Between Singapore and this post, we explored Bangkok before arriving in Chiang Mai by train for our placements. To keep it brief, in Bangkok we explored the many night markets, we visited the shopping malls (mainly Siam Paragon and Central World) and we visited a few temples/palaces. We also went to Calypso ladyboy show in Asiatique – it wasn’t bad, but you had to tip them for a photo. Also managed to find some mega-yakult, sugar cane juice, Nama chocolate and ate lots of pad thai. We went to Thip Samai – a restaurant that apparently serves the best pad thai in Thailand – and it was only $THB80 a serving!
When we arrived at the Gap Medics’ ‘Jungle House’, we met briefly with the other newcomers and chilled before we went out for the Sunday markets in the city. The Jungle House is located about 30-40 minutes from the city, so every one-way trip to the hospital takes around that long.
Our first day at the operating was only a half-day. The first thing we observed was a vasectomy from outside of the operating theatre. It appears that the surgeon made incisions on each scrotum, found the spermatic cords before surgically resecting a segment from it. The scrotum was then stitched up again and there was quite a bit of blood. Afterwards, the surgeon talked with us and mentioned that when finding the spermatic cord, the vas deferens (which are the conduits for sperm in ejaculation) may slip out of the spermatic cord when we grab it. He also mentioned that blood vessels appear similar to the vas deferens, but the former has an endothelial layer, so we can use tests to detect the presence of endothelium and hence find out whether we grabbed a blood vessel or the vas deferens. In a few months time, the doctors would check for the presence of sperm in the patient’s ejaculation. If there is azospermia (no sperm), then the vasectomy was successful. If there is oligospermia (some sperm), then we check again at a later time and the patient may use condoms to ensure contraception.
The second thing we saw on the first day was an operation to remove kidney stones. The surgeon talked with us and mentioned that there were 3 methods: shockwave, open surgery (if the stone is greater than 10mm) and endoscopy. He also mentioned that the procedure costs around $THB7000-9000. Spinal block was firstly administered to numb the back, local anaesthetic was administered and some device was attached through the urethra from the glans penis. Support was thread through so that the camera could move fluently and a basket was used in an attempt to grab the kidney stone. So during the endoscopy, we could see everything from the camera displayed on a screen. The uretic orifice was dilated by an inflation from a balloon and we saw lots of bacteria indicated by floating white stuff. When we finally got to the kidney stone, it appeared big, brown and yellow. We couldn’t grab it out, so we tried shockwave, which sounded like a kind of like a pneumatic drill, but it didn’t work. During the procedure, support was replaced frequently. Unfortunately, we had to leave before they could get the kidney stone out.
After our first day, we had a basic Thai lesson and a global health lesson on medical terms.
Our second day was a lot quieter. The first thing we saw was a resection of the prostate gland because of benign prostatic hypertrophy. Like the other two surgeries, this involved a penis as well and the tool used was called a resectoscope. The resectoscope was fed through the penis like the previous case and we could see a ring of wire using electricity and heat to cut through the tissue easily whilst gas was being produced. On the monitor, the tissue appeared pale, however it appeared a lot darker outside of the body. Lots of blood mixed in saline solution was collected as the prostate is a vascular organ. In benign prostatic hypertrophy, usually about 80% of the prostate is removed. However, the whole prostate is removed in a carcinoma. The reason why the whole prostate is not removed is because the prostate is located external to the urethra and it plays a role in ejaculation contribution and erectile function.
The second thing we saw was a right pneumothorax due to fractured ribs caused by a motorcycle accident. Because fractured ribs heal themselves, the goal of the operation was to drain the blood from the right lung. Firstly the skin over the right lung was sterilised with betadine, local anaesthetic was administered and the surgeon punctured the a hole through the lung. Quite a lot of blood spurted out before the surgeon jammed his finger in to stop the flow. He then pulled out his finger in order to connect the the orifice with a tube and tied the skin to the tube with suture. The collecting flask was placed under sea level and collected about 400 cubic centimetres of bloood. Afterwards, the doctors and nurses called out the patient’s name to wake him up.
After our lunch break there was a cataracts operation which we could really see much of. The surgeon didn’t want us to go inside the operating theatre due to religious beliefs, but we watched from the outside. Our supervising nurse told us that they were going to replace her lens with an artificial one. Because there weren’t any surgeries for the rest of the day, our supervising nurse taught us basic suturing and we bummed around until 4.30pm. At night time, we had a global health class on dengue fever.