Report of “Education of Global Medical andHealth Science Leadersin the Coming Generation in Cooperation andCollaboration with ASEAN Countries”
Kobe University Graduate School of Health Sciences
Department of Community Health Sciences
Yamato Tsuboi
1. Introduction
I’ve benn dispatched to the Depatment of Physical Therapy, Mahidol
Univesrity in Thailand for 1.5 months. The purpose of my exchange program
was to learn health promotion and physical therapy in community. This
report summarized experiences that I got from this program.
2. Program Overview
Term: 4 Feb 2017 ~ 20 Mar 2017 (45 Days)
Country: Thailand
University: Depatment of Physical Therapy, Mahidol Univesrity (Salayacampus）
Corresponding author：Assistant Professor Dr. Pakaratee Chaiyawat
3. Program & What I Learned■ Overview
For the first 4 weeks, I’ve participated in the postgraduate course of physicaltherapy in community. In this course, I’ve mainly studied health promotion
and physical therapy in community with 3 teachers and 3 postgraduate
students. The items below are programs what I’ve experienced in this course.
・Home visit physical therapy
・Health education・Lectures on health promotion
For the last 2 weeks, I’ve visited the Siriraj hospital (the oldest and biggest
hospital in Thailand) and the Physical Therapy Center for clinical practice.

■ Physical Therapy in Community
Home visit physical therapy
Thailand is a developing country, but is getting an aging society rapidly
before social welfare service has fully developed. Unlike Japan, Thailand
doesn’t have the long-term care insurance system, which means service forthe elderly isn’t enough available.
As case study, I’ve visited 4 cases with teachers and postgraduate
students. We’ve visited several times for each case for diagnosis, evaluation,program development, and treatment.
In discussion of case study, the ICF (International Classification ofFunctioning, Disability and Health) model was applied. Although the ICF isfamiliar to physical therapists, many physical therapists don’t seem toclinically make the best use of the ICF. In case study, however, they could
make the best use of it. It was impressive that they really put special
emphasis on the differences between patient’s perspective and physicaltherapist’s perspective. We, healthcare professionals, tend to be biased forpatient’s perspective due to medical knowledge, skills, and experiences.
Hence, we need to be aware of that fact at first, and need to seek patient’s
real perspective (needs that they want). After getting needs, all we have to
do is to go toward them with evaluation and treatment. It’s fundamental, butdifficult to be aware. This re-cognition can be so helpful for my career as oneof the physical therapist.
Among physical therapy in community, it’s also important to grasp thecharacteristics of communities and patients’ homes. In case study, I’vevisited 3 communities whose characteristics are different. In terms ofpromotion of patients’ social participation, understanding of industries andsurroundings is informative. Because disparity of wealth is widened in
Thailand, physical therapists have to adjust it, and do their best in thelimited situation. For grasping communities, physical therapists may need toregularly get along with them.
Words of Dr. Pakaratee on physical therapy in community left animpression. She said, “if you work in clinics, you can treat just patients whocan come to clinics. If you work in community, you can approach various
kinds of patients. That is attraction and strength of physical therapy incommunity.” That reminded me of the significance of health promotion incommunity.

Health education
I’ve had the opportunity to plan and organize health education forcommunity-dwelling elderly people, caregiver, and patients after amputation.
We held the seminar, “The health of elderly “How to bring away / preventfrom the joint pain”, for approximately 100 community-dwelling elderlypeople. In planning stage, we fixed the flow of whole program and eachsession, setting, preparation of fixtures. On the seminar day, several things
such as layout of setting and timetable were different from what we expected.
Because, in addition, it was held at outdoor restaurant, several things that
we couldn’t predict were happened. Teachers and students, however, dealt
with them flexibly, and the seminar succeeded safely. From them, I learned
some lessons. Firstly, they remind me of the importance of preparation. In
this kind of seminars, we often have the opportunity to work together withsome stakeholders. We need to communicate well with them for sharing
information and avoiding misleading. The second thing is to be flexible. We
need to be prepared for happening what we couldn’t expect, and settle down
to deal with them. Finally, we need to do our best. In this kind of event, it’s
seldom that we can host events without any limitations of time, person,space, environment, and recourses. We, however, fall easily focusing onaspects that is impossible to be changed. We should focus on modifiable
aspects that can help to break through challenges.

Lectures on health promotion
As lectures, I attended classes of motivation and coaching, which areimportant factors among health promotion. In the class of motivation, Ilearned how to motivate patients to change themselves. For improving
motivation, we need to grasp real needs of patients. To do that, developing
good relationship is the first step. In the class of coaching, I learned theconcept of coaching and how to coach. Healthcare professionals including
physical therapists tend to like teaching, which is just telling information
unidirectionally. Coaching is the most significant and effective way.
Coaching is defined as letting coachees how to find solutions. I shouldn’t
forget that physical therapists help patients to find solutions, and those whoshould find solutions are patients themselves.
■ Hospital & Clinic
Thai physical therapists have the right to start a business as physicaltherapists unlike Japanese. Many Thai physical therapists open their own
clinic. In clinics, physical therapists have to diagnose patients’ illness at first.
Physical therapists also have to screen whether patients have red flag signs
or not. When patients show red flag signs, physical therapists refer them todoctors. When patients don’t show any red flag signs, physical therapists
move onto the process of evaluation and treatment. Physical therapists with

direct access are responsible, and risk management is quite important toprotect physical therapists as well as patients. Diagnoses by physicaltherapists are different from those by doctors. Those by physical therapists
should guide orientation of treatment.
4. Cultures
Foods & Drinks
Thai foods are quite cheap, that cost about 30 or 40 baht per meal. Many
Thai people often eat out. Many Thai foods are spicy and sometimes salty.
For drinks, even green tea contains sugar. In shopping centers, there aremany Japanese and South Korean restaurants.
Transportation & Environment
Bangkok, the urban city of Thailand, is one of the most famous countries fortraffic jam in the world. However, Thailand has developed the BTS sky train
and the MRT (Subway), which improved traffic jam. For Japanese, it’s still
heavy traffic jam. It’ll be gradually improved by extending railways of theBTS sky train.
In Thailand, there are many obstacles for elderly people and people
with disability. Many facilities such as shopping centers and stations cleared
obstacles, but there are many obstacles like steps outside.
Religion
Most Thai people believe in Theravada Buddhism. They often visit temples.
Actually, to what extent they believe is dependent on people. Some donate alot, some just pray to Buddha for luck. In weekend, temples often holdtemple festivals.
Finally, I really appreciate everyone’s best support.