I’ll be back....

I can’t believe this APPE rotation has come to an end so quickly! I have had an amazing time exploring this beautiful country and I’m very sad that it is time to leave. 

I am truly grateful for the opportunity to be able to become completely immersed in the Thai culture and compare and contrast life here versus in the U.S.  Seeing the way Thailand’s universal coverage system works was very rewarding as it allowed me to see the pros and cons of a very different approach to healthcare, how barriers are overcome, and the access patients have to healthcare professionals.  Although the system is very different, it was humbling to see the length some healthcare providers go to ensure safe and efficacious care to their patients.  

Throughout all of our site visits we were able to experience first hand how accommodating and hospitable the people of Thailand are, not only to their patients, but to our large group of American students and faculty as well.  I will deeply miss Thailand and it is safe to say I will absolutely be coming back to this amazing country!

 

And just like that....

          Its all over. A once in a lifetime APPE rotation is over in the blink of an eye. I don't know where to begin. I am extremely grateful to be given the opportunity to immerse myself in another culture and most importantly, view pharmacy from a whole new perspective.

          It was impressive seeing the pharmacy world ran so differently and how knowledgeable each of the pharmacist and health care staff were. The way they utilized universal coverage so well was something I have never seen before and the Thai healthcare professionals ( from physician to nurse to pharmacist to professor) are all so proud of it.

        This journey would not have been as amazing if it was not for the awesome people I was accompanied with. Sharing the experience with some close friends, creating moments and unforgettable memories that are once in a lifetime. This includes not only my classmates, but the faculty who guided and challenged us every step of the way. I made sure to get the best photos of them as well!

I was sweaty for 90% of this trip. still worth it though

Watch out for ILS when visiting the temples. Jared seemed to have caught it a few times.

 The best pictures are the ones that you have no idea exist.

Sorry Dr. Bose, but the world needs to see this magnificent photo of a professor in the wild.

The face of a man that fires 100 Naplex questions per minute

Hill tribe pants in full effect

Added a few new dishes to the arsenal

no words

See you soon

It’s truly unbelievable that we are back in Bangkok one last time and leaving this beautiful country tomorrow. Words can’t describe how amazing and rewarding this experience was. Being alongside some of my closest classmates made this an unforgettable trip and APPE. 

It’s hard to recount all of the amazing learning experiences we had on this trip. One that will always stick out in my head was sitting in on a physician’s leprosy clinic. We sat alongside other students from around the world and were able to see first hand what the disease presents as. Seeing patients with TB, Leprosy, Malaria, etc really helped put in prospective some of the disease states that we don’t see as much in the states. We had the opportunity to work alongside various healthcare workers and we really got to see how unique Thai healthcare is. While many aspects of pharmacy do differ such as Brand drug names and community pharmacy access, the focus in patient care remained the same. 

The cultural experiences we were able to have is really what made this APPE an experience I’ll never forget. Thank you to all of my classmates, Dean Tanzer, Dr. Bose, and Dr. Copeland for sharing this experience with me! I can’t wait to come back!

Goodbye Thailand

I feel truly blessed to have had the opportunity to spend a month in Thailand.  All of its hospitality, culture, and compassion was extremely humbling.  This experience surpassed my expectations and gave me better insight on how countries, though so different, also share the same common goals.  Thailand deals with many disease states that for us are considered rare.  Although they face numerous barriers, the health care professionals do a great job allocating their resources for the good of their people.  The pharmacists we met were well trained and very knowledgeable in their specialized fields.  Even though the hospitals, clinics, and pharmacies lacked the fancy new machines and shiny floors, the care being provided to the patients was top notch.  Everyone was eager to learn and gain new ideas from us on how to further improve their care.  Little did they know, we were the ones gaining the most.

I am really going to miss Thailand.  It was great spending this time around genuinely good people who allowed me to learn more about myself.  Until we meet again, thank you Thailand!!

Alfonso Ramirez

What an experience!

As we are ending this rotation I am incredibly thankful to have had the opportunity to travel to Thailand for this experience. We were able to see and interact with so many different health providers each contributing to Thailand's larger health system as they promote their citizen's health and well being. One major component that I will definitely take away from this rotation is having a better knowledge of different types of tropical diseases and how to best care for a patient who presents with one.

Additionally, even though there are many similarities between the health systems of the U.S. and Thailand, there are also many differences between them. One of which being that Thai pharmacists seem to be much more involved in their health system than those of the U.S. They played many different roles and had different patient care responsibilities depending on their units, each with a commitment to helping better the lives of others!

Thank you to everyone for making this such a great trip!

Closing time....

Today is the last day of our rotation in Thailand. Time flew by the past four weeks and I’m sad to be leaving. I’ve gained many life lessons and had many experiences that I will remember forever. Here are some of my favorite memories from this trip:  

In addition to the pictures, one of my favorite parts of this trip was learning about Thai traditional medicine. Thai traditional medicine focuses on the body being out of balance which then results in a disease or ailment. I enjoyed the natural medicines course that I took in pharmacy school, so to see it be such a big part of another culture was really cool. I said many times throughout this trip that if I ever were to work in Thailand, I would work at a traditional medicine hospital.

However, I think one of my biggest takeaways from this trip and something that really stuck with me is the dedication and commitment that the pharmacists here exhibited towards their patients. Many of them work long days to get all of their work done and see hundreds of patients a day in their clinics. I know that this attitude is something I admire and I hope to emulate when I become a pharmacist. 

Thank you to everyone who helped make this trip possible! I am so grateful to have been given the opportunity to learn about another country’s healthcare system. 

Lastly, I will finish by saying that no matter what language you speak, a smile is universal and can mean more than words do

To Thailand: Thank you and I'll be back!!

I can remember sitting in class P1 year and hearing about the Thailand APPE that would be offered to us a few years down the road. P2 and P3 year, although stressful, they flew by and APPE year came sooner than expected.  I was fortunate enough to be selected to go on the Thailand rotation I dreamed about for years, I have to say that it has been one of the best experiences of my life.  I have learned so much, from both an educational and cultural standpoint. 

Being able to learn about dengue, leprosy, and HIV in an area with higher incidence rates than the United States has been a true privilege.  Not many students back home can say they have interacted with leprosy patients, seen the varying stages and had the opportunity to palpate their nerves.  Not many students have gone to a dengue specialized hospital to see and discuss real patient cases, treatments, and outcomes.  And not many students have visited an HIV/AIDs specialized community and hospice center.  For these reasons and many more, I feel that the Thailand APPE is unique and educational in ways that no other APPE has to offer.  I have seen first hand that the health system does their best to help its people. We can definitely benefit from taking a few tips from the Thai Health System.

Aside from the lectures, hospitals, and clinic visits, it has been fun visiting the many different temples, taking a Thai cooking class, bathing, feeding and playing with elephants, and having the opportunity to immerse ourselves in Thai culture.  I have learned several Thai words/phrases.  I have enjoyed eating a wide variety of Thai dishes.  I have no complaints from my trip, other than I wish it wasn't over so quickly.

To my classmates and friends, thank you so much for making this trip such an amazing experience!  To the future classes coming on this trip, you won't regret it!

-Jeannette Ramirez

Final Reflection

This APPE has truly been an unforgettable experience both educationally and culturally. Throughout the course of this rotation I have had the privilege to learn about pharmacy and the healthcare system in Thailand from various pharmacist, physicians, professors, and nurses. During the morning session we would listen to lectures about different disease states and the healthcare system in Thailand. The afternoon sessions were comprised of visits to different pharmacies from all different settings as well as hospitals, patient clinics, and even patients homes. During these sessions we were able to apply our clinical knowledge when the pharmacists or physicians at the sites would present us with patient cases currently under their care and asks us questions about the disease states and the therapeutics used. It has been eye opening to see how the role of the pharmacist in Thailand differs from that of an American pharmacist with much more emphasis on direct patient care. I look forward to utilizing the new clinical knowledge learned during these site visits as I transition from a pharmacy intern to pharmacist.

In addition to the wealth of clinical knowledge that this APPE provided, a wealth of cultural awareness was also gained. As one of the most accessible health care professionals it is crucial to be culturally aware, as there will be a vast array of patient backgrounds coming to me, seeking advice. This rotation has given me the opportunity to see how other cultures live and the importance of being sensitive to other beliefs and customs. I am honored to have had this opportunity and strongly believe it will be an integral part of my success as a compassionate, knowledgeable, and effective pharmacist in the community I serve.     

Once In A Lifetime Experience

I have dreamed of coming on this international Thailand APPE rotation since my first year of pharmacy school. This experience is one that has been a once in a life time opportunity not only to experience the Thai culture, but also the aspects of the  healthcare system here in Thailand. 
It was very interesting to learn about and experience firsthand the disease states that are more rare to the U.S such as dengue fever, tuberculosis, and malaria. Also, I enjoyed learning about the advantages and disadvantages to the universal healthcare coverage scheme that Thailand has. Some of the advantages of this are that every citizen in the country can have access to healthcare and medications. However, we did see that some individuals had long wait times and were not able to have the best quality of medications depending on what is on the national essential drug list. Lastly, we learned about traditional Thai medicine, and how it is often used with westernized medicine in order to achieve the best outcomes for patients. 

As a group, the 14 of us learned a lot, but we also had a lot of fun learning about the culture of Thailand. Some of the highlights included visiting the Grand Palace, the temple of the reclining Buddha, and visiting a floating market and train market. My personal favorite days included the traditional Thai cooking class, our days spent with the elephants, and the day we went to True Love Cafe and played with Siberian huskies! 

This rotation has been an unforgettable experience and it is safe to say these 4 weeks have gone by too fast! I hope that life brings me back to the beautiful country of Thailand one day in my future. 

Thank you!

Jess Breitweg

Khob khun ka Thailand

As I have gone through two years of pre-pharmacy and three years of pharmacy school, a dream of mine has always been being able to study abroad. Finally this dream came true when I was able to come to Thailand to complete one of my advanced professional pharmacy experiences. I am so grateful for this opportunity because I have learned so much. Before coming here, I thought Thailand was going to be an extremely hot place that would have completely different healthcare than we do in the United States. I was right that it is extremely hot, but to my surprise, I was wrong about their healthcare and how different I thought it was going to be. As we traveled throughout Thailand, we visited many hospitals, primary care centers, pharmacies and I realized that although there are differences between Thailand and America’s healthcare systems, there are also a lot of similarities. The largest difference is that Thailand has Universal Healthcare Coverage which covers medical care and prescriptions (not always first line therapy due to cost) while America does not have Universal Healthcare Coverage so patients usually have private insurance that they have to pay for but they usually get first line treatment options.

As a healthcare provider this APPE has taught me how to be more respectful, dedicated, disciplined and culturally aware of my patients. After coming to Thailand, I now have a better understanding of why massages, herbal medications and acupuncture may be used before or even in place of medication. I have learned that Thailand is not necessarily behind in time with American medicine, they just believe in different treatments. I know in the future not all of my patients will be from America, therefore now that I have a better understanding of another culture and their healthcare, I believe I can be culturally sensitive to many of my non-American patients. I am forever grateful that I have been able to come to Thailand to learn about their healthcare system from pharmacists and pharmacy students. I am also very thankful for the time I was able to spend at the temples, playing with elephants and cooking traditional Thai cuisine.


and yes a baby elephant beat me up!

Abbey Henry 

Time to say goodbye

The Thailand APPE experience was a chance of a lifetime. During this rotation, I was given the chance to learn about a very different healthcare system in a developing country. Being able to see firsthand how a different society lives is an eye opening experience. For example, Thailand has universal healthcare coverage that applies to the majority of its people and sometimes migrant workers from other countries. This coverage covers medications, hospital stays, herbal medications, and various other practices, like massages and acupuncture. Practitioners here try to combine western medicine with traditional practices for the betterment of their patients. While this seems like an amazing thing at first, Thailand also deals with overcrowding and the overuse of systems. Watching how integrated the pharmacists are in the hospitals and how they deal with this less than perfect system is truly amazing. They are very resilient and are making the best of the situation as well as trying to improve it in any small way they can. 

During this time, I was able to interact with pharmacists and students alike and learn about the culture here in Thailand. It was amazing to communicate with your peers and compare what you know to what occurs in a different country. Additionally, we were often given the chance to see how they interact with their patients. I was able to see leprosy patients who were cured or dealing with relapses, patients who had HIV/AIDS living in a hospice area, and young children who had dengue. A group of us even got a chance to go to a NICU. 

Overall, I had a great time here and truly enjoyed it. I think the lessons I learned here will carry on with me throughout my practice as a pharmacist. I would highly recommend this rotation. 

The end is near..

Our time here in Thailand is coming to an end. I have learned so much over these past 4 weeks. It sure has been quite an experience, traveling to numerous hospitals, universities, markets, temples, hotels, and eating various Thai dishes.

It was amazing to see the many differences, as well as similarities, there are in the healthcare system between Thailand and the U.S. Just like the U.S., Thailand is continuously trying to improve their system. After we visited Bangkok Hospital in Chiang Mai, the pharmacy manager asked if we had any recommendations on how they could improve (this hospital was a private hospital, already very well run (reminded me of hospitals back home), and gorgeous). Since Thailand has universal healthcare coverage, almost all medications are free and healthcare is reasonably affordable being about 1 baht (equal to $1). This has its pros, like making it easier  to see a doctor. Comparing this to home, many people cannot afford to see the doctor and then on top of that pay for their medications. Then there are cons, such as spending your whole day at the hospital between waiting to see the doctor, nurses, and then the pharmacist. Since Thailand is a developing country, many medications that we use back home are too expensive for Thailand to get, but they still try to use drugs that have good efficacy but less expensive. Also, there is a lot of use of herbal medicine and massage. If the doctor recommends this as therapy, it will be paid for by the government. I also thought that it was interesting that pharmacy in Thailand adopted the U.S. 6 year program, but their residency program is 4 years and not paid.

We also got to visit a community pharmacy, which is very different than community pharmacies back home. In Thailand, you don't need a prescription for many medications, so the pharmacists can counsel and prescribe medications to patients. In the U.S., we are working hard to get this. I feel like this can lead to trouble because there can be drug-drug interactions and also many antibiotics are sold without a prescription, they get misused just like in the U.S., and then resistance becomes an issue. I liked hearing that the pharmacist has this "power" but I also like that we leave the diagnosing up to the doctors. 

Thai people are so welcoming and polite. No matter where we were, we were always welcomed with sawadeeka (which means hello) and a smile. If you had any questions, they would try their best to help you out, even if they couldn't speak good English. They would also apologize when they couldn't find the right words to say. Its amazing to see how other cultures are welcoming, polite, and caring. This reminded me to continue being nice and welcoming to people you encounter, even a smile can change someone's day

The food was one of the major concerns for me since before going on this trip, I never had Thai food and I can be somewhat picky and don't like too much spice (which Thai love). This trip has taught me to be open to trying new things, as there were times I wasn't 100% sure of what I was eating. We ate a lot of family style meals, which helped because I got to try various dishes, which I did enjoy most of them. My favorite Thai dish is cashew chicken and mango sticky rice for dessert. I even learned how to make them when we went to the Thai cooking class, so now I can cook it for my family back home! But I cannot wait to go home and eat real American food!! Look at how delicious..

My favorite day was when we went to see the elephants! This was not a requirement for the course and we went on an off day. All of the adults elephants were rescued, mostly from riding activities. We got to learn so much about the elephants such as what they eat, how the keepers take care of them, and got to help make sticky rice with herbs inside to help keep the elephants healthy. It was nice to see that the keepers had so much love for the animals, and they were not in chains and had free range of the park.

Ever since I learned about this APPE rotation at one of the open houses, I was so eager to make this one of my rotations. I was ecstatic when I learned that I was one of the ones that got chosen. This entire trip was beyond anything I had expected and a real eye opener. I am so grateful for the new friendships I have made and all the information I have learned along the way. This will help me as a future healthcare provider because now I have experienced first hand what care is like in another country. I feel like I am more well-rounded which will help me take care of my patients and keep an open mind. Some may think may think that we have it easy in the U.S. while others may see it as hard, but not many people from America get to partake in something like this and see how hard in can be in other countries. I will never forget this amazing experience and wouldn't trade it for anything.

Until next time,
Chelsea

Reflection

       The Thailand APPE was a great experience. It was a great way to see healthcare in a developing country and to immerse ourselves in a very different culture. Learning about the differences in the healthcare scheme was very interesting and quite amazing. Pharmacy in Thailand is extremely different from the USA as many medications can be bought without a prescription from the community pharmacies. Also, clinical pharmacists are a developing profession there and are working to show their value on hospital floors. Lastly, pharmacy education in Thailand is slightly different as the students can choose one of two tracks to go down, either pharmacy care or pharmacy science. Pharmacy care would be for either a community or hospital pharmacist whereas pharmacy science would be for industry, manufacturing or quality standards pharmacists. Students will take different classes in their final years based on which way they want to go with their profession.

       Overall this was an amazing experience where new friends were made and old bonds got stronger. Thailand was eye opening in many ways and taught me many lessons as well as how grateful I am for all the little things we have here in the U.S. I would highly recommend going on this APPE to any of the future students.

An Amazing Experience

The Thailand Advanced Pharmacy Practice Experience broadened my mind to both the healthcare and culture of Thailand. I was surprised to see all of the similarities and differences to our own healthcare back home in America. One of the biggest differences that we had encountered and learned about was the Universal Coverage Scheme (UCS). A majority of Thai people are covered under UCS meaning that they have to pay little to nothing for their medications and hospital visits. At a glance, it seems as if this system would work perfectly but there are definitely pros and cons to it. A majority of patients have great access because of UCS but they have to sacrifice their time with long waits at public hospitals and a more narrow selection of medications. I think it was great to get all different perspectives on universal coverage throughout our site visits because it is such a topic of debate back home. Most who are debating this topic in America have not experienced firsthand what universal coverage is like and by taking part in this experience I have opened my mind to the actual pros and cons of what it is. Unlike Western medicine, herbal supplements are much more widely accepted and integrated into care. Patients combine the use of western medicine and herbs as well as massages to help improve recovery. There are many clinical trials that have been/are being done that show the benefits of adding massage therapy post-pregnancy and post-surgery. Overall, I was amazed to see how resilient Thai people are. A majority of the people that we encountered had so little, but worked so hard. This was an amazing experience to be a part of and I would recommend this to any pharmacy student as it truly helps you to understand what patients may have to go through to receive care.

-Nick Raschilla

Chiang Dao Hospital

On Monday we started off the day with a two hour drive to get to Chiangdao Hospital in Chang Dao, Thailand. In this northern part of Thailand the people speak a different dialect, mainly live in tribes and this area has a lot of poverty. When we arrived at the hospital we listened to a lecture presented by Dr. Kudchaporn Intravong about Chiangdao Hospital and the care they offer to their patients with HIV/AIDs and/or tuberculosis. We learned that this hospital has 60 beds and most of the patients are from ethnic minorities. Along with medical care, psychological care, socioeconomic care and home health care, the hospital sets up PHA (people who’re living with HIV and AIDs) so they have a support network. Similarly to America, this hospital has a multidisciplinary approach for patients who have HIV/AIDs and the team consists of PHA, doctors, nurses, pharmacists, volunteers and health officers. Next we listened to a lecture presented by a pharmacist who works at pharmacy located in the part of the hospital that has all of the specialized clinics. After our lectures, we were taken on a tour to explore the hospital. Like many other hospitals in Thailand, this hospital was partially inside and partially outside and there was very limited air conditioning. I saw several stray dogs and cats roaming around the hospital. In the first part of the tour we were brought to the different clinics including HIV, TB, HTN, CKD, DM, methadone and NCD. There are usually around 40 patients per day in each clinic. Usually when patients come to the clinics, they will first see the nurses, then the doctors and finally the pharmacists. From here we were brought to the Medical Laboratory where we saw how the staff look under microscopes to examine TB and have an ELISA machine to determine the patients’ viral load of HIV. The next location we got to see was the emergency room. In the emergency room, the nurse said most of the patients present with trauma from motor vehicle accidents, more specifically motorbikes without helmets. The nurse explained that every month there are about 300 cases of Dengue Fever and about half of the cases are hemorrhagic Dengue Fever. Fortunately, less than 5% of these cases turn into Dengue Shock. After this we went to see the Delivery Room. In this hospital they deliver babies that have HIV + or HIV – mothers, therefore the pharmacist showed us the medication they give the HIV + mothers before the babies are born. There were two women in labor here with large straps around their bellies. Instead of getting epidurals, like we do in the United States, the treatment of choice for women in labor is massaging the abdomen. Where the two women were located was a small room with maybe 5 or 6 beds in it (very little privacy) and no air conditioning so it was very hot! I was surprised to learn that no family members were allowed to be in this room with the mother as she prepared to give birth. When it is time to actually deliver the baby, the mom gets moved to another more private room. After the tour we walked back to the air conditioned conference room to cool down and eat lunch. It was a busy hospital and we are thankful all of the staff took so much time out of their days to teach us.

MBK Center

At night a few of us traveled to the Mah Boon Krong (MBK) center in Bangkok. It is one of the largest shopping centers in Thailand with over 2,000 vendors and 8 floors. This center is a perfect example of the culture of shopping in Asia. The mall is not filled with department stores and chain retailers, but each floor is packed with small self-owned vendors. The best way to describe it is similar to an outdoor market in Thailand but in a mall setting. When traveling to Thailand, a visit to MBK should always be considered.

True Love Cafe @Neverland

Yesterday after arriving in Bangkok myself and another student traveled to downtown Bangkok to True Love Cafe @Neverland. At this cafe, we enjoyed some refreshments before we got to play with over 20 Siberian huskies and other various pups! These dogs are very well taken care of and love eating carrots and ice. We had a great time destressing and playing with these beautiful animals.

Back to Bangkok

Today we said our goodbyes to Chiang Mai and to our two favorite van drivers in Thailand! We arrived at Chiang Mai International Airport around 8:30 AM, checked in, went through security and boarded the airplane at 10 AM. We took Bangkok Airlines and the flight from Chiang Mai to Bangkok was an hour long. Thankfully we had a quick and safe flight. When we arrived at BKK, we collected our luggage, posed for a selfie and then got in the vans to head back to Hotel Windsor Suites & Convention. It definitely felt like we were “home” when we hit the legendary Bangkok traffic. Whenever we get stuck in traffic Noi likes to say “welcome to Bangkok”! After getting settled in, most of us went out to lunch either at the Korean Barbeque or Ramen. Later on in the day we got to relax whether it was lounging by the pool, exploring the city, reading, catching up on some work or watching TV. Tonight we will pack our small bags in preparation for the upcoming beach days! We are so excited that we are able to end our Thailand APPE with 3 beach days!