Exchange Program

Ramathibodi Hospital, Mahidol University
Thailand

Shogo Nishino

Introduction
I went to Ramathibodi Hospital from 4th to 29th April. I went there with mytwo friends and one student from Tohoku University came to the same
Hospital. Ramathibodi Hospital is a hospital of Mahidol University. Mahidol
University is the biggest university in Thailand and has four hospital inBangkok, the capital of Thailand. I heard Ramathibodi Hospital is the 3rd
big hospital, but has the best equipments. I studied in Emergency
department for first two weeks and in Internal Medicine for second twoweeks.
Emergency department
I elected emergency department in first 2 weeks. I want to check thedifferences between Thailand and Japan. I rounded there with 4th gradestudents in Mahidol University. They were more active than Japanese
students. They always checked medical record and asked their teacher to findtheir own question. I think it is very good and I want to be active like that.
I receive the lectures by professors from Hong Kong who specialized poisonand doctors in emergency department. Professors from Hong Kong spoke
English so fluent that I could not understand the entire lecture, but theabstract I can understand had me notice the importance of toxicology. Anddoctors in ER told me about emergency medicine in Thailand, how to treat
burned patients, and so on. It was very interesting.
I learned many things specific in Thailand, for example Rabies andvenomous snakes. In Thailand there are many wild dogs and many rabies
patients who were bitten by them. Therefore in Thailand there are two typedof vaccine, ERIG and HRIG. ERIG is equine rabies immune globulin made byhorse and HRIG is human rabies immune globulin made by human. Thereason why there are two types is that some people are allergic to ERIG. If
the patient is allergic to ERIG at a test, we must choose HRIG despite its highcosts. Moreover I went to a snake farm run by the Red Cross. I could see manysnakes there, and learn many things about snakes. In Thailand there are 600species, so it is called “snake paradise”. 60 of them have venoms and 10 isvery important because they are fatal. Venoms have two types, hematotoxin

and neurotoxin. Each snake has either venom. So, it is important to identify
the snake that you are bitten at treatment. Then we watched the snake show
and had wonderful experience like the picture below.
General medicine
I studied at the department of General Medicine. Because it is the first day
after songkran, Thailand New Year holiday, doctors seemed to be very busy.
In general medicine I saw many patients who I had never seen in Japan. For
example, primary CNS lymphoma, posterior reversible encephalopathy
syndrome, Nocardia brain abcess, multi drug resistance Acinetobactor
pneumonia. These were very interesting for me, and these diseases doesn’t
present in Japanese textbook. So, I had to study in English, which was very
good for me.
And I can see a rare case, a Prader-Willi syndrome patient. She was 24 years
old, and had hypotonia, obesity, hypomentia including autism, learning
disability and obsessive compulsion disorder. Moreover, she had diabetes,
SAS and pulmonary hypertension due to obesity. Her weight was about 120kg
and increasing due to her hyperphagia. She came to the hospital because ofpneumonia. In Japan, it is said that prognosis of this disease is the same asnormal person. In Thailand, because of infection, the patients can live until
about 15 years old. I have known that infectious disease is serious problem inThailand, however I was very surprised that such problem influences theprognosis of the patient like this.
I saw the two OPD, geriatric OPD and HIV OPD. A doctor in geriatric OPD
taught us many things, and the most impressing thing is how to identify
severe AS. I saw the patients who had systolic murmur, and I think she
might have aortic stenosis and she needed echocardiography. However, hetold us that medical resource is limited, so I have to decide whether apatient need additional examination through physical examination. I knew
physical exam is very important, but I have never thought physical exam as
such useful tools. And in HIV OPD I can see a lot of HIV patients I havenever seen. In Thailand the knowledge about HIV is not spread. So HIV isthe very big problem. In Thailand many HIV patients came to Hospital withhis wife or husband, both of them are HIV patients. I thought that we must
do something about HIV in Japan in order to avoid such cases. Moreover
doctor said that the situation in rural area is more severe. In rural area
people don’t have enough time to go to hospital because of their work,agriculture. So many HIV patients are untreated and HIV is now spreading.
Conclusion
I could learn many things in Thailand. All Thai students study harder andstudy in English. And Thai student in study will beat Japanese student. I
think that I have to study more. This stimulated me very much.
Moreover the experience with Thai friend became my treasure. So, I wantto communicate with foreigners now.
These two things are what I could gain in exchange program in Thailand. I
want to be a good doctor and international person through theseexperiences.