Mango Nicky Rice

Today I went into the COVID isolation unit with the head medic there. They ain’t playin’ around with PPE, man. It is literally head to toe, including dedicated slip on loafer shoes that get soaked in a sanitizer barrel before being reused, full-body suits a la Squid Game or   Outbreak , shoe covers, spraying every door handle as we go in or out before and after we touch it.  There’s no air conditioning here and it’s about 85-90 degrees minimum all the time during  the day.  Today’s COVID numbers weren’t terrible. 3 COVID patients, one unlucky patient with both COVID and Tuberculosis, and one lady in alcohol withdrawal whose husband is one of the COVID positive patients.  As we approached the building, I could hear a woman’s voice shouting in Burmese with the familiar timbre of alcohol withdrawal fervor.  We entered the unit after donning our COVID sauna suits. The first problem was that the TB guy was lounging in bed next to the alcoholic lady’s bed. No mask on anyone. The medic had a

I\"ve been telling people for a year that I am going to be in Thailand. I\"ve realized lately that geographically, yes, it is still Thailand. But being so close to the Burma border, this fellowship has very little intersection with Thai people, customs or language. Even the food here is heavily influenced by Burmese culture. At our hospital, everyone speaks Burmese or Karen, the staff is almost all Burmese, the patients are strictly Burmese.  Traditional Burmese Karen clothing  I thought I would need to learn Thai. But actually it\"s more helpful to learn Burmese or Karen. I know a tiny bit of Karen language from working with the refugee microenterprise in Houston in the past. I even have Karen clothes handmade by my Houston refugee friends. So I am happy to be among Burmese and Karen people again.  The two biggest adjustments I\"ve been making at work in the clinic/hospital are: 1) Adjusting to the limited resources and the poverty of our patients (which limits the

I learned that there is a Migrant Fund in Thailand to provide low-cost healthcare for the millions of Burmese migrant people on the border.  I\"m still learning about it, but it sounds like either you are a migrant worker and you can have the M-Fund or migrant folks can pay 100 Thai baht per month (Approx 3 USD) and receive care in the Thai medical system. This is a great deal, because it includes outpatient and inpatient care.  I\"m seeing a fair number of patients at our little hospital that would be admitted immediately in America and need frequent monitoring, labwork, imaging and/or consultants: Upper GI bleed, Appendicitis, Alcohol withdrawal (we have 4 EtOH patients at the moment), Lupus flares, severe malnutrition, hypoxia, thalassemia. Here in our little hospital, they are admitted, but we do not have many lab results available, we have no official imaging, no endoscopy, no consultants other than Surgery which only comes on Fridays. We do have most essential medicatio

I glanced into the Diarrhea Treatment Room, which had zero diarrhea patients at the moment, and and we started using it room for normal inpatients. I saw a man who looked about 45 years old. His foot dangled over the side of the bed rail and was ensconced in a translucent plastic bag. I assumed it was a foot wound, maybe a diabetic foot wound, even though I have yet to see one here yet. People do have diabetes but it is less common in the USA. The Burmese tend to have controlled weight, and the main diabetic issues seem to be that they eat a lot of rice and don't have easy access to medication. The medic went into the room with me to help interpet. The medic told me, "He has a cut on his foot from playing football." I went to go investigate the wound, but before I could even see the foot, the medic and patient motioned to the patient's right upper thigh and said he also had something there. That's weird, I thought. Maybe a cut on his foot spread up his leg? Then t

  I had just been wondering if I would lose my critical care skills while I\"m out here without the structure of western medicine, hospitals and resources. As it turns out, patients get hypoxic, hypotensive, and unstable here, too! The difference is, things move much slower here and we don\"t have all the medications, equipment and algorithms for really sick patients. I had started observing the clinic/hospital\"s departments one-by-one and saw the outpatient departments (OPD) last week. Then I figured out that the real emergencies seem to occur once the patients become inpatients. So my goal this week was to spend the days in Inpatient Department (IPD) and the Reproductive Health (RH) with the pre- and post-partum inpatients to learn from the midwives and RH medics about how they handle deliveries and OB complications. I\"m still processing the case of a young adult who passed away last night, combing through it in my mind, wondering how it could have gone differen

The breakneck speed of the American Emergency Department I am used to does not exist here on the border.  For one, the pace of life doesn\"t lend itself to being in a hurry, even though the frenetic weaving through traffic of scores of motorbikes might lead you to believe otherwise. It is not the stressed-out, pissed-off vibe you get in big American cities. People aren\"t cutting you off in traffic because their schedule is more important than yours. They cut you off on the road because that median traffic  stripe is only a suggestion. There are still plenty of people braving the humidity on bicycle (like me), on foot or on electric scooters - which are slower than motorbikes. People are just trying to get to or from work, get their veggies and curry from the market, and hang their laundry so they can sit outside their homes at dusk and enjoy the mild breeze.  I spent the first few weeks feeling useless because I can\"t speak/read Thai (since I\"m in Thailand) or Bu