October 2015 | Issue 20
Building new bridges for electives
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By Melvin Lim

Class of 2019

As a new medical school, LKCMedicine does not yet have students on elective in Year 5. However, planning for that phase of our student journey by the faculty is well underway. During the September recess week, two members of the clinical faculty and four students from Year 1 and 2 visited the Mae Tao Clinic (MTC) in Mae Sot, Thailand, to explore elective possibilities.

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 The team with Dr Cynthia Maung (centre)

Speaking to Dr Cynthia Maung, we found out more about the clinic she established in 1988. Today, the clinic not only provides healthcare, but also advocates refugee rights. We also had the chance to observe MTC's various inpatient departments. Aside from witnessing the remarkable way in which the clinic's highly trained medics (a group of qualified nurses who in the absence of doctors have taken on additional responsibilities through hands-on training) worked, we also gained a better understanding of the challenges and conditions faced by the patients, who were mostly displaced Myanmar and ethnic people living along the picturesque Thai-Myanmar border.

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L-R: Assoc Prof Tham, Dr Mikiko from Japan and Chun Jie

In the medical inpatient department, Year 1 student Wong Chun Jie observed the crew of highly capable international volunteer doctors at work. Despite the seemingly underdeveloped state of the clinic, MTC remained comfortingly familiar in its use of drugs, simple diagnostic tools, and certain simple procedures. Since the clinic does not possess any imaging modalities other than an ultrasound machine, this meant that X-ray images were very rarely available. This made us reflect and appreciate even more the importance of taking a good patient history and doing a physical examination when caring for a patient.

Year 2 student Judith Goh was attached to the reproductive health department and had the chance to witness a few of the roughly 2,700 deliveries that occur at MTC a year, which was all-in-all a very new and fascinating experience as the Year 2s have yet to start their obstetrics and gynaecology block. From our professors, we understood that as medical students, it was nigh impossible to see and participate in a delivery in Singapore.

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Judith (right) with medics from the reproductive health department

In the paediatrics department, Year 2 student Aletheia Chia saw a variety of conditions, ranging from the congenital to the acute to the outright rare. Many of the cases were complicated by underlying malnutrition. In addition, the remarkable level of competency the medics in MTC possessed was clear for all to see. They function as doctors, nurses, pharmacists, counsellors, educators, cleaners, cooks and students all at the same time, while performing their job to the best of their abilities despite only having a short training period.

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(L-R): Aletheia (right) with a medic from the paediatrics department; me examining a patient at Mae Tao Clinic

I was attached to the clinic's surgical department and saw the efficient manner in which surgery can be done with limited resources. From the way in which patients were treated and interacted with, it was apparent that the medics and doctors at MTC focus on delivering the highest standard of patient-centred care. Despite the challenges the clinic faced and the scarce resources, the standard of care is always the utmost priority — to the extent that clinic staff willingly accepted pay cuts when funding dropped, instead of compromising on patient care.

In many ways, MTC resembles a health institution in Singapore. It is organised into internal medicine, paediatrics, reproductive health, eye, surgical and even acupuncture departments and has inpatients and outpatients. The diseases seen at the clinic are not unlike those seen here - lifestyle diseases - albeit the disease progression is typically further along compared with anything we would see locally.

Perhaps one of the strongest resemblances between MTC and any other clinic in Singapore is the compassion and enthusiasm that cut across any language or cultural barrier — shared and felt amongst the medics, doctors and, for five short days, us four medical students — serving toward the delivery of patient-centred care.

It was an incredibly educational and eye-opening trip for our team. On behalf of the students, I would like to express our gratitude to the clinical faculty, LKCMedicine Assistant Dean and Heads of Year 3 and 5 Associate Professor Tham Kum Ying and National Neuroscience Institute Senior Consultant Associate Professor Tchoyoson Lim, as well as the staff and medics of MTC for their hospitality, guidance and willingness to educate us.