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...