clinic-o-rama

this past week ive been to clinic everyday (besides monday, which was constitution day and a national holiday....kinda ironic considering there is no constitution right now). i forgot how tiring it was but it's good to be around patients all the time again. snapshot into clinic life:

tuesday was my first day volunteering at the reproductive health clinic. i walked in, got a short tour, and then immediately started seeing patients. the clinic is staffed almost entirely by nurses; the doc is consulted only if there's a problem. as a family planning clinic, most people come in either to get birth control (advice on choosing a method or to buy since it's cheaper than other places), get STD testing, or to get an annual exam (pap smear, pelvic, and breast). abortions are illegal in thailand but abortion counseling is available at the clinic; there are also abortions done but it's not advertised and im not yet sure about the circumstances surrounding that yet. i was able to assist on abortion counseling for a foreign couple that came in with an unplanned pregnancy; they were backpacking around asia and didnt want to go back to europe because (as the husband stated), they 'weren't done traveling yet.' they weren't using any form of contraception and wanted to have a kid in two or three years (they were mid-30's) and as i was talking to them, i felt like they needed to think about it more. the guy seemed to be putting pressure on his wife and i felt like he wasnt really thinking about the physical/emotional consequences of what was going on....in thailand, you can get affordable, high-quality health care but i cant imagine if they were backpacking in cambodia or something somewhere and just decided to get an abortion at a random clinic. i mean, really, it's like putting your life on the line. sometimes it's hard for me to understand what people's priorities are, but i tried to be as helpful and impartial as possible (of course). im not sure what the outcome of the situation was because they were going to bangkok the next day and likely went to a clinic there.

besides sitting in on some counseling sessions, i also got to do a few pap smears/pelvic exams. at first i was nervous about doing it since i hadnt done one since ob/gyn in march, but all the cervices (i have no idea if that's the correct plural form - cervixes?) were easy to find. it's also a little different here because they just use slides and a wooden spatula to collect the cells (vs thin prep, which i think i used at beaumont). also, the women stay dressed here and just change into a sarong (or paa tong in thai) i also saw some std's, including chancroid, assisted in a condom demonstration, and watched some nurses do birth control counseling. when it slowed down near the end of the day, i also got into an interesting conversation about women's rights, contraception, and condom use with some of the nurses there.

im actually kinda surprised at how low condom use is among the patients i encounter here (usually due to male resistance. most often heard comment: "it's not fun"). i feel like thais are really focused on the present (instant gratification) vs thinking about future consequences (is having an unplanned pregnancy 'fun'? what about getting an std?) what really upsets me is hearing about people who are definitely educated about these issues (ie nurses) continuing to have unprotected sex with their partners even when they know their partners have sex with other people or even after they themselves are diagnosed (and occasionally treated) for STD's (obviously from their partner). im not sure what else can motivate behavior change if you dont care about changing after youve already had an abortion or gotten an std like hepatitis or hiv or whatever. i mean, maybe it doesnt matter after that point, but i still think it should.

wednesday: i guess i gave a good impression in clinic on tuesday because i was invited to tag along to vieng pa pao where a nurse set up a pap smear/pelvic clinic at the local public health station. we got a little lost on the way there and when we arrived there was already a line of about forty women. lots of them were also already in sarongs and i was impressed at how many people faithfully got pap smears every year to check for cervical cancer. in three hours, we saw about 75 patients. i did sixty breast exams and then did pap smears for the last hour. i also saw some std's, including a woman who likely has hiv - she had the worst case of shingles (zoster) ive ever seen and i talked to her for awhile about it. for non-medical ppl, zoster is basically a reactivation of the virus that causes chicken pox - it causes a really painful skin rash with blisters that erupt in a dermatomal distribution. she was really frustrated because she had been to the local hospital and the doc there told her they didnt have any medicine (?!) for it. afterwards, she visited a Thai traditional medicine doctor who blew some herbs on her skin lesions with a pipe, but it didnt help. she's had the lesions (one covering over a quarter of her back and the other over her breast) for about three weeks now and she's upset because (1) it's painful, (2) it smells terrible and no one wants to be near her, including her kids, and (3) she just wants it to go away. i told her there was medicine available and she should try to go to chiang mai to go to another hospital. i also recommended that she be tested for hiv, but i dont think she's going to. it was nice to be able to sit with her for awhile though - i hope it helps.

thursday (my 26th bday!): i tried to go to hiv clinic but got tired of waiting for the id doc i usually sit with (he came a few minutes after i decided to leave but ended up writing me a note apologizing, which was really nice). instead, i had a relaxing day with chris and got a nice package at the spa and went out for sukiyaki with some thai friends.

friday: copd/asthma clinic day. the doc was late as usual so i got to chat with the respiratory therapist who does pft's for awhile and observe some elderly people do spirometry. i decided that i like elderly patients, especially thai elderly people from the countryside. they all still wear traditional clothes and they're really nice and funny, except when they cant answer questions or are confused about their medication (still nice, but not so funny). i saw an interesting case of a young woman with hiv and an unknown lung disease in her left lower lobe. She was previously hospitalized for 4 weeks because she was coughing so much and couldnt swallow anything - later they found out that she had ulcers in her esophagus and some vocal cord problem as well. despite biopsy and cultures, no bug has been found, so they're presumptively treating for tb. she's gotten a bit better but is still having trouble eating and is losing weight. interesting, but also sad.

that was this week in a nutshell. chris and i have been having good times in thailand, and went bamboo rafting down a local river with a bunch of friends for Father's Day (also the King's 79th birthday) last tuesday. at night, we attended the Royal Flower Show in Chiang Mai and lit candles for the King. it was really patriotic and fun, and made me happy to be a Thai person. The King is a really amazing individual and recently won awards from the UN Food Program and Time Magazine in Asia for his commitment to sustainable agricultural development for the poor in Thailand. :) Yay leaders for social justice!