February 8, 2017

Adult Care

Medical Inpatient Department

The Clinic’s Medical Inpatient Department treats a variety of conditions, with a special isolation ward for patients with particularly contagious illnesses such as respiratory infections and diarrhoea.

 

History

Mae Tao Clinic functions as a hospital facility with several inpatient departments (IPD). Until 1999, there was only one inpatient department, treating medical, trauma, reproductive health, and child inpatients all in the same space. In 1999, the continually growing patient demand led to the expansion of the clinic and separation of departments, eventually resulting in the Medical, Children, Reproductive Health, and Trauma/Surgery IPDs that exist today.

The Medical Inpatient Department (IPD) admits patients with severe medical problems and cares for them 24-hours a day. The most common cases include acute respiratory infection, urinary tract infection, gastritis/ulcer, dengue fever, hematologic disorder and diarrhoea. We see an increase of patients with non-communicable diseases such as liver failure, cancer, stroke, diabetes, cirrhosis, hypertension, nephrotic syndrome and heart disease.

The current Medical IPD has 53 beds. While the total number of admissions are slightly decreasing in recent years, the average length of stay at Medical IPD has increased. This is due to chronic cases that are presented more at the clinic. Even in a well-equipped, modern hospital setting, these cases would be an extreme challenge.

For severe cases that cannot be treated at MTC, we have the option of referring patients to Mae Sot General Hospital. The department in-charge and the medical staff are faced with the task of deciding who will be referred for treatment, taking into account the survival rate of the patient and the cost of treatment. MTC refers patients with communicable diseases such as HIV, Malaria, and Tuberculosis to government hospitals both in Thailand and Burma or our partner organisations, Shoklo Malaria Research Unit (SMRU) and Burma Child Medical Fund (BCMF) for patients to receive sustainable treatment.

MEDICAL IPD IN NUMBERS (2017)

Total admissions 2,003 patients
Average length of stay 6.6 days
Referrals per year 161
Number of shifts per day 3 (24 staff)
Number of beds 53 (68% of bed occupancy rate)

Challenges

Transportation costs to the clinic are high, many times almost equivalent to the daily salary of a migrant worker. Patients without legal documents or who have crossed the border from Burma are often afraid of being arrested by Thai police or immigration on the way, hence, they often delay too long before coming.

Over time, the range of illnesses treated has become broader – but the constant over time has been that patients arrive at the clinic with illnesses in advanced states. If the patients could have a higher level of health knowledge, act more on prevention, and obtain treatment earlier, many of the conditions, such as diabetes for example, would be preventable or treatable.

The Medical IPD also faces family issues – a patient may be dropped at the clinic by friends or family, however, these people often cannot afford to miss work in order to be their attendant. The responsibility falls upon the medics to support patients.

In other cases, the whole family travels to the clinic together. They may live far away and are unfamiliar with Mae Sot. The presence of family members increases crowding at the clinic. Sometimes, the family members search for work in Mae Sot while attending to a sick family member.

The Medical IPD cannot alone solve the problem of tuberculosis, malnutrition, lack of health care inside Burma, or the extreme social and economic challenges of our patients. The Medical IPD aspires to treat the patients with the best care possible with its resources, utilising strong collaboration with other clinic departments as well as other organisations to address the broader issues that result in its high caseloads. Still the high numbers of cross-border patients require greater collaboration in the community to battle health issues.

Meet Our Patients here: http://maetaoclinic.org/our-services/our-patients/

(Last update 19 April 2018) 

Outpatient Department

 

In 2017, Medical Outpatient Department (OPD) provided medical consultations to 24,375 patients. 57% of them were migrant workers from Burma residing in Thailand and 43% crossed the Thai-Burma border in search of medical care. Our Medical OPD consists of 9 consultation rooms (4 general; 1 respiratory; 1 malaria; 1 chronic disease; 1 ultrasound investigation; 1 first visit consultation room) to provide our patients with privacy, and an accurate diagnosis and treatment.

 

History

In the beginning, all of the medical services available at MTC were provided under one roof. Patients came for treatment of a wide variety of ailments, ranging from malaria, to having wounds dressed, to the delivery of babies. Equipment and medical supplies at this time were scarce and food was limited and very simple. Despite the limited resources of the clinic, no one was ever turned away.

Although the space was small, an effort was made to keep trauma and maternal health patients separate. In 1999, MTC expanded to allow the establishment of separate departments, ultimately leading to better standardised treatment of patients and the adoption of established protocols. In 2000, the Medical OPD moved into a new building in old Mae Tao Clinic with 6 consultation rooms, 4 for general care, 1 for chronic disease patients and 1 for malaria cases.

The Current Department

The current Medical OPD is located on the new Mae Tao Clinic compound, with expanded function. Of the 24,375 consultations in 2017, 16,672 were new cases and 1,738 cases were chronic disease. Communicable diseases such as malaria and tuberculosis have been decreasing in recent years while non-communicable disease cases have shown increase.

Our Medical OPD consists of 9 consultation rooms: 4 for general care; 1 for respiratory disease; 1 for malaria cases; 1 for chronic disease; 1 for ultrasound investigation; 1 for the first visit consultation. A separate space to treat malaria patients has always been necessary at MTC, a newer development is a separate room to treat patients with chronic and respiratory diseases.

The department handles a varied range of medical problems, from minor conditions to malaria, tuberculosis, pneumonia, cardiovascular and neurological diseases, and chronic conditions such as diabetes, hypertension, epilepsy and thyroid disease.

Ultrasound helps the Medical OPD medics to diagnose various diseases more accurately. In case of severe ailments, Medical OPD refers patients to Mae Sot General Hospital for additional investigation. Expenses for these referrals are either covered by the patients themselves, or by our partner organisation Burma Child Medical Fund.

* Lower respiratory tract infection (LRTI): while often used as a synonym for pneumonia, can also be applied to other types of infection including lung abscess and acute bronchitis

* Upper respiratory tract infections (URI or URTI) are illnesses caused by an acute infection which involves the upper respiratory tract including the nose, sinuses, pharynx or larynx.

 

Challenges

MTC cannot fully treat most of the chronic disease cases that are presented, such as diabetes, heart disease, and hypertension. Both the lack of resources and infrastructure to support the health care needs of long-term patients are issues yet to be overcome. It is a frustration and a challenge for the medics when they cannot provide the proper treatment for a patient, but it is also a challenge when they can.

The staff of the Medical OPD continually work to ensure that patients take their prescribed medicines properly. When patients speak a variety of different languages, and often cannot read or write, this presents considerable obstacles. In 2005, new medicine distribution bags were created in order to eliminate the need for a patient to be able to read. Since the implementation of these bags, the dosages and schedule for taking the medicines are depicted through pictures, making it much easier for the patient.

Language barriers and illiteracy have also been a challenge when it comes to educating patients about their illnesses. With Medical OPD continually getting busier, the medics can only spend a small amount of time with each patient, so the clinic has been producing more printed education material to distribute to patients. However, these printed materials need to be produced in more languages and need to take into account patients who cannot read. In order to overcome obstacles of patients with illiteracy, the clinic also use pictorial information on the medication bags.

Staff

7 medics with 1 Community Health Worker (CHW) work together in the Medical OPD.

(Last Update: 10 May 2018)