luang prabang part deux

it seems like forever ago since we went to luang prabang even though we've been back in chiang mai for less than a week. i am motivating myself into finishing a luang prabang entry now by eating some really yummy cantaloupe, which is now in season.

the last two days in luang prabang focused on day trips around the city. on monday (3/25), we slept in, moved from the villa santi to the apsara boutique hotel (also a converted french villa), and then hung out in town at l'etranger bookstore for a bit before going down to the mekong river and hiring a boat to Tum Ting Caves, two caves carved into limestone cliffs that house 4500+ Buddha images (some of them are carved into the cave themselves). People visit the holy site every year in April around Thai/Lao New Year and bring Buddha images to leave in the caves or wash in holy water (there used to be a spring in one of the caves and a trough is carved into the wall for washing Buddhas). The tradition continues even though (i think) the water has dried up and i'm not sure if people can still leave Buddhas in the actual caves themselves. it was a really beautiful, relaxing ride down and we saw many aspects of river life -water buffalo bathing themselves in the water, men fishing and boating, women doing laundry, women and girls collecting river vines (similar to seaweed, which is then dried with sesame and tomatoes for a really yummy snack - see pic of chris with this snack drying in the sun), kids swimming, etc. we also stopped at two villages (one of them pretty touristy) and saw families making local rice wine, women weaving cloth, and people chilling at the temples. for those who have been to asia before (or certain chinese restaurants), you most likely have seen wine with crazy animals bottled inside, many of which are said to have medicinal properties. in this pic, i am holding a small vial of rice wine with a cobra inside.



after enjoying sunset on the boat, we walked to l'elephant, the most famous french restaurant in town, for dinner. chris had buffalo steak (which he said was ok) and i had this amazing pork dish with basil mashed potatoes and super yummy blue cheese & walnut salad. for dessert, we had a fruit tart with french pastry & chocolate mousse. perfect way to end a long day :)



on our last full day in laos (monday, 3/26), we woke up early (around 6 am) to participate in giving alms to the monks and novices who make their morning alms rounds in the city. this is a Buddhist tradition where monks and novices take their alms bowls and walk barefoot in neighborhoods in order to give lay people a chance to offer food and drink for the day. monks generally eat only once or twice a day and are not allowed to eat anything after noon (or midday). luang prabang is one of the few cities where this ritual is still a part of daily life and thousands of monks and novices (and many lay people) taking part in it. chris and i went out at 630 and were a little late already, but we were able to buy two baskets of sticky rice and had some fruit from the hotel that we gave to the monks. after alms was over, chris and i enjoyed breakfast ourselves and then took a hired car to Kuang Si Waterfall, a national park and animal reserve. we had heard before that there were bears and a tiger at the waterfall and were kinda dreading seeing animals kept in crappy conditions, but were pleasantly surprised when we found a large enclosure with many Asian black bears playing and sunning themselves.

there were also kickass signs in english about the bears and tiger (housed separately), the situation re: hunters/poachers (most animals were saved and repatriated by the lao gov't who caught them after they had killed their parents), and what we could do to help. on our way back from the waterfall, chris and i ran into one of the australian volunteers who was working with the bears. he gave us a lot more info about the bears, the rescue mission, and advice on what size shirts to buy. one cool fact about the asian black bears is that they have this v-shaped stripe on their necks that's like their own fingerprint (every one is different). also, because it's kinda in a crescent shape, lao people decided to call them 'moon bears'. :) the shirts we have find out more about asian bears here!



back to the waterfall. unfortunately, chris and i dont have so many pics of the waterfall because chris (and the bag he was carrying with all our stuff) fell in backwards into a pool (the first level of the waterfall) while he was attempting to take a picture. our camera died in this accident, but everything else (including chris) was soaked, but fine. chris was grumpy after he fell in and didn't want to go swimming anymore, so we ended up just hiking up and exploring a bit before heading back. we did make our way up to the top of the large falls though on a somewhat obscured path and were able to look down on the park and the falls - next time we go back we're definitely swimming there!



after returning from the waterfall, we were hot and unhappy, but ate a great lunch at dao fa cafe (i had cobb salad and chris had a chicken curry sandwich). the power was out in luang prabang all day and i suffered through a relaxing (but really hot and sticky)massage at khmu (an ethnic minority in laos) 'spa'. when my massage was over, we still had some time before dinner so strolled around, stopped in at joma cafe for a drink and pastries, and spent an hour or so doing crazy shopping for souvenirs at the night bazaar. exhausted, we enjoyed a fab dinner at the apsara restaurant (attached to our hotel). i had a refreshing salad, fish cakes with tomato basil sauce, and chris & i shared mango and sagu (like tapioca) in coconut sauce. i also enjoyed a beer lao before turning in for the night.



last (half) day in laos. before boarding the flight back home to chiang mai (which was much more turbulent and made me doubt whether i wanted to travel in prop planes again), we walked the city and made a trek out to the local Phou Si market (about 4 km away) in the heat. we were super disappointed in the market (i had heard there were really awesome textiles there, but it was mostly vegetables and a few textile stalls and then some other stuff) and i had gippy tummy, so we took a tuk-tuk back into the city. there, we bought a beautiful hmong batik hanging from mulberries, a local NGO supporting village crafts, sericulture, and art. we also found an awesome picture album at yen sabai, started by a 25 year old laotian in a small house, and ate a traditional lao lunch at tamarind cafe, a restaurant started by a young couple (the man is lao and his wife is australian and writes about lao food and history). it was really awesome to have a lao meal since many of the cafes and restaurants in luang prabang focus on foreigner food and not many places serve local fare. there is also not as strong of a street food culture (noted by caroline, the co-owner of tamarind, as well). chris and i got plates to share and loved the different dips (esp. this tomato based one), enjoyed with the dried river vine/seaweed and sticky rice, ate buffalo sausage (YUMMY, but im obsessed with sausage up here), pickled bamboo and ginger, and 'heavenly' buffalo jerky (like moo pan). i also really appreciated the iced cinnamon bael tea and enjoyed reading about the history of lao food in the menu and hearing about it from caroline. i DEFINITELY recommend this place if you're headed up to luang prabang.



and that's it! we've been back in chiang mai for a few days and a lot of stuff has happened, but that will have to wait for another blog entry. work is going well though, and i'll update soon. :)

livin' it up in luang prabang, laos

for the uninitiated among my readers, the art of a visa run can be very important if you're planning on spending any significant time abroad. there are tons of different types of visas (each letting you stay in the country for a specified amount of time) and when your visa expires, you need to find a way to get a new one. there are a few ways to do this, including

1) Go to immigration and apply for an extension and/or a new visa. this inevitably takes a decent amount of time (waiting at immigration, being told to come back later because they didn't get your number, them telling you your paperwork is insufficient) and also $$.

2) Leave the country and then come back into the country. When you come back, you get a new visa! chris is on a sort of spouse-visa where he can get a three month visa every time he leaves the country and comes back. since we last left the country in december for our weeklong trip to vietnam, his visa expired this past week. we decided to go to laos for a four-day weekend to renew it :)

on a tip from my college friend judy chen (who lived in laos for a bit, but is now back in the US), we booked a package through lao airlines that included a two-night stay at the villa santi , a converted french villa that also has a resort attached outside of the city. although i had stressed that i wanted to stay in the city, we were told when we arrived that the hotel was full and that we had to stay at the resort (about 6 km away and accessible by shuttle bus only). the resort turned out to be okay - bigger rooms, nice grounds, etc. the first night we were there we arrived around eight, ate lao food for dinner at the hotel restaurant, and watched some tv (yay cnn & hbo) before heading to bed.

First full day in Luang Prabang (3/24):

buffet breakfast at the hotel which included a mix of western and lao foods. i had some baguette with jam, an omelet with ham and local mushrooms, and homemade yogurt with fruit salad. chris (as usual) ate a little of everything in the buffet. :) the coffee is fantastic in laos and is made french style, carrying on some of the culinary traditions post-colonial times.

we boarded the 9 am shuttle to the city and then walked around for the next twelve or so hours. snapshots of the day:

luang prabang is a (somewhat) easy city to navigate once you get your bearings. it's located on a peninsula between two rivers (the mekong and the khan) and filled with temples, much like the old city of chiang mai. people aren't really into using names of roads to navigate, and the same stretch of road changes names every couple hundred meters or so depending on what temple is nearby. A former capital of laos and one of the cities that was essentially untouched by america's 'secret' war during the vietnam era ,luang prabang was named a UNESCO World Heritage Site in 1995. im not sure what that means, but i think that it restricts the amount of development that can be done within certain zones of the city. some people are happy about this (preserving heritage, etc) but some are unhappy because they feel that they're not allowed to reap the rewards of development (ie concrete houses - you can't tear down old wooden buildings). interesting debate, for sure.

in any case, some of the many places we visited on our first full day:

1) Temples. Two of the most famous temples we visited (among at least a dozen) included:

Wat Xieng Thong (a 16th century temple known for its glass murals, a small 'museum' area housing a former king's funeral chariot decked out with nagas, and its gold facades) and Wat Phou Si, one of many temples housed on Mt. Phou Si overlooking the city. I noticed that many of the wats had the Buddha standing with his palms at his sides and fingers pointing downwards. this is the 'Buddha calling for rain' stance and only found in Laos.

Temples in Laos function as homes (and schools) for young boys and many hundreds of them are sent to Luang Prabang to join a temple by their families at certain ages (some as young as six or seven). Most men in Laos have been a novice at some point in their lives, especially if they are educated. Novices participate in the morning alms ceremony (starting around dawn), where they walk barefoot through the city with their alms bowl and receive food (mostly sticky, or glutinous, rice) from Buddhists who wait on the sidewalk with offerings throughout the city. chris and i participated in this ceremony (or tak baht) on the third day we were in Luang Prabang.

2) Shopping! after discovering a cool booklet promoting sustainable tourism in Luang Prabang called 'Stay Another Day: Laos' , i led chris around to a bunch of cool shops/projects supporting local artisans, fair trade, and the preservation of Lao heritage. two of the shops we visited, ock pop tok (translated as east meets west in both lao and thai) & kopnoi (little frog) had free exhibits about lao culture as well. the first was an exhibit about hmong culture and hmong batik, featuring an elderly hmong woman painting batik onto hemp in the main room, a traditional hmong house, and great information and actual pieces of clothing from different hmong tribes throughout the two-story showroom. the second exhibit at kopnoi focused on sticky rice, its history, types, and how it is planted, harvested, and eaten in laos. both were really educational, interesting, and manageable (in terms of space and offered reading material). i think it's really hard to find a good blend between commercialism and education like that in chiang mai, but maybe im just looking in the wrong places.

chris and i also stopped in at this really cool NGO project called Big Brother Mouse started by an american expat (previously a publisher) in conjunction with local Lao college students to address the lack of children's books available in the Lao language. basically, college students and recent graduates learn all different aspects of publishing (writing, translating (many books are in lao and english), illustrating, layout, etc.) and have published a series of books for readers at all different ages. they're really awesome and chris and i donated some money to help put books in two local children hospital's waiting rooms so kids could have books to read while they were watiing. if you ever go to luang prabang, you can stop in at their office, check out their books, and also help them with english practice/proofreading.

i noticed that there were a lot of really cool local ngo's trying to help encourage either community-based education initiatives (like Big Brother Mouse, which also has cool signs up around the city encouraging reading, responsible tourism (give books away instead of candy to kids!) or help preserve local traditions/artwork. many of these initiatives are started by or staffed with young people and it's exciting to see how passionate they are about their work and country.

3) Chill-out places. chris and i had a snack (tuna cakes with lime aioli mayo, yum!) and drinks at l'etranger, a cool cafe/tea room/library/bookstore before heading to a show at the royal ballet. l'etranger rents books for travelers to read at 20 cents an hr and allows local lao to borrow books for five days at a time for free (to encourage reading!). they also sell books, many relating to southeast asian and lao history, politics, travel, etc, and screen hard-to-find movies (like wordplay!) upstairs in the evenings. i really loved the place and we ended up visiting it twice while we were in luang prabang. :)

4) Art. i convinced chris to go see the royal ballet with me after we saw kids practicing at a summer camp run by performers at the National Museum (the King's old palace grounds, also home to a series of art exhibits in the Royal Lao Ballet Theater). it's really similar to thai classical dance, where people wear elaborate costumes (and masks) and act out scenes from the ramayana. none of the participants talk during the actual performance, with music and song being provided by musicians who sit on the side of the stage. we saw a scene from the ramayana showing how a princess was saved from a giant (who had kidnapped her) by a monkey general, who brought back the princess back to the king (who refused to take her back because he thought she had been unfaithful to him). the princess maintained that she had been chaste and submitted herself to a 'trial by (sacred) fire' to prove her innocence, the authenticity of which was confirmed by three sages who were called to monitor the proceedings. in the end, she passed the sacred fire test and became queen. overall, a decent story, but kinda frustrating that she was the one that had to prove anything (after she was KIDNAPPED by a scary giant!) - it's like women were being held responsible for anything that happened to them (whether it was in their control or not) starting thousands of years ago. ugh.

we weren't able to take many pictures in the theater, but overall, chris and i enjoyed the show (especially the little monkey kids!).

i also super enjoyed this exhibit at the national museum called 'Quiet in the Land'. this was an exhibit that paired mostly American artists with local artisans in Luang Prabang and allowed them to create different types of artwork reflecting their experiences. some of the features of the exhibit included portraits (done in pencil) of different monks and novices, hmong-style embroidery depicting important scenes from one's life, a boat that was built to house meditation in silence, and a short film highlighting different scenes in and around luang prabang with music and short thoughts/commentary. example: 'he said that in laos, there never used to be any written thing marking a person's grave. if people still remembered the dead person, they would come visit the grave and lay flowers and incense on it. when they ceased to remember, then he would cease to exist." the film at this point showed a clearing in the woods where there was a massive pile of flowers and incense (no grave/head stone or indication of who was buried where).

5) Food. aside from tuna cake snack at l'etranger, chris and i grabbed yummy sandwiches and fresh lemon soda for lunch at the scandinivian bakery (french bread & pastries are amazing in laos!). after the ballet, we also ate a fancy lao dinner at the three nagas where we enjoyed sausage, mushrooms and veggies steamed in banana leaves, pork & eggplant curry, and spring rolls.

more updates (on days 2-4 in laos) to come!

when it rains, it pours

it's not really raining in chiang mai, but i think it sums up how i've felt the past week. of course, visitors/guests/PI's must all come in droves, so here's a quick rundown of who ive hung out with for the past eight days:

thursday (3/15) - met with porn at empower. she's one of the managers/head honchos at the chiang mai empower, located in a roomy house with lots of common areas for cooking, eating, watching tv, using computers, etc. we had a long chat about empower, sex workers, the programs and outreach that are offered at the center, research among sex workers, etc. i was disappointed to find out that they didn't accept any volunteers for a time period shorter than three months and wished that i had visited earlier (doh!). in any case, i got to hear about some cool projects they run including a day/night care center for children of CSW's and 'Friday clinic', where a local public health doc and nurse come do STI testing at Empower. overall, the CM center seems to be less structured than the BKK center (at least when i volunteered there in 2002-2003) and more like a home away from home for a lot of women.

friday (3/16) - AHRN (Asian Harm Reduction Network) held their annual weeklong (?) workshop and this was responsible for bringing many people to chiang mai. on friday, karyn (good friend and executive director of TTAG, Thai AIDS Treatment Action Group) arrived so we (chris, karyn, and i ) met up for dinner. every time karyn comes to chiang mai, she visits the 'Ancient House', a restaurant housed in this 180 year old teak mansion built in the traditional Thai style. it's pretty cool because you can get your own room, sit on traditional triangle pillows on the floor, and there's some kickass northern thai food. our pick for the night was definitely this hors d'eouvres/set thing we got, featured in the picture. this included fried sour sausage balls, northern thai traditional sausage, nam prik noom (this green chili dip made with peppers and eggplant), thai vegetable soup/curry, and laab moo (minced pork 'salad'). after dinner, we met up with brigitte, an australian and a current project coordinator with TNP+ (Thai Network of People Living with HIV/AIDS), and had some good conversation re: what's going on with TNP+ now and what people were thinking about doing with Abbott.

Brigitte and Karyn noted that a huge problem was that thai civil society was super kickass and strong but that a challenge was that people really couldn't speak English/communicate with foreigners without a translator/facilitator that could help with the language barrier. also, a lot of the civil society groups (including ones that participated in the mass movement and protests around the US-FTA talks) had their true bases among the people (farmers, laborers, etc). for example, TNP+ has very few members (if any) that can speak English at all because many PLWHA's who are more educated or in a position of 'higher' social status feel that membership within TNP+ is in Thai ('chuay'), which can be loosely translated as 'ghetto.' i really feel that it is amazing that such broad coalitions have been formed (and continue to exist) across thai civil society though - for the abbott protests that are happening now, many NGO's (not directly related to HIV/AIDS) have come out in support and it's great to see that people are starting to recognize that HIV/AIDS isn't just a disease/health problem but actually about poverty, inequality, and a host of other factors. laura, current Global AIDS Fellow (GAF) at AMSA, also brought this point up when she talked about how some board members in AMSA felt like we (as an org) were just cutting AIDS when they were talking about eliminating the position this year. (thankfully, her and many others worked to save it!)

saturday (3/17) - gig invited us to this organic food festival/seminar for local farmers at jj market in chiang mai. we went around 10 am, hung out at gig's booth (i think he was volunteering for a friend's org?) where they displayed all the varieties of indigenous rice in Thailand, gave out information about genetically modified organisms/rice (which they are against), and had a petition to sign. Cloth and other products made from organic cotton was also available for purchase at the booth. Many farmers were at the event and came dressed in traditional wear. i noted that many of the young women were wearing white dresses and my friend told me that this signified that they were unmarried - i wonder if the guys had a similar designation, but it didn't seem like it. the highlight of the food fest was (unsurprisingly) the food. for 99 baht, you were able to eat unlimited samples of northern thai food, distributed at little straw huts around a courtyard. highlights included: khao soi (noodles with coconut-milk based curry), khanom cheen (rice noodles also served with northern style sauce), khao haw puk (rice noodle/crepe stuffed with organic vegetables), and more. unfortunately, chris and i had to leave early because i had a meeting with a JHU prof that was visiting and one of the PI's i work with here re: the QOL (quality of life) paper that i'm helping to write.

saturday (3/17) - tuesday (3/20) - nonstop meetings with Dr. Suwat (MD/PHD PI here who does tons of community-based, behavioral intervention trials) and JHU prof, Dr. Albert Wu (AW). AW is awesome since he was one of the main people to design/create the most-widely used tools to measure HIV-related QOL, the MOS-HIV. even more awesome, he is really down-to-earth and super supportive re: students. chris, myself, and i went to mo'c mo'l with him for dinner and he gave me some good advice regarding residencies & career plans. i am trying to finish the paper im working on (discussing the translation process of the MOS-HIV and another non-specific QOL tool, the SF-12, into Thai and their reliability and validity when administered to 100 PLWHA's on HAART in Thailand) in the next few weeks so that it can be sent off to QOL journals by the time i head back to the US. i'm also excited to (maybe) be a part of the team here that is going to write a series of papers on data from this trial that has been going on for the past three years looking at the impact of HIV+ peer educators and special training for HIV docs/nurses on dropout rate, adherence, risk behavior, and more among almost 800 PLWHA's on HAART in Northern Thailand. This trial was HUGE and involved 45 community-based hospitals throughout Northern Thailand; funding was provided by Horizons/the Population Council and MEASURE. Reps from all the hospitals were at the dissemination meeting held on Monday at a local hotel (hence the nonstop meetings beforehand to go over presentations, data, etc). and afterwards (debriefing). more on this QOl stuff later.
bottom line: yay for profs who care about students!

tuesday (3/20) - i skipped out of lunch with dr. suwat and dr. albert since i had a prior commitment with lara, the head of ethics/irb at RIHES. she treated me to this awesome lunch at jerusalem garden, where we had meze (a platter with hummus, baba ghanouj, tzatiki, tabouli, fried cheese, and more) and talked about my PP project (she helped give suggestions on the thai version of my questionnaire), her fam, my fam, and RIHES. good times - she's definitely been a huge support to me while i've been in Chiang Mai.

wednesday (3/21) - after teaching at m-plus (where i talked about gender roles and expectations in Thailand and the US), i hung out with some of my students while waiting for chris to pick me up. they invited me to come check out Project HOPE, the NGO where they all work, nearby and said they had some interesting TB projects going on. i enjoyed the class and got some interesting perspectives about why people delay marriage (or just don't get married) here, including that many jobs will only take women who are unmarried ('Miss').

after chris picked me up, we headed over to the night bazaar area (which we both hate) to meet up with brigitte from TNP+ and laura frye (AMSA GAF). brigitte and i met up first and she gave me some materials from TNP+, including a brochure that featured pics from the 2004 Bangkok International AIDS Conference on the cover. I positively identified my profile holding up a banner stating 'Say NO to Bush's Toxic Trade Deals. Break the patents, Treat the People!' good times.

laura joined us a little later and we talked about the whold abbott thing and TNP+ before brigitte had to bail and catch her flight back to bangkok. chris and i were starving by that point and dragged laura to fuji with us so we could grab something to eat. laura updated me on AMSA goings-on and i gave her some info about my Fogarty experience here. i haven't had much of an opportunity to spend time with Laura in the past, so it was nice to connect (in all places, Chiang Mai) and feel somewhat back-in-the-AMSA-loop again.

thursday (3/22) - poo (ID fellow) called a few days earlier and told me to come meet her on Thursday since she's now back from meetings in Singapore. i joined her in clinic, where i saw many patients i had seen before (including two older women with the unknown CMI (cell-mediated-immunity) defects, a guy who had gone blind from CMV retinitis, and an older Caucasian man with his young (deaf) Thai partner. The older man noted that he had read about me on the Internet (he must have googled me), which was a little weird.

I also saw an interesting case (now recovered) of disseminated penicilliosis/salmonella sepsis. Because Poo was busy, the patient and I got to talk a little about his history. He hadn't been treated before his sepsis even though he had known of his diagnosis for almost ten years, and interestingly said that he thought he contracted the virus either in moscow or thailand. finally, he said his wife (also +) just gave birth to their child a little over a week ago and was sterilized immediately afterwards...i didn't get to talk that much about reproductive intentions, but wish there was more time to explore this in clinic (maybe the nurses talk about it; i have no idea, but docs definitely don't touch on family issues...this is partially secondary to time restraints, but i think it's also in their training to just focus on medical problems and not other things).

afternoon - rounds with dr. thira and the ID team. lots of interesting cases to report here, including sepsis secondary to Strep suis (from pigs), and still pretty rare worldwide, but first reported in SE Asia, idiopathic CD4 lymphopenia complicated by CMV esophagitis, axial osteoarthritis (sterno-clavicular joint) in a non-IVDU growing gram-negative coccobacilli, the most horrendous case of b/l mastitis i have ever seen, and a possible ethambutol-induced drug rash (pt was treated for tuberculous joints and not pulmonary TB). i also met the visiting med/peds resident from minnesota who was rounding with the ID team, patrick.

poo also gave me this QOL study report that the head HIV nurse had put together and asked if i could maybe write something up with it since the crypto chart review is proving to be more difficult than expected (charts/medical records are kinda a mess here). poo is adamant about pushing on though and i think is getting a resident/med student to assist with data collection. right now, i'm supposed to try to read through this 50-page Thai report and see if i can do something to it/write it up in English.

at night, i went to dinner at MK with Aum & Gig and Aum's good friend Ann (married to Narin a few weeks ago)... chris couldn't join us because he was completing yet another interview online but came out briefly for bud's ice cream afterwards. in any case, my medical knowledge came in handy when ann asked about some advice re: conceiving after a procedure. we also had good times talking about aum back in her nursing school days. aum is leaving for bangkok and her new nursing job at bangkok hospital next week! :(

ok, that's enough for now! chris and i are off to luang prabang, laos for a few days since chris's visa is expiring this weekend.

ps CONGRATS to everyone who matched!! im excited to see you all as bona fide docs in a few weeks :)

announcements, air pollution, and abbott

1) there was a post up about performing abortions that i took down on advice from a good friend. if you're interested in reading it, please send me an email or IM - i'd love to hear people's comments. thank you to everyone who has read/commented/helped me process so far.

2) I won the Global Health Action Committee (GHAC) Chair election in absentia at the AMSA National Conference in DC this past weekend :) i've definitely missed AMSA and am really looking forward to working with next year's leadership (esp all the GHAC coordinators and all GHAC peeps) in advancing global health action and advocacy.

3) Due to fires in Burma, Laos, and Thailand (both forest and those set by farmers who burn rubbish and/or practice slash & burn techniques) , the air quality in Chiang Mai has deteriorated considerably with decreased visibility and increased smog. Apparently the carbon particles in the air are more than twice the acceptable limit. Public health officials have encouraged immuncompromised & elderly to stay indoors if possible. Chris and i recently joined the ranks of those wearing masks whenever we venture outside.

4) There is a media war right now in the Asia edition of the Wall Street Journal regarding Thailand's issuance of a compulsory license on Abbott's Kaletra (liponavir/ritonavir), a common second-line HIV/AIDS drug (also used first-line in the US) with tons of back-and-forth among those supporting vs those hating on Thailand. There was a super inflammatory editorial titled 'Bangkok's Drug War Goes Global' in the March 7th edition of WSJ-Asia, and then lots of letters following. In any case, here's some quick background with all acronyms explained:

The Thai MOPH (Ministry of Public Health) announced that they were issuing a compulsory license (CL) for this drug a few months ago. For those not familiar with intellectual property/patent issues, this means that Thailand is going to make its own generic version of Liponavir/ritonavir using GPO (government pharmaceutical organization) facilities. Compulsory licenses allow countries to either manufacture their own generic versions of drugs currently under patent or to import generic versions from a country who wishes to sell. The rationale behind issuing a compulsory license, which is perfectly legal under current WTO (World Trade Org) trade agreements (Article 31, TRIPS - Trade Related Aspects of Intellectual Property agreement) is to dramatically lower the cost of the drug so that it can be accessible to more people in that country. A compulsory license is used for a specified amount of time and a royalty is given to the patent owner (in this case, Abbott).

In 2005, Brazil also announced that they would issue a compulsory license for Kaletra and produce their own version of the drug. However, this never came to fruition because the Brazilian government and Abbott agreed on a special reduced price for a certain number of years in exchange for Brazil withdrawing its compulsory license. Thailand also entered negotiations with Abbott after the Kaletra CL was announced, but the Minister of Public Health determined that Abbott's offered reduced price was not sufficient enough and Thailand is going forward with the Kaletra CL (the government is currently in process of importing Kaletra from an Indian generic company, Hetero - I assume this is to cover until GPO can get its own production going).

Abbott is PISSED OFF about this and announced yesterday that it will:

1) Refuse to register any new pharmaceutical products in Thailand AND
2) Withdraw any pending applications for registration

until Thailand changes its position (basically, until Thailand withdraws its Kaletra CL).

This is UNPRECEDENTED and means that no new Abbott products will be allowed to enter the Thai market. One registration that is being pulled is the heat-stable version of Kaletra, rarely accessible in the Global South. The entry of this drug would be huge, as the current version of Kaletra requires refrigeration (which is obviously difficult in tropical settings/rural areas/areas without constant electricity). Abbott has previously been criticized for not registering or making this drug accessible in countries where it is likely needed the most. By pulling the registration for heat-stable Kaletra (among other drugs, including those to treat heart disease and other general conditions), Abbott is sending a strong message to the 580,000 people living with HIV/AIDS in Thailand - as well as to the other governments considering issuing compulsory licenses in the future.

As messed up as it seems, pharmaceutical companies have a total monopoly on where they choose to register their medicines. Registration (for US people) is the equivalent of submitting your drug to the FDA for approval. If you don't submit it to the FDA, it can obviously never be approved/sold in the US. Same goes for other countries. If Abbott refuses to register drugs in Thailand, those drugs CANNOT be approved/sold here which obviously restricts access for not only new HIV/AIDS second-line drugs, but all sorts of drugs in general. The Thai Network of People Living with AIDS (TNP+) protested in front of Abbott offices at 1 pm today. i really wish i was in Bangkok at times like these.

on a semi-work related front, the head of the ethics/regulatory compliance office at RIHES invited me to give a talk to all the study coordinators (heads) at RIHES about these same issues (compulsory licensing, TRIPS, etc). she's a good (american) friend here and has helped me with some of the IRB stuff i'm working on for my demographics study on women who receive abortions here. she noted that tons of people had recently been coming to her with questions and she didn't know so much about it, so she decided to bring in me instead.

i also submitted an abstract last month about these Kaletra CLs in Brazil and Thailand last month to the American Public Health Association national meeting, building on some of the preliminary research I did at the WHO this past summer. Guess all this IP knowledge does come in handy sometimes :)

volunteering & international women's day

today was international women's day! there wasn't much celebration in chiang mai but karyn had tipped me off to a march/cultural show/celebration at Thapae Gate sponsored mainly by Empower Foundation, an NGO for mostly women CSW's where i volunteered teaching english during my year in bangkok. there's an office in chiang mai and it focuses on migrant issues as well as many of the Shan (and others) fleeing Burma become involved in sex work as they don't have many other options as stateless and undocumented people. this year's theme for the local international women's day was therefore fittingly named 'women in transit.' chris and i missed the march but enjoyed some acts of the show, including a Thai man who sang and played a Karen harp, and a Norwegian woman (who works on the border and speaks fluent Shan) singing both English and Shan songs she had written herself about the political situation in Burma. all the Burmese women in the audience waved rolled up pieces of paper and use them like lighters, waving them back and forth in the air. it reminded me of anti-war songs and rallies in the us, but smaller, and more intimate.

at the show, there was also a pick up truck housing an art exhibition called 'Labour sans Frontieres', a collection of handmade paper maiche dolls made by migrant women. The dolls, or 'kumjings', are meant to bring attention to the issues facing migrant women in Thailand and also convey their hopes and dreams. Each doll has a 'passport' written by its creator detailing where she has been and where she would like to go. So far, the kumjings have traveled within Thailand and to many countries abroad, including Singapore, Canada, Spain, Japan, Cambodia, Korea, Austria, Sweden, and many more! For more info on the project, just click on the Empower link I posted above.

i haven't been into empower in chiang mai, but have meant to go for months. i got their contact info from one of the mc's at the gathering today, so hopefully i will go and visit next week! maybe i will check out volunteering opps there as well, although it is a little late...and i just started volunteering at another NGO, m-plus. read more below:

since i was in maehongson last week, i didn't go to ben's first meeting with people from m-plus (this NGO directed at gay/transgendered men and male commercial sex workers, or CSW's) where we had volunteered to teach english for the next two months. instead, i joined him for the first formal class last night.

i was expecting the class to be made up of m-plus clients, much like the women i taught at empower. instead, it was a mix of men and women, mostly from an NGO a few doors down called Project HOPE that focuses on HIV/AIDS education and prevention. from what i gathered, m-plus and Project HOPE collaborate a lot. there was also a fourteen year old transgendered MTF (male-to-female) who has a HUGE crush on Ben (but he is convinced that Ben is Japanese).

it's been awhile since i taught English (and it was Ben's first time) but as Ben had told me, the English proficiency of the students in our class is surprisingly high. It seems like a lot of them have college educations and we have some recent college grads in our class. One of the outreach directors of m-plus also sat in and participated in the class (I think he also wanted to check out if we were legit or not - he said we passed the test after class was over). :) For the first class, Ben and I focused on introductions and then months/days of the weeks/seasons and other measurements of time. after class, some of the women approached me and asked why i spoke such great Thai (rare compliment to hear in Thailand if you're Thai-American). i chatted with them for a bit and expect to become better acquainted with them in the next few weeks. :)

magha puja day & more in bangkok

chris, bryan, and i took a flight down to bangkok friday so that can bryan could spend a few days in the city before heading back to nyc. since we got back to my uncle's apt around 630 pm, we decided to drop off our stuff and head directly over to siam square to catch dinner and a movie. the skytrain to siam was packed (friday night, beginning of holiday weekend). fortunately, we all survived and watched dream girls, browsed the food court at paragon, and ate pizza hut after the movie got out since everything else was closing. i also got to browse the goods (clothes, purses, shoes, jewelry) that hawkers were selling on sheets they had laid out on the street in siam square and realized that i really miss that aspect of life in chiang mai.

we all really enjoyed the movie, but bryan noted that he didn't like when the actors/actresses broke out in song when they were supposed to just be having a conversation. i replied with, 'that's what happens in musicals!' bryan's response: 'but this was a movie trying to be a musical, not a musical trying to be a movie.' we all have our own opinions. :)

the next day (saturday) was magha puja day. this is a major buddhist holiday and commemorates the day when 1250 arahants (enlightened people) assembled spontaneously to hear the Buddha give one of his famous sermons discussing the fundamentals of Buddhism (avoid doing bad, do good, purify the mind). this day is also important because the Buddha had personally ordained all the 1250 arahants himself. during Buddhist holidays, people try to make merit by going to the temple, giving donations, and also buying flowers, incense, and candles for 'wian tian', or a ceremony where you walk around a temple's main hall three times (for the Buddha, the Dharma (teachings of the Buddha), and the Sangha (those who follow the teachings of the Buddha).

bryan, chris, and i spent the day touring wats, or temples, in Bangkok. we got off to kinda a late start because i had to go to my mom's seamstress/tailor and have my measurements taken first since my mom wanted me to get a suit made for residency interviews later this fall. the seamstress was really nice and said, 'I totally expected you to be super huge the way your mom was talking about you! She said you were as big as an elephant, but I think you're still nalaak (cute, good) and not fat.' i was kinda mad at my mom for saying that to her but also relieved that she wasn't going to talk to me about how fat i was (common theme in Thai culture). the measurements didn't take very long and the shop was conveniently located across from playground! (a concept store on soi thonglor), so we stopped in for lunch at vanilla cafe. highlights of our meal included: cherry coke (with the syrup given to you separately to mix in), bacon and apple salad with this super yummy dressing, and warm sunken chocolate cake with ice cream. i had my standard grilled salmon with linguine pesto, and chris had a huge pork chop with spiced apple and raisin topping. bryan had pasta (rigatoni with italian sausage) as well. after exploring playground! for a little bit and checking out their art gallery space, we hopped in a taxi and braved bangkok traffic for quite a long time before arriving at Wat Phra Kaew (The Temple of the Emerald Buddha) and The Grand Palace.

It was super hot by the time we arrived at the temple (noonish) and there were a lot of people (especially Thais) there to celebrate the holiday. The shrine/hall where the Emerald Buddha was kept was closed off to the public and the surrounding area was filled with Thai people, many dressed in all white, chanting. we were able to explore the rest of the temple/palace grounds though. one highlight of the Grand Palace was seeing the Changing of the Guard, which i imagine is much like the same ceremony at Buckingham Palace. after our tour of Wat Phra Kaew, we stopped by the pier market for some refreshments and walked a few blocks over to Wat Po (the Temple of the Reclining Buddha and the site of the first university in Thailand). At Wat Po, bryan made merit and attached gold leaf to the Saturday Buddha (there are Buddhas in different positions - walking, sitting, standing, etc, for each day of one's birth - more on this in the mae hong son post below).


chris and bryan also got their fortunes told by local Thai fortune-tellers at the temple who use a mix of numerology, astrology, and palm reading to discuss your personality, work, and life. i was the scribe during this time and also helped translate. i don't feel at liberty to disclose others' fortunes, but i will say that the first thing the fortune teller told chris when he sat down was, 'this boy is really attached to his mother - he is a mama's boy!' this was really funny to me as its a long-standing joke between me and chris (and exactly what his cousin tony told me the first time we met).



after fortunes, we boarded a super packed boat to Siriraj Hospital, where Nan was waiting for us. While we waited for other people to show up, we sipped cold drinks at a thankfully air conditioned Black Canyon at the pier. Later, we walked to another local wat for wian tian before heading to dinner at Studio 9, which was celebrating its grand opening. Nan had luckily reserved the last table earlier in the week for our party, which included my close Bangkok Thai friends (nan, mon, krit), nan's friend may, and chris, bryan, and myself. Studio 9 is part of Patravadi Theater, an open air playhouse/restaurant featuring performances that blend classical Thai traditions with more modern art forms. we didn't stay for the entire show due to the overwhelming heat, but saw pieces featuring acrobatics, khon (masked drama), candle dancing (Thai classical dancing where women carry two lit candles in their hands while dancing), musical fusion (using Thai classical instruments to play modern songs with a band), and more. i had a good time even though we had the worst seats in the house and would like to go back on a cooler night in the future. i urge anyone going to bangkok to check it out as well.

after the show, we wanted to go sing karaoke but everyone was too hot and/or tired to go on, so we parted ways and ended up at home. because no one is allowed to sell alcohol on Buddhist holidays, we figured that a lot of establishments might be closed as well. in any case, we got to hang out with my cousin Ted (visiting from Irvine, CA) and talk to my mom and my aunt on Skype. kinda like a mini family reunion, which always entails funny stories about the past and people making fun of each other (in a joking way) on my mom's side of the family. we ended up going to bed close to 2 am and i attempted to see the full lunar eclipse from my uncle's balcony but wasn't able to see the moon.

today ted and my uncle likhit left for phuket to visit my uncle chin (and go scuba diving). we're planning to go to asia's largest open air market (jatujak weekend market), maybe sing some karaoke, and grab dinner at mon's family restaurant before heading back to chiang mai. bryan is back to nyc tonight as well and ending his 10 day journey in Thailand.

sunday update:

we got a little late start after going to bed way late the night before but headed off to jatujak market in unbearable heat so that bryan could get a sample of market life here. sadly, none of us bought anything but i did drink some cold crysanthemum tea. after exploring the market, we headed back towards siam and i took chris and bryan to jim thompson's house. jim thompson, an american former gi, is credited with revitalizing thailand's silk industry in his name still carries on at many of his silk stores throughout Bangkok (and abroad today). he was a former architect before he served in the armed forces during WWII and loved Thai art and culture. To build his house, he traveled throughout Thailand and bought all these ancient Thai teak houses on stilts and brought them back to Bangkok, where he re-assembled them according to their ancient forms and connected them together to build a larger Thai-style house. Now, his house displays his vast collection of Thai art, Chinese porcelain, and more. it's a great museum, really manageable, and there are tours in English. jim thompson disappeared at age 61 - an age a Thai astrologer/fortune teller told him that he must be careful of danger - on a trip to malaysia and no one knows what happened to him. the paper with his reading from this Thai astrologer still sits framed on his wall in the library.

because he believed in astrology, jim thompson also had a series of paintings/drawings depicting the siamese zodiac with one for each animal of the zodiac. we thought these were pretty cool and each picked up a print of our animal (bryan - horse, chris - sheep, tanya - monkey) that came with an explanation and horoscope breaking down the type of person you are from the month and day of your birth. i am a wild monkey, chris is Lord Buddha's sheep, and bryan is (sadly) a horse with a broken leg.

after jim thompson's house, we met up with nan and took a taxi to mon's restaurant, prachak, which has been in her family for four generations. it's a hole-in-the-wall but well known throughout bangkok for its chinese roast duck, bbq pork, and dim sum. my oldest uncle ate here when he was in medical school back in the day. we chowed down on tons of yummy food and then had some down time at uncle likhit's apt before heading to the airport. bryan's flight (bkk-nyc) left at 1 am, so he had a little extra time and started his blog of our trips here.

now we're back in chiang mai....and im back to work tuesday!!

mae hong son

although we only spent two full days in mae hong son, we definitely packed in the sightseeing. mae hong son is a province located in mountainous northwest thailand bordering burma and is most famous for its diversity of ethnic minorities, good weather, and blooming sunflowers covering mountains in nov-dec. the winding mountain roads are often treacherous due to the inordinate amount of curves you have to drive through (1,864 curves in less than 300 km from chiang mai-mae hong son...there are shirts sold in mae hong son saying 'i survived 1864 curves' as well as certificates you can get from the local tourism office). we took the easy way out because we flew on a prop plane (30 min flight vs 8+ hr drive) and it was well worth the extra $ we had to pay because i would definitely have gotten carsick.

first night in maehongson:

we wandered around the center of the city, featuring Jong Kham Lake, and two famous Shan-style temples (Shan people, also known as Tai Yai here, are from Shan State in Burma), Wat Jong Kham and Wat Jong Klang. there are parts of the temple that are forbidden for women to enter, which is common in Shan-style temples but made me kinda :( because that's uncommon in most of Thailand. these temples featured an interesting collection of carved wooden figures and also a small museum with random things (ie foreign currency). we also watched a show on the National Geographic channel about one man's attempt to catch civets in Indonesia (he failed).

dinner at fern restaurant, supposedly one of the best places for thai food in maehongson (according to let's go thailand, anyway). live music performed by guy on guitar who sang covers of farang songs. pretty decent green curry and bbq chicken wrapped in fern leaves.

first full day in maehongson: breakfast at the hotel (included in the price of the room), then off to sunflower cafe to meet our driver for the day. we had a roomy ford truck and bryan sat shotgun so chris and i had the backseat to ourselves. the driver couldn't speak hardly any english so took to conversing with me even though he really wanted to talk to the guys. highlights of this looong day trip included:


elephant riding (this was mostly for bryan , who claimed he didn't care if he rode an elephant or not, but chris and i knew he was lying). bryan got his own elephant and chris and i rode another named mapae, who was 28 years old and very happy and playful. the mahout was laid back and let mapae generally do whatever he wanted, which included stopping to eat a lot and tear leaves and branches out of trees/brush and play. the mahout also had a slingshot and collected pebbles to shoot at random noises or mapae if he wasnt paying too much attention. the ride itself was fun but the scenery was not as interesting as i had hoped. we did get to cross a river though, which was cool.

paduang karen village (also known as the Long Neck Karens) the situation of these people is sad because they fled burma to thailand but are still stateless. their village is set up mostly as a tourist attraction for people to come and see the women who have a cultural practice of putting metal rings around their neck to give the impression that their necks are elongated. women can start wearing neck rings at the age of five and gradually add more and more rings as time goes on. supposedly, the metal rings push down on the clavicle but don't actually increase the length of the neck. we didn't take pictures of the women because i felt it was kinda exploitative, but supposedly they all have a choice as to whether or not to wear the rings and can also remove them if they don't want to wear them anymore.

mae aw village - this is a former Kuo Min Tang Chinese village on the Burmese border. not much to see here, but we did get some home-cooked man tou (chinese buns), sampled some tea, and ate good chinese food (fried pork, chinese sausage, and vegetables with mushroom oyster sauce). there were lots of free roaming horses and cattle in this village as well.


tum pla (fish cave) - local Shan believe the fish here are sacred and don't kill them, so they grow up to 1 m in length. tehy are soro brook carp and are bluish colored, and found only in six provinces in thailand. the cave was interesting because you could see the fish trying to swim against the current into the rock but supposedly no one knows where the water comes from (you see the fish from a cavern, not really a cave). we fed the fish here lettuce, tangerines, and fish food. the tangerines seemed to be the biggest favorite. note how big the fish are (in the really clear stream) in this pic!


random coffeehouse in the 'switzerland of thailand' (pangtong palace?) - at this homestay, our driver showed us coffee plants (i never knew what they looked like before) and giant bamboo groves. we also saw the 'roasting room' where coffee beans were roasted.

phu klon mud spa - according to the guy who introduced us to the menu at the spa, there are only three mud spas like this in the world with the other two being located in romania and israel (random, right?) the hot springs at this mud spa warm the mud, which is taken and purified. next, some thai traditional herbs are added to the mud and it's left out to bake in the sun. at the spa, you can see a mud pit, get a mud mask, or do a full body mud wrap. chris and i did the full body mud wrap while bryan got a mask. it was fun and not really spa-like at all (we were painted with mud and had water dumped on us from a big trash can in wooden 'shower' stalls by the spa workers when it was over - very thai style) and i felt like that it really did make a big difference. the spa workers, like many others in thailand, were convinced chris was thai and decided that we should be having children.


Wat Phra That Doi Kong Mu - this temple is on a hill overlooking Mae Hong Son town with an amazing view of the city and the surrounding environs. Two Shan stupas house the ashes of two famous monks from Shan State in Burma. Like many other wats that we toured in Mae Hong Son, one of the chedis at the temple had different Buddha images for each day of the week. You can make merit by donating to the Buddha corresponding to the day of your birth. The Buddha image for Sunday, for example, is standing, while Bryan's Buddha image (Saturday) is sitting on the coils of a naga (mythical serpent). The naga has many heads and uses them to make a roof over the Buddha to protect him from the falling rain.

Another interesting contraption related to the Buddhas corresponding to the day of your birth is a Lazy Susan-like thing holding different bowls with the days of the week labeled on them. These are encased with a glass box-covering and a slit for coins or bills is made at the top of the glass box. When you step up onto this wooden box, a motor activates that turns the lazy susan. You get off the box when the bowl corresponding to the day of your birth comes under the slit for putting money in and then drop coins or bills into the bowl, hoping they fall in. i had bad luck the first two times i tried this and didn't succeed, but the third time i was successful. making merit can be fun after all ;).

on the way back down the mountain from this wat, we noticed other wats and staircases leading to the top of the mountain, so we decided to walk there after we got dropped off at the hotel to check them out. i don't remember the name of the first wat we went to, but there were a series of faceless buddhas sitting in a circle in the museum there that i found intriguing. also, there was a large seated Shan-style Buddha outside as well as stone lions guarding a tall (old-looking) stone naga staircase. needless to say, we didn't make the trek up the stairs but had fun exploring the area around sunset.



dinner at kai mook, a local chinese-thai restaurant, where we tried local curry with wild boar. wild boar didn't really taste like anything, kinda like bland super chewy pork. we also had bananas fried in batter. after dinner, we walked around the local night market again & picked up a few souvenirs. chris also bought his absolute favorite food ever, moo ping, or marinated pork on a stick, and was instantly a star among the local temple dogs there, who followed him around and begged for pork until he gave them a little to eat.

second day in maehongson: the driver of our truck offered to take us around again and came up with an itinerary that seemed okay, so we hired him for another day. the big highlight of this trip was a huge cave, called Tum Lod. Tum Lod is one of the oldest known caves in Southeast Asia and is made of limestone. There is also a wide stream running through it with huge blue-green fish. At sunset, or around 6 pm, tons of bats and birds fly into the cavern to sleep. If they run into each other or one falls into the stream, they get eaten by the fish! we didn't get to see this, but our guide confirmed that it was true.

The cave is made up of one main cavern with three caverns coming off of it. We had to hire a guide with a lantern and a man on a bamboo raft to take us to the different caverns, which we explored by climbing up lots of wooden stairs. In one of the caves, also known as 'Coffin Cave', there were many wooden coffins that were discovered by anthropologists years ago. In different areas of the cave, there were children, women, and men buried. Another cave, nicknamed 'Doll Cave' at all these rock formations that looked like small dolls. Overall, the experience was pretty amazing.

Wat Tham Wua Sunyata - a forest monastery located on a large parcel of land. This wat was very peaceful and beautiful and focuses on running vipasanna meditation retreats. We explored the meditation cave, which was more like an outpost from a short limestone cliff, and the main hall with large Buddha images.

lahu new year celebration - we just happened to run across the end of this village's new year's celebration on our way back from mae aw village and our driver stopped to see what was going on. basically, drunk guys were lighting unbearably loud firecrackers while a few men in the middle of a circle were playing traditional music while a larger circle of women danced around them. free cold drinks (red and orange pop, water, and beer) were distributed to anyone at the celebration, and everyone was decked out in traditional costume. people were friendly to us and i was happy that we got to see a local cultural celebration.

Sesame oil ground by water buffaloes/cows - located in a little house with an open hut in the backyard, this is the only place in the North that still makes sesame oil 'the old way'. The method is simple - basically the cow/buffalo is hooked up to this wooden contraption and walks in a circle. As the cow/buffalow walks, the wooden pestle grinds the sesame and the oil is collected from the bottom. One bucket of oil takes about three hours of grinding. Once the oil is done, it is purified and then used to make different products such as lip balm (which i bought!).

the flight back to chiang mai was pretty non-turbulent and i decided that maybe prop planes weren't so bad. for dinner, we dropped in at pasta cafe & also had some homemade ice cream (i tried red bean & green tea - yummy!) on the walk home. the next day, we were off to bangkok!

a little buddhism with bryan & the giardia story

bryan, one of my best friends from college and a groomsman in our wedding last august, left N. America for the first time to come visit chris and i in thailand. he arrived last friday and we did some standard chiang mai tourist stuff (seeing lots of wats, walking around the old city, shopping at Warorot Market, and hanging out by the Ping River) for a few days. Mostly it was just me and bryan hanging out because chris was recovering from Giardia (more on this below).

one of my fave parts of the wat circuit again was being able to have a short chat with a monk at Wat Prathat Doi Suthep. bryan had read some of this book i picked up there last time (karma for today's traveler) and we'd had some discussions about buddhism before we went to the temple. one question bryan had was why (according to buddhism) you would have to suffer the consequences of some bad thing you did in a past life when it wasn't really you that had done it, and i think the monk did a good job of answering the question by talking about his concept of 'self' and the buddhist concept of rebirth. he also gave a great analogy for karma, comparing it to salt water. in this analogy, salt represents bad karma and water represents good karma. some people have really salty water to begin with but can add water (by doing good deeds) to make it less salty. alternatively, you can also make pretty clean water more salty by adding salt (bad deeds). because your sins can't really be forgiven in buddhism (or 'cleaned' away), all you can do is "shift the balance of the compartments" by adding either salt or water (and it's your choice). it may take a long time to see a difference though - like the monk said, you can't expect to shift your balance overnight if you've been doing bad things (or have really salty water) with just a few drops of good.


Giardia story:

I always make fun of Chris for his stomach being "weaksauce" in Asia. Thus it came as no surprise that Chris got his first parasite in Thailand (he figured it was from some of the stream water at Jae Sorn Park where we went camping a few weeks ago). i took him to the hospital sunday to get some blood drawn because he had been having diarrhea all night and had just finished a 5-day course of Cipro that i had bought him with not much improvement. we didn't have to wait very long and first met with a cardiologist (staffing the internal med outpatient clinic in the AM) who took his history, did an abdominal exam, and ordered labs. she was later called to the cath lab so we went over the lab results with a GI doc who was called in to take over clinic. i was able to look at chris's labs before we saw the doc again and it was much as i expected - he was dehydrated (Hb 17) and his white count wasn't elevated, but there was a left shift. His stool sample was also positive for occult blood. the GI doc was pumped that i was a medical student and could speak thai, and said that he was going to prescribe an antibiotic for chris. i was like, hello, he already took cipro for 5 days and it hasn't gotten better. he suggested taking a 7-day course of cipro (for traveler's diarrhea) and then i was like, well, i was just going to start giving him flagyl. he agreed with my plan and said that if chris didn't get better in a few weeks he should come back so they could send his stool for O&P. i was like, who wants to have (bad) diarrhea for weeks? we ended up just buying flagyl and now chris is better. i thought to myself, hey, i might not be such a bad doc after all. :)

although chris is better now, he originally flipped out on me after he read this forum about all the nasty side effects people had after taking flagyl. he woke me up after taking one dose to discuss his concerns. i was like, 1) is it good to trust everything on the internet? and 2) is my husband one of those problem patients? after talking to him about it (and a few days of him realizing he didn't have any side effects), he decided that he would rather take flagyl than having diarrhea for another month.

Mae Hong Son:

With Chris mostly recovered from his bout of Giardia, we decided to fly out to Mae Hong Son for a few days since we'd never been there before and Bryan wanted to see the mountains. After checking out one nasty guesthouse, we gave in to our snobbiness and got two rooms at a hotel in town (clean sheets, air conditioning, private bath with hot water, breakfast = 800 baht a night, or around $20). I also booked a private car with a driver from a local cafe to take us around for the next day. The car ended up being a comfortable Ford truck and the driver/guide took us around to a lot of the local sites, which included temples, a fish cave, hilltribe and minority villages, and more. I'll post pics and info tomorrow!

yay!

The medical specialty for you is.... Internal Medicine

Internal medicine is better than any of the specialties. When a patient comes in for a check-up, you can send them home with a clean bill of health. And when a patient comes in with high blood pressure, you can prescribe one of a wide variety of drugs, including beta-blockers, diuretics, and ACE inhibitors. And when a patient comes in with some other problem, you will be able to refer them to one of a long list of your colleagues.

To find out what specialty best fits your unique personality, go to:

What Medical Specialty Is For You?