Health and Beauty

The silent killer

Sukumvit Hospital employs advanced techniques to reduce blood loss during brain surgery.

In the case of a recent patient who visited Sukumvit Hospital, a passing headache ended up being a serious condition. The patient, a 40 year old man named Khun Chatra, had a history of headaches but at the end of last year, his frustrations grew when he experienced a severe headache on Father’s Day, with painkillers and regular meals proving ineffective against the pain. Worried about the severity, Khun Chatra consulted with a friend who is a doctor to understand the root cause for the persistent headache. He then decided to visit Sukumvit Hospital, where doctors did a routine examination followed by an MRI that scans the brain using electromagnetic waves. The results showed that the patient had a large tumour, initially believed to be five centimetres in size, in the right side of his brain. The medical team who examined the patient agreed that surgery was necessary to treat the tumour as it was very large. Due to the size, the tumour was likely pressing on key areas of the brain, causing complications. Two doctors specialising in neurology, Dr. Jackree Thanyanopporn, specialist in Neurosurgery and Interventional Neuroradiology and Dr. Juksanee Thanyanopporn, doctor of Neurology, made it clear that there was no choice but to operate.

Dr. Jackree describes the condition of the patient…

“Khun Chatra came to the hospital with a headache. On the day we examined him, we saw that he had severe headache symptoms and his hands trembled but he did not have any weakness. When we ordered the MRI, it was found that he had a brain tumour that was pressing on the right side of his brain that controls limbs, resulting in his left hand tremouring. Afterwards, it was communicated to the patient that the condition puts him at risk of a left hemisphere paralysis and there is the chance of blood loss, loss of memory function, convulsions, and other complications.”

Dr. Jackree describes the condition of the patient…

“Khun Chatra came to the hospital with a headache. On the day we examined him, we saw that he had severe headache symptoms and his hands trembled but he did not have any weakness. When we ordered the MRI, it was found that he had a brain tumour that was pressing on the right side of his brain that controls limbs, resulting in his left hand tremouring. Afterwards, it was communicated to the patient that the condition puts him at risk of a left hemisphere paralysis and there is the chance of blood loss, loss of memory function, convulsions, and other complications.”

Dr. Juksanee Thanyanopporn

After Dr. Jackree saw the diagnostic images, he evaluated that it was a benign tumour and not a malignant tumour, but because of its large size it had the potential to cause blood loss during surgery. To begin the process, the doctor injected dye into the bloodstream, then employed a technique called catheter angiography embolisation, a minimally invasive treatment that blocks the blood vessels to reduce blood flow to an area. Dr. Jackree explains, “Tumours are alive, therefore they can draw new blood vessels. By implementing a catheter angiography embolisation, we can stop this from happening and subsequently reduce blood loss during surgery. This process begins with a close study of MRI results, checking the body’s vitals once again, and then using what is called a ‘Navigator,’ a visual imaging programme that can determine what is needed during the surgery, including preparing the operation room, what incisions are required and what should be avoided, and what to do to ensure no mistakes happen.” Dr. Jackree also explains why the catheter angiography embolisation procedure is beneficial for patients like Khun Chatra: “Patients who are of older age are at risk of blood loss during an operation because the heart will work hard during surgery, which can result in complications like an acute heart attack. The biggest benefit of reducing blood loss through a catheter angiography embolisation is that the patient is safe during the surgery. Although this technique can be used to treat tumours, it is important to consider where the vessels will be occluded, as some locations are not possible. “Brain tumours are a kind of disease that you will never be sure of unless you get tested or unless you have defining symptoms. Many patients in Thailand will wait until they have limb weakness to get an X-ray, then further tests are needed to be determined whether the tumour is benign or malignant. A patient’s medical history is also important, particularly whether they have other diseases or cancers as it adds to the chance of it spreading to the brain. It is imperative to get examined straight away if you suspect a tumour. “Symptoms of a brain tumour differ depending on its location and size. In the case of Khun Chatra, he suffered from headaches, and trembling hands but some people can have numbness, fainting, limb weakness, blurred speech, double vision, and hiccups. Many of these symptoms are similar to stroke. Therefore, finding the root cause it is important so that it can be determined if the tumour is good or bad, and what kind of treatment to seek. A follow-up 3-6 months after is also crucial for reducing the chance of recurrence.”

The patient, Khun Chatra, reflects on the entire treatment process and surgery…

“After listening to an explanation from the doctor, I understood that the risks were quite big with chances of disability and death. But thanks to Dr. Jackree, Dr. Juksanee, and the hospital staff, I was able to make a fast recovery. If you look back on my timeline, I arrived on Dec. 7th. By Dec. 8th we had a plan, Dec. 9th the doctor performed the catheter angiography embolisation, Dec. 10th I rested in the ICU, and on Dec. 11th I underwent brain surgery. Despite being a big procedure, I woke up within half an hour after the anaesthesia wore off. I was able to talk to relatives and the doctor, and was thrilled to have been able to recover quickly. When I think about how I was able to recover, I believe it is a combination of the doctors’ talent and skill and the level of service the hospital were able to provide me. They took very good care of me during my 17 days there.”

As springtime comes upon Thailand, I have been reflecting on how Thailand was my “springboard” into this new world of Eastern life including Laos, Malaysia, Vietnam, Cambodia, my Bali life and then being brave enough to expand into Nepal and India. One of the many things I uniquely thank Thailand for, other than new cuisine and cooking classes, vibrant island tours, Northern Province indigenous peoples, my discovery of Matcha, Buddhist culture and art, local Batik textiles and Durian (my goodness what a list!) is the fabulous Thai massages and being trained in the art of this form of body work.

Being a massage therapist for many years at the time of my decision to train in the Thai way wasn’t too hard a decision to come to when on my first journey into Thailand. I first met my lovely trainer, Jidapa Norsai, on Phuket when I was first exploring some of the main tourist spots trying to decide where to settle for a bit to paint; Bangkok, Chiang Mai, Pai, Koh Samui, Krabi and Phuket. After I had made the decision to settle in Phuket I soon re-contacted Miss Jidapa and enrolled in her school of Thai Massage that was licensed and certified through a proper government venue and was excited to begin this new journey. I am sharing this idea to those out there waiting for Thailand to re-open (hopefully come this April edition release that has changed) and feeling like they wish they had something to do or new to learn. If you can find someone in your area to experience this training with, now may be a good time. I do feel hands-on bodywork in these days of social isolation and a “no-touch” ruling in general can be damaging for human connection. Massage and bodywork of any kind can be so healing. Even just being available for your loved ones, family and friends, it is a gift to be shared.

There are many different schools all over Thailand to go to and various styles to take. I think the key, if you’re not a practitioner and just wanting to learn techniques to share, then the most important factor is the ease of which the course is structured and location. I organised my time to be able to take the course in Phuket Town at a time I had finished up with my 3 month “self-tour” of mainland Thailand and had decided to “hunker” in Phuket for another three. I organised to move into my new home in Kamala after my course so could stay in a small hotel across the street from the school. Phuket Town is so charming to spend some real time in, so it certainly wasn’t a trying situation.

I was impressed with the chiropractor that was also based at the school and it was a real treat to learn the Thai massage way. The main basis for most Thai massage I found in my training was with the way in which the practitioner moved and stretched the limbs of the person while doing some good deep pressure, sometimes with thumbs, sometimes with knees. It encourages the client to engage in “active relaxation” which can be easier said than done! I already knew some Shiatsu work from previous training however the “moving of other people’s limbs” while I stretched them and put pressure on various areas was new to me. If the client is very limber this can be a challenge. There are some very advanced Thai therapists that can lay on their backs while supporting you up in the air with their feet while you relax on top of their feet as they push into your back! This is not a level most attain to but being able to walk on the back, hang from a bar from the ceiling to massage the client with feet can be done. The normal basic way really is just like some of these pictures demonstrate, using thumbs for deep pressure and using one’s forearms and palms for some effleurage type massage, with or without oil. There is also a ‘tapping” method which uses the sides of the hands closest to the pinky to alternately tap rapidly on various areas of the body to loosen and heat up the muscles in that area.

My course was a month intensive training 5 days a week, 7.5 hours a day. It was a professionally certified and licensed massage course that I chose to do to add to my already massage therapist professional resume however, one might think about a weekend workshop or something similar to learn some of the basic moves to practice on family and friends. In this human contact touch, a little can go a long way.

I will always remember the first experiences of my Thai time back in 2015/16 and have been in and out of Thailand many times since. I’ve taken home with me many gifts of experiences from Thailand; tangible art, great new recipes, beautiful textiles and clothes but the best gift I received from Thailand, other than having the privilege of writing for Expat Life in Thailand and sharing my art and healthful ideas, has been the gift of giving a real proper Thai massage!

Bird’s Nest is known as caviar of the East for its best rare food only for royalty like connoisseur in the East. It is as precious as caviar. Initially known as Swallow Nest, it was first consumed in China more than 1,500 years ago during the Tang Dynasty. It was considered as rare royal food. Chinese traditional medicine later on confirmed benefits to health and youth after a long record of real efficacy. There are countless interesting stories about this expensive delicacy. It is a ‘must take’ food for pregnant woman and mother as well as for people recovered from sickness or operation. In China, it is usually prepared to impress inlaws or even business associates. I recalled my grandmother in spending long hours to double boil her bird nest soup. Even now, when I go for any hospital visits to friends, a basket of bird nest is generally the most appropriate gift.

Expat Life sat down with Ivy Chau-Soonthornsima, Partner from PrimaNest to learn more about this superfood and its wonders. Chinese have long believed in the visible and tangible health benefits of bird’s nest consumption. Let us explore how this superfood claims to shorten patient recovery time, boasting an “elixir” effect in rejuvenating the skin and giving a more youthful appearance.

Bird’s Nest phenomenon

Ivy explained, “Today with advance scientific technology, bird nest has been tested and proven of its benefits. There are hundreds of reports done by scientist in many countries, which finally explained the myths about Bird nest to the new generation.”

She further elaborated, “Today, bird nest benefits are no longer a myth. Modern science identifies the key ingredient in bird nest as “Glycoprotein”. This so called “super protein” is a principal substance the human body can produce, but regresses over time due to ageing and illness. “Glycoprotein” can be found in abundance in Swiftlets’ nests, which are made from the bird’s saliva. In the past, no scientific explanation can be made on the health benefits of the people who consume bird nest, as Glycoprotein was not known until its discovery, which garnered a Nobel Prize in 1994. Glycoproteins in bird nest are enriched in EGF (Epidermal Cell Growth Factor), Sialic acid and 19 other types of amino acids.”

Expensive delicacy

A good bowl of bird’s nest soup in a restaurant may cost over 1,000B. Different grades of ready to drink bottles range from 100 to 500B. What exactly is this bird’s nest? Ivy described, “Bird’s nest refers to the saliva produced by the Swiftlet birds, while making its nest. The saliva acts as glue, pasted to form a thin flaky wall in the nest. When the saliva comes in contact with air, it hardens and a white bird’s nest cup is formed. The entire process takes around 30 days.”

Bird’s nest can be classified into Cave Nest, House Nest and Grass Nest. They are then grouped further into White Nest, Golden Nest and Red Nest. Cave bird’s nests are mainly harvested from natural caves in the states South of Thailand. The harvesters often face considerable danger when harvesting these bird nests. Since free, naturally living Swiftlet forms cave bird nests, some people consider them to be more valuable than bird’s nests found in houses. Thus, cave bird nests often fetch a higher price as compared to house bird nest. It is important to know that cave nest or house nest are from the same Collocalia specie thus it has the same bioactive value from the glycoprotein which is the main content.

Tips in consuming this superfood

Bird’s nest contains glycoprotein and amino acid and is rich in mineral content such as calcium, potassium, phosphorus, carbohydrate, iron and iodine. These nutrients have many benefits to the body, such as improve metabolism, tissue and cell growth; and enrich vital energy. Experts have concluded that bird’s nests have three main functions in enhancing the rebirth of cells and tissues, improving the immune system and strengthening the body health and accelerate recovery from illness.

More questions to ask our expert, “How often can I eat bird nest? Can I eat too much bird nest? When is the best time to consume bird nest?”

Ivy advised, “Bird nest can be consumed daily. An average person can consume anything 3 to 5 grammes of dried bird nest. The body will discharge any excess consumption. It is best to take a spoon of bird nest in the morning when the body is fresh and the stomach is empty, ready to take full benefit of bird nest. It is also best before sleep, as the rich antioxidants will help the body to eradicate free radicals as the body heals during our sleep. Empress Dowager of China had been consuming bird nest before bedtime as a royal ritual.”

Ready to go and easy to eat

In the old days, my grandmother would buy dried bird nest. The cooking process was long with soaking in water, picking the feathers, and slowly double boiled to make the soup. Now, ready to drink bottles are stock on shelves in the supermarkets. The question is “Are manufactured bottles as nutritious as home-cooked version?” Ivy clarified, “Yes, ready made bottles contain the same nutritional value. The old way of preparing your own dried bird nest may easily result in overcooking or burnt. The “modernised” factory way is safer and more hygienic. For example, here in PrimaNest with our factory in the South of Thailand, our procedure involves handpicking the feathers by mineral water. The process is 100% pure with no addictive or preservative. The way we “de-germ” is at 105 degrees of boiling water which is not possible to do at home.”

The miracle of bird’s nest on skincare

Apart from being an edible food, bird’s nest has been applied to skin dermatology use. Ivy clarified, “To understand the benefits that bird nest can work on our skin, we need to first be acquainted with EGF (Epidermal Growth Factor) which can be found in human cells. Normally, the human body can produce EGF, but its capacity usually subsides with age or pollution. EGF stimulates cell proliferation, differentiation and development. With this efficacy there has been endeavour to extract EGF from various plants to produce a premium skincare line without realising that EGF is abundant in natural bird nest. And it is this EGF in the bird nest, which contains properties, and structural characteristics most similar to those found in human body. Bird nest extract cosmetic contains EGF and Sialic acid that helps restore skin cell from within, prevents fine lines, acne, comedones (black/whiteheads), freckles, and other types of blemishes.”

After learning the benefits of this wonder food, I shall pursue the ancient Chinese royal ritual to have a spoonful of bird nest before bedtime, and put on a bird nest facial mask to sleep!

Making new strides Sukumvit Hospital’s advanced walking robot can help patients who have suffered from stroke, paralysis, and other cerebrovascular complications, walk again.

Sukumvit Hospital has recently welcomed new innovation that has increased the potential of their Rehabilitation Center in helping patients who have suffered from stroke that has resulted in mobility loss and paralysis. These developments also aid with other cerebrovascular complications such as spinal cord and nerve injuries that have resulted in mental and physical damage. Recovery from these conditions require interdisciplinary advice, especially in regard to drug treatment and the rehabilitation process, which uses advanced methods under the supervision of doctors, physiotherapists, and occupational therapists to stimulate the movements necessary to help patients regain their ability to walk. An example is walking training, which is currently evolving thanks to technology. It has now reached a stage where a walking robot, an ‘exoskeleton,’ has been certified to help patients improve mobility by letting them imitate walking on the ground.

Dr. Pannawish Wongwiwattananon a Rehabilitation Medicine Specialist at Sukumvit Hospital’s Rehabilitation Center, explains that…

“Most stroke patients have symptoms of hemiplegia, which describes paralysis of one side of the body, stiffness, weakness, and lack of muscle control. In severe cases, patients may experience paralysis in the entire body. Patients who have hemiplegia can use the robot ‘exoskeleton’ after the acute phase of their condition (two to 48 hours) while in the subacute phase (approximately two weeks after). The robot is effective in aiding recovery because it can be used to practice walking. In the past, we would require two to three physicians to support the patient while they practice walking. However, with the ‘exoskeleton,’ this is no longer necessary. “With this new technology, patients with cerebrovascular disease, paralysis, and injuries to their spinal cord and nerves, are able to practice mobility while also training their muscles to walk in real life. It allows the patient to twist their knees, hips, and waist, and tilt forward and side to side as normal. It also lets the patient walk on the ground and not a treadmill, which is more similar to real life. Unlike older models, this new ‘exoskeleton’ means the patient will not lock their waist or pelvis. It also aids in developing muscles in the waist, back, and hips, and helps brain cells recover to.

Dr. Pannawish Wongwiwattananon

Dr. Vorawat Eawsinphanit

Dr. Vorawat Eawsinphanit, another Rehabilitation Medicine Specialist at Sukumvit Hospital’s Rehabilitation Center, provided information about… “After a cerebrovascular patient receives in treatment in the critical (acute) phase, approximately 70% will have residual abnormalities such as weakness and trouble swallowing water or food so it is imperative to begin rehabilitation as soon as possible. Many patients and their relatives do not know what the necessary steps are, so many will rely on massage therapy alone. But the six months after an individual survives a cerebrovascular problem are considered the ‘golden period’ of recovery so it is critical to seek all types of rehabilitation. “At our centre, we provide many services such as regenerative rehabilitation, integrated medicine, and modern medicine, delivered by a team of physicians, physical therapists, internal medicine doctors, neurological specialists, neurosurgeons, and others, all of whom use modern medical technology to aid every individual case. One notable example is the ‘Exoskeleton,’ a robot that can help stimulate the muscles and cells in the nervous system that have been damaged. Another facet of therapy is Transcranial Magnetic Stimulation (TMS), therapy that focuses on the function of pulsed magnetic field to stimulate nerve cells in the brain. This non-invasive technique can help patients regain their ability to walk. Similarly, Hyperbaric Oxygen Therapy (HBOT) helps increase supply of oxygen to the parts of the brain affected by cerebrovascular conditions like stroke. Patients must realize that even if recovery is slow after six months, it does not mean one cannot recover. Whether it is the first six months or the six months after, rehabilitation therapy is crucial.”

Problems and solutions:

Dr. Vorawat discusses problems that patients often face and how the hospital can aid them. Firstly, depression. 80% of patients with cerebrovascular disease face psychological problems as a result of having limited mobility. The severity of the depression depends on each patient, but in cases of severe depression, a multidisciplinary team can help a patient recover both physically and mentally. Moreover, Dr. Vorawat advises caregivers of patients with cerebrovascular disease to not leave patients at home. They should seek consultation with a doctor so they can enter a rehabilitation programme as soon as possible. Every day that passes without doing anything is one less day spent towards making a full recovery. Only careful planning with a team of doctors, physicians, and occupational therapists can help an individual return to normal life as normal.”

SUKUMVIT HOSPITAL 1411 Sukhumvit Road (Ekkamai BTS) Phrakanong Nua, Wattana, Bangkok, Thailand 10110 Tel: 02 391 0011 www.sukumvithospital.com Email: [email protected]

by Khun Pissara Umavijani

After many years of being a perfume collector, I wondered what made perfumes magic. I have a friend, Anuchy, we spent hours smelling, talking about fragrances and what made them special. We decided to order raw materials from different global suppliers. On arrival, the joy of discovery was greater than anything we could imagine! That was the beginning of an inwards and outwards journey.

Scents link directly to our brain. They stimulate our emotions. It is the most primal part of perception. It creates wonderful and powerful mind tricks. I have discovered the reason behind the creation of Parfums Dusita: Good perfumes make you happy; great perfumes make you dream.

I came to Paris in 2011 with nothing but dreams. My father died in 2006. The experience of losing him made me realise how ephemeral life was and how important it was to build something, to be happy and to do what you love. I knew my heart was in perfumery. I wanted to affect other people as my fragrances affected me.

I believe we need good perfumes in life. We need sensation that links directly to our brain and stimulate our emotions. We make decisions based on scents without knowing. It is a primal perception.

I created Dusita with passion. I wish to make people dream, discover, and feel this sensation of happiness. Through the countless hours of working and collecting inspirations everywhere, I believe that perfumes will speak for themselves. I believe that people will always seek a good scent. Creativity is characterised by the ability to perceive the world in new ways, to find hidden patterns, to make connections between seemingly unrelated phenomena, and embracing originality.

Parfums Dusita is about happiness each creation is crafted to portrait an aspect of it: Issara is about freedom, Mélodie de l’amour is about love, Oudh Infini is about discovering new things and places, and Erawan is about personal growth.

Creativity is also about making connections. I am always thinking about the world and the experiences I have daily, but sometimes I like to open one of my father’s poetry books and see how it makes me feel.

I started to think of how my Father’s wonders about his longings and his ability to ever be happy. I believe that happens to all of us; we eventually reach points of uncertainty. We need to find a way to reach peace of mind. I started sketching. As he mentioned in a poem, I drew the Sun Moon Lake and a golden Thai temple in the middle. It was a representation of a guiding source of light, steadiness and tranquility.

I think about elements and select picture colours when drawing. I paint the fragrance already in my mind. The temple translated into incense; the water into freshness. These are my two main scents: Frankincense and Mint Citrata. I want to depict tranquility, but also the roughness of difficult times. I decided on a contrasting astringent green fig scent.

In my lab I worked on my idea of fragrance. The name Le Pavillon d’Or came later, but I called it my “guiding light” fragrance. I do many trials. I start balancing a few materials as a core then build. Developing perfumes is a process that takes months. You have to let it macerate, evolve, be organised and keep the olfactive direction you wish it to go in check.

When I am in Thailand, I collect succulents. I fell in love with the crushed Boswellia leaf smell. This inspired me to use Omani Frankincense Green Sacra. I found this material soft, delicate and breezy. It also blends well with white florals. One perfumer basic is to know the materials, analyse facets and evolution, but you must evaluate how they perform inside a composition and how they interact with other scents. It is a continuous learning process. Every time I enter my Paris laboratory, I discover something new… magic for a nose! That is why perfumery is my never ending passion.

When the formulations are ready, I send them to Grasse, where they blend them with globally sourced precious raw materials. Creating perfume concentrate in large quantity is also another expertise I admire. Each year I get the raw materials to analyse them from different sources such as Grasse Rose de Mais, Tunisian Orange Flower Absolute, Madagascar Vanilla Absolute and Indian Sandalwood. If the quality is right, I use it in my formulation.

Today we are speaking with Dr. Nick Walters, B.S., M.D. (USA), DTM&H (London), FAAFP, ABFP (Diplomate). He is one of the world’s leading experts in family medicine, tropical and preventative medicine. He works at Bangkok Adventist or Mission Hospital, a non-profit medical facility here In Bangkok. Dr. Walters is also one of the editors of the SEAMEO SE Asian Journal of Tropical Medicine and Public Health (SEATROPH). The magazine is published by the SEAMEO Regional Tropical Medicine and Public Health Network (SEAMEO TROPMED Network). One annual volume comprises of six bi-monthly issues (January, March, May, July, September, and November).

When did you first come here to Thailand?

I first came to Thailand in December 2002.

What has changed here the most?

The cost of things has gone up but as is present everywhere in the world, Thailand has become more digitally connected and so many people seem to have a cellphone to access social media.

What has changed here the least?

People still like to go out with families or friends to eat together.

Can you tell us about your job at Mission Hospital?

I am a medical doctor at Mission Hospital in Bangkok, Thailand. I am also an editor of a medical journal published by SEAMEO (SE Asian Ministers of Education Organisation) Regional Tropical Medicine and Public Health Network (TROPMED), called the SE Asian Journal of Tropical Medicine and Public Health.

Where do you like to go when you are off work?

I like to go out to eat dinner with my wife. We try to have a date night once a week. Being a doctor keeps me out of the house for many hours each week, so I do not mind being at home when I am off work; in fact I enjoy it. There is always something that needs to be done in the house and if my wife and I are both doing it together, it is a joy. Another thing we do that I really enjoy is having free medical clinics for poor people in various parts of Thailand. Mission Hospital is under the Christian Medical Foundation, so we do free clinics in various parts of Thailand from as far South as Songkhla, as far North as Chiang Mai. From Tak in the West to Nan in the East. We usually go into villages where there is a need and provide medical care. This allows me an interaction with people that most visitors to Thailand would not see and it is very fulfilling.

What are your favourite places to eat?

Any place vegetarian.

Can you tell us about your family?

I am married and we have two children. My oldest son just finished dentistry in California last year and works as a dentist there. My youngest son is in medical school in California. My wife is here with me in Thailand.

What do you do for fun?

Redecorating around the house little by little and am an avid reader of history.

What advice do you have for any expatriate who wants to move to Thailand and live here?

Learn the language. Do not wait until you can speak Thai perfectly before trying to speak Thai, because it will never happen. Thai people are very forgiving of us foreigners when we try to speak Thai. Mix with Thai people. Enjoy the interaction.

You are an American medical doctor with a Thai medical licence here in Thailand. That is completely unheard of, it is extremely rare. Can you please tell us more about how you managed to do that?

I came to Thailand and went to a formal language school to learn Thai. I did this for 9 months, 20 hours a week, 4 hours each morning, 5 days a week, in a language school. I then volunteered in the afternoons at the Mahidol University Hospital for Tropical Diseases immersing myself in the medical language. I then studied medical Thai for another 9 months with a tutor and continued to volunteer at the hospital. After this 18 month period I took my medical boards in the Thai language and passed all 3 parts on the first time in what I consider a miracle from God. The effort was worth it because living in Thailand is much smoother if a person can understand Thai. I do not use a translator at work, and I see both Thai and foreign patients for general medicine as well as tropical diseases, for which I also have a specialty.