Medical Elective, Bangkok, Matthias Mitra (2020 cohort)

Scalpels, Systems, and Street Food: Lessons from Thailand to Oxford

Earlier last year, during medical school at the University of Bristol I travelled to Bangkok for an elective in paediatric surgery and liver transplantation at Ramathibodi Hospital, Mahidol University. It was a unique opportunity to see one of South-East Asia’s busiest paediatric liver transplant centres in action. I expected to learn about surgical technique and patient care, and I certainly did, but what surprised me most was how much I learned about healthcare systems, resource allocation, and how children’s surgery can be sustained in very different contexts.

Life in Bangkok as an Elective Student

From the moment I arrived, I was immersed in the clinical and academic life of Ramathibodi. Each day began with ward rounds in the paediatric surgical unit, where cases ranged from neonates with complex congenital anomalies to children recovering from transplant. I attended outpatient clinics, sat in on teaching sessions, and spent hours in the operating theatres, observing procedures that I had only read about before. 

The focus on biliary atresia was particularly eye-opening. I saw children who had undergone Kasai portoenterostomies at a very young age, some successful, others sadly progressing to liver failure and requiring transplantation. The complexity of their journeys emphasised how early diagnosis, timing, and surgical expertise are all critical in shaping outcomes.

Outside the hospital, I was able to explore Bangkok’s vibrant culture, from wandering its bustling street markets to visiting the Grand Palace and taking weekend trips to its many islands. These experiences helped me understand healthcare in Thailand not just as an academic exercise, but as part of a much broader social and cultural landscape.

Key Lessons from the Operating Theatre

The most memorable moments of the elective came inside the operating theatre. Observing a paediatric liver transplant was extraordinary, the scale of preparation, the technical precision of the surgeons, and the teamwork between plastics, general surgery and paediatric surgery departments was unlike anything I had seen before. It was a masterclass in collaboration, where every member of the team played a vital role.

What struck me most, however, was how these surgeries were made possible in the first place. Paediatric transplantation is incredibly resource-intensive, requiring not just surgical expertise but also intensive care beds, expensive medication, and long-term follow-up. In Thailand, this is supported by a cross-subsidiary funding model: private patients paying into the system help cover the costs of public care. It’s often described as a Robin Hood approach, and it allows children from less privileged backgrounds to access world-class treatment.

Coming from the UK, where the NHS is funded through taxation, this contrast fascinated me. Both systems aim to ensure fairness and access, but the mechanisms are very different. Seeing the Thai model in practice broadened my perspective on how healthcare can be organised, and it made me reflect on the ongoing challenges the NHS faces in balancing demand, funding, and equity.

Carrying the Lessons to Oxford

I am now working in paediatric surgery at the John Radcliffe Children’s Hospital in Oxford. The children I see here may not face the exact same challenges as those in Bangkok, but the underlying questions are strikingly similar: how do we provide highly specialised care sustainably, and how do we make sure it reaches every child who needs it?

Alongside my clinical work, I have also become more actively involved in global paediatric surgery. Under the mentorship of Professor Kokila Lakhoo at Kellogg College, I have been learning how surgical provision in children is shaped not only by local clinical practice but also by international collaboration, training, and system design. I am soon to undertake a course in global paediatric surgery, which I hope will deepen my understanding of how children’s surgical care can be improved worldwide. This has given me a new sense of continuity, building on the lessons I first encountered in Thailand, now applied in Oxford, and looking outward to the wider world.

Looking Ahead

On a personal level, the elective also helped clarify my own aspirations. While I remain drawn to surgery, I am equally keen to keep practising within paediatrics more broadly. What excites me most is the intersection: where medical and surgical care meet, where the technical demands of an operation are paired with the long-term management of a child and their family.

It also left me with a deeper appreciation for the value of global perspectives. Alongside my time in Thailand, I went on to undertake a second elective at Stanford University in paediatric interventional radiology under Prof. Avnesh Thakor. Together, these experiences have shown me how children’s care is shaped not just by technical expertise, but also by innovation, collaboration, and the way health systems are structured. Medicine in Oxford does not exist in isolation; lessons from Bangkok, California, or anywhere else can and should inform how we practise. I hope to continue working in environments where I can contribute clinically while also learning from the systems around me.

Gratitude

Looking back, I feel incredibly grateful. To the team at Ramathibodi who welcomed me so generously; to the children and families who allowed me to observe their care, and to my colleagues in Oxford who are now guiding me through my first months as a doctor.

This journey, from Bangkok’s operating theatres, to Stanford’s innovation labs, to Oxford’s paediatric wards, has been transformative. It has deepened my knowledge of paediatric surgery, sharpened my awareness of health systems, and reinforced my commitment to making care both excellent and equitable.

Most of all, I am deeply thankful to the Alumni Grant, without which I could not have pursued these opportunities. It made possible an experience that will continue to shape my practice for years to come.