The Buie's last day

Thursday was the Buie’s last day teaching with us this year. It was a real blessing having them here with us and we pray they will be able to return next year. The students gathered around and prayed for the Buie’s at the end of the day as seen in this picture.

We also all learned something new today. One of the students asked us about a bean none of us had ever heard of before. The student had heard that it is poisonous, but it is popular to eat in Burma. Thanks to the newly installed internet at the training facility (thanks to Bob Bowling!) we looked it up instantly. The Djenkol Bean is poisonous and causes kidney disease when eaten Raw. However, if properly prepared by boiling it and changing the water a time or two, or by soaking it in saltwater for a few days, it takes the poison away and it is quit nutritious. Then we looked up how to treat Djenkol poisoning so the students are prepared for this very possible emergency in Burma. Here is a picture of the Djenkol Bean. More information can be found by searching it on Google. The students did add that it smells awful. I occasionally eat some strange things but I think I will just stay away from the Djenkol bean for now.

We started off yesterday with more small group presentations per Dr. Buie’s assignment the night before. They covered all sorts of abdominal pain including appendicitis, ulcers, gallstones, urinary tract infections, and ectopic pregnancy. Dr. Buie also taught on one of the more

important subject of T.B. We were surprised at the high numbers of TB the students are reporting. Of the 24 students 5 of them reported TB in their family and 22 had TB in their village.

Gayle Buie used very creative and fun ways to teach about nutrition. She used yarn to show how long the intestines were and made peanut butter and banana sandwiches to talk about food groups. This was a tasty idea and for most of the students their first peanut butter and banana sandwich.

Gayle also used a sock with a tennis ball in it to

show how food moves through the intestines. The students really enjoy and get a lot out of the hands on activities.

Sawadee Krap from Thailand,

Rick

A Good Day of Worms and Black Eggs!

I finally got a few pictures of the Audience Response System I talked about in the last blog. I think the pictures help explain what it is and how we use this technology in the teaching. You can see the question and then the bar graph of the students' answers instantly on the screen behind Dr. Nilson.

The students gave a couple more presentations today. Here is Ken Saw in one picture and a small group presenting in another.

We used poor Bob Bowling as an example to the class about how to address health and safety issues in villages. Bob is wrapping up the big dormitory construction project on the Kalnin Leadership Center property where we do the teaching. Awhile back we had the students walk around the property and find health and safety issues. As each issue was identified we also had them set up an action plan on how to correct it. They did well with issues they can address themselves like putting fish in empty bodies of water so no mosquitoes will grow. However, they have difficulty forming committees or addressing authorities. Because there are still no handrails on the steep outside steps to the newly constructed dorm, Bob was the perfect scapegoat and example. Here is a dramatic photo of the confrontation of Bob by Dr. Nilson in front of the class! It was all in good fun, of course. Bob made a call to the construction company and the rails should be up by the end of the week. We can only begin to understand what it is like in their country, but obviously they are not encouraged to address authorities with any requests like this.

This week Dr. Jim Buie and his wife Gayle are teaching the Barefoot Dr students. They have both taught Barefoot Drs in the past but not for a couple of years, so all these students are new to them. It has been great to have their experience and encouragement this week. Today we learned about WORMS! They are totally disgusting little parasites that can be a huge problem in the developing world. The Buies made good use of some gummy worm props to illustrate their points. Also quite tasty! Gayle told the students something to the effect of “The worms havealready eaten you, so you might as well eat them now!”

They also brought some useful gifts for the students including good old- fashioned thermometers. The students actually all received digital thermometers last year, but many of the batteries had already died and they have been unable to replace them. Even we could not find batteries for the student’s thermometers in our short search. It was cheaper and a better long-term solution just to get them the low-tech version.

The Buies have also been teaching and having the students practice taking vital signs. Jim has been showing them how to exam a patient and teaching on common diseases. Jim finished up with the abdominal exam on one of the students.

All the talk of worms and abdominal issues made Bjorn and I awfully hungry. So, when we got back to our hotel, we walked down the street and decided we would eat in one of the local dives on the side of the road. To our delight they had a special treat “100 yr old eggs!” Just the look of these black rotten eggs is enough to give you abdominal pain. Of course, we both had to try it (see the pictures below). Nether of us had ever had one before and actually they were not bad . . . . Not good but not bad. To top the experience off, it all took place across the street from the Thai “Office of Disease Prevention and Control.”

It was a good day!

Week two completed!

This week’s highlights.

Dr. Nilson also made a point with a tee shirt that read, “ Where you live should not decide if you live or Die!” He was emphasizing how important and doable preventative health care can be, particularly with children. The Barefoot Drs can save many more lives preventing disease than simply by treating sick patients.

It has been another busy but great week. There are a few highlights I did not get a chance to tell you all about on the Blog.

One is that we have a new toy. Bjorn ordered an Audience Response System for us to use with the students. There has been a bit of a learning curve for the students and for us but it promises to be a huge help. It is basically a radio frequency receiver that hooks to your computer with a program for collecting data. Each student gets a small hand held clicker. We project a question on the screen with multiple choice or true / false questions and the students can answer with their remote clickers. This way we know what the individual students know, not just the class collectively. We get the data instantly and can immediately show it in graphs or charts on the screen for all to see.

This brought up an interesting problem for us. The students were very confused when we would ask them a negative question like “What is not the right answer?” Evidently, most of them have not been exposed to these types of questions before. This is something we did not realize until now, and it is very important because as Westerners we talk like this often. So many times in the past when they were confused it may not have been the subject matter but the way the question was presented that was the problem.

Another highlight was on Friday when we decided they needed more practice on paperwork and how to actually take care of a patient from start to finish. They had significant difficulty with this. We had them break into small groups then take a history and exam on an actual patient (one of the students with severe abdominal pain). We then projected one of their field patient log forms on a white board and had them fill in the blanks so then we could all see and ask questions. This was great practical practice on how to see a patient and use the form. They had quite a bit of difficulty with this. It took at least two hours to go through what we thought would be a fairly simple exercise. Again, we as Westerners take too much for granted. One of the translators told me that often in Burma they are not taught critical thinking. In many classrooms you do not ask questions and you only give the right answer. You definitely do not question the teacher. We are asking them to do all of these things, but we have realized we must first teach them how to do them.

Here is Abraham (one of our translators) helping to fill out the projected log form.

In this picture Thin Bey is summing up the conclusion on the patient and what drugs to use. The patient has a 5 yr history of stomach pain and the problem is likely an ulcer. We expect him to start feeling better by Mon.

The students have been continuing with their presentations. Here is Zimi Ram presenting on the eye.

Splinting practice

Yesterday Dr. Susan McDowell showed the students how to use some splinting techniques using a “SAM” splint and Ace wrap for fractures in arms and legs. Dr. McDowell gave them all their own ace wraps among other supplies she donated to the program. The “SAM” splints are courtesy of Cyril Thomas who will be joining us in a couple of weeks.

One of the students saw an interesting orthopedic case in one of the villages. A hunter shot a wild bore but it charged him. Before the bore died he rammed into the hunter's arm, breaking his humerus (upper arm bone). Using techniques from last year the Barefoot Dr splinted the arm with bamboo and cloth for 6 weeks. When the Barefoot Dr last saw him, the hunter is recovering but he is still very stiff in his arm. These “SAM” splints will be lighter and flexible and easy to use. This new splints and Ace Wraps will make it much easier and faster to splint injuries.

This week started with Dr. Susan McDowell joining us for a second year in a row. Dr. McDowell is an Orthopedic resident from Indiana University and has already started sharing her valuable skills with the Barefoot Dr. Students. She had the day off on Tues. so she could go see one of the “model villages” here in Thailand. The visit to this primitive village gave her a better understanding of what it is like where the students come from. The village she saw, however, has many advantages because it is in Thailand and not too far from modern towns.

The students are continuing their presentations on various subjects. Here you see Ester Mai Mai giving an excellent presentation on Rheumatic Fever. She even used visual aids and she made use of the anatomy dummy.

I have been continuing to teach them about germs and how disease is spread. I will make them all germophobic yet.

I have also been teaching them about how to use their books. It dawned on us that they may not have ever been taught how to use things like an index, charts, and vocabulary lists in books. Sure enough, this turned out to be a difficult and valuable subject for them. Something we have been taught from a very young age and take for granted is a new concept to many of them. Of course a few of them have had more formal education and had an easy time with this subject. From the teacher's standpoint, this was an important revelation for us. We had been struggling with why they were not looking things up as we asked them to and why they were having such difficulty finding subjects in the book. Their difficulty following us in the book information turned out to be our error because we did not start with how to use the book. It simply never dawned on us until the end of last week.

Until next time.

Rick

Where are the dentists?!

Where are the dentists?! This picture is of one of our students with a severe tooth infection. Last week the side of his face was swollen and red. He was literally wincing with pain as he sat in class. I don’t know how he managed to sit through our lectures at all with that type of pain. We started him on Amoxicillin and after a week he has very little pain or swelling. However, this is only a short-term solution to the infection. As you can see from the picture those teeth are in bad shape and at least one needs to come out. We can teach them a lot about teeth but they should really have a professional dentist to help us deal with these types of issues and teach the students what to do in the field.