Chiang Mai University, Thailand
Manik Chhabra, Fall 2010
During my time in Chiang Mai, my work focused on continuing and completing projects that I had begun during my Fogarty year, namely a project examining adherence to HAART in vertically infected HIV+ Thai adolescents, and a second project examining treatment outcomes in HIV positive patients living in the Klong Toey slum community in Bangkok.
The purpose of the "Adherence" study is to characterize the prevalence of adherence among vertically infected Thai adolescents, and to examine the social factors that affect adherence in this population (e.g. depression, drug use). This is the first study to characterize adherence in this population in Thailand, and the results will be a first step to designing future interventions. Since my Fogarty year ended in June 2010, additional interviews continued in my absence. While in Chiang Mai, I was able to enter interview data as well as to conduct a chart review of the 45 additional interviews conducted between June and December 2010. Analysis and construction of a manuscript is currently ongoing. An abstract of the preliminary results was completed during my time in Chiang Mai and was just accepted to the International Conference on HIV Treatment and Prevention Adherence in May, 2011.
The second project stems from work I was involved with through the Mercy Centre – a non-profit organization providing home care for HIV positive individuals living in the largest slum in Bangkok. During my Fogarty year, we had begun to examine patient data from the past six years and had two abstracts accepted to the International AIDS Conference. During my return, the goal was to develop a system to methodically collect patient data in order to help evaluate patient outcomes as well as assist with advocacy efforts on behalf of this vulnerable population. The previous review of charts was a lengthy process which entailed a cumbersome chart review. In order to streamline this process in the future, I designed a Microsoft Access database in Thai using input from the Mercy staff to allow them to enter patient data on a more consistent basis. I conducted several trainings with staff, and we are now in the process of beginning to enter all new patient data into the database. We have also submitted two additional abstracts to the International Congress on AIDS in Asia and the Pacific (ICAAP) conference in Korea.
Finally, I had previously worked with a rural health center serving Shan migrants near the Thai-Burma border to conduct quality improvement reviews and trainings in HIV care. I revisited the clinic and helped conduct a chart review of HIV/AIDS patients at the clinic and provided recommendations for continued care of these patients.
International rotations in Chiang Mai
Though my current rotation in Chiang Mai was not spent in the clinic/hospital and was arranged primarily through contacts I developed while working in Chiang Mai, I had previously spent time working in the Chiang Mai University Hospital (Maharaj hospital) in the pediatric infectious disease clinic. The hospital has a variety of departments (family medicine, internal medicine, pediatrics, surgery, ob-gyn), and students from other programs have rotated through these departments in the past. I think working in the hospital can provide students the opportunity to see patients and disease pathology that is unique to the region - but one thing to be wary of is having to take more of a "shadowing" role in daily activity, as the language barrier is extremely high, and not having interpreters makes it difficult to independently conduct clinical and hospital visits.
Visiting Chiang Mai
Getting to Chiang Mai
It is usually best to arrange flights through Bangkok, as these flights are typically cheaper than flying directly to Chiang Mai. There are a variety of cheap local airlines (Air Asia, Nok Air, Bangkok Airways, Thai Air) which have regular flights between Bangkok and Chiang Mai ($30-70; 1 hour), or else buses are plentiful and a cheaper alternative ($20-30; 10-12 hours).
There are no visa requirements for US citizens arriving into Thailand. Visitors obtain a 30 day entry permit on arrival, and may cross the border into Burma, Laos, or Cambodia, and return to Thailand in order to "renew" the permit. For up to date information, please consult the US State Department website.
United States Consulate, Chiang Mai
It is advisable to register with the embassy prior to your rotation through the Smart Traveller Enrollment Program (STEP). Thailand has been subject to political turmoil in recent years - and while this has had a limited effect on Chiang Mai - notices through the consulate provide up to date travel information on protests and violence. The consulate is located east of the Old City in Chiang Mai. Consulate Website.
Routine vaccinations, as well as Hepatitis A, Hepatitis B, Typhoid, and Japanese Encephalitis are among those recommended depending on your area of travel in Thailand. There is no malaria in major cities (including Chiang Mai) - however, dengue fever is a significant concern, and it is advisable to bring/use bug spray. Please consult the CDC travel website for further information.
Emergency medical care can be received at the public hospital, Maharaj hospital (also known as Chiang Mai University Hospital - or Suan Dok (in Thai)), or the private hospital, Chiang Mai Ram. Please consult individual insurance plans and MedEx emergency evacuation guidelines/recommendations.
Housing is available close the Maharaj hospital in the Nimmanheimen area as well as around Chiang Mai University. Guesthouses typically cost in the range of 300-600 baht ($10- 20)/night. Long range stays can be arranged at certain guesthouses, or else apartments are available for rent on a month to month basis for approximately 5000 baht/month (a popular apartment complex on Nimmanheimen catering to ex-pats is Baan Thai). Furnished apartments can be found simply by walking by and asking to see a manager (although it may be difficult to communicate in English at times).
Chiang Mai is a fairly walk-able and bike-able city. Local transit methods include local public taxis (the red trucks or "song teaw") which typically cost 25-40 baht for locations within Chiang Mai, or the Tuk-Tuk (an auto-rickshaw), which may cost anywhere from 60-120 baht. Bicycles can be rented on a monthly basis, as well as motorbikes. Motorbikes can be rented by depositing your drivers license. Please wear a helmet and use extreme caution if renting a bicycle or motorbike as traffic patterns are quite different in Thailand compared to the US.
Food that is found at both local street vendors and restaurants is safe to consume (a welcome departure from food in other SE Asian countries) - and most sidewalk restaurants provide filtered water/ice to all customers. Most local and sidewalk restaurants will require you to order in Thai however, (unless you're willing to simply point at what you want) - so try restaurants like Hong Taew Inn or Lemontree early in your visit, where the menus contain both English descriptions and the transliteration in order to learn the Thai names for the more delicious dishes.
While it is not possible to open a bank account without a work permit or permanent address, money can be exchanged at any of the local banks or withdrawn from ATMs. ATMs typically charge 150-180 baht for withdrawal from a foreign bank (plus applicable bank fees). Therefore, it might be useful to bring US dollars (new $50 and $100 bills are preferred) or traveller's checks (subject to a $1 service charge per check) for exchange.
Internet cafes and wi-fi spots are plentiful in Chiang Mai, and the Nimmanheimen area very likely has the highest density of coffee shops per square foot in the world. For local cell phone use, you may bring a cell-phone that allows for sim cards internationally, buy a cheap one locally at one of the malls (Kad Suen Keaw or Computer City), or have one "jail-broken" for international use for approximately $10. Phones typically will cost $20-30, and a sim card will cost $1-2. You may get "top-up" minutes for your specific sim card at any local 7-11 or Tesco Lotus.
While Lonely Planet, Rough Guide, and Let's Go guides provide decent descriptions of attractions in the area, they typically are not all that reliable for restaurant/entertainment options. Would recommend buying the Nancy Chandler map/guide Chiang Mai - which provides a detailed overview of items in the city.
Chiang Mai has a high density of temples, the most famous being Wat Phra Thap Doi Suthep, which offers nice views of the city. A day trip to Doi Inthanon National Park is worth the time, and a number of different treks are available in the region which can be organized on your own, or through various companies.
There are a number of cooking schools that offer one or multi-day courses (I previously took a course with the well publicized Baan-Thai school. The Chiang Mai Thai Farm Cooking School is something my friends have done and enjoyed. One week or multi-week massage courses are also available - I took one previously at the ITM massage school, but friends have also recommended courses at the Old Medicine Hospital, which is a bit cheaper.
See attached Map of Nimmanheimen area which includes a list of recommended guesthouses, restaurants, massage/spas in the areas that was compiled by a friend.
Feel free to contact me if you have any questions or would like specific recommendations. I absolutely loved my time in Chiang mai, and it is one of my favorite cities in the world to visit.
Manik Chhabra, MS4