In the News and Organ Transplant!

We began our morning working throughout many ambulatory care clinics. One of these was the organ transplant clinic. This is run by 5 pharmacists and includes liver, heart, kidney, and lung transplants. We met with two of the pharmacists- Win and Beer.

Siriraj hospital has the largest ambulatory organ transplant clinic in all of Thailand. There is no national organ donation list in this country, so patients requiring a new organ must ask a family member in order to survive. The pharmacists at this clinic focus on providing lifelong immunosuppressive drugs to transplant patients at the lowest necessary doses.

The pharmacists we were working with today also pointed out our picture in the Thai National newspaper, Thairath. This picture was taken by reporters on Tuesday during our group's visit to The Grand Palace, and the article describes us as respectful and happy foreigners supporting their King who recently passed away.

Siriraj Hospital Day 2

Today was our second day at Siriraj hospital. The majority of the day consisted of observing and working with a few of the ambulatory care clinics that the hospital has. Specifically we were able to work with the heart failure, respiratory, warfarin and organ transplant clinics. If someone asked me which one was the most memorable and interesting, I would have to say it was the warfarin clinic. Although the response may be biased by my interest in anticoagulation, it stood out to me because of the techniques that were being used in a country that struggles with health literacy and compliance. The patient we saw at the clinic had low adherence and low knowledge about their disease state. The patient was educated by the pharmacist using a book of pictures as an aid.The education of the patient was comprehensive and included information about the disease state, the drug, side effects, and the importance of a consistent diet. Although I could not understand the conversation between the patient and pharmacist, I sensed through the patient's body language that she was learning. The patient was originally instructed to take a rather complex regimen of warfarin. To address the issue of compliance, we changed the regimen of warfarin to be much more simple. In addition, the pharmacist actually filled up a pill container for a week to reflect her new regimen. To also help the patient to remember the regimen, the patient was given a calendar. This calendar (pictured below) shows the patient what dose to take and when. It uses colored stamps to signify which strength of the warfarin to take and also represents how much of the tablet to take. Both of these techniques to improve adherence are simple and taught in any pharmacy school, but I have never personally seen them implemented to the extent that they were implemented with that one patient today.

King Chulalongkom Memorial Hospital.

Yesterday, we toured a community pharmacy in the Siam district of Bangkok. Thai pharmacy is very similar to American pharmacy, however, for most medications you don't need a prescription (aspirin is one of the medications you do need a prescription for!). We also had a lecture on pharmacy in Thailand and the different paths a student can take within the pharmacy program.

Today, we went to King Chulalongkom Memorial Hospital. We had a general tour of the hospital and then went over infectious disease patient cases and discussed the similarities and differences between Thai and American hospital pharmacists. We then split up to tour different wards in the hospital to review patient cases and medical records. During the medical record review we were confused about the patient's date of admission because it said 2559. Fun fact: in Thailand the year is 2559 because they go by when Buddha died, which was 543 years before the death of Jesus. We met some amazing people over the past two days and are very thankful they took the time to teach all of us!

Siriraj Hospital: Mahidol University

Today was the first day of hospital clinical site visits in Bangkok! Today, Daniel, Christina A., Jennifer, and Devon C had the opportunity to visit the largest hospital (2,200 beds) a teaching hospital, Siriraj Hospital associated with Mahidol University, in Bangkok, which employs over 220 pharmacists! It was a day filled with information on inventory, poison control, adverse drug reactions, and health systems information, but what stood-out was their lecture from their Director of Pharmacy. She spoke about how they were a "Super Tertiary Hospital" where they see patients who have already failed care in Community Hospitals. They are the toughest patients, and she explained that with extensive care comes higher costs of care.

They discussed the concept of a seven-star pharmacist:

1. Caregiver

2. Decision maker

3. Communicator

4. Manager

5. Life-long learner

6. Teacher

7. Leader

This could not be more inclusive as to the role of any pharmacist, whether retail, hospitalist, or a pharmacist in academia. 

Her presentation was truly inspiring, and put into perspective the differences in the health care system  between Thailand the The United States of America. 

Siriraj Hospital: Mahidol University

Today was the first day of hospital clinical site visits in Bangkok! Today, Daniel, Christina A., Jennifer, and Devon C had the opportunity to visit the largest hospital (2,200 beds) a teaching hospital, Siriraj Hospital associated with Mahidol University, in Bangkok, which employs over 220 pharmacists! It was a day filled with information on inventory, poison control, adverse drug reactions, and health systems information, but what stood-out was their lecture from their Director of Pharmacy. She spoke about how they were a "Super Tertiary Hospital" where they see patients who have already failed care in Community Hospitals. They are the toughest patients, and she explained that with extensive care comes higher costs of care.

They discussed the concept of a seven-star pharmacist:

1. Caregiver

2. Decision maker

3. Communicator

4. Manager

5. Life-long learner

6. Teacher

7. Leader

This could not be more inclusive as to the role of any pharmacist, whether retail, hospitalist, or a pharmacist in academia. 

Her presentation was truly inspiring, and put into perspective the differences in the health care system  between Thailand the The United States of America. 

(Pictures to come)