I guess Thailand was a natural choice for me to undertake my elective. Earlier, I was thinking of going further to the UK or US but my close involvement with the Thai-Australian community as event MC and performer for the last decade has allowed me to interact with many Thai people who do not understand the Australian healthcare system (having presumptions based on the Thai system) or having certain negative perspectives on the doctor-patient relationship. Thus, I felt the need to learn more so that I can come back, contribute and help my community here in Australia.
There were three aims which I devised for my elective:
- To learn and experience the Thai Healthcare System
- To observe the Thai medical culture (doctor-patient relationship)
- To learn and practice Thai medical language
I spent 2 weeks in Obstetrics and Gynaecology and 4 weeks in General Surgery.
There I was able to observe a number of things.
Firstly, the large population meant that waiting rooms would be inundated with patients an obvious pressure on both junior doctors, consultants and the healthcare system.
This is coupled by the large number of medical students in the rooms and theatres, a stark contrast to the almost one on one supervision enjoyed in Canberra (There was hardly any space theatre to see what was going on, but luckily they viewed me as a final year medical student and allowed me to scrub in to a number of cases).
The clinics, rounds, surgeries and team meetings were superb opportunities to learn new things, revise what was already known and practice my clinical and surgical skills.
Apart from that I gained insights that helped achieve my elective aims.
The Thai healthcare system is an interesting one in which there are three types of health insurance; civil servant insurance, company/private health insurance and the ‘Gold Card’ or ’30 Baht to treat all ailments scheme’ – where patients only pay 30 THB (~1.50 AUD) to access limited benefits paid by the government.
There was a case of an elderly woman who was diagnosed with breast cancer. Her health literacy seemed poor so her daughter was there to discuss treatment options. The consultant asked her daughter what insurance her mother had – the ‘Gold Card’. He said that there is a drug, Trastuzumab, that would be highly suitable for her. Unfortunately it is not covered by the Gold Card, they would have to pay millions of Baht for a course of Trastuzumab. The daughter was in tears while her mother looked at us blankly. I was very emotional in that consultation, feeling sorry and hopeless for the family but also grateful for the Australian Healthcare system for securing a breakthrough deal with the pharmaceutical company.
I experienced extreme hierarchy within the hospital environment. However, it was nice and refreshing to see women running an entire surgical team.
I was able to practice my Thai medical language skills which was daunting but also extremely beneficial.
I believe that the experiences gained and observations seen will help me communicate more effectively with the Thai-Australian community – understanding their perspectives of healthcare and using accurate language will definitely allow me to educate, encourage and give them a sense of hope for their own health and wellbeing here in Australia.
Overall Thailand was a great elective for me, although the doctors and medical students speak Thai, it would be difficult for non Thai-speaking students to have close interactions with patients without disrupting the busy workflow of the day with interpreters.