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Throughout the module, the importance of sound clinical judgement is
emphasized, particularly when it is based on good history-taking and a
recognition of the prevalence and range of pesticide-related health effects.
Pesticide poisoning often goes unrecognized because of the failure to consider
it as a possible diagnosis. Promoting the skills of enquiry and critical appraisal
of laboratory tests and the clinical grounds upon which a diagnosis of pesticide
poisoning is based or excluded prepares medical students more realistically
for their future roles as community physicians and decision-makers.
Description of the module
The pesticide module consists of four sections:
An introductory section outlines the format, sequence, and the relevant
learning concepts contained in the module (see Appendix to this paper).
It includes a brief summary of a problem, along with questions, suggestions
for discussion, and learning objectives.
The students' section (10 pages) presents the clinical scenario and poses
appropriate questions.
A tutor's guide (17 pages) provides background information on the
epidemiologic issues and pesticide toxicology, and suggests useful concepts
and facts for discussion during the course. It is assumed that the
tutor does not have expertise in toxicology or epidemiology.
A list of 15 articles and texts that were sources for the module, including
Thai Ministry of Public Health statistics, journal articles about pesticide
poisoning incidents in Asia, and two useful textbooks (see Appendix to
this paper).
A preventive role for physicians
The use of pesticides in Thailand's agricultural sector is widespread, intensive,
and poorly regulated. Pesticide use is increasing and free-market competition
has led to a proliferation of 150 pesticide formulations sold under 3 000 trade
names, many of which are of substandard quality (Gaston 1988). The application
of pesticides is often excessive and indiscriminate, and often leads to
personal exposure as well as high residues on food and considerable environmental
contamination (Foo Gaik Sim 1985). Basic protective gear is seldom
used and adequate training in pesticide use, handling, and storage is rare.
Recently instituted regulatory measures, aimed at compliance of the Food and
Agriculture Organization's International Code of Conduct on the Distribution and
Use of Pesticides (FAO 1986), are unlikely to have a great impact on use at the
local level (Gaston 1988).
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