Wednesday, October 25, 2006

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Women's work

Yesterday was a good day even though I spent half of it hacking up a lung (I can’t imagine having smoker’s cough…I hate coughing!!) I didn’t do much in the morning but then got my act together and went to RIHES (the research institute where I work), had a long chat with L about various things, including birth control. A lot of women here don’t really know anything about birth control (even health professionals) because it’s kinda skimmed over in school and also because it’s culturally not acceptable to talk about stuff related to sex/family planning if you’re not married. Engaged doesn’t count. In lots of trials, women who are HIV+ have to agree to use some form of contraception, and we were talking about how it wasn’t really okay to say, ‘just buy anything and take it’ without proper counseling. Oral contraceptive pills are all over the counter here (as is most medicine…I saw Keflex for sale yesterday when I went to pick up azithromycin for my freaking amoxicillin-resistant strain of strep) and it comes with instructions, but I’m sure most people don’t read the insert.

The first time I had this conversation with L, I happened to get my period and not have anything on me, so I went downstairs to ask these two secretaries/admin personnel if they had a pad (tampons are also not popular here – I wonder if people think you lose your virginity if you use a tampon?) I could use. They did, but somehow the topic of birth control came up. One of the secretaries had heard it could help in the treatment of acne but she was scared to take it. Another told a story of her friend who started taking OCP’s before her marriage and got dizzy and nauseous. They had a ton of questions about it and felt comfortable asking me as a Thai-American, medical person, and also because I was married. I was thinking to myself, we should just do a private seminar for all these single women who want to know about this but don’t feel they’re in a position to ask about it because they’re not married (and likely not sexually active, as “good” and/or educated women). There are actually a great number of single career women here – I think a lot of them felt as if they had to decide between a career/education and a family (and/or sex life). Since they’ve made the career decision, they are celibate and they don’t date (or not to my knowledge anyway), which is sad. I’m not sure if this is their own choice or if Thai men are just too intimidated to date someone who is highly independent and educated (probably a bit of both). Sometimes I bring up the topic of sex/birth control but only if I know the women well (and never if men are around with a group of women) – I know the topic is taboo but want people to know that they can approach me if they want to know something and that I’m comfortable about talking about my own experiences/sharing my knowledge.

My Swattie friend Libby who’s on a Fogarty in India is actually trying to look at a similar issue (but from a different perspective) among HIV+ women in India. She states that there is a lot of social pressure for women to bear children there and wants to examine HIV+ women’s views on having children, family planning, etc. I think that that’s a super interesting question and wonder about possibly asking women (since we see a lot of them in the HIV clinic here) about their reproductive intentions, especially the younger women who don’t have any children yet and are often single or in a relationship (some of them are in serodiscordant relationships as well). With the MTCT (mother-to-child-transmission) rate being super low (<5%) style=""> (more on this later – I can’t believe I never finished my paper on that at WHO)

Anyway, back to my day yesterday. While waiting for Poo in the ID fellow room, I was able to write a five-page research proposal on the retrospective chart review we’re doing to compare cryptococcosis in immunocompromised vs immunocompetent patients. It was good to be productive again and also reminded me of college, where I would just sit down and write a paper and then print it out when it was done an hour a two later. Poo was impressed, but it wasn’t anything too difficult. After I was done writing, Poo and I hung out while waiting for P’Nui (Poo’s fiancĂ©e) to pick us up. He was late getting off of work, so we ended up chatting while Poo played Diner Dash (a heavily addictive game if you want to check it out). Poo tried to tell me I was an inspiration to her in Thai but I didn’t understand the word she was using. Luckily, she was able to translate it into conversational Thai (‘someone who makes someone feel like they can do more, and better’) as well as English. She said that previously she didn’t make a lot of plans or goals for herself in her life but after meeting me, she started thinking about what she wanted to do and where she wanted to go. It was really sweet! I’m happy that I can be a mentor to people regardless of where they are at in their lives. One thing I’ve learned for sure though is that you can make tons of plans, but sometimes life just has a different road map altogether for you – you definitely have to take things as they come. I think the best part about planning is being prepared for opportunities as they arise though…I’ve been lucky, sure, but I’ve also been prepared. I told Poo about a conversation I had with former Swarthmore IC director Anna Marie (does anyone reading this remember her?). She was generally useless, but I remember having this conversation with her when I was a first-year or a sophomore about thinking about where I wanted to be in five or ten years and thinking about my CV and what I wanted it to look like (or what I needed to do in order to get where I wanted to go). I’ve remembered that conversation until this day, and have really thought about long-term things I want to accomplish or things I’m interested in but haven’t had the chance to do yet (and how to go about getting $$ to fund me to do such things J ) So far, it’s worked pretty well. That being said, I don’t think life should be about your CV at all, but I think it’s your life experiences that can really make up your CV – what issues you choose to work on, who you choose to work with, how you choose to make a difference (even in your daily life). Even though I don’t have the most kickass boards scores (or grades in med school, for that matter), I’m happy about what I’ve accomplished in medical school, not just as a student, but as an activist (and a daughter, wife, and friend). In the long run, it really is true that no one remembers what your GPA looks like (even five years down the road)…thank god I don’t want to match in urology though. I wonder what my priorities would be then ;)

Tuesday, October 17, 2006

Judgment

Talking with Poo about how other people wonder why she’s an ID (HIV) doc. A lot of other docs (or people in general will say), "those ppl did it to themselves; why should you help them?". She says she’s sorry for the stay-at-home housewives who never did anything wrong and got infected from their husbands. She is not sorry for the men who got it by sleeping around/going to sex workers. I tried to express that it shouldn’t really be a matter of whose fault it is or assigning blame to people, but I understand about the women issue. Like should people be treated differently because they are thought to deserve something? Smokers and lung cancer? IV drug users and HIV? Although I agree people should take responsibility for their lives, I also think it’s necessary for us to think about humans as humans and maybe not be so focused on assigning blame. Who should be allowed to receive treatment when there are limited resources? It used to be Thai policy that active drug users could not receive ARV from the government...is that fair? Who decides how much people's lives are worth? Unfortunately we do make these judgments everyday. Drug companies make these judgments, American foreign policy makes these judgments, and we, as physicians, will make these judgments. I think that's been a hard thing for me to come to terms with. People with crappy insurance don't deserve crappy care but sometimes that's all you can give them because that's what they can afford.

I remember a conversation I had with my mom about assigning blame when I originally started working with HIV+ people. She held the belief that people must have done something to get it (and they shouldn’t be doing that stuff anyway, so they ‘deserve’ it). What about the women who get it from their husbands? (well, she replied, someone is doing something wrong in any case - he shouldn't be cheating on his wife). Not so black and white though. Even when thinking about my own life, it's hard for me to think that anyone deserves to be infected just because they have sex, esp. since I’ve engaged in a lot of risky behaviorin the past and was just lucky that I wasn’t exposed since I grew up in a low prevalence area. If you're going to assign blame and talk about victimization and fault, exactly how are you going to break all these people in to groups of no culpability (victim?), kinda responsible for getting infected, responsible for infecting others, etc? What do you tell the girl who slept with her fiancee who was infected and then became positive herself? (She found out when her fiancee, 22, died). How much blame do you assign an iv drug user who grew up in the slums and originally started using drugs to escape poverty, the miserable reality of life? What about the sex worker who is trying to raise money to send back to her family? Are all of us who engaged in premarital sex wrong? Do we all deserve std’s and a death sentence if we don’t get access to drugs? Do you personally still know any virgins? What if you were infected by your first partner and ended up infecting others, not getting sick until 10 years later? How many of you have been tested in the past?

I've been more aware of lots of subtle kinds of judgment, discrimination, stigma, lately. I'm taking private Thai lessons, and during my last lesson, my teacher brought this book called ‘ a day in a life’, which is collection of short stories about different people in thai society. Yesterday I read a story about this kid who lived with his alcoholic father. He had this piggy bank that he talked to everyday and put money in because he was saving money for new shoes. All the kids at school made fun of him because he was poor and had crappy shoes and his teacher was like, you should tell your dad to buy you new shoes, but he knew that his dad wasn’t going to buy him anything so he just kept saving. He also did really good things like donate money to his friend whose house burned down and he also found 200 baht but returned it to the owner (and got a 50 baht prize). At the end of the story, the kid’s dad broke his piggy bank when he was drunk and took all his money to buy alcohol. The kid bought a new piggy bank and then the whole story started over.

After reading the story, my teacher will ask me questions to see if I understood what I read (usually about the characters in the story). What kind of person do you think the narrator is? What about his father? She wanted to me to say his father was a bad person (and he didn’t really sound like a good father) but I didn’t want to get into the ‘all alcoholics are bad people.’ She was like, there are a lot of Thai people (mostly men) who are alcoholics…people should help themselves…why cant people just quit? My teacher talked about how there wasn't AA in Thailand, how she had a friend who quit once, and had respect for people who quit, but she really believed it was just a choice to drink a lot of alcohol (and then become alcoholic). I tried to bring the shades of gray into the conversation and brought up things like genetics, family, support, circumstances….I think that's a big thing I've learned over the years working with the underserved both at home and abroad...everything is some shade of gray, and I'm totally wary of people who just want to judge people in a black/white fashion. I'm wary of it in myself as well.

Finally, I never fail to be surprised at racist comments that my own (extended) family make (“I hate when the Burmese beg for money in the street.” “I refused to learn Spanish because I hate the Mexicans.”) What’s up with that? I try not to listen because arguing is futile (and disrespectful over here). Interesting to think about Race vs nationality – people are more into hating on other nationalites here (no 'Asian' bond exists). Why do people always have to look down on others/pass judgment? Are they making themselves feel better in some way?

Saturday, October 14, 2006

ok, i havent updated in forever (again)

i hate when i get behind on blogging but sometimes just feel overwhelmed after a few days have passed and i feel like i have to catch up. however, i just thought about it and it's my blog, so i really can do whatever i want. i was pushed to update by bryan though, so here i am on saturday looking at my little book where i record what i do everyday and trying to figure out some themes to write about that might be interesting.

Food:

food is always a good place to start. ive had some fantastic food over the past few weeks. last night, poo,p'nui and i went to the Chiang Mai Food Festival. This yearly event lasts for a week and is roughly equivalent to a Thai County Fair, complete with a stage (there was a traditional Thai music/dance competititon last night), games, rides, and of course, food. I think there were maybe 30-40 food stalls there from famous restaurants in CM selling really yummy Thai food for very little money. We had two whole fish prepared in different ways (one with peppers and herbs that was broiled and the other that was grilled and covered with salt), yum woonsen (a sour/spicy noodle salad with seafood), sweet pork jerky, and more. p'nui and i also drank a pitcher of singha beer and i turned really red (surprise, surprise) but wasnt really drunk. after eating, poo played a bunch of the games that they had there and was able to shoot a stuffed animal to win a prize. it was kinda funny - all these guys were watching her load this wooden gun and shoot because she was all dressed up and is really little. when she won her prize, they were all like, we want to play too! but none of them won anything. lol.

other food ive been eating lately includes khao soi (this noodle/curry dish famous in Northern Thailand), young bamboo shoot soup, beef curry, Chinese pork dumplings, Chinese scrambled egg with tomato (best hangover food ever! i used to eat this after partying all night in Beijing and found out they sell it downstairs in the Taiwanese restaurant for $1), different kinds of yum (spicy salad), toast with butter/sugar or sankaya (this Thai spread), and more...i love Thailand, especially for the food. :)

Bangkok:
last weekend i went to Bangkok and got to meet up with a bunch of friends and see my uncle and aunt. since everything revolves around food here, these are the meals i had there:

friday night: dinner at the nai lert park buffet with poo, p'nui, and two ppl who picked us up from the airport. (poo had to go to an ID fellows meeting in Bangkok and was staying at the hotel across the street from my uncle's apt, so i just tagged along for the ride)

sat: i had two dinners - one with sarah and ken, who were in thailand for their honeymoon, and then again at this resort in nonthaburi where i sang lots of karaoke and ate leftovers with nan, krit, and about twenty other girls.

sun: brunch at kuppa with amalee and some of her friends (celebrating her bday!) - i just had bread pudding though, and then real lunch with my aunt and uncle at MK (sukiyaki), dinner at the airport with p'nui

work:

work has been really picking up lately. poo and i are working hardcore on our crypto study since she's leaving for a course in bangkok in two weeks and will be gone for two months. i have come to greatly appreciate the electronic medical record since charts here are basically pieces of paper stapled together and are hard to get info out of. will update more re: this project later.

i had a bit of a run-in with hopkins ppl re: this interview project i had planned to help out on with iv drug users. this will be the subject of a separate post (the next one) because i actually have to go work on that project now. i know this wasn't the most exciting blog, but it's a start...just trying to get back into the swing of things again. :)