so the last few days have been an interesting mix of learning more about the different research projects that are going on at RIHES and tagging along with this group of visiting Japanese docs that are here for an intensive short course on infectious disease. Some highlights included:
One day of lectures (this is like going back to med school, but it's stuff I'm actually interested in, so I liked it. Also, it was the Japanese docs being pimped, not me J ) Topics covered included anthrax, ARV (antiretrovirals for HIV) in Thailand, TB, and dengue.
I also went to another lecture on infection control in the hospital and on antibiotic resistance in the ICU – it's totally crazy; the head ICU doc here is really super dedicated and does his own monitoring of all the pts admitted and their bugs and resistance profiles. Based on the drug sensitivities, he creates protocols every few months that he tries to get the other docs to use and when the sensitivity profiles change, he changes his protocols. He also went on this massive hand-washing campaign to try and get nurses, physicians, and other auxiliary staff to wash their hands before and after contact with patients (by hiring random people in the hospital to observe pre-and-post patient handwashing, he found that in a step-down icu there was only a 2% handwashing rate before pt contact – craziness!)
Anyway, I think the stuff he’s doing is really interesting and might meet with him to see if I can contribute in some way since his sample sizes are pretty small and are focused on the university hospital. Btw, the university hospital officially has ~1200 beds but unofficially they just put extra beds in and most ppl think there’s at least double that amount – it’s crazy).
Rounds in the ICU (for you medicine ppl out there, one of the main bugs here in ppl with acute exacerbations of COPD and/or hospital-acquired pneumonia is Acetinobacter baumanni. How weird is that? Pseudomonas is in second place, and MRSA is really not common).
Adult ID Rounds. We saw the craziest case of this 21 y/o woman who originally was admitted with spontaneous pneumothorax. Her lung didn’t expand after they put in a chest tube, and then they saw all these loculated cysts on CXR that ended up being ECHINOCOCCUS. How crazy is that? Even CRAZIER though is that she kept having a fever and was found to have empyemas throughout her pleura on Chest CT. When they went in to take out the pleura, they cultured the abscess fluid and found ASPERGILLUS. So now she’s getting antifungal meds (amphotericin B here) and is s/p a 3 wk course of albendazole for the echinococcus. Totally wild, even for Thailand. Other cases I saw included probable Strep suis (from pigs) infection causing a brain abscess and right-sided visual loss and hemiparesis and these weird skin lesions, cryptococcal meningitis in an immunosuppressed diabetic with rheumatoid arthritis, and miliary TB/tuberculous meningitis in this super old dude who was disoriented and had fever (he also was previously treated for a UTI but his neuro status hadn’t improved). I really like ID and am almost 100% sure I will do a fellowship in it or maybe just fast-track into it out of medicine residency.
Meeting with the coordinators of the MA (methamphetamine) study and the PA(Project Accept)-Thai Study. The MA Study is a kickass study that has over 2000 subjects that are between 18-25 year olds and either use MA themselves or are the sex partner of someone who uses MA. There’s a really extensive baseline questionnaire and then follow-up questionnaires every 3 months for one year. There’s also an intervention (but it’s over already) that runs for a couple of hours per week for eight weeks vs. a control group (also lectures for 2 hrs for 8 wks, but there’s not much interaction and uses a government-sponsored ‘life skills’ curriculum). Anyway, there’s some preliminary data on MA use and tattooing (which is really common here) and I might do some work with that until the suboxone trial with IV drug users gets off the ground, so that’s exciting. I visited the MA drop in center they have set up near the University today and met the team that works there and had lunch with them. Thai ppl are often pretty shy when you first meet them (esp if you can speak Thai and are from somewhere else) and only a few people talked to me, but it seems like a fun place to work. I’ll probably set up a meeting next week with the data coordinator to look at some of the surveys. The head people for the study are also super cool and I totally get along with them.
The PA-Thai study is huge and entails bringing voluntary counseling and testing into different communities surrounding Chiang Mai, including hill tribe and rural, isolated communities. They go to communities every weekend to do community mobilization and run the clinics and I’ll probably join them next weekend (Ben is going this weekend, but I had originally planned to go to Vientiane, Laos to visit Judy…I dunno now because tix are expensive and hard to find, but I might go and check at Lao Airlines (randomly on the first floor of my building tomorrow). There’s more to the study, but I won’t go into it now.
Outside of work, I’ve been hanging out with my fellow Thai Fogarty fellow named Poo (it means crab in Thai, and isn’t pronounced like the word youre thinking of). She’s a first year ID fellow and we get along really well; she reminds me of my other Thai friends in Bangkok. We often go out to eat and I’ve been hanging around the ID office whenever I’m free. She also took me to Tesco Lotus with her boyfriend Nui and Ben and I got a bunch of stuff for our rooms. Yay people with cars!
Ben and I also went to Monk Chat yesterday at Wat Suandok, a temple which is part of a monastic Buddhist university. Monk Chat is basically held for monks to practice their English and for Westerners to learn more about Buddhism. We talked to some monks from Laos that were studying in Thailand and it was pretty cool (aside from getting eaten alive from mosquitos). I would like to go to the temple more and get back into chanting/meditation/listening to Dharma talks while I’m here.
On my to-do list: check out yoga places, find a new Thai teacher (I think the one I went to for two hours ran out of stuff to give me), learn how to ride a motorcycle.
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