Coastal Maine Global Health Fellowship

Green pit viper, commonly found in Thailand.  Interesting case of the day:  A 23 year old male presented at 6:00 this morning after being bit by a snake. He was bit twice just superior to the left medial malleolus. The bites occurred around midnight while he was walking in the woods (a lot of people work the night shift in the rubber plantations. Yes, terrifying). He presented with swelling and pain at the site of the bite, and also spreading proximally up to his left knee. He had no other symptoms. On physical exam, his vitals were normal- no tachycardia, normal blood pressure.  Left leg was markedly tender to palpation from his left calf into his foot. He had obvious swelling to the left foot and calf as well. His pulses and sensation were intact. There were no associated skin changes other than some focal ecchymosis isolated to the site of the bite. There was no blistering or associated erythema. He was able to move his ankle, but his range of motion wa...

Cough medicine has become the bane of my existence since getting to Thailand. Every single patient with a cough, from infant to adult,  wants "cough medicine" (well the infant doesn't ask, but their adult asks for them). I've had it up to here with freaking cough medicine. IT DOESN'T WORK. No studies have found that any "cough medicine" works for cough or the common cold. Studies have compared all the cough medicines out there with placebo and have yet to find that the medicines work better than good 'ol rest and rehydration. I'm doing my best to explain that to my patients here. I think the translator that works with me most frequently is getting sick of hearing me say "No, I don't think you need cough medicine. In fact, cough medicine doesn't work! I usually recommend hot tea with honey." I think I need to make up a pamphlet so I can just hand it to my patients, rather than having to repeat myself like a broken record 1...

It's been a while since I last posted...sorry about that. I have collected a smattering of pictures since the last post, that will serve well as a brief visual update:) Friday November 8: After our morning rounds while preparing all the discharges for the day, this lovely green beetle came for a visit  Pharmacist Touch (left) and Dr. Chang Noi enjoying another delicious lunch prepared by Phi Pon. Saturday November 9: Jen evaluating little Jack, a little boy who just underwent multiple urologic procedures with the urology team from Singapore to repair hypospadias amongst other urethral anomalies that he has been struggling with since birth. He had a suprapubic catheter placed after the procedure to allow his urethra to heal. Here Jen is trying to figure out how to effectively secure the foley bag to this active little boy so that he can go home and it doesn't fall out--for me to deal with his acute urinary retention on his emergent return. I think we can came up wi...

Nothing remarkable happened today, I just took a handful of pictures and thought it was worth sharing with you all!  Jen sharing his butterfly ultrasound probe with all of this morning during rounds. Truly an amazing tool to have in any setting, especially when resources are limited. I have found myself using the portable ultrasound machine (sonosite) that we have available to us far more than I did at home just because CT is so expensive (although we do have one here!). The visiting surgical team from Singapore rounding on one of their post-op patients this morning in one of our private rooms. This patient had an open cholecystectomy and was doing well this morning. (That's Badura on the far right, our trusty and amazingly brilliant translator!)  This was one of our ICU level patients this morning. I initially admitted her a few days ago when she presented with profuse diarrhea for several days. She was hypokalemic to <2.0 and hypotensive. That improved somewha...

Dr. Chang Noi facing the nursing station. Behind him is the "ICU" where our sickest patients are placed. We currently have two patients being monitored there.  This week has already been entirely different than last. For some reason I think the world decided it wanted to test me when Jen was gone and Mew and Yot decided to leave, and now things have calmed down a bit again. Not to say that this week has been entirely uneventful. We have had some very sick patients this week, which has kept us on our toes. First thing Monday morning during rounds I was told there was a patient in the ER "vomited blood". Now we all know that can mean literally anything--from some blood streaks in the sputum to frank massive hemoptysis. Well, in this case it was the latter, and I knew it pretty quickly when I saw a puddle of blood in the ER doorway entrance. There was blood everywhere. Fortunately, the patient was stabilized with IVF and TXA, only had one additional episode o...