The Tortoise Beats Hare

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 Burmese (language of most of the patients here on the border) or their tribal languages of Karen, Karenni, Shan, Chin, or the others. I did joke with them that I can actually speak more Karen language than Thai due to working with Karen refugees in Houston for several years. Most of the migrant folks around this part of the border are Karen people, and they love it when I say Da Bluuu ("Thank you").

Trying to learn a little Burmese at home!

Fortunately, living overseas in Asia for 2 consecutive years in the past does help with the transition. Also, I was asked to spend the first month or so observing each department in the hospital in order to get a sense of how things work, who is in charge, what could use some fine-tuning. And, of course, my emergency medicine mind is always thinking of what crisis we could be missing. 

 This "clinic" is really a hospital. It started over 30 years ago as a small clinic and has blossomed into a very impressive system of healthcare given limited resources. In addition to the expected outpatient medical clinic, there is a robust women & reproductive health department; Eye Clinic; Dental Clinic; Blood bank; Pharmacy; Vaccination Unit. There is also a separate COVID unit; 24-hour Labor & Delivery pre- and post-natal department as well as basic neonatal ICU and also a combined adult/pediatric inpatient department. One of my staff friends heads the Domestic and Child Protective Services Department. To boot, the hospital also has their own sewing department to hand sew scrubs.
They have conference and meeting rooms on campus as well as a row of independent buildings rented out to partner organizations. 

Post-Natal Ward

Partner organizations’ buildings on site

Medic with a patient in an exam room 

Medics here run the clinic units. They are trained by an apprenticeship-type model. All the charting is hand-written in English (Good for me!)
The pharmacy has an impressive inventory. I asked the lovely pharmacy tech printed out the whole list for me. The most costly items are Bag-Valve-Mask.
They have HIV HAART drugs, a pretty hearty stock of antibiotics, and most of the common drugs you\"d want for primary care and for basic inpatient. 

I vacillate between stressing out that I don\"t exactly know my role here yet and enjoying this respite from the craziness of the American ER. Everything feels so slow right now. I feel guilty when things aren\"t going fast at work. But I also know that the way to do it right here is to go slow and earn their trust, integrate into their system, and help in the ways that I can. 

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