Coastal Maine Global Health Fellowship

Thailand has the cutest kids. It's a fact. They're cute, even with their snotty noses and coughs that don't need cough medicine. This is one of the many benefits of working in Thailand- the kids are just too darn cute. Most of the girls show up in Disney princess outfits, and the boys show up in superman capes. I can't talk to them all that much, besides making goofy faces at them and trying to make them laugh, but usually that's all they can do anyway, so we get along well.  Most of the pediatric illnesses that I've seen here in Thailand have been viral gastroenteritis and upper respiratory infections, which is not much different than at home. The majority of these cases have been benign illnesss, but I've seen a handful of sick kids. My time here has definitely given me the opportunity to improve my sick vs not sick radar, which is an indespensible skill when it comes to our littlest patients. I am thankful to all the children and their families f

Case: A 23 year old male presented on February 16 with two months of dyspnea. On arrival is oxygen saturation was 77% on room air. Josh and I were called to the bedside for evaluation. On further questioning he admits to two months of this progressively worsening difficulty breathing and also 2-3 loose stools daily. He's had significant weight loss as well, approximately 5kg over the last couple of weeks. He has had a poor appetite. He denies any drug or alcohol use. He is not a smoker. He has no lung problems. On exam the patient is very thin and in obvious respiratory distress with 2-3 word dyspnea. His oxygen saturation improved with oxygen via nasal cannula and he was around 96% on 3 liters via nasal cannula. His lungs were remarkably clear, with slightly decreased lung sounds in the left lower lung. He had no lymphadenopathy, no jaundice, no oral or skin lesions, and no abdominal distension or tenderness. He had no lower extremity swelling. He was febrile to 39 degrees c

Thailand is beautiful. And hot. In the dry season it doesn't rain for 8 months straight and it certainly never snows. So getting around via motorbike is an ideal form of transportation, and as you can imagine, a lot of people do it. A lot of people also do NOT wear helmets, and a lot of people also think it's a good idea to get on their motorcycle unhelmeted after having a few cocktails. Inherently, this leads to a lot of fun for us in the ER here at KRCH. Recently I've taken care of two young men who suffered traumatic brain injuries that probably wish they hadn't had that extra drink, or that at least they were wearing some cranial protection.  The above patient was a 38 year old male who presented after being found down next to his motorcycle. His family brought him in, obviously intoxicated. It is unclear how long he was down, as he could not provide any history. My first impression of him was when he fell off the stretcher in the ER trying to sit up aka he w

Maine Medical Center trained me well for dealing with orthopedic injuries. As residents we were lucky enough to train without orthopedic residents fighting over our broken bones, so I feel quite comfortable managing most acute fractures. But once the patient leaves the ER with their splint made with care and love, I'm not sure what the orthopedist's typically do from there. But here at KRCH I get to function as the ER doctor that treats the fracture acutely, and manages the patient in follow up. It's actually kind of nice, because for the most part, bones heal amazingly well, and it's been satisfying to see the patient in follow up, pain free. The following is just a smattering of some of the fractures I've seen during my time here at KRCH. Distal tibia and fibular fracture in a 24 year old male after falling off a roof. He was roofing and reportedly refused to wear the safety harness. I splinted him and subsequently casted him after attempting closed reductio

Mr. Yagogo returned yesterday, reinforcing why it can be so challenging to work in a rural setting in a developing country. As a reminder, Mr. Yagogo suffered bilateral medial tibial plateau fractures after being involved in a mining accident around December 9. We referred him for orthopedic referral on December 16. Yesterday he returned to KRCH requesting an xray. He was told to follow up with the orthopedists in Kanchanaburi, but because that is 4 hours from his home, he came to KRCH instead. Great, so I have no idea what they did, what they want to do with the fractures (how long should he be casted, how long should he be non weight bearing?), or why they decided not to treat both fractures. After a prolonged conversation through the translator it becomes a little more clear. The patient had been placed in a long leg, straight cast on the left leg, with instructions to weight bear minimally on the right. No surgery was performed. He didn't know when he needed to take the cast

I may have already mentioned that pregnant ladies terrify me. When obstetrical patients come in to the hospital they are hoping to have the best day of their life, but sometimes it could be the absolute worst--things can turn terrible in an instant. In the ER, it's almost always already the worst day of a patient's life, so as an ER doctor my job is to try to make it a little bit better. I prefer this scenario. In emergency medicine we are not frequently exposed to obstetrical patients once they reach about 20 weeks gestation, and the little experience that we do get is in our intern year, assisting with all the uncomplicated deliveries. And what's even scarier than a pregnant woman? The brand new human she brings into the world--the neonate. Unfortunately, they are NOT just tiny adults.  Here at KRCH we currently have a late pre-term infant that we are caring for in the ward with hyperbilirubinemia. The patient was born on 12/30 at 35 weeks 3 days of gestation v