Reflections on Contrasts and Similarities in Laos from Sansanee Craig (PL3)

Posted on behalf of Sansanee Craig (PL3)

Sabaidee from Laos!

I can't believe it's already been three weeks since we arrived! In retrospect, time seems to have gone by so quickly despite the slow-paced day to day living. Contrast seems to be the theme of this month. Contrast between the hotel we are staying in and the hospital wards. Contrast between the fully functioning drager ventilator in the PICU and the lab's inability to check blood gases. Medications are cheap and supplies are plentiful, but patients have to pay out of pocket for everything. The residents fill out prescriptions on rounds for syringes, flushes, medications, which the parents take to the hospital cashier and pharmacy, bringing back plastic bags of supplies. One Laotian mother said to me "We have everything in Laos, just not enough money". No portable cxr, defibrillator, or cardiac monitor in the PICU, but you can easily buy oral cefixime and IV tylenol. 

A typical day consists of seeing patients with residents from 9 - 12, lecture from 2-3, then studying/ reading in the afternoon. I'm spending this week at Mahosot, one of the three pediatric hospitals in the capitol. There are two others, Settathirat and National Children's Hospital, on the outskirts of the city. They tend to have more limited diagnostic capabilities, so more severe cases will be transferred to Mahosot. Right now, the general wards are full of acute diarrhea cases, likely Rotavirus. Most stay 2-3 days, then leave without issue. PICU has 3 patients: H. Influenza meningitis in a 9 month old boy, severe pneumonia in an intubated 2 month old female with Downs syndrome, and gross hematuria in an 8 year old (G6PD?). 

In the afternoon, I sit in on allergy clinic and am happy to see that eczema is eczema the world over and treatment is the same. Back on the wards, the residents ask me about the sensitivity of bedside cold agglutination testing for mycoplasma pneumoniae. Hm... I remember something about that in med school, but can't we just send PCR or serology? No? Let me go look that up in Pubmed and get back to you .... 

Not only is my lab technique knowledge being challenged, so are many presumptions on "western medicine": Silverman scores, not APGARs, in the NICU (French) and the Australians examine abdomens with the legs flat on the bed, not bent at the knee. The residents have to know so many languages! The Korean-donated library is full of Korean medical journals, radiology reports come back in French, Australian and US attendings round with the residents, and a Thai attending holds Grand Rounds once a month.

And yet despite the contrast in our training, it's fun to see the similarities: residents going out for dinner after work, complaints that evaluations aren't done in a timely manner, the chiefs agree making resident schedules is a headache, and the med students still get pimped on rounds. 

So long for now!

Sansanee