nerdy post (skip the first part if youre not into medicine)

so the last few days have been an interesting mix of learning more about the different research projects that are going on at RIHES and tagging along with this group of visiting Japanese docs that are here for an intensive short course on infectious disease. Some highlights included:

One day of lectures (this is like going back to med school, but it's stuff I'm actually interested in, so I liked it. Also, it was the Japanese docs being pimped, not me J ) Topics covered included anthrax, ARV (antiretrovirals for HIV) in Thailand, TB, and dengue.

I also went to another lecture on infection control in the hospital and on antibiotic resistance in the ICU – it's totally crazy; the head ICU doc here is really super dedicated and does his own monitoring of all the pts admitted and their bugs and resistance profiles. Based on the drug sensitivities, he creates protocols every few months that he tries to get the other docs to use and when the sensitivity profiles change, he changes his protocols. He also went on this massive hand-washing campaign to try and get nurses, physicians, and other auxiliary staff to wash their hands before and after contact with patients (by hiring random people in the hospital to observe pre-and-post patient handwashing, he found that in a step-down icu there was only a 2% handwashing rate before pt contact – craziness!)
Anyway, I think the stuff he’s doing is really interesting and might meet with him to see if I can contribute in some way since his sample sizes are pretty small and are focused on the university hospital. Btw, the university hospital officially has ~1200 beds but unofficially they just put extra beds in and most ppl think there’s at least double that amount – it’s crazy).

Rounds in the ICU (for you medicine ppl out there, one of the main bugs here in ppl with acute exacerbations of COPD and/or hospital-acquired pneumonia is Acetinobacter baumanni. How weird is that? Pseudomonas is in second place, and MRSA is really not common).

Adult ID Rounds. We saw the craziest case of this 21 y/o woman who originally was admitted with spontaneous pneumothorax. Her lung didn’t expand after they put in a chest tube, and then they saw all these loculated cysts on CXR that ended up being ECHINOCOCCUS. How crazy is that? Even CRAZIER though is that she kept having a fever and was found to have empyemas throughout her pleura on Chest CT. When they went in to take out the pleura, they cultured the abscess fluid and found ASPERGILLUS. So now she’s getting antifungal meds (amphotericin B here) and is s/p a 3 wk course of albendazole for the echinococcus. Totally wild, even for Thailand. Other cases I saw included probable Strep suis (from pigs) infection causing a brain abscess and right-sided visual loss and hemiparesis and these weird skin lesions, cryptococcal meningitis in an immunosuppressed diabetic with rheumatoid arthritis, and miliary TB/tuberculous meningitis in this super old dude who was disoriented and had fever (he also was previously treated for a UTI but his neuro status hadn’t improved). I really like ID and am almost 100% sure I will do a fellowship in it or maybe just fast-track into it out of medicine residency.

Meeting with the coordinators of the MA (methamphetamine) study and the PA(Project Accept)-Thai Study. The MA Study is a kickass study that has over 2000 subjects that are between 18-25 year olds and either use MA themselves or are the sex partner of someone who uses MA. There’s a really extensive baseline questionnaire and then follow-up questionnaires every 3 months for one year. There’s also an intervention (but it’s over already) that runs for a couple of hours per week for eight weeks vs. a control group (also lectures for 2 hrs for 8 wks, but there’s not much interaction and uses a government-sponsored ‘life skills’ curriculum). Anyway, there’s some preliminary data on MA use and tattooing (which is really common here) and I might do some work with that until the suboxone trial with IV drug users gets off the ground, so that’s exciting. I visited the MA drop in center they have set up near the University today and met the team that works there and had lunch with them. Thai ppl are often pretty shy when you first meet them (esp if you can speak Thai and are from somewhere else) and only a few people talked to me, but it seems like a fun place to work. I’ll probably set up a meeting next week with the data coordinator to look at some of the surveys. The head people for the study are also super cool and I totally get along with them.

The PA-Thai study is huge and entails bringing voluntary counseling and testing into different communities surrounding Chiang Mai, including hill tribe and rural, isolated communities. They go to communities every weekend to do community mobilization and run the clinics and I’ll probably join them next weekend (Ben is going this weekend, but I had originally planned to go to Vientiane, Laos to visit Judy…I dunno now because tix are expensive and hard to find, but I might go and check at Lao Airlines (randomly on the first floor of my building tomorrow). There’s more to the study, but I won’t go into it now.

Outside of work, I’ve been hanging out with my fellow Thai Fogarty fellow named Poo (it means crab in Thai, and isn’t pronounced like the word youre thinking of). She’s a first year ID fellow and we get along really well; she reminds me of my other Thai friends in Bangkok. We often go out to eat and I’ve been hanging around the ID office whenever I’m free. She also took me to Tesco Lotus with her boyfriend Nui and Ben and I got a bunch of stuff for our rooms. Yay people with cars!

Ben and I also went to Monk Chat yesterday at Wat Suandok, a temple which is part of a monastic Buddhist university. Monk Chat is basically held for monks to practice their English and for Westerners to learn more about Buddhism. We talked to some monks from Laos that were studying in Thailand and it was pretty cool (aside from getting eaten alive from mosquitos). I would like to go to the temple more and get back into chanting/meditation/listening to Dharma talks while I’m here.

On my to-do list: check out yoga places, find a new Thai teacher (I think the one I went to for two hours ran out of stuff to give me), learn how to ride a motorcycle.

feeling somewhat productive

so today was a good day...there are no more formal meetings scheduled for ben and i, so we're pretty much left to our own devices to figure out what we want to do. fortunately, this morning there was a CAB (community advisory board) meeting so ben and i sat in and i translated some of what was going on for him. it was pretty interesting, actually, and a variety of topics were covered (recap of the International AIDS Conference and the Global Village held there, a presentation on a study of the different places people can buy and drink alcohol around Chiang Mai, review of the current data from a study that's going on regarding voluntary counseling and testing in communities surrounding Chiang Mai, introduction of a study that Merck is planning to do re: the new HPV vaccine in HIV+ women, and more...) it was actually really informative and interesting to hear from non-medicine types (PLWHA, or people living with HIV/AIDS and community members) although i don't really understand Northern Thai dialect. after the CAB meeting, there was a yummy served lunch.

in the afternoon, ben and i hung out with our site mentor, dr. vit (also a thai american who's been working in thailand for the past few years) and chatted about the different studies that were going on, politics (both in thailand and abroad), the shan, and other fun things. before i knew it, it was 4 pm and i had to book it in the rain to my first thai lesson, where i ended up reading tons of proverbs /allegories and then answering reading comprehension questions about them...the reading comprehension questions reminded me of 2nd or 3rd grade, but it was a good time). My Thai teacher attempted to convince me to try and do some dictation but I refused. I might do some tomorrow, but I really don't remember how to write Thai at all.

Anyway, I'm going to try and go everyday for this first month since it's going to be slow at work until I figure out what I want to do. I'm really interested in this trial that works with injecting drug users but there's some administrative holdups right now and we're not sure when the trial will actually get off the ground (hopefully by the end of this year). In any case, I'll probably check out some other studies in the meantime, including one that just ended testing a six-week intervention for youth (focusing on sexual health, decision making skills, etc.) who are both sexually active and active methamphetamine users. the interventions just ended :( so i won't get to see any of them but i think there could be interesting data to look at and im also interested in analysis and writing, so we'll see.

Tonight was also Ben's bday so me, him, and Vit went to eat Korean food. Entertainment for the night included random drunk Korean dude in the back taking off his pants and then the girls with him giggling. It was a little too much excitement for us and we headed back home. So, that was my day. Not the most exciting, I know, but I feel like I'm settling in and making progress on a few fronts (including finding someone to do my laundry - this nice American lady who relocated to Chiang Mai a year ago and lives down the hall invited me in to chat for awhile last night and told me I could have my laundry done with hers and that it would be picked up and delivered weekly for ~ $1.50. how sweet is that!!!)

back by popular demand :)

I know I haven’t updated in ages, but the last few months have been a flurry of activity (school-related and otherwise) that it’s taken me awhile to even get to the point where I can face the blank page staring at me from Microsoft Word. I figure it’s time to start writing again though, especially because I’m not scheduled to do any more extensive traveling over the next few months.

Currently, I’m settling into my new digs in Chiang Mai, Thailand. Chiang Mai is the second largest city in Thailand and is located in the North – population estimates fluctuate between 150,000 and a couple million people, mainly because it’s difficult for people to agree on what’s considered Chiang Mai due to urban sprawl. There’s also a huge expat community here and tons of tourists. Sometimes when I go into the Old City I feel like it’s a gigantic Khao San (the backpacker area of Bangkok). However, I’m excited about living here (once I make some friends) – lots of people love it because it’s filled with chill nightlife (but also clubs), coffeehouses, art galleries, temples, cafes, and more. I’m planning on buying a motorcycle or scooter (Vespa, anyone?) to get around since there is effectively no public transportation here aside from taxis (tuk-tuks) and songtaews, which are these red converted pick-up trucks with a cover in back that pick people up wherever they go and then eventually get you to your destination. They don’t follow any prescribed route, so unless you’re going somewhere close, it’s difficult to estimate how long it will take you to get to where you want to go (not the most convenient thing). Also, it’s much more expensive than what a bus would cost…too bad there are no buses in Chiang Mai.

In any case, I arrived in Chiang Mai last weekend. I’m going to be working with the Research Institute for Health Sciences (RIHES) and met with some PI’s (principal investigators, or the people in charge of research studies) last week to help give me an idea of the different studies that are going on right now and where I can fit in. I need to decide what I want to do and am really excited about this one study that looks at access to care for HIV+ IV drug users, but want to keep an open mind and also gain clinical experience both in and outside of the hospital setting. The other fellow (a friend from Case Med, Ben) arrived about 10 days before me and had the opportunity to go on ID rounds and also to clinic, so I’m looking forward to that. Although it’s slow right now, I know that it usually takes 3 months whenever one goes abroad to really start doing anything, so I’m on track of where I want to be – I found an apt (roomy, centrally located, fully furnished studio) the second day I was here, moved in, and I’ve already had a visitor (my friend Judy from Swarthmore, who is finishing up her post with Population Services Intl in Laos). It was actually really nice that she came and crashed with me for a few days because it lessened the shock of me actually being alone in a city I didn’t know. We didn’t really do anything but hung out, talked a lot about college, life, what’s going in the US now since she’s going back (I made her watch the White House Press Conference with Stephen Colbert), and ate yummy food. Exactly what I needed though. I might go visit her in Vientiane (Laos) next weekend before she packs up and heads home.

Pre-Chiang Mai was madness. After finishing up the Fogarty orientation course in Bethesda, I spent two or three days in Baltimore at Hopkins meeting with the US investigators and doing logistics stuff (payroll, health insurance, etc.) since my Fogarty fellowship is administered through the Hopkins School of Public Health. I also took the Thai Fellow to the Inner Harbor so that she could see her first aquarium, hung out, and ate seafood. Following my few days in Baltimore, I flew home for a night and then got on a plane the next morning to Los Angeles (where my now-husband is from). I think I might take a hint from him (those of you who've seen our wedding website story will get this)and just condense the rest into a timeline:

• July 5-18 – Bethesda, MD for Fogarty orientation (like a mini-course on global health) at the NIH. All US fellows and foreign fellows (we’re paired to encourage capacity-building at our foreign sites) attended and it was fun getting to know everyone from all over the globe.

• July 19-21 – Baltimore with Ben and the Thai fellows.

• July 22 – Fly to LA with Chris on the 6 am flight. Arrive in LA, pick up rental car, go to Glendale Galleria to find a dress with sleeves to wear to the Thai temple, and then run to get my hair and makeup done for the Chinese Wedding Banquet held that night at this huge Chinese restaurant in Monterey Park (Ocean Star). About 300 people attended our Chinese wedding banquet (held by Chris’s parents). I knew about 20 of them, but it was all good. We got to visit each of the 30+ tables and toast them with wine goblets filled with warm Coke in our hands (warm Coke generously provided by the Chinese banquet manager…I think I would’ve preferred wine, seriously).

• July 23- Thai Buddhist Ceremony at Wat Thai in Los Angeles. My parents got married at this temple almost thirty years ago and hadn’t been back since, so it was cool to see how much bigger it was. The ceremony consisted of nine monks chanting, us offering alms to the temple, listening to a sermon on marriage, and other rituals surrounding the wedding. It was really nice, although Chris didn’t understand what was going on a lot of the time because everyone was speaking Thai (we translated later).

• July 24 – I took USMLE Step 2 CS (the clinical skills portion). This seemed like a good idea when I scheduled it, but I seriously studied for like 2 hrs the night before. I think it turned out okay anyway, but I was really exhausted. After USMLE Step 2 CS, we went out for Chris’s mom’s birthday at this Shanghainese restaurant before taking the red-eye back to Michigan.

• July 25-August 4 – pre-wedding planning. Two of my best friends from Thailand, Nan and Mon, arrived on July 28^th to hang out (it was both of their first times in the USA) and help out. They were super invaluable and loved being bridesmaids in an ‘American’ wedding. During these two weeks, I had my bridal showerette/bachelorette party in Royal Oak (thanks Liz and Suhani!!), had a civil ceremony with Chris in Chelsea (in Buddhism, marriage is secular and not religious) and got 'officially married', bdid last minute wedding stuff (wrote the program, made the seating arrangements, etc.) and prayed I would fit in my Thai wedding dress.

• August 4 – Rehearsal and rehearsal dinner in Ann Arbor. Everywhere was relative central (family came from Chicago, Texas, California, DC, NY, Canada,Thailand)…

• Aug 5- I had to wake up before 6 am because the wedding started at 10 AM in Grosse Ile (I got married in my parents’ backyard), but had my hair and makeup done in Ann Arbor. A high school friend did my makeup (we used to play soccer together and do theater together and were reunited on myspace) and it was wonderful. My photographer actually drove me around the whole morning (and also to the wedding) and we had a really great conversation about being Asian-American (among other things) while driving to my parents’ house. The wedding was really awesome – we had both Thai and Western ceremonies (with accompanying dress changes and both kinds of food) and were surrounded by our family and friends in two large tents in my parents’ backyard. I wrote most of the Western ceremony (which was non-religious) and Chris and I told stories about each other and also wrote our own vows (some of which included Dr. Seuss J). Although we had some technical difficulties with the speakers (the music kept cutting in and out because the tent was far from the house), all the guests started singing ‘Close to You’ when the music cut out and we were dancing with our parents – it was really cute. My dad also had his first public speaking debut and gave a really amazing toast. Anyway, y’all probably don’t want to hear too much about the wedding. Take home point: it was kickass!!

• Aug 6-15 – Honeymoon in Brazil! Chris and I spent time in Salvador, Recife, and at Muro Alto Beach (Nannai, Porto de Galinhas). We watched a lot of DVD’s, ate a lot of food, and had good times together.

• Aug 17 – I flew to Thailand! Although I'm happy to be here, I'm sad that I'm alone and won't see Chris until December. It reminds me a lot of when I first started dating him four years ago and was living in Bangkok while he was living in LA. Before coming to Chiang Mai, I spent a day with my friends Nan and Krit in Bangkok, mostly at Siam Paragon, and saw some of my family.

Okay, that’s the update on my life. More humor to follow. Y’all better be ready to start commenting. :)