As a member of the Duke-NUS Project KAREn team, I was fortunate to have the opportunity to spend time in the Karen hill tribe village of Hoay Khao Lip (HKL) near Chiangmai in northern Thailand in January and May 2010.This project was the first student-initiated community service project.

On our first trip, we sponsored a lunch for the children of the primary school. This “special” lunch which included chicken and eggs was a treat for these children. This is because their normal meals typically consist of rice and soy bean paste. We could sense their gratitude and joy as they tucked in happily. At the school, we also had the chance to interact with the teachers who showed us their traditional way of hair lice eradication which involved mashing up apple custard leaves and alcohol into a paste and applying it on the hair of affected children for 20-30 minutes.

HKL children waiting for games to start.
Our living accommodation in Chiangmai -
Sleeping bags in wooden stilt houses.
 
Team Leader, Ee Tat Xin, presenting a token of
appreciation to the CEO of Mae Wang Hospital.
At HKL village, we successfully conducted several important public health measures. We designed health record books to chart the anthropometric data of the children and maintain their health records such as vaccination schedules. The HKL children were found to have high incidences of hair lice, dental caries and skin conditions. Thanks to the care and generosity of Duke-NUS staff and students, we also had eight large boxes of toys in our possession. Toys are luxury items for HKL children. Their innocent eyes lit up with delight and excitement as we distributed them. At the same time, we were amazed at how polite and orderly they were during the toy distribution.

The dedicated team of Project KAREn brainstormed and came up with a detailed questionnaire and history taking forms to help screen for the most common medical conditions such as gastric and respiratory conditions. We also decided to chart the anthropometric data of the adults in the HKL village. Doctors and nurses at Mae Wang Hospital in Chiangmai informed us that a medical van travels to various villages in the Karen Hill Tribe region on a monthly basis to conduct general health and dental screening. However, the HKL villagers had yet to benefit from this government-funded initiative. Therefore, we decided to conduct health screening for adults in the village on our second trip to Chiangmai.

Often in health screening, one may run into the danger of overscreening and not target the most prevalent chronic illnesses in the village. Fortunately, we met up with Dr Jay and other senior nurses from Mae Wang Hospital to understand more about the health profile of these villagers. Mae Wang hospital is a secondary hospital that sees all health conditions that cannot be managed by the primary care facilities. These sites, which are also known as anamais in Thai, are usually scattered within the subdistricts and hill tribes, and are similar to the Singapore polyclinics, except that they are manned by nurses due to a shortage of doctors.

During our health screening visit, we performed blood glucose, urine tests and general physical examinations and screened 72 patients over 2 days. More serious medical conditions were referred to either the anamais or Mae Wang hospital. Our work received tremendous support from the locals. Nurses from Mei Wang hospital travelled up to the village with us and spent their entire weekends tirelessly helping us with translation. Thank you Pi-Laa, Pi-Tick and Pi-Pom!
Our efforts saw us take two patients to Mae Wang hospital, one of whom, a 42 year old lady, came to us delirious and confused with a suspected severe psychiatric condition. We took her vital signs and found that she had a very rapid heart rate and high fever of 39°C. Physical examination revealed symptoms suggestive of pneumonia and incidental goiter. She was rushed to the hospital and diagnosed with decompensated heart failure secondary to pneumonia. Fortunately, she was sent to the hospital in time and received intravenous antibiotics. Another highlight of our trip was when we diagnosed a lady to be in labor and rushed her down to the hospital. The last we heard, she delivered a healthy bouncing baby boy who weighed 3.2 kg!

Smaller projects such as dental screening, dental hygiene education, education on hair lice eradication as well as soy bean projects also allowed us to build rapport with the villagers and educate them on simple health care practices. In many ways, I felt that such work cannot be underestimated and that even a medical student can save lives.

Quoting Oscar Wilde: “The smallest act of kindness is worth more than the grandest intention.” Project KAREn was one of the most fulfilling experiences I could ever have had during my Duke-NUS years. It taught me so much and I will never forget the beautiful memories and strong friendships forged in HKL village.
Stream of patients on day of health screening.
 
First-aid for an infant with a bleeding finger.