2014
Exchange Program
Ramathibodi hospital, Mahidol university, Thailand

Masao Tatebe
2014/04/07

1. Introduction
I did my clinical clerkship at Ramathibodi hospital in Bangkok,
Thailand from 7th April to 1st May 2014. Within 4 weeks, I spent
first 2 weeks in ID (infectious diseases) department, and other 2weeks in FM (family medicine) department.

2. About Ramathiboby hospital
Ramathibodi hospital is one of
the biggest hospitals in Bangkok.
At least 5,000 outpatients visit
this hospital per day. They havemore than 1,000 beds for tertiarymedical care.
I stayed in the dorm in thehospital. We could use air
conditioner, desk, refrigerator,microwave, shower (only coldwater). There were a lot of mosquitoes, so we fought them everyday. There were many usefulfacilities (library, computercenter,sportcenter)inRamathibodi hospital. We
could use them every day.
Ramathibodi
hospital
islocated in the central place in
Bangkok, so it was easy to go
many places by taxi or BTS
sky train.

3. ID department
In ID department, we went the professor’s round every day. Therewere a lot of HIV patients in the wards. Doctors in ID department
explained to us their conditions, problems and treatments inEnglish. There was apatient suspected of adrenal
hemorrhage,
andtheprofessor gave us a question
about infectious diseases
with adrenal gland. We had
no idea at that time, so we
studied them after we went
back to our dorm. The
answer were TB, CMV,
histoplasma, cryptococcus
and meningococcus. We heard that there were a lot ofhistoplasmosis patients in south-eastern Asia.
There was a patient infected with HCV, and the professor told us,“If their skins are dark and eyes are dirty, where can you see theirjaundice?” It was difficult for us to answer the question. The
answer was under the tongue. To be sure, his region under his
tongue was yellow.
We had an opportunity to visit the ID outpatient clinic. Manypatients were follow-up care for HIV. Some HIV patients had theasymmetry of the amount of lipid on their face and arm. The
cause was the side effect of d4t which was one of the anti-HIVdrugs. That was why they had lipodystrophy.

4. FM department
In FM, we could get a variety of opportunities to study FM, andall of them were very interesting for me. I’ll show you my schedule
for the first week below.
DateMon
TueWedThuFri

8:00-9:00
Orientation
Interesting case
Home care conference
Self directed learning
Morning report

9:00-12:00
Home visit
Thalassemia clinic
Health care system lecture
1:1 OFM teaching
OFM observe

13:00-16:00
Palliative topic
Geriatric assessment clinic
Geriatric conference
Brief intervention clinic
FM academics

Every morning, we had a variety of conference in English or Thai.
When it was in Thai, resident doctors translated it into English

for us. Though it was hard for me to tell my opinion in English, we
could join the discussion. The most interesting activity was“Home Visit”. Home visit team (FM doctors, nurse, social worker,
medical student, etc) visit patients home every morning.
We could accompany the team, and I went to a patient home who
had dementia. The patient was 89 years old woman, andcaregiver was her daughter. The daughter had psychiatricproblem like mania. The daughter felt fear toward anything about
the patient, but she could try to practice the oral care after
talking with membersof Home Visit team. I
thought that this wasan important advancefor this family. I could
learn that the patientfor FM is not only thepatient but all offamily members.

5. Daily life
Basically we had lunch in Ramathibodi hospital, and dinner outof the hospital. The students in Ramathibodi hospital were sokind, and we often went todinner with them. They knew a
lot of good Thai food restaurants,
so we could have a lot of delicious
Thai foods. On weekend we went
to many places for sightseeing
and shopping with them. We
could enjoy Songkran festivalwith them. This was traditional
water throwing festival inThailand. This is celebrated as the traditional New Year's Day. I
appreciate them giving us a lot of experiences in Thailand.

6. Conclusion
Through this program, I could geta lot of valuable experiences andmake many friends in Thailand.
They were very kind, so we could
enjoy everything in Thailand for amonth. They were good speaker
in English, so I could studied
English through talking withthem. The encounter with them is invaluable. This is the greatest
treasure for me.
I think that I was very happy to join this program. I appreciate allof them who supported us.