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. 

DIY: Lanna Herbal Massage Ball

We have now made it to Chiang Mai University located in beautiful northern Thailand!! Other than enjoying some amazing khao soi (a traditional northern dish) we have been busy learning about alternative medicine. The people of Thailand truly believe in incorporating western medicine with traditional Thai medicine. On Monday, we had a lecture on traditional Thai medicine in the morning and then followed by a lab session in the afternoon, where we made our very own lanna herbal massage ball. They consist of dried up herbs ranging from lemongrass to tumeric. These massage balls once put together are steamed and applied to parts of the body to help with muscle pain.

Chiang Mai University

Today we visited Chiang Mai University's College of Pharmacy. We learned about the Thai health system, the role of pharmacists in Thailand and about the use of Thai Traditional Medicine (TTCM). We were given a tour of the Thai Traditional Chinese Medicine (TTCM) clinic and taught more about the practice of Thai massage and acupuncture. When then participated in a brief compounding lab where we made herbal compressed called Lanna Herbal Massage Balls and citronella bug spray. The university welcomed us with an American lunch of Pizza Hut.

Chiang Mai!!!!

       This weekend, we finally made it to the beautiful city of Chiang Mai. This is where we will be spending a total of 10 days exploring pharmacies and universities in the northern part of Thailand. Saturday and Sunday, we got time to shop around the markets, play pool with friends, and even attended a cooking class. The markets varied in size depending on what day you went, Sunday being the bigger of the two. Pool was also very interesting considering that here in Thailand the game called "Snooker" is more popular than pool. This is a game that involves smaller pockets along with smaller pool sticks making it harder for us to play. Even though it has only been two days, Chiang Mai seems like it has a lot in store for us to do and explore. 

        

Asia Scenic Cooking Class

Today was a relaxing day where we enjoyed cooking and eating many different traditional Thai dishes. Our instructor took us through their garden where they grow a wide variety of herbs and spices including ginseng, basil, and turmeric. We then went through and made a multi course meal that included salad, stir-fry, soup, curry, a spring roll, and a dessert. The food was delicious and we were sent home with a cookbook so we can continue to cook Thai food in the future. Chokh dī!

Today in Chiang Mai we took part in a cooking class at Asia Scenic Thai Cooking School. We prepared multiple courses, in which flavors burst forth from the fresh ingredients. With a menu of dishes to choose from I prepared hot basil stir fry, papaya salad, a spring roll, tom sab, khaw soi, and finished with deep fried bananas. I left today full from our many courses, but craving to prepare and enjoy much more.

Korean BBQ and Dessert

Tonight Dr. Choi treated us to Jang Won Korean BBQ restaurant in "Korea Town." We all took our shoes off and sat criss-cross on the floor in front of a low table. We ordered several meals to share in

order to get the best experience. As pictured, we were given so many side dishes, spices, sauces and main dishes that we didn't have room for anything else! The food was so good we kept eating even when the restaurant temporarily lost internet 😆.

Next Dr. Choi brought us to a Korean dessert shop where we got HUGE shaved ice dishes to share. They offered so many different flavors such as green tea, oreo, strawberry, red velvet, and many more! It was very filling and we all left very full. We were all very thankful for Dr. Choi's recommendation and generosity.

Queen Sirikit's National Institute of Health

          On our adventures today, we got to visit the Queen Sirikit's National Institute of Health. While here, we got an extensive lecture about Dengue and the different sub types associated with it. Dr. Supradish went into detail about the different signs and symptoms, epidemiology, and the different treatment options associated with Dengue. This part of our day was super interesting since Dengue isn't really a prominent disease in the United States. She explained how they have cases of Dengue ranging from as old as 90 years old to as young as 9 hours old. After our lecture, we were given a slight tour of the hospital while also getting the chance to meet different patients that have Dengue fever. This experience was definitely a shock since it was something I never thought I would get the chance to see up close. Overall, it was a very informational visit to the Queen Sirikit's National Institute of Health. 

Ramathibodi Hospital Day 2

(Chemotherapy Pharmacists)

Today we rounded up day two at Ramathibodi Hospital. Our first stop was in the chemotherapy unit, where we discussed chemotherapy regimens all morning with two of the clinical chemotherapy pharmacists at Ramathibodi Hospital. We were able to sit in on patient visits and observe what the pharmacists discussed with their patients about different regimens. Most of the visits conducted were to ensure the patient knew how to take their medications, to discuss if they were experiencing any side effects related to the medications and to just be an extra support for the patient. One of the chemotherapy pharmacists we talked to is actually the only pharmacist in Thailand to be licensed in both Thailand and the United States. She discussed some of the research she has done throughout her years as a pharmacist, one of them being ginger studied in patients undergoing chemotherapy regimens to help reduce nausea. The ginger capsule she created is currently in Phase III clinical trials and it is bringing so much attention to the U.S. that a drug company from the U.S. offered her a contract so they can reproduce the drug in the states. However, she declined because she wanted to stay true to her culture and use the drug to help the people of Thailand specifically affected by this. Another fun fact about herself is she found that banana extract helps with patients who experience a rash from their chemotherapy regimens. This research is also undergoing clinical trials currently and she even got the King of Thailand to fund her research!

In the afternoon we mostly spent our time visiting various pediatric units at Ramathibodi Hospital with many of the pediatric pharmacists. We were able to see a number of patient charts and review drug regimens pediatric patients were on for different disease states.

Pictured below are some pharmacy students on rotation at Ramathibodi Hospital. We had lunch with them this afternoon. They are on week 3 of their 6 week rotation at Ramthibodi Hospital. Very similar to us, each of their rotations last 6 weeks but they are required to complete 7 blocks with 1 block off instead of our traditional 6 blocks.

Central Chest Institute of Thailand

Today some of us visited the Central Chest Institute of Thailand, a hospital with focus on cardiovascular and pulmonary disease. In our time there we visited an anticoagulation clinic, asthma/COPD clinic, and TB clinic. We discussed how patients are counseled on their anticoagulation treatment and TB treatments, and observed a pharmacist counsel a patient on proper inhaler technique. It was interesting to see how their processes here are fairly similar to those in the US. When looking at a digoxin toxicity case later in the day, a notable difference came in the fact that the lack of having the antidote stocked in the hospital as it was too expensive. While it is also expensive in the US, it's typically on hand should it be needed. This emphasized how cost barriers can vary from country to country, and may not be something that's typically considered when thinking of how other country's health systems work.