International Course: Neurology for Non-Neurologists

It was a month ago when an offer to take an international course in Bangkok was posted on the page of IMAN (Islamic Medical Association of the Philippines). I inquired about it thinking that it is the best way to jump-start my slumbering brain while setting aside the question on who's to take care of the little one while I am on a 2-week course. But as Mr. Coelho put it, "And, when you want something, all the universe conspires in helping you to achieve it."  By all means, we found someone to look for our Amina while I am in class. It was a major separation anxiety on my part, but I need to deal with the reality of leaving her at times when I return to work. 

The international course was Neurology for Non-Neurologists which was conducted by Prasat Neurological Institute (PNI), a Thai government institute, which aims to train general physicians all over Southeast Asia about updates in neurology and neurosurgery, focusing mainly on stroke and epilepsy. There are five of us from the Philippines while the rest of the 20 participants are from Myanmar and Laos. They invited doctors from other Southeast Asian countries as well but only participants from the abovementioned nations turned up.  

Outside the Thai Massage and Acupuncture Unit with Dr. Tipyarat Saringcarinkul (the one in pink dress on my right) . Yes, massage and acupuncture is included in the post-stroke Rehab management as statistics proved that those procedures increase patients' recovery rate. They have a spa right inside the hospital! Unfortunately they only cater to patients. Haha! Otherwise, we would loooove to have some foot massage and try acupunture too!

Aside from the different set of lectures, we were also exposed to the facilities and the actual medical management that PNI has to offer. In the Philippines, government hospitals are synonymous to being stinky, crowded, undermanned, lacking medical amenities, with stressed, stressful and rude staff including doctors and nurses. But in PNI, we were surprised at how advanced and modern the hospital is! Sure it is crowded, like any other government hospital, but it doesn't stink and it is well-maintained! Too bad I cannot post photos taken inside their Rehab building and in the Acute Stroke Unit to prove my point. Haha! They even have a prayer room for Muslims, that made me appreciate it even more. 

The two-week course expanded our horizon about the medical culture in our neighboring countries. I learned the difference in the structure of our medical education. In Thailand, as well as in Myanmar and Laos, they do not need a 4-year pre-medical course before entering medicine proper. Instead, they have a six-years medical program consisting of 3 years of pre-clinics and 3-years of clinical skills. Here in Thailand, they spend one year of internship and another two years of working in the communities before they earn their medical license. Medical licensure exam in Thailand consists of three parts: 1.) written, pre-clinics 2.) written, clinical skills and 3.) oral, Objective Structured Clinical Exam (OSCE), each part given on different times within a year. Now that we have started to adapt the K-12 program in the Philippines, I believe we also need to restructure our medical education so as not to waste those years of learning some courses which are not vital in the medical field.  

Neuroradiology Conference

They bring actual patient during grand rounds where resident extract history and perform physical exam right in front of everyone. After that, the patient is then brought to the ward and discussion continues. 

Neurology Grand Rounds 

Living here in Bangkok for more than a year now made me notice how polite and respectful the Thais are. In fact, as I always tell my friends, I have felt discrimination as a Muslim more in the capital of my own country than here in Bangkok. Truth is, the Thais never made me feel like I am different because of this piece of cloth on my head or because of my language. Generally, Thailand is a nation of respectful people. This trait is deeply embedded in their medical culture. Sure there is also a hierarchy but consultants do not insult or put down residents and interns during rounds and/or conferences. We have initially observed this during a neuroradiology conference. An intern orally presented the case, no powerpoint presentations whatsoever, and then a resident presented her clinical impression and differential diagnoses. The consultants asked a few questions or some clarifications and added their thoughts on the discussion. The atmosphere was light, there was no stress nor sense of impending doom in the air, the discussion was free flowing from all sides: the interns, residents and the consultants. It is way far from what happens during grand rounds and conferences in the Philippine setting where consultants shout, yell and insult residents and interns who cannot pop the "right" answer to their questions. We, Pinoys, primarily assumed that no boljakan happened because of our presence, the international students. But, we've also attended several grand rounds and the same thing happened! I got the chance of asking Dr. Metha, one of the young neurologists, if this is the regular set-up on a normal grand rounds. He affirmatively said yes. I asked what happens in a scenario when an intern/resident cannot answer some questions thrown at them and this is his exact answer: "Oh it's okay. This is a training hospital so we cannot expect that they know everything, we do our best to teach them the knowledge that we know. Grand rounds is an avenue for learning and should not be stressful." And he smiled. Waaaaah!!!! I wish all consultants in the Philippines think that way and I pray they realize that putting down interns/residents in front of everyone will first, hinder the learning process which will reflect on that person's performance as a physician; second, drops someone's self-esteem; and third, definitely won't make them a better person. I think most consultants in the Philippines have a problem with bloated ego. I am not generalizing as I met plenty of consultants who are so kind and are devoid of issues *winks*. Perhaps it is a consequence of the competition in the medical arena. I believe our generation of doctors condemn this practice so I hope the time comes when this will be obliterated and free flowing medical knowledge and ideas would ensue. In shaa Allah.   

With Dr. Thanaboon Worakijtharnrongchai, the one wearing a gray long-sleeved polo shirt at the center. 

Dr. Khwanrat Wangphonphattanasiri at the Epilepsy clinic.

Team Pilipinas, reprezzent! (back L-R: me, Faizar, Nash, front L-R: Marwa and Weng)

More than the medical knowledge that we gained (and weight too!) is gaining friends! It is my first time to meet my co-participants from the Philippines and it is so amazing how easily we have clicked! Learning was so much fun when you're with like-minded people. Besides, it was my pleasure playing tour guide and introducing to them my favorite halal Thai food and restos. I am sure they had enjoyed their stay while maxing out their cash for shopping! Haha! I wish to see them again in Pinas, now I have a reason to visit Zamboanga City in the future. In shaa Allah.  

I am grateful to Dr. Naheeda Mostufa who informed us about this course and to Sir Mark Santos who submitted our application for a slot. They are instrumental to the knowledge that we acquired and to the priceless experience that we had. Alhamdulillah. :)