From Thighland to Thailand

February 25, 2010

Thailand 3.4 4th day

Filed under: Uncategorized — markchinmd @ 4:13 pm

Thailand 3.4

February 22, 2010-Monday- 4th day

Most of us were early risers today, REALLY early due to the lack of acclimation to the new time zone.  We were in the zone but in the wrong one.  Even the rooster hadn’t crowed.  Lester and Larry went to he market, some of us blogged, and others repacked for a day trip to the Sahasartsuksa School (I got the spelling right this time).  After a pleasant meal topped with a mango/sweet rice combination we gathered in the lobby to sign documents and more documents for our visas into Myanmar.  It would have been a heck of a lot easier to stay in on place but it’s hard for Bill to sit still in one place so the team is on the move.

We looked so cute with our matching blue scrub uniforms and laminated photo ID badges with MTI and FCBC logos furnished and professionally hand crafted by Gail and Bill.  They’re so talented.  A few dedicated and proud individuals (“good listeners”) liked the badges so much that they wore them all the way from Fresno to Bakersfield to LAX to Bangkok to Chiang Rai on the bus and on the plane in their sleep and while awake; they wore them like jewelry for 36 hours!  I found out later they just didn’t want to get lost from the group.  We either look like a large tour group or a special needs group lined up with our respective photos so that we all know what we look like and say “nice picture”.  Some photos look like mug shots and others looked like models especially the one that looks identical to the one on the cover of SALT Fresno magazine. But the idea was to look professional.  I think that the badges and the lanyards are really our leashes because it’s been pretty ruff so far.  Our transportation arrived with Luka’s team that included some interpreters and church members.  It was a pleasure to see Ghan, Luka’s wife again.  She has such a pretty smile and remembered us all.  I tried introducing Jennifer as my wife but no use tricking her.  Jennifer got grossed out.  She’s pretty sharp and I couldn’t fool her.

And then I saw Auntika, or “A” as we call her.   You might recall her from the pictures we took of her condition vitiligo.  Her face had looked like a sad clown’s face with dripping tears of normal naturally normal dark skin on a pale white face and spotty hands and arms with splotchy brown and white pigment.   Her unnatural light skin always made her stand out in a people-of-color crowd and the vitiligo (MJ’s disease) patches made it more so.  The last trip I had brought her some cover makeup to blend the darker skin to lighter so that it was more uniform and   was less of an attention getter.  When I saw her from a distance I noticed that she had an EVEN skin tone.  It was either a great makeup job or maybe she had some special treatment that American medicine couldn’t treat and that I had no knowledge in treatment.  I felt humbled at first until she said that the dark spots just went away after getting married about a year ago.  We were happy that she appeared “cured” in that her skin complexion was even and looked relatively normal, to us.  Before her unevenness brought her attention but now it was just her beauty.  Aesthetically it looked a lot better.  I couldn’t believe my eyes.  I was truly happy for her.

Vitiligo rarely goes into remission and is very hard to treat; really it’s rarely cured.  So I jumped on the chance to brag how my magic application of the makeup cascaded into a cure.  Lester coughed and I heard muffled “God-complex”; yes I felt empowered.  A few moments it hit me and I was again humbled to my knees.  Thank you Lester for bringing me down to earth.  It dawned on me that the vitiligo was actually worse and now has spread to the other pigmented areas wiping those remaining melanocytes out.  Now she was pale white.  She is supposed to be DARK!  THAT is her natural color, not white.  Further discussion with her revealed that the condition developed in childhood it didn’t really bother her; she just lived with it.  Now she feels that she is too white like an albino and is more self-conscious about her skin because her ghostly complexion stands out amongst her native villagers.  Some in her culture believe that when you loose your color that you will die soon and she is scared.

She lacks the protective mechanism of the melanocytes and needs to protect her skin from the sun and the UV radiation that makes her susceptible to skin diseases.  Her arm pigment is fading and she doesn’t wear shorts due to remaining vitiligo patches.  I brought her more blending and cover up makeup if she wanted to blend the remaining areas.  But sadly, she isn’t cured, rather worse.  My professional business is beauty but my interpretation of beauty including even skin tone needs to be reevaluated.  Someone asked her, ”So you’re married now, is your husband cute?”  She just responded by holding her hand against her chest and said, “He has a good heart.”  Now THAT’S beautiful.

We loaded up the trucks and bus headed out to the school.  Richard yelled out “same spot” and jumps on the back of the bus clutching the bars spread eagle.  I think he was in the marine airborne division.  Go ahead, be my guest.  Richard looks death in the face and just laughs.  I think he has a death wish but he is as giddy as a school boy having a great time.  The school’s just minutes away as we passed the golf course the Lowe’s yelled “detour!” Bill had his own detour to the bank with Luka to change currency so that he could cover our expenses on this trip but I wondered as you could hear that all familiar laugh all the way to the bank!

We set up in our usual spot with Bob and Cindy manning the triage area guarding the gates so to speak.  Crowd control.   People line up crowding the entrance screaming and raising their hands waving like a Hanna Montana concert.  Remember they’re kids.  Oh, adults are doing that too!  Andy and Cindy assure them that they will be seen. Next!

We anticipate that today’ scenario is an example of what each clinical day will be like.  The first hour is to unload set up all the equipment and stations (remember the bins?): eye charts, eye examination, optical bench to grind lenses and install into frames, medical, dental, and pharmacy stations.  Today we have the luxury of a large room; at some clinics we are bumping elbows.  The triage area check-in the patients get vital signs and determine their concerns or ailments.  Do they want an eye exam and need glasses or do the teeth need cleaning or do they have a toothache?  What medical complaint do they have? Luka’s team provide the much needed and appreciated interpreters.  Pastor Jack escorts the patients to their respective waiting areas and tries to get them to accept Christ.  He only gets about fifteen seconds to do that so it’s pretty hard.

Irma and Gail do the eye chart examinations.  When the patient says, “What chart?” they know they have a problem.  Irma gets a lot of stares because she’s so hot looking.  But they are also trying to figure out what she is.  I mean ethnically.  She doesn’t think that they have seen a Mexican before.   Arlean helps Dr. Chinn with the actual eye examination determining the prescriptions.  The Rx is taken to Dr. Tajiri who then selects the lenses and guides Leroy and Jennifer into making the glasses who grind the lenses smooth to fit and pop into the frame.   They sit at a bench with this tremendous ear-piercing hum from the vacuum whining to remove the fine mist of particles from the grinding glass.  That vacuum sucks. They wear masks and eye protection.  They need earplugs but after the trip they won’t need them since they’ll probably be deaf (workers comp!) and they are at risk for developing pneumonoultramicroscopicsilicovocanoconiosis (go look that up in Webster’s) from the inhaled silicon dust.  They deserve hazard pay.  Maybe it’s a bad idea to have the attorney working in that particular position.  The patients all smile as they walk away with custom made Tajiri designer glasses.  Some with 20/20 vision don’t need glasses but want to buy the frames just for their looks. Incidentally, if I didn’t mention it or if I did it deserves mentioning again, Dr. Tajiri has donated about $10,000 worth of optical supplies.  Kudos to Dr. Tajiri.

The optometric dept. works like mad cranking out lenses after lenses making dozens of glasses.  You can see the cloud of dust hovering around Leroy and Jen. They are  working like mad and the team delegate at least six team members to function with efficiency. They were almost done when one patient tried to sneak in and was almost turned away but the team felt sorry so they fitted him for glasses.  When he put them on he cried, “I can see!”  They were so glad  that they let him through. The optical crew was the last to pack  up and look exhausted.

I know that they cannot see into the future but it is my opinion that this backlog could have been avoided by the Eye team. They could have been more visionary and better prepared for the onslaught of patients.  They were blinded by the fact that there was way too many patients to see in so little time.  However, their reputation proceeded them.  If they had foresight they would have eyeballed the situation and after careful examination they could have seen what was developing.   Instead they had tunnel vision that clouded their judgment.  Of course, hindsight is always 20/20 and they all wouldn’t have left red-eyed.  See what I mean?  Hopefully, they will see it coming next time.  Is that clear?

The pharmacy dept. sets out and displays their drugs organized from Amoxicillin to Zithromax.  You can identify the pharmacy with the sign DrugsRUs hanging over Dave’s head.  David is the lone pharmacist this trip and already we miss Ben and Gerry.  He’s trying to drum up business and asks, “Drugs anyone?”  After counting thousands of those pills one-by-one

The medical docs set up stations for physical examinations and are ready for poking and probing and injections of medications.  A student desk becomes a makeshift OR table and examination bed.   I requested my own boutique section for BOTOX injections but was denied. I’m a moron having not brought my stethoscope.  What was I thinking! It’s like wearing a holster without a gun. Got my scalpel though.  I sheepishly ask Cindy if I can borrow one of hers and she says, “Baaaad doc!”

Kane looked around and in a confused and surprised look asks, “Where is the CT scan?  What?  No X-rays, no labs?”  Sorry Kane but finding out if someone’s diabetic you have to use the “taste test” on the urine. Or if you’re too squeamish see if the ants are attracted to the urine.  Do you want to know how we obtain a stool specimen to check for worms?  You will pray that you get a glove 50% of the time.  In the US we’re so high tech that 80% of the diagnoses is based on tests and not by touching the patient. He’s looking for gloves that are in limited supply.  We actually have to touch the patients and risk catching what they have and our aseptic technique is far from ideal.  Jennifer knew that so that’s why she got nine vaccinations.  Masks are one barrier.  Our own skin is the other one.  But we like to be hands on.  We see headaches, dermatologic disorders, orthopedic injuries, repetitive stress injuries, tendinitis, aches and pains, GI disorders, ear infections, and respiratory conditions.  Okay, that was one patient and then we move on to the next.

We get a steady stream of patients but fortunately when it gets slow the docs get a chance to work on their golf swings. Being a surgeon I can’t help my thirst for blood and the triage nurses send me a bone now and then.  Most surgical problems can’t be dealt with here.  But this hanging, protruding eyelid lesion bothers this one patient so I quickly prepare my Ginzu knife to lop it off.   Kane is concerned with my eyesight since I have to wear these telescopic loopes that he helps me see better with his flashlight. Swish! Swoosh! Gone in 60 seconds.  Okay, I’m not that good but seven stitches later she’s cured.  Leroy is fascinated and gets in on tape.  Jack’s experience really helps out and we often bounce cases off of him for advice.  His soft and soothing voice not only calms the patient but calms me down too!  Bob is in his element and enjoys talking to the patients.  He’s done this a lot working in Myanmar helping out with the medical clinics near Mae Sot.    I’m reminded to stop telling the patients that we accept cash check or credit card with an id.  I forget I’m not at home.

The dentists always seem to be organized.  They are up and running in a flash with four treatment substations, one for cleaning and one for extractions and two with capabilities of restoration.  Lynelle gets her feet wet right away and starts going to the patients and says, “Ahhh.”  She gets a clue why their here and either cleans their teeth or send them over to the dentists.  Larry is the extraction maniac flinging teeth over his shoulder one by one.  Lester and Bill are on a seek and destroy mission for cavities, drill out a hole, patch it up with tooth bondo then delicately craft the new architecture.  Richard is at the center of attraction and has his central supply unit for instruments and cleaning.  Fortunately the loud high-pitched humming from the optical vacuum cleaner drowns out some cries and protest from the children dental patients.  Curiously a few students changed their minds and “Uh, no thanks” and bolted.  Those dentists need sensitivity training or at least turn up the music to drown out excess noise so that the kids won’t be scared away.

This was a nice day as a dry run in a controlled setting.  It’s not going to be nicer than this.  We got spoiled today with the facilities and space.  How did we do? In about seven hours we saw 52 eye patients, 57 medical patients, and 61 dental patients.  Pretty fair distribution.  We felt pretty good and we are ready for the tougher challenges and conditions and longer day.  The newbie’s jumped right in and I am amazed at how smooth the day actually went.

Of note is that a few American Baptist missionaries started this Sahasartsuksa School in 1957 in a shack with 57 students.  Now it serves 3200.   The school administrator knows the history and was appreciative to Pastor Jack for the Baptists coming back once again.

There was this 17 year-old girl, the last one of the day who was upset.  Pastor Phonekeo helped calm her down and then began to talk about Christ and her beliefs.  He shared his personal story with her and at the end, prayed with pastor and accepted Christ into her life.  One conversion; one at a time.  Yes it was a good day.

MTI, Fresno…signing off

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