August 22, 2017

Sara Schwanke Khilji, M.D., M.P.H., is a textbook example of being in the right place at the right time. In her case that place was Bangkok, Thailand, a little over a year ago.

Dr. Schwanke Khilji, now a clinical hospitalist and assistant professor of medicine, OHSU School of Medicine, was a primary care doctor working in a medical school in Kuala Lumpur, Malaysia, when she first heard about OHSU's presence in Southeast Asia. Having worked as an overseas research fellow in Thailand, supported community health education efforts in Sri Lanka and implemented the first clinical sub-internship program in Malaysia, the position of OHSU's director of interprofessional education based in Bangkok, Thailand, was all but made for her.

OHSU Global 

OHSU faculty have made significant contributions to global health work in a number of countries for many years. In 2014, OHSU Global was established to bring together education, research and clinical initiatives and develop a special focus in Southeast Asia. 

"OHSU Global was created to organize and maximize our contributions in global health as well as to develop an OHSU presence in Southeast Asia that serves faculty, learners and global partners," said Justin Denny, M.D., M.P.H., director, OHSU Global. "We are grateful to faculty such as Dr. Schwanke Khilji who are helping develop and focus the power of international educational exchange to improve global health."

In partnership with Bangkok Dusit Medical Services and Mahidol University in Thailand, OHSU Global has created opportunities for students, residents and faculty in Thailand, Laos and Myanmar. Areas of focus include ophthalmology, nutrition, occupational health, emergency medicine, dentistry, nursing quality and leadership training, informatics, pediatric care, rehabilitation and infectious disease research. It is through Mahidol University – particularly at its premier teaching institution, Siriraj Hospital – that Dr. Schwanke Khiliji advances OHSU's education mission across the globe. 

Win-win partnerships

Dr. Schwanke Khilji coordinates educational exchanges between the two universities. OHSU faculty visit Mahidol University to observe its 2,000-bed health system and both learn from and share their expertise with Thai physicians and care teams addressing acute and chronic illnesses as well as tropical and infectious diseases. During these visits, as well as during reciprocal visits from Thai teams to Portland, Thai medical professionals share their experiences and educate OHSU representatives about Thai approaches to health care, serving both institutions.

Dr. Schwanke Khilji also developed an elective opportunity for medical students, a four-week rotation based at Siriraj Hospital Mahidol University, during which students also learn about essential concepts in global health.  

"It's an incredible experience for our students," said Dr. Schwanke Khilji. "They get to look at their biases and are given a wider perspective on their approach to evaluating and treating patients."

The four-week rotation is designed to bring students back to the basics of medicine. Their time with patients and in the classroom show them the importance of primary care as a crucial part of the continuum. Some students end up working on research projects in addition to their clinical rotations.

"This opportunity gives students such a broad view of the world and motivates them to think about the role they might play when they head back to the U.S. to continue their medical education," she said.

Student immersion across missions 

Larissa Weirich, third-year M.D. student, recently returned from a clinical and research rotation in Southeast Asia. The first month was spent at Siriraj Hospital and in rural clinics where she and her classmates participated in daily rounds, including patient examinations. The students also had didactic sessions with Dr. Schwanke Khilji about global and public health issues. 

"'The fact that Sara is onsite makes a huge difference," said Weirich. "Sara speaks the language and understands how the medical system in Thailand works. As a medical student, we got so much out of this experience because we were able to ask Sara questions."  

Weirich and a classmate spent their second month abroad at hospitals around Thailand, where they interviewed medical directors, nurse epidemiologists and facilities personnel and collected data for Marcel Curlin, M.D., associate professor of medicine, Division of Infectious Diseases, OHSU School of Medicine, who was getting a Zika virus research project off the ground. The two learned about the epidemiology of the virus and the disease burden of the region. The students' work will apply to their scholarly projects, part of the OHSU School of Medicine's YOUR M.D. curriculum.  

"I have a greater appreciation of and knowledge about how other medical systems outside the U.S. work," Weirich said of her experience. "It makes you understand things don't always have to be done one way – you learn to think outside the box."

She especially appreciated the opportunity to confront cross-cultural communication challenges.

"We were able to travel outside of the city, which helped me realize that in the smaller hospitals, they don't have the same resources as they do in the big city," she said. "They don't have access to specialists, labs or diagnostic equipment to deliver the health care the community needs. Often physicians have to be resourceful and creative delivering health care with the resources available to them. They are meeting the community where it needs it most."

Weirich plans to pursue an internal medicine residency after medical school and incorporate global health. Meanwhile, she said she intends to incorporate the listening skills she learned in Thailand into her care of patients.

Collaboration is exciting, need is great

Meanwhile, Dr. Schwanke Khilji will head back to Bangkok in mid-September after spending the summer seeing patients at OHSU Hospital. She's got a new cohort of students to prepare for and is also building an interprofessional program based in the region, developing residency and fellowship opportunities and continuing to refine the elective courses and field experience for students. 

"There's a lot of potential with my role and what OHSU Global is able to offer these students. I'm thrilled to be part of making this collaboration happen and helping educate the next generation of health care workers, globally and at home," she said "Bridging the medical community's ability to treat patients and cure disease around the world is really exciting. The need is great."

Pictured top: OHSU medical students Larissa Weirich (far left) and Emily Ager (second from left) visit Rajanagarindra Tropical Disease International Centre, Suanphueng, Thailand.

Pictured bottom: Sara Schwanke Khiliji, M.D., is a clinical hospitalist and assistant professor of medicine, OHSU School of Medicine, and director of interprofessional education for OHSU Global in Bangkok, Thailand.