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. :)