February 2016 | Issue 22


Seeing the full spectrum of trauma in Northern Thailand
Reudi Chan.jpg

By Brenton Sio
Class of 2018

During the year-end break, I spent a 10-day elective clerkship with the trauma team of the Maharaj Nakorn Chiang Mai Hospital, in Thailand – Chiang Mai University's teaching hospital. I had become interested in how large regional hospitals manage trauma cases and the types of cases they treat, after accompanying a team of doctors from Tan Tock Seng Hospital (TTSH) on a trip to conduct the Skills in Trauma And Resuscitation course at Calmette Hospital in Phnom Penh, Cambodia. With the help of Assistant Dean for Years 3 and 5 Associate Professor Tham Kum Ying, I applied for a clerkship at the hospital.

s a Level 1 Trauma Centre, the Maharaj Nakorn Chiang Mai Hospital receives the most severe trauma cases in Northern Thailand, sent either directly to the hospital if the casualties are nearby, or from referrals by rural hospitals that lack the facilities to manage severe cases.

During the holiday season, Chiang Mai, which is a travel destination for many because of its distinct beauty, cultural heritage and natural attractions, sees a significant increase in road users, particularly motorcyclists. Without strict enforcement of helmet laws, motorbike-related accidents are a notorious reason why many people are rushed to the hospital every day. These patients can come in with anything – from minor injuries such as superficial cuts and abrasions, to serious trauma such as traumatic brain injury and internal bleeding.

On the first
morning, I met the general surgical residents of the trauma team in the operating theatre. They were just completing a tracheostomy (the insertion of a breathing tube through a cut in the neck) for a patient involved in a motorcycle accident one week ago. He had suffered severe head injury, and required long-term mechanical ventilation. Shortly after the operation, the trauma team was activated to the Emergency Department (ED) to prepare for another victim of a road accident. This patient had also suffered a severe head injury, and the rural hospital where he was referred from had already intubated him and inserted a chest tube to drain the blood and air in his chest cavity, in order to sustain him on the two-hour journey here.

Me with the statue of Prince Songkla Nagarind Mahidol, Father of Thai Modern Medicine, in front of the ward building

I met the rest of the trauma team at the ED. The trauma team, led by an attending trauma surgeon, was made up of residents of the orthopaedics, cardiothoracic, urology and emergency departments. When the patient arrived, the team worked seamlessly to evaluate all his injuries. Having previously joined the TTSH team of doctors at Calmette Hospital, I was really able to appreciate the approach the trauma team has taken to manage this patient. The coordination between and composure of all members, while working under immense pressure, are crucial for the best outcome. Although this patient needed urgent neurosurgical intervention to control the increased pressure in his head from bleeding, there was no other severe injury and he was eventually stabilised. Within an hour, we were back in the operating theatre, finishing the other elective operations scheduled for the day.

​L-R: Enjoying lunch at a local restaurant serving Northern Thai cuisine with Year 5 Chiang Mai University medical students; and visiting a yearly carnival with Year 3 Chiang Mai University medical students

​The team attends to a variety of trauma patients, including victims of road traffic accidents, falls from height, machinery-induced injuries, and interpersonal violence just to name a few. There is hardly a typical day, and the severity of injuries sustained by the next trauma patient entering the emergency room is never predictable. Not to mention, trauma activations can occur anytime. Indeed, throughout the year-end holiday season, the team was kept busy round the clock, regularly making trips into the operating theatre late in the night.

It was still term time for the local medical students and I had the opportunity to meet some of them. They
were extremely helpful in translating for me when communicating with patients and keeping up with team discussions. They also brought me to the city's many iconic places to be immersed in their culture and to savour some local Northern Thai food. It certainly enriched the experience I had in Chiang Mai.

Whilst being known as a fast developing city, places like Chiang Mai have much to offer and share with young
medical professionals like us. As we progress through the years, it is important to build close relations with our medical counterparts in the neighbouring countries, in order to create more learning opportunities in the future, and to appreciate the delivery of healthcare in different settings. At the end of the day, we all have a common goal – to provide the best possible care for our patients.