End scene

Astounded, that’s the first word that comes to mind when I think of Thailand. For any person thinking to themselves should I do this APPE rotation, is it worth it, can I afford it, will I be able to cope with being in a foreign country for an entire month? My answer will always be yes. Take the leap of faith, let go of your fears and do this APPE rotation. I will be the first to say that I signed on to this rotation at the very last minute. I was completely unsure of myself and if this was really something I wanted to do. I ended up convincing my best friend to do it with me and to say the least, this was the most beautiful opportunity I’ve had since P1 year. 

Thailand has allowed me to grow so much more than I even realized. I have gained more patience, more understanding and greater appreciate for all that I have. Personal lessons I learned on this trip was firstly to walk away, secondly to be grateful and lastly to take the time to enjoy every moment. Walking away from anything that will allows yourself to compromise below what you believe is worth it is surprisingly difficult. None the less I learned this lesson in the Markets of Chang Mai. I have never been one to bargain but when thrown into that situation, I learned a lot about myself and my abilities. Second lesson learned was to be more grateful for the simple things in life like clean air, clean water and having a fundamental support system of people who truly care about you. I can say that on this trip I made new friends that are one in a lifetime. I will never truly be able express how appreciative I am for the supportive friends I had on this trip. 

Thailand will definitely push you to get outside of your comfort zone, it will allow you to open your mind to a different lifestyle which in turn will allow you to grow. For me Thailand was so much more than just books, the drugs and the hospital but it was an experience that allowed me to truly see how advance we are medically. How fortune we are to have the state-of-the-art hospitals, outstanding care and amazing medical personnel. This APPE is one that is all encompassing, so much that I wish it were required. If you were like me and are borderline between going and not going, GO! Take the leap of faith, I promise you won’t regret it. 

Fairwell Thailand

Spending a month in Thailand has been such an amazing experience that I surely will never forget. I learned about pharmacy and the public health system as well as many cultural customs. Learning about Thailand's universal healthcare system and how every person in Thailand has insurance was interesting since that is not the case for people living in the United States. I found it interesting that people have one hospital that they can go to to receive care and how the must be referred by a doctor at their assigned hospital in order to receive free care at another hospital in the country. Otherwise, receiving care from another hospital will cost them money. They also only have a certain drugs that are covered by this universal healthcare coverage. This makes sense to keep prices down. However, I learned that what is considered first line in the United States might not be offered/covered in Thailand because they have chosen a cheaper option to start with first. Then only if the other therapies fail will they go to better and more expensive option. It is great that every person in Thailand has health insurance but the downside of this is that waiting times for important medical tests such as and MRI might be as long as 30 days. In the United States if you need an MRI you usually get it with in a couple days. 

Some cultural things I learned about are that Thai people often take their shoes off before entering a house or small building. They also bow when saying thank you and toilet paper is not always provided in the bathrooms.

I would recommend this APPE rotation to anyone who is lookin to learn something new and get out of their comfort zone!

Gone but Not Forgotten

Well Thailand, you've taken my money and sense of what the word "hot" means, but you've given me an amazing cultural experience with memories that will last a lifetime.  This experience has allow me to learn so much about Thai culture, the Thai healthcare system, and how my friends and I can improve our viewpoints of the healthcare system in the United States. The culture in Thai is so welcoming no matter what hospital or clinic we got to visit. Every person we got to meet was so excited to see us and show off what their place of work had to offer to the people of Thailand. This was a big shock to me because it is an idea that is going away in the United States. Most people, not all, look at their place of work as just a job that pays the bills, but in Thailand, they are proud of where they work and couldn't wait to show us every aspect of it.

When I decided to go to Thailand, I thought it was a third world country that didn't really have much to offer or didn't have the capabilities to offer great healthcare to the people of Thailand. Boy was I wrong. Some of the hospitals and clinics we got to visit were even up to the standards of the United States. Some hospitals had an ambulatory clinic, some had more than just 3 pharmacists working in the entire building, and some even did research that, at one point, was almost bought by a US company for millions of dollars. It was a complete shock to me how advanced Thailand is in their healthcare. As far as their Universal Coverage goes, Thailand is an example of it working. This is something that is debated in the United States all the time and it is a topic in which I believe Thailand is more advanced than we are. We just haven't come up with the right way to implement it into our society. Maybe, it is where Thailand can help us learn and grow.

As far as what I have learned about me from Thailand, I have learned I need to be way more patient and understanding, I'm smarter and more confident than I give myself credit for, and you always learn something new everyday. Thailand was a culture shock for me with so many new foods to try, places to see whether they were clean or not, and so many people to meet. We learned that people wait hours and hours in waiting rooms to receive healthcare and yet, people in the US can't wait 5 minutes to receive their prescriptions in a pharmacy. Thailand taught me I need to be more patient with things I do along with more patient when dealing with patients and physicians. As far as going out of my comfort zone, I had the opportunity to eat a scorpion and even teach Thai students about residency programs in the United States. Both experiences, along with others, were things I never thought I'd be able to get to do and are things I will never forget.

In conclusion, Thailand is a once in a lifetime trip. It is a place that may not be one of the cleanest places, but offers so many life experiences I will never forget. Anyone thinking about taking this experience in years to come, all the advice I have to offer is do it and give it all you got. Be open-minded, be willing to experience things even if you're scared or nervous, and be willing to learn and make memories that will last a lifetime.

4 Weeks Come and Gone...

Wow. I never expected four weeks time to go by so fast. In that time I was able to explore a unique country while learning about my profession in an area of the world that differs so much from our own. In this post I will attempt to convey some of what I learned along the way.

This rotation has allowed me to learn about the healthcare system utilized in Thailand. They operate with a universal healthcare system that allows all Thai citizens to receive healthcare at no cost. Patients will wait for hours a day to see a doctor and pick up prescriptions. Generally all of this can be completed at one facility in one trip, which differs from our system in that prescriptions are sent to an outside pharmacy (in most cases) and picked up at a later time. Community pharmacies also use prescriptions very differently than we do in the United States. Pharmacists are able to essentially prescribe and dispense drugs based on patient symptoms and presentation. However, this has resulted in high antibiotic resistance rates. They also have a large number of fraudulent pharmacies in which the owner purchases a license from an actual pharmacist to open a store and distribute medications. They have started to implement measures that allow patients to recognize which pharmacies are legitimate and which ones are phony.

I have also been able to make myself more aware of cultural factors that influence some people's decision making as it pertains to their healthcare. Traditional Thai medicine as well as Chinese medicine are huge components of treatment of diseases and conditions in Thailand. We were able to visit traditional Thai medicine wards as well as an entire facility that provides services such as massage and acupuncture to name a couple. This is useful in the way that I practice because it may help me understand a patient's decision making in the future and allow me to better empathize with my patients.

As time goes on I will periodically do some self reflecting on my time in Thailand and how my experiences will change me or how they may already have changed me. Traveling has always been a great way for me to push my comfort zone so that I may grow as a person. This trip certainly did that for me and I found that I had plenty to ponder on throughout the entire trip.

To any students considering this as a rotation in the future, it is well worth it. Be aware that, unfortunately, life in Thailand is not glamorous for many people; however, if you approach it with an open mind and with the intentions of fully exploring this opportunity and all that it has to offer, you will be royally rewarded with an experience you will never forget. 10/10 would recommend this elective rotation.

Goodbye Thailand!

After spending this past month in Thailand, all I can say is I’m very grateful for this experience. I’ve learned so much about Thai culture, their healthcare, and way of life. Additionally I’ve learned so much about myself through this journey. I think one of my favorite visits on this trip was at Ramithibodi Hospital in Bangkok. The head pharmacist Nani and her entire staff were very welcoming and embodied what it meant to be a pharmacist at Ramithibodi. I took so much away from the two days we spent with them (ie. approach to care for difficult to treat patients). Throughout this journey I noticed a lot of what the healthcare providers do is for the Thai people and they are really culturally tied to their roots. They look at treating patients with more natural remedies like herbals before resorting to conventional drug regimens. This experience has made me more culturally aware of others and has made me realize how much of an impact one’s beliefs/ faith can have on their health. 

As for myself, looking back this journey was definitely a growing experience. Living in a different country for an entire month can be challenging and rewarding. I’ve learned how to quickly adapt to another’s way of life, different food and cultural experiences. I’ve learned how important it is to take care of yourself and to always stay positive, no matter how challenging the situation may seem. I’ve learned how important it is to have a support system and building friendships along the way because everyone needs someone to lean on every once in awhile. This experience has given me the strength to go outside of my comfort zone more often. I will certainly be taking these life lessons I’ve learned along the way and implementing them in my future practice as a pharmacist. With that being said, I don’t think I would’ve learned these things about myself if I did spend four weeks in Thailand. I’m leaving this place with a sense of pride and new found confidence, knowing I was able to experience living and learning in Thailand this past month. 

Farewell Thailand!

It has truly been an amazing month in Thailand, filled with unique educational and cultural experiences that have taught me so much. The Thai health care system is a great example of how universal health care can be utilized along with the pros and cons compared to a private payer system such as the U.S. Before traveling here, I did not expect Thai pharmacists to have as big of a role on the health care team as the U.S. I was quickly proven wrong as pharmacists have many of the same responsibilities, such as patient consultation at outpatient clinics and interprofessional collaboration with other health care professionals. Many medications in Thailand do not require a prescription and can be bought at a local pharmacy, such as antibiotics for an infection. Because of this, community pharmacists play a crucial role in drug selection and counseling to make sure the patient is being appropriately treated.

Throughout the trip we did many cultural activities and visited some amazing places. We visited several temples, traveled to the floating market, attended a Thai cultural show, and enjoyed a variety of delicious food. In addition to our planned activities, I spent a lot of time exploring the cities we were staying in, finding lots of markets and places to eat. One of the main takeaways I have from this trip is a sense of adventure and a willingness to go outside my comfort zone more. I hope to continue these traits in both my personal and professional lives upon my return to the U.S.

That's a wrap Thailand

As Thailand APPE comes to an end, I wanted to take the time to reflect on the last 4 weeks of this experience. I had a great opportunity to visit various hospital and clinics both in Bangkok and Chiang Mai. They were many modern and up to date hospitals in Thailand, but others made me feel so fortunate to live in the United States. Hospitals here in the US -- despite local have a certain standard. I am not only talking about standard of care, but the upkeep of the hospitals. We are very lucky to have hospitals were they are for the most part clean and tidy.

On a different note, I have learn that you do not need a lot to be happy. Some of the people that I have meet on this trip have so little, but yet are some of the happiest people I have ever seen. It is almost unfair how much we have back home while others have so little. This trip has taught me to be more thankful than ever for the life that I am fortunate enough to live. 

My Thailand Experience

Spending the past 4 weeks in Thailand has been one of the most incredible experiences of my life. I am so grateful to have had this opportunity and I will always remember this rotation as being one of the highlights of my entire time at UNE. This Thailand rotation has allowed me to learn a lot about the Thai healthcare system, Thai culture, my peers, and myself. This experience was truly amazing and a once in a lifetime opportunity to live in a different country for a month and have many academic and cultural experiences.

Throughout this rotation I was able to learn a lot about the Thai healthcare system and how they have universal health coverage. I also have a much better understanding about the similarities and differences between hospital and community pharmacies in the United States vs. Thailand. I really enjoyed being able to have these kinds of discussions with Thai pharmacists and pharmacy students, as well as being able to tour many different hospitals throughout Bangkok and Chiang Mai. I have also learned a lot about different diseases that are not as common in the United States, such as dengue fever, leprosy, or tuberculosis. It was a great opportunity to learn about these disease states and then observe the interaction between a doctor and a patient that had the disease.

I have also really enjoyed our cultural activities and I have learned a lot about Thai culture in general. Visiting the temples, going to the floating market, doing the cooking class, and trying many new foods has made this rotation not only academic but a cultural experience as well. Throughout this Thailand rotation, I have also learned a lot about myself. This trip has given me a lot more confidence and independence. I have realized how important it is to push myself and go outside of my comfort zone, and I am so glad I decided to do this rotation. I am very grateful and have a deeper appreciation for everything we have in the U.S. (the opportunities, technology, care, living, etc), and I truly believe this whole experience will positively affect how I work and care for patients when I become a pharmacist.

Thailand Summary

On this trip, I have learned a lot about different healthcare systems, tropical diseases, and culture. I have also learned a lot about traveling and exploring foreign places. We certainly spent a lot of time out of our comfort zone.

Since being here, I discovered I have a new favorite food, khao soi (a curry and noodle dish from northern Thailand). I have been thrilled with all of the food I have learned to love here.  It has been interesting to compare authentic Thai food to the Thai food sold in Maine. 

The most beneficial knowledge I gained from this trip is the knowledge of their healthcare system. Since Thailand has universal coverage for all Thai citizens, it was enlightening to see the benefits and challenges of it first hand. Since this is a pivotal time for healthcare in the US, this was convenient timing. With only 1/5 of the GDP of the US, Thailand makes universal healthcare work, although we saw many sacrifices that had to be made by the Thai people and healthcare providers. 

Although all of this taught me a lot, the most valuable experiences I have had in Thailand are those I experienced with my friends. We explored everywhere (including where we were advised not to) and laughed every step of the way. They made even  nights in so much fun and were always up for any adventure. I will look back at this trip fondly, missing the warm Thailand heat as we go back to the cold winter in Maine. 

What I Learned In Thailand

Before leaving for Thailand I was often asked what I was going to learn and what I’d be doing in terms of pharmacy. Though I had viewed the schedule and syllabus I wasn’t quite sure myself. Entering the 4th week of rotation I can say that I have learned a lot more than I thought I would both culturally and medically. 

First of all, I knew Thailand was poor but I didn’t know how poor. I have realized that there are some people that literally do not have any value and make a living from selling handmade gifts at the market. What really struck me was when my friend was trying to barter and the lady said “I need food, I can’t discount.” 

One particularly enjoyable day was sitting in on a Thai Pharmacy class at Chiang Mai University. We were given an

opportunity to present to the Thai students about pharmacy in the United States depending on the field we were interested in. Here's a photo of me giving a presentation on residency! 

We have visited many pharmacies in Thailand including primary, secondary and tertiary hospitals. Some of the primary care hospitals seem very outdated compared to America but the tertiary hospitals are very advanced and are actually a lot nicer than some hospitals I’ve been to in America. I have learned that the Thai pharmacists follow mostly the same guidelines as Americans with the exception of drug choice. 80% of Thai drugs are brand name because of the universal coverage system and theories of the patients. Furthermore, I have learned a lot about the universal coverage system allowing access to all patients no matter their financial status. This creates chaos in the hospitals which are almost always flooded with waiting patients.

ภาพสะท้อนของประเทศไทย

The time we spent in Thailand was a wonderful experience to learn from. While here we spent much time learning about their healthcare system and how in some ways it surpasses our own. With the implementation of universal healthcare, many people can get the care that they need without being stopped by the extravagant costs of treatment that many Americans face. Its implementation seems to have been well done and is something I hope to see implemented in the states within my lifetime. However, it was surprising to see that in most hospitals all patient records are in paper form as opposed to being electronic. Having seen this in practice, I feel that I've taken our use of electronic patient records for granted. 

I was also impressed by the large scale use of traditional medication in the healthcare setting, such as message, acupuncture, and cupping. Coming to Thailand I'd expected to see some traditional treatment in practice, for example as a specialized clinic like one we visited in Chiang Mai that was dedicated to this. However, I was surprised to learn that this was supported in major hospitals and by the universal healthcare. Coming from America, where there's such a push to immediately treat using medication, it was refreshing to see this as an accepted treatment option. 

 

Our Last Weekend:(

As our trip starts to come to an end, we have been able to kick back and relax on the nice Sai Kaew beach resort. Here, we have been soaking up the sun, playing pool, swimming, and so much more. It has been our weekend getaway after all of our hard work here in Thailand. The resort offers so many cool things to do and see along with providing great food and drinks to enjoy. Overall, it has been a great weekend with some great people to wrap up our trip here in Thailand.

Sai Kaew Beach Resort

We have been spending the weekend relaxing at our resort in Koh Samet, an island in the Gulf of Thailand. It is a nice change of pace from the cities we have been in for the majority of the trip and is a great way to conclude our rotation in Thailand. There is a long beach to walk down that is lined with different restaurants where you can enjoy a scenic view of the Pacific Ocean while eating. A large portion of the island is Khao Laem Ya National Park and the island as a whole contains many different beaches and resorts, plus a small town where some locals reside, overall a beautiful place!

Sai Kaew Beach Resort and Fire Show

Today we traveled to Sai Kaew Beach Resort in Koh Samet, Thailand to spend our last few days of the trip! We traveled 4 hours by van and then took a speed boat to the island. The resort is home to many beautiful beaches and serves as a popular tourist destination. Koh Samet was named after the many 'Samet' trees which grow on the island. It is a national park and under the protection of the Thai government. Later in the night we had a group dinner on the beach and it ended with a fire show. 

Duang Prateep Foundation

 On our Thailand adventures today, we got to visit the Duang Prateep Foundation along with touring the community and school located in the district there. It was a shocking experience seeing how people live in the community. The foundation was brought about in order to educate the community along with starting a school for the younger kids. When we got to visit the school, the kids were so excited to just wave to us and say hello. Despite their hardships, the community sticks together in order to make sure all of their people are happy. It was a heartwarming experience that definitely made me appreciate the things that I have back in the United States.

Chiang Dao Hospital

As mentioned in an earlier post, on Monday we visited Chiang Dao Hospital in Chiang Mai. This hospital is 60 bed public hospital. The hospital bases its treatment and care off of six core values: Safety, Professional, Integrated, Relation, Intelligence and Transparency (aka. SPIRIT). Most importantly, their mission is to "develop health systems according to standards for safe, transparent and fair services."

The picture below is of the pharmacy department in the hospital. Pharmacists showed us typical HIV medications used as treatment for the HIV patients being seen at the hospital. Seeing that HIV is prevalent in Thailand, all healthcare providers practice educating patients on disease prevention and control.

Wat Pra Bhat Nam Put Aids Hospice

Today we visited a center for patients with HIV or AIDS. The patients that live here are generally not accepted by their family due to their diagnosis and the stigma that comes with it. Patients who aren't

as sick and are strong enough to care for themselves are given a tiny home on the campus for free as well as food and all utilities free. Those that are too sick to care for themselves are cared for in the hospital on campus by workers and volunteers. Some of the patients that are strong enough will also volunteer to help care for those that need extra help. There are currently 170 patients admitted in the hospital.

We also visited a room where the patients who pass away are kept. Most families do not want their bodies after they pass away because they had HIV/AIDS and so the facility has to keep them. Some were created and put into bags and others were full skeletons in boxes used for scientific purposes or cultural processes.

The number of patients at the facility is decreasing due to transmission rates of HIV/AIDS decreasing as people become more educated. The decreasing rate may also be due to the fact that more families are accepting of relatives with HIV/AIDS and allow them to stay home.

Lastly, we walked up a hill to a temple where some patients pray. There were tons of monkeys.

HIV/AIDS Community

Today we visit a community that provides care for HIV/AIDS patients. It's a home to patients who need care that their family cannot or will not provide to them. It has a large living area that's upkept by its resident patients as well as volunteers. There is also a hospital onsite to provide extensive care for patients who need it. Up the hill from this healthcare campus there is also a series of temples. This was a unique site to have visited, very unlike anything I have seen in the states.

Khum Khantoke Cultural Dinner

Tonight we went to the Khum Khantoke Cultural Center for dinner where many Thai people performed cultural dances. Before each performance, an announcer would tell the story of how the specific cultural dance came about and its meaning to the Thai people. There were performers of all

ages and they all dressed up very extravagantly. This was a very interesting way to learn more about the Thai culture in a fun way.

We all sat on little cushions on the ground and the dinner was served family style where we shared several dishes. Even after the 3rd week of rotation we still were able to try new foods that were great! At the end of the performance the audience was invited to join the dancing.

Words and phrases I have learned in Thai

I wanted to share some words and phrases I have learned in Thai

Kha (kah) - a polite way to say yes if you are female. You also put it at the end of many phrases to show politeness.

Khrap (crap) - a polite way to say yes if you are male. You also put it at the end of many phrases to show politeness. 

Chi (chia) - Yes, usually said to a friend or equal.

Mai (my) - No

Sawasdee (sah-wah-dee) - Hello. - usually followed by kha or khrap depending on the gender of the person saying it.

Khawp khun + kha/khrap (kop-koon) - Thank you

Khaw thot + kha/khrap (kah-tode) - I'm sorry

Mai khao jai (my-cow-jai) - I don't understand

Mai pet (my-ped) - not spicy

Pet pet (ped-ped) - very spicy

Rot daeng (roe-dang) - red car, a taxi service popular in Chang Mai that is like a tuk tuk XL.

New Experiences

I have had so many new and exciting experiences on this trip to Thailand. First I ate a scorpion and a cricket! They actually were not that bad, very crunchy and chewy. I liked the cricket more than the scorpion, although I don't think I will be making either of them a regular part of my diet. One time was enough! I then got the chance to hold what I believe is a very large boa constrictor. However when I asked the man what kind of snakes they were he told me "A black one and a yellow one." Many of my fellow classmates do not like snakes and thought I was a little crazy to hold one on my shoulders. Last but not least we got the chance to ride an elephant through the jungle. It was not exactly a smooth ride as the elephant went up and down hills and even into the water, however, I really enjoyed the experience. Our elephants name was Laujaun.

Baan Mitratorn Orphanage

Today we visited the Baan Mitratorn orphanage. This orphanage is a part of the Ubolratana Foundation and the name Baan Mitratorn means "home of caring friends." This organization was established in 1998 and began as a place to provide relief and care for only children infected with HIV/AIDS. Today, it also provides help to other children who are not infected with HIV, but may be living in difficult conditions, abused, or afflicted by hardships. Currently, there are about 38 children that live in this orphanage and the ages range from 3 months to 23 years. Out of the total 38 children living here, 18 of them are HIV positive, 3 have HIV/AIDS, and 17 children are affected by hardships. Baan Mitratorn provides daily antiretroviral medication for the children infected with HIV. All the children staying here are also provided with an education as well as life skills, such as doing their own laundry once they are old enough. We took a tour of the orphanage, but unfortunately we were not able to see or play with any of the children. The children were still in school and they also explained to us that they did not want to separate the orphan children from the other students, as it could cause stigma and they did not want any of the children to be teased. The children living here seem to be cared for really well and they are given an education and many opportunities.

Chiang Dao Hospital

Today we visited the Chiang Dao district hospital north of Chiang Mai close to the Myanmar border. This hospital serves Thai residents, native tribes people, and migrants from Myanmar. The presentation they gave us focused on the prevalence and treatment of HIV in the district. HIV has been a burden in the country, but they now have better access to antiretroviral therapy and have made advancements in patient counseling to prevent the disease. The first line treatment they use in adults is one combination capsule once daily which increases compliance compared to more complex regimens. This is not as easy with children however since they require a variety of dosing that is weight based, so many children are required to take multiple medications which can sometimes be a barrier to adherence.

Elephants and Tigers in Thailand!

Today we visited the Thai Elephant Conservation Center and the Tiger Kingdom here in Chiang Mai. It was quite an incredible day! The Elephant Conservation Center includes an elephant hospital and a training school and it helps to conserve and protect the Thai elephants from extinction. We were able to observe a few elephants being treated in the hospital, for example, one of them was 75 years old and had kidney disease. Then, we watched a show where the elephants themselves were painting pictures of elephants! We also got to ride the elephants which was a lot of fun. After the elephants, we went to the Tiger Kingdom where some of us got to pet the tigers! This was an unforgettable experience for sure. They also had newborn tiger cubs there that were only 1 month old, and they said this only happens about once a year. Being able to ride an elephant and pet a tiger made today one of my most memorable days here in Thailand.

Health Promoting Hospital

We visited the Ban Saluang Nok Sub-District in a rural part of Chiang Mai. We listened to a lecture by the head nurse of the hospital on how they are actively engaging the community members through activities, prayer sessions and home visits. We were fortunate enough to be invited into the home of one of their long-term patients. He was an 80-year-old man with hypertension and other comorbidities. He was bed ridden due to disease progression that led to both his legs being amputated. He lives with his wife in a home donated to them by the villagers where she dresses/changes his bandages every day, twice a day. It was an eye-opening experience, his wife was so gracious for letting us into her home and the villagers were very welcoming. It was a completely different way of looking at health care and an experience I will never forget.  

Shinawatra Silk Factory: Princess Edition

This past Saturday (November 23) a few of us visited the famous Shinawatra Silk Factory in Chiang Mai! It was amazing to see how silk is produced via the cocoon of the silkworm. Thai silkworms are generally yellow compared to Chinese/Japanese silkworms which are white! 

FUN FACT: This silk factory was visited by Princess Diana back in the day!

Princess Diana visiting the Shinawatra Silk Factory

A lady making silk from the cocoons

Daydreaming

We had a cooking class on Sunday. During our break we all kinda separated into our own little corners and just started to relax. I found this little corner with this hammock on and despite lowkey afraid I was gonna fall out of this thing, I decided to lay there for a bit. Originally, I planned on napping cause we did have an early morning but as I started to lay there I just started to soak in everything that was around me. We were kinda in the middle of no where. No sounds of cars or loud noises, just the birds chirping and the nearby pond where the ducks would roam around.

I found myself starting to zone out and I started to play some of my favorite tracks to put me in a mood. As I sat there listening to Nujabes, I started thinking about how blessed I was to be here. That all the choices I've made led me to be here at this point exactly. I remembered starting college and wanting a chance to go abroad and study. Or even how nervous I was applying to pharmacy school and thinking I wasn't going to make it. I remembered how I felt interviewing and how excited I was when I got in. I remember struggling through school and thinking I wasn't going to make it. But eventually I got through it all. Then I started thinking of when I would actually make it and how May 2020 isn't that far away anymore. I thought of my parents and how all their struggles would finally pay off cause both their sons would finally make it in this world. I thought about how much they'd pray for me and thought about what seeing them on graduation would be like. I thought about my friends and how they all stuck with me through it all.

Thinking about all that, sitting in that hammock made me realize how far I've come and how much more I have yet to do. But all I could do was to lay there and appreciate all that I've been blessed with. The mood was perfect with the perfect instrumentals to put me in the zone. As I laid there thinking about how traveling the world puts me in my element, it made me realize that I am exactly where I needed to be at that moment.

-Ajay

P.S: Anyone actually reading this should definitely check out Nujabes instrumentals. Its just something else. :) 

Chiang Mai University Presentation

When I came to Thailand for this APPE, we sat through a lot of presentations of different institutes and hospitals. I actually never imagined I would have to give a presentation as well. We were asked by the director to give a presentation to 4th and 5th year pharmacy students to talk about different areas of pharmacy. We split up into groups and each of us decided to give a talk about the possible future routes we would take after graduation.

We split up the groups into Community pharmacy, pursuing a residency, and fellowships/ specialty pharmacy. The presentations were short and it was not a big deal compared to other presentations we had to give while being in school but it was a really cool experience to be speaking in front of a group of students in another country. I was hoping I wasnt speaking too fast and that they understood what I was trying to say. What was really cool was that the director gave us time after the presentations to sit in discussion groups where we all really got the chance to talk to the Thai students. They were all super nice and super hospitable. They asked us a few questions about pharmacy but then we ended up talking like regular people about things like food, and places to see in Chiang Mai. I'm really glad we had the opportunity to do something like this. 

Chiang Mai University Faculty of Pharmacy Visit

This week we were able to sit in on one of the courses offered at the CMU faculty of pharmacy; it was their English course. We received a talk from an American professor regarding interviews and CV preparations. Afterwards, we presented three different talks on the varieties of pharmacy experiences available in the US. The Thai students seemed to enjoy learning about our pharmacy operations as it is significantly different from what is utilized here.

Pharmacy students from the Chiang Mai University Faculty of Pharmacy.

I was a part of a group that discussed a few specialty areas of pharmacy: specialty pharmacy, nuclear pharmacy, and fellowship. Having worked in a specialty pharmacy and completed an APPE at Apothecary By Design, I discussed specialty pharmacy with them. This is something that is not seen in Thailand, and when I explained that some medications can cost $30,000 per month or 900,000 baht, they were astonished at the pricing.

We got to speak with the students in small groups and ask them questions and answer questions they had for us. Their ability to speak English was impressive, as most if not all of the students understood what we were saying. They asked about our drive-thru systems at retail pharmacies and laughed when I equated them to the drive-thru at McDonald's.

Thai Elephant Conservation Center

Today we visited the Thai Elephant Conservation Center. During our time here we watched an elephant show, where we saw their strength as they pulled around logs and intelligence as they painted pictures. After the show we got the chance to ride on the back of elephants through the conservation center. It was an amazing and unique experience we had with the elephants.

Nong Han Market

Sunday, we went to a Fresh Food Market in Nong Han district where we learned a lot about different food used in traditional Thai dishes. First we learned about a variety of rices,Thai Jasmine Rice or Hom Mali is available in both white and brown varieties and is the most commonly eaten type. Sticky Rice or Khao Neow gets its name from how it looks and feels after it is cooked. This type of rice has a milky, opaque color and is actually steamed rather than boiled, Sticky rice is used in one of my favorite desserts (mango sticky rice). Brown or Khao Neow Dumhas is a reddish-black color and is slightly crunchy. 

Another interesting thing we learned at the market was about the pink eggs. The Thai name for the pink egg is ไข่เยี่ยวม้า(khai yiao ma). It originates from an Asian tradition that involved preserving the egg for several weeks or months using a process that combines clay, ash, salt, quicklime and rice hulls. While it is pink on the outside, the pink egg is actually greenish-black or dark brown once peeled. After checking out the Market we made our way to a Thai cooking class where we put our new knowledge into practice. 

Earthquake

Early this morning, at about 6:50 AM I was awoken by my lamp rattling against my wall and the curtains shaking. After being confused about what had happened, we learned of a 6.1 magnitude earthquake that occurred on the border of northern Thailand and Laos, which is close to where we are currently staying in Chiang Mai. News articles reported that the earthquake was felt as far south as Bangkok and that the sky scrapers were swaying in the early morning as a result. The shaking was minor and not harmful to us in any way but interesting to experience a natural occurrence that doesn't happen in New England.

Muay Thai Boxing

Last night, a group of us went out to a small strip in Chiang Mai that has a Muay Thai boxing ring at the end of it. We were told by previous students that we should experience a Thai boxing match if we had the opportunity so we jumped right on it. At first they were asking 400 baht (about $13) for admission, so we went to play pool and darts nearby while we waited for the price to come down.

Two of the Muay Thai boxers from Chiang Mai.

After some time, we went back and talked them down from now 200 baht per person to 150 baht per person (about $5). We got to witness a couple of the Muay Thai boxing matches. Some of the boxers were from other places in the world, for example, one woman was from Germany. It was great to see how sportsmanlike they are here. At the end of the fight the boxers acknowledge each other's performances or sometimes even after each round. It was a fun experience to have while in Chiang Mai!

Community Home Visits

During our Thailand rotation some of us had the opportunity to go on community home visits with pharmacy residents in Bangkok. During these home visits the residents would review patient medications with the patient and their family members. They would also take the patient's blood pressure and heart rate during the visit and ask the patient about their diet and daily activities. This day has been my favorite academic experience so far on this trip. It was very eye opening to see the living conditions of these patients. The second picture shows a patient with his medications (many of them unlabeled) which he stores in a basket. The last picture shows standing water filled with pollution that was three feet away from this patients front door. Many of the people living in this community do not own cars or motorbikes and can not afford to take a taxi to the doctors office or pharmacy. I really enjoyed learning about these free services and visits the community pharmacies in the area provide to these patients and how beneficial there are to the health of the community.