I arrived just after the official start time, 8:30, and we actually started only 10 or 15 minutes later. The opening ceremony involved several of the head doctors in IM plus some ministers giving speeches. I had a moment of sheer terror when the WHO representative was asked to speak and I realized that I didn’t know if I was going to be asked to contribute to this. (Fortunately, I wasn’t.) In America, this would be a brief welcome formality, but in Lao the opening and closing ceremonies are important parts of the conference. So important that there are usually multiple camera men, and today, 2 videographers. I have to be very careful not to make faces during the opening ceremonies, because the videographers seem to particularly enjoy recording the one Falang in the room.
At the end of the opening ceremony, the Minister of something related to health gave a long speech that involved frequent use of the Lao word for child, and I watched the other dignitaries and attendees expressions of alarm and then amusement as we all realized he had no idea what kind of conference he was at. Bor Pben Yang, at least he knew it was about doctors and patients.
The dignitaries at the opening ceremony.
The first talk was a series of studies on patient satisfaction on one of the inpatient and outpatient wards at Mahosot. Interestingly, despite what would be considered sub-standard facilities (one one of the nicest, newest wards in Lao), 100% of the inpatients and more than 60% of outpatients thought the quality was “Good.” The other options were moderate or poor. Generally, positive answers were in the 85-100% range on all the subsets of the surveys, which were conducted twice several years apart. I don’t suppose there’s any way to figure out whether the patients really are that satisfied, they fear if they answer negatively their care will be affected, or they are just being polite non-complainers. I can’t imagine finding a group of American patients who would answer a similar survey the same way, however.
At the first coffee break, I tried a banana-leaf wrapped snack. I was skeptical, because several times in the past week the banana leaf has been filled with pork, sticky rice, and bean paste which I don’t actually like that much, but eat because it’s usually offered as part of some ritual event. This was sweetened coconut sticky rice, egg paste, and a pudding that i think was made of tapioca, though, and it was delicious. The rest of the morning was Thai doctors and the Lao endocrine fellow introducing them and the topics. It is nice to see Vasana, one of the graduates of the first residency class and now a HF sponsored fellowship grad, in a leadership/teaching role now.
Dr. Vasana introducing topics and her Thai colleagues. Isn't she beautiful?
I ate lunch in the VIP room, with the Lao senior teachers. Alounxay, a recent residency graduate and staff on the Cardio ward, served the most senior teachers lunch - as in, opened their boxed lunches and set things out for them - and then made coffee and tea for everyone as they finished their food. That’s a job you won’t find any American staff doctors doing. . . cultural differences. The box lunches were pretty good - pork and beans and white rice with a few slices of fried mekong fish or fried rice and soup - so I’m glad they saved money on a buffet.
After lunch, I went downstairs to peruse the pharma shopping area. It was interesting, especially when I realized the book stand was run by one of our residents - a second year who is not super motivated on the wards. The residents had mentioned something about his driving to Thailand for books in the past, which I thought was odd, but didn’t question further. I guess he’s running an import business now. He was doing brisk business with residents, staff, and medical students. I can’t really begrudge this - he is giving access to resources that they otherwise might find harder to get - and I think his mark up was only a dollar or two per book. Maybe he should have become a businessman, not a doctor. I bought a copy of the mass general handbook of internal medicine “Pocket Medicine” - it’s smaller than the real thing, has a beautiful pink cover, and was 6$. American MSRP - 60$. I probably should have owned one in residency, but better late than never, eh?
Afternoon was mostly Thai doctors - Movement disorders, chronic kidney disease, spondyloarthropathy - before the coffee break. At the end of each session, awards were presented to all the speakers - wrapped presents in boxes for the Thai visitors and envelopes for the Lao speakers. One of the senior doctors, or if present dignitaries, is called to the front of the room where a lovely young woman holds a silver bowl with the present or envelope in it. The presenter takes it out and hands it to the speaker while the audience claps rhythmically. Then they hold the pose of giving/receiving until the pictures are taken.
Presenting thank you presents.
After the coffee break, we had a really great presentation from a Lao MD/epidemiologist about causes of fever in 2 distant provinces - one far north and one far south - that was impressive in reminding me of the quality of research that’s being done here with limited resources. And how much it can help them with treatment, like choosing antibiotics that the common local pathogens are susceptible. Brent would be please to see how frequently this means Doxycycline rather than ofloxicin, azithro, or ceftriaxone. Then we had some case presentations, one of ITP treated with cyclophosphamide which prompted a lot of discussion and I’m pretty sure there’s no evidence for, but since I didn’t completely understand the presentation, I kept my mouth shut. (I had just given a talk on thrombocytopenia thursday to the residents, so I’m a little worried they are getting mixed messages, but I think the discussion was heated enough to let them know that’s certainly not a well-accepted first line treatment.)
Thai visiting doctors and their current and former fellows and a few of the senior Lao doctors who have made fellowship possible by building the program.
The second day of CME featured: a Lao Nephrology fellow who will be returning from Bangkok soon talking about Rhabdomyolysis - (seems particularly relevant given all the earthquakes recently including one on the Lao/Myanmar border), our senior GI physician talking about GI cancers, another Thai physician discussing the interaction between PPIs and Plavix and the development of H Pylori resistance in Thailand and the interaction between PPI metabolism and H pylori eradication, several case presentations, and discussions of dialysis access and bronchoscopy in Laos. It all seemed useful and relevant, not to simple or too complicated to be useful here. And the PPI metabolism was new to me too - interesting! The first coffee break featured wafer-like, crispy cookies and small green jelly/coconut/mysterious centered treats wrapped in saran wrap, as well as the usual eclairs and cake. Lunch was fried rice and soup or pork and beans and breaded chicken with white rice. I opted for the fried rice. The second coffee break was fruit and very sturdy jello-like heart shaped pudding treats both days. Oh, and powdered soy milk in hot water - I liked the hot powdered milk drink in tanzania, and I found this tasty too (of course it has sugar added), although after a day of sitting and listening to lectures with breaks for food, I certainly didn’t need the calories. I tried to replicate the powdered milk drink in america, but was unsuccessful. There’s something about the texture of the milk powder that makes ours not work.
So overall, although I don’t fully understand most of the content, CME was positive. It was organized entirely by the Lao doctors, seemed relevant, and certainly showcased some HF grads in leadership roles (in addition to the lecturers, many of the people instrumental in planning are our former residents.) I wore 2 beautiful new sins an got many compliments including the ultimate one - “If you changed your hair color, you would be like a Lao woman.” (I challenge you to find a more gracious and complementary group of people than the Lao, so I know it’s not personal, but it’s still nice.) The residents looked engaged in the lectures, the residency grads and even a couple residents asked questions, a good sign that they are both paying attention and learning, and not afraid to speak up. Pharma paid for part of it, but didn’t seem to have any impact on the lectures themselves, and was not given time to speak, just space downstairs to sell the attendees stuff (and give them pens and hand outs, of course.)
The beautiful ladies of IM - Residents Payvanh, Khamvay, Libby, Velouvanh (Fellow at KKU) and Phouthasone. Phouthasone was unhappy about being in the sun. Notice my beautiful woven silk Sam-Neua style sin; This is what gets the compliments, not actually me.:)
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