SIRIRAJ HOSPITAL & THAILAND David McKenzie, MS4 Thailand and Bangkok ■ Thailand – Established mid 14th-century. Never controlled by a European country – Climate: tropical and warm! – Official language: Thai ■ Most things also available in English – Religion: Buddhist – Government: constitutional monarchy – Currency: Thai baht (1 USD ~ 31 Thai baht) ■ Bangkok – Capital of Thailand – Metro population >14 million – reasonable public transportation with sky rails and subways ■ Traffic is bad though! – Street life popular: plethora of street vendors with food and goods – Smog commonly an issue! Siriraj Hospital ■ Oldest and largest hospital in Thailand ■ Opened by King Chulalongkorn in 1888 due to large cholera outbreak, which killed the King’s son in 1887 ■ 2300 beds ■ Medical school: 250/class – Considered one of the most competitive teaching hospital in country ■ The country’s referral center for all other hospitals “True success is not in the learning but in its applications to the benefit of mankind.” -Siriraj philosophy Smog ■ Smog: polluted air (smoke + fog) typically resulting from coal plants, vehicle exhaust, factory emissions – Sun + nitrogen oxides + volatile organic compound (VOC)→ photochemical smog – VOC’s from gasoline, paints, cleaning solvents – Creates ground-level ozone ■ Worsened by high humidity, periods of warmer, drier weather and weak winds – Upper air warm enough to slow vertical circulation – Basins surrounded by hills/mountains particularly susceptible ■ Typically worse in mornings due to less air movement ■ Severity measured on Air Quality Index scale: – 85-104 ppbv: “unhealthy for sensitive groups” – 105-124 ppbv: “unhealthy” – 125-404 ppbv: “very unhealthy” Bangkok Smog ■ Bangkok is high traffic area, with many diesel-engine vehicles – Thailand’s pollution department: vehicle emissions contribute ~60% of smog ■ Also contributing are emissions from factories and power plants, and open burning ■ Reached levels >150 ■ >400 schools closed due to levels in late January/early February Reducing Initiatives ■ Individual level: N95 masks, reduce outdoor activity ■ Systemic level: – Sent drones, planes and trucks spraying water – Water cannons – Governor, Police General Asawin Kwanmuang declared city “pollution control zone” ■ Road closings, limit diesel gas, outdoor burning and construction ■ Limit cars on road according to license plate, reduce opening hours of factories – Prime minister ordered factory inspections – Expanding public transportation rails ■ Not-so-reducing initiatives: – Used to be a ban on most polluting vehicles – Owning car is symbol of affluence Health Effects of Smog ■ In 2015, air pollution said to be responsible for 37,500 deaths in Thailand – Causing health problems or exacerbating existing conditions ■ World Health Organization has described PM 2.5 (particulate matter with diameter of 2.5 microns – large component of smog) as carcinogenic ■ Increased risk of heart disease, lung cancer, stroke ■ Ozone can irritate respiratory system, reduce lung function, reduce immune defense against respiratory bacteria ■ WHO: air pollution caused 4.2 million premature deaths in 2016 – More than AIDS, TB and malaria combined ■ Even efforts to reduce smog may be harmful – Water-spraying methods increase moisture, and often have sugars dissolved in it, promoting fungal growth ■ Been called a PR stunt Profound Clinical Experience ■ While on my plastic surgery rotation I went to clinic 1 day/week. Clinic there was…different. The attending, resident, nurses and secretary each had a desk on one side of the room, each about 3 feet apart – without any partitions. The residents and attending did much of the consulting/histories at their desk, then did the physical exam portion on the opposite side of the room. There were 6 beds, though these had curtain partitions. Though I was surprised at the lack of privacy, I also was surprised at the spectrum of diseases they saw. Many things I had learned about in text books but never seen, or even things I had just never seen. Cleft lip was extremely common, however I also saw a repaired omphalocele, cutis aplasia congenita, Pierre-Robin sequence, multiple congenital malformations, and many others! All the residents and attendings were very accommodating and very willing to teach me about Thai people and culture. “Tuk-Tuk” Taxi Profound Cultural Experience ■ There were many, but the transportation and the food will likely prove most memorable. ■ Transportation: traffic laws are more suggestions than laws. Lane lines aren’t followed, whether people are just driving on shoulders or straight down the middle of 2 lanes are expected. I don’t think right-of-ways actually exist, as drivers turn and merge in front of others constantly. Crossing the street was usually a game of chicken and hoping oncoming traffic would see you and slow down/stop. ■ Food: I still don’t know what 90% of the street food was after being there for 6 weeks. Most of what I tried was usually quite good though, despite the questionable (at best) sanitation of street vendors. Cooked and uncooked food would sit out on a cart all day in 90+ degree heat incubating for hours. Remarkably, I only managed to get gastroenteritis once. That said, cuisine is a large part of the everyday culture and I enjoyed experiencing it! Wat Suan Dok Wat Arun lit up at night on Chao Phraya River The Grand Palace in Bangkok My wife, Sarah, and I at the resort at Tubkaek Beach Doi Inthanon: Highest mountain in Thailand Reclining Buddha at Wat Pho & my Wachirathan Waterfall – the attempt to squeeze it into 1 picture picture doesn’t do it justice References ■ “Bangkok.” Wikipedia, Wikimedia Foundation, 6 Mar. 2019, en.wikipedia.org/wiki/Bangkok. ■ Beech, Hannah. “Bangkok Is Choking on Air Pollution. The Response? Water Cannons.” The New York Times, The New York Times, 30 Jan. 2019, www.nytimes.com/2019/01/30/world/asia/pollution-thailand-bangkok.html. ■ EPA. Smog - Who Does It Hurt. Smog - Who Does It Hurt, www3.epa.gov/airnow/health/smog.pdf. ■ “History.” SIRIRAJ, 2 Mar. 2018, www2.si.mahidol.ac.th/en/history/. ■ Romo, Vanessa. “Thai Officials Close Schools As Toxic Air Pollution Chokes Bangkok.” NPR, NPR, 31 Jan. 2019, www.npr.org/2019/01/30/690181723/thai-officials-close-schools-as-toxic-air-pollution-chokes-bangkok. ■ “Siriraj Hospital.” Wikipedia, Wikimedia Foundation, 30 Dec. 2018, en.wikipedia.org/wiki/Siriraj_Hospital. ■ “Smog.” National Geographic Society, National Geographic, 9 Oct. 2012, www.nationalgeographic.org/encyclopedia/smog/. ■ “Smog.” ScienceDaily, ScienceDaily, 15 Feb. 2019, www.sciencedaily.com/terms/smog.htm. ■ Vejpongsa, Tassanee. “Thai Government Scrambles to Respond as Bangkok Choked by Smog.” The Diplomat, The Diplomat, 1 Feb. 2019, thediplomat.com/2019/02/thai-government-scrambles-to-respond-as-bangkok-choked-by-smog/. ■ “The World Factbook: Thailand.” Central Intelligence Agency, Central Intelligence Agency, 1 Feb. 2018, www.cia.gov/library/publications/the- world-factbook/geos/th.html. ■ Zhen Tan, Guan. “Here's What You Need to Know about Bangkok's Smog Problem.” Mothership.sg, Feb. 2019, mothership.sg/2019/02/haze- thailand-singapore-advisory/..