Tham Hin Camp - IOM internship experience

The camp I am working in is on the border with Burma (Tham Hin), a few hours east of Bangkok (so the middle latitude of Thailand). Famous for being visited by Angelina Jolie as part of her role as representative for UNHCR.

I am now an official IOM (international organization for migration) intern. This group is responsible for the management and coordination of the health and migration in refugee camps throughout the world. They are closely affiliated with the UN. This should give me a foot in the door if I want to pursue international medicine later. It also is a great way to get my foot in the door for future jobs or volunteer experiences (it always helps when you have prior experiences and realistic expectations).

IOM is responsible for all of the health checks for refugees being resettled in the US, responsible for the cultural orientation (a 5 day 5hr/day crash course on "this is America" for those refugees being resettled to the US), and responsible for booking the actual flights for the departing refugees.
I started my first day in the camp with a bang, tb patients with medication side effects in the morning and teaching my very first sex ed/HIV education class in the afternoon. I think I would be burned at the stake if I were to teach the same info in the Utah schools. It was a lot of fun and I think it is a great start to memorable experience.

With the hiv/aids education we have at least increased the knowledge and awareness of the refugees about the dangers of IV drug use, unprotected sex and HIV. Many of the people we have been teaching about condom use have never seen or used a condom - so most of the class is spent familiarizing them with the proper use and stressing the importance of single use. We also found the resources to provide free condoms for the refugees. We even created a HIV education video in the Karen language about HIV and the importance of condom use for the Karen to watch before they consent for HIV testing as a step toward emigration to the US.

So most of my work the first week remained in the public health realm of things and I have not gotten to use my mad medicine skillz.

The second week went well, Monday I got up early 5am to travel to the camp with the "sputum van." This is the group that is responsible to collecting sputum samples (a series of three over three days) for TB screening with both smear and culture. The organization and compliance was amazing. Over two hundred patients came and hacked into a cup in less than 1 hour. The sample is then held to the light to look for chunkies thereby ensuring an adequate sample rather than a tube of saliva.Then it was again back to the secondary school to speak with students and teachers about the United States, about which there is intense (can't think of a better word - more time in a foreign country without English is dulling my wits - drat) interest since almost all of the 10,000 refugees with be relocated there. Initially it felt awkward to stand in front of a class of very attentive listeners many of whom were much older than me with such life experience - and to pass myself off as an expert about everything American is a joke. That said I relaxed and after a few questions from the crowd about my relationship status (single? married? how old? etc..) the ice was broken and it became a very informal question and answer session. With questions from how one can become a doctor to what is snow like or even if military conscription is mandatory. I really had a wonderful time and enjoyed the curiosity and excitement with in the room when they spoke about the US. It really makes you realize how different the world really is and that we are very fortunate to come from the US - which affords us some great opportunities. Little do they know the surprise in store for them. After two fun filled hours of laughing and spinning wild tails of televisions in every home and at least two cars in every drive way I had to go back to work.Next stop the IRC (international refugee committee) - IPD Inpatient Department. This building is about three times the size of a US living room. This is where the docs follow many cases of malaria, dengue, fever, GI distress and deliver about 1 baby/day. I went there for morning rounds with Dr. Anilay (unsure of spelling) who is a Ethiopian trained physician whose husband works in Bangkok and she has a 6 month contract with IRC. She received additional training in infectious disease and was really informative about the course of the diseases and early physical exam warning signs since they have only the ability to do a urine dip stick, hemoglobin, dengue test and a blood smear. I learned a ton and realized that if I were to work with the refugee population I saw myself more in this role, though no surgery was done here (a bit of a conundrum for a future surgeon). I am still amazed when doing medicine internationally how clinics and practitioners can do so much with so little resources.
Boy that was just Monday morning.

I did continue with HIV and AIDS education though less than the previous week because I wanted to experience as many aspects of the health responsibilities within the camp - including an intense discussion learning about the vector control and water sanitation practices within the camp when I was concerned by a man who I thought was pouring dimethrin (an insecticide used for fogging machines) into the water supply. Turned out to be a coincidence of circumstance and another great learning opportunity.

Then it was off with Dr. Yen (the TB expert) north to Wat Thamkabok an old Hmong refugee camp 2 hours north of Bangkok. There I learned about the difficulty of a successful TB treatment program among a transient population where many of the refugees would travel outside the camp for the day to work or travel back to Burma. Thus, they would miss their daily medication doses. This visit also emphasized the importance of adequate precouseling for TB. Dr. Yen and I visited the camp to talk about TB treatment with the remaining Hmong refugees (20 people) who had not yet immigrated to the US because they continued to be sputum and culture positive for multi drug resistant tuberculosis. Originally, these patients were told that they would only need a few months of treatment – which has now extended for some to be over 2 years. With this miscommunication and the side effects of the 2nd line treatment necessary for the eradication of MDR TB infection, the Hmong people lost faith in the medical care they were being provided and were reluctant to continue – even if this meant never going to the US. Additionally, this non-compliance has lead to even more drug resistance and treatment programs with no realistic end in sight.

I continued to have similar experiences and remain involved in both the public health and medical operations of the camp during my last week. There are many other eye opening and learning experiences but this was a good smattering. As to whether I am a future surgeon or a future public health officer. I am still sure that my medical interest lay in surgery - you really can't beat the instant gratification and the ability to truly help someone when they need it most. I have not yet found the perfect combination that is out there for me but I am sure it exists somewhere. My experience at the camp just scratched the surface of the vast world of international health and refugee care. It truly was an amazing opportunity.