Residents' Experiences:
Thailand Rotation Summary March 2005/updated August 2006
Internal Medicine and Medicine Pediatrics residents may spend 1 or 2 months in a rotation based in northern Thailand at Chiang Mai University. Chiang Mai University is the major tertiary referral center for northern Thailand and southern Laos. The hospital, called Maharaj Nakorn Chiang Mai, or “Suan Dok” Hospital locally, is a 1,800 bed hospital which has all the specialties of medicine and surgery, and often has a census which exceeds its bed capacity. Check their website for more details: www.med.cmu.ac.th
Residents have the following options, as well as others, for their activities while on rotation:
Spend time on an inpatient Internal Medicine or Pediatrics service.
You are assigned to a ward team and will participate in morning report, rounds and afternoon and evening admissions of patients. Average number of admissions per team, which will include medical students and residents, may be as high as 20 patients per call night. You do not need to stay over night with your team unless you choose to do so, but I would recommend staying overnight on call at least once. Activities will include bedside rounds on multiple ill patients, opportunities to observe how complex medical problems are handled in a relatively resource poor setting, and other residents with outstanding physical exam and differential diagnostic skills. You will not be admitting patients on your own, but will be in an observing capacity. Residents will be able to speak English, but their fluency will vary. Medical students and residents do their own urinalyses, blood smears and India ink stains of CSF for cryptococcal meningitis (very common in this area of the world with a high incidence of HIV/AIDS); you should take the opportunity to learn the basics of these skill sets. At morning report all of the admissions (as many as 80-100) are listed on a blackboard with the admitting diagnosis; you should write down these interesting cases and in the afternoon should seek out these patients on other ward teams.
Other opportunities at Chiang Mai University itself:
If you are interested in a certain subspecialty of medicine or pediatrics, such as HIV/AIDS, tuberculosis, general ID clinic, GI, pulmonary or cardiovascular care in the tropics, you can ask to attend clinics, which are in an adjoining building and often occur in the morning. Staff physicians and residents may see 30-50 patients per half day in outpatient clinics, and the range of pathology is fascinating. Ask the Chief Resident in medicine or pediatrics for the current outpatient clinic schedule, and to ask staff members for permission to observe their clinics. Also exciting is to spend 1 or 1 nights in the ER (with the resident covering ER for pediatrics or medicine), where many sick patients may choose to go home without treatment once faced with the reality of their medical bill. Be sure to ask a resident to give you a tour of lab, radiology, ultrasound, pharmacy – all fascinating to observe and contrast with our wealth of resources.
CONTACTS AT CMU for resident rotations:
Dr Chaiyut Charoentum, Division of Hematology Oncology, Dept of Medicine (he is officially helping with resident rotations as of 2005) ccharoen@mail.med.cmu.ac.th
06-587-0900
Dr Virat Sirisanthana, Chairwoman, Dept of Pediatrics (Peds Allergy and ID)
vsirisan@mail.med.cmu.ac.th
Dr Thira Sirisanthana, Director, Northern Thailand Research Institute (ID/HIV) (first Chair of IM who helped us)
ssirisan@mail.med.cmu.ac.th
Dr Ong-Ard, Chairman, Dept of Internal Medicine (GI) (Current Chair of Medicine 2006)
ongard@mail.med.cmu.ac.th
Dr Khuanchai Supparatpinyo (ID) (Has done a research study on resident's knowledge of Strongyloides with the U of M, also a paper with Dr Walker on cutaneous TB)
khuanchai@idthai.org
Dr. Siwaporn Changkrachang (Neurology) She is the 2nd Chair of Medicine who helped the U of M
schankra@mail.med.cmu.ac.th
Dr Kajohnsak Noppakun (Nephrology) He is the first international faculty from CMU to come to MN - participated in the Global Health Course for 7 and 1/2 weeks in July and Aug 2006
knoppaku@mail.med.cmu.ac.th
Pramote Vanittanakom, PhD (helped obtain CMU University wide approval for U of M affiliation agreement) Associate Dean for Post-Graduate Studies and Foreign Affairs Faculty of Medicine
Dr Supot Wudhikarn (Gave CMU university wide approval for U of MN affiliation agreement) Dean of Medical School
Off-campus opportunities during your Chiang Mai rotation:
McKean Rehabilitation Institute
McKean Rehabilitation Institute is a very famous facility in northern Thailand, founded in 1908 as a leprosy hospital and rehabilitation institute by Dr James McKean. Currently, the hospital has multiple activities in northern Thailand including hospital ward rounds twice weekly, dermatology clinics in Chiang Mai, and community based rehabilitation visits which are conducted in surrounding villages. The hospital provides general rehabilitation, as well as care for patients with active and quiescent Hansen’s disease.
McKean will accept residents for one week rotations. These rotations may be two days one week, (to coincide with ward rounds), and two or three days another week. After residents have received approval for their one month rotation in Chiang Mai, they should contact Mrs. Heather Smith, the Associate Administrator at McKean rehabilitation hospital, in order to coordinate a rotation.
Excerpts from a profile of McKean at: www.pcusa.org/health/international/profiles/mckean.htm are as follows:
McKean Rehabilitation Institute
Chiang Mai, Thailand
In 1998 McKean celebrates the 90th anniversary of commencement of ministry to leprosy sufferers and continues as a charity center providing help and hope for leprosy patients and disabled people also.
Founded in 1908 by a Presbyterian missionary Dr. James McKean, as the first asylum for leprosy sufferers in Southeast Asia, this center developed over the years through various stages. From a leprosy colony it became a leprosy hospital and later a leprosy rehabilitation center. Now McKean is a general rehabilitation center integrating leprosy patients and people physically disabled from other causes in its therapy rooms, wards and rehabilitation projects, including the community-based projects outside the center.
McKean built a new rehabilitation center in 1993 - the first building constructed in this area to be user friendly for disabled people. Here we provide hospital based rehabilitation therapy including surgery, physical and occupational therapy, counseling, vocational training, aids to daily living, and socioeconomic assistance. After discharge from the wards, disabled people are encouraged to practice independent living in nearby cottages, using the skills learned during their hospital stay. They are also encouraged to be involved in the gardening and nursery projects and to learn income generation skills.
Through the community-based rehabilitation team, McKean is facilitating disabled people in their home areas to improve their situations physically, economically and socially. This team also continues to help people affected by leprosy to live healthily and productively in their own home areas.
At the north end of the property McKean provides Buraphaniwet Village for the elderly disabled people who have no homes or families. About 50 people live in small cottages. Another 50 who are blind, infirm and very disabled need total care in two hostels. Chaplains minister in each area of McKean and there are churches established in the hospital area and in Buraphaniwet village.
CONTACTS --McKean
Mrs. Heather Smith, Associate Administrator
heather @mckeanhosp.org and send a copy of your e-mail to: thsmith@loxinfo.co,th
Dr Trevor Smith, staff physician
Dr Pajon Wongtranyarn, staff physician
Mrs. Pacharee, head nurse
When contacting Mrs. Smith, please be certain to ask what medical supplies may be useful for us to try to bring to Thailand, and what general medical lectures the staff at McKean Rehabilitation Hospital would appreciate hearing from the visiting resident physicians.
Tuberculosis and Chest Disease Center
Resident physicians have the opportunity to spend one week with Dr Attapon Cheepsattayakorn, Director of the 10th Zonal Tuberculosis and Chest Disease Center located in Chiang Mai. Dr Attapon has been the director of the Tuberculosis Center for 16 years. There are 12 tuberculosis regional treatment centers in Thailand, and he manages the oldest one. Typically, mornings are spent seeing approximately 20 new patients per day, reviewing CXR’s and sputum results, and counseling patients. Nurses provide patient education and directly observed therapy. Family members are brought into the center for active case contact investigation. Nurses also provide home visits in the afternoons, and residents should inquire about accompanying staff on these visits.
After residents have received approval for their one month rotation in Thailand, they should contact Dr Attapon to coordinate spending one week with him while in Chiang Mai .
Contact-- Tuberculosis Center rotation:
Dr Attapon Cheepsattayakorn
531 Lumphun Road (opposite Suriwong Book Store, on the south side of town)
Nonghoi Muang
Chiang Mai 50000 THAILAND
attaponche@yahoo.com
Vector Borne Disease Center
Also located in Chiang Mai is the Vector Borne Disease Center, which provides diagnosis and treatment for vector born diseases including malaria and dengue fever. This complex is located within walking distance of Suan Dok Hospital. The Center provides information regarding the epidemiology of vector born diseases in Thailand, and allows residents the opportunity to work with malaria laboratory staff to learn to identify malaria parasites on thick and thin films. Information on vector born disease control efforts is also available. Residents may have the opportunity to smaller towns, to participate in malaria treatment clinics. The Office of Vector Borne Disease is a subsection of the Office of Disease Prevention and Control, Zone 10, for Northern Thailand, which includes vector-borne diseases, tuberculosis and HIV/AIDS.
After residents receive approval for their rotation in Chiang Mai, they should contact: Miss Srisucha Chawprom csrisucha@yahoo.com, who will coordinate your rotation.
Other contacts at the VBD Center include:
Mr. Sawart Cholaphol, Lab Supervisor
Dr Songwut Puttamai, Director, Office of Disease Prevention and Control
447 Thanon Lamphun
Tambon Wat Geht
Amphur Muang
Chiang Mai 50200 THAILAND
Expectations for residents rotating at Chiang Mai University:
Residents must first have your rotation approved by Dr Peter Duane, or Dr. Brad Benson, and Dr. Patricia Walker, who is the site coordinator for the Chiang Mai University rotation.
After approval of your rotation, resident physicians may personally contact all of the above named individuals in order to begin coordinating their rotation. Be certain to remind your contacts that we have an international affiliation agreement with Chiang Mai University, and that Dr. Walker, the site coordinator for CMU, has been involved with approving your rotation. Please carbon copy me on all of your communications with Thailand as well. Be certain to bring business cards for yourself, (have them made if you don’t have one already) and to obtain business cards for all people with whom you are in contact while at CMU. Most first meetings begin with the formal exchange of business cards. In Thailand, the proper courtesy would be to send a formal thank you letter to each individual who helped you on your rotation, and it will be important to obtain their business card in order to do so.
Please also be certain in your e mail to inquire as to whether or not it would be helpful to bring medical books or other supplies to Thailand. If you are able to bring CD-ROMs, PDA applications or books, for example, these would be excellent gifts to bring with you. I have also discussed with the departments of internal medicine and pediatrics, as well as the off campus rotation sites, the opportunity for staff in Thailand to request lectures on common medical topics, to be given by resident physicians from the University of Minnesota. I would like this rotation to be a mutually beneficial one, and oftentimes residents and staff in Thailand are very appreciative if resident physicians provide more information on mentoring Chiang Mai residents regarding US educational opportunities.
Upon return to Minnesota, residents will be expected to provide a written report on their rotation in Thailand, as well as one lecture on the clinical work they were involved with, or a disease/health policy or research project upon which they focused, while in Thailand.
SITE COORDINATOR - THAILAND ROTATION:
Patricia Walker, MD, DTM&H,
Associate Medical Director, International Track
Department of Internal Medicine, University of Minnesota
651-254-3448
patricia.f.walker@healthpartners.com
For a version of the Thailand Rotation Description in PDF format, click here.
Return to: Department of Medicine : Medical School : Academic Health Center : myU : U of M Home
