Arrival and Orientaton - Work:

I am starting my second week in Lao. I arrived last Sunday (one week ago yesterday) after 29 hours in transit - I flew Denver-LA, LA-Bangkok (17 hrs) and Bangkok-Vientiane with a long layover in Bangkok. I left at 6:30PM on Friday and arrived at noon on Sunday.

I spent the first week getting to know the people and places I will be working. There are 22 residents in the internal medicine program - 8 interns and 7 second and third years. They rotate at 3 hospitals - Mahosot, Settarthirath, (Setta) and Mittaphab. Mahosot is the closest to my home, where I will give lectures on Thursdays, and where I will teach beginning English on Tuesday and Thursdays. There is pretty good teaching on cardiology, GI (which is actually more general medicine) and Infectious disease wards there, so I will probably not do much rounding at Mahosot. However, it is home to the majority of the senior Lao doctors involved in the residency program, so I should get to know it well.

Setta is likely where I will round most days - there are few internal medicine graduates there currently, so there is a need for teaching rounds. Right now the three residents at Setta speak good English, so we were able to understand each other last week. It will be more interesting when the residents with less English proficiency rotate through. Christine (my predecessor) speaks enough Lao to do half or more of the presentations in Lao, so I will be a challenge for the residents.The residents will pick out a few cases to review with me each day. Last week we saw AML with tumor lysis syndrome (there is no chemo here and even if there were neutropenic fevers would be a nearly insurmountable risk,) fever which was not dengue or rickettsia (two of the more common causes of fever,) and likely temporal arteritis with no ability to do biopsy confirmation and an ESR that had been ordered but not drawn, but improved with steroids. Since they save the hard cases for teaching rounds, it will probably often be challenging for me to figure out what if any recommendations I can give.

Mittaphab is the newest of the three hospitals, but looks the oldest, and is undergoing renovations and new construction, so we spent several minutes wandering around the basement looking for administrators who’s offices had been moved from the (now empty) administrative ward. It has a fairly good teaching structure with 3 general and one cardiology and one ICU team, all of whom have staff doctors that are internal medicine grads and round with the residents daily. There was good teaching happening there when we visited last week, so I will likely not spend a great deal of time rounding there.

I met many people last week - IM teachers, hospital directors, University of Health Sciences staff doctors who oversee our program and the medical school, and many of the medicine and pediatrics residents. I am sure I will not remember all of them, but hopefully they will be forgiving when we meet again. I also (theoretically) learned how to get many places. I am certain I can get to Mahosot (a few blocks by bicycle) and to the Thai-Lao friendship bridge (where I will pick up doctors from Thailand for grand rounds), and pretty sure I can get to Mittaphab. Today I will try to make sure I can get to Setta, where Christine and I can follow up on the patients we saw last week.

This week, I will start Lao lessons, teach my first Beginner english class to the residents, and give my first Thursday lecture (luckily, I get to use the first week to introduce myself.)