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Beyond Our Books: Project KAREn

By: Jason Leen and Zhang Zewen, 2nd year Duke-NUS medical student

Jason: 30 April 2010
“I’ve been thinking a lot lately about takingchances... Because the truth is, every time you ake a big risk in your life, no matter how it ends up, you’re always glad you took it.” This is  one of my favorite quotes from the medical television show Scrubs, which sums up one of the most valuable experiences I recently took part in: Project KAREn. I was very fortunate to be part of this health screening/educational project where a group of seventeen first and third year Duke-NUS medical students,including my good pal Zewen and myself, went to a hill tribe in Chiangmai, Thailand, which has little access to healthcare. The goal of Project KAREn was to perform a general health screening of the residents such as measuring blood sugar, blood pressure, taking a medical history, performing physical examinations and dispensing medicine if required with the assistance of Dr Paul Yen, a faculty member from Duke-NUS. When I first heard about this project, spearheaded by one of my seniors, Tat Xin, I was very excited because I had never been on a medical mission before. As soon as we were ready to go, political unrest/violence was severely increasing in Bangkok! However, the group decided to take the chance to fly off and thus began the first Duke-NUS community service trip in Thailand.

After two hours on the plane, we arrived at Bangkok International and it was emptier than usual. We were careful to not mention anything about the red and yellow parties andafter a four-hour wait, we were ready for ourtransferring flight to Chiangmai.

We arrived at Chiangmai airport where we met our guide and contact, Uncle Sam, a Singaporean who was living in the village and helping the villagers. We took a rickety rental bus where we crammed nearly 12 of us in the back with our luggage while the remainder took Uncle Sam’s truck. I felt like a sardine in a can. One of the major destinations we went to was the local medical centre where we spoke with the nurses who would be our translators,and the attending who gave us general health information about the village. Thereafter, as we headed up the mountain, it was breathtaking to see the forest-filled hills and even more amazing to see a family of five on one motorcycle. Eventually, we reached the village where the curious children came to welcome us. Seeing all the cows, roosters, wooden huts, and the lack of electricity allowed me to reflect on the simplicity of the village. Watching the beautiful sunset as the day came to an end, we knew that the next couple of days would be a testament to our months of long planning.

Zewen: 1 - 2 May 2010
The second day began not with the typical alarm of our watches or handphones, but from the crows of the roosters reared in the village. One by one, each of us woke to the unique morning call, and found a simple yet delicious breakfast awaiting us. As per the day before, Uncle Sam had arranged for the local villagers to prepare food for us, which consisted of breads and fillings such as “kaya” and egg mayonnaise. We were genuinely touched by the fact that the locals prepared food that we were accustomed to, and it was heartwarming.

After breakfast, each of us were instructed to set up respective stations and to get ready for the villagers, as the village chief had informed them about the health screening available. The stations generally consisted of a height and weight station and status record, followed by blood sugar, pressure and temperature taking, a history taking of health complaints they had,a physical examination, and last but not least, a prescription counter.

The first and third years were split evenly, such that at all stations would have at least one senior to guide the juniors. Dr Paul Yen was situated at the final station, approving the prescription of drugs and writing any referrals to the local hospital if he deemed necessary.

By 9.30am, we were ready and a few villagers appeared at our makeshift waiting counter. The expressions on many of their faces revealed gratitude, even before any of us performed our services. As soon as we started with the first patient’s registration, more and more arrived, ranging from the young with their parents stagging along, to the elderly of the village.

Perhaps the greatest difficulty was with the history taking station. The language issue was greater than expected, but fortunately with the help of the nurses from Mae Wang hospital, we were able to note down most of their complaints even though much time was needed. At the same time, the physical examination station was also busy with people waiting, as each of the students hoped to examine the villagers meticulously. As busy as most of us became, we also tried to rotate amongst the stations such that each of us could experience different aspects of health screening.

One of the most memorable events of the first day was when we spotted a febrile villager who had a high fever and problem with her heart, which was picked up upon physical examination. Immediately, she was evacuated to the local hospital and was later found to have a congestive heart problem. We found out later that her condition was stabilised, and were relieved that we had probably made a difference to her condition. The screening ended in the afternoon, with a hefty lunch in between that. We had a debriefing session at the end, jotting down what we had done well and what could be improved. Overall, we were satisfied with what we had achieved, having seen a total of approximately 30 patients on the first day.

Following our own reflections, we carried out the second day’s health screening with a more effective screening procedure, having learnt from what we did on the first day. Executions were smoother, and the patients we saw in total increased by another 40. In addition to screening, we also helped to apply some first aid for certain villagers who required immediate help, such as a baby with a cut on his finger and an elderly with skin sores.

As the saying goes, all work and no play makes Jack a dull boy. Most of us spent the remaining time on both days with the village children, indulging in activities such as football and even trekking. A few of us were taken aback by the maturity and hard skills possessed by the children, most whom were aged 5 to 12. Even though they did not have a great depth of education compared to children from our own country, they had essential life skills rarely seen in the concrete jungles where most of us come from.

In groups, they were able to bring us around the Karen Mountain, and impressed upon us the marvellous sites of the region. It would be difficult for us to imagine what it would be like without the comforts of home, such as computer games and Internet service, but to them, the world outside was their playground, with nature providing endless resources in their childhood.

As the day grew darker, we headed back to the village, with a sumptuous meal awaiting us. With the two days of general health screening over, we discussed plans for the workshop we would be conducting on the third day into the night

Jason: 3 – 4 May 2010
We were quite sad as we knew it was our last full day in the village, but there was still a lot of work to be done. It was time to educate the children on three important topics: 1) oral hygiene 2) soybean and protein 3) lice removal which was organised by three first year students, Sharon, Ran Ran and Adrianus. Once again, language was a real issue and therefore there was a lot of acting/stage play and posters with very clear pictures to deliver the message that they should brush regularly, put more protein in their diet and learn a special way to remove head lice. Luckily, we had a local villager who knew English to translate for us.The children were very attentive and it was quite amazing seeing 20 + children brushing their teeth in unison. I am glad they were having fun and I really do hope they remember what we taught them. As a token of our appreciation, every child received a toy donated from the school by playing a game similar to hot potato.

Surprisingly, Uncle Sam wanted us to perform a play for the children later at night and the children would perform some songs and dances for us. We all agreed and I knew it would be quite a treat.

However, the children had a surprise of their own for us. They enthusiastically wanted to bring us to their secret waterfall. On the way, I was touched by how some of the boys made walking sticks for us. I really hope they didn’t think we were too old. In addition, they picked out fruits for us to try and even pointed out where the snakes were so we could avoid them. Eventually we reached a small but a very lovely waterfall. The children automatically rushed towards the water to refresh themselves from the long hike. We followed them into the water and I was quite amazed by how different the feeling is when one enters a natural pool of water where there are a lot of uneven surfaces, slippery rocks and pits. Although I had my concerns at first, I couldn’t resist jumping from the top of the waterfall.

We had to go back to the village before nightfall and thought of a skit during dinnertime to perform. We did Snow White and the Seven Dwarves with “hidden messages” through the skit such as drink your milk, brush your teeth and comb your hair. The kids really enjoyed it and after we were done, they performed some local songs and dances. What a way to end one of most memorable trips of my life!

The next morning, it was quite sad that we couldn’t stay a bit longer but it was our time to go back to Singapore. However, to our surprise, the children came to say “seeya later” as they knew that we would return. As hugs were given and final pictures were taken, we all hoped we made a difference in their lives, even if it was a small one. As the bus was loaded and about to leave, we saw some the girls making hearts hapeswith their hands and we followed suit. Finally the bus left, and as we rode down the hill, I began to reflect. Their way of life and ours was quite different but they took pleasure in the simplest things. I think a lot of us city dwellers can learn from this experience. Even with the language barrier, it was a memorable time for both groups and we could tell from their body language and faces that they appreciated us and the work being done. I can personally say Project KAREn was a huge success and a giant step forward in helping to improve the health of the villagers. Furthermore, referring back to my favourite quote, I can say I am very glad I took the risk and both Zewen and I know that we will return real soon!

Jason and Zewen are currently second year medical students from Duke-NUS Graduate Medical School. Zewen graduated from the National University of Singapore with a Bachelors degree in chemical engineering and Jason graduated from the University of Toronto with a Masters and a Bachelors degree in physiology.