The Mae Tao Clinic is located in Mae Sot which is situated 8.5 hours North-West of Bangkok by bus, and 15 mins from the Burmese border by bicycle. The clinic was originally established as a single room clinic in 1989 by Dr Cynthia Maung, a Burmese doctor, to provide essential free medical care to Burmese refugees and migrant workers. The clinic has since grown exponentially over the past 20 years, through generous donations and foreign aid.

The Burmese refugees are both internally and externally displaced, living in either refugee camps in Thailand or within the jungle of the Burmese border. As a result many must travel long distances to reach the clinic and frequently arrive in desperate need of medical attention. It is difficult to determine the size of the population this clinic serves, however the clinic estimates a target population of approximately 150 000 people.

Due to the complicated political and social situation surrounding Burmese refugees entering Thailand illegally, the clinic is barely visible from the road side, although it extends back to include a multitude of buildings including paediatrics, medical inpatients and outpatient clinics, surgery, reproductive health, prosthetics and a laboratory/blood bank.

The clinic is run primarily by ‘educated’ Burmese refugees who train to become medics (two years for basic medical training) before specialising in their chosen department. All of the training is done on site and is supervised by more senior medics, with international doctors aiding in teaching and providing equipment. All the Burmese medics are trained in English and are able to act as interpreters.

I was initially disappointed by the lack of hands-on experience but then realised it was actually a good thing since it meant that the clinic is self reliant due to the locally trained Burmese medics. I did, however, get to observe a multitude of unusual and interesting medical and surgical cases.

The other challenge involved the lack of blood tests and imaging. The clinic has a primitive laboratory which can perform limited tests including haemoglobin levels, cross-matching, malaria blood smears and dipstick urine analysis. All other blood tests have to be sent to the Mae Sot hospital and the clinic has to pay per test which means, for example, that for liver function testing only AST would be performed as it was too expensive to order all of the enzymatic tests. Therefore testing was rarely performed and most diagnoses were based purely on signs elicited and educated guesses.

As mentioned earlier the clinic has several different departments and during my five weeks there I rotated through the reproductive health, medical inpatients and outpatients, and the surgical department.

Week 1 – Reproductive Health Outpatients

• Antenatal checks – vaccinations, deworming, vitamins, examinations, education
• Family planning – contraception, sterilisation, education
• Gynaecological problems

Week 2 – Reproductive Health inpatients

• Delivery room – assisting in deliveries, newborn examinations and vaccinations
• Abortions – spontaneous, Dilation & Curettage (D&C)
• Neonatal Intensive Care Unit (NICU)
• Transfusions for pregnant women with malaria

Week 3 – Medical inpatients

• General ward work and rounds
• Common diseases during my rotation:
  • Infectious diseases – malaria, TB, HIV, dengue, measles
  • Gastrointestinal – cirrhosis, Hepatocellular Carcinoma, gall stones, liver abscesses
  • Renal – nephrotic syndrome
  • Cardiology – Congestive Cardiac Failure, Renal Failure
  • Neurology – strokes, Parkinson’s Disease
  • Adverse Drug Reactions – Stevens-Johnson syndrome, transfusion reactions

Week 4 – Medical outpatients

• Combination of western GP and sub-acute section of an Emergency Department
• Interesting presentations included beri beri, marasmus, kwashiorkor, measles and malaria

Week 5 – Surgery and Trauma Department

• Trauma – debridements, suturing, dressings, minor procedures
• Surgery – inguinal hernias, hydroceles, lipomas, amputations, land mine victims
• Most procedures only use local anaesthetic but ketamine is used for amputations or more major surgeries

I highly value the unique opportunity I have had to visit and work at the Mae Tao Clinic and to observe medicine which is practised very differently than in Australia, due to educational, cultural and financial reasons. The social aspects of my visit must also be mentioned, as they were of equal worth as the medical aspects; learning about a new culture and the personal struggles of not only the patients, but the medics themselves was challenging and intriguing. I thoroughly enjoyed this elective and would recommend it to other students with an interest in refugee health.