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Mae Tao Clinic, 2010 - Benjamin Williams, medical elective

My wife and I went on elective in the summer 2010 at the start of our 5th year. It was at the Mae Tao Clinic ( which is a clinic on the Thai side of the Thai-Burma border in a little town called Mae Sot. It's a great little hospital with about 100 inpatient beds between medicine, surgery and paediatrics as well as a small birth centre, a mental health centre, a pharmacy and outpatient medicine, surgery and paediatrics.

The clients are primarily Burmese migrants living and working in Thailand and Burmese people who come over the border seeking the essentially free care at the clinic. They mainly come from the ethnic Karen or ethnic Burmese populations but there were patients from all Burma's ethnic and linguistic groups.

Not many of the patients speak English. Fortunately, the clinics home trained medics were on hand to translate more often than not (many of whom do speak English). Even in the absence of translation patients would be more than happy to let you examine them so long as you were respectful. The clinic is staffed almost entirely by 'medics' who are trained at the clinic and whom we worked alongside in a fairly equal partnership. They have a couple of years vocational training alongside teaching which is done partly by the senior medics and partly on an ad hoc basis by Western doctors volunteering. As their training is pretty ad hoc their knowledge could be quite patchy but they have a wealth of experience and are very good with the common conditions which come through the door. The medics also share in cleaning the wards and nursing the patients with patient's families and we were quite rightly expected to join in as required. Working with the medics by and large was really fun and very educational. Occasionally, more junior medics sometimes came to us for advice about a patient's diagnosis or treatment which was a privilege. Whilst we were there one Australian registrar and one Canadian nurse practitioner were also at the clinic. In the town of Mae Sot there was a fair few volunteers working with various projects along the border.

So our normal day at the clinic depended on your department. Outpatient clinics were much like general practice and really good experience. Stress, anxiety back pain, peptic ulcers and UTI's were all very common presentations. When working in inpatients we would generally go around alone or in a pair and do a combined adults and paediatrics ward round, examining the patients as we went. The medics themselves didn't do a ward round system and only usually reviewed patients if they asked for it. From this we would identify those patients whose conditions were deteriorating or had evolved making it apparent they didn't have what they were diagnosed with on admission. We then would talk this through with the medic looking after them and if we felt it was beyond us we would get the registrar to review them later in the day. This seemed like a good way to work together and meant we got the most out of seeing as many patients as possible. We saw cases of lots of malaria, pneumonia, nephrotic syndrome, pyelonephritis, appendicitis and more. But also at least one case of leptospirosis, likely melioidosis, leprosy, scrub typhus, tetanus, pulmonary and meningeal TB, other opportunistic infections, superior vena cava obstruction and we managed to diagnose HONK clinically whilst the glucose meter still wasn't working. Also, the local practice of injecting coconut oil for penis enlargement was possibly the commonest cause for presentation to the surgical department other than soft tissue abscesses.

So the clinical experience was fantastic but we did loads more than that. After work we taught an English class for a dozen or so of the medics. On Saturdays we went and discussed Buddhism with a local monk who wanted to practice his English. He also took us to visit his family in the surrounding villages. We went to a Karen language church attended by the general of the Karen National Liberation Army (who sang the old rugged cross in English for us!). We also went to karaoke and clubbing with some lads from the bar down the road from our house which was both very fun and a bit strange. We had some holiday time in Koh Tao and Chiang Mai either side of our clinic placement too!

All in all we learnt a lot. Medically, the biggest thing was a huge boost in our confidence in our clinical skills, especially our ability to pick out the deteriorating patients. About dengue fever, both treating it and probably having it. But we also learnt all sorts of things like how to teach English (sort of!), the life and beliefs of your everyday Thai Buddhist, and about real generous hospitality.

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