Monday, March 9, 2015

Final update from IM resident Joe Messana during international rotation in Chang Mai, Thailand



This week’s clinical responsibilities were unfortunately abbreviated secondary to illness. A learning point from my own case of bacterial gastroenteritis deals with the antibiotic recommendations that we are instructed to follow in America. We are told that due to give azithromycin as Campylobater resistance to fluoroquinolones is 20% in the US and is likely higher when infections are acquired during travel abroad. However, physicians in Chiang Mai typically still start with ciprofloxacin for traveller’s diarrhea initially and may give azithromycin if there is no clinical response. I had two days of azithromycin treatment without clinical improvement, but my fever broke 6 hours after ciprofloxacin. Notably, there were two formulations of ciprofloxacin I could take which were available at the local pharmacy without need for prescription. One was cheap, had higher rate of GI side effects, and was less potent, while the other cost 90 baht a pill (~@$3) and was much more reliable. My course also drew my attention back to how remarkable antibiotics are. I think I may have forgotten this fact as we prescribe them routinely, but my disease was controlled in a matter of hours. They are such powerful tools when used appropriately. It also harkens back to the talk I gave the weeks before regarding antibiotic resistance, and how that prospect is so frightening. 

In clinic, I’ve been participating long enough to start seeing patients for follow-up, which is rather gratifying. One repeat patient is seropositive with Hep B coinfection, and she came back for follow-up and vaccinations prior to her leaving for an extended trip in the US. It was interesting to think about this case from the opposite side of the ocean – thinking about people traveling to the States as opposed to the VFR that I see in my continuity clinic back in Minneapolis that are leaving the US for a period of time. 

Working with Dr. Parichat in outpatient clinic, I saw 3 AOID patients in just one day! This phenomenon is so intriguing. I’m eager to do more research about it. Apparently it is also prevalent in Taiwan.

This week marks actually marks the end of my infectious disease exposure at Maharaj Hospital. I start a stint in nephrology next until I leave for the states. Time is so relative, and just unceasingly seems to fly forward. It feels like I just arrived here a week or two ago. Being in this community where Buddhism is so prominent, you could definitely feel the increased “tone” of mindfulness in the general population. Hopefully this exposure left a long-lasting imprint that I will take back with me to the states.

Two weeks in

*disclaimer* This was written a few days ago and now being posted!   Mambo from Arusha! It has been two weeks into our four month long stay...