Day 7: San Patong Hospital
WARNING: VIEWER DISCRETION ADVISED! (Open foot wound below)
Who knew you could see so much in 9 hours!? Today I got to spend the day at San Patong Hospital which is a small government run hospital about 10 minutes from Randy’s house. He warned be in morning that I might not see much, so I went into it thinking that it would be a pretty slow day. However, that was not the case. I spent most of the day in the Emergency Room and about 200 patients went through in that time! These people are very efficient.
The day started off great because Randy gave me a ride to the hospital on his moped, or as he calls it, his scooter. It wasn’t hot yet, so I got to feel the wind in my hair while looking at the beautiful countryside. What a treat.
(I could probably talk for hours abouts what I saw today so I will try keep it short. It might sound like a paper for school 🙂 Also, I didn’t feel comfortable taking pictures so you will have to use your imagination.)
After meeting the nurse I was going to spend the day with, she gave me a tour of the hospital. It was pretty small- probably comparable to a rural hospital in the US. I got to go to the ICU and all of the wards or what we would call units in the US. We then went back to the Emergency Room where we would spend the day. I saw so many cool things in the course of the 9 hours I was there. There were many wounds that needed dressing changes because the clinics were closed so that was really cool. I have never seen wounds like these, tendons were exposed! There were also stitches that needed to be put in (by nurses not doctors). At the end of my day, there were four car accident victims that came in. When the ER staff heard it over the radio, you would have thought it was Christmas. They were actually cheering! All of the people I watched clearly loved their jobs. These car accident victims were pretty beat up and one was even sent to the city to be monitored by the ICU so it was interesting to see how this small hospital took care of acute patients.
I think the biggest difference I noticed from a Thai ER to an American ER was how fast patients move through. I would say that the average patient stay today was under a half an hour! In America that is not the case! It is way shorter because the staff does not have to chart everything they do, the doctor does not have to see every patient, and there is not education provided at the end. Also, privacy does not exist here. There were probably almost always 6 patients in the department and they were all just crammed into the room. They could have held hands! They would only close a curtain if they were putting in a catheter or something. In America, people complain about have to share a room with one other person! Also, when it got busy, they would just put people anywhere they could fit them, so there was people on gurneys in random hallways, outside the ER, and basically in the break room. Randy said it best when he said the guidelines here are just a suggestion.
Even though I was supposed to be shadowing a nurse all day, I spend a lot of the day with the doctors at the hospital. The first doctor I spent some time with was the Emergency Room doctor. I got to see the not-so-pretty side of labor and delivery when one of the patients came in with abdominal pain and they didn’t find a fetal heart beat anymore. When a fetus spontaneously aborts, you need to get all of the remnants of the pregnancy out of the uterus out because they can become infected and the woman has a high risk for bleeding. So, I got to go observe the doctor scrape out this woman’s uterus. It looked so brutal! I felt for this woman because not only did she lose her baby, but she had to go through a very uncomfortable procedure all by herself. It was good for me to see that if I want to go into labor and delivery it is not all healthy babies being born to good families.
The next doctor I spent a few hours with was the only surgeon that the hospital has. Man, this trip has had it’s fair share of surgeons!? He came in to the ER to diagnose a case of appendicitis, found out that I was a student and didn’t stop talking to me until I left! The doctors had pretty good English, so I think it was fun for them to practice on a native speaker. This doctor also clearly loved to teach- he always made sure to explain what and why he was doing something which was really fun. He also told me about all of the problems in the world like obesity, alcoholism, and carbon dioxide emissions making it so hot in Thailand. I have done a lot of smiling and nodding this trip, my goodness! It was so cool that these doctors let me learn and see things today, it made my experience very valuable!
In Thailand, when you first get to the hospital, you need to go to the counter and be registered. After you are registered, you get a number and wait for it to be called to see a triage nurse. Then that triage nurse determines which doctor you need to see. After you see the doctor and get your prescription for medication, you pay for your visit in order to get your medications dispensed. This process is for non-emergent cases/outpatient cases, and only costs the Thai people about 20 baht or about 60 cents in America. That is literally cheaper than the T-shirt I bought yesterday.
For more emergent cases, patients are taken down to the Emergency Room for triage. After the triage nurse determines what they need, they are taken into the ER. The patient then sits down on a bed and given care very quickly. After they are taken care of, they are given a bill that they need to pay and then they are told they are good to go. The doctor does not even need to see them during their stay. The nurse I shadowed for a lot of the day told me that it costs 50 baht to come to the Emergency Room which is about $1.16 USD. Because it is a government run hospital, no patients pay for their care if they are admitted. However, their families have to provide care for them. The only thing that the nurses do are medical specific such as give medications or change wound dressings.
Even though cheap healthcare sounds great, there is a reason that it is cheap. This type of healthcare is bare minimum health care. Their diagnostic equipment is very old and simple- no bells and whistles. Even the gurneys that the patients lay on are as simple as possible! We use gurneys on the floor that I work on and just got new ones that are motorized so we don’t have to use so much effort when pushing it. I think the mattresses where I work are at least 4 times as thick as the ones here! I went up to the ICU as well here and the beds were the same- just steel with a very thin mattress. They had one electric bed that was new, but was probably many years older than the beds we have at UMMC in America. Very interesting.
However, what was most interesting to me is that even though the health care here is bare minimum, the care provided was still good. The nurses and EMTs were very knowledgeable and skilled at their job. The were a great team and all of the same components of patient-centered care were there, so it just proves that the basis for great medicine is a good provider, not always the best equipment.
The most eye-opening thing that I noticed was that how unsanitary everything was. Alcohol wipes do not exist here. The reason I noticed the lack of cleaning so much is that cleaning between patients is a large part of my job. In the US, we clean everything that was possibly touched by both the patients or providers between care. This includes monitors, cords, diagnostic equipment, and the bed itself. We also always change the sheets between every patient. That is not the case here. The little boy needing stitches, the old man with an oozing foot wound, and the woman complaining of abdominal pain all use the same bed, equipment, and sheets. They don’t even wash the thermometer after putting it in a patient’s mouth! Washing hands is just a suggestion here as well. Another interesting thing here is that for a sterile procedure you actually have to take off your shoes and put on flip flops that stay in the procedure room. In fact, most people working were wearing flip flops. These people do not wear closed toed shoes and getting gross things on your feet is no big deal. One girl was doing a dressing change and some discharge dripped onto her foot and she just brushed it away (gag). It is just so different here because at work we always talk about how disgusting everything is! I definitely have a new perspective!
I got to learn so much today and I am very thankful. It was very nice of Randy to go through the trouble to set this up! Mostly, I am thankful for our healthcare in America even if it costs a fortune. There is a reason for that! It will be fun to tell my coworkers about how good we have it and compare the two hospitals. A new prospective never hurt anyone. The next few days will be more relaxed. Beth and Paige missed their flight in Chicago last night, so will be delayed about 24 hours and get here on Monday now. It will be nice to just chill out, but we can’t wait for them to get here!