Coastal Maine Global Health Fellowship

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...

Mr. Yagogo had a bad day. Well I guess he probably had a pretty bad week. Mr. Yagogo, a 26 year old otherwise healthy male, presented on December 16th, about 1 week after being involved in a mining accident. He states he was working in the mines when some large boulders fell on top of him, knocking him to the ground. He was primarily hit in the legs with the boulders, but he was hit in the head as well. He did not lose consciousness. Since the injury he has had headaches and has not been able to walk due to knee pain. He initially presented to Chedi Clinic, which is our clinic located on the Thai-Myanmar border, about 45 minutes northwest of KRCH. Border crossing in Chedi or "Three Pagoda Pass" The three pagodas at Three Pagoda Pass Dr. Chang Noi (stands for "little elephant") sent him to KRCH after an initial evaluation for head and neck CT as well as bilateral knee xrays. On arrival, imaging was performed. Head and neck CT were negative, which wa...