Wednesday, September 27, 2006

fun times

ok, so this post ended up being deleted when i tried to publish it...not so fun. in any case, this post was about fun things i've done in the past few days. i wrote it after reading a bunch of dense articles on quality of life and statistics (can somebody explain cronbach's alpha to me?) ...anyway, here's a snapshot into my quality of life lately :) besides the post being deleted, i feel like it's been improving as time goes on...

fun friends:

i try to hang out once a week with my next door neighbor/landlady chi. last week we got a massage at this women's prison which was cheap (120 baht for an hr) and one of the best massages ive gotten in chiang mai! my masseuse was nice and we had a cool conversation touching subjects like learning massage, how the women who work there get paid, where we were from, etc. the program they have at this prison seems pretty cool - the women get to choose if they want to enter a vocational program and there's a salon, a massage room, and a store that sells items that the women make (embroidered pillows, tablecloths, etc). i wonder how many women pursue the professions they learn in prison after they get out.

after the massage, chi and i ran a bunch of errands (including eating noodle soup with homemade fishballs, picking up belgian chocolate, pork filled chinese buns (baozi!), and going to the bank) before picking up her daughter at international school. it was cool to see the school grounds and be surrounded with kids from five to eighteen getting out of school and kinda weird in a way - i havent thought about being back in secondary school forever. anyway, in front of the first grade classroom, two girls approached me. one said, 'who are you?' and the other said, 'i know, she's a mom. are you a mom?' and i laughed and said no, i was the friend of a mom there. this short conversation reminded me that little kids just see other people as kids vs. grown ups and also that i could be a mom at my age. even more surprising, i think i am looking forward to being a mom....i just dont think im going to be able to pick up my kid from school though :(

aside from hanging out with chi, ive met a new friend through karyn. when we met, we actually realized that we'd met at the International AIDS Conference in Bangkok two years ago since we both were doing work related to IVDU's. anyway, her name is maddie, she's british, and she's been living in chiang mai for the past four years. she also has a thai bf who does work with ivdu's and who id met before in bangkok. we met for coffee and then she took me to the harm reduction center here where i'm going to try and hang out. i was kinda dressed up since i had to give a journal club talk on cryptococcosis in immunocompetent pts in the afternoon and they were nice (but kinda wary) of my presence, which was totally understandable. cool thing is that the house isnt located too far from my apt and i think i can really help out just talking about HIV/AIDS, ARV, coinfection with Hep C, etc. right now they're going through some restructuring and there's a retreat this weekend, but maddie and i are going to try and think of some ways that i can help out, so im excited to get involved with the community.

in my own condo community, i hung out with the ramen shop owners mai and his brother one night last week when it was pouring and i was too lazy to venture out for food. i was on the only customer in the shop and they gave me free beer and we talked about different things, including the effect of smoking on health, hip-hop, motorcycles, and why I didn't speak Thai perfectly. i was really surprised to find out how little mai knew about smoking (besides that it was 'bad' - he asked what effect smoking had on his lungs, if it affected anything else, etc.). when they asked me about seeing hiv patients, i talked a little about hiv and was like, safe sex is really important, y'all should wear condoms whenever you have sex. this was followed by awkward silence but im serious. girls arent supposed to talk about this stuff, but i feel like im in a unique position and they are just like, oh, she's a crazy american....oh wait, american policymakers are totally all about abstinence and not giving people any sex education. blast!

finally, i dragged poo and nui to this free concert hosted by the US embassy and consulate in Chiang Mai and CMU's Faculty of Fine Arts in celebration of HM's (his Majesty's) 60th anniversary on the throne. the concert featured the New Orleans All Star Brass Band, made up of three generations of jazz performers, and it was awesome! the venue was a little terrible though (huge convention center with horrible acoustics) and it was a lot of Thai people's first experience with jazz, so they weren't totally comfortable clapping along or dancing, which the performers really encouraged. p'nui and i danced though :) and i think they thought it was interesting. cultural exchange in action. after the concert, i hung out with ben and his friend at the drunken flower, a local pub/restaurant that is frequented by the NGO community and cool farang. i liked the atmosphere but didnt drink anything...i just have no tolerance these days and dont like riding home alone when i dont feel well. i think things'll be much better when i have a motorbike though...

fun food updates:

last night vit took me to eat my first shan meal, so im expanding my culinary horizons. the restaurant was on the second floor of this house and well decorated - it was open with bamboo poles and woven mats for the roof (the owner built everything himself), and the lamps were upside down containers used to hold sticky rice at the market. ill have to take a pic next time i go there. anyway, it was really cool because the house was surrounded by trees and vines and it was just like hanging out in a house. the food was great, and vit told me before we got there that there wasn't a set menu - you just show up, the owner tells you, 'i recommend these two or three dishes today,' and then he tells you what they are and you agree. last night we had stir fried tofu with green beans and peppers, this soup with onions and dried fruit (a little sour, only eaten in southern china/northern burma), and pork with peppers and this yummy sauce. i also tried shan tea (a little bitter, and black) and learned some shan words with vit and the owner. it was very chill, and we even got a sneak preview of the gallery they're opening on the first floor with burmese paintings done by a shan artist who i think also lives in the house.

work is going well too...but that's not the subject of the post. :) more pics to come soon!

Thursday, September 21, 2006

coup d'etat






As many of you already know, there was a coup d'etat in Thailand on Tuesday night. Basically, General Sonthi Boonyaratkalin, the army chief (who was sacked by the PM Thaksin Shinawatra) took over (with the support of other armed forces and the national police). The Thai PM was in NY at the UN General Assembly and so wasn't around to stop the army surrounding the Government House, his residence, and other key points in Bangkok. Thai TV channels were also taken over and regular programming replaced with videos of the King and Queen and songs about them that people note were associated with coups in the past. In the beginning, no one really knew what was going on (whose side where the soldiers on?) but a series of announcements were made on behalf of the coup leaders, who are calling themselves the Democratic Reform Council. The first announcement gave the reason for the coup ('The current government administration has caused conflicts and undermined the harmony of hte people as never before in history...The nation has been governed in a corrupt manner...The council is steadfast in its objective, which is not to take over the government permanently and it will return power to the people as soon as possible.") The second declared nationwide martial law. The third coup announcement noted that the current constitution (written in 1997) has been abrogated and the House of Representatives, Senate, Cabinet, and Constitution Court were dissolved; however, other courts retained their authority. Gen Sonthi has stated that he will be the acting PM for the next two weeks until the Democratic Reform Council can get things in order. They expect to have elections within the year (the previously scheduled election was to be held next month), and people are looking to see whether or not they keep the ir promise.

Many Thais were not surprised that the coup occurred as there have been mass protests calling for the PM to step down (resulting in snap elections held earlier this year). These elections were later voided due to possible election fraud and the refusal of opposition parties to participate. While many do not support Thaksin because of his actions, people I have talked to generally say that they wished that an alternate path was taken to bring him down from power. However, most talk is behind closed doors now because the political future of Thailand is uncertain, although many express hope for a better future.

So far, daily life hasn't been affected by the coup (although Wednesday was declared a national holiday). However, there is a rule against assembly now (more than 5 people should not be assembled together) to promote peace. In Chiang Mai, I saw a police officer and army officer together at the mall the day after the coup. A patient who works with the Air Force also noted that his leader has thrown his support behind Gen Sonthi and is now accepting orders from him, which most military units appear to be doing. The military has announced that it has the King's support and many are wearing yellow armbands as yellow is the color of the King. Yellow shirts are traditionally worn on Mondays this year to celebrate the 60th anniversary of the King's ascension to the throne and show love for the King (I'll post a pic of this on Monday, as I just picked up a yellow shirt last week). Thai people love and respect the King as one who loves his country and uses his power to work for social justice, especially poor people. The King has opposed Thaksin's rule and has made thinly veiled remarks against him during his Kingly speeches, including advice that Thaksin should listen to others and hear opposing views ( It seemed that Thaksin was trying to sue everyone who spoke against him for libel at one point). So far, the King hasn't made a public speech, and some people I've talked to suggest that he will not. Gen Sonthi has stated that the King was not part of the coup plans, however.

That's it for now. Obviously, I didn't present a very detailed analysis of anything but you can all read more about it on the Internet if you'd like as I'm not sure who is (and is not) reading this blog. An interesting article that was forwarded to me today in the Asia Times titled "Thailand: All the King's Men" can be found here.

Thanks to all of you who sent emails or IM'd me to make sure I was okay; it's nice to feel loved in my home away from home.


workin' and groovin'

At a food market with Poo (bags of curry go for 15-20 baht, or around 50 cents each)


With the exception of the day-after-the-coup, these past few days have been the most productive days of my fellowship, both personally and professionally. However, I’ve also developed a little homesickness (which I didn’t really expect a month into my time here) that has led to insomnia. I think a lot of the homesickness has to do with missing Chris and the feeling like we’re always somehow in transit re: our schedules and don’t get to talk as much as we would like to.

On the personal front, I’ve made some new friends at the MA drop-in center (Baan Ruk Puen, the House of Loving Friends in literal translation, but more like ‘Where Friends Care for Friends’) and hang out there often in the afternoons even though it’s looking more like I won’t actually be doing any data analysis with the MA study as all the data is essentially taken already. Ying, one of the more outgoing interviewers/youth outreach workers there, invited me to go to the ‘Walking Street’ with her Sunday night. There are two walking streets in Chiang Mai (Sat and Sun nights) and basically they shut off a portion of downtown to cars and people just come and set up stands (or put a sheet down on the pavement and their wares on top of it) and sell all sorts of things, including clothes, gifts, art, food, etc. There are also some street performers. I hadn’t been in a few years and this one has gotten a lot bigger; Ying and I spent about three hours walking around and didn’t see the whole market. I picked up a pink ‘I love Chiang Mai’ shirt and a present for Chris. Good times.

On Monday, I received my first motorcycle lesson from a nurse at the MA center. She was giving me a ride home from Baan Ruk Puen and was like, let’s go and ride now! I was a little shaky with balance at first but eventually felt comfortable riding around in this empty parking lot after about an hour. It was fun and I’m getting a hang of switching gears and whatnot. However, I’m still a little terrified when it comes to riding in Chiang Mai traffic, which has increased significantly over the past few years. I’m going to have a few more lessons and hopefully will buy a secondhand bike sometime this week or next. :)

Food update:

I finally tried the Taiwanese hole-in-the-wall restaurant that’s right next to my apartment building, and it kicked ass! I had some jaozi (pork dumplings!) for 40 baht ($1) and fried rice with Chinese sausage (lap chang) and it reminded me of living in Beijing again.

Over the weekend, I also had some pasta at this local restaurant (catering to farangs) and got to chat with one of the head waiters there, who asked me why I could speak both English and Thai really well. I told him a little about my background and he told me his sister died of HIV/AIDS a few years ago. He didn’t really know much about HIV but I told him that treatment was now available through the universal health care program in Thailand using generic drugs produced by the Government Pharmaceutical Organization (GPO-vir, which is a combo of d4T, 3TC, and NVP). I’m not sure if he believed me, but I think it’s good to try and educate where you can.

Last night I ate dinner with Poo and Nui at CMU’s undergrad campus. Every night they set up food stalls and the food is yummy and cheap. I had some fuktong (Nui says it’s a kind of pumpkin) that was super yummy, tofu with pork, and lab (special northern thai dish) with pork. Pork is really common in Thailand, much like beef is in the US. My favorite part of the meal was the pineapple smoothie though (fruit smoothies are sold all over here and made with fresh local fruit) – it was 5 baht (about 12 cents). My quality of life (foodwise) is seriously better here than it is in the states.

Work life update:

All my meetings have been really productive and exciting over the past few days and I now have a better idea o of what I’m actually going to do here, which includes both community work and also clinical work. Some projects I’m going to work on include:

  • Access to care for HIV+ IV drug users. This was supposed to be a substudy under a larger multinational trial comparing oral suboxone vs. methadone as opioid replacement therapy for heroin users, but was not funded because it looks at treatment (rather than prevention) and also because US funders didn't think that it would 'add anything new' to what is already known (drug users have problems accessing care). Totally helpful, I know, especially when 30% of Thailand's IDU's are HIV+ and that rate hasn't changed in over ten years. Anyway, I'm going to look into applying for some grants and will probably be the person-in-charge for this project, so that's really exciting! I'll get to go on home visits, interview drug users, and analyze the data. There's been a preliminary proposal written so far but I think we'll have to scale back due to the lack of funding. The head PI here for the project is really chill and a family doc (also with a PhD in public health and really into harm reduction and drug use). I met him two years ago when a JHU prof sent me up here to check out the site and he commented that he didn't recognize me because at that time I seemed very "young, energetic, and outgoing." I wonder what that says about my past two years in medical school ;)

I think I've changed a bunch since college though in terms of becoming more grounded in my work, what I expect from myself, and what I expect from others. I also have different kinds of relationships now, both professionally and personally. Personally, I think my family dynamics changed after my mom was sick and I helped take care of her (weird to switch roles - I'm happy she's better now so I can go back to being a kid in a way). Also, I'm married now and look forward to having a family of my own (!) :)

Sometimes I still find it hard to believe that I'm both a mentor and a leader to others but I think it's really important to be supportive of others and try to meet people where they're at. I like listening to other people's stories (good to be in medicine cuz you get to hear lots of them...even ones you sometimes don't want to hear, like this one patient who would not stop talking about his rash for 30 mins today) and giving advice...more often than not though I like helping people think about what they actually want to do because I think that's more important...and way more useful to the person in the long run.

  • Back to the work theme. Other things I'm going to be working on include some different writing projects - a possible review of penicilliosis in immunocompetent patients, writing up the data from a quality of life pilot study done a few years ago among HIV+ patients, and maybe designing my own little project on quality of life among the patients in HIV clinic. I'm giving a journal club this upcoming week on cryptococcosis in immuncompetent patients as well.

Clinically, I sit in with Poo every week at HIV clinic (we see between 10-15 patients during a ~3 hr morning clinic on Thursdays and Fridays) and join on ID inpatient rounds if I'm around during the afternoons. I also attend weekly journal club, where Dr. Kuanchai always notes that I'm 'clinically inclined' to Dr. Thira. :) Actually, I'm interested in everything, but I think people don't quite grasp that. It's okay though because I get to split my time both at the hospital and in the community. I'm looking to volunteer at some local NGO's (like Thai Drug Users Network) as well, so that should be cool as well. :)

Next post: life post-coup (generally the same as life pre-coup), but a little quieter...

Friday, September 15, 2006

getting my ass into gear

so the last two days have been (surprisingly) productive since ive decided that i want to definitely be started on a few projects by the beginning of october.

thursday:

i should've gone to ID outpatient clinic in the morning but thought it was wednesday for some reason. instead, i walked down to smoothie blues, a family-owned place catering to primarily farang, and had a yummy breakfast consisting of pancakes, eggs, bacon, and fresh orange juice. i also read part of the bangkok post and the august 2006 uk version of marie claire (which has way more articles in it, btw) before meeting up with ben for lunch at a local street food stall.

in the afternoon, i went to meet with some people from the methamphatemine (MA) study. The head person had originally suggested i look at some of the questionnaire data on tattoing, so i met with the behavioral data person, A, to look at the questionnaire and get some of the data. i helped translate the questionnaire into english and A said she would help me if i figured out what i wanted to look at. i have no statistical background whatsoever, but she uses SPSS (ive been told by multiple friends now that it's worthless, but that's what she has), and checked out some books for me from the library on how to use it (i'm picking these up on monday). later, i bonded with some of the MA head people by showing them wedding pics from the US. they noted that most of them were single (A has a boyfriend but he's getting his PhD in Tasmania now) and that it was hard to find men who would date highly educated women. also, it appears that many of the older women chose between having a career/education and having a family. kinda sucks.

anyway, after i met with a, she suggested i go over to the drop-in center (Baan Ruk Puen, or the House of (loving) Friends - sounds dumb in translation, but it's fine in Thai). i did, and hung out with a bunch of the interviewers/youth outreach workers there; most of them are women (i think there are 2-3 guys out of maybe 12 people). it was fun; i told the story of how i met chris and answered questions about being thai-american and just got to know everyone better. all the single girls were like, "Where's the other fellow? the head person (Orn) said she would bring him over today so we all got dressed up." it was kinda funny though because the head person also told them that he was 21 or 22, but he's really 28. random.

when they were getting off work, they invited me to go eat at this all-you-can-eat steak buffet held at a hotel. i tagged along and ate mostly thai food (the steak wasnt great), including tons of fishballs, for about 70 baht. lots of hotels in thailand also have these karaoke singers that sing during your dinner. there were two at this place who sang separately (a woman who sang thai songs and a gay guy who sang english songs). it was kinda hilarious because the gay guy just made up some words that weren't really in the songs, but nobody caught on since everyone was thai there. i think it's interesting that many singers here likely sing phonically (is that a word?) rather than knowing the actual meaning of the words they're singing...or that's what it sounds like, anyway.

after dinner, i ended up staying up pretty late (for me, that's like 1 am here) and emailing up a storm. i set up a meeting with this family doc who does a ton of drug research here (i want to investigate other areas for being involved while waiting for the suboxone vs methadone trial to start - ill probably do interviews for the access-to-care subproject in that trial, which looks at barriers to care for hiv+ iv drug users). i also emailed some local NGO's to see if i can get involved in some way, and wrote to the head of this Advanced Study of Thai program at UW to see if he could give me any leads for an advanced Thai teacher in Chiang Mai. sometimes i wonder if all those years studying mandarin were a waste (i remember so little now, but still understand it). oh well, we'll see what happens - i haven't ruled out returning to china in the future. :)

friday:

woke up early (around 6) and then went back to sleep until 8. got up, and got ready for ID OPD clinic. poo was post-call so she got to clinic a little later than usual and i had time to pick up iced coffee and sweet rolls for breakfast. this is the first time ive been to clinic before it's actually started so i got to hear the head nurse give a PSA-style speech about wearing condoms as an HIV+ person to avoid spreading the disease (and also to avoid being superinfected, or receiving more virus), the importance of taking meds daily and at the correct times, etc. She also gave some basic information about clinical trials that were currently enrolling and encouraged people to ask questions about meds if they had any when she met with them personally (all patients meet a nurse briefly to pick up meds and make their next appt after seeing the doctor).

there weren't as many patients in clinic in the morning (we saw 10 in less than 3 hrs). i took notes while we saw patients though and observed that of the 10 patients we saw, 6 were women. five of these women found out they were hiv+ because their husbands/partners had died, prompting them to get tested. the first patient was 22 and said her boyfriend died last month. she was obviously anxious and had no clue about hiv, what CD4 count meant, what she should do, etc. poo was kind to her and tried to lecture her about basic hiv stuff like no meds until CD4<200,

I'm interested in gender differences between quality of life among men and women and also on women's perspectives...I feel like I would be so angry if Chris was like, 'By the way, I have AIDS', or just died on me and then I found out I was infected from him...not that you can do anything about it at that point, but it's frustrating - and probably really depressing, especially if you're widowed. Today (this is a week later now, because this post was half deleted) we saw a 52 year old woman who was clearly depressed, recently widowed, and was now living with her youngest child. She said the older child didn't know her status and she was embarassed to tell him. She just started taking ARV and looks pretty cachexic. Sad.

Back to last Friday - in the afternoon, I hung out at the MA drop-in center and asked to observe a 3-month follow-up questionnaire with a 20 year old in the MA study. it was really interesting to see the effect of MA use on this kid (who seems like a really nice guy, student at a local technical institute) - he clearly had no concentration and had to ask to have a lot of statements/questions repeated, including the one asking if he had any problems concentrating in the past week. He seemed really out of it in terms of dates too and had to repeatedly look at a calendar to see what days comprised 'last week' or 'last month'. However, he impressed me by being able to answer all the 'tell me whether you think this statement is a myth or a reality' questions (some of them were really tricky; they had to do with drug use and/or sex) and being really adamant about condom use. Right now he states he has about 5 regular sexual partners but uses condoms with all of them...good thing, yeah?

Friday night I had a yummilicious burger at Mike's Burgers and Wawee coffee with Ben. Ever since then, I've had a burger craving, but am in general liking the fact that I've cut way down on red meat, eating pork and chicken instead. Poo apparently thinks I've lost weight as well (Thai people are obsessed about weight and will likely comment on whether they think you've gained or lost weight almost everyday).

A funny story (in retrospect) having to do with weight:

On Wednesday and Saturday nights, there's a market set up outside of the mall across the street with local food vendors and others selling clothes and knicknacks of different sorts (cell phone holders, umbrellas, hello kitty pencil cases, etc). There's also foot massage chairs set up and I thought I'd get an hr massage for 3 USD. Unfortunately, the woman who was assigned to give me a massage was convinced I was pregnant. She was an older (maybe 50-60ish) and meant well, but as soon as I sat down, she was like, "Oh, are you pregnant?" And even after I replied in the negative and told her I was actually just 'fat' , she kept harping on it and making comments like, "But your legs are really swollen and it's like when Thai people are pregnant and are going to give birth!", "You should go see the doctor and get a pregnancy test," and "Oh, are you still single (implying virginity)?" I think we spent half an hour on this topic and the massage was actually pretty painful in multiple ways. Oh well, though. Thai people I told the story to thought it was funny and that the masseuse was a little out of line, but that's life. At least I know that it wasn't just me being offended after awhile.


Wednesday, September 13, 2006

rant

this is a rant.

as many of you know, i speak thai and im thai american (both parents are thai, born and raised in the us). you may think this is an asset considering im in thailand. however, in matters of being introduced to people i work with, it totally is not.

case in point: today i was excited to go on my first field visit with PA-Thai (Project Accept Thailand), a trial that's complicated to explain, but the jist of it is that there are seven different sites (communities) in Northern Thailand and three teams: Community Mobilization, Voluntary Counseling and Testing, and Post-Test Support . The three teams go to each of the communities separately eight times (in 'rounds') over a period of two years. The point of the trial is to take community-based voluntary counseling and testing for HIV to rural communities. By doing this, the study group will obtain epidemiological data on HIV infection rates in (more) isolated communities/different ethnic groups, give HIV education to communities, and provide support for those who test positive. It's actually pretty cool, and a lot more in-depth, but I think that's enough info for now.


Today I was assigned to go to Mae Tang (a 1.5 hr drive from Chiang Mai in a 4-wheel drive vehicle) with a VCT group which consisted of a team leader, two nurses (one counselor and one lab person to do the HIV rapid tests), and the driver. The head of the whole VCT group also rode in our van. She also has 'porn' in her name and her nickname is Bee. Anyway, she was super nice to me and spent a long time explaining the VCT component to the trial to me including the different ethnic communities they were working in, what the data had shown so far, and how they were trying to make modifications in their work based on the previous two 'rounds' (they're on their third round, or third time through the communities right now). After this intro, she had to go do QC at the other site (where the other Fogarty fellow was) but I tagged along to see it since it was in a Lahu (ethnic minority) community.

I was there briefly but got sent back to the original site in the event that there were cases I could sit in on. The original site has 50% Thai speakers, so Bee thought that there was a good chance that I could understand if someone came to get tested. Alas, there were zero cases. However, that is not my rant.



A nurse and our driver talking at the rapid test table


The community center where the VCT was set up in Mae Tang



My rant is that in the 6 hrs I spent at the site (consisting of an open air room with aluminum ceiling and mats to sit on on the floor), hardly anyone talked to me. I tried initiating conversation multiple times but no one was interested even though they were clearly bored out of their minds. I eventually ended up taking a long nap instead and reading 'Jonathan Strange and Mr Norrell', which I left in the car on the way back home (Grrr). I was told that some people on the team were disappointed that I was chosen to be with the team because they originally had thought I was Thai and they wanted to speak English. I told them multiple times to speak English to me but they refused. They also asked me if my English was any good when I first met them (I was like, yeah, I'm American). Finally, they all got up to go buy snacks at a local store but didn't invite me. When they were halfway down the road, I was like, "Where are they going?" The person they left in charge of the VCT booth was like, "Oh, to buy snacks. Do you want anything?" I was like, whatever.

Meanwhile, people talk to the other fellow all the time. I know because I was at the other site (although the two ethnic minority ppl talked to me there) and also from conversations with him. I am not mad at the other fellow or jealous, I'm just frustrated with the situation. The situation being that I am not viewed as being 'cool' or 'interesting' or 'worthy of really talking to' because I can actually speak Thai and my parents are Thai. This happened to me when I was working in Bangkok and two Dutch students came for the summer to do a study on HIV+ children. They spoke no Thai but everyone wanted to be seen with them and/or hang out with them/help them in every way they could. I only ever went out with the non-white staff there once, and that was with the Dutch girls, even though I had been working there for a year. I tried to explain this to Poo, the ID fellow, but she didn't really get it. She likes me, anyway, but it's sad sometimes to only have one friend.

She's a good friend though. She invited me to ID Journal Club yesterday. It was pretty informal - just me, her, the resident who gave the presentation, and the attending doc who also happens to be the head of the Research Institute for Health Sciences (where I'm based) and the ID Dept. I had scanned the paper quickly before the presentation and was able to make some semi-intelligent comments. Poo noted that the attending thought I was diligent (score!). I was also introduced to this Chinese resident, Helen, who was born and raised in the UK. She married a Thai dude (his family owns this huge mall here and is mega-loaded) and then moved to Chiang Mai, where she's doing a neuro residency. Craziness. I am trying to figure out who her Thai teacher was (she can read and write and is totally fluent) and maybe will look into some of the data the neuro dept collects on intracranial mass lesions in HIV+ patients (med ppl: mostly toxo, crypto, some TB). I really like ID. I am going to do it (this is probably not a surprise to any of you). :)

Monday, September 11, 2006

eek! i havent updated for a week!

im not sure what happened, but it appears i havent updated in a week. instead of boring you all with minute details of the last seven days of my life, i'll attempt to provide a quick synopsis.

i spent the past three days (i took a long weekend - sat, sun, mon) in bangkok. about 90% of the time was spent at bangkok hospital, where my uncle is recovering from a 3vCABG (translation for non-medical peeps: triple bypass). the hospital is a private one and crazy nice...on the ground floor there's an S&P (bakery/cafe), Au Bon Pain, 7 Eleven, and more. my uncle called it a 'hospitel' (combining hotel and hospital)...i found it to be like a spa. Anyway, if you're in a private room, you need to have someone stay with you overnight, and so this weekend that person was me. Most of the time there were other people around, and i got to hang out with four cousins i didn't really know well before since most of them had only recently moved up to bangkok for work. their nicknames are cha'ay (peekaboo), nit noi (a little bit), nong (younger one), and oam (i dont think there's a translation for this). they're all around my age, which is cool. maybe i'll get to see them more when i go down to bangkok, but i think it was awkward for them to interact with me because they assumed i couldnt really speak thai (even though i can, grrr). oh well.

other highlights of the weekend included catching up with old bkk (bangkok) friends, including nan (a bridesmaid in my wedding and a cardiovascular icu nurse at the largest public hospital in thailand), krit (gay dude who is a super great friend and took me to the airport yesterday), noi (red earth makeup artist at siam square - she did my makeup and hooked me up with free makeup applications in chiang mai) and amalee (fellow fulbrighter who has lived in bkk for the past five years and works on development/child trafficking issues). i miss bangkok!

pre-weekend highlights.

friday: my neighbor and landlady chi (chinese-american mom) invited me to hang out with her on friday morning, so we went to run errands while she showed me around town. we got our nails done at this local place, and i got a nice french manicure and pedicure done for 350 baht (almost $9). she also took me out to lunch at this local vegetarian restaurant (all you can eat for 65 baht - $1.50) and introduced me to this homemade ice cream place (yay custard apple ice cream). we talked about asian american stuff, living abroad, and other interesting things. good times, fun stuff!!

friday night: dinner with ben and some admin ppl at the research institute where i 'work'. this one girl would not stop talking about going out with her friends and getting drunk. needless to say, i lost interest after awhile. her friends were even like...'smile and nod'. at least she gave me a ride home though.

thursday: i went to opd (outpatient) clinic with poo from 9 AM-1 PM. there were about 110 patients for 2-3 docs to see in the morning. saw lots of hiv cases, some sad cases of patients who decided to change their own meds and ended up developing resistance, one of a cachexic hill tribe woman who didnt understand any thai and didnt have an interpreter, a guy who looked fine but had a CD4 count of 4. got a new phone from the research institute and am just figuring out how to use it (still) but it's loads better than my old piece of crap. thursday night, i got this massive headache and felt sick, so could not really enjoy eating at this restaurant next to a waterfall that poo and nui took ben and i to. after taking some ibuprofen i got better though, and poo, nui, and i went to the night market (really small scale jj, open stalls, cheap clothes that i cant fit into because im too big).


wednesday: kickass 2 hr thai massage, 240 baht ($6). other stuff as well, but not as exciting.

today:
i have grand plans to get a bunch of stuff accomplished - going to journal club in the afternoon and will try to read more papers and get a proposal together to look at quality of life among the HIV+ cohort here. also plan to check out the gym across the street - im getting tired of being sedentary and also im really sick of people telling me im really fat (thai people are super bad about this. two examples from the weekend: one woman, who's my aunt's friend, was like, 'you're tanya? i thought you looked familiar; i met you a few years ago, but you've gained so much weight now. wow, you're really fat! how many kilos have you gained?" Example number 2: my uncle (who i went to hang out with at the hospital) saying, 'hey, if you gained a few more pounds, you could enter the miss chang (elephant) contest (for super huge women in thailand).' uh..thanks.

more updates to come :)

Tuesday, September 05, 2006

luck be a lady tonight

a short post on last night happenings...overall, i had a totally unproductive day but got picked up to go eat 'jim joom' at this thai buffet after poo got off work. jim joom is northern thai suki where you basically pick whatever you want to eat and throw it in this ceramic/clay pot filled with soup on a burner. this thai buffet was ginormous and in addition to all the fixings that come with jim joom (seafood, meats, veggies, etc) there were snacks (like steamed buns, shu mai, cold salads, etc), a large grill where you could grill your own meats and whatnot, and this dessert bar with ice cream, thai dessert (including shaved ice with additions like beans, corn, tup tim krob, etc), and a toast bar. toast is really big in thailand with some little cafes specializing only in milk (all flavors) and toast. there are yummy spreads to put on your toast here, lots of them of thai fruit and also other things that im not sure how to explain in english.

anyway, jim joom was fun because there was live music and it was in an outdoor setting with an aluminum roof top. even funner (yah, i know, funner isnt a real word, but i like it just the same) was that a mahout came with his elephant and stood outside. the elephant was really happy and kept dancing, and kids would go out and buy sugar cane or bananas to feed it. poo fed the elephant and then told me that the elephant was 4 months pregnant and it's good luck if you walk under a pregnant elephant's belly three times. i thought to myself, 'self, you can always use some good luck', so went to the elephant, wai'd to it (traditional thai greeting of respect), and walked under her belly and around her in a circle three times while the mahout (elephant caretaker) recited a blessing. afterwards, i paid the donation of 59 baht with 60 baht and got a lucky baht coin (like a penny) in return which im supposed to keep with me and not spend. pretty kickass, if you ask me. not everyday you get to walk under a pregnant elephant.

right now im at the hospital in the id staff room and am thinking about going on afternoon rounds with poo and her resident tong (poo later told me not to come with her, so im just hanging out in the id room). this morning i had a short discussion with dr. kuanchai about maybe doing something with the adult hiv+ cohort they are following at the university hospital here (about 1000 patients) - dr. kuanchai says no one has done anything about adherence or quality of life, so that would be something to look into (i could also use my thai skills and administer the questionnaire myself while pts were waiting in opd (outpatient) clinic). anyway, i need to think about it more and look up some past literature and stuff, which i will do immediately after i finish this entry...which may be now. :)

Sunday, September 03, 2006

weekend

overall, my weekend was nice and relaxing.

saturday was a solitary day, but it was good for me to remind myself that it's ok to be alone and i can actually amuse myself without other people around. i started the day off doing some laundry (yay hand washing) - you pay by the number of pieces you wash here so i just do my own underwear (sorry if this is TMI for some of you :) ). after that, i went to a local spa for a body scrub, massage, and facial. very nice (anyone thinking about coming to visit...definite thailand perk!!)

after the spa, i headed over to this local cafe (wawee coffee) that serves really yummy coffee and has these huge branches with both indoor/outdoor seating and fountains and gardens. i usually get iced coffee there and read the daily english-language newspaper here (the bangkok post)...it's kinda ironic that im often more up-to-date on news here and what's going on in the world than when im back in the states. btw, judy and i found the most kickass article on nyc's oldest bartender, hoy wong, while we were also engaging in similar newspaper-reading activity at said wawee coffee. if you are interested in reading the article, click here:
http://www.msnbc.msn.com/id/14462796/

after i was all caffeinated and ready for more adventures, i attempted to locate the art gallery where my co-worker's husband was having an opening for an exhibit on abstract seascapes. i thought it might be down this one soi (sois are side roads/alleys off of main roads) that is known for boutiques, antiques, and other fun stuff so i wandered down there and went into a bunch of stores. the whole soi was mostly empty since it was late afternoon on a saturday so i had fun browsing but didn't buy anything. later, i got a text msg telling me that the art gallery was actually 2 sois over from where i was, so headed over there and found it to be packed. the art was really awesome (and also affordable) and there was a good mix of people (all ages and both thai and farang. fyi, farang means foreigner (generally white) ). my colleague introduced me to a cool farang couple that does advocacy work in chiang mai (they're older, but still young - probably early 30's) and i spent a long time chatting with them. we were later joined by vit, who was sporting a green shirt that had a lime with fangs on it. on further questioning, the lime with fangs represented a familiar on this online rpg, kingdom of loathing. we made fun of it for awhile, but vit convinced me to check it out when i got home. i now admit that i am mildly addicted to this game, but you should all check it out too (you can wikipedia it if you want) - it's a pretty kickass rpg that just makes fun of rpg's and pop culture in general . plus, everyone is a stick figure. what's not to love?

i also had some kickass noodle soup at this noodle stand that vit recommended (thai-ish noodles, but all the workers there are shan) on my way home from the art gallery. it was 20 baht (or about 50 cents). if i just ate on the street or in small shops all the time here, i would spend less than $2 a day on food.

sunday:

poo and nui picked me up around 11:30 for a day of chiang mai adventures. first, we grabbed lunch at this thai place a little outside the main city (menu for lunch included cha boran (like thai iced tea), sukhothai tom yum noodle soup, satay (chicken sewers with peanut sauce and cucumber/vinegar sauce), and som tum moo yoh (pork sausage with papaya salad - moo yoh is awesome and eaten a lot in the north)). poo was impressed by my spicy-eating abilities. i was amused because my family is from Southern Thailand (known for the spiciest food EVER) and they always think im a huge wuss. anyway, poo gave me props for being able to eat spicy when compared to non-Southern peoples.

after lunch, we stopped by an ancient monastery, wat umong, to feed fish (they were full though and nothing ate our fish food, but i saw a snapper turtle!) and visit Buddha images, kept in ancient caves. the temple also had wooden signs tacked up to the trees with Buddhist proverbs in both english and thai. one that i remember stated, 'all honest work is honourable work,' which reminded me to humble in my daily life (i feel like docs often get a big head about themselves and why their work is more important than others). the temple setting was really beautiful (ill upload some pics soon) and we were visited by a monk, who gave us a short dhamma talk on how it was less important for us to visit the temple regularly than to try and observe the five precepts everyday in our daily lives (take home message: do good in your daily life to reap the benefits of karma). he also asked us which of the five precepts we found it hard to keep, and nui answered that he still drank beer. (i first thought that the monk asked us what the five precepts were, and i said, 'to not kill people'. then nui was like, no, what ones are we still deficient in? lol). the monk talked about why drinking was no good (losing money, causing health problems, other stuff) and poo later made fun of nui after we left the temple. anyway, im not capturing the essence of it, but it was nice to have a chat with a monk, who urged us to try and make a commitment to keep the five precepts for one day. btw, the five precepts are:

1) Do not kill (or intentionally harm other living beings)
2) Do not steal (or take what is not given to you)
3) Do not commit sexual misconduct (also be respectful in relationships)
4) Do not lie (or speak harmful thoughts)
5) Do not do drugs (other than for medicinal purposes)

poo and i had a short discussion about the 4th precept because she noted that she sometimes had to lie to patients re: their diagnosis when their families didn't want the truth to be told. this is common in asian cultures where younger ppl make decisions for elderly ppl and it might be bad luck/bad form to tell an elderly person they have cancer or some other diagnosis. i dunno how i totally feel about this (growing up in the western culture of autonomy), but i've read a lot about it in the past during my medical anthro/bioethics courses and think it's interesting.

oh, the temple visit also reminded me of a discussion ben and i had with a monk at wat suandok about how buddhism is a way of living and people don't need to be 'converted' to Buddhism. More on that later, perhaps.

After the temple visit, we drove up to this reservoir and got some fruit and drinks at this cafe overlooking Chiang Mai. we also saw a couple in western wedding wear taking professional pictures outdoors, which got us talking about poo and nui's upcoming wedding (next year) and me and chris's love with taking pictures in thailand. lol.

Later in the afternoon, we went into full shopping mode, with stops at Tesco Lotus and Central Airport Plaza. Poo paid some of her telephone bills and signed up for ASDL and UBC to be connected in her room at the hospital, and I picked up a big fan (good to save money on electricity and also :)'er for the environment vs. A/C) and some towels. Exhausted from walking around the mall, we ended the day at this large covered outdoor market (talat in thai) that's actually not too far from my condo. the talat sells everything, but we only went to the food stall part. food stalls here are awesome, and basically sell a bunch of premade food (curries, stir fry, etc) on these huge platters. you pick what you want and they put a serving into a small plastic bag for you and tie with a rubberband (ill also upload a pic of this later). at this talat, a single serving of food is 20 baht (or ~50 cents). i picked up a small roasted catfish (25 baht), stir fried vegetable (kinda like a cucumber, but not) with egg (20 baht) and a single serving of steamed rice (5 baht) for dinner. i ate the leftovers for breakfast this morning, so that was definitely a worthwhile meal :)

yay for chiang mai adventures! i think i will pick up a motorbike soon. :)







Saturday, September 02, 2006

mo'c mo'l

this week has seemed crazy long so i (and poo) were way happy when it was friday. btw, poo is a machine. she works the entire day post-call (call=staying overnight at the hospital and answering calls on id patients and sleeping little, if at all) and then still goes out partying at night. it is really ridiculous. anyway, yesterday was one of those crazy days for her.

in the morning, i joined her in ID clinic (mostly HIV+ patients). one dude had a CD4 of less than 10 and we examined his chest films (patients carry around their medical records with them here). it was pretty cool (but sad); we saw textbook PCP, then a CXR after treatment with the PCP resolved but another new nodule forming (the pt had complained of chest pain in the area as well), and now they're thinking he could have Nocardia or something; they need to bronch him to try and get sputum to stain and culture. He can't start ARV treatment yet and he is sad. I hope he doesn't die before he can start. Also, I saw this pt that was being transferred from another hospital with cryptococcal meningitis. he was stiff as a board and unconscious. i was surprised more people weren't freaking out (his family kinda was) but most of the staff around were like um...let's see if we can find an open bed on our ward. he really looked like badness (fun term that medical ppl use to connotate exactly that..badness). ill check on him next week after he starts his amphotericin B.

after ID clinic, we had khao soi (yummy noodles with this spicy soup - kinda like curry, but a northern thai specialty) to celebrate the end of the short course and the Japanese docs' stay. I got relegated to the 'adult' table (go figure, even though im the youngest kid) and ended up talking to this japanese doc who came to supervise the other docs (he's an md/phd and has a really funny body habitus - basically, he has a huge paunch but small arms and big legs and a kinda smallish head and he is balding). he is nice and tries to make jokes but it's funny because sometimes they don't make sense and then the thai doctors are like what? and then laugh awkwardly. im actually really surprised at how bad the japanese docs english was. anyway, we had an interesting conversation about female physicians (he said that Japanese female physicians were discouraged to continue working as a physician after marriage and asked about the situation in the US), University of Michigan Med (I forgot that there was a Japanese health clinic run by the family doc Michael Watters (i don't remember his name) at UMMS), the medical education system in US, and American college life. the cool head ICU doc was also there and said he was nervous about this presentation he was scheduled to do in the US in the fall. apparently his presentation was one of fifteen picked to compete for this international research award and he's nervous about his english (although it's really pretty good), so i offered to help him go over his slides and listen to his talk. I'll also investigate potential projects with him. :) Poo says he has much power in the hospital, and he's really cool.

At the lunch, I ate crazy amounts of food, including yummy thai fruit (longan!) and this ridiculously yummy ice cream sandwich. Ice cream sandwiches here are actually like real sandwiches - sweet bread with ice cream in the middle. It's actually really good, and there are people who make homemade ice cream and sell it on the street in hot dog buns (seriously) or hamburger buns. You can also add toppings to it, but the toppings are things like corn and beans. It's actually pretty yummy (I know it sounds gross, like bananas and cheese...but that's actually yummy too! Chris and I ate it unknowingly in Brazil).

in the afternoon, i went to a peds id lecture with ben (sadly for ben, the slides were all in english but they all talked in thai). a bunch of peds fellows/attendings gave short presentations on their research re: the immune response to HIV+ children who receive different types of vaccines (Hepatitis, Japanese Encephalitis, MMR, etc). There was also a review of immunology, and i forgot how much i enjoyed that sequence. perhaps i should investigate peds projects as well.

i am totally impressed by how much literature people read here (including residents). it's also all in english, which is their second language, but there's tons of journal clubs and just informal reading all around. i need to start reading more, as usual.

in the evening, we went out with this japanese docs again to this really awesome indoor/outdoor cafe/bar/restaurant named mo'c mo'l (short for monkey club and moon lover). it's open but covered (so you dont get rained on), there's raft-walkways between the cafe and the restaurant/bar part, live music, and fish and frogs in the pond they've constructed...think tropical garden). there was tons of food, as usual, and rotating thai bands that sang both english classics and thai songs. dr kuanchai (young id doc, poo's boss, and totally awesome dude all around) was rocking out to some of the music. the japanese docs all got drunk on beer and bacardi blueberry/vanilla liquer. kinda hilarious, but also kinda fun. after mo'c mo'l, poo, nui, ben, and i went to the original monkey club near where ben lives for more food and a fleeting moment of clubbing (mostly it was us going in to the club area to try and find poo's friends) most clubs here are packed, there's a thai band playing covers of current hit thai music, and people stand around their tables (or carts) and kinda dance and sing along. ben was dragged into the melee and said he was afraid. it was good times, anyway, but i turned in right when i got home.

on the agenda for the rest of the day: 2.5 hr spa treatment (body wrap, massage, and facial) at chiang mai oasis spa and maybe lara's husband's art opening at a local thai gallery in the evening. i havent been that productive since waking up, but did hand-wash all of my underwear (cost for laundry is per piece, so i think it's a waste to throw in underwear) and caught up on email.

hey, people, if you're reading, comment so i know this isn't all going into a black void!!