Progress notes

I cannot believe that tomorrow marks week 4 of semester already! Time has been flying, yet passing so slowly at the same time :\ I haven't got much time to spend blogging but here is what has been happening...

I had my New Grad interview on Monday (12th Aug)! I'm not feeling 100% confident but it's over! My questions weren't too hard; I just found that I had a complete thought block and I put that down to how nervous I was :( Hopefully the panel take nerves into consideration! My questions were about: skills and role of an RN; a scenario; the multidisciplinary team; social media; CORE values; and infection control. Unfortunately now the long wait continues until early October when we get the result - offer, or no offer. I have also applied for a New Graduate Program within the private sector to increase my chances of getting something.

I'm yet to really get on top of any of my assessments - yes, partially my fault, but many thanks to factors out of my control. Last week a burst water main affected a few of the university buildings, and a result our online library was offline. That meant no access to databases, journal articles, etc. This proved frustrating on one hand because I was unable to access academic sources of information. However, on the other hand, I didn't feel guilty continuing my procrastination and even allowed myself a few sneaky wines! As of this afternoon, all systems are back in action; eeeeek, deadlines are looming! I am a little worried about having all the work done in time, especially because placement begins soon (read on!).

Lastly, placement begins soon! My four-week placement starts on August 26 and for that time I have AM shift. I'm surprisingly feeling good about placement (which is rare - I only ever associate really negative words with placements!) and am not only looking forward to consolidating my clinical skills, but also getting my head around AM shift and giving everything a good go. Up until last semester I'd never had an AM shift before. EVER! And it sucked, but that's another story. There are four of us that are renting a house in Orange and I am able to take my gym membership with me which is fantastic! My man plans on driving out to visit on the weekend too!

Besides university and work, I've been trying to keep myself sane and get back into some kind of routine! Before uni went back, I went camping for a weekend in Karuah National Park. Absolutely beautiful there and our campsite had a great view of the river. The following weekend, made it to Awaba State Forest for a 4WD which was good fun and resulted in another part of the 4WD giving in. Yay for repairs...

And last Friday, most of the Wolfpack reunited for a Thai dinner in the city! It was amazing to catch up with everyone and see what people have been up to since Thailand.

Aaaaanyway, I best be off to prepare for class tomorrow and get my bag packed. I hope to post more regularly but I'm sure you understand how hard it is. I just keep reminding myself that there is finally light at the end of the tunnel!

Cheers to a productive day today!

Elephants bring good luck, especially when the trunks are up

I'm sitting in my home in Sydney, where the weather is 16.9 degrees, a drop of 15 degrees from what it is currently in Bangkok. It's been almost 2 weeks since I arrived home, and the trip now feels like a dream. I flick through my photos and think about what I experienced... and it all seems like a million worlds away. The most trippy part for me is wrapping my head around the fact that I finally made it overseas for the first time!

When I think back to arriving in Bangkok and venturing out for the first time I can't help but laugh. I had these horrible ideas in my head of being followed or pick-pocketed, yet I felt so safe and accepted. I remember worrying about what I'd be eating and feared getting sick, yet I ate fresh fruit, drank iced drinks and brushed my teeth with tap water! But most importantly, I kept my mind open to what lay ahead of me and what I would be experiencing as part of the Experiential Nursing Program. I knew before the trip that barriers in verbal and non-verbal communication would exist, and these barriers required me to be flexible and adaptable when interacting with people. Learning a few words in Thai definitely helped and it is evident that a smile can mean a lot. Also, being immersed in an unfamiliar culture compelled me to be aware of my own beliefs and customs and I remained open-minded to new and differing scenarios, always conducting myself in a culturally safe and appropriate manner.

I struggle to think of anything that would have enriched my life or influenced my personal or professional development to the extent that this trip has. I can say that without a doubt, I returned home with a greater appreciation of the health care available in Australia and a greater understanding of socioeconomic issues and their impact on health in developing countries. Where do I begin describing what I witnessed? Diseased and injured organs and limbs. Forensic photographs of horrific accidents. Babies born with lethal abnormalities. Women swaying around poles atop bars, expressionless. The sad result of sex tourism and children left in orphanages. Rubbish dumped in streets. A homeless man and his dog sleeping underneath the train station. Unprotected motorcycle and scooter riders transported 2, 3 or 4 passengers. Polluted waterways filled with rubbish and dead fish. Exquisite temples standing between rundown apartments and tall commercial towers. Markets selling medications that would require a prescription if sold in Australia. Women begging for money with children asleep in their laps. Private hospitals filled with international clients. People living with HIV socially isolated and forgotten about.

All of this just emphasises the fact that health care should be a right, not just something that exists to those who can afford it. The focus of health in Thailand needs to change from elective and cosmetic, to prevention of illness and promotion of health; through increasing education, eliminating stigma, and reducing social inequalities. Our visits during the program also highlighted the need for better equipped rural and remote facilities and recognition of their importance in the health care system for reaching disadvantaged populations.

Overall, this experience confirms my choice of career: Nursing, the art of care and healing that translates universally regardless of language, country, and culture. I know that I am destined to do more than work on a general ward; I want to be working to help the disadvantaged, I want to work in rural Australia, I want to travel overseas and see where nursing can take me, and I want to contribute to changing the culture of nursing in Australia.


Things I'll miss about Thailand:

• Living in a completely unfamiliar environment and culture
• Walking through the city and exchanging smiles with strangers
• Meaningfully relating to people non-verbally
• Venturing out in to the city not knowing what to expect
• Seeing squirrels scurry along power lines
• Playing with gorgeous and happy children
• Sleeping less than 6 hours a night and dreaming about the buffet breakfast I'll wake up to
• The buffet breakfast
• The street vendors and fresh produce
• Being able to afford to eat prawns in every meal
• Conversing in a new language (Sawaadee-ka!)

I will even miss:

• Waking up so early to allow copious amounts of time for traffic
• Eating too much food because it is too delicious not to consume
• The heat and the interesting smells
• Sitting on a bus for hours being able to absorb the views of changing landscapes
• Blowing my nose every 30 seconds while eating the spiciest meals

What I'll remember for the rest of my life:

• Being so welcomed into an entirely different environment and culture
• Discovering an absolute love and passion for travel
• Participating in a rich learning experience and further discovering my interest in health care
• Pushing myself beyond my comfort zone and surviving
• Immersing myself in the experience and making the most of every moment!

But for now, reality beckons. A few days ago I received my subject results for last semester; 3 Distinctions and a High Distinction - absolutely stoked! On Monday, I'm back at university for the last 6 months of my degree! It's all starting to feel a little more real, especially with my New Graduate Interview date fast approaching. I also have an upcoming placement in Orange (Western NSW) which will give me a perspective of rural nursing and I cannot wait!

Health for Wealth Day 10 - RSU

Rangsit University

The drive this morning took us north beyond the province of Bangkok and into Pathum Thani. It was an enjoyable drive with changing landscapes, vast street vendors, and a display of extreme living conditions.

52/347 Muang Ake, Phaholyothin Road, Lak Hok, Pathum Thani 12000

In the cafe we were met by Jeffrey Wollentin, the Director of International Affairs. He was extremely welcoming and lead us to the board room where we were then introduced to the Assistant to the President for Internationalisation, Jeroen Schedler. He opened the presentation with an extremely interesting and educating talk about Thailand and Pattaya as he was made aware of our visit, and empowered us to be adaptable, accepting, and culturally competent people. A great example he used is as follows: a meeting may be scheduled for 10am, yet Thais may arrive any time after 10:15am. Is that annoying and frustrating because they are not on time? Or is it smart and advantageous because it's give people time to talk, network and share ideas, resulting in a smooth-running meeting? Morale of the story - be open-minded to different ways of doing things, develop strategies and coping mechanisms, and not block our minds with opinions and miss potential opportunities and experiences.

The presentation went on to introduce the history of RSU and the courses it provides. RSU is one of six universities/colleges to offer an International Nursing Program in Thailand - these programs are classified as 'International' as they incorporate English into their teaching. However, RSU is the only institution to offer a unique overseas component, with students completing their fourth year of study in Sweden.


Rangsit University history:

• Opened in 1986 as Rangsit College, only accepting 50 nursing students
• In 2000, the Exchange Nursing Program started
• In 2002, the Master Degree Nursing Program commenced
• 2010 marked the beginning of the Double Degree Nursing Program, containing an extra 20 credit of English
• Following the floods in late 2011, the gardens were spray painted in preparation for early 2012 graduation ceremonies

Bilingual Double Degree 4-year Nursing Program
The double degree is made possible with cooperation between the School of Nursing at Rangsit University, Thailand (RSU) & School of Health, Care, and Social Welfare at Malardalen University, Sweden (MDU). Total tuition fees: 720,000 THB

The two degrees studied are a Bachelor of Nursing Science (RSU) & a Bachelor of Science in Caring Science (MDU). The structure provides good value and balance containing anatomy, physiology and pharmacology from RSU, and 'caring science' and the art of nursing from MDU. The fourth year of the program is taught in Sweden. English is used in the general education and elective courses, and bilingual language is used in the 'Foundation' and 'Nursing' courses at 50/50 in proportion.

Thai teaching staff
A Student Nursing Council handles affairs on campus. Thai teaching staff require at least a Masters Degree to be able to teach at the university. As well as maintaining Thai culture and traditions, they work with international staff to help introduce and foster new ideas.

Dr. Kaitsara Sen-Ngam, Assistant Professor of the Bilingual Program, and Pranee Tudsri (RN, MA) then gave presentations about the current health of Thailand and child health care. I found this to be the most educational presentation of our Experiential Program and found it interesting to learn about the health of a developing country. I will share some information below.


Health of the population of Thailand

• 0-14 years of age = 25.5% of population
• 15-59 years of age = 67.4% of population
• > 60 years of age = 11.1% of population, expected to reach 14% by 2015
• Life expectancy of males in 1964 was only 55.9, increased to 70.6 in 2010 and is estimated to be 76 in 2030
• Life expectancy of females in 1964 was 62, increased to 77.5 in 2010 and is estimated to be 82.7 in 2030
• The elderly are cared for by their families, with many families living in multi-generational arrangements, thus decreasing the burden on the health care system and reducing the risk of hospital-acquired infections
• An arising problem is increasing depression due to decreasing socialisation of the elderly
• Nursing homes do exist but only for the very sick when families are unable to assume care

Major causes of death

The leading cause of death of males and females is cerebrovascular disease, 9.4% and 11.3% respectively. This is followed by road traffic accidents, AIDS and ischaemic heart disease for males (8.1%, 7.9% and 6.4%), and diabetes, ischaemic heart disease and undefined causes for females (8.0%, 7.5% and 7.2%). These causes are not too different from those in Australia. The major causes of death among 0-14 years are perinatal asphyxia, birth trauma, road traffic accident and accidental drownings, and among 15-49 years is HIV/AIDS and road traffic accidents, highlighting a population at risk of HIV/AIDS infection. We were told by Dr. Kaitsara that currently the US has a vaccine for HIV in the works...

Risk behaviours of children and adolescents are eating behaviours, sexual behaviours (thus HIV), drug addiction, cigarette smoking, alcohol consumption and driving behaviour. There are multiple health problems as a result of communicable and non-communicable diseases: diarrhea, acute respiratory infection (with pneumonia being the number one cause of death in infants), dengue haemorrhagic fever, encephalitis, HIV/AIDS, tuberculosis, as well as low birth weight and premature births, obesity, malnutrition, dental caries, asthma, cancer, renal disease, blood disorders, pollution, car accidents, water-related accidents, and mental health problems. Drownings in Thailand are largely related to low safety standards and this can be seen by children swimming in rivers and canals unsupervised and with no barriers to prevent entry to the water. This may be due to the water being an important transport route in Thailand. There are also currently no government campaigns or programs. As I have mentioned in a past post, mental illness are still taboo in Thai culture with many individuals seeking help the traditional way. With temples still the first stop for those experiencing mental and emotional ailments, awareness of mental illnesses is slowly increasing in Thailand and the Bachelor of Nursing Science includes 6 credits of study about mental illness. Wat Pho is an example of such a temple that contains monks who may specialise in medicine, meditation and oriental medicine.

Health service system in Thailand

Family-centred care

It has been recognised that the family is the major participant in the assessment and treatment of a child and adolescent. Families have the right and responsibility to participate individually and collectively in determining and satisfying the health care needs of their child.

Primary care

For primary care to be successful it must be accessible, holistic and provide continuity of treatment. Use of appropriate technology allows responses to reflect the changing health needs of the community and individuals.

Child health services

Antenatal care:

• Health promotion, preventative health services and health education
• Prevention and treatment of anaemia
• Tetanus toxoid immunisation

Postnatal care:

• Promote breastfeeding
• Nutrition assessment
• Lifestyle and emotional counselling
• Family planning

Child health care (0-5):

• Immunisation completion
• Promotion of good nutrition and eating habits
• Assessment of growth and development
• Home visits

It was then time for lunch where there was a huge buffet put on for us and we were able to sit and converse with some of the current nursing students of the university. We had some students sing their nursing song to us in Thai and handover beautiful flowers as a welcome gift, and then had a quick tour around the School of Nursing and were shown some of their clinical laboratory rooms which were quite impressive. Again, I instantly felt like friends with these students thanks to the common interest and passion in nursing. They were all so eager to talk to us and practice their English communication.

Overall, I was extremely impressed by everything we were told and what we saw around the campus. I am a little jealous of the double degree RSU offers, and would have definitely been interested in such a course had it been offered upon my enrolment in Sydney. They have a great emphasis on international development and have relationships with many universities around the world including the University of Queensland and Griffith University in Australia. It was also great to gain a broader perspective on health issues and needs that are impacting on a developing country.

Health for Wealth Day 9 - Vejthani Hospital & Siam Reiki

Vejthani Hospital

It was an early start this morning - to allow plenty of time for traffic, of course. We arrived at the hospital about 30 minutes early but that meant time for coffee! I was really excited for a presentation about maternity and paediatric care, but it was an opportunity for the hospital's facilities to be put on show from an executive perspective, unfortunately again the meeting not matching the itinerary's focus.

1 Ladprao Road, 111 Klong-Chan, Bang Kapi, Bangkok 10240

Vejthani Hospital was established in 1994 with the vision to be the leading private health services provider dedicated to delivery of high quality responses to society's changing health care needs.

Hospital capacity:

• 12 storey building (34,964 sq. m.)
• 500 inpatient beds
• 95 Grand Single rooms, 10 Suites, and 11 VIP Suites
• Over 300,000 patients per year
• International patients from over 40 different countries
• Most patients are Arabic

Staff:

• Over 700 full-time employees
• Over 300 physicians and dentists
• Over 200 nurses
• International Correspondence team
• Overseas offices in USA, UK, Australia, Canada, China, Bangladesh and UAE

Inpatient services:

• Adult Intensive Care
• Renal Dialysis Unit
• Paediatric Intensive Care
• Grand Wing Inpatient Department
• Arabic Inpatient Department
• Paediatric Inpatient Department

Outpatient services:

• 24 hour emergency care - Ambulance and Mobile Critical Care Fleet
• Consult rooms and peaceful environments for patients awaiting test results, including an area for massage
• Outpatient surgery
• Clinics including - allergy, breast, cardiology, colorectal surgery, dialysis, ENT, endocrinology, eye, gastroenterology and hepatology, hand, hematology, infectious diseases, nephrology, neurology, neurosurgery, obstetrics and gynecology, orthopaedics, plastic surgery, psychiatry, radiology, rehabilitation, respiratory, rheumatology, skin laser and cosmetics, spine, thoraric, ART (assisted reproductive technique), TJR (total joint replacement), and urology.

Facilities and Services:

• 3 separate check-in and service counters
• Arabic
• Thai
• International
• Multilingual interpreters
• Restaurants, coffee shops, Thai massage, and book and toy stores
• Internet services and WiFi
• 500 vehicle carpark
• Airport transfers and travel arrangements
• Prayer rooms
• In-house serviced apartments and hotel accommodation
• Multiple customer contact lines: English, Arabic, Bangla, Myanmar, Russian and Ethiopia hotlines

What seems to be a typical view from a private hospital ward room

The hospital prides itself on its specialisation in ART and TRJ, adopting computer navigation and minimally-invasive techniques. New technologies extend to its Yuyama automated pharmaceutical robot, allowing for electronic medication ordering and smart dispensing (but not administration to the patient!). I felt as though there was still a huge focus on plastic and cosmetic surgery with the tag line being "Beauty is within reach".

We were given a tour of the hospital by Sawitree (DNS) and it all felt much the same to every other private hospital we had visited. I left a little confused as I asked one of our hosts about mental health facilities and I was told that no mental health facilities exist in the hospital, however the website states that there is a psychiatry clinic. Mental illnesses are still taboo in Thailand and temples are usually the first and only place where people who suffer from mental ailments go to seek help. Check out this article for an interesting read about participation of religious organisations in mental health care in Thailand.

Interestingly we also learnt here that organ donation is not yet legal in Thailand, and there is no voluntary system for donations, including bone marrow. Only family donations are accepted from living donors between 18-65 years old. In saying that, Australia is currently ranked only 17th in the developed world with its "opt in" consent law. Countries including Spain, Belgium, France, Norway and Italy achieve much higher donation rates with "informed consent" laws, where everyone is considered a donor unless they specify otherwise.

I could go really on with my reflection contrasting various aspects of Australia health care and its facilities to Thailand, but I will leave you with some food for thought. In all private hospitals we have visited to date there has been no mention of education regarding illness prevention or health promotion. Is this contributing to the focus of plastic and cosmetic surgeries? Rather than investing in pharmaceutical robots worth millions, could money be better spent, with money redirected to the public/rural/community sectors? 

Institute of Applied Holistic Health Sciences

A change to our afternoon itinerary had the group under the impression we were off to learn about holistic care of the elderly - sounded strange as we had learnt that Thailand doesn't have 'nursing homes' like Australia does. Where we found ourselves was Siam Reiki at the Institute of Applied Holistic Health Sciences with two Reiki Masters: Katherine and Mohana.

Siam Reiki: 4115 Rama IV Road, Phra Khanong, Bangkok 10110

Having not heard much about Reiki in the past I was quite interested in this different approach to health and healing. Reiki (meaning universal energy) is a hands-on therapy focusing on energies and vibrational frequencies, and works by expanding auras and the seven chakras. A reiki therapist acts as a channel so that the energy is transferred to the recipient and thus identifying areas of congestion. The causes of these blockages can be spiritual, mental, emotional or physical and are usually detected before physical symptoms become apparent.

I won't go in to too much more detail, but reiki supports medical procedures and practices and neither conflicts or interferes with treatments. It aims to assist in healing of the body quickly and naturally. Reiki is also a consistent method for relieving and reducing stress, tension and hypertension by releasing congested energy produced by day-to-day activities.

Siam Reiki was founded in Bangkok in 2008, with the Institute of Applied Holistic Health Sciences established in 2010 in response to the increasing need for international standards of quality control and procedures in training. Courses are run to include an assessment of students to ensure the development of competent practitioners, and courses are recognised professionally enabling practice in medical, spa and health resort areas. Overall, it was a very interesting experience and I do believe there is a place for holistic practices in modern health care.

Upon arriving at the hotel, it began to rain very heavily. Kate and I were keen to check out the department store in Siam Paragon, and I bought myself another pair of shoes before heading to MBK for another wander around. It was a very successful shopping expedition!

Shopping in MBK: Sunscreen not available in Australia!

Health for Wealth Day 2 - BCNB & Bumrungrad

Boromarajonani College of Nursing, Bangkok

Victory Monument

Following a quick walk down to Victory Monument (we arrived at the college very early) we were greeted by Chanpen Ninwatcharamanee (DNS, RN), the Deputy Director for Academic Affairs at 9am. The presentation conveyed information about the college and its nursing education and accreditation.

2/1 Phayathai Road, Rajthevee, Bangkok 10400

In 1946, the BCNB was first established to help solve the problem of a nursing shortage following World War II. BCNB was originally named the School of Nursing, Midwifery and Public Health, and was later named "Boromarajonani" in honour of Her Royal Highness, the King's Mother. As well as being nationally recognised for its high standards of education, it was the first nursing college under the jurisdiction of the Ministry of Public Health.

Programs provided by the college are:

• Bachelor of Nursing Science, 4 years
• Teaching and learning in Nursing, 4 months
• Primary Care Nursing Practitioner, 4 months
• Emergency Nursing, 4 months

International Short Course Programs offered, also 4 months in duration:

• Critical Care Nursing: Adult, Paediatric and Neonatal
• Clinical teaching in nursing
• Midwifery
• Orthopaedic nursing

The curriculum of the Bachelor of Nursing Science encompasses holistic care to both the health and sick and establishing comprehensive health care service models. The degree is bound by a conceptual framework based on caring, teaching and learning, and environmental factors, with the aim of producing nurses that respect the rights and dignity of their patients, and nurses who commit to lifelong learning. For course completion, students must complete 144 subject credits over at least 8 semesters, and hold a GPA of at least 2.00.

Yearly competencies

1st year:

• Understand individual differences and adapt to various situations
• Admire and respect all
• Demonstrate self-care ability
• Face problems and deal with conflicts appropriately
• Demonstrate responsibility, virtue and ethics
• Demonstrate communicating in English in daily life
• Seek knowledge using technology
• Demonstrate and develop an understanding of human nature

2nd year:

• As above, plus
• Promote health and prevent illness
• Demonstrate continuing self-development to accomplish goals
• Provide holistic nursing care through practice experience

3rd year:

• As above, plus
• Introduction to Midwifery
• Develop a nursing report and nursing articles using the English language

4th year:

• As above, plus
• Demonstrate clinical judgement and creative thinking
• Demonstrate emotional maturity
• Work as a team leader and in-charge nursing
• Demonstrate leadership skills

Once students have graduate from the college, they are required to work within the government sector for a minimum of 4 years, before having the freedom to move around within the nursing profession and work for the private sector.

Kainapa Kaewjuntra (RN), Deputy Director for Student Affairs, then gave a brief presentation that provided insight about how the students of the college are supported during their studies. The college appears to take every measure to ensure a comfortable, safe and healthy lifestyle for their students.

Accommodation

• Accommodation is provided for the duration of their studies, and students are required to stay in dormitories on site
• A curfew of 7pm is enforced for the students' safety, which is enhanced with 24/7 security
• 6 buildings in total - one housing 150 female students, with another housing only 50 male students
• Housekeepers attend to the dormitory sites and clean bathrooms and common areas
• Each dormitory room houses 3 or 4 students, and shared bathrooms are located at one each of each level

Service and Facilities

• 3 meals are provided per day at the cafeteria for a small fee
• Meals are served within certain times, during which students may come as it suits their schedule
• Counselling and student advisory services
• Library and campus-wide computer facilites
• Laundry
• Student clubs, societies and activities
• Gymnasium and swimming pool

Dormitory living

Awarding academic performance

• Scholarships are provided for outstanding academic performance
• Exchange programs are also offered for a very small number of students with the aim of broadening world views, experiencing new cultures, and developing leadership and communication skills
• The STIKES Bali Exchange Program has been their most recent project

What I loved about the college is that its students appear to be really taken care of through a structured and nuturing environment. Efforts are made to ensure that students have time for visitors, as well as being able to provide care to other students and participate in extracurricular activities. The students are also very happy and warm, and quickly greet you once in their presence, making us feel part of the family.

Fourth-year students showing us around the campus

I found that the course structure really focuses on a few key points: holistic care, learning about the whole person, and understanding how different factors affect health and health promotion. In contrast to the Bachelor of Nursing in Australia, the Bachelor of Nursing Science offers Midwifery (so jealous of this - midwifery is offered as a post-graduate degree following one year of clinical work as an RN), a more in-depth theoretical and practical experience, and has a huge focus on leadership and communication (particularly in the fourth year of study), thus producing well-equipped and more confident nurses. There is also the mandatory summer semester when studying nursing in Thailand, whereas the summer semester is voluntary in Australia. Also noteworthy is the fact that UTS Nursing students are currently unable to attend exchange programs as part of their degree - the only way this is possible is by undertaking the double degree, Bachelor of Nursing and International Studies. I hope that one day Australia can adopt programs similar to those offered in Thailand to offer their students such an amazing and educational experience that I believe will contribute greatly to their personal and career development.

It was definitely eye-opening experiencing a glimpse of dormitory life and seeing how four students squeeze into a tiny room. I cannot imagine living like that during the course of my studies! I also wish we had uniforms half as many as theirs look, with the first year uniform differing slightly from the second, third and fourth year students.

Nursing uniforms - college, community, hospital, and graduation

Such beautiful, hospitable, and empowering women

On the road to our next visit...

The Poor while the Rich looms in the background: on the way to Bumrungrad Hospital

Bumrungrad International Hospital

33 Sukhumvit Soi 3, Wattana, Bangkok 10110

So being my first introduction to the private sector, I was completely overwhelmed by what I experienced at Bumrungrad Hospital (pronounced bahm-roong-raht, meaning 'care for the people'). The vibe of the hospital was something different in itself; the foyer and lobby feeling more like an airport or five-star hotel, filled with foreigners that I had not passed in my travels through Bangkok so far. While waiting for the lift, it was impossible to miss the immaculately presented and cheerful staff.

On the 21st floor, we stepped into a large meeting room and took our position around the table. Big leather chairs, coffee and pastries; I was content. Mack Banner, the CEO, greeted us and begun his presentation about the hospital and its financial successes as a result of the influx of the "international market". This was not the presentation we were expecting. I was hoping to learn about how the rise of medical tourism has impacted Thailand… however, I pressed on.

The care provided by the hospital is considered first-class, with adequate staffing, boutique stores, and luxurious hotel style rooms to boot. To further influence the upper-class international market, the hospital provides Visa extension services and is in partnership with Thai Airways, accepting frequent flyer mileage as payment for checkups.

Hospital history

• A 200-bed facility was opened in September 1980
• In 1989 the hospital was listed on the Stock Exchange of Thailand
• The main hospital building was opened in January 1997, costing 110 million USD, with a 500 bed capacity
• 2001 saw an influx of 12,000 Middle Eastern patients as a result of tighter Visa restrictions in the US
• The US TV program, 60 Minutes, featured the hospital in April 2005, and compared medical expenses between the US and Thailand
• Focused on a cardiac patient whose bypass surgery would have cost $100,000 (USD) in the US, vs only $12,000 in Thailand
• The newest outpatient clinic building was opened in May 2008
• Not long after, the hospital experienced financial uncertainties for 3-4 years during the global financial crisis
• Achieved voluntary US accreditation

Finance

• Bumrungrad Hospital is a public company traded on the Stock Exchange of Thailand
• The majority of shareholders are Bangkok Insurance Public Company Limited and the Sophonpanich family (one of Thailand's most respected business families)
• 70% of patients are self-paying
• Net profit = 15.1% in 2012
• Margin (EBITDA) = 25.3% in 2012
• Most business from Australia comes from plastic surgeries

Hospital information

Capacity:

• Over 1.1 million in- and out- patients treated per year
• 538 inpatient beds
• 473 Medical/Surgical/OB/Paediatrics
• 37 Adult Intensive Care
• 14 Cardiac Care
• 9 Paediatric Intensive Care
• 6,000 outpatient capacity per day
• 1st July, 2013 saw 3,700 outpatients treated
• 270 examination suites
• 24-hour emergency care, and ambulance and mobile critical care fleet
• 21 floors
• 10 floors for clinic rooms
• 2 floors for imaging equipment
• Technology
• 64-slice CT scanner
• Automated lab onsite
• Nuclear medicine

Services:

• Communication
• International referral offices in major cities (Australia, Bahrain, Bangladesh, Cambodia, Ethiopia, Hong Kong, Indonesia, Mongolia, Myanmar, Nepal, Oman, Russia and Vietnam). These offices promote the hospital and its health personnel, organise travel arrangements for patients, and also obtain a 10% commission from the initial patient fee
• Contact centre that handles 300-500 emails per day
• Over 150 interpreters
• User-friendly website that allows potential patients to research doctors, procedures, costs, and book appointments
• Comfort
• International patient lounges and segregation. There are separate check-in desks for Thai locals and foreigners
• Cultural amenities and prayer rooms
• Restaurants and shops
• Hospital wide wifi and bed-side laptop rental

Ironic: McDonalds

Staffing:

• Over 4,700 employees
• Doctors - over 1,300; 300 full-time (working in over 50 specialties and sub-specialties)
• Nurses - 1,000; with 60% of staff under the age of 30
• 5,000 THB per month in public sector, vs 16,000 THB for a new graduate
• Pharmacy on every outpatient department floor
• Swisslog pharmacy robot - enabling electronic medication ordering and dispensing

Basically, I feel very uncomfortable about a lot of the information I learnt at this presentation. Don't get me wrong, I can see where such a hospital fits in and caters for elective surgeries and provides care for those who cannot afford healthcare in their own country (or afford health insurance). Something that wasn't mentioned in the presentation was The Bumrungrad Hospital Foundation that was established in 1990, and is dedicated to providing healthcare to underprivileged Thais. The Foundation has provided over 100,000 Thais with free services ranging from check-up programs to life-saving surgery for children with defective hearts. But is this enough for the disadvantaged populations? And who decides who gets what treatment? 

No doubt, the hospital is an attractive workplace; providing higher pay rates for nurses and roster flexibility. The fact that private hospitals are selective about the patients admitted and treated means there is less stress (I have never seen such warm and happy nurses), minimal waiting times, greater infection control (well, there really is NO infection) and no acute mental illness. It hardly felt like a hospital, especially when standing in a huge hotel-style room that is the size of my apartment, overlooking run-down tin-roofed shacks below.

At the end of the day I guess it all comes down to money making. The hospital has not only created a greater number of jobs, but also helps stimulate the Thai economy through increased tourism. BUT, why is there no focus on health promotion and illness prevention? And what else is being done to help the local Thai population that cannot afford care?

The view from the 16th floor

To top of a busy day, a few of us checked out Jim Thompson's House - Thanon Rama I, Wang Mai, Pathum Wan, Bangkok 10400 (in short, very close to Ibis Siam and down a small alley way). Entry was only 50 THB for people under 25 years of age, and there are guided tours provided during the day. Unfortunately photography is not permitted inside the house. The restaurant there is also very reasonably priced, and the food was amazing! Not every day you can say you ate dinner out of a pineapple ;)

A boat charging through the canal at the back of Jim Thompson's House

Spirit House - to protect the property from evil spirits

Precious artifacts collected by Jim

Jim Thompson's House

For more information and the story of Jim Thompson, check out http://www.jimthompsonhouse.com

The Long Haul

This sums up my existence for the past 5 weeks. I have only one week of clinical placement left, and I am (just quietly) very excited to see the end of this stressful, unpaid, emotional and tiring period of time. I have been at two different hospitals gaining experience in the areas of paediatrics, medical-surgical and mental health. 

I'd hoped to have had time to blog about my experiences whilst on clinical, but evidently have not. I won't bore you with detail now, but between waking up at 4:30am and coming home to work on written assignments, I have not had time for life; let alone even begin to consider locations for my New Graduate application or think about my upcoming Thailand trip. I can reveal that I do plan on blogging about the phenomenon of 'nurses eating their young' - feel free to contact me if you have details or experiences you would like to share!

Only 11 days now until I will be aboard a plane bound for Thailand - I can almost count down the days on two hands! During this time, I will be finishing my last week in mental health, applying for a New Graduate program, buying last minute travel items/clothing, studying for an exam, packing, and finding time for sleep! Everything important for Thailand is sorted (I think!). Flights- check. Accommodation- check. Travel insurance- check. Travel details registered- check. Cultural tours- check. Sitting down with a book and a cocktail following a swim and a massage, then getting stuck into Thailand's health care system- pending...

Hey, everybody. Here's some fun facts.

"Hey, everybody. Here's some fun facts. The population of Thyland is sixty three million people. It is twice the size of Wyoming. It's chief exports are textiles, footwear and rice. Each year, approximately thirteen thousand people are killed in car accidents in Thyland." Alan - The Hangover II.

The Experiential Nursing Program, provided by University of Technology Sydney: BUiLD (Beyond UTS International Leadership Development) is allowing 20 students to experience and gain an understanding of how global economic development influences healthcare in developing countries. The program will allow for immersion into life in busy Bangkok, attending lectures and participating in volunteer projects. We will be taken into Bangkok's largest public and private hospitals to explore the vast needs and challenges of the Thai healthcare system: issues and ethics in delivering care; economic growth; responding to natural and humanitarian crises; and the rise of infectious diseases, such as HIV/AIDS, as well as medical and sex tourism.

The lecture topics include:

• Introduction to the Thai healthcare system: Ministry of Public Health
• The role and development of nursing in Thailand: Thai National Council of Nursing
• The rise of medical tourism: Bumrungrad Hospital
• Training nurses for community care: Faculty of Nursing, Assumption University
• Moral competence - Buddhism and nursing practice: Bangkok Hospital
• Maternity care: Vejthani Hospital
• Child care in the community: Slum Child Care Foundation
• Treating the AIDS epidemic in sex-tourism districts: UNAIDS
• Tsunamis and crises - Disaster care in Thailand: The Red Cross

My current knowledge of nursing in Thailand.

I am yet to travel to Thailand, or overseas at all! The extent of my knowledge of Thailand and its health care systems is quite limited; however, some quick research has highlighted some interesting facts. I learnt that Thailand has a system that supports universal health care which focuses on primary care, and that nurses are significant providers of these health care services and play an essential role in enhancing the health of the community, particularly in remote areas. Also, despite access to improved drinking water and sanitation, there is still concern about infectious diseases such as HIV/AIDS, tuberculosis, malaria, dengue fever, hepatitis and rabies.

My expectation of the program.

I am extremely excited to be traveling overseas (particular to Thailand) and can't wait to experience different environments and cultures. I expect to gain a greater understanding of Thailand's current health care systems, encompassing: potential advances in medicine and nursing; health concerns, needs, and socio-cultural factors unique to differing populations in Thailand and the impact of these on individuals, populations, and health care systems; and appreciate how health care practices differ to those that are standard in Australia's health care. 

I also expect to be challenged by being immersed in an unfamiliar culture. This will compel me to be aware of my own beliefs, customs and attitudes, and to be extremely open-minded and respectful whilst conducting myself in a culturally safe and appropriate manner. I hope to reach a point of cultural competence and understand how different religious and beliefs can impact on the health care I provide, particularly in the multicultural context of Australia.

I hope for this experience to positively influence my academic studies and my future career as a Registered Nurse. I look forward to developing a greater appreciation of the role of the nurse, particularly community nursing (which is one of many areas of interest of mine), and the implications of their role on the health of the locals in remote areas. Important personal attributes that I feel would benefit my studies and future career are: widening my therapeutic communication skills, written, verbally and non-verbally; flexibility and adaptability to differing and challenging clinical situations; and enhancing my critical thinking skills to allow for effective clinical judgement. Most importantly, I think that this nursing program will allow for self-awareness and self-reflection, with identification of gaps in my knowledge provide direction for future clinical investigation - allowing me to carry on my quest to become a competent, confident and efficient health care provider.


What now?

I should mention now that I have Kate to thank for this amazing experience - she was the voice inside my head and encouraged my decision to apply. Kate is one of the most down-to-earth people I know and I am extremely lucky to consider her a close friend, so I was ridiculously excited when we were both accepted into this program!

On June 27, Kate and myself fly to Thailand! We decided to check in three days early to enjoy some tourist time in Bangkok before meeting the 18 other students on the morning of June 30. Flights and accommodation have been booked, so now I must survive the next 4 weeks of clinical placement! Bring it on!