พิลาส [dance]

The rest of our first week at Mahasarakham University has been filled with many incredible experiences. On Wednesday we covered the campus on our bikes! The morning started with all 6 of us foreign students biking to the nearby little market. We enjoyed coffee frappes and shared corn waffles and coconut waffles. Corn seems to be included in almost every dish in Thailand from an ice cream topping to a waffle batter! We’ve also noticed/learned a few other interesting food/eating customs in Thailand. Knives are not available to be used as utensils. All meals, from a whole fried chicken to noodles and papaya salads, are eaten with a fork and a large spoon. Also eating the last bite in Thailand is thought to bring you good luck to your love life! Now we are offering each other our last bite of every snack, smoothie/frappe, and meal ha! Our new favorite frappe is hazelnut coffee that comes with real chopped hazelnuts on top.  

 Our second stop of the day was a tour at the Paleontological Research and Education Center (the only one in Thailand). A few professors and PhD students shared their research on fish, dinosaur, and botanical fossils. They explained that fossils in Thailand are often found by the local people, then the researchers venture out to the site where they excavate the area for a few days to determine the area they while need to bring back to their lab at the University and place the area in a plaster and burlap mold. Then they carefully work away at the plaster mold to uncover the fossils in their lab. It is was very neat to get an up close look at the immense amount of fossils they had and even use the air gun ourselves to help reveal the bones of a dinosaur tail they are currently working on. We also loved the adorable Dino-themed water they provided to us!

Outside the Paleontology Center 

Cleaning a dinosaur fossil!

So excited about this museum

Next we hopped on our bikes for a spontaneous trip to the University’s Silk Innovation Center.  The ladies there were so excited to graciously share with us each step of the silk making process beginning with the eggs that they incubate. One mother lays 300 eggs at a time! We were able to see eggs that just hatched into larva today and were munching on finely chopped Mulberry leaves. After the larva grow for several weeks, they form cocoons and each tray holds 20,000 silk worms and their cocoons. The innovation center had 17 different varieties of silk worms, Thai silk worms have a yellow cocoon.  The cocoons are then placed in hot water and 1 cocoon can make 300 meters of silk. It was truly impressive the skill that the ladies used to pull the silk from the cocoon into a silk thread… we were very excited to try this ourselves! In the loom room we were able to touch the soft silk and even got to use the loom to weave a small section of fabric. We both gained an even greater appreciation of what a true masterpiece silk is after seeing how difficult it was to even do a simple pattern (which is actually controlled by the feet)! It was also fun to learn a few different uses for silk beyond cloth. The silk worm can be boiled or fried after being removed from the cocoon. A few adventurous students in our group tried this as a snack! We all tried the cosmetic products that are made from the silk protein and we were graciously given a souvenir bag filled with silk protein soap and cocoons to use as exfoliating pads.

Silk made in Mahasarakham

The trays that each contain 20,000 cocoons

Making silk!

With our wonderful silk gifts and staff of the Silk Innovation Center

Next we biked to a nearby campus coffee shop for a quick yummy snack of pork dumplings (that Thai students call meatballs) with great dipping sauces. Then we parked our bikes at the Faculty of Pharmacy and got in the school van to take a trip to the Samakee Primary Care Unit. Samakee means ‘together’ in Thai and there truly was a sense of togetherness at this comprehensive care center aiming to provide health promotion, disease prevention, and curative care to the local people of the Maha Sarakham area. The family care physician was an impressive doctor who gave a presentation on the services provided at this clinic and a tour of the facility. We both really liked him, as it was obvious he loved his job. He stated that primary care physicians are the lowest paid doctors in Thailand and that his medical students refer to his rotation as a “vacation rotation.” As we struggle with this stigma in America in terms of family medicine and primary care services, we could definitely relate and appreciated his dedication to patient care. We explained to him how in our country, we are fighting to have pharmacists recognized as providers so we can expand ambulatory and primary care services.

Coffee shop lunch

Samakee Primary Care Unit

The services provided at this Primary Care Unit included outpatient treatment of common chronic conditions such as diabetes mellitus, administration of vaccinations, wound dressing, patient education and counseling, pap smears and breast cancer screening, family planning, and referral to hospital and specialist. The physician described that each day patients arrive without making an appointment and wait to see the family care physician in his chronic care clinic. He is typically able to see 20 patients each morning. Then in the afternoon the doctor and his team of nurses, healthcare volunteers, and often a pharmacist conduct home visits at 1 to 4 patients homes, spending about an hour with each patient. On some days a grand team, which includes a dentist or specialist like a physical therapist, conduct the home visits. This sounded similar to our Pharmacy Practice Experience visits that we conduct during our first 3 years at Auburn’s HSOP, but with a multidisciplinary team.  The idea behind the home visits is to bring the hospital to the patient and to decrease emergency room visits. It also provides a cost-effective way to care for the elderly and home bound.  

The pharmacy practice model at the Primary Care Unit consists of dispensing and counseling in the morning and participating in home visits in the afternoons. Other pharmacy services provided include performing hygiene checks at the local markets every 3 months (to ensure clean water, etc.) and helping with health screening for diabetes and hypertension at local festivals.   

Samakee Primary Care Unit Pharmacy

Beyond the medical clinic the Primary Care Unit facilities also included a dispensing pharmacy, a dental clinic, laboratory clinic, and a Thai traditional medicine shop. We learned that there are two tracts within the medical field doctors in which doctors can be trained: western medicine or Thai traditional medicine. Thai traditional medicine entails massages for treatment of pain, many types of tea that help to lower cholesterol and improve cardiovascular health, and natural remedies for ailments such as peptic ulcers and the common cold. Patients can select which treatment method they prefer and communication between the western and traditional medicine physicians is crucial. The physician shared that he often has to train his medical students to be open and receptive to the Traditional Thai medicine practices.  We truly enjoyed this visit, it was very interesting to see this one stop healthcare practice and learn about the gateway to further care and community services it provides.  

Outside the Primary Care Unit with staff and students

After returning from the Primary Care Unit we pedaled over to our Thai dance class taught by our wonderful Thai friends and a pharmacy student friend of theirs who is a very talented Thai dancer. They choreographed a dance for us to perform at the New Year Party on Friday night. The movements are very intricate and beautiful, but challenging, as they require one hand to have fingers open and the other hand to have fingers closed at the same time, plus our fingers do not bend into the beautiful curve that Thai dancers grow up pressing their fingers to form! This was a fun bonding and learning experience and we even finished the night teaching the Thai students the American dance ‘The Wobble,’ which brought everyone smiles and laughs.

Learning the Wobble, our greatest gift to the people of Thailand thus far

Our last bike stop for the day was to the small market for fruit smoothies from our favorite smoothie stand. We’re working on our punch card! After 12 smoothies you get one free, we’re already up to 4 in 2 days :) Watching the lady cut the pineapple for our smoothies lead to an exciting discovery of how the pineapple slices in Thailand look like rings of sunshine, which we’ve been so curious about! They are simply making diagonal cuts to remove the brown rind spots left on the pineapple! 

The next morning our bikes stayed put and we took the van to the Mahasarkham University Hospital. This is a beautiful new 12 story hospital that opened last year.  This facility is the site where medical students from Mahasarakham University train and features a 24 hour emergency service of 3 beds and 1 pediatric bed, as well as 4 specialty clinics that are open 2 days a week, a 20 bed inpatient ward, a specialty inservice unit where patients can pay out-of-pocket for service, and a pharmacy that serves both inpatients and outpatients. We enjoyed touring the facility and speaking with other healthcare providers and fellow students about how the similarities and differences in healthcare in Thailand, Japan, and the United States. It was neat to see the day-to-day functioning of this hospital pharmacy that contains 600 medications and fills 200 prescriptions per day for both inpatients and outpatients. The medications were mostly in unit dose packages, and one drug that was interesting to us to see was norfloxacin 400mg tablet, as this is not a commonly used flouroquinolone in the United States and not frequently found on hospital formularies. The pharmacist showed us their prescription order entry system where the outpatient orders come on a printed sheet, while inpatient orders are hand written by the physician in the patient chart and a carbon copy is brought to the pharmacy by a nurse. The pharmacist shared that every day they have medication errors due to misinterpretation of handwritten medication orders. She also showed us the pharmacy computer software system, which is used in every hospital in Thailand but the facilities are not linked to share information. She showed us an example of a level 1 (furosemide and digoxin) and a level 2 drug interaction that the software system detects, as well as the patient lab reports that are available in the software system. It was also neat to observe other medication safety initiatives that the pharmacy utilized much like we have seen in the United States, with a Look-Alike-Sound-Alike chart posted on the wall and high alert stickers on ampules of digoxin and other medications. Lasix is a high-alert medication here.  We learned that 5 pharmacists work at this hospital with 2 performing purchasing and drug acquisition roles and 3 performing order entry and dispensing functions, as well as rounding with the physician on the 20 patients in the inpatient ward daily. We were able to see the inpatient ward and observed the medication cart, which contained drugs placed by the patients bed number and the MAR kept for each in an individual folder on the cart. Paper charts are used for each inpatient. We were easily able to interpret the labs as these are conducted in English. When we asked about IV medications the pharmacist shared that these are prepared by the nurse at the patient’s bedside (the fluid and drug go in the bed number drawer in the floor cart, and the nurse removes these to make for the patient).

                       Hospital waiting room                                                Emergency Room

Medicine on Pharmacy shelves

                      In the hospital pharmacy                                            The hospital pharmacy

We also enjoyed seeing the specialty clinics at the hospital. We visited and spoke with the ENT physician who showed us the recently opened audiology clinic. There is only one university in Thailand that offers a degree in audiology, so it was rare and unique to have this service in Maha Sarakham. The ENT physician told us he mainly sees patients with ear pain and upper respiratory tract infections. He also sees many young adults from motorcycle crashes, as most do not wear helmets here. We also visited the hemodialysis clinic, which had 8 beds and 1 isolation room from patients with HIV or hepatitis. We felt this was more spacious and cozy feeling than any we had seen in the United States. The nephrologist shared that patients come twice a week for hemodialysis unless the patient has an electrolyte abnormality or other complication, because it is transportation is an issue and the dialysate fluid is expensive. It is so costly in Thailand that some hospitals even have to reuse the fluid, even if the patient has a viral infection. The nephrologist hopes to expand to peritoneal dialysis once her staff receives the necessary training. We also witnessed a patient and her family receiving information on kidney transplant she would undergo at the only hospital equipped to perform transplant surgery in the region, Khon Kaen Hospital. In Thailand, most citizens are not organ donors due to religious beliefs, so patients can sometimes wait years for transplants. Live donor transplants, such as receiving a kidney from a relative, can happen within a few months though. The other specialty clinics at the hospital are dermatology and psychiatry. There is not direct pharmacist involvement in any of these clinics or the ER at this hospital. Airi and Risa, from Japan shared that after a pharmacist has practiced for a long time in Japan they can work in ER.

Next we crossed the street to visit the Thai traditional medicine clinic associated with the Faculty of Medicine, where we each were treated to a demonstration of a short therapeutic massage and aromatic tea remedy containing a thai herb, saffron, and pandan leaves.  Erin swears her long-standing shoulder tendonitis was cured by the deep tissue massage of her neck and shoulders. Megan has never had migraines and hopefully never will after receiving the massage of her head and neck for migraine relief! We again were given a lovely souvenir, this time it was oil to apply for topical pain relief and a balm that can be smelled to alleviate motion sickness or applied topically to help soothe insect bites and bruises! The mosquitoes are everywhere in Thailand so we’ve definitely collected some bug bites. We brought along bug spray with us and recommend bringing bug spray as a travel tip for any future Thai travelers! Using bug spray any chance we can and before bed is now part of our daily routine! Another more fun part of our nightly routine is listening to a fabulous duet of 2 Taylor Swift songs at the same time before we fall asleep!   

Dr. Pattarin, an extremely nice professor in the Faculty of Pharmacy, treated us to lunch yesterday at Black Canyon Coffee. We were able to enjoy spicy Tom Yum Soup. Traveler Tip: there are roots and other items in this soup that are used to provide flavoring like a bay leaf in the United States, but they’re not removed from the soup. If it doesn’t look edible don’t try it! Megan accidentally ate one of them and it was not a pleasant tasting experience. We enjoyed Pad Thai and Chicken with Chinese Rice Noodles. To drink we had Cha yen, also called Thai Tea, which is black tea with sweetened condensed milk.

In the afternoon we had another dance practice to prepare for our big performance and found gorgeous large yellow flowers, that reminded us of peonies, falling from a tree right outside our dorm. It was a reminder to soak in the simply beautiful moments that are all around in Thailand. It literally rained flowers.

That night we had a really fun time at the night market. The night market is only open on Sunday, Monday, and Thursday night, but being nearby to campus it is a big social and shopping event for all the students at Mahasarakham University. Our wonderful Thai friends have been so great at transporting us to and from places and Erin hitched a motorcycle to the night market with our sweet friend Prim. Motorcycles are definitely the most popular form of transportation in Thailand!  The market was divided in 2 sections: one for merchandise and one for food. We enjoyed looking through all shops and noticed phone cases and clothes seemed to be the items to buy…they are everywhere! Our favorite part of the night was sampling so many foods from the vendors in the food section of the market. We tried soooo many things:

·   Donut balls –  we purchased to bring home for breakfast the next day

·   Silk worm larva – a popular crunchy snack, which we bravely tried but won’t be snacking on again!

·   Thai rose apple – a sweet spongy texture  

·   Jack Fruit – similar in taste and texture to a starburst, very yummy!

·   Kao-Jee - leftover sticky rice formed in to a patty then dipped in a egg wash and grilled on a stick, also this is the Thai nickname that was given to Hannah, the student from the Univeristy of Tennessee in our group!

·   Isan style sausage – which was pork flavored with spices and contained noodles!

·   Rubies – pomegranate candy gummies in coconut milk

·   Fried green onion and zucchini patties and purple sweet potatoes patties with a sweet soy dipping sauce

·   Khanom krok – the best Thai coconut milk pudding we have had yet! These are crispy on the outside and creamy on the inside  

·   A cream filled crepe

·   Boiled Corn

·   Kao Tan – we were very excited to finally try this crispy rice cake with a caramel drizzle since it is Erin’s Thai nickname! It was delicious and reminded us of Quaker rice cakes!

Donuts!

JackFruit!

Which brings us to Friday. We wish that every morning could begin like this morning! We enjoyed coffee and the donuts we had purchased the night before at the night market in our dorm room. Splitting the 8 different donut balls we got was fun and we decided the powdered sugar with a topping of raspberry jelly was our favorite! Then our awesome Thai friends picked us up and took us to receive therapeutic Thai massages from the Thai traditional medicine clinic we had visited the day before. This was true medical treatment I wish everyone could have an order for! We had to register as patients with the hospital (an experience, since the form is in Thai) and have our vital signs taken (height and weight in meters and kg, please!) before slipping into comfy pink scrub-like outfits and slippers for our massages. We felt like Meredith and Cristina in Gray’s Anatomy when they escaped to the dermatology floor :) We each had 45mins of a deep massage on our necks and backs followed by 15 minutes of a hot herbal compress for only $10! The aroma and warmth were wonderful and a soft breeze was even blowing through the open doors during our massage!  We are excited to learn how these herbal compresses are made during an afternoon traditional Thai medicine lesson we have 2 weeks from today.

This afternoon we enjoyed some free time and decided to enjoy the perfect weather and some hot mint and lemon tea on the porch of our dorm. We used this time to work on plans for upcoming weekend trips to Chiang Mai and Surin (and our blog of course)!  Then it was time to get ready for the New Year Party at the Faculty of Pharmacy. Each Faculty (school or college as we call it in the US) holds a celebration shortly after New Year to celebrate the achievements of the past year and exchange gifts. Our group of 6 exchange students got to dress in traditional Isan (Northeastern Thailand) dress. We felt like princesses in this gorgeous elaborate attire. The New Years party was set up with tables in the courtyard of the pharmacy school and dinner was Korean Barbeque served family style with ice cream (our favorite dessert!!). The evening began with a blessing from Dean Kanjaslip and a slideshow of events from the past year. We even spotted our very own Dean Evans in a picture from the US-Thai Consortium for Pharmacy Practice Meeting held in Bangkok this past May. Next were performances by the new faculty and support staff, which is a tradition each year followed by a new tradition, a traditional Thai dance performed by the international students! We were a little nervous to perform but had a lot of fun and the crowd seemed to enjoy our entertainment! We hope you do too (will post the video soon)! The rest of the evening included a gift exchange (to get a big gift, one must dance!) and awards presentation. It was fun to meet more of the pharmacy professors and join in lots of smiles and laughs and we were very grateful to be included!

With Dean, professors, students at New Year Party

Fun fact: At dinner, Dr. Pattarin explained to us that the colored cloths used in the City Pillar ritual and other Buddha offerings symbolize a glorious life. The individual colors don’t mean anything in particular, just the colorful cloth as a whole brings joy and well-being. Another thing we believe is worth mentioning is how unbelievably respectful our Thai student hosts and hostesses are. Not only do they treat us with exceptional care, but they display so much respect for their teachers. At any meal, the teacher is served first. Tonight, we witnessed students get up and get ice cream and bring back a dish for Dr. Pattarin and let her start dessert first, even though she hadn’t even asked for ice cream! It is pretty wonderful to witness this system of respect and nurture, as Dr. Pattarin also treats her students marvelously through her many teachings.

This has been the best first week of school ever, and we are excited for the three more to come. We are also looking forward to a weekend of working on the presentations we will give next week, exploring the sites and foods of Maha Sarakham, and our trip to the nearby large city of Khon Kaen with our Thai friends on Sunday!    

America shout-out of the day: Congratulations Erika Glover for receiving a job offer from Rite-Aid today! Wooo future Pharm.Ds!