Audio Upload | Nov 28, 2023 10:28 AM
Nov 28, 2023 • 9:39 AM - 10:29 AM • Denise Billen-Mejia • Audio Upload
Speaker 0
00:08
Hi. Welcome again to Myth, Magic, Medicine with me, Denise Billen-Mejia. Today my guest is Tanya Wansom, who is an
American-born, American-trained physician, and PhD, whose specialty is Infectious Disease. And she's going to talk to us about
emigrating the other way. Hi, Tanya, thank you so much for joining me, especially since it's nighttime there.
Speaker 1
00:33
Yes, it's in the future. I'm talking to you from the future, which is exciting. At least we're on the same day. Sometimes if it's nighttime
there, then I'm like I'm the next day, . But thank you so much for having me. I'm really excited to be here. Yeah.
Speaker 0
00:52
I take a lot of calls with so totally the same What do you think is really positive about. The career aspect of your life. And what do you
think the biggest negative is?
Speaker 1
01:03
So that's a really good question. So I think one of the biggest positives has been the ability for me to really create my own career and
my own path to do something a little bit nontraditional and also within because you're dual national. Yeah.
Speaker 0
01:26
It's allowed you more.
Speaker 1
01:27
Yeah, yeah. But yeah, we can talk a little bit more about my career path and why. I think that's interesting. But I also believe by doing
the work that I do, I'm uniquely positioned to have the greatest impact. And being here and using my skills, my degrees and my past
experiences really allows me to make a unique and lasting impact that I don't think I necessarily would have had. I think it would just
be a different kind of impact if I stayed in the United States. And so I'm really grateful for that.
Speaker 1
02:05
And it's also, for me, a way to give back because during... so my parents are both in medicine, my dad's a physician, my mom's a
nurse. But during the late seventies, the US didn't have enough physicians. So they were giving green cards to many physicians from
different countries. And obviously I'm really grateful that my dad had that opportunity so that I was born and raised in the US.
Speaker 1
02:31
But it also contributed to massive brain drain, actually, of physicians.
Speaker 0
02:37
We had that from Britain too.
Speaker 1
02:39
Yeah, of course, from many countries. But at that time in Thailand there were three medical schools and so my uncles also immigrated
to the US and are physicians. But one of my mom's eldest brothers, 95% of his class left Thailand. And as a low middle income country
at that time, they had invested all this in trying to train the next generation of doctors. And then they were like, awesome, there weren't
any yeah, we have no doctors that we spent like six years training. And so, I mean, I see both sides of it, but I think that me coming
know is kind of like a way obviously they don't have that same challenge anymore right now.
Speaker 1
03:21
And actually it's interesting because a lot of people train in the US and then come back to Thailand and practice here. Actually we
practice medicine.
www.sembly.ai
Page 1 of 13
Speaker 0
03:30
So you mean Thai? Or people whose parents like you parents born who then come over, or these are Thais who go and train in the US.
Speaker 1
03:41
And then come yeah, they're like Thais who go and do residency and or fellowship in the US. And then come back and practice
medicine in Thailand. Um, yeah, that was not common at all in my parents generation, but yeah, so I think that's one of the biggest
positives is I feel like I am contributing and it's kind of full circle for our family in a way. And then one of the biggest negatives is I don't
have a Thai clinical license. I do have a research license. And so I'm able to see participants who enroll in clinical studies or clinical
trials. And I also get to consult.
Speaker 1
04:21
A lot of physicians will call me for consults, et cetera, but I really do miss actually having my own patients and then practicing clinical
medicine, because I did enjoy that. And obviously we spend a lot of time training to do that. And so.
Speaker 0
04:39
Um I feel like that one of the has to be kind of a trade off because you wouldn't have as much time to do the research and to do all the
different work. Let's back up a little bit, because that was perhaps unfair to put that right at the front, but it's staying there. Why don't
you explain briefly? Yes, you were a little American kid, Thai kid, speaking Thai for a little while, and then mostly English because of
school. And you went to college, obviously. You left Michigan to come closer to me in Swathmore, Pennsylvania. What did you study
when you were undergrad?
Speaker 0
05:14
So as an undergrad, did you know that you would go into medicine? It was your intention.
Speaker 1
05:21
My parents are traditional Asian parents, and since they're in medicine, they're like the pathway to success is to go into medicine. So I
was resistant, I think. But in college, actually, I was very interested in and got interested in in HIV AIDS activism. And then also, as I
mentioned, I was very interested in medical anthropology and how culture affected people's perceptions about medicine and medical
care. And so, I don't know. I thought about law. I thought about a lot of different things, but then my parents were like my mom
specifically was like, if you want to be part of our family, then must go to medical school.
Speaker 1
06:15
Or essentially, she said, you know what? You can do anything you want after you graduate from medical school.
Speaker 0
06:25
Get a career first, but then I'll be a doctor.
Speaker 1
06:29
But anyway, I felt that it. It was a after in between college and med school. So actually, I did Chinese studies in college, and I was very
interested in China and wanted to go to China. There was some burgeoning HIV activism going on at that time. My parents were very
strongly against it because they were like, well, some of those people get disappeared that are talking about HIV, and it's great that
you're an idealistic, like, 20 something year old, but why don't you go to Thailand? Because there's actually a lot of interesting HIV work
there. I hadn't spent any time in Thailand growing up, didn't really speak Thai, and I just spent, like, four years and I studied abroad in
China as well.
Speaker 1
07:15
So I was like, Chinese was pretty good at that point. So then I was like, Well, I'm going to go to Thailand, but. Actually that was life
changing for me. So I did get a Fulbright and I was working at the Thai Red Cross AIDS Research Center and they were conducting
some of the first trials of HIV like antiretroviral therapy in this entire region. And so I did some very interesting work there. So I did like
activism and the fact that I was working with a local community organization that targeted mostly sex workers, trying to get them
educated and involved about HIV. And so that was very eye opening for me.
Speaker 1
07:56
Coming from a small town in Michigan, not having a lot of exposure to sexwork exactly. And then just seeing how did sex work really
come about here? During the Vietnam War and for American soldiers, for lots of allied soldiers, for R&R and then how that was
built up, just learning about that and yeah, all the power dynamics and just, being in a position where I was trying to help teach them
English so they could negotiate with clients better and thinking about choices and just realizing stuff isn't black and white, like real life
or whatever. And then also at that time, there wasn't widespread anti-retroviral treatment available. The only way that you could
www.sembly.ai
Page 2 of 13
possibly get treatment was to enroll in a trial. And so I think there was interesting ethics around that. And so I was working on making
sure people understood informed consent and just got really interested in clinical trials and how they could be used to, like,
Speaker 1
09:04
push and advocate for life saving care for people. And so I was an interpreter in the clinic. So there were Australians, dutch people. So
this was a collaboration between Thailand.
Speaker 0
09:16
Your Thai came back to you pretty quick.
Speaker 1
09:19
Yeah, so I actually learned Thai during that year. I spoke some English, but I was really immersed and was yeah, really tried just to
speak as much Thai as possible. And then I think it was interesting because my parents didn't believe that I spoke Thai. And they were
like, we have no understanding, like, how can you be an interpreter in a clinic? And their extended family was like, Tanya speaks Thai
now. Yeah, it's interesting because they speak actually a southern dialect of Thai at home.
Speaker 1
09:56
And then I speak Central Thai, so I don't really understand.
Speaker 0
10:00
Do you now live in the center of Thai?
Speaker 1
10:02
Yeah. So Bangkok and that area speaks central. And most people, if you went to school, you would learn the central. It's like learning
Mandarin.
Speaker 0
10:13
It's like learning the Queen's English, only I've got to get used to the King's English now.
Speaker 1
10:18
.
Speaker 0
10:20
So. So did that give you more encouragement? You wanted to be a doctor at that point. Were you waiting to go through interviews and
stuff?
Speaker 1
10:31
Yeah. So then I was like, I'm doing infectious disease. This is amazing. There's so many ways to contribute, actually. I was like, If I
don't get to med school, I'll just stay in Thailand. Because there was amazing civil society, the actions at that time to get anti-retrovial
therapy, I just felt like it was a really pivotal, interesting time to be involved in both community organizations and from the medical side
of things, to say, who is going to be eligible for care and what is the CD4 cut off? Or if you use drugs, can you be eligible?
Speaker 1
11:11
At the beginning, they were like, no, if you're on drugs, you don't get antiretroviral therapy. So I think it was really interesting time. Yeah.
A lot of the activists that I worked with at the time are still active in civil society in Thailand. So it's been interesting because they were
like, we remember when you weren't even a doctor yet, or 20 years ago, when you were marching with us to Parliament and stuff. So, I
think that definitely encouraged me to go to medical school. And then I was like, oh, yeah, when I'm finished, I'm going to come back
and do more.
Speaker 1
11:45
And so I think that was really important, formative experience for me. And then, actually, during medical school, I kept taking time off
and coming back to Thailand or doing these small research projects and keeping in touch with different people. And then even when I
did my ID fellowship and my PhD, which was in clinical research from the School of Public Health, it was about HIV, hepatitis,
co-infection, and looking at cohorts in Baltimore. Right, you were James Hopkins. Yeah. So I did work both here and in Baltimore.
www.sembly.ai
Page 3 of 13
Speaker 1
12:27
So I always kept working here and coming back here. And then an opportunity came up. When I was finishing fellowship, I was
recruited for a position in Thailand because people knew that, you know, had said, I would like to come, know if there is something
available, then think of me. And they were like, we thought of you. You should come, that you're done and qualified.
Speaker 0
12:57
So actually, this was sort of in the cards anyway. Even I thought you had gone back because your parents went back, and so you
thought it would be good for the children, really? You were the driving force.
Speaker 1
13:09
Yeah, I was the driving force. I actually thought I would always stay involved in Thailand, but when I went to medical school, I really
thought I would be in academic medicine and so that was like a big departure for me, like getting an MD, PhD. I was like, of course I'm
going to stay. And I actually did stay. So, I had won, like, an internal training grant at Hopkins. I was on the path to.
Speaker 1
13:38
You know, just stay on faculty. I was junior faculty, so I had my first faculty appointment when this position came. Yeah, working on
writing another grant. So it was very difficult, actually decision for me to leave. And my parents actually, I think, were a little surprised
because they were like, this is your dream. You are at Hopkins why are you thinking about going to Thailand? Although they were
encouraging because they were like, you're pregnant.
Speaker 1
14:09
So it is like a good time to know and having young children, depending where you are. But very was very nice, I think, to be here in
terms of the ability to have help and just the culture of children. Thai people love children, and so I think it's very different. You would
go to a restaurant here and they would be like, it's a baby. From our Americans would not feel comfortable, I don't think, having some
stranger being like, a baby. Let me take them.
Speaker 0
14:46
Let me just walk around the restaurant. Your child.
Speaker 1
14:48
Yeah, exactly. And here that would be quite common.
Speaker 0
14:53
People would be like, oh, it's a baby, let's like, is it similar to I think of when I go to Indian restaurants and being British, we got a lot of
Indian restaurants. There's sort of this assumption if you're a grown up, you're an auntie or an uncle to whichever child is in front of
you. An extended family of huge proportions.
Speaker 1
15:13
Yeah, exactly. So I think that's there people are happy to see children and aren't like, why is your kid making noise here? Or taking up
space?
Speaker 0
15:30
I think it was just like a very different welcoming kind. So the actual impetus to actually move to Thailand was a job offer from
Thailand?
Speaker 1
15:42
Yeah, it was a job offer from the US military, actually. So they run, like. The US. Military HIV Research Program. Well, I'm not in the
military, but I was a contractor. But they previously had a very actually large program here, and they ran, like, HIV vaccine studies,
some cohort studies. The US
Speaker 1
16:06
CDC is here and works a lot with the Thai Ministry of Public Health and for quite a long time actually had clinic here that served people
at high risk for HIV. And then they use as a platform, I think, for a bunch of different very interesting studies. And some of those are
still ongoing and funded by the military. But I was originally recruited yeah, as an infectious diseases physician to work within that
program. And so I did that for a couple of years.
www.sembly.ai
Page 4 of 13
Speaker 0
16:35
And what led to the next pivot?
Speaker 1
16:38
Yeah, so the next bit was during a previous administration, the priorities of the Department of Defense changed, and there was not
continued funding, actually, for some of the work that we had hoped to continue here. And so a large portion of the program and the
studies that I was working on, they were just like, yeah, we're just not doing that anymore. And so I think that is the downside of being
a contractor or oh, yes, you can walk into work on Monday and walk out Monday evening unemployed. Yeah, exactly. And so they were
like, well, exactly. The funding didn't come through as we expected. And so it was a little bit like that not that sudden, but it was like an
unexpected kind of exit at that time.
Speaker 1
17:40
But I really think it was difficult at the time because I was like, oh, no. Then you're, like, regrets. Like, I should have stayed. Why did I do
this? But actually, I think that was definitely for me, in hindsight, of course, a blessing in disguise, because it made me really think
about, did I want to be here? Did we want to go back? This was, like, right before COVID And so we decided to stay here.
Speaker 1
18:05
I had an opportunity, actually, to return to my roots and work with. A local, new kind of nonprofit social enterprise that had just gotten
funding from the Global Fund for AIDS,TB and Malaria to run a community centered kind of implementation science project targeting
people who use drugs. So, they were like, we want to test and treat people for hepatitis C in the community and be the first study to
really do this outside of the hospital, outside of clinic, outside of tertiary care settings, which is at the only time or only place at that
time where you could get hepatitis C treatment. And I was like, oh, this is me. Yeah, it's like, HIV, viral hepatitis, I was like, I love this. I
want to work with marginalized populations.
Speaker 0
18:56
Come home again.
Speaker 1
18:57
Yeah, exactly. So it was kind of homecoming. And I was like, okay, let me try this for a year, and if this project works, then that will be
really cool. And, yeah, we'll have implications for advocacy, for public health. And so I did that, and I'm still actually doing that work.
Now, it wasn't sustainable for a long term just because my children go to International School and it was a local nonprofit.
Speaker 0
19:30
They were paying Thai salary.
Speaker 1
19:32
Yeah, exactly. And my husband was like, this is great. He's like, I know you're happy. You're, like, flying all over and doing your thing. But
he was like, let's think about something. So I was like, okay. So I actually, um.
Speaker 1
19:45
Looked around and had my eyes open and just talking to people in my network that I was looking for different kind of work or different
projects to work on. And then I started becoming involved in other trials like I mentioned. And so they were looking to start this
multinational trial testing a new drug for gonorrhea. And they were like, do you know anything? And I was like, yeah, of course I was
know all these things are related, like HIV, sexually transmitted infections. And how I originally was approached were like they were
having difficulty getting the protocol through the Ministry of Public Health, IRB [institutional Review Board] and somebody was like
Speaker 1
20:29
Yeah. You're identified as a person who understands you may understand these people okay. Yeah. How this works. And since you're
American trained, you also understand how people are thinking from a European or an American perspective. And we're just having
trouble understanding the people in Geneva. We're having trouble understanding what is going on in Thailand.
Speaker 1
20:57
And you kind of need, like, cross cultural yeah. Interpretation is not just exactly words. so I think that's know a lot of actually what I do
is, like, yes, of course I have technical expertise in infectious disease, but I also know speak to Thai investigators or the Ministry or kind
of try to understand what's going on and say the right things or.
www.sembly.ai
Page 5 of 13
Speaker 0
21:24
Um, you might have a better idea of what the question actually is.
Speaker 1
21:31
Yeah, exactly. Or, you know, when people I think Thai culture is sometimes like, yeah, not so direct, or not necessarily not aggressive,
but some things very polite. Some things may come off as aggressive and then people will just withdraw or it's difficult for them to
engage if somebody's like yelling or not even yelling, but even just, like, being very direct or raising their voice. And so. Yeah. I was
hired, and I basically came in and helped smooth over, I think, a lot of sometimes there were misunderstandings, but sometimes it was
just a matter of being like, okay, trying to figure out what type people wanted or wanted to communicate and what they wanted to
communicate and trying to do it in a way that was like, palatable, I guess.
Speaker 0
22:24
Yeah. So people really understood they weren't attacking each other.
Speaker 1
22:29
Yeah, exactly.
Speaker 0
22:30
Now, I had thought before we met briefly, before we started recording, that your husband was also Thai, but as a Chinese American, he
was born in the States as well.
Speaker 1
22:43
Yeah, he was born in the States as well. Yeah. Okay. His parents are immigrants, first generation.
Speaker 0
22:49
Yeah. But I wonder how easy was it for him to feel integrated in the Thai community? Thai and China is very close to each other, but
not exactly the same.
Speaker 1
22:59
I think culturally, he much easier and then even, like, learning to speak the language. So because he, uh, background in speaking a
tonal language, he went to Thai school here, and he could pick it up a lot more quickly, I think, than somebody who didn't have any
background speaking a language with tones like different tones. Why are you saying the same way over and over and then he actually
looks very Thai. So many people here are like, your husband looks more Thai than you, even though you say that he's Chinese, they're
like, he looks Thai. So I think it wasn't so hard for him to integrate. Think, you know, being in Bangkok, it's such a metropolitan, such a
huge city, that later on we were able to meet a lot of people that are from all over but also like Americans or other English-speaking
people that he feels at home with.
Speaker 0
24:06
Has he had a similar reasonably smooth path, career wise, having moved?
Speaker 1
24:11
So it's very interesting. He's in IT and he's actually kept one of the same jobs that he since we were in Maryland, so. Yeah. I was like,
now, he's been there for a long time, but pre-COVID, he was one of the only people who was working remotely. And even when we
initially moved here, he was like, hey guys, I'm going to go to Thailand. My wife does this project, maybe for two or three years, but then
I'm going to come back. And so everybody's like, okay, first they were like, we don't know.
Speaker 1
24:50
Maybe you can work remotely, maybe not. We'll just try. And then it worked. And then post-COVID, actually, his entire division became
remote and stayed remote. So it was interesting shift, because I remember they were like, you can't work remote. And then they were
like, Everybody works remote.
Speaker 0
25:08
My husband had this I mean, we stayed within the States, but we had that sort of like, I could do exactly the same job because I'm still
talking to you on a computer, even if you're in the same office, we can do this. People didn't want to move, but having been forced
through COVID to see that you can work remotely. And there's a lot of push-back from people right now. They've got to justify having
these expensive offices.
www.sembly.ai
Page 6 of 13
Speaker 1
25:29
Yeah, exactly. That was part of the reason they made his group remote was they were trying to reclaim office space or maybe they
didn't need so much office space. So now his entire group is remote and then yeah, he's also been able to be an independent
consultant and sometimes he takes on some other smaller IT projects. But the interesting thing for him is he actually works night, so
he works Eastern Time and I think for him that's probably the biggest negative is working at night. Maybe he doesn't work all night, but
he has to be there for meetings.
Speaker 0
26:10
What's his night?
Speaker 1
26:12
Exactly.
Speaker 0
26:14
This is really fascinating. It's quite different from the previous twelve interviews because it's been lots of different countries are being
represented. But let's talk a little bit about attitudes to health care then and really life altering things like the attitude to death. The
impetus to this was from Tatyana, who's in both S2 as an American doctor and in S3 as an immigrant doctor. And she said when I was
just chatting with her once, you can't tell somebody bad news. It wasn't allowed.
Speaker 0
26:53
And several other people in this series ah, by the time people are watching you, all of those are now available. Is that you would
perhaps be really truthful to the family gently, but you never tell the patient, which is not going to fly in America unless the person was
incompetent. So, what's the attitude like there?
Speaker 1
27:17
So I think that's somewhat similar, especially with the older generation, like for know, if someone had cancer, traditionally some people
exactly like you could tell a family member, but maybe in my parents generation, they wouldn't tell the actual patient. I think that's
changing a lot now and people with more information do want to know or want to be more active participants in their health care. And
so I think that's definitely changing. I think it's also because there is a lot of Western influence here and like I said, a lot of people here
go to train, actually in the UK or the US. For example, and then they return. And then Thailand, interestingly, is also a hub in this region
or one of the Centers for Medical Excellence, so people would come here for health care.
Speaker 0
28:20
So like Singapore, Thailand, it's one of the major medical tourism spots.
Speaker 1
28:26
Yeah, exactly. And it's like now people are also into medical tourism and so, yeah, so I think it's interesting. And so that, you know,
obviously, that has impacted how health care is delivered. And the style in which people discuss is the attitude towards the inevitability
of death at some point.
Speaker 0
28:52
Is it understood differently?
Speaker 1
28:54
There is there a different traditionally, yeah. So the national religion, although there are other religions here, but the majority of people, I
think, do still identify as Buddhist, or Theravāda Buddhist specifically. And so I think, yes, inevitably, there is death. And then if you are
Buddhist, you most likely do believe that my family is Buddhist, like, in reincarnation, and so that you would have another life, and
you've had lives before this as well. And so I think that people do have a different view of death, and there's maybe less, although
sometimes I see it more where people are like, do everything. I think sometimes I can see more of that here that's come from the US.
Where they're like anything to prolong
Speaker 1
29:51
but I think traditionally here it's been like, well. Yeah. That's futile. That care is, like, futile. Or you could just go easily, or it's time to go
to the next life. This is the end. Yeah.
www.sembly.ai
Page 7 of 13
Speaker 1
30:11
I do think that there is traditionally a different kind of view of death of both people and also other things. Our dog died last year, and I
was thinking about that because. They at the temple, they also have, like, a pet crematorium, so we were able to go there and have a
little ceremony for him. But I was like, this is kind of nice. And talking to helps the children. Yeah, and then the children were there with
us, and then we were like, do you think?
Speaker 1
30:42
Yeah. And then they were like, oh, we hope Yoda if he's a dog again, like, that he has, like, a nice family, or where do you think he is
now? And I was like, I don't know. We don't know for that too. Yeah, exactly. So I think that is interesting or that people talk about
more. One thing that I also think is interesting about death and the culture of death here is one thing that we had talked about before,
about how everything's like an extended family.
Speaker 1
31:12
And so you would go to a funeral here of someone who you didn't know, but they were a family member of someone you might be
close to, for example, that you worked with. So my uncle, who was the first person in my parents' generation to immigrate to the US.
And help bring my mom over. Back in the 70s, passed away. It was a little bit after COVID, so a few years ago. But I remember the
people I worked with doing the Hep C project. Like they sent a wreath and close colleagues came to the funeral.
Speaker 1
31:52
They've never met him ever in their lives but knew that he was important person to me and yeah, we're just there for support and that is
very common in Thailand. So I think that's been interesting for me to see like how people come together around death in a different
way. Because in the US you wouldn't. That would not be common. I think, like, a colleague that you maybe worked with in clinic, if
somebody closed, if it was somebody that worked with you yes, you would definitely yeah, exactly. But you wouldn't be like, let me go
to your great-uncle or your cousin, like this person I've never met before, to their funeral or wake or whatever.
Speaker 1
32:35
But here it's very common. And yeah. Kind of expected, in a way. Yeah. People were apologizing that they couldn't come, and I was
like, I didn't expect any of you. It's nice, or to send something or a donation.
Speaker 1
32:52
People would donate in the name of the person who had passed away. Yeah. So I think that's been interesting for me to learn about all
these different traditions that we didn't necessarily do when we were growing up, just because I wasn't surrounded by any Thai of did
Michigan choose them rather than they chose Michigan? Yeah. So my dad did residency in Ohio, and then a friend of a friend was like,
there's not enough doctors in Michigan. And because, you know they are auto workers.
Speaker 1
33:31
They have really good health insurance with the unions, and so they're like, this is a good place to come because there's not enough
people. I think that's, like the story of so many immigrants. Right. It's like somebody knew somebody, and then they just ended up
there, and then it's like, 40 years later or 50, An enclave of Thais there now. Yeah, there are more Thai people there now, but there were
many more in Chicago area, and there was a Thai temple there, so we would go there sometimes, like, at New Year to go to the temple.
So I think people who grew up in cities with Thai temples, a lot of them did go to Thai school on the weekends and learn traditional
Thai dance and yeah.
Speaker 0
34:19
Thai basketball. Did your parents allow you to sort of drop Thai when you entered school? Because it sounds like they strong opinions
on your career choices.
Speaker 1
34:31
Yeah, no, they really wanted to speak Thai with me, but I find that this is very common and it's true even like people who are living in
Thailand. Since our kids go to International School, a lot of the Thai parents are complaining any that their kids only speak English to
them. I think they tried and then they were like, this is a losing battle. What are we going to really do? They tried to speak Thai around
us and then to me for a certain amount of time, but actually now my parents almost exclusively speak English to me. They're kind of
just used to it. And then I'm like, can you speak Thai to my kids?
Speaker 1
35:07
And they're like, oh, we forgot. And then I don't know.
www.sembly.ai
Page 8 of 13
Speaker 0
35:11
As you explained, they speak South and not Central.
Speaker 1
35:14
Yeah, they can speak Central Thai though, because other Thai people who are not from their region, they have to, but I don't know, I
think they're just used to it. And then yeah, of course with my husband they're like, well, we speak English with Chris. So I was like,
okay. Yeah.
Speaker 0
35:32
They're like, I said, this is different from the other twelve interviews because you went different way. And so pretty much everybody will
know the basics about how Americans learn medicine. Don't have to go up.
Speaker 1
35:45
Yeah.
Speaker 0
35:46
Do you feel there were any well, you weren't questioning clinically at any point in Thailand when you were with the American?
Speaker 1
35:53
It was mean, I could see patients, but they must be enrolled in a clinical trial or a clinical study. And so even now I do the in the
community study that I am a part of where we test and treat drug users for HIV or hepatitis, STIs and things. I do get to talk to patients
in that capacity and then provide care within under the umbrella of like you are a consultant to the other medical people there. Yeah,
exactly.
Speaker 0
36:28
So I'm not sure you can answer this since you haven't worked know, the way you would have in the States, but did anything strike you?
This is always the question to the immigrant doctor.
Speaker 1
36:38
Yeah.
Speaker 0
36:38
What struck you as strangest thing about American medicine or the best thing about American medicine?
Speaker 1
36:43
What was I think a good thing about American medicine, or at least I think my training. And I think this is partially just me too, right? It's
like, oh, I want the patient to understand and be involved in their care. And I think it's partially also just like the volume and depending
where you are, of course, if you're the only doctor. I remember in one of my fellowships here when I was in med school, I had a year in
Chiang Mai and going to the infectious diseases clinic. I mean, they had to see hundred people in not that many hours in their HIV
clinic. So, yeah, you can't spend like 40 minutes with every patient being like, do you understand your CD4 count and what's going on?
Speaker 1
37:30
I think. It. And yeah, I think culturally, the expectation is like, well, I'm the doctor, so I know what's best for you. And it's a little bit
patriarchal where they're like, this is what you have to do, and there's no discussion about it. So I think that maybe is a downside.
Speaker 0
37:56
It'd be nice if it was a little more measured, but also acknowledging that the doctor probably knows more about it than the patient. Of
course, there's people that have got some strange syndrome rather, and they know so much about that one thing.
Speaker 1
38:12
So I think when I get to see patients, I actually do ask them, okay, you've had HIV for so long and you're well controlled and you take
the medicine every day because the doctor told you to. So Thai people are known for actually being quite super adherent in general,
but yeah, I just am like, do you understand what this number means? Or whatever. And so I think people are surprised and, yeah, some
of them are really happy that I would take an interest in teaching them or trying to answer questions that they have or be like, you can
ask me any question. I'm not going to be offended or embarrassed. And even when I do these community workshops where we're
training drug users to do peer outreach, I'm like, ask me anything.
www.sembly.ai
Page 9 of 13
Speaker 1
39:01
It could be the craziest thing. And yeah, there are very interesting questions, and some of them I'm like, I've never thought of. I I like
that part about I mean, not all doctors are like that either in the US. But I think at least generally. People are willing to have a
conversation or I think if a patient is the time constraints really? Yeah, no, totally like primary care like that's not happening all the time
but I think people do want the patients to be interested and they can ask yeah, of course to a certain extent and do as much as they
can to control their illness not have it control them. Exactly.
Speaker 1
39:48
So I think that is one thing that I've appreciated about the thing that, you know, the healthcare system in the US. I'm sure many people
have talked about it, but just like, how insurance is set up and I don't know, I think that there's not true safety net for so many people is
probably, like, the worst thing. And, yeah, of course, you came from NHS. There is still national healthcare in Thailand. Do you get
everything and would you get like state of the know oncology care? No, but, I mean, you're still level. Yeah, a level playing field.
Speaker 1
40:31
of health care. And you wouldn't necessarily go bankrupt know, if you were pregnant, you could go to the hospital and NAB your child.
Where I feel like in the US. Sometimes that's not the case. Or people are scared to go, I think, or they put it off and then it costs even
more because. But even for little things, I was so thankful we have this global travel insurance, especially when we go to the States,
but yeah, my six-year-old was doing something ridiculous like at his grandparents house, and I don't know what he was doing. Oh, I
think he was trying to do karate or something with his brother and then fell and cut his scalp on the edge of the fireplace or whatever.
Speaker 1
41:23
But he had to go and get. It was a laceration. I was like, you're going to need stitches or staples or something. So we end up getting
staples. But if we didn't have insurance, it was like, a lot of money to go to the urgent care. I was like, I wish I had a stapler. I would
have done it.
Speaker 0
41:41
But you don't carry that stuff around with you anymore.
Speaker 1
41:44
Yeah, exactly. Even if we were in trouble, we could have afforded it as two person, like, working family, but it was more. How much was
it? I think without insurance, it was like $800 or something.
Speaker 0
42:04
I feel like for a simple laceration yeah.
Speaker 1
42:07
For five staples or something. Yeah.
Speaker 0
42:11
So I was just like, there are times when the cost of American healthcare is just. Amazing. One of my sons was in a car accident. And
so, of course, he was fine. He walked away from the ER fine, but he got checked out. And I remember looking through the bill because
the certain amount would be covered by our health insurance. And I was going through it and I think, how do you charge $1,000 for
Betadine?
Speaker 1
42:39
Right.
Speaker 0
42:40
From Betadine.
Speaker 1
42:45
Of course. My people. So I think that is crazy. So you can get really excellent health care in Thailand for not that much money? Yeah, a
fraction of that cost.
www.sembly.ai
Page 10 of 13
Speaker 0
42:57
But dollar for dollar doesn't make sense because everything else costs less. My youngest son actually went on a volunteer thing to
Thailand when he was 13, and he was, like, the richest kid in the I mean, all the American kids he was with were ridiculously wealthy,
and he was walking around saying, they're giving away whole meals for $2.
Speaker 1
43:22
Yeah. Now, you can still actually get some meals on the street for not that much. Yeah. Would be like $3. I think that's the interesting
part about Thailand. In Bangkok, you can get still meals for $3, but you can also get, like, Michelin Star, so you could spend, like
somebody would be happy to take your money everywhere in the world. Yeah, exactly.
Speaker 1
43:46
But it's interesting that there is such a gamut here that you can still get a $2or $3 meal many places in Bangkok, and then yeah, you
could all spend, like, $1,000 or something crazy if you wanted to at the high-end restaurants.
Speaker 0
44:04
We've been chatting for a while, so before we go, please call me again. I'd love to continue talking, but before we go, is there anything
you'd like to tell America, whoever's listening to this, many of whom would be doctors, about the work you're actually doing? Now,
you've started your own consultancy.
Speaker 1
44:25
Yeah. So I think if I wanted to talk to American doctors, I think you can always embrace looking beyond your degree. I think we spend
so much time being like, well, the only thing I know how to do is be a doctor and have this really narrow view of what that means,
whether it be clinical medicine or, like, teaching in med school. So, I also had that very traditional view. Not everybody is thinking about
academic medicine or what is it that's the triumvirate of clinical medicine, teaching and research. And so I was like, I love all those
things.
Speaker 1
45:07
I'm going to do all of them. But I think there are so many different career pathways or opportunities out there that you can just keep an
open mind and it's never too late to do something different with your degree.
Speaker 0
45:25
Do you do some career-coaching with people?
Speaker 1
45:28
Yes. So I also do career coaching. If people are interested in making a change, it can be non-traditional or not. So I know that I have
quite a non-traditional career path, but yes, I also do career coaching. And I have a YouTube channel that I haven't posted on in a while,
but I should again, where I just talk about (hard to find time, especially with two children). Yeah. But I just talk about yeah.
Speaker 1
45:53
Coaching has really impacted me and changed my life and just little tools from everyday life about how I approach, um. Yeah. I think
just, like, the daily ups and downs of life. And I will do one soon about traveling, because, like we talked about, I have been traveling a
lot for work lately, and it's like a very good microcosm where I think there's many opportunities when traveling to practice all different
sorts of tools. Like mindfulness probably hypnosis, too. Like even like self hypnosis.
Speaker 0
46:28
I was thinking more like acceptance.
Speaker 1
46:31
Yeah, exactly.
Speaker 0
46:32
Sitting in an airport, waiting for a plane to finally show up.
www.sembly.ai
Page 11 of 13
Speaker 1
46:36
Exactly. Or, like, how to deal with disappointment because your bag is lost or whatever.
Speaker 0
46:44
The very reason you went somewhere is closed today. Yes.
Speaker 1
46:50
American doctors, like, you don't need to feel stuck.
Speaker 0
46:54
I think our training I do have a few British doctors who listen to this.
Speaker 1
46:59
Oh, yeah.
Speaker 0
47:00
British doctors have not necessarily equal burnout, but they've certainly got a lot of the same issues.
Speaker 1
47:05
I think there is challenges. Yes. For sure. From. Hearing from my British Friends I think, you know, you don't need to feel stuck. And I'm
sure you would agree, Denise, like, there's so many things that you can do with medicine, like inside or outside of medicine. And I'm
really grateful for my medical training.
Speaker 0
47:26
I would encourage people to look at all the options necessarily they want to jump ship now but just realize how much else is out there
and have know if I had known, I could have been a hypnotist 30 years ago I would have been a hypnotist 30 years ago whilst practicing
medicine.
Speaker 1
47:42
Right. No, I think that's totally true. So I think people are doing all sorts of interesting things, and you can too.
Speaker 0
47:52
Do you have the opportunity to teach in the Thai educational system?
Speaker 1
47:56
Do you have people rotating through or is that not no, I've actually hosted some American residents here from my former program who
are interested in global health. But I am looking into teaching actually. They've started some English language programs here, like
international medical programs, actually my father's alma mater. And so they had approached me to do some teaching there and just
even some mentorship because, you know, a lot of people here are interested in doing some postgraduate training and maybe
returning and maybe not. So I am actually also working on getting my adjunct appointment at Hopkins. And so I hope to. Um, be
involved more.
Speaker 1
48:45
Yeah.
Speaker 0
48:45
You you stop climbing. You're not at the top, you're just sort of climbing up.
Speaker 1
48:49
Yeah. Or be involved in, like yeah. In collaborative research projects. Yeah. It's fun, actually, to host. When I had a medical resident
here, it was interesting to have him and see what is the day to day work like or what am I doing?
Speaker 0
49:08
So thank you so much for spending this time. This has been great. I hope we meet again soon, and I hope lots of people go and look at
the link, which will be in the show notes, both on YouTube and on the regular podcast. Thank you so much.
www.sembly.ai
Page 12 of 13
Speaker 1
49:22
Thank you, Denise. This was really fun.
Speaker 0
49:29
Thank you for joining us at Myth, Magic Medicine. If you have found this episode useful, you can apply for free CME credit through the
link provided in the shownotes. If you're not a medical professional, please remember while we're physicians, we're not your
physicians, so please consult with your own healthcare professional if you think something you have heard might apply to you or a
loved one. Until next time. Bye.
www.sembly.ai
Page 13 of 13
