Breathing

It's been a fairly wild ride thus far.  So there's two reasons it's not very easy to breathe here:

1. The traffic is insane!  Cars here, buses there, and then the skytrain (which does a great job of alleviating traffic) traps all the smog underneath its mighty tracks.
2. Tuberculosis is everywhere!  For those used to traveling in developing countries or our country's jail system, you might not be surprised about this.  But I don't think I've seen too many patients without TB.  No one wears proper masks (N-95s are too expensive), and no one is (understandably) bothered by it because most everyone seems to have it.

 A few interesting tidbits from the hospital:

• The cases are incredible, and are for the most part super advanced manifestations that we only read about:
• HIV complicated by CMV retinitis and CMV polyneuropathy rendering the patient blind and bed-bound
• CMV encephalitis
• Acineotbacter resistant to every antibiotic under the sun except COLISTIN (for those not from MD land - we don't really ever use colistin in the US because it's so toxic)
• Infective endocarditis (heart valve infection) with a bioprosthetic valve throwing emboli to the gut causing toxic colon
• HIV with disemminated tuberculosis (this is a recurring theme...anything you might think TB could do, it does here with the backdrop of HIV).
• Mycobacterium abscessus (rapid-growing nontuberculous mycobacterium) in several cases that's resistant to almost every antibiotic combination we have.
• Classic skin markings in syphilis in the backdrop of HIV
• Krukenberg tumors (complication of ovarian cancer)
• And the list just keeps going...
• Open-air wards are the norm.  It's unfortunately no wonder that everyone's TB and various drug-resistant bugs are passed around.  Patients are packed 4 to a wall.
• My attending got mad at the general team when they had an active pulmonary TB patient hanging out with everyone else.  The team's response was that there just simply was no other isolation room at the time, and the best course of action was to place this patient near the window for "better" ventilation.  Unfortunately, they were all correct in their thinking (still no masks, though).
• Picture here
• The faculty and staff work so hard, it's quite impressive.  Just to give you a taste: medical students, residents, and fellows don't get a single day off during each month-long rotation.
• The hospital has really every modern diagnostic option we have.  They even just installed a PET-CT scanner last year.  Interestingly, they just use the options much less frequently secondary to cost.

• Their clinical lab is probably superior to ours.
• Residents here do a ton of their own lab draws, lab work, microscopy, etc.
• There is a computer-based ordering system, lab result system, and digital radiology system.  They still use paper-based notes...Just like WashU!!
• The nutrition here, at least I think, is better than what we serve our patients :-):

So it's really fascinating to see an over-burdened public institution working to maximize the resources they have for the patients that need it most.  Really impressive stuff.  More photos and topics to come:

• Outpatient clinic
• ICU stuff
• Generic medicine controversies
• The three-tiered health-care system in Thailand (and why it's quite impressive)
• The work-a-holic residents and fellows I work with
• Eastern vs Western medicine (and why Western trumped Eastern in Thailand)

Off to meet Eli status post cooking class number who knows how many :-)???