Fourth Day of Class: Thursday, August 30, 2012

Schedule:

8:30am-3:30pm: Site Visit to Health Promoting Hospital

On our way to one of the Health Promoting Hospitals (HPH) in a rural village.

The outside of the Health Promoting Hospital. It almost looks like a resort.

Our conference room where we were given information about the responsibility of the Health Promoting Hospital and the villages that they oversee.

Main Health Care Concerns in Thailand

Diabetes, obesity and cardiovascular disease have high prevalence. I was very surprised by this since I thought that most Asian countries eat healthy foods and have active lifestyles; thus avoiding some of main problems that America is currently experiencing. However, we learned that one of their side dishes, sticky rice, has four times as much carbohydrates as regular rice due to the nature of the rice grain and the method of preparation of the rice. Thus, since sticky rice is cheap, it is a staple in Thai's diets, causing greater incidence of chronic diseases.

Further, most of the drinks here are extremely sweet and most street food is fried, adding to the diabetes, obesity and cardiovascular problems.

Health Care System of Thailand

There is a high shortage of health professionals, particularly in the public sector and the northeast region (where I am studying), including: nurses, dentists and physicians (not pharmacists though). 

In order to overcome this challenge, Thailand's health care system attempts to focus more on preventative rather than curative measures. Further, nurses and midwives play a larger role in treatment of the patient, rather than having sole dependency on a physician.

An HPH will usually have only a nurse available, and only occasionally will a doctor be present. These are not the only staff, however. Every HPH has multiple Village Health Volunteers (VHV) who are each responsible for 10-15 families in their village. Their main role includes visiting assigned families monthly to survey their health, ensure that they are taking proper medications and provide any health information to the families as needed. These VHVs form the foundation of Thailand's health care system and to me, it is completely amazing that the health care system can rely so strongly on just volunteers. Would this type of communal commitment be possible in the United States?

HPH: It does not have a lot of technology and machinery needed to treat patients. It's main role is prevention of disease, where it focuses 75% of it's budget towards prevention and 25% of the budget on curative means.

Benefits:

• smaller economic burden
• small incidence of infectious and non-infectious diseases

Disadvantages

• is it always feasible to prevent all diseases?
• how do you implement a public health policy that interferes with one's lifestyle? For example: smoking, eating certain foods, exercising, sexual activities, etc

Martin, our translator and presenter on the HPH, shows us the record profile of a patient. 

Here, we are able to see a patient's last visits' weight, blood pressure, current diseases, etc. Interestingly, however, if the patient is infected with HIV/AIDS, this information would not be written down into the record book and thus this information would not be accessible to the public. In contrast, if the patient has cancer, this information would be available to the public. Why do you think there is such a difference?

As seen, in Thailand, there are almost no confidentiality policies as compared to the United States.

After the presentation, we had a chance to go  visit Martin's village. He talked about these main points:

• Communal effort can change a village from being defined by it's violence and drug use to it's education and farming
• Ordinary people deserve a good life
• Planting a single tree in Thailand will provide a future for one's child

Just look at the view of our lunch spot! We are eating a restaurant at the Dam that we visited a couple of days ago.

Some of the courses we had during lunch. So delicious!