As our Summer Program students prepare to return to Canada and continue their studies we have one last reflective piece to offer from Jocelyn Stairs, a medical student, who spent the last 5 weeks as a member of the GHO Summer Program at Khon Kean University (KKU) in Thailand.

Dalhousie Students at Khon Kean University, Thailand. Summer 2012 (photo courtesy of KKU website)

It’s hard to believe that the third week of my obstetrics and gynecology elective in Khon Kaen Thailand is coming to a close. I spent today in the gynecology outpatients department. It wasn’t my first time there, but I had a really great translator today, so I was able to conduct some history and physical exams with her help. The morning was a little slow which gave me a chance to reflect on some of the differences in the clinic that exist in order to conserve resources.

First, there are no appointment times for a clinic visit. The clinic starts promptly at 9 am following inpatient rounds, but patients start flooding the outpatient departments at 6am to stand in line to be seen (all outpatient departments are located on the first floor so there is an absolute frenzy of patients in the hallways). patients are seen by a medical student or a group of students who take their history, then they must wait for an opening in the physical exam room, then wait again for the pelvic exam table to free up. Most women wait 5-6 hours just to have a well woman or antenatal exam.

As well, to maximize the number of patients that can be seen at one time, patients are seen on bridge chairs in a narrow hallway behind the exam rooms. These chairs sit back to back and the medical students flit between them. To maximize space in the exam room, one patient will be interviewed at the desk while the other patient will receive a physical exam on the other side of a curtain. As a result of this setup, there is really no confidentiality. I asked the medical students about this, and their response was that Thai people are pretty easy going, so they aren’t really concerned. This made me rethink the reasoning behind the emphasis on confidentiality (or concern over lapses in it): it is a problem when it is broken not because it is an inherent requirement of medical practice but rather because our North American society expects it and we in turn promise to provide it. Therefore, any breach in confidentiality can be seen as a breach of contract between the physician and the patients. In the Thai context, confidentiality is not offered, either because it is not an option due to resources or because Thai people do not value it. As a result, the lack of confidentiality is an expected norm and is not regarded as a problem because it is not part of the doctor-patient contract.

While I found these differences to be a bit jarring, I keep trying to remind myself that this is their normal and that it works relatively effectively for them. My experience thus far has provided with a wealth of new experiences and learning about clinical medicine, social determinants of health, and healthcare practice in a low resource setting. Seeing medicine practiced in a manner that is so different from home has afforded me the opportunity to reflect not just on differences in healthcare but on why we practice healthcare the way we do in the West. I can’t wait to see what else the final week will bring.

To learn more about GHO Summer Programs please visit: http://gho.medicine.dal.ca/dalhousie-students/dalhousie-individual-electives.htm

To read a story, published by KKU, about this program. click here