Child and Adolescent Psychiatry

“Striving for success without hard work is like trying to harvest where you haven’t planted”
David Blye

Almost all successful people always have big dreams; John F Kennedy dreamt to send a man to the moon finally his dream came true, Writhe brothers dreamt to fly on the sky as freedom birds finally there is the first airplane, Beethoven dreamt to be musician despite deafness finally he came to be one of the greatest musicians of the world. By the way, only dreaming is not enough, we must also have the strong will to realize those dreams. I am only a little girl that has her own dream to be a Child and Adolescent Psychiatrist as well, and these are the reasons of my will.

Throughout my several years of my life since I was grown enough to read books especially after Buddhist meditation program when I was in high school, I found out that I was interested in religious matter, philosophy, the books about positive thinking and self-improvement. Because of my character, there is no doubt why psychology becomes my favored aspect.

As a medical student, I realize that not only the patients’ symptoms and medication must be considered by the doctors but also psycho-social as well as understanding we must concern about. Hence, I always approach in mental aspects even though I was not on Psychiatry. Reflecting patients’ feeling, counseling, touching, being silent and active listening; these are techniques from my Psychiatric Professors that I normally apply to all of my assigned patients. Even though I am the youngest doctor of the care team, the patients and their relatives usually trust me and express their feeling to me .That is my motivation to do my best on taking care of patients.

Due to loving psychiatry and also children, I decided to be enrolled in elective program in Child and Adolescent Psychiatry in order to clarify the roles of physician in this field and also explore myself. The responsibility of Child and Adolescent Psychiatrist is divided into 2 parts which are firstly being physician in hospital that serve not only the patients but also their parents and family. I realize that it is not easy to endure with long term management and repetitious advice for this group of mental disorders, however I am certain that I can stand.

The second important duty is the health promotion and the prevention. I have a good chance to follow my Professors for school mental health. The group process is arranged that is leaded by child psychiatrist. I like this style of work; teamwork that psychiatrists have to work together with psychologists, social workers, teahers, etc. In my view, group process has a lot of benefits, for instance, learning how to work together with others, face the conflict, solve any facing problems, create new benefits by lots of idea, improving the responsibility, think maturely and perform in several role in teamwork. Because throughout my academic time, I always do activities including the position of team leader, member and staff of several works, I am supposed to do well in the leadership role of teamwork certainly.

In conclusion, I think Child and Adolescent psychiatry is not only my favorite subject but also the most perfect job for my character. Therefore I definitely decide to be trained as a Child and Adolescent Psychiatrist.

By the way, I realize that application of this position of internship is not definitely meant to be Siriraj staff. However I wish to be one of the staff of medical school because of these following reasons.

Firstly, I love teaching since I was a young student in the primary school. My teacher usually assigned me to tutor my classmate that got poor scores. When I was in high school and medical school, I had several chances to be a volunteer in Academic Camp for poor students in rural areas of Thailand and be a volunteered tutor of Blind School. I always feel proud and valuable when my teaching and speaking attempt can simplify and clarify lesson to those children.

I realize that the teacher as well as doctor is such a sacrificed profession. It is an honor for those ones who perform this obligation. One good doctor can save a lot of people,additionally, one doctor and teacher can make much more benefit to the mankind. With no doubts I would like to get that opportunity as well.

Secondly, I wish to study abroad in order to open my view and apply update medical knowledge to Thailand. In my opinion, the purposes of studying abroad consist of, firstly, achievement and lots of salary that is advantageous and secondly, being staff in medical school for making a benefit to society. I have desired to go abroad since my fourth year, absolutely, not for the former reason but the later. Therefore this is one of my reasons to apply for this position.

Thirdly, research is one of the beneficial works. We can improve ourselves and sharpen our brains by creating new question or hypothesis and seek for the way to prove and answer those questions. Unquestionably, technology and knowledge can be developed by the researches, reasonable study can create the great benefit to the mankind. In order to get more experience, practice and also learn how to do the research. I have already asked Professor Nuntawach to assign me as an assistant in his pilot study. I realize that as the position of staff of medical school, research is one of compulsory duty and I believe that I can do it.

Eventually, with my strong determination to accomplish my purpose, I decide to apply for this position. I realize that working in my beloved aspect can create the most effective outcome and also my everlasting happiness. Without hesitation, I will sacrifice myself for making benefit to the mankind and society and cultivate my blessing for the needy people. Last but not least I have never forgotten as a doctor, I must continue this valuable profession, and hopefully my skills will bring good health to the people of my mother land

“Life is happiest when you are needed by others and can do things for others”
Master Cheng Yen

Making a decision

Do you have “Dream”.

Absolutely, everyone has their own dream and make an effort to catch up their destination.

Life seem boring without challenging. Motivation and inspiration drive one’s breath to go on.

And my own dream is being child and adolescent psychiatrist…

By the way, any ways aren’t covered with carpet, the rough and difficult route color life colourful.

I found out myself 2 years ago when my rotation rotated to psychiatry department. I do love the way to approach the patients in mental aspect that rarely be met in other department. Most of doctors search for organic or medical condition and manage by medication and surgery perfectly but few of them search for the real cause of bio-psycho-social. Most of doctors try to advise the patients based on theory but few of them try to support and understand their patients’ feeling seriously.

Actually I realize that mental problems are the most common trouble of one’s life. No one never face suffering but how many of them can fix the trouble with matured coping. Mental problem vary from normal variant to mental disorder that closed relate to science and neurotransmitter which some of theory are proved already but most of them are questionable. I think it is such an interesting field and suitable with my character.

Once I dream to be the staff in medical school, have USMLE exam and train in residency and fellowship in USA…

The day of psychiatry training application is coming, this position is special due to the chosen one is internship only 1 year and start residency course immediately as well as get a special opportunity to be considered as a staff of Siriraj hospital, comparing with the common compulsory line to be intern 1 year follow by 2 years in suburb before coming for training. However only 1position is required.

Anyway this time I’m confused and still cannot make my decision.

Between applying in position of child and adolescent psychiatry resident that is my dream and being a doctor in suburb that no progression and waste my time 2 years … nothing must be confused, doesn’t it??

I desire acquisition of knowledge but lesson doesn’t appear only in school. I love teaching and being a teacher as well as doctor but class not only in a square room and in medical school, I can teach my patients, my junior doctor or my crews anywhere.

Progress can make my life flourishing, but I also yearn for experience of being real human.
I would like to going abroad to be an excellent physician, on the other hand I can be a good doctor that can take care of many patients after graduate in Thailand as well.

I’d like to go to rural district to get more experience…. It’s such an odd idea comparing with many of my friends who scramble for the way to be as close as downtown and facility for instance applying for fixing ward in large hospital or being in preclinic in medical school.

But I would like to make some benefit as a general practitioner as much as I can before I’ll take the rest of my whole life for psychiatrist. I do love to learn more in other aspect other than medical viewpoint for instance being in the position of community hospital administrator, being leader of hospital staff for health care, health promotion and health prevention, creating new project that is beneficial for my folk.

I have ever been suburb for 2 months when I was the 4th and 5th year for community research and family folder… I found out that I love this lifestyle. I can learn more from there for example lifestyle of folks, how to get along with nurses or other hospital staffs smoothly without conflict, how to be not only a good doctor but also perfect leader in community. I would like to be a little candle in dark place that much more valuable than being a common light in luminous area although merely short time of my life.

I realize that I’m too young including my though, my vision and my experience. hope to be much more matured and understand life better…

Am I a stupid girl if I will leave behind my best opportunity to apply as a staff of Siriraj hospital and go on being such a common doctor in rural area before coming training psychiatry.
Or apply as a staff of medical school to fulfill my dream to be a doctor as well as a teacher and I can make a benefit to society as well…

How can I do???

Ethic camp

On my weekend after new year celebration, I had an opportunity to participate in ethic camp at Chon La Preug resort, Nakonnayok.

The camp consist of workshop, buzz group and scenario that activate us to consider about physician morality, conflict between doctors and other health care occupation who must work together, and also relationship between doctors and patients.

The patients that were broadcasted in mass media as the plaintiffs to sue doctors, were invited to clarified their information in media in their views and expressed opinion about current physician. Absolutely we could not change their negative thinking to doctors. However instead of quarrel and being enemy, we took this chance to understand our patients’ feelings more, their view reflected us what most of patients need from their doctors that not only medication but also compassion and good communication to clarify patients’ status.

Actually in my view, because of media, people misunderstand the truth and criticize doctors as the offenders. On the other hand, we, doctors portray a complainant as a devil to destroy us either.

Everyone usually need understanding, empathy and supporting especially from their doctors that they trust and salute to. Just open our hearts, we will find out that compassion and communication skill can protect ourselves perfectly. No one is offender or devil at all in many cases, but misunderstanding caused from bad communication, I suppose. We cannot treat them only medication, but also treat their feeling as well, love and care our patients as our beloved person, advice and educate them as well as patients’ relatives clearly, frequently and sincerely.

I believe that virtue is the strongest shield, though mistake occur, forgiveness will always follow for the good doctors absolutely.

Volunteered doctor in Ranong, Thailand

This is another activity that is my memorable time. My friends and I went to rural area in Ranong as volunteered doctors last year.

This was my first time as a 5th year medical student to take care and also prescribe for lots of patients without consulting and signing of my professor… OH MY GOD!! The patients will still be all right after visitting us??? ><

In order to be perfect in being a real doctor (without professor) first time, we must do homework much; reviewed common problems that anticipate to meet and also dose of medication as much as we could.

After finishing our class around 4-5pm friday, we hurried up to catch the bus that would depart from Bangkok around 6-7pm and take a whole night in non air conditioner bus about 8-9 hrs… Opps!! I could not deep sleep on the seat that could not lean down, so chatted with my partner and counted the stars until my friend feel sleepy. However due to lots of fatigue, finally I was unconscious and slept on uncomfortable seat. We arrived our destination around 4am and pave mats on the floor as line of troops without discriminating gender due to not enough area.

The morning started at 6am after we took a bath and had an excellent breakfast that was prepared by folks for us. Then we began our duty immediately by history taking, physical exam and prescribe for our patients.

And everything finished around 5pm with about 900 patients (10 doctors). Wow!!! It’s impossible… almost 100 people per one of us anyway I must be the most clumsy and service slowest of us, I supposed.

We ended up my exhausted day by traveling to view waterfall that is not far from our place, had another excellent meal (from people around there as well) and catch the bus going back siriraj to start our work on Sunday….

It’s such an impressed experience, I’m proud to make a little benefit to society though it’s not a big deal… but hopefully I’ll have some chance for this job again

Personality Development

Don’t compare yourself with anyone in this world, If you compare you’re insulting yourself

No one manufacture a lock without a key

Life laugh at you when you are unhappy, smile at you when you are happy and salute with you when you make others are happy

Every successful person has a painful story, every painful story has a successful ending, Accept the pain and get ready for success.

It is easy to judge the mistakes of others but difficult to recognize our own mistakes.

It is easier to protect your feet with slippers other than cover the earth with carpet.

No one can go back and change the beginning but anyone can start now and create a successful ending.

If a problem can be solved, no need to worry about it

If a problem cannot be solved what is the use of worrying.

If you miss an opportunities don’t fill your eyes with tears. It will hide another better opportunity in front of you.

“Changing the face” can change nothing but “facing the change” can change everything.

Don’t complain with others, change yourself if you want peace.

Mistakes are painful when they happen but year’s later collection of mistake is called experience which leads to success.

Be bold when you loose and be calm when you win, heaten gold become ornament, beaten copper become wires, depleted stone become stature so the more pain you get in life you become valuable.

Teenage pregnancy

This is my experience in 4th year to make a research in community hospital. Absolutely, this is one of compulsory programme for the 4th year to create 1 community research per 1 group. And I had a chance to go to Koa Yoi Hospital, 30 beds hospital in Pechburee.


The first day of us start at antepartum clinic, because we had never passed Obstetrics department before (5th year curriculum), we looked clumsy to approach patients and just followed the instruction of generous nurses.


After finishing the morning antepartum clinic, we met the administrator of the hospital and found out that he is specialized in Obstetrics. Wow! it’s no doubt that this small 30 beds community hospital is capable of ceasarean section including complication cases and there are lots of antepartum cases in ANC


In ANC we realized that most of pregnant are teenage, the data was inspected and we found out 46% of ANC pregnant is lower than 20 years old.


That is not a trouble?? Or they disregard . Almost of folk here haven’t thought teenage pregnancy is a trouble at all because it is too easy to find teenage pregnant in this society. In addition their mothers as well as their granny were teenage mother as well.


So we start and use this problem as my community research


The activity that impressed me much was workshop for elementary students; Prathom 5-6 about sex education. Due to the children are cooperative and the topic is interesting, everything was all right


The other subplan is visiting and approach night-working teenage girls. Their family problems and their background were not different from the character in soap opera. These life story teach me to open my eyes, be broad-minded and understand others more. However their lifestyle and vision could not be changed after 2 visits absolutely but hopefully my advice can give them more advantages, Give up smoking, have safe sex and return to have a school life again if it is possible.


Absolutely, I got such a memorable time for creating my first own research, managing intervention. Though it just a simple research that take only 1 month, I am very proud and got much advantage for this.

Bye Nior' si115

Graduation come again.... my close seniors just graduate

and these are pics of Bye 'Nior party

let's see

Bueng Cha-Warg trip

This was in community medicine duration several months ago (I just have some more time for posting).

After finishing our task, we didn't hesitate to have a nice trip in Supanburee

and these are our pictures of the trip

Community medicine

It is the compulsory programme for the fifth year to make a project in community hospital. Absolutely, I got a memorable time again at Bang Pla Ma, Supanburee. Firstly, I got a good chance to make a satisfied thing for my patient. Secondly, I found out that being in a community hospital is not too bad at all, I learn more from there especially the way to work happily with others… such as nurse, etc and how to manage the health care system in a small hospital that only 3 doctors are on responsibility. Lastly, nice trip with my nice companions.


Ok… I will start my story … hope you can follow my proud matter till end.><

As I told you already, every fifth year students must go to a community hospital.. 5-6 students a group for our project of family folder. We must search for the most interesting family, make family folder, and approach the patient in aspect of bio-psycho-social. 2 family folder must be completed.

Our patient is a 72-year-old woman that got stroke for 5 years. The problems are environment and care giver’s health. Once the patient could move; stand, walk, sit by device and herself. Due to she lie on the floor so long and has not got appropriate rehabitation, hemiplegia from stroke is worse gradually,she can just lie still on the floor. Her daughter,52 year-old carer, must carry her from the floor to toilet and take a bath many times a day. Absolutely myofascial pain and osteoarthritis of care giver progress rapidly.

We consult a physiotherapist of Bang Pla Ma Hospital and we found out that being on bed is more beneficial for rehabilitating. She can use another site of extremities for sitting by herself when they are strong enough, touching floor of her feet can develop motor, sensory and power of muscle, besides being on bed safe the carer’s energy to carry and move the patient.

Because of these advantages of bed, we ask for donation from Bang Pla Ma Hospital. Luckily, the authority of the hospital agree and support our idea. Moreover in order to fix care giver’s health problem, myofascial pain and osteoarthritis, wheel chair which was useful only when go outside and lay down silently with lots of dust at the corner, is adviced to be used for transfer the patient instead of carrying.

The special exercise device that we created ourselves was set up on the ceiling over the position of donated bed. I proudly present that the device consist of just simple and economical component such as rope, PVC, rubber tube.. thanks the Bang Pla Ma technician for gratuitous material. The goal of this device is rehabilitate paralyzed upper extremity, prevent the bad one from further joint stiffness, on the other hand, maintain the power of another site. I suppose that the patient pretty like it (you can see from pic) she look happy to exercise with her new toy.

In addition, to prevent bed sore, we create a clock for recall care giver to turn the patient every 2 hours and advice her to use bed pan instead of carrying the patient to excrete (lie down position) on the floor

change from the floor to the bed

set up device

ok... get a new toy ><

the clock for remind care giver to turn the patient every 2 hours
advice

change from lie down excretion on the floor to bed pan

training rehabilitation

demonstration transfering

Absolutely, everyone is happy, the patient has better quality of life as well as her daughter, the care giver, especially my friend and me.
This memorable experience tell us….

“One of the most fulfilling feelings you can experience is
when you do your best at this moment to do good for others”
-Master Cheng Yen-

Koh Larn trip

After finishing the third week of being Extern in Anes. department... my friends and I arrange a summer trip

Wow!! its unbelievable ... there is such a beautiful beach not far from bangkok

Let see... pictures can clarify my impression more than any words

my friend on Parachute

Fon: pretend to be korean actress ><

my friends in my glasses

me with 2 handsome guys??

LOVE... hey! can u read it

wow!! 2 models from Paris .. haha

it's really such a nice trip... maybe it is also the last one before my graduation

take fresh breath can give us liveliness and power to fight again

><

TV channel

this is another task of mine.... promotion for donation in TV channel

let's see the picture

depart from Siriraj hospital

on the way

oh!!! our destination

receive the telephone and answer the question about donation and also about health

TV program in broadcasting

my friends pretend to be MC

take photo with real MC

Please DONATION in MAHIDOL day

Prince Mahidol Adulyadej

statue of Prince Mahidol at Siriraj Hospital

“I don’t want you to be only a doctor but I also want you to be a MAN”

the quote of Prince Mahidol, the father of King Ananda Mahidol (Rama VIII) and King Bhumibol Adulyadej (Rama IX) of Thailand. He was also regarded as the father of modern medicine and public health of Thailand.

In order to appreciate his virtue and be grateful to him, 24th Sep (the dead day of Price) of every year is settled to be Mahidol day.

And this is a good opportunity for Mahidol students, especially Siriraj medical students, to be volunteers. All of the outcome of donation is determined thoroughly for only buying medical devices and using for a numerous poor patients in Siriraj hosptal, absolutely not including academic affair or research matter.

We, volunteers, are seperated to almost 30 lines in Bangkok and other provinces around Bangkok for asking donation (totally about 80 outgoing times). We must ask for donating house by house. It may be exhausting, some of people that didn’t know sometimes look down on us…. however we are always proud to be a part of this charity.
This volunteering work is not compulsory course however almost of all students participate in this job. Absolutely, I am a volunteer every year, used to be head of Bang-ka-pi line and this year I’m a medical student committee for Mahidol's day donation.

I suppose You can realize that this way is extremely beneficial not only for the poor patients but also Mahidol students. I think This is a brilliant method to instill student a good attitude of altruism, compassion and follow Prince mahidol’s teaching “the patients’ advantage must be considered first”

Moreover, as a volunteer, I got lots of valuable experience, the kindness of people impress me. Though some of them are very poor such as a beggar, pity elder man,..ect. are willing to sacrifice a little of their scant money for this charity because they trust in Siriraj Hospital and hope these little donation will be more advantage for someone….. it’s extremely impressing, isn’t it….,

And these are example photos

this's a special occasion to ask for donation by BOAT (normally, travelling the by bus to destination and by foot for asking donate house by house) by medical student committee for Mahidol's day Donaiton .... it's such a nice experience!!

let see

wow!! 2 romantic guys haha><

how to donate???

in the market






i''m promoting to folks for donation

"Hello, sir. we come from Siriraj foundation. Please donaite in Mahidol day. absolutely, All of your money will be used for Siriraj poor patients and also buy medical devices...."

Mahidol flag.... souvenir for donor


the crews

Ahhhh!!!! finish this day chariry... Be so proud and happy to do a good job..

these are just sample photos...

As I told you above there are almost 30 lines and about 80 times totally to ask for donation... whenever you, the readers meet us, student volunteers in our uniform with donation box and flag... please don't hesitate to donate for the poor patients l...a...

THANK YOU SO MUCH for your kindness ^^

PS... you can do a charity and help other people all the time, not only for any special occasion,

Be Happy with your good job.... Good Luck

Child and Adolescent Psychiatry

It seemed not any portent that I would be a doctor untill I had attended “wish been DOCTER”, the camp for high school students of Siriraj medical school, before entrance examination….

Likewise that time, I’ve just found out that I’m falling in love with enchanted PSYCHIATRY…. There is not any omen as well…

The 4th year medical student must pass department of psychiatry for 3 weeks, due to this department was my last one of my 4th year, this field has never been in my choices and I had somewhat disliked psychi because…..
- I wouldn’t like to work with insane patients,
- human thought was too complicated to understand
- my 3rd year score was very poor.

But in the 4th year, After studying psychiatry, I realized that it is one of interesting subjects. Moreover communication skill is important for therapists, you can realize that speech is only one confident and proud talent of mine… I love talking with the patients as well as my friends (when they face any problems and ask me for my advice). I am always happy if ones’ suffering are lessened after our conversation.

In order to explore myself… I applied for child and adolescent psychiatry, elective course in my last 2weeks vacation of my student life.
1 week pass rapidly… I suppose I’m falling in love psychiatry sincerely…

The way that professor approach the patients is different from other kind of specialists. They notice thoroughly verbal and non-verbal language, behavior, communication, social skill, cloth, the reaction of patient and patient’s family members, etc… , predict one’s personality and thinking. Specially they care of ones’ feeling, each speech sentence is produced careful and reasonable. Absolutely, I can apply this subject matter in my life to be a good mental health person as well as good communication skill.

In aspect of child psychiatrists, it’s no doubt that they must be excellent parents that bring up their children perfectly.
Dr. Wanpen, I can touch her warmth and think of my own mom and my granny when studied with her... she is my respected model and such a nice woman..
Dr. Suporn, another one of my model of child psychiatrist said that she had applied the theory for her own child and found out that though these methods are too difficult to continue all along (in thailand) but if parents are steady, these ways are very effective for child rearing… moreover she supposed she might not be able be a good child psychiatrist if she had never tried by herself (with her child).

Absolutely, I have never known what the right method of child rearing is… so do most of parents, I suppose. Child psychiatry department arrange weekly “Parent Training program”, and I had a chance to attend this activity last week, I realize that it’s extremely useful for everyone (not only for parents). The lesson consist of how to use “I” message to present one’s feeling directly that is better than “U” message or BLAMING which discourage listener’s feeling and useless way for behavior improving, including emotional reflection practice, the method to cease bad mood expression that result in arguing, etc.
In conclusion, this class was beneficial and I realize that I’m the one must practice these lesson as well.


By the way, Psychiatrists are extremely deficient; 400 general psychiatrists and only 100 child and adolescent psychiatrists in Thailand, on the other hand, I suppose you cannot imagine what a numerous psychiatric cases there are; including the admitted patient and psychiatric problems that are anticipated to solve.

Hopefully, I can be a good and excellent one same as my respected Professor in the future…
Wish my dream come true..

Maproa collection

this is a cute child that my friend crazy about... he is a young star.
Let see how cute he is and you'll fall in love with him...

"MAPROA"

Pediatrics

Pediatrics is one of the busy and exhausting department for siriraj medical student...
Due to lots of task and my laziness, I’m far from writing any mail or updating my blog. However I still think of this classic way, writing blog can give me a chance to revise my daily story. ok i'll try to write my story as much as i can...

I’ve been in Anan building 4th floor for 5days ago, just today I have known n’ dance(TeamB, I’m in Team A), the well-known chronic disease girl that my friend usually told me about her behaviror, she is just a common girl that usually prefer to play with any male doctor other than female ones obviously... and i just got that experience today, she deny to play with me and call out keng, my wardmate to talk and play with her… I cannot believe what a 5-year-old flirtatious girl she is…. Hahaha

now I have 5 cases in my responsibility... arriving ward to progress them around 6.30am before morning ward round with resident and progress them again after my class in the afternoon before eveing ward round....
the new case just admitted yesterday and I hurried up to finish my pneumonia report last night(1.30am) … the case presentations are usually prepared so i'm quite busy and exhausted every now and then
moreover In pediatrics we, the medical students must be on overnight duty, that's the first time in my life

Being in Pediatrics department is somewhat exhausting however I usually proud to be a part of team and take care of my patient myself... that is such a nice feeling....