Fall 2009
East Meets West

synapse: University of Nevada, Reno School of Medicine

Kuhls receives the honorary plaque

Kuhls receives the honorary plaque of appreciation from the surgeon general of Thailand. Photo courtesy Pisespong Patamasucon, M.D.

Global health study can be an enlightening component of the medical education process. The desire to form international relationships is a significant part of that process at many medical institutions.

Story by Marcie Newpher

Such is the case with the international programs established in 2003 between the University of Nevada School of Medicine and Pramongkutklao College of Medicine near Bangkok, Thailand.

The college, a military medical school that was established more than 35 years ago as part of the Royal Thai Army, has medical strengths and technological advancement in areas of combat casualty, orthopaedics and parasitology.

Developing a relationship with an international school with expertise in some fields of medicine not emphasized at the University of Nevada School of Medicine serves to strengthen educational goals and experiences locally, according to Pisespong Patamasucon, M.D., professor for pediatric infectious disease at the school.

The partnership started with initial funding from the Thai Physicians Association of America whose members did internships at the College of Medicine, said Patamasucon, a Thai native.

He worked on many collaborative projects with the medical college for 10 years before establishing the formal partnership between the two schools that began six years ago, and laid much of the preliminary groundwork. This relationship initially offered a training program for Thai physicians to come to Nevada for workshops and collaboration.

“The Pramongkutklao College of Medicine identified certain areas they wanted to develop with our help, most especially trauma services and emergency medicine,” said Ole Thienhaus, M.D., dean of the School of Medicine.

As a result of combining the Thais’ interest with expertise residing in the faculty ranks at the School of Medicine, collaboration with the surgery department naturally followed.

In 2004 several School of Medicine faculty and staff members, including Deborah Kuhls, M.D., associate professor of surgery, joined the partnership between the two schools.

“Dr. Patamasucon approached me five years ago to go to Thailand when they were realizing that of the top causes of death in their country was traumatic injury due to blunt trauma, motorcycle accidents, pedestrians struck by motor vehicles and some penetrating trauma,” Kuhls said. She spoke at the annual Thai pre-congress session on trauma and trauma systems.

Topics Kuhls presented during that conference included development of trauma center, intensive care unit, emergency room and operating room designs, administration in the trauma center, human resource development for the trauma center and quality improvement.

In addition to this initial key area of focus, according to Thienhaus, through time and repeated mutual visits, pediatrics, teaching methodology or problem-based learning and graduate medical education became subsequent areas of interest as the College of Medicine began to expand and develop its own programs with help from School of Medicine physicians and surgeons.

In 2007 Melissa Piasecki, M.D., associate dean for faculty affairs and development, who specializes in forensic psychiatry, became involved in the program with Thailand because of her interest in what the Thai medical systems provided for education as well as their clinical services.

“The opportunity to join a teaching team from our school going to a ‘sister school’ was very appealing to me,” said Piasecki, who met with Thai faculty and worked with pediatric residents. “We discussed death and dying issues and talked about the tsunami victims with their child psychiatry faculty and I learned about their trauma work.” During that visit, Piasecki also spoke on forensic aspects of child abuse.

College of Medicine faculty took their turn visiting Nevada this past winter. Members of that entourage included Lt. Gen. Sahachart Pipithkul, M.D., director of the medical center; Maj. Gen. Kittipol Pakchotanon, M.D., dean and director of the college’s hospital; Maj. Gen. Teerayudh Sasiprapha, M.D., director of the academic affairs division; Senior Col. Prasong Lomthong, M.D., assistant administrative director, and Senior Col. Prapaipim Thirakhupt, M.D., Center of Academic International Relations administrator.

Patamasucon said the main purpose of the Thais’ visit to Nevada in February was to discuss mutual cooperation for the next five years and to reflect on what happened during the first six years of the partnership. “It was also a chance for our Thai colleagues to look for ways to collaborate and for opportunities to gain research experience for faculty and students,” added Piasecki.

Certain basic science research areas especially interested the Thai visitors this winter; specifically work conducted by Thomas Kozel, Ph.D., professor of microbiology and immunology, on the bacterium Burkholderia pseudomallei.

According to Kozel, this bacterium is the causative agent of melioidosis, an acute or chronic bacterial infection that is found in tropical regions of the world.

Consequently, Patamasucon previously co-authored articles on melioidosis published in the Journal of Pediatrics in 1975 and again in 1982 following the resettlement of Southeast Asian emigrants in North America.

“Melioidosis is most unusual in the U.S., but it was found occasionally with troops who returned from Vietnam. It can be difficult to diagnose and treat,” said Kozel. “Melioidosis is a particular problem in regions of Thailand. This bacterium is a particular concern as a potential biowarfare agent because it is believed to produce a rapidly lethal infection following inhalation of small numbers of bacteria.”

The College of Medicine faculty also toured the school’s anatomy lab viewing the 15 tables, each containing a cadaver and computer with a touch-screen monitor for viewing dissections developed by Carl Sievert, Ph.D., professor of physiology and cell biology.

Two months after the visit from the Thai faculty and in spite of some civil unrest in the country, Thienhaus made his initial visit to Thailand accompanied by Patamasucon in April 2009.

Excited to see the Thai program at work, Thienhaus was specifically interested in their parasitology department as this expertise does not currently exist at the School of Medicine.

The itinerary included Thienhaus lecturing on ethical dilemmas in clinical practice and tours of the Thai medical school facilities.

“I had a chance to meet the deans of two other medical schools, one in Bangkok and one in Chiang Mai,” Thienhaus said.

The relationship with Chiang Mai University, located in northern Thailand, and the College of Medicine, exists due to a recently signed partnership agreement between the two schools that includes resident exchanges and program education.

Unlike Pramongkutklao College of Medicine, the university is not a military medical school; however, it is similar in enrollment with more than 100 medical students per class. Thailand has more than 10 medical schools, but the prime locations of medical college and university make these institutes an attractive selection for students.

Beyond the faculty relationship that has been in place for five years, School of Medicine students have had the chance to participate in an elective program in Thailand for several years.

This summer, Bailey Cannon, a fourth-year medical student specializing in obstetrics and gynecology, enjoyed such an opportunity.

“During the summer between my first and second years, I spent one month in Africa working in village clinics. It was during this trip I made the commitment to make global health a part of my career,” she said.

Spending four weeks in Thailand, Cannon was able to learn more in the field of women’s health, particularly prenatal programs, child birth and the differing technological advancements.

“I feel so fortunate to attend a school that allows me to strengthen my education by training in many countries. Overall, I feel these international experiences will make me a very well-rounded and culturally sensitive physician,” she said.

Peggy Dupey, Ph.D., assistant dean of admissions and student affairs, echoed Cannon. “The exchange program is very exciting, and we’re happy to see increasing student involvement.”

Looking to the future between the College of Medicine and School of Medicine, the Thai school will soon host the International Medical Education Consultants, a Bangkok-based meeting for medical educators throughout Thailand. Piasecki, Miriam Bar-on, M.D., associate dean of graduate medical education, and Sievert are all keynote speakers at this conference.

Other likely possibilities for collaboration include more student exchanges between the schools and continuing opportunities for graduate medical education program design comprised of competence-based evaluation and promotion.