These people have very little, and the costs for Medical School reflect their poverty. Many of the students come from the provinces, and they live in the type of accommodation you have seen in previous pictures.
About half the students come from the villages, and they are sponsored by their villages - but they get no living costs. When they complete their training, they are expected to go back to their villages - it is these people who are the focus of the Family Practice two year internship that was started this year. The other half of the students are non-quota students, and they pay some tuition to come to school.
For students from out of town, they must find a place to live - there is accommodation provided by the school that costs about $1 per month. Even at that,there is the occassional student who cannot afford the fee, who has asked to live with the monks, and he is fed if there is food left over. The men's accommodation is 10 km from the school, and the women's accommodation is 5 km from the school. We visited one of these places. The conditions are harsh. How these people are able to look the way they do every day evades us, as we would have difficulty doing what they do with what they have. When you look at the pictures, you will understand. The most striking part of this place is that these young women who are learning to be physicians endure:
• 14 beds as bunks in one room;
• virtually no storage space,
• one hotplate and wok,
• no window screens(Japanese Encephalitis and Dengue fever are endemic here);
• four toilets, four showers without doors, and two washing areas for 160 women;
At night in mid March to mid June the temperatures are 44-46 C during the day, cooling to about 32C at night - the shutters are closed for safety and the motorcycles are moved into the rooms for security - there is no air conditioning. There is no place to study. There is no protection from mosquitos, but some have a net over their beds. How they can maintain enthusiasm for what they do every day is an inspiration for me; these people are so grateful for what we do here - and I can see the reason why.
There are many funding agencies which have been here, and there continue to be many organizations and countries that send resources from western countries to these people who live with a different expectation. In order to replace the accommodation for med students, a major international health funding organization looked at building a facility across the road from the Med School. Anything they build must be of "world standard", and the rooms would be air conditioned in a 5 story complex. The med school could not pay the electric bill for the air conditioning, and the med students have no money. This is simialr to one new hospital in town in which the air conditioning bill is ½ the total hospital budget. The projected cost of the building was $6 million, and the budget would not be sustainable. The result is - no new building, and the med students continue to travel 5 to 15 km every day.
Learning medicine is a struggle. Most of the students who finish Med School do not own a book. Today fully 1/3 of the Interns do not own a stethoscope. When Clarence arrived here in 1998, he could not find the treatment protocols for peptic ulcer disease, as there was no Internal Medicine book newer than 1979. There are a few books, now, and we have helped them consolidate current knowledge into soft cover books, translated into Lao. I went through the library - the majority of the texts belong in a museum, and the majority of the students cannot use the books - they cannot come back from their accommodation at night to study here, and they do not have a place to effectively study, where they are living.
There are many other amazing disparities:
• I pay more money for my bicycle rental than doctors at the med school make.
• Motorbikes here are $940 new, but $250 to $300 second hand, and this cost reflects that the person is from the middle class economically.
• There are no bicycle helmets, there are no baby seats, there is no need for a driver's license, and entire families travel on one motorbike.
• An elevator is a major expense to install and especially to maintain - yet there are no ramps between floors in some hospitals.
Both Faculties have accomplished a phenomenal amount here in the last few years, and the people from Calgary continue to take on new challenges with unexpected enthusiasm - and success. The new medical school curriculum has started, using our curriculum as a template. The new family medicine program has started, and the integrated clinical program began this week. When Nick Luff arrived to help out, 2 of 25 computers work, and now all work, there is a high speed internet connection to the med school, some of the hospitals, and to the guesthouse where we all stay. Faculty and students have been taking courses to learn how to use the internet, and the students are doing searches to address medical questions.
The Faculty has been partnering with the Lao people to help them do their job more effectively - it takes time, patience, and acceptance - acceptance that this program is not ours - it is theirs.
There are many issues that we can address and many areas where we can help, today:
• Maintenance support for equipment is appalling, and they need a person with the skills that Darlene has;
• $30 - $60 thousand dollars would provide the med students with a much more livable environment, where they could actually study, they could cook, and they could wash with some privacy --- with effective planning, this task could be accomplished with a small group of visitors;
• I will work with some of the anesthesiologists to help with their equipment, their training of residents, and the integration of the family medicine internship;
• Partnering with Khon Kaen in some projects is a definite possibility for us, thanks to the relationship established with Noi;
• The potential for improvement in the IT area is almost limitless;
• The need for training in English language skills and Lao skills is profound - the medical students would benefit from ongoing teaching in this area.
This is an amazing project. You may remember, 'Give a man a fish, and you feed him for a day; teach a man to fish, and you feed him for a lifetime." This project is about helping other human beings help themselves. These people are intelligent, resourceful, and poor. They have taught me about managing with less, about the importance of accepting life for what it is today, and about the phenomenal resilience of the human spirit.