Kwai River Christian Hospital – Thailand
Kwai River Christian Hospital (KWCH) is situated in Thailand, in the Western mountainous region of the Thai-Burma border. This 45-bed rural hospital has busy outpatient, inpatient, and public health units, treating the full spectrum of tropical maladies, surgical, and obstetrical cases. People cared for include a great number of displaced persons, refugees, and transient migrant workers from Burma.
Students can participate in all the services offered at KWCH. The Physician staff are constantly available for supervision and assistance. Arrangements can be made for those who express an interest for more experience in a particular medical field. Obstetrics and public health experiences are also encouraged. KRCH has a research and learning emphasis, working together with a research institute on tropical disease research projects.
Location & Community
Kwai River Christian Hospital (KRCH) is situated in Thailand, in the Western mountainous region of the Thai-Burma border, in the town of Sangkhlaburi, Kanchanburi Province. The region is rural and moderately hilly with enough flat areas for rice fields and small towns. Ten villages are within a 10 kilometer radius of the hospital, comprising a total population of 5,000 -10,000. The main road to the area was paved in 1986. The hospital is located in the village of Huay Malai, about 16 kilometers from the town of Sangklaburi. December to February is the cooler season. March to June is hot. July to November is the rainy, humid season
Visitors flying into the Thai capital city of Bangkok and overnight in one of the recommended guest houses. Transport from Bangkok to Sangklaburi is via bus or minivan service. From Sangklaburi to the hospital, visitors travel via taxi-bus, or the hospital may arrange to send a car.
For current information please visit the Thai embassy website appropriate for one’s home nationality. United States citizens can obtains visa information from the website of the Thai Embassy in Washington, DC. Americans first arriving in Thailand should ask for a tourist visa at the airport. This is valid for 30 days. For periods up to 90 days, Americans should apply for a tourist visa in advance. Physicians should also send their medical license to KRCH in advance.
Traveler’s Health & Safety
No vaccinations are required for entry into Thailand, unless traveling from an area with yellow fever or a cholera epidemic. Hepatitis A and B, tetanus, and influenza vaccines are recommended for all. Consider Japanese B encephalitis vaccine if staying more than three months. Generally speaking, malaria prophylactic medication is not recommended. Long sleeves, mosquito nets, and mosquito repellent containing DEET should be employed. One should consult with their personal physician before traveling, and refer to the CDC Travel Website for the most up-to-date health information.
The hospital provides care for a population of Thai, Karen, Mon and Burmese people. These include a great number of displaced persons, refugees, permanent migrants, and transient migrant workers from Burma, as well as residents of a large refugee camp nearby in a mountainous rural area along Thailand’s border with Burma. In addition to patients from the local area, many are referred from the town of Sangklaburi or the border town of Three Pagodas Pass. Some even travel from within Burma to reach the hospital. Particularly vulnerable people groups here include migrants who have no Thai citizenship papers and therefore no access to the government health services – KRCH provides critical medical care to thousands of these people who would otherwise have none.
One-half of the patients speak Thai fluently. Other common languages include Burmese, Mon, Pwo Karen, Sgaw Karen, Laotian, Chinese, and Hindustani. Most of the KWCH staff speak both Thai and English. Volunteers at KWCH will be provided with an interpreter. Acquiring some facility in Thai before or during one’s visit can be extremely helpful.
Medical Care Services
KRCH is a 45-bed rural hospital with busy outpatients and inpatients departments and a public health unit, which treats each patient as an individual without bias towards their religion, nationality, race, gender or wealth. The Hospital was founded in 1960 and is under the auspices of the Church of Christ in Thailand, the main Presbyterian organization in Thailand. The hospital also works cooperatively with the American Refugee Committee, the International Rescue Committee, and the Burmese Border Consortium in caring for the health needs of refugees who require hospitalization for surgery or serious medical conditions.
The most common diseases managed are malaria including cerebral malaria, acute respiratory infections, tuberculosis, leptospirosis, chikungunya, dengue fever, diarrhea including amebic and bacillary dysentery, typhoid fever including perforated typhoid ulcers, intestinal parasitism, diseased teeth and gums, obstetrical complications, HIV/AIDS, anemia/malnutrition, trauma, and ever increasing cases of diabetes and hypertension.
The Out-Patients Department (OPD) serves approximately 60 patients per day. Patients include causalities of the Burmese civil war, just a few miles away and, while leprosy has been wiped out in Thailand, several leprosy patients per year come across the border from Burma with no other option for treatment. In addition to general outpatient care, the OPD offers a basic dental service and an Elderly Care Program to screen women over 60 years of age for treatable diseases common in old age such as glaucoma, cataracts, high blood pressure and diabetes.
The In-Patients Department (IPD) serves approximately 1,800 patients per year. These include displaced persons from the nearby refugee camp who are referred to the hospital by the American Refugee Committee for serious medical problems and surgery when they need care that cannot be provided in the refugee camp hospital. The IPD has 45 beds and is capable of accommodating up to 60 patients. IPD work includes a busy surgical unit that performs 400 procedures a year across the spectrum of orthopedics, urology, obstetrics and gynecology, plastics, ear, nose and throat, and trauma including landmine and gunshots injuries. 100-150 obstetrical deliveries are also performed each year.
Public Health Initiatives
The hospital’s Public Health Unit provides important on-site and off-site health monitoring, health promotion and disease prevention services, including:
- Ante-Natal Clinic that provides continuity care for approximately 50 women per month.
- Postpartum Clinic for new mothers to be checked one month after giving birth. Family planning information and education is also provided.
- Under 5s Clinic that aims to fight child malnourishment and preventable diseases, serving approximately 60-70 children per month. This clinic provides vaccinations as wells as the Malnourished Program – a malnutrition intervention project funded that provides powdered milk and vitamins to underweight under-five children and children of HIV/AIDS and TB patients.
- HIV/AIDS Clinic serving approximately 30 people per month. A proportion of the migrant patients attending this clinic receive free antiretroviral drugs.
- Sangklaburi Safe House is a community health residential facility and rehabilitation clinic for adult and elderly non-Thai migrants or stateless people who have complex and chronic physical or mental illness or disability, are isolated from all family supports and have no income to pay for their necessary care.
Tuberculosis intervention is a major undertaking of the Public Health Unit. In the rural border area where KRCH is located, the care of tuberculosis patients throughout their period of mediation presents a number of significant challenges. Patients must take their medication each day for the full period – a minimum of 6 months – or risk developing drug resistant tuberculosis, however, the patients may have travelled significant distances to reach the hospital, they may be migrant workers with no permanent residence, the surrounding hilly terrain makes travel to receive medication difficult, particularly in the rainy season, and patients speak a variety of different languages. In this challenging context, the hospital provides a comprehensive tuberculosis program:
- On-Site TB Clinic run by the hospital’s Public Health Unit, which provides screening and check-up services to approximately 70 people per month.
- A Mobile TB Clinic run by the hospital’s Public Health Unit once a month at Three Pagodas Pass – the nearest border crossing point between Thailand and Burma. At this site it provides screening and check-up services, including to patients who cross the border to attend the clinic.
- Tuberculosis Inpatient Ward with isolation rooms, where patients spend the first two weeks of treatment.
- Mobile Directly Observed Treatment (DOT) team of motorcycle drivers who travel each day from the hospital to the homes of approximately 30 patients. The DOT drivers, who are trained in TB treatment and able to speak the local languages, find the patient, supply the medication and directly observe the patients taking it.
- Sala’ Residential Treatment for migrant patients from remote areas beyond the reach of the DOT drivers can stay on-site in the ‘Sala’ – the hospital’s housing for TB patients which has 20 living quarters. In the Sala, the patients receive observed drug treatment, regular health check-ups and charitably funded food allocations. Patients stay for the duration of their treatment, and also learn new craft skills that they can use to generate income after returning home.
Healthcare Profession Staff
Full-time physician staff includes Drs Murphy (American general surgeon), Martin (Swiss internist), and Sha (Burmese internist). Visiting physicians come from the USA, Australia, and the UK.
Medical personnel usually do inpatient department rounds together in the mornings from 8:30 – 9:30. Thereafter, they move to the OPD that runs 9:30 – 12:30 and 1:30 – 5:00. OPD is open 5 1/2 days a week, Monday thorough Saturday midday. Physician staff are constantly available for supervision and assistance. Arrangements can be made for those who express an interest for more experience in a particular medical field. Obstetrics and public health experiences are also encouraged.
KRCH has a research and learning emphasis, working together with the Armed Forces Research Institute of Medical Sciences on tropical disease research projects. KRCH hosts a field study site for surveillance of multi-drug resistant malaria along the Burma border, and for research on influenza and on other tropical diseases and medicine.
KRCH has standard reference textbooks in all the major specialties. These are often one or two editions old. A stand-alone PDA loaded with Epocrates and other reference tools can be useful.
Student Lodging & Meals
Visitors are usually housed in one of the volunteer apartments. These have electricity, running water, indoor toilet, and shower. Most have a refrigerator and stove. Electricity (220 volts, 50 cycles) is on most of the time. A hostess/cook prepares the meals and does laundry.
Wireless Internet is available around KRCH most of the time. However, during storms or power cuts, it is usually off.
INMED invites all participants to consider raising extra funds to donate to support this facility. While such efforts are not required, they will provide opportunities INMED personnel to become involved in this important aspect of international healthcare.
The hospital regularly solicits for donation of supplies. These typically include surgical gloves sizes 6-8, examination gloves, bulb syringes, disposable emesis basins, disposable skin staplers, Silastic or Teflon-coated urethral catheters, recent edition standard medical reference texts, cephalosporin or quinolone antibiotics, rescue and long-acting inhalers for asthma, acetaminophen suppositories. Inquire about the most up-to-date KRCH supply needs.
Thailand itself offers a plethora of vacationing opportunities for those coming and going. There are no supermarkets in the village where the hospital is located. There is a weekly local market once a week on Thursdays where the locals sell their homegrown produce. Some small shops are available in Sangklaburi, 16 km away.
Behavior & Dress
Visitors before arrival should to watch the World War II movie Bridge On The River Kwai, for which this region is best know. Visitors are also expected to remain chaste and sober for the duration of their stay at the KWCH and generally show respect to staff and patients alike.
Casual but smart lightweight cotton clothing is the rule. White coats or ties are not necessary. Scrubs can be worn if preferred. In deference to local custom, short pants not recommended for women unless worn after hours. From December to February warm pajamas and a light jacket may be necessary as it can be cool at night and in the mornings during this “cold season.” A waterproof jacket and umbrella is useful for the rainy season as well as shoes or boots that can cope in muddy paths around the hospital. If bringing white nursing uniforms please bring at least two white uniforms, either dress style or jacket-and-slacks.
What To Pack
Visitors should bring copies of all healthcare profession licenses, diplomas, or certifications. A carry-on bag should be packed that contains essentials items just in case one’s luggage becomes lost. Bring clothes appropriate for the weather. The electricity available is 220 volts, 50 cycles. Plugs used throughout Thailand are the two-pin American style. If a voltage transformer is necessary, one should bring it along. Useful items include stethoscope, flashlight, and alarm clock. Those how play a musical instrument that is portable, please bring it along. They may use it to amuse many, for there is not a great deal of entertainment in Huay Malai village!