Chao Phraya Abhaibhubhejhr Hospital

A part of our two-week Neuro course is a day trip to Prachinburi province to visit Chao Phraya Abhaibhubhejr Hospital (pronounced as /dzao-pya-ah-bai-bu-beh/). It is a tertiary hospital located on the eastern side of Thailand, 2 hours away via van. CPAH is on the forefront of promoting Thai traditional medicine. Patients are treated and cured with the use of Thai traditional techniques and herbs alongside modern medicine. In fact, they have a pharma lab within the institution that formulates and does scientific research on different locally known herbal medications.  They also have a museum beside the main hospital building housing intriguing medicinal displays.  

    

With Dr. Makorn Limudomporn (in dark blue polo and tie), a PNI alumnus who is now practicing at CPAH. He toured us around the hospital including the ER and Acute Stroke Unit. He also showed us the efficiency of Tele-Stroke and how it speeds up stroke management and patient recovery. 

In front of the Thai Traditional Medicine Museum

This Renaissance-style building was built as a residence for King Rama V, no wonder why most of the furniture and antiques inside are related to him. Inside is an old-style pharmacy with shelves containing different potions, herbs, and medicinal insects and reptiles. Yes, reptiles! 

 

 

Just like in PNI, Thai traditional massage and acupuncture is also incorporated in the rehabilitation program of stroke patients. They have shown us their vast massage room as well as the oils and herbal medications used. There were particular leaves and oil they apply on the skin to loosen muscles which I observe my grandmother used when a cousin accidentally sprained an ankle. More or less those leaves and the pharmacological mechanism are the same.

CPAH is the main referral center of  the secondary hospitals in the surrounding provinces. They only refer neurosurgical patients to Bangkok which happens seldom since the most ischemic stroke patients are immediately brought to the hospital and are given rT-PA with the help of the Stroke FAST Track and the Tele-Stroke program. FAST Track is an efficient process in assessing and managing stroke starting with the Emergency Medical Services (EMS) which coordinates between patient and the right hospital. EMS must have a goal of shortening the time of transporting a patient to the hospital. FAST is an acronym for Face (face fallen on one side?), Arm (can they raise both arms?), Speech (slurred speech?) and Time (call emergency hotline if any of these signs are present). An ER personnel must detect signs and symptoms of ischemic stroke for fast administration of thrombolytic therapy (rT-PA, which has a window period of <4.5 hours only).  

Dr. Makorn showing us how to use the Tele-Stroke machine and its advantage over using Facetime or other video-calling apps. 

Tele-Stroke is a technology that uses electronic communication methods such as telephone, internet and videoconferencing to provide exchange of medical information. This aims to improve patient care among stroke patients. Dr. Makorn even emphasized how Tele-Stroke is efficient and effective as he can see patients and start medical therapy while he is still at home. This is very easy to install and to adapt in our provinces in the Philippines for as long as the electricity ceases to fluctuate and the speed of our internet improves. 

Tele-stroke machine at the Stroke ER. Do you see me? Haha!

After the tour, a sumptuous lunch was waiting for us at the dining area of Abhaibhubhejr Day Spa. They have a private spa inside the hospital premises! How awesome! The dining area was enclosed in a glass room with a beautiful garden view. 

With Wai Phyo (on my right), a fellow Muslim physician from Yangon, Myanmar, sharing the table with us.

 

Our last stop was the herbal pharmacy shop inside the hospital where we were given 30% discount! Wahahaha! I bought some herbal turmeric face and body scrub, rose extract soap, and lotion. I thought about my Mom who, most of the time, prefers using traditional Meranao herbs in treating illnesses until now. I remember the bitter taste of papaya leaves extract she used to make us drink whenever we're down with a fever. Also, remember the gunda leaves extract she made me drink when I was in labor? Haha! I swear that precipitated my labor! Had she been a doctor, she'd definitely advocate the use of scientifically tested (or in her case, circumstantially tested and proven) herbal medications together with modern medicine. Nevertheless, she is a very compliant patient.

This field trip made me all the more admire the Thais. Western knowledge came to them but they didn't threw away nor resent their traditional ways and culture. Instead, they made scientific research about what they already have and use it alongside modern and new techniques. Indeed, they are the unconquered people.

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. :) 

Halloween in BKK

The embassy hosted its first ever Halloween party for the staff and their families last night. Now guess who's the youngest party-goer? No other than our little Yam! It's the first ever party she has ever gone to and it's a halloween! Hahaha! I don't remember going to any halloween party before so I guess, it's my first time too!  

This mummy greeted guests at the door. 

I have no idea what to wear for the party since I don't like being either under- or over-dressed so I came being just my usual self with a big ribbon-headband on top my head. Hahaha! For the little one, I dressed her in a sailor girl outfit, a gift from Jabar's former colleague, and accessorized it with a pointy evil-horn headband with a pitchfork. Pink para matchy-matchy kami. Hihi. 

Embassy peeps. Hubby wore his kimon and red sahal. To those who might comment why he wore a religious outfit for a halloween party, relax.  He doesn't mean to disrespect the symbolism of the said outfit, like I said above, we came as our usual selves. 

With Ms. Lanie

Someone doesn't seem to enjoy the attention but she was so attentive to everyone. She was observing everybody especially the kids as they were running around. She doesn't seem to get irritated by all the noise, in fact she was enjoying seeing a lot of people and the lights on the ceiling. Is it too early to train her social skills? 

With Ms. Mae and her pretty daughters Sandra and Sofia who came as the Addams Family. 

Food, singing, games, the little one and I enjoyed everything!

With Khun Yupin, the Thai embassy staff who's being a huge help to everyone in their office. She was one of our first visitors at the hospital when Yam was born. Khun is a Thai equivalent for Miss and/or Mister.

With Ms. Michelle who came as Chun Li. 

There's Jeremy, Ico and Sofia, who topped the 3 best costumes in the kids category. Vice Consul Jay who hosted the event came as a Bangkok motorcycle driver. Haha! Nice! 

And the night was capped with the award for the top 3 best costumes: Manith as Sadako, Ms Lanie and hubby as witch and skeleton, respectively;  and Ate Rose and hubby as Lola Nidora and Rogelio (pero siya daw talaga si Alden! hahaha!) respectively. 

'Til the next embassy party! Thanks for inviting us!