and health record. If the child keeps up with all of his/her weight-checks and vaccines, they are able to receive free sick visits at the OPD. Above is the scale. Small children are placed in the hammock to be weighed while older children may hang from the bar. Below, are some small feet hanging out. :)


Friday was a national Buddhist holiday and most of the hospital staff had the day off. After rounds and lunch, we set out for an adventure with David into the nearby town of Sangklaburi. There were no taxis running due to the holiday, but we fortunately found three kind and willing motorbike drivers with three extra helmets. (Very few riders here actually wear helmets). Sangklaburi is the largest town in the district and lies on a lake with the largest wooden bridge in Thailand leading to a small Mon settlement. The bridge in the picture below is not this bridge but a shot captured on our bike ride into town. :)