Travel letter from student exchange Student exchange in Bangkok, Thailand Name: Camilla Sørensen E-mail: Camilla_1227@hotmail.com Phone number: Who did you travel with, if any: We were 8 nurse students in my exchange program from all over Denmark, 2 on module 11 and 6 on module 6. Home institution (Denmark): VIA University College Randers Class number (Denmark): S12 Host institution/university (Thailand): Ramathibodi School of Nursing, Mahidol University. Hospital/Place of clinical placement (Thailand): Ramathibodi Hospital Speciality: Medical and surgical ward. Exchange period: 27/01 2014 23/04 2014 Before going abroad - Why did you decide to study in Thailand? I applied at my school to take the 6 th module in Thailand, because I want to learn about a different nursing culture. An international trainee period could therefore give me an opportunity to experience being away from home and find out, how a foreign culture is. Also I wanted to go to Thailand, because I was hoping for an exciting and educational period, where I could develop myself as a person, and where I could learn a great deal about a new culture and ethnic varicosities, that I could use when I got back home. I believe that we in the future will encounter more and more nationalities in the Danish hospitals and getting used to this will definitely be an advantage in my future nursing career. 1
- Why did you choose Thailand? I have been in Thailand before, on vacation. I found the culture and the people there, very interesting. Their culture is very different from ours, and I wanted to see something really different from the nursing in Denmark. I thought Thailand would be the perfect choice. I also chose Thailand, because I had the opportunity to travel along with other students in a program that was tried out before and planed in details for us. I had heard about Thailand from a friend who had been there two year before and she had had a wonderful time, which made me come to the final decision to go! And I have never regretted it. - How did you prepare for your stay abroad? I started by going to the preparation day in Aarhus. After that we made a closed group on Facebook, where we exchanged information and frustrations about our trip. Economy: I had a saving that I used during the stay. I also applied for money from Nordea Fonden and DSR. I got 2000 kr. from DSR. My approximately budget: - Thai school and accommodation: 8000,-. I stayed in an apartment with one other girl. - Tuition fee: 1200 USD (can be refunded from SU-Styrelsen) - Flight tickets: 6000 kr. - Visa: 900 kr. - Tuberculosis immunization: 100 kr. - Food, fun and traveling in Thailand: min. 6000 kr. per month (travelled every weekend) Travel: Via Facebook I arranged to travel with 6 other girls. But I already knew 2 of the other girls, from VIA Randers. One of the girls found a flight ticket with AirFrance for 6000 kr. Immunizations: I got the immunization from tuberculosis and hepatitis A+B. My doctor told me no more was needed. 2
Other preparations: From the Thai Consulate in Denmark I got a non-immigrant visa, so I could stay and work in Thailand for 90 days. I also made a list of what I needed to remember to bring, buy and do before leaving, it helped me a lot so all the thoughts was on paper instead of in my head during my module 7 exam. Experiences and outcomes - Professional outcome: The first week here, we went to the Thai school, where we learned a little Thai like to find our ways, say our names, where we lived, numbers and letters and a lot of dishes and nursing words. We learned it all very convenient, first we had the theory, and then we went to the market with the teachers and ordered fruit, or on the subway and asked for directions. It was a really good week, where we also learned a lot about their culture, holidays and religion. In Week 2, we started at Ramathibodi hospital. The first week at Ramathibodi hospital, we had many activities. - Learning about health care system in Thailand. - Library tour, complementary nursing, learning how to communicate in Thai and Thai culture. - Visit health promoting hospital. - Visit Mercy Center a home for children with AIDS/HIV. After this first week we started working at Medical Nursing unit, at Intermediate Ward. We were going to work here for the next 6 weeks. We developed our practical skills, and learned new things. How to give respiratory care, wound care, feeding and IV medicine. While practice on the Intermediate Ward, we also had lectures in - Nursing management of hypertensive patients. - Advanced care for stroke patients. 3
After the 6 weeks on Medical nursing unit we spent our last 4 weeks on Surgical Nursing Unit on Traumatic Ward. Mostly we had our clinical practice on the ward, where we gave IV-push and IV-drop medicin. We learned about non-verbal communication, about neurogical signs examen, wet-and dry dressing and wound care. While practice on the Traumatic Ward, we also had lectures in: - Pre-Postoperative Nursing care - Nursing care and management in trauma patients - Observed APN caring patients with wound and ostomy - Observed APN caring surgical patients - Observed care at surgical operating room - Nursing care and management in patients with Gastrointestinal problems - Observed APN caring patients with breast cancer - Nursing care and management in trauma patients All in all it has been really exiting; we have seen a lot, learned a lot and had a great deal of fun doing it. Sometimes we needed to be very very patient. But most of the time they have a lot to teach you, and do everything they can to tell you about their way of nursing. 4
How did you find the contact to the patients? I think the contact to the patients have been really interesting. I have throughout the process communicated with patients through our teachter or with the little Thai that I've learned. I have seen and experienced how important and how far you can come with nonverbal communication, and I have also experienced how frustrating it can be, if the patients don t understand you or if you don t understand them or the teachers. But I have also learned, that you will learn to understand each other, one way or the other, if both parts are interested in trying. Cultural outcome: Your experiences regarding the culture of the health care system? We learned and experienced that Thailand s health care system, depends on witch insurance you have. The public employees got free health care wherever they want. The private employees had bought insurances, which mostly got them free choices of where to 5
go to hospital. The rest of the Thai people were registered at the hospital near their home and the treatments were free to some point, but if they needed treatment in another hospital, they had to pay or not be there for more than 72 hours. It was really confusing because there were a lot of different insurances. After going home from hospital, most of them had one or two visits from the homecare nursing, and after that the family had to take care of them even though they could be paralyzed, have decubitus etc. It was up to the nurses to decide how much help they needed. Often it was a big responsibility, which was left to the family. We also saw a lot of self-medication, because they could buy antibiotics and all kinds of medicine at the pharmacy, we normally need prescriptions. If the patients had a common cold or some kind of disease, they would go to the small medical centers or to hospital in the morning, and sit in a line until there where time for them. Only people, who had been there before, could have an appointment. They did not have their own doctor, so they always saw new doctors, and no one, except the patient, had the total comprehensive view of the patients medical history. Your experiences regarding the culture of health care? Both from the preparation day in Aarhus and during my exchange I have learned a lot about Thailand s culture. In general Thai people are very kind and open-minded and spiritual. They respect the monks, live their lives very spiritual, where it s all about being kind from the heart to others and live a good life so you and your family lives well and get good luck. They also respect their dynasty in a whole other way than we do in Denmark, they got pictures everywhere of them, also in the private homes, and no one talks bad about them. Twice a day all Thailand stands still and listen to the royal song, which also comes if you for instance go to the cinema. The last thing they also really respect is the elderly and the teachers. When you go past them, you have to say hello and show respect. You also say Ajan Tiraporn (teacher + name) when you talk to them, and if the teachers is late you just wait. The students must always show respect for their knowledge and their position. On the ward I saw the big difference when we made physical examinations. The nurses in Thailand do much more than we do in Denmark, almost like small doctors. They are really 6
talented but also really hard to the patients sometimes. The patient is always humble to them, and do whatever the nurses tell them. I think on that point, they could use a bit more education in ethical senses and keeping the patients integrity intact. They use the culture a lot in their nursing. For instance they talked to the patients about coping skills if you are stressed, they advised you to make a merit to the monk. In the morning a lot of people went to the hospital monk to make a merit and help the sick ones. The nurses are also allowed to advice the patients in traditional medicine like herbs. And they also use a lot of alternative medicine like massage and zone therapy in their nursing. Social outcome: How did you interact with your colleagues at the hospital and at the university? I was met only by friendly and welcoming people. Sometimes some of the teachers could seam rude, but it was only because of the cultural differences and their lack of language skills, because if you talked more with them they where nice and sweet and tried everything to make us all happy. Sometimes they brought fruit, snack and food for us to taste and sometimes they brought us to some markets or temples that they wanted to show us. Some of the teachers talked about their private life with us, and some of them 7
kept it for themselves, but they all wanted to hear what we had been doing in the weekends etc. In general they were all much more open than the Danish population Did you interact with the local population? Yes, first of all we talked to a lot of taxi drivers and restaurant owners. But we became god friends with the people around where we lived. We also talked a lot with some Thai students at the school. Which important experiences did you gain during your exchange? I really learned a lot about myself. I learned to be away from home, and to live close together with 7 other girls. I also learned how to have a daily living in a foreign country and culture and I learnt how far you can come if you are open-minded to new people and a new culture. I also learned to appreciate Denmark, how we live, our healthcare system and also our taxes. But have also seen, how a society with less money, still can manage to make a healthcare system that works. Anything else you think other students need to know about studying in Thailand? Thailand is an amazing experience, and a great opportunity to see a different culture, and learn a whole new way of nursing. At the same time it s a great way to learn a lot about you and get a lot of great new friends. In the weekends, there are also a lot of opportunities for travelling. Every weekend lasts 3days, so you have time for seeing big parts of Thailand. During my stay I have been on the beach in Phuket, koh Phi Phi, Krabi, koh Phangan and Hua Hin. I have been diving in Pattaya twice, I have seen wild elephants in the jungle in Khao Yai National Park, I have seen temples and jungle in Chaing Mai and I have been around Bangkok to see parks, markets, theatres, cinemas, shopping malls, temples, being on a food course and on a biking tour around the city ect. If you choose this exchange you really have the opportunity to learn and see a lot and it s an experience for life! 8
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