dissuaded from eating raw freshwater fish . Indeed , immigrants to urban areas persist in this practice and contribute to an increased incidence of cholangiocarcinoma in Bangkok and other major cities . Cholangiocarcinoma is associated with heavy liver fluke infestation and has limited treatment options even for aggressively managed disease states . So part of our parasitology training included , what is a common exercise for Thai medical students , but was clumsily-executed by us : preparing and examining infected stool samples to search for various parasites under a microscope and diagnosing malaria-infected blood with rapid-test kits .
The typical Thai medical education has generally the same residency structure as in the United States , but the formal medical education starts directly after high school with a six-year course that heavily emphasizes clinical experience . Thus , we would often see many students in the operating rooms- the younger students with their case-studies observing , and the older students taking a more active role in the surgery . One of the residents confided in us that he had undergone so much personal growth and change since he made the decision to become a physician as a teenager and while still in high school , that he found his taste for the profession waning . Unsurprisingly , this vagary of the medical profession crosses continents and cultures , yet in his case it was a bit more constricting . Although his medical education only cost $ 2,000 / year , he is bound to serve as a physician in the military for 10 years following his graduation . While it ’ s impossible to unravel the web of social and cultural threads that manipulate the decision to become a physician in Thailand , it is worth noting that their profession seemed highly regarded and accepts only the highest scoring students , yet it doesn ’ t offer the same salaries that American physicians enjoy , even by Thai standards .
A main reason for the emphasis on clinical experience in Thai medical education is bound up in the reliance on skills and techniques rather than on the latest technology . My friend shadowed a skilled pediatric trauma surgeon who could not find an IV access point on a severely hypotensive Trisomy 13 newborn . In lieu of an ultrasound , he inserted a needle into the upper thigh and tapped lightly on his syringe plunger to find the area of least resistance that indicated the location of the femoral vein so he could expose it . He no doubt learned this technique the way the use of forceps used to be taught and practiced in the United States : masters pass down years of skill and knowledge to protégés who might practice the art of medicine as one would a violin . regardless of whether I practice in the inner city of Louisville or in the mountain coalfields of Eastern Kentucky . Now that we are back in the United States , our group has a keener eye for discerning our community ’ s needs based on an understanding of their culture , and we can work with our patients to find creative but respectful solutions to their problems .
Thomas Ems is a second year medical student at the University of Louisville School of Medicine .
The artistry of our Thai mentors was an inspiration to our group , reminding us that we can rely on our resourcefulness and the skills of our teachers when technology might not be available . I was left thinking about far Eastern Kentucky and how much it had in common with the forested and underserved regions of rural Thailand . I realized that the goal of my medical education is to develop a flexible response to the health care needs of a unique population ,
JANUARY 2017 15