goodbye, chiang mai

for me, goodbyes are always anti-climactic in a way and sometimes a little awkward. how do you sum up a year's worth of experiences in a short conversation, make sure that the other person got to say nice things (and then coming in to make sure it's not soo awkward), and then saying nice things yourself without sounding like a complete doofus, etc. sometimes i feel that it's too bad that people, including myself, don't always feel comfortable receiving praise or having nice things said about you by people you really care about. my response is usually smiling and saying 'thank you' but sometimes i wonder if i look/sound totally sincere (even though i am). it's different when you're standing up on some stage somewhere receiving an award, or whatever. i dunno why.

so goodbyes generally engender such nice (yet awkward) conversations. i've had a couple of these over my past week in chiang mai, but am past the awkwardness of it all and actually really appreciated the honesty, sincerity, and opportunity to also say thank you to people who've made a difference in my life over the past year. some snapshots of goodbyes:

kae's birthday/goodbye, tanya - i've had three really good friends from the MA study this year (ying, kae, and aum). aum moved to bangkok about a month ago to start working as a nurse at bangkok hospital, so i'll see her when i go down over the next few days.

kae and ying weren't going to be in chiang mai at the same time (kae had just come back from a job interview in bangkok, and ying was going on thursday night), so we planned to eat suki (hotpot) wednesday night. other ma people couldnt make it, so it was a small group - me, ben, noom, ying, and kae. as soon as we finished, it started thunderstorming like crazy outside, so we hung out for a little while waiting for the rain to let up.

following suki, noom decided he really wanted to sing karaoke. ying, on the other hand, wanted to go to a bar and drink because she was nervous about her upcoming interviews/tests in bangkok. we ended up going to karaoke and having a really good time. noom is actually super into it, so it was good to have a boy voice. later on in the night, gig joined us. we danced, drank, and sang until midnight, and i was surprised at how many thai songs i knew.

i'd kinda forgotten that this was my goodbye to ying, which i said to her hanging out of gig's car in the parking lot of the karaoke place. ying was super nice and i'll definitely miss her - she's a true character and we had a lot to bond about over the past year.

i'll also miss kae. she is hardworking and her heart is always in the right place. last night, she accompanied me to wualai walking street (much smaller than the sunday craziness in the old city) and helped me pick up some silver bracelets (i couldn't leave chiang mai without some silver!), a shawl/scarf for the strapless dress im (hopefully) wearing to graduation, and some souvenirs/gifts. we had fun talking to this 65 y/o grandma at one of the silver shops, who thought it was super cool that i could speak thai even though i grew up in the US (and that i cared about thailand at all). after walking street, we joined maddie at 8 inch, and stuffed ourselves with pizza and pasta. yum!

poo and p'nui - thursday was my last day at ID clinic this year, and it wasn't as crazy as i thought it might be. i saw some interesting cases of hardcore lymphadenopathy (Burkholderia psuedomallei, or meloidosis, toxoplasmosis, and histoplasmosis in two different patients) and lots of HIV/hepatitis B and/or C co-infected patients. i also got to have short conversation with Aj. Thira about my future plans (medicine, ID and maybe psych...he was like, what??, lol) and took one picture of clinic before two nurses who didn't know me went kinda crazy on me. (i said poo said it was ok). afterwards, i went to lunch at black canyon with poo, p'nui, and p'nui's co-worker. i got to talk to poo for a long time when p'nui and his friend went off to run errands and she apologized for not being around for the latter half of the year, but i was totally like, dude, that's not your responsibility ( to be taking care of me) when you're working full time (x2), trying to do research for your thesis, and on call to save $$ for her wedding. she was really sweet anyway though and said that i was an inspiration to her and thought i carried myself like a grown-up and had grown-up kinds of thoughts. this may sound funny to you as you read it, but it was really nice (in thai), and i probably am not translating it in the best way.

on friday night, poo and p'nui took ben and i to a popular restaurant ('the good view'), on the river ping. we had a smorgasbord of thai food, including som tum (green papaya salad), pla neung manao (fish steamed with lime), tod mun goong (fried shrimp cakes), tom yum talay (seafood spicy/sour soup), chicken wrapped in banana leaves, and crab fried rice. to top it off, we had mangos and sticky rice for dessert (it's mango season!) we also enjoyed the live music and drank some singha beer (poo didn't because she was post-call). after i got home, poo talked to me on googlechat for awhile and said that i was one of her best friends and that she (and another doc) thought i was 'born to be an infectious diseases doctor'. im not sure if she said what she meant to in english, but either way, it was pretty cool. i hope i see her and p'nui at the airport today!

lara - i met up with lara and family at khun chuen, a local vegetarian restaurant and (all-you-can-eat lunch buffet) yesterday. we were all a little exhausted from the heat, but raksi got to play bingo with his parents and we made our way through the yumminess of the buffet. i also drank two glasses of iced bael tea and felt refreshed. rung was really tired so i didn't get to talk to him much, but he said that chris and i should come in for a live portrait the next time we were back in chiang mai since pictures didn't capture the true feeling/spirit of a person (and were two-dimensional). yet another excuse to come back :)

lara and i talked a little bit about work/the year/the future at lunch and then i accompanied her to her friend's house to pick up raksin's soul brother for a movie. lara had originally convinced me to go watch smith family robinson with them (i think it's a take on swiss family robinson and a cartoon? i have no idea) but after we hung out for awhile at her friend's house, i was like, maybe i should go home (and seriously pack). we said our goodbyes in her car in front of chiang mai rama hospital, and she thanked me for my support and friendship over the past year. i think it's really gratifying when you can do something to help those you care about around you, like giving advice on how to treat Enterobius (for all your medical nerds out there), which Raksin was telling me (in detail) about. He had some pretty awesome theories about the pathogenesis and stuff as well, including two of my faves:

"The worms are having a party in my butt!"
"The medicine isn't working because the worms are babies and too small for the medicine to see. Second theory: Medicine isn't working because the worms are at war and shooting cannons at it!"

Kids should help write medical textbooks. How awesome would that be? Maybe I could stay awake for more than half an hour and actually concentrate on it. ;)

as an MD2B, i've really had some awesome (and often intense) opportunities and experiences to help both patients and friends with health-related issues this year. i want to thank everyone who trusted me enough to let me participate in their process of getting (or staying) well, in whatever way that 'well' was defined. thank you for letting me into your lives and for helping me learn more about myself - and how i would like to practice medicine - in the future.

last day at RIHES

today is my last full day in chiang mai, and ive been (surprisingly) able to part with many papers and pack most of my stuff for tomorrow. yesterday was my last day at RIHES and i felt super nostalgic at one point (during the tea ceremony ill talk about below) but kept it together and successfully made it through the day.

yesterday, i ended up waking up at 430 am, mostly due to a thunder/lightning storm that really helped cool things off in chiang mai (i think we've reached108 degrees in the past few days). for some reason, i couldn't fall asleep again even though i usually love thunderstorms so i sorted through lots of papers, started packing clothes, and getting things ready for the last day. in honor of our departure, the RIHES admin staff organized a tea party for us. ben and i were hoping it would be a small affair, but there were more people there than i expected. i'd met most of them before, but because i wasn't really affiliated with any big study this year, i really didn't feel like part of a team (although i have a lot of friends who work on the MA study, but i don't think they were invited). so basically, it's this conference room with snacks/tea in the middle and chairs lining both walls.

when ben and i arrived, Dr. Thira and Dr. Suwat gave us their seats (which i was really embarassed about) and then oiy started the program with a pretty formal speech welcoming everyone. Next, Dr. Thira gave a speech about the Fogarty-Ellison program and said some nice things about us and hoped we had a good experience while in Thailand. Of course, he then chose me to stand up first and give an impromptu speech (i didn't prepare at all even though i had already gone through this at the reproductive health clinic...i think i sometimes do better off-the-cuff). I could've spoken in English but spoke in Thai anyway, using many of the incorrect pronouns as expected (I apologized for this at the beginning). Although there were few people there that I was close to, I said thanks to everyone for being helpful, welcoming, and supportive. I also said that I had never really wanted to come to Chiang Mai because I didn't have any family or friends here, but at the end of these eight months, I really felt like Chiang Mai was like another home for me. Thinking about this made me a little sad, but I'll likely be back. Noom took some pictures for me during this event.

After Ben spoke, Dr. Thira presented each of us with silver plates that say "Given in appreciation for your contribution to the HIV/AIDS Research Program, Research Institute for the Health Sciences, Chiang Mai University, 27 April 2007" and certificates of completion from the Fogarty-Ellison program. Ben and I noted that the certificates were printed on regular copier paper and were just very unofficial-looking. We were both a little disappointed by this fact - although I'm proud and happy that I participated in this program, I would definitely not be proud of displaying that certificate.

In the 'party' that ensued, I felt a little awkward because I didn't really have a team (like Ben) to hang out with or talk to, but did get a chance to talk to Dr. Suwat for a little bit about the situation with the Thai CL (compulsory license) and received some gifts from study teams that I had helped out with (re: translation, or whatever). Afterwards, Ben and I were taken out to lunch by Utaiwan (one of the Thai Fogarty-Ellison fellows) at this restaurant overlooking Chiang Mai and stuffed ourselves with Thai food. This is a common theme when people are going to leave...goodbye dinners, with LOTS of food, and as the guest of honor, you don't have to chip in. Sometimes I feel bad about this, but lots of times I just enjoy the food. :)

In the afternoon, I had a short meeting with Dr. Suwat about the QOL manuscript and then said goodbye to Vit, our on-site mentor, RIHES admin staff, and walked to the hospital to say goodbye to Dr. Kuanchai and P'Wilai (the head ART nurse). Unfortunately, P'Wilai was attending a conference in Bangkok, but I got her email and will keep in touch with her. Hopefully I'll be able to work with her to help put a manuscript together for the QOL study she did among patients at the ARV clinic but right now we're just waiting to see about IRB approval that Dr. Thira's going to facilitate. It's kinda ironic, but as I'm wrapping up my time here and getting ready to leave, I've never felt busier in terms of potential projects/work that I'm going to be working on with various people here. Vit sent me an email today with the same sentiment, and wrote "Still can't believe your stint here is up! Anyhow, as I told you at the start of this (not so long ago!) that don't equate being here for 10 months with working on projects based here for 10 months!" So true!! Many of my projects are just beginning, but I look forward to seeing them through. A shortlist of what I'll still be working on post-Fogarty time here include:

1) My reproductive health study at the clinic (cross your fingers for JHU IRB exemption!) We're almost ready to submit, but I can't believe how many hoops I had to jump through to submit a proposal...new human subjects research training (they changed their rules to have to do this new training on May 1, 2007), creating a special account for JHU IRB student investigator status, uploading documents, blah blah blah. Good to experience, though.

2) QOL manuscript with Dr. Albert and Dr. Suwat. (Note that I'm now into the Thai tradition of using first names - I like it, and it reminds me of college). Dr. Albert said my last draft was excellent and I just need to find someone to help me with some stats back at Michigan and then it should be done and ready for submission :)

3) QOL manuscript with P'Wilai (talked about above).

4) Crypto study with Poo. Poo is having a resident help find more info (charts are crazy here), but will likely create the database and do the analysis here. I may help, but my main role will be writing it up. This might take a few months for all the data to be collected though.

5) Editing/rewriting some papers from the conference I attended in Jan (co-sponsored by the Center for Public Health and Human Rights at JHU) on infectious diseases issues in the border regions of Myanmar/Burma for a supplemental issue of the Journal of Conflict and Health. The first paper that was assigned to me is really interesting and studied risk behavior and susceptibility to HIV of boatmen from Bangladesh who travel back and forth between Bangladesh and Burma. I'm really excited to work on this paper and will likely be listed an author, so that's also very cool.

So, even though I'm leaving (very!) soon, I feel that I'll maintain a strong connection to RIHES and people in Chiang Mai. I was sad leaving yesterday, being like 'This is the last time I'll be in the hospital, or in RIHES, or wherever' but at the same time, I know it won't be too long before I'll be back. Next entry: farewell to friends this past week in CM.

reproductive health clinic goodbyes

as many of you know, i've been volunteering at this local reproductive health clinic for the past six months or so, and today was my last day there. i had been super slacker about doing some data entry for some data they had given me awhile back, so frantically tried to finish that during my time at clinic ( and i did! ) i was also touched because i was incorporated into a similar ceremony to that performed at RIHES last Friday (see previous entry) where the emeritus director of the clinic was honored. after he got his gift basket and scented water, he gave a small talk giving the requisite advice and blessings/well-wishes for the year. One piece of advice I appreciated from his talk was that in our (work) lives, we should try to always do the best we can and be nice (or do good) by others. Sometimes it's easy to become discouraged/disheartened when you feel like you're nice to someone or are doing good work, but they're not recognizing you or trying to work with you to achieve a common goal. At times like these, sometimes you just want to be super weh to that person, but you shouldn't be, because you know that you did your best to work with them (or whatever), and the only time you would be sad (or regretful) in the future is if you remembered a time when you were mean to them, or did something that you weren't proud of later. it's kinda common sense advice and a modification of the golden rule, but it was nice to hear from an elder and i think it's really true. especially in a small clinic, it's easy to get caught up in petty politics and drama, and sometimes it's important to take a step back from all of that and put things in perspective.

after his talk, the emeritus director decided to honor me too since it was my last day at the clinic. this consisted of a number of awkward moments, including:

1) Having me give a little talk on Songkran, the celebration of Songkran in the US, and how I felt about celebrating Songkran in Chiang Mai this past year.

2) Asking people to say nice things about me, and two people from clinic I work with being embarassed and kinda arguing with each other about who should say nice things about me. "No, you go!", "No, you work with her more." Way to feel honored, right? In the end, a bunch of nice things were said about me anyway.

3) Me having to give an impromptu speech in Thai about my time at the clinic. Although I'm pretty fluent in conversational Thai, having to come up with a speech in formal Thai thanking people and saying how nice everyone has been to me is much more difficult for me. This was funny in light of the conversation I had with Maddie (who kindly offered to drive me to work today in her air conditioned truck) regarding all the different pronouns and their levels of formality in Thai (esp. for women). I'm sure I messed up some when giving my 'speech' today but oh well; I think Thai people just smile and laugh at me or think it's cute.

4) Getting gifts from the emeritus director, including an embroidered pouch and a traditional Thai shirt with the clinic logo on the front and its printed on the back. I also had to try on this shirt with everyone watching me and then people commented on how it fit well (and made me look not fat).

All in all, it was a good experience and i'm actually really excited about the shirt (i even tried it on again when i got home). The remainder of my day at clinic centered around lamenting how hot Chiang Mai is with clinic staff (seriously disgusting right now), putting final touches on my questionnaire that's going to be administered to patients seeking abortions at the clinic, and seeing some patients and giving some clinical advice (i identified strawberry cervix and gave the patient 2 g of metronidazole for treatment of Trich). I've really had a great time at the clinic, gained a lot of experience with a speculum, and felt like I contributed by putting together this questionnaire that will be used to improve data collection at the clinic. I'll also be involved in analyzing the data because it will be sent to me (if I don't come back to CM) by clinic staff, so that's something to look forward to in the coming year.

The last really nice thing that happened to me at clinic was that this nurse who was originally super wary about me getting involved with certain procedures and having access to data offered to give me a ride home today. she said she really appreciated all the help i'd provided in clinic over the past few months and said i was easy to talk to and trustworthy. she also offered for me to come crash at her place anytime i was visiting chiang mai in the future. this meant a lot to me (even though i probably won't take her up on her offer) because i think it took awhile for her to see what i was all about, but since she's decided that she supports my research project, she'll definitely help me out when it comes time to collect data and interpret it. she's a great nurse and really good with patients, so i appreciate that she thought i really cared about my work and would be a kickass doc. i am very excited about being a doc and know that i am, and will continue, to find ways to contribute to communities around me through my own (tanyaporn-style) practice of medicine. ;)

the end of an era

granted, the title may be a bit dramatic, but my time in chiang mai is quickly coming to an end. the days here seem even more numbered since chris left tonight and im writing this after returning to what feels like a really empty apartment. chris and i have lived in this studio (together) for the past six months and since he's Star Alliance Gold, he was able to check in three bags from chiang mai home. this was nice because he ended up taking most of our stuff, and i just have to bring one bag (mostly with my clothes and maybe some books) down to bangkok when i leave chiang mai in a week (!).

chris is excited to go home, but i have more bittersweet emotions. thailand really feels like a second home to me, and despite the (many) frustrations i've had this year with the fogarty, i've always loved living and being in thailand. i feel really blessed and lucky that chris and i got to spend a large part of our first year of marriage together in chiang mai, traveling around thailand and southeast asia, and just enjoying being husband and wife without the stresses of school, work, etc. like most other times i've been to thailand, i've made some really great friends here and expanded my thai 'family'.

there's lots to love about thailand. food is number one on many (including me and chris's) lists. food is seriously available here 24-7 and can range in cost from snacks for 5-10 baht to straight up meals (rice/noodles) from 20-40 baht (a little more than a dollar). street food culture is strong here, but there are also stalls that have seating areas, especially at night food markets, and a broad range of restaurants. chris's favorite thai snack , moo ping, (marinated pork on a stick), sells for 3 baht a stick, and is eaten with sticky rice. once, when i was gone to a conference in bangkok, chris ate it for dinner and was really proud that he spent less than $1 on 10 sticks of moo ping and sticky rice.



in chiang mai, chris and i eat thai, chinese, laotian, mexican, american, and italian food on a regular basis. there is such a diversity of things to eat and we've become friends with some people at local restaurants and food stands, including the couple who sells fruit on our soi. they know that chris and i always get green mango (for me) and pineapple (for chris), but will explore other options (like cantaloupe, rose apple, or watermelon) if our faves are sold out. you get a bag of cold, sliced fruit for 10 baht and it's seriously a terrific (and filling) snack on a hot day. this reminds me - i have some green mango in the fridge now! :)

fruit and veggies are really cheap here and there's many kinds of both that are hard to find (if available at all) in the states. besides raw fruit, you can get smoothies/shakes/yogurt mixed with fruit all over the place. i dont really even know what most of the fruit/veggies are called in english, but ill try to figure it out and update you all.

ok, maybe i should start sticking to a list format before i start waxing poetic about every other thing ill miss about thailand ;) following is a list of things i love about thailand:



1) The people, esp. my friends and family. I like that Thai people are generally friendly, laid-back, and that friends are really like family here. For example, one of my friends who lives in Bangkok offered to come up to Chiang Mai (a 9 hr bus ride each way) to help me clean my apt and pack to go home. I told her that was too much, but I think she's coming anyway.





I think it's nice that certain traditions are also preserved in Thailand, like celebrating Thai New Year by wearing traditional Thai clothes and conducting a ceremony where you pay respect to your elders (we just had this ceremony at RIHES last Friday). It consisted of everyone participating in a small 'parade' from the second floor to the fourth floor of our building. The procession consisted first of Thai musicians, followed by men carrying special water in silver bowls used in the blessing ceremony (elders bless younger people by splashing water over your hands), and women carrying gift baskets. Later, we all gathered in this assembly room and sat on the floor while some RIHES women performed a traditional Thai dance with knives and then listened to each 'elder' present at the head table give advice and blessings for the coming year. At the end, we formed a single file line and got blessed by all the elders. I like that stuff like this happens every year because I feel like it builds community and makes you feel like you're part of something bigger than just yourself....I also always love hearing elderly people tell stories about back-in-the-day and imparting their experience and thoughts on us young peoples.


Another nice Thai thing is having EVERYONE and their mom go to the airport with you to send you off if you're going on a big journey (returning to the US for a long time counts as one of these events). I think that this might be happening less since the airport was moved to Suvaranabhumi and it's expensive (and difficult) to get out there right now, but I'm sure I'll still have a few friends with me at the airport at 4 AM to help me check in for my flight at 6 AM. Heck, how hard is it to find someone in the US to take you to the airport at that time? (Y'all know what I'm talking about).



2) Last minute plans (or lack of plans at all). Thai people sometimes dont really plan things in advance, but just call you and are like, "Have you eaten yet?" "Do you want to go camping?" "Are you available right now?" This has both good and bad sides, but most of the time it's fun and we've been on lots of adventures that we never planned on...and we've done our share of last minute bookings at well (see previous phuket entry - we booked that ticket the day before we left!) I also appreciate that temples are open spaces and that you can drop in at any time. Chris and I visited two local Burmese temples before he got on the plane to make some donations and also ask for a safe trip home. I always feel welcome at temples and friends who have visited (of other faiths) have also noted the same feeling when visiting temples in Thailand.

3) Thai karaoke (plus cheesy dances that go along with the karaoke). Chris loves it too, even though he doesn't really understand what's going on (I explain it to him). We also sing our tried-and-true boy band songs at karaoke when they're available.

4) Quality of life. My quality of life here could seriously NOT be better. although we wish we had a washing machine, we send our laundry to get done (washed, dried, folded/ironed, and delivered to our door weekly) and it generally costs less than $3 a week for both of us. we also used to have a maid come to our apt once/twice a week (included as part of a rent) for around $8 a month. Besides help with housework, I also enjoy regular massages ($3-$5/hr) , pedicures ($5 for a super nice one), and get my hair washed and blow-dried ($2). obviously, NONE of this stuff happens for me in the US, unless im treating myself to something special.

5) DIY/handmade stuff. I really appreciate all the little shops/boutiques/stalls, street culture, and the ability to get unique clothes, accessories, and home stuff for really cheap (or pretty reasonable) prices at such places like the market in front of our local mall (Kad Suan Kaew, held Thurs-Sat nights during the summer), 'Walking Street' on Sundays (where a few miles of the 'old city' gets shut down and filled with vendors selling everything you could imagine), JJ market or Suan Lum Night Bazaar in Bangkok (sadly being shut down later this month), or in the night markets held around Chiang Mai University.

6) Since Chris doesn't understand Thai TV, we've been semi-addicted to this channel called 'Zone Reality' which doesnt have any commercials (I'm not sure how they make $..all their commercials just advertise different shows that they play). They apparently buy seasons of shows and then play them over and over again. So far, we've seen tons of Rescue 911 episodes, most of the episodes from Seasons 1-3 of Hogan Knows Best, quite a few episodes of Dog: The Bounty Hunter, and then an assortment of different forensic/crime shows (ie Dr G: Medical Examiner). Sometimes we also watch National Geographic Channel in Thai.

7) Our motorcycle. I've really liked riding around with Chris through the city this year - you definitely avoid getting caught in traffic jams and it's easy, cheap, and fast. We're both looking forward to driving when we get home though (I can't believe I haven't been behind the wheel in over eight months!)

OK, that's about it for now. More posts to come!

phuket!

at the last minute, chris and i decided to fly to phuket to visit my uncle gin before heading back to the US. we hadn't seen him since we've been in Thailand and we'd also not been to the beach, so we thought it'd be a perfect opportunity to do both. we stayed with my uncle (on the second floor of the tour agency where he's a manager) and got to spend some quality time with him, mostly while eating, and some of his friends.

the first night we got to phuket, our uncle took us to his co-worker (and friend's) house noom. noom's current partner is a swedish guy who owns this crazy three-story house on a small hill overlooking patong beach, one of the major beaches in Phuket. this house features two pools (one on the second and third floor), a fantastic view with balconies/decks all around, and more. noom & his partner were hosting a barbecue and we gorged ourselves with fish, shrimp, pork ribs, and bell pepper skewers. in the remainder of our three-day trip, we ate TONS of other yummylicious food, including lots of chinese-thai style food, including pork & mushroom hot pot, shrimp wonton & noodle soup, fish noodle soup, and pa tong ko (or you tiao in Chinese, a yummy pastry). we also had some great seafood, which phuket is renowned for. our uncle took us to a local place with his friend pui, and we all feasted on fish from the Andaman Sea, mussels made with this yummy ginger and basil sauce, crab, and giant prawns.

our second day in phuket was spent on an all-day boat tour of Koh Phi Phi and the surrounding environs. the highlight of this trip was the amazing snorkeling we got to do at Khai Nok Island where there's a HUGE coral reef with tons of fish. this was chris's first time snorkeling and he had a good time (despite still recovering from his sprained ankle). we also got to enjoy some beach time on the white sand beaches of the different islands, feed some monkeys from our boat at 'Monkey Beach', and peek into a cave renowned for swallows' nests (which they use to make bird's nest soup, super expensive and famous among Chinese people). you used to be able to go into the cave to take a tour and climb a bamboo ladder, but the cave was bought out by a private owner a few years ago and now it's closed to the public. it was kinda weird to be a tourist-for-a-day, but we got to sit next to the only other thai family on the boat and they chatted with me for a bit before our trip ended for the day. (commonly asked questions, which they asked once again: are you thai? what about chris? what do you do here? can hiv/aids be treated? when you 'grow up'/finish school, are you going to practice medicine in the us or thailand? etc.) overall, we had a good time even though the waves were pretty choppy and it wasn't super sunny, and we were happy to return home to our uncle's place at the end of the day.

our third day in phuket was pretty uneventful since my uncle came down with a bad chest cold and spent half of it sleeping. we hung out at the office for half the day, watched some movies (the pursuit of happyness, little miss sunshine) and watched the tour agency staff play some cards. in the afternoon, we ran some errands and stopped at a local jewelry store (Gems Gallery), which claims to be the biggest jewelry store in the world (i don't know if this is true, but it is pretty big). my uncle's good friend pui, who used to work for the store for twelve years and helped set up the chain in Phuket, helped me pick out some pearl jewelry and then hooked us up with a major discount. chris joked that i could finally put the commonly heard 'you didnt get me a wedding present' to rest. all in all, im very happy with the purchases, which include earrings, a necklace with a single pearl, and a pearl ring. yay!

now we're back in chiang mai after a long trip from phuket. there's no direct flight from phuket to chiang mai, so we had to take a flight from phuket to bangkok and then connect from bangkok to chiang mai. the chiang mai flight was delayed (something about a plane being disabled and blocking the runways) for about half an hour. in any case, door-to-door it took about six hours to get home. we're pretty knackered now and are just chilling out for the rest of the night, but things need to kick into high gear tomorrow. i can't believe my year off is almost over...more reflection on this point in a future post.

happy songkran, or sawadee pii mai!

thai new year (celebrated this year from april 13-17) is madness in chiang mai. traditionally known as a water-pouring festival, songkran has turned into more of a water-throwing "fight" of sorts. not a mean-spirited fight of course, but pretty intense nonetheless. we don't have tons of pics of actual songkran celebrations, mostly because chris already lost one camera to water this thailand trip and we didn't want to risk losing another.

the actual new year was celebrated on april 13th. at 8 am, dance mixes of popular (American R&B/hip-hop) songs started blaring from loudspeakers conveniently positioned across the street from our apt into our windows. it was like having a dance party in my room all day (from 8 am-7 pm). people began flooding the streets around 10ish. there are two groups of people who go out to celebrate songkran, people who walk and people who sit in the bed of a pickup truck. there are also other groups (like people who stand on the sidewalk/edge of the road with hoses and buckets waiting for you to drive by). chris and i have been both at different points of our songkran experience. i will share with you the finer points of either here:

1) People who walk. If you're going to an area where there is hardcore Songkran celebrations going on, you'll likely get wet, especially if you walk along the side of the road where trucks are going by (usually at like 1 mph). Getting wet while walking is not so bad because people generally (unless you are in the moat area) don't dump TONS of water on you. People who walk usually carry water guns (ie small amounts of water) and are not dangerous to you (unless totally wasted, which is not uncommon.)

2) People in pickup trucks. It is fun to sit in the back of a pickup truck if you have adequate water-throwing materials (a huge 32+ gallon trash can filled with water, buckets, etc). We had kinda wussy water-throwing paraphernalia (really small bowls, a small basin used for laundry to hold water) when we went out to Mae Tang yesterday, but it was fun anyway. What happens when you are in a pick-up truck is you get water thrown on you by other passing pick-up trucks and also by little kids (and adults) who line the sides of the road/freeway/whatever, and dump water on you (some of it ice water). We are not talking about small amounts of water here, people. Gig, Aum, Chris, and I got drenched at least 20 times (but mostly Chris and Gig). Sometimes the water is not the cleanest (as people collect it from wherever they can, including ditches, etc.) and Chris is currently on a course of cipro s/p getting some river water in his mouth.

Other times you may be targeted by water-pourers/throwers is when you are riding around on your motorcycle. You cannot avoid this, even if you do not ride in the lane closest to the sidewalk. Chris and I thought we were being smart by riding in the other lane, but learned our lesson when we got totally dumped on by a passing pick-up truck. Lesson for Songkran: Accept that you're going to get wet, be good-natured about it, and bring a change of clothes if you're going anywhere where you care about being dry.

one of the oldest temples in Chiang Mai. During Thai New Year (this also happens in Laos), one ritual that many people participate in is the washing of Buddha images. Gig washes (ie pours holy water) on the Buddha in front of Wat Phra Singh every year and invited us to go along (so we did, on Friday afternoon-eveningish). in the north, there's also a tradition where you build 'sand' pagodas. in the old days, people would bring a bucket of sand to the temple to and dump it on the temple grounds. This would help keep the temple dry when the rainy season (next month) came. Nowadays you can just 'buy' a bucket of sand for a donation at the temple and pour it (and place a banner/flag of sorts in it) in a designated area. for some reason, we got sidetracked after pouring the water over the Buddha and didn't pour sand. we did, however, put tons of satang (coins) in alms bowls placed in front of the eight Buddhas (for the days of the week - see mae hong son posts for more explanation.)

other chiang mai songkran highlights included a long-awaited barbecue at maddie and north's place (great homemade potato salad by maddie, pork, shrimp, thai seafood sauce (also homemade by maddie), beef kebabs, and a little too much beer for tanya) & pancakes (and my fave, durian) at joanne and ben's place. we've also had more than our fill of ice cream at the (somewhat) newly opened Bud's Ice Cream of San Francisco in Nimman Promenade. next post - phuket! (where we are now)

play!

besides work, there has been lots of playtime as well! im currently writing this entry from my uncle's apartment in Bangkok, where we're spending some time with Chris's parents who are in town for a few days. (more on bangkok later)

in the past week, chris and i have been pseudo-party animals. this for us means meeting up with people almost everyday (and night). we usually have a much more laidback existence, but for some reason, we kept getting invited out. here are some highlights:

last weekend, we spent a lot of time with my fellow co-worker lara, her husband (and really great artist) rung (pronounced roong) , and her son (aged 7), raksin. it was awesome to be in a 'family' setting again (ie with a house, kids running around, etc.) and chris noted the different kind of energy he felt while we were visiting. it reminded me of being in college and getting invited over to your prof's house and being like, 'wow, a real house (with real food)', interacting with people of different ages than you outside of a work/school setting, reminding yourself that there's a world outside your own. i know that there are lots of different kinds of families (im not trying to be heterosexist or kid-centered here) but in thailand, we mostly hang out with people around our age/in our studio and it's a treat to be invited over to a house or on a road trip (in a car) since we just have a motorcycle here.

in any case, we spent a bunch of time at lara and rung's place over the weekend. chris was jealous that rung had his own little house/studio next to their main house and we got to see some of his works-in-progress (he is doing a major exhibition on the Thai King next month in Bangkok). as a typical first-grader, raksin was running around everywhere, and had his toys/books spread out in the garden area. saturday morning, lara made us yummy banana pancakes and coffee for breakfast and we chatted until lunch, when we headed over to a neighborhood laotian restaurant. the owner is apparently a famous pop singer in luang prabang (where chris and i just returned from) and we had some really great lao-style pho noodles, laab isaan (minced pork/spicy salad), and sweet peanut dip. rung also introduced chris to a new moo ping (marinated-pork-on-a-stick) stand in their neighborhood.

on sunday, lara called up in the afternoon and asked if we were interested in going to Mae Sa with them (about 45 mins away, in the mountains). she warned us that it would be a kidfest with her friend caroline and her two kids coming along. we didn't mind, so joined them for a road trip up to their friend's resort (Proud Phu Fa). on the way to the resort, we stopped at a small waterfall for the kids to play in and had some snacks. the resort was really beautiful and designed by the owner himself ( he was a classmate of rung's when they studied art together at CMU). we hung out by the pool, watched the kids run around in the large garden, ate some delicious vegetarian thai food, and enjoyed the full moon over the mountains. chris and i were most entertained by the fact that lila, caroline's daughter who just turned 4, switched back in forth between perfect thai and british english. language acquisition among children is really intriguing and amazing to me. it's also interesting to hear about how kids navigate between different languages (and different worlds). raksin is sometimes confused when people don't match his expectations of what language they should speak - for example, when we were out a local restaurant/pub named sudsanan the other night, his dad was speaking thai to a swedish dude joe. raksin asked his dad, "is joe thai or farang (foreigner)?" and his dad tried to explain that joe was a foreigner, but that he spoke thai. raksin was also originally confused by me (and chris) but after a few days decided we were cool and just spoke whatever language he wanted to us.

more family stuff: since chi (our next door neighbor) and family are going on vacation to the tibet/china border for a few weeks, we were worried that we wouldn't be able to hang out with them before chris headed back to the states. things were pretty hectic with their schedule, but wednesday night they ended up being free so we hung out at their place and ate these yummilicious hamburgers that chi made. i also split a bottle of singha beer with chi (chris refused to drink) and hung out/chatted with chi while chris played legos with jasmine (their daughter, also seven). later, we watched disney's high school musical with jasmine and ate homemade chocolate chip cookies before heading off to bed.

non-family stuff. one of the ma staff who moved to bangkok to be with her bf returned to CM for a few days because her bf was having his commencement ceremonies. (note: a member of the royal family has to be the one handing you your diploma at graduation, so commencement ceremonies are held year-round in Thailand). we went out drinking with some of the ma staff at the same bar we had pae's birthday celebrations at months ago (i think october, before chris came). the dudes were really funny (esp this one guy, yai,) because they were really drunk and wanted to talk to chris (in english). basically what this amounted to was ying sitting next to thai dude (yai or noom), who asked her how to say stuff in english, then the thai dudes trying to speak in thai (or english) to chris, then me half-listening and trying to translate and then chris responding. after awhile, they cut out the middlemen and started speaking thai-glish among themselves. i was actually very impressed with chris's thai.

two bottles of whisky later, people were pretty drunk. a carnival/fair was set up nearby and chris, kae, and ying tried their hand at darts (you must break seven balloons with your darts to win a prize - otherwise you get really crappy consolation prizes). chris and ying both popped six balloons, and kae popped five. disappointed with the results, we ended up going to eat rice porridge (kao tom) at a streetside stall before heading home for the night (this was tuesday, mind you!).

celebrating chris's birthday:

chris turned 28 on thursday, which was also the day libby came into town. i went to clinic in the morning (and saw a cool case of herpes zoster) but chris picked me up for lunch. we went to the big mall here, central airport plaza (yay air conditioning!), ate at fuji (one of our fave japanese restaurants), took sticker pictures, and played basketball. at night, we met up with ben and libby, hung out at ben's house for a little bit, and then went to House, a fancy CM restaurant, for dinner. my fave part of the meal was chocolate almond cake (chris's too)!

the next day, we had a lazy friday brunch at bake 'n bite with libby and ben which was super nice, stopped in at wawee coffee, and then headed to kad suan kaew to meet up with ying and kae. there, we stuffed ourselves with pizza, and went shopping for a bit. when we got home, we packed a bunch of stuff for our overnight bus trip to bangkok. ben and libby stopped by briefly again, and then p'nui (poo's fiancee) picked us up to take us to the bus station. nine hours later, we arrived in bangkok. more updates on bangkok later!

ps echoing a sentiment from james hudspeth's blog: im also looking forward to going home..just not looking forward to leaving. we heart chiang mai :)

work (and play)

post-luang prabang, everything kicked into high gear. let's talk about work first, since i always put off talking about it in my blog...there's so much other fun to be had.

moving forward:

1) Quality of Life paper (evaluating the validity and reliability of two QOL questionnaires, the MOS-HIV and SF-12 in Thailand)

Dr. S returned from the US and met with me to talk about some of the new stats that Dr. A wanted in the paper. He also talked to me about the order of authorship and i was a little let down because he told me i would be second-to-last even though i essentially wrote the entire paper. After consulting with some friends, i have decided that when i send the final draft out (hopefully this weekend) i will ask him if it's possible to be second author.

Although i know authorship is pretty political, i think it's nice to be able to support students. i was really hoping to have a publication in a peer-reviewed journal before residency apps, and one of the other people on the paper is also keen on having me achieve that goal. i hope i remember what it's like to be a student when im an attending writing papers somewhere and give authorship to up-and-coming peoples over those who already have a ton of papers anyway.

Anyway, besides the authorship thing, the paper is pretty close to (my) final draft, so once it gets approved by the two main people on the paper, it will be off!

1a. Quality of life trial

The other trial that Dr. S is working on right now that i discussed in an earlier post (700+ pts started on ARV about three years ago, tons of data on EVERYTHING - quality of life, adherence, risk behavior, SES, etc.) is coming up on three years, where they're going to administer a battery of questionnaires again. The issue of lipodystrophy/lipoatrophy came up at a previous dissemination meeting with all the hospitals and Dr. A gave us some tools to look at from NIAID. Dr. P translated them into Thai and we pilot tested them last week in the HIV OPD clinic, which was fun (and interesting). Kinda reminded me of HIV-NAT days, when i helped Dr. Mark administer LD questionnaires.

After i finish the QOL paper on the validity and reliability of the two QOL questionnaires, Dr. S invited me to work on another paper (discussing improving SES, or socio-economic status, with starting HAART) with him. i also might help do some writing for the big (main results) paper that Dr. A is working on.

2) Reproductive health questionnaire

i finally got to have a meeting with the head doc and some of the nurses about incorporating a better intake/questionnaire form when women come to electively terminate pregnancies. they helped make corrections/clarify stuff on the form i wrote and agreed to administer the questionnaire and keep it separate from the identifier information. hopefully this is implemented soon (waiting for bureaucratic approval) and data can be collected! im kinda proud for pushing this point because i think it will really help with health services at the clinic and won't just be for me (and my research). i will finalize my CHR (Committee for Human Research) forms and hopefully qualify for a JHU exemption. ill likely have to return to CM sometime in the fall to collect (paper) data as well.

3) Thailand, TRIPS, and Compulsory Licensing : a lunchtime lecture by yours truly!

the clinical trial coordinators for each clinical trial meet once a month here to talk about clinical trial issues, collaborate, and sometimes learn about research/ethics/etc. the lunch is hosted by the regulatory affairs unit where my good friend lara works. with all the crazy stuff surrounding the compulsory licenses in Thailand, she was getting approached by lots of staff asking for more info about it. since she didnt know tons of background about TRIPS, etc, she invited me to be a guest lecturer at their monthly meeting yesterday.

i threw together some slides that i had from previous presentations and then combed through emails, read through the Thai MOPH (Ministry of Public Health) white paper that they wrote on the topic of their three recent compulsory licenses, and utilized the CP-TECH/KEI information available to me (yay Thiru!). lara gave me a super nice introduction and mentioned the time i had spent at the WHO. im actually really happy i participated in the Global Health Fellows Program now (even though it was a little crazy at the time, and i didn't finish my paper....maybe it will actually get done if my APHA abstract is accepted, esp. since SO much has happened in thailand since that time). i also made great friends in geneve - y'all know who you are.

before i went to give my presentation, liz noted (over AIM) that she thought i was never nervous. i think i get a little nervous before some kind of public speaking appearance (does anyone remember the first time they presented in the VA ICU - i do, and it was my first medicine patient of M3 year), but feel pretty comfortable speaking in front of a crowd, probably because ive done it a bunch of times. liz said i never seemed nervous even if i was. i hope this continues when i get back on the wards. :) back to the talk:

i was a little nervous that some of the staff (all Thai except Lara) wouldn't understand since i was presenting in English but tried to speak slowly throughout and staff seemed really into it. a few people were super engaged and asked me a lot of questions once it was over (and i think the people in the back were interested as well, but were trying to translate among themselves). lara said it was a big hit because no one got up and left even after she was like, 'ok, thanks for coming, it's over' and hung around to talk about it.

4) More quality of life (and other stuff) at Chiang Mai University

hopefully ill set up a meeting with one the head ARV clinic nurse today, who wrote this crazy long report in Thai about some research she did among ARV naive pts who started to take HAART on the NAPHA (the national HIV/AIDS treatment program here which offers universal access to those meeting treatment criteria). poo (ID fellow) gave me the report a few weeks ago and noted that Dr. Kuanchai thought something might be able to published from it. ive read through a lot of the report (all in Thai) and approached the author last week at clinic. i only got to talk to her briefly about whether she ever thought about writing anything in English/publishing in either Thai or international journals, and she said no. (she does all this research, writes it up and binds it, and then just puts it in the medical/nursing library. CRAZY!!) i think there's actually a lot of interesting data in her report and am going to see if she's interested in working together to put an abstract or paper together - hopefully this will get her involved and interested in disseminating her work/experience to others both here and abroad.


ok, play update later. gotta get ready for clinic!

PS Happy Happy Birthday to my husband, Chris!!
PPS Welcome to Thailand, Libby Houle!