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 :)
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