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Clinical Immersion in Thailand

Global clinical experience provides valuable insight to nursing students and faculty.

Set in Southeast Asia, Thailand is a beautiful country with mountains in the north and breathtaking beaches in the south.

The opportunity to participate in a clinical immersion in Thailand provided first-hand experience in global healthcare.

For two weeks, students from the University of Michigan School of Nursing, Ann Arbor, Mich., traveled nearly one hour by van to the small village of Khe-tun, in the district of Tajaloong.

The morning commute to the village was an adventure in itself as floodwaters had washed away rice fields, houses and roads, allowing a brief glimpse into the daily life of those living in the remote northeast portion of Thailand.

At the clinic, many patients were assessed for an acute chief complaint, provided intervention and sent home; not many were counseled in depth about behavioral changes or further counseling on how to live a healthier lifestyle.

Deciphering the Demographics

The village of Khe-tun is primarily an agricultural community. The main health problems and concerns identified by the community during an open forum were hypertension, diabetes mellitus, obesity, pain in knees, legs and back, alcohol use, and accidents.

The majority of patients seen at the local clinic were youth for acute chief complaints, often due to swimming in nearby floodwaters, young adults for complaints due to motorcycle accidents, and elderly for chronic conditions such as hypertension and diabetes mellitus.

Psychosocial health was also addressed by frequent home visits; evaluation of diet, health hazards in the home and the vegetation growing near the home was performed.

Education was provided at each home visit about importance of receiving healthcare, small behavioral interventions that may be done to promote healthier living and the importance of following up with the clinic for chronic disease management.

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Reflecting on Health Literacy

While language was a major barrier to providing health counseling in Thailand, health literacy was another major challenge. Thai language is very different from English.

Reflecting on difficulty communicating with many of the patients provided insight into how patients may feel when one does not understand their disease process, medical jargon, or medication instructions. These feelings of isolation from the lack of Thai language skills prompted students to feel compassion for those who have poor health literacy.

Just as Mayer & Villaire (2007) explain, "Those with low health literacy skills feel similarly isolated and alone when they encounter health-related information phrased in language they cannot effectively 'translate.'"

Mayer & Villaire (2007) further explain, "Research suggests that those with limited literacy skills report poorer overall health, are less likely to make use of medical screenings, seek medical care after they have reached later stages of disease, are more likely to be hospitalized, have poorer understanding of their treatments, and have lower adherence to medical regimens" (pg. 8).

Furthermore, routine chronic care follow up was not witnessed as routine, rather, only when an issue arose did the patient come to the clinic seeking healthcare.

Case Study

One day, a 55-year-old female presented with a chief complaint of headache and sore throat for one week. No medications had been taken for pain relief.

While her vital signs were within normal limits, a fasting blood sugar was elevated. Her history was positive for diabetes and hypertension. She had blurred vision, urinated two times in the night and was expressing excessive thirst.

She took no diabetes medications. Her diet consisted of fish, vegetables, fruits and banana and pumpkin in coconut cream for dessert multiple times throughout the week. Her only exercise was from daily activities.

Her physical exam was unremarkable and the plan specified Phatalijone (an herb given before antibiotics), Mowang and Paracetamol for pain.

When she returned for follow up, her fasting blood sugar was normal. Although her blood sugar had returned to normal, and the high value the previous visit may be related to her acute illness at the time, education and counseling at that visit could have been beneficial. However, she was sent home, with minimal education and no additional behavior counseling other than avoiding sweets in her diet.

This case not only allowed for a greater understanding in the frustration and lack of understanding that may occur when communicating with those of a different culture and language, but also exemplified what might occur when speaking with a patient whose first language is not English in primary care in the U.S..

As Misra-Herbert & Isaacson (2012) explain, a non-family member translator should be utilized, speaking directly to the patient in a normal tone voice, being aware of personal space and avoiding gestures are all techniques that should be utilized. Slowing down, using plain language that is non-medical, drawing pictures, and focusing on a small amount of information will help understanding, they say.

Overall, the case allowed for reflection on cultural barriers and considerations to remember when encountering a patient in the office who may not be from the United States.

Community Health in Common

In conclusion, traveling to Thailand and working in the small village of Khe-tun highlighted the importance of community health and understanding the culture in which one is practicing medicine.

The experience of clinical immersion in another culture allowed this provider to gain a glimpse into the experience of non-native patients in the U.S. A greater understanding of health literacy was gained and the experience underscores that patience, creation of a safe environment and cultural understanding may lead to better healthcare for patients.

References for this article can be accessed here.

Jessica Roossien is a family nurse practitioner in Grand Haven, Mich. April Bigelow is a clinical assistant professor at the University of Michigan School of Nursing in Ann Arbor.

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