EXPANDING CULTURAL UNDERSTANDING IN A THAI MEDICAL ACADEMY
Thomas Ems
By the time we reached the Phramongkutklao College of Medicine dormitories in Bangkok , the eight University of Louisville Medical School students comprising our group had already been travelling around the region for a few weeks . We had abandoned the comforts of home : cold glasses of milk , Mexican food , and toilet paper , along with our pretense of composure and fashion . Our strategy of coping with the heat by wearing the tiniest amount of clothing allowable gave us the appearance of having arrived in Thailand in order to mow the country ’ s lawns . We had also each made our own contribution to the milieu of exotoxin and American gut flora in the sewers of the region . With the exception of myself ( due to having been to the region before ) and another inexplicably hardy colleague , all of us had suffered bouts of explosive diarrhea which struck one on a days-long ferry trip and ruined another ’ s weekend in Bali . Nevertheless , it gave our group an unflinching resolve to eat safely in a country that seemed to laugh at our ambition .
So it was a tired , yet excited , group that began a two-week long course at the only military medical cadet school in Thailand . The second week involved shadowing specialists in the fields of Pediatric Emergency Medicine , Plastic Surgery , Orthopedic Surgery and Anesthesiology ; however , the purpose of our trip was not so much to learn medicine , but to experience the differences in medical practice in a foreign system . Our lecturer-hosts were more often than not , educated in the United States and although they sometimes lectured in Thai to their students ( our lectures were in English ), all of their handouts and texts were in English . We even saw a few English-language First Aid for the USMLE Step 1 books being used by the students . The first week of our visit was a series of parasitology lectures which might have easily been titled , “ Parasitology in Bangkok : How to Maximize Suspicion of Street Food in the American Medical Student .”
Our lectures highlighted one of the largest differences between medical practice in the US and Thailand : the types of diseases encountered . The endemic level of parasitic infection in Thailand is
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such that each medical student from our host academy participates in the collection and testing of around 300 stool samples during annual rural-population screenings . Parasite-borne illness is more prevalent in Thailand than in the US for many reasons , we learned : mainly due to a lack of access to health services and education in the forested and uninhabited border regions shared with its neighbors Cambodia and Myanmar , the immigration of foreign workers that goes largely unchecked in these regions , and the cultural practices of the farmers in the rural areas of Thailand . One tradition in particular was underscored by every lecturer as having an enormous health impact and provided insight into the differences between Thai and American rural culture .
Thai rubber farmers and shepherds will often leave their homes at 4 a . m . with a woven-reed container of sticky rice , citrus fruits and spicy peppers . For lunch the farmers catch fish from the freshwater streams or rice paddies and “ cook ” the fish by squeezing citrus juices over it . Upon seeing the color of flesh turn white , they eat it with the sticky rice and peppers . The practice is so ingrained in Thai culture that even after being informed that the color change induced by marinating the fish in citric acid does nothing to protect them from microorganisms therein ( particularly the liver flukes Clonorchis sinensis and Opisthorchis viverrini ), the local populations cannot be