I was fortunate to participate in a workshop with many other UMN faculty in Bangkok shortly after I arrived in Thailand. The workshop was supported by the CDC, the International Organization for Migration (IOM) and the U of MN and was designed to improve physical exam skills among IOM physicians. Some of you might be wondering what exactly is the IOM and what kind of work do they do? I first learned about the IOM through my continuity clinic at the Center for International Health. When new refugees arrive to the clinic they bring their IOM paperwork which includes documentation of a pre-departure medical exam. This “overseas medical exam” as it is sometimes referred to is required by U.S. law for all refugees resettling in the U.S. For the last year or so, the U of MN has been involved in developing training sessions around the world (including Uganda in May 2018) that include didactic sessions and clinical simulations to better standardize and improve the physical exam among IOM physicians.
It was a very rich and meaningful experience to meet and interact with physicians from all over the world (from Egypt to Pakistan, Nepal, Indonesia, Turkey, Ukraine and more), all of whom share an interest in refugee healthcare. There was a moment where I had a flashback to this book that I loved as a child called “Children Just Like Me” which tells the stories of children from all walks of life in dozens of countries and wondered if perhaps that had been a foreshadowing of my future career interests.
"Training of trainers" (ToT) group from UMN, CDC, IOM at hotel in Bangkok.
The group of trainers affiliated with the U of MN included 8 physicians, 5 nurses, a psychotherapist, medical interpreter instructor and Doris Duke fellow. Most of our time was spent doing clinical simulations to practice a newly standardized physical exam checklist but there were also session on debriefing, interprofessional teamwork, pediatric development and pediatric nutritional assessment. I gave a case presentation and lecture on medical errors and interprofessional communication based on the Ebola case that occurred in Texas in 2014. It was a nice opportunity to more about medical errors, especially in the setting of diseases with public health significance.
After spending two and a half days in Bangkok most of us flew to Mae Sot where we toured the Mae La refugee camp, Mae Sot Hospital, Mae Tao Clinic and the Mae Sot IOM clinic. In Minnesota we have a significant number of Karen refugees from Burma, many of whom come from the Mae La refugee camp so it was a special experience to be able to tour the camp and learn more about the history and challenges these people have faced. Mae La refugee camp has been in existence since the early 1980s and is the largest refugee camp for Burmese in Thailand (over 90% Karen people). Residents of this camp were allowed to register for refugee status with UNHCR only until 2005, thereafter they are not eligible to register and thereby resettle (this is a complicated situation that I will not elaborate further but you can research yourself) and the result is that the refugees have very limited options: either stay in the camp where they are relatively protected from arrest and removal to Burma but with minimal freedom to move and work, or attempt to live and work outside the camps but do not have legal status and everything that goes along with that privilege (e.g. work permits, health insurance).
UMN ToT group in Mae Sot, getting ready to drive out to Mae Tao Clinic.
The IOM physician that we met in Mae Sot told us that the camps will be facing significant budget cuts in the coming year, up to 80%. Currently the hospital within the camp is funded largely by the International Rescue Committee (IRC) which is a U.S.-based humanitarian aid agency. You can explore their website to learn more about their work and donate if you are interested in supporting their cause. The topic of refugee health and human migration has been in the news a great deal lately with the ongoing conflicts in Burma, Syria and East Africa. I would encourage you to try to learn more about these situations and how you can help, including locally in Minneapolis-St. Paul. Here are two resources I came across in the last year that I would recommend to this interested in this topic:
- Movie: Human Flow
- Book: Tears of Salt
*We are also fortunate to have two events happening in Minnesota in the next few weeks related to mobile populations including refugees:
(1) Travel and Tropical Medicine Seminar (TTMS): Mobile Populations & Implications, September 19th from 6-8pm at Ben-Pomeroy Student Alumni Building on U of MN St. Paul Campus, you can register here.
(2) Lives and Challenges of Refugees, Migrants, and Displaced People Along the Thailand-Burma Border: A Talk with Dr. Cynthia Muang, October 4th from 6:30-8pm at Wilf Family Center Auditorium, Masonic Children's Hospital, more information here.
After the trip to Mae Sot, I flew back to Chiang Mai with Dr. Brett-Hendel Paterson and Dr. James Nixon where we met with faculty at Chiang Mai University Faculty of Medicine to discuss areas for continued collaboration between UMN and CMU, with a special emphasis on medical education and palliative care. I will share more about the projects I am working on this year with reflections on life in Chiang Mai in my next post.
Dinner with Dr. Nixon, Dr. Hendel-Paterson, Dr. Patama (Palliative Care at CMU) and resident Bim who recently did an elective rotation in Minnesota.
~ Megan
Extras:
We found this sign after going through security at Don Meuang Airport on Bangkok. We thought it might be nice to incorporate something like this into resident work spaces.
Sign on the wall in local restaurant, a quote from the Dalai Lama.
I was told this is technically a parasite of the tree but I feel like it worked very well as a ponytail.
