viet nam

for the holidays, chris and i decided that it would be a cool idea to visit a southeast asian country that we hadn't been to before so we planned a weeklong trip to Viet Nam. my little brother derrick flew over from the states and met up with his gf who was studying abroad in Beijing last semester in Hong Kong. they met up with us in Bangkok and we all flew over to Hanoi together.

usually, i do all the trip planning once we get to a certain location. this time, however, i was busy with work and couldn't be bothered so chris made a lot of the arrangements. our wedding photographer, zim, was a real lifesaver and gave us a lot of great travel advice. even better, she booked hotel rooms and a driver for us in hanoi since she had just been traveling through a few weeks earlier. in any case, we arrived in viet nam with me not having researched much, a 2000 copy of Lonely Planet Vietnam, and some emails from Zim. it all worked out though.

our main plan was to spend 2 days in three different locales - Hanoi, the capitol, Sapa, a mountainous town on the border of Vietnam and China, and Ha Long Bay, a bay filled with thousands of rock formations (similar to the South of Thailand, but on a larger scale). Here are the highlights of each city we visited:

Hanoi. Hanoi is a very colorful city with no traffic lights and no traffic rules. There aren't too many tall buildings but a lot of them are very long (you used to have pay taxes based on the size of your store/house front, so people just built really long houses instead of wide ones). Although there are sidewalks, Hanoi takes 'street life' to a whole new level. It is basically impossible to walk on the sidewalks because they're filled with parked motorcycles, tea/coffee/noodle/snack shops (basically stools and small folding tables where you can watch the traffic go by), fruit/vegetable sellers, and the overflow of shop goods onto the street. This means you have to walk in the actual street, which is also overflowing with motorcycles, bicycles, cars, tour vans, more vendors, and people. There are hardly any traffic lights (and people dont always obey the ones that do exist) so it's mostly chaos, with people making their way through the traffic by using their horns. Hanoi is the first place where we noticed 'pimped-out' horns - echoing horns, horns with different tones, melodic horns. My understanding of the horn is that it indicates that you better get out of the way/go faster or you're going to get run over. Craziness.

Highlights of Hanoi included:

The Temple of Literature (first university in Vietnam, with 'doctor steles' - basically, if you get a doctorate, your name gets engraved on this plaque on a stone tortoise, which is one of the four holy animals of Vietnam).

the 'Hanoi Hilton', where Vietnamese (and also American) prisoners were held (and/or executed) during different wars.


a water puppet show (where the stage is a waist-high pool of water and puppeteers stand behind a grass curtain and control the puppets on these bamboo poles - crazy!) Other highlights included the Vietnamese Women's Museum, Ho Chi Minh's Mausoleum, and various pagodas around the city. Many of the pagodas and ancient artwork in Vietnam are very similar to Chinese art and architecture (Vietnam won its independence to China in the 1400's). We also had yummy dinners at Wild Rice (where we met up with Karyn from TTAG) and Bobby Chinn's.

Over the weekend, we took an overnight train to Sapa. The train was really dirty (they didn't change the sheets at all, and there ) even though we took soft sleeper seats. Sapa is known as a trekking destination because of its mountainous location, but we came during the weekend to also see the weekend market, where ethnic minorities from the surrounding area flood the city to buy and sell local goods. They all dress in their traditional clothing, and it's really amazing to see the different colors of cloth, headscarves, etc. all at once. Chris and I picked up a few indigo-dyed pieces of clothing at the weekend market and took a walk to Cat Cat Village, a local Black Hmong village that's been flooded with tourists and unfortunately litter (everywhere!). The second day, we booked a 16 km 'easy' trek through the mountains with a local guide and visited three villages, Y Ninh Ho, Lao Chai (both Black H'mong villages), and Ta Van (Giay village). We only ran into a few other people on our trek and it was really nice and peaceful. Most of the scenery consisted of water buffalo, chickens, rice paddies, and mountains. We also saw some cool irrigation systems built out of bamboo cut in half and a wooden pestle to ground grain driven by the flow of a small waterfall. All the children in the different villages said 'hello' and 'bye-bye' to us and some tried to peddle bracelets and other things but often got bored and just ended up tagging along for awhile. Eating highlights included: 'Sapa' style beef/pork/fish (much like Chinese sizzling plate, or tie ban, dishes), pho, stir-fried noodles, an omelette at a special restaurant run by an NGO that teaches disadvantaged young people how to cook/run a restaurant, and the ever classic traveler's food, banana pancakes.

Ha Long Bay - this part of the trip was the worst part as we booked a tour through our hotel in Hanoi and they ended up cramming us into a van and a boat. it was foggy so we couldnt appreciate the whole seascape with all the different rock formations, the food wasn't good, and we didnt get to go kayaking (as promised) through different caves. we spent christmas dinner in a 'three-star' hotel (maybe a one star hotel in the US?) and that was ok, but i flooded the bathroom since the tub and the wall had nothing in between them. thank god for satellite tv though - i watched lots of it when i couldn't sleep. overall, disappointing, so if you're headed out there, book your own private car and boat so you don't suffer the same fate as us.

Best part of the trip by far (conversation between Tanya and Chris):
Tanya: What's been the favorite part of your trip so far?
Chris: The plane ride over here.
Tanya: Seriously?
Chris: Yes. I want to go home.
Tanya: The plane ride doesn't count as part of the trip.
Chris: OK, the water puppet show.

This was like three days into it. In retrospect, we did enjoy our time in Vietnam (esp Sapa and Hanoi) but were just exhausted from doing all the planning and frustrated at a lot of the dirtiness (can we have a shower curtain without blood stains on it?). Chris said that maybe we've become snobs. I dunno, but I feel like we are getting old. Traveling with Derrick and his gf (age 20) also put this into perspective for us. In any case, I like being married. And there is a sense of comfort in getting older as well.

clinic-o-rama

this past week ive been to clinic everyday (besides monday, which was constitution day and a national holiday....kinda ironic considering there is no constitution right now). i forgot how tiring it was but it's good to be around patients all the time again. snapshot into clinic life:

tuesday was my first day volunteering at the reproductive health clinic. i walked in, got a short tour, and then immediately started seeing patients. the clinic is staffed almost entirely by nurses; the doc is consulted only if there's a problem. as a family planning clinic, most people come in either to get birth control (advice on choosing a method or to buy since it's cheaper than other places), get STD testing, or to get an annual exam (pap smear, pelvic, and breast). abortions are illegal in thailand but abortion counseling is available at the clinic; there are also abortions done but it's not advertised and im not yet sure about the circumstances surrounding that yet. i was able to assist on abortion counseling for a foreign couple that came in with an unplanned pregnancy; they were backpacking around asia and didnt want to go back to europe because (as the husband stated), they 'weren't done traveling yet.' they weren't using any form of contraception and wanted to have a kid in two or three years (they were mid-30's) and as i was talking to them, i felt like they needed to think about it more. the guy seemed to be putting pressure on his wife and i felt like he wasnt really thinking about the physical/emotional consequences of what was going on....in thailand, you can get affordable, high-quality health care but i cant imagine if they were backpacking in cambodia or something somewhere and just decided to get an abortion at a random clinic. i mean, really, it's like putting your life on the line. sometimes it's hard for me to understand what people's priorities are, but i tried to be as helpful and impartial as possible (of course). im not sure what the outcome of the situation was because they were going to bangkok the next day and likely went to a clinic there.

besides sitting in on some counseling sessions, i also got to do a few pap smears/pelvic exams. at first i was nervous about doing it since i hadnt done one since ob/gyn in march, but all the cervices (i have no idea if that's the correct plural form - cervixes?) were easy to find. it's also a little different here because they just use slides and a wooden spatula to collect the cells (vs thin prep, which i think i used at beaumont). also, the women stay dressed here and just change into a sarong (or paa tong in thai) i also saw some std's, including chancroid, assisted in a condom demonstration, and watched some nurses do birth control counseling. when it slowed down near the end of the day, i also got into an interesting conversation about women's rights, contraception, and condom use with some of the nurses there.

im actually kinda surprised at how low condom use is among the patients i encounter here (usually due to male resistance. most often heard comment: "it's not fun"). i feel like thais are really focused on the present (instant gratification) vs thinking about future consequences (is having an unplanned pregnancy 'fun'? what about getting an std?) what really upsets me is hearing about people who are definitely educated about these issues (ie nurses) continuing to have unprotected sex with their partners even when they know their partners have sex with other people or even after they themselves are diagnosed (and occasionally treated) for STD's (obviously from their partner). im not sure what else can motivate behavior change if you dont care about changing after youve already had an abortion or gotten an std like hepatitis or hiv or whatever. i mean, maybe it doesnt matter after that point, but i still think it should.

wednesday: i guess i gave a good impression in clinic on tuesday because i was invited to tag along to vieng pa pao where a nurse set up a pap smear/pelvic clinic at the local public health station. we got a little lost on the way there and when we arrived there was already a line of about forty women. lots of them were also already in sarongs and i was impressed at how many people faithfully got pap smears every year to check for cervical cancer. in three hours, we saw about 75 patients. i did sixty breast exams and then did pap smears for the last hour. i also saw some std's, including a woman who likely has hiv - she had the worst case of shingles (zoster) ive ever seen and i talked to her for awhile about it. for non-medical ppl, zoster is basically a reactivation of the virus that causes chicken pox - it causes a really painful skin rash with blisters that erupt in a dermatomal distribution. she was really frustrated because she had been to the local hospital and the doc there told her they didnt have any medicine (?!) for it. afterwards, she visited a Thai traditional medicine doctor who blew some herbs on her skin lesions with a pipe, but it didnt help. she's had the lesions (one covering over a quarter of her back and the other over her breast) for about three weeks now and she's upset because (1) it's painful, (2) it smells terrible and no one wants to be near her, including her kids, and (3) she just wants it to go away. i told her there was medicine available and she should try to go to chiang mai to go to another hospital. i also recommended that she be tested for hiv, but i dont think she's going to. it was nice to be able to sit with her for awhile though - i hope it helps.

thursday (my 26th bday!): i tried to go to hiv clinic but got tired of waiting for the id doc i usually sit with (he came a few minutes after i decided to leave but ended up writing me a note apologizing, which was really nice). instead, i had a relaxing day with chris and got a nice package at the spa and went out for sukiyaki with some thai friends.

friday: copd/asthma clinic day. the doc was late as usual so i got to chat with the respiratory therapist who does pft's for awhile and observe some elderly people do spirometry. i decided that i like elderly patients, especially thai elderly people from the countryside. they all still wear traditional clothes and they're really nice and funny, except when they cant answer questions or are confused about their medication (still nice, but not so funny). i saw an interesting case of a young woman with hiv and an unknown lung disease in her left lower lobe. She was previously hospitalized for 4 weeks because she was coughing so much and couldnt swallow anything - later they found out that she had ulcers in her esophagus and some vocal cord problem as well. despite biopsy and cultures, no bug has been found, so they're presumptively treating for tb. she's gotten a bit better but is still having trouble eating and is losing weight. interesting, but also sad.

that was this week in a nutshell. chris and i have been having good times in thailand, and went bamboo rafting down a local river with a bunch of friends for Father's Day (also the King's 79th birthday) last tuesday. at night, we attended the Royal Flower Show in Chiang Mai and lit candles for the King. it was really patriotic and fun, and made me happy to be a Thai person. The King is a really amazing individual and recently won awards from the UN Food Program and Time Magazine in Asia for his commitment to sustainable agricultural development for the poor in Thailand. :) Yay leaders for social justice!

weekend warriors

i know, ive been really crappy about updating again, but i have a semi-good excuse! chris and i have spent the last four weekends out of chiang mai (i posted on two of them)...and then i got sick. i still have a sore throat now but it's not too bad if i don't talk and don't try to swallow anything. anyway, a short synopsis of what's been going on:

last weekend: mae salong. mae salong is known for tea, akha villages, and chinese-thais.

we just tagged along with gig and aum, who went to visit their good friend goh. goh's family just renovated their wooden house into a guesthouse on this mountain (mae salong). his uncle also just opened 'mae salong farmstay,' where you get your own private bungalow and bathroom overlooking these tea plantations. highlights of this weekend included getting to eat lots of yummy yunnanese food, seeing a tea plantation and an orange plantation, and visiting some akha villages to ask them if they still planted cotton or did traditional weaving. we saw old akha women turn freshly picked cotton into thread using this wooden spool-like device, but noted that no one really did traditional weaving anymore (they just buy everything with wages from family sent to work in the city). gig might set up some projects like he did in lampang out here in the future.

two weekends ago: bangkok.

chris and i hung out with a lot of old friends, including amalee (from fulbright times) and her bf dave, nan and krit , and karyn (executive director of Thai AIDS Treatment Action Group). as usual, our two days in bangkok centered around food and shopping. highlights included dessert at the oriental hotel shop at central chit lom with karyn, katak (fried chicken, papaya salad, etc) in siam with krit and nan, oishi all-you-can-eat japanese/thai buffet with my uncle likhit, and tha chang (thai/western fusion) with amalee and dave. we miss bangkok a ton (esp public transportation!) in the two days we were there, we took taxis, boats, and the skytrain. it is nice to have a motorcycle in chiang mai though.

work update:

leprosy hospital visit:
last thursday i went to visit mckean institute/hospital, which used to be one of the largest leprosy centers in the world. it's now focused on rehabilitation for people with physical disabilities and it was pretty amazing. we got to go on ward rounds with a trauma-surgeon-turned-family-physician, take a tour of the facilities, and talk to one of the missionaries whose worked on disability for over thirty years in thailand and se asia. she told us a lot of interesting stories and talked about how holistic their program was - they tried to not only address medical issues for people with disabilities, but also encouraged independence and tried to help the disabled generate a sustainable income and be accepted in their communities. they had disabled people working in the workshop making prosthetic limbs, special shoes, etc, and also a large store where people were trained to do handicrafts (cards, jewelry, lacquerware, woodcarving, etc, most with a christian theme) - many of them did them at home and then came to deliver their work about once a month to the shop. also on the grounds was a large village for elderly disabled/old leprosy patients, organic farms, chickens/pigs, and more. everyone seemed really excited to be given a second chance there and it was very :) ....i found myself wondering if they all had to convert though, and then felt unhappy that i was thinking about religion especially because it was clear that they were doing such amazing work and having a great impact on these people's lives, who were often abandoned by their families after they were disabled. i wonder if it's from being american and the climate about religion there and the (often) christian right doing things that don't seem very christian to me. anyway, it was also interesting to see how most of the hilltribes had been converted to christianity, although we saw one kid on a motorbike with a bumper sticker that said 'missionaries suck'. i wonder if he knew what the sticker said, but he sped off before we could ask him.

reproductive health clinic:
i made a connection a reproductive health clinic and went to talk to the director there. he had obviously not read any of my email with my cv and was just interested in whether i could see patients (i said i couldnt without supervision) and when i wanted to volunteer. it was difficult for me to get any information about programs they had there. i think what ended up happening at the end was that i agreed to come in on mondays and tuesdays and shadow in clinic (and likely do some pap smears and pelvic exams) and then they would take it from there. they have some interesting projects, like a group with elderly people to talk about sexuality, and some focus on hill tribe issues, so i'll see. the head doc was also supportive in the fact that he said i could likely do a small project if i saw something i was interested in and could have access to their medical records. i start volunteering there on tuesday.

im interested in doing a small project in hiv clinic where i interview HIV+ women about reproductive health/contraception/family planning. ive noted that a lot of women are in serodiscordant relationships (meaning their partners are HIV-, as their previous partners have likely died) and some are interested in bearing children, even though it's generally discouraged by the docs in clinic regardless of their health status. im not sure if the nurses have a role in discussing contraception but i'd be interested to hear patients thoughts about it, so im putting together a proposal right now and maybe will be able to start interviews in jan/feb.