Reflections on Time Abroad
An Externship to Thailand Teaches Important Lessons and Expands a Doctor's Perspective
"'Sawasdee,' a traditional Thai salutation meaning both 'hello' and 'goodbye', continues to echo through my head each time I think about my international psychiatry externship during my 2nd year of residency. My stint in Bangkok, Thailand was one of the best experiences of my residency training and I continue to have fond memories of the month I was lucky enough to rotate at the Chulalongkorn Hospital and work with some of the friendliest, most gracious people I have ever met.
"While there, I trained under Dr. Rasmon Kalayasiri, (a substance abuse researcher who collaborates with Yale's own Dr. Robert Malison), and shadowed Chulalongkorn child psychiatry residents as they completed their daily clinical duties and didactics. Needless to say, the experience was both incredibly fun and enriching. I was fascinated to get a glimpse of how psychiatry practice and training differ from their counterparts in the United States. Thai-unique, non-American elements, including the open air design of the hospital, traditional white nurse's uniforms (complete with caps), purple patient uniforms/gowns, and the emphasis on exercise for the patients were just a few of the many interesting things I witnessed.
"All of the psychiatry residents were young (in their early 20s) and the majority of them lived together in spare quarters near the hospital. As a result, the kinship among the residency class was similar to that of a large family, namely in the closeness that can develop, but this 'family' was not at all exclusive; I was warmly embraced into their group, and any hesitation I had about traveling so far by myself disappeared upon my meeting these people.
"Highlights of my trip included singing group karaoke, staying in a traditional Thai house in a remote part of the country, exploring a floating market, and visiting some of their homes. I was delighted to spend my evenings with the residents as they poked fun at my exuberant appetite for their delicious cuisine; on weekends they were my personal tour guides as I visited all the spectacular sights in Bangkok.
"With regard to the research component, I had the opportunity to visit multiple substance abuse rehab facilities. One rehab center, which was particularly memorable, was run by Buddhist monks and open to anyone with a substance use disorder, including international clientele. The patients I met there described drinking a concoction of herbs prepared by one elderly monk (apparently the sole proprietor of the recipe) to facilitate their detoxification. Patients at this center were taught how to meditate, to listen to their bodies, and to acquire strength and inner peace. They would awaken early in the morning and perform chores to keep the facility clean and well-maintained. Art was used therapeutically, and the patient artwork on display included an array of stunning sculptures and paintings.
"Indeed, the opportunity to learn about one's specialty through a different culturally lens is one that I heartily recommend seizing. Just as recreational travel always has the remarkable effect of expanding one's perspective, traveling for educational gain stretches the scope of learning while invigorating, rather than enervating. I have made friends as well as professional contacts in Bangkok, and look forward to reuniting with them someday declaring: 'Sawasdee!'"
Dr. Christina J. Lee, Yale Psychiatry Faculty
Investigating the Use of Pharmacologic and Behavioral Treatments in Malaysia
Dr. Tejani was also able to develop an independent project, which involved describing methods of heroin and amphetamine administration in Malaysia and investigating how these have changed over time since the introduction of heroin to the country. She was fortunate to attend a regional conference on opioid use and to learn from clinicians and researchers throughout East Asia and the South Pacific.
She remarks, "I came away with a deeper understanding of substance abuse issues in the region and a level of compassion and commitment to those struggling with these disorders that would not have been possible without this experience."
Dr. Emily Tejani, Yale Psychiatry Resident
A Cross-Cultural Experience in the Psychiatric Wards of Changsha, China
"The experience provided me the opportunity to see how similar and yet how varied psychiatric presentations and treatments are across the globe. In Xiangya hospital, drug company pens and tissue boxes filled the busy outpatient attending's office who had multiple medical students hovering around a patient in distress -- a familiar sight. Yet not so recognizable was an almost entire hospital with patients experiencing first break psychosis (given limited resources, most beds were allocated to first break patients) or mania and the absence of a requirement to obtain consent to speak with family members (physicians there found it peculiar that we would require such consent given that it was in the patient's best interest to have collateral information). The experience in China helped broaden my Western-centric view and provided me with recognition of the similarity of psychiatric symptoms despite a significantly different cultural backdrop. I am extremely grateful to the residency program for helping to arrange this cross-cultural experience; without help from the program in securing funding and collaboration with the Yale China Association this trip would not have been possible."
Dr. Amelia Villagomez, Yale Psychiatry Resident
A Resident's Experience in Learning Stress Resilience
"I still remember the moment when I first learned of the earthquake in Sichuan, China on May 12, 2008. Sichuan is my home province . The deadly earthquake took more than 80,000 people’s lives. Fortunately my family survived, but I cannot possibly imagine how much they were traumatized by this unbelievable disaster. When I heard many school students died in the earthquake, I decided to go back home to help. With support from former program director Dr. Kirwin and present director Dr. Rohrbaugh, I took a three-week vacation to go back to Sichuan with Dr. Heather Goff, an assistant professor at YPH. We decided to hold workshops for 'school-based post-trauma intervention' in three cities with the most severely damaged areas. Workshops were sponsored by Professor Lin Chen, the director of the National Key Laboratory of Cognitive Science in the Chinese Institutes of Academy.
"We fortunately had support from well-known PTSD experts at Yale, Dr. Southwick and Dr. Marans, in the Child Study Center. Taking their advice and guidance, Dr. Goff and I constructed the syllabus for the workshop. Our goal was to help school teachers understand the psychological needs for their students, normal and abnormal reactions to earthquake, and basic counseling skills. Our team included one coordinator from Professor Chen’s lab, local government staff and two voluntary translators. One of them was a third-year medical school student from Cambridge University in London who came back home for summer vacation. In three weeks, we had trained a total of 268 middle school and high school teachers. At the beginning of each workshop, we asked everyone to say a few words about themselves. Without exception, everyone talked about their experience during the earthquake. Although I learned much information from the media before I went back to China (my parents compiled two volumes of earthquake news from a variety of newspapers and magazines), I was still shocked by the magnitude of the tragedy. I was deeply moved by stories told from people’s own experiences. One day, when we were in a workshop, several teachers suddenly jumped up. Neither Dr. Goff nor I realized that it was an aftershock until someone shouted 'Earthquake! Earthquake!' Desks and lamps were shaking for seconds. Nobody left, the workshop continued. Heather and I used it as an example to teach feelings, thoughts, and behaviors.
"Three years passed by since my trip to Sichuan. Many people and their stories are still in my mind. The person whom I miss the most is a 7 year-old elementary school girl. This little girl survived from the school building collapsing. However, some of her friends died. She came to the workshop with her mother and quietly sat in the classroom playing with her mother’s cell phone. During the break, her mother told us that her daughter had changed to a different person since the earthquake. Prior to the earthquake, she was very happy and outgoing, the most popular girl in the school. She became quiet, shy and fearful, and could not be alone for any second after the earthquake. Her mother had to take her to the workshop. She asked her mother to buy her a bottle when they were shopping together, which made her mother worrisome. We did not get a chance to talk to her or her mother as we tried to cover as many subjects as we could. The next day, the little girl, wearing a bright yellow skirt, came with her mother again. By the end of the workshop, she told her mother, 'Mom, I am normal. I am not crazy. I just acted younger than I am.' She approached Dr. Goff and I and asked to take a picture together. Before I went back to Sichuan, I doubted whether or not I could help people who were deeply traumatized and suffered so much from their loss. This little girl gave me courage to complete our mission. She taught me that people, even as young as 7 years old, could be resilient.
"It was an unforgettable experience from my residency training and my professional life. I learned more from those earthquake survivors than any textbooks and papers that I have read. I am always grateful to everyone who helped me accomplish this workshop. My thoughts are with those dedicated teachers and their young brave students."Dr. Ke Xu, Yale Psychiatry Faculty