Thailand Faddy Khamis Thailand is the only country

Thailand Faddy Khamis

Thailand is the only country in south-east Asia to have escaped colonial rule. Buddhism, the monarchy and the military have shaped the countries society and politics.

• Siriraj Hospital is the oldest and largest hospital in Thailand (1) • It is the primary teaching hospital of the Faculty of Medicine Siriraj Hospital, Mahidol University. • 2, 000+ beds and more than one million outpatient visits per year, Siriraj is one of the largest and busiest medical centers in Southeast Asia. • Siriraj is the largest public hospital in Thailand. Its tertiary care unit is the referral center for all hospitals in Thailand. • The late King of Thailand, Bhumibol Adulyadej, received treatment at Siriraj before his passing in 2016 (2)

International Experience Goals • Demonstrate appreciation for the language and culture of a non. American and/or non-English speaking population. • Identify the challenges of serving individuals from different cultural background abroad compared to serving individuals from different background in the US. • Explain strategies for providing healthcare services, including health promotion, prevention, and medical treatment, to populations in settings with varying levels of resources (human resources, infrastructure, capital etc. )

• Our group visited several Temples during out stay in Thailand. Each temple had a staggering amount of detail put into the architecture. • Before our trips, my group would read about the history of each temple and share what we learned with each other.

• One of the biggest challenges I faced was the language barrier. Many non-medical Thai citizens did not speak English. The language is very difficult foreigners to learn in a short time period. • To overcome this, we would explore the city with Thai medical students who we befriended on our rotations.

Serving individuals of different cultures domestically: • Most likely will communicate in some amount of English. • Patients are more familiar with American customs • The provider feels more comfortable with using the resources at their disposal Serving individuals of different cultures abroad • More likely will speak in their native language. May not be able to speak English to the provider. • The provider will likely have to learn the cultural customs to treat their patient without offending anyone. • Provider may not readily know how to go about using available resources.

My topic of interest was HIV prevention and patient response to bad news. In 2012, the AIDS Zero goals were announced at the launch of the National AIDS Strategy in Bangkok at an event that brought together hundreds of people from government, civil society and the private sector. (4) Five strategies will be used to achieve the AIDS Zero goals. 1) expanding rights-based and gender sensitive prevention services for populations with high risk behavior. 2) ensuring the protective social and legal environment essential for HIV prevention and care. 3) Create a sense of ownership among provincial and local authorities in preventing and solving AIDS-related issues 4) Provide new strategic information to inform and guide the national response at all levels. 5) Improving the effectiveness of the government’s existing HIV-related programs and services.

Major Risk factors for HIV • Although Thailand has had considerable success in HIV prevention since it peaked in the 1990’s, HIV still remains an issue in the country. Risk behaviors primarily associated with HIV transmission have changed since the peak of the epidemic. Unlike the HIV epidemics in most developed countries (IV drug use), studies of HIV infection in the Thai population during 1993– 1995 found that heterosexual transmission played the major role. Studies during the early phase of the epidemic found that more than 90% of HIV infected men reported having sex with female sex workers, whereas only about 1% had a history of injection drug use. • HIV rates (2009) (3) • Total population: 66. 88 million • Prevalence: 1. 2% • Incidence: 0. 1% since 2002

Profound clinical experience When patients would receive a primary diagnosis of HIV, syphilis, or herpes for example, they would remain calm during the clinical encounter. They would discuss the care plan, and the patient would thank the provider and then and leave. When I’ve worked in STD clinics in the USA, whenever I worked with a patient who got a primary STD diagnosis, they would look to the provider for empathy and compassion. Often they would take time to express their emotions. My preceptor stated that in Thai culture, saving face and preservation of ones honor and reputation is incredibly important. If my preceptor were to reprimand her patient for poor choices, it would embarrass the patient. If the patient began crying or expressing grief in the office, it would also embarrass the patient. The same applies to my preceptor. Thai patients are more likely to internalize their emotions during a clinical encounter. This can have emotional repercussions on the patient later in life.

I was really stunned by how friendly the Thai people were. Several evening dinners were spent eating with locals for hours who we happened to sit next to. Despite the massive language barrier we faced, we were able to laugh, joke around, and share stories with all kinds of Thai people.

Chiang Mai, Thailand

Wat Phra That Doi Suthep, outside Chiang Mai

Koh Tao Island

Works Cited • 1) https: //en. wikipedia. org/wiki/Siriraj_Hospital • 2) http: //www. pattayamail. com/thailandnews/hm-king-bhumiboladulyadej-passes-away-151995 • 3) https: //www. ncbi. nlm. nih. gov/pubmed/19381074 • 4) https: //www. unicef. org/thailand/reallives_19074. html