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.

Ramathibodi Hospital

Today we split into 3 groups and my group visited Ramathibodi Hospital in Bangkok. Ramathibodi is a tertiary care hospital that has 1,200 beds. The pharmacy department is split into four departments; compounding (both sterile and non-sterile), dispensing, clinical pharmacy, and drug supply management.

We first visited the sterile compounding department where we learned that their process is much like the one we have in America except for the manual process that occurs. Next we visited the inventory department which looked like a large warehouse of drugs. We learned that as a hospital their formulary has 60% brand drugs (which they call "original") and 40% generic drugs. They often analyze their formulary to attempt to get the most effective drugs that are also cost-effective. We learned that they focus more on the "accurate property of the drugs" rather than how much they cost, which is why they have 60% brand name drugs.

Next we visited an outpatient dispensing pharmacy which was driven mainly by robots. Upon entering the prescription into the computer a label prints and the technician puts that in a basket, then places the basket onto a sensor that magnetically labels the basket as that specific prescription. The

basket is then placed on a conveyer belt to be brought to the filling technician, then to the pharmacist who places the basket on another sensor to do the final check of the prescription with the drug and label.

Finally we visited the chemotherapy compounding department which was very similar to America. We learned that patients can request to pay more for a more personalized and comfortable chemo area. Also, there are volunteers that knit hats and donate them to the patients who are losing their hair.

Sirindhorn Hospital

Today we visited Sirindhorn Hospital in Bangkok. It is a government hospital with about 345 beds. This hospital provides western medicine as well as Thai traditional medicine for the patients. Patients do not have to pay for their hospital visit, as long as they are registered to this specific hospital. However if they are not registered, then the patient has to pay. We learned about the role of the pharmacists here and had a tour of the inpatient and outpatient pharmacies, as well as the medical supplies and storage area. It was interesting to notice how the pharmacists here are mostly female with only one male pharmacist. This is a similar trend to the United States. We also had a great discussion today with the hospital pharmacists about the similarities and differences between pharmacies in the U.S. vs. Thailand. For example, patients in Thailand must see a doctor every visit before getting a refill of their medication, in case of any changes. Also, the hospital and pharmacy are all in one location to make it easier for the patient and it is more of a one stop service. We ended the day learning about their emergency response and got a tour of the emergency department and an ambulance. We also toured their traditional medicine department which includes services such as acupuncture, cupping, and Thai massage.