Friday, May 30, 2008

nakhon phanom

im wrapping up my time here in Thailand and have had the fortune of going on two work-related visits to Sa Kaeo (near the Thai-Cambodian border) and am currently writing from Nakhon Phanom (near the Thai-Laos border). the visits have been super short (one night, two days max) but useful; i've gotten to tour the labs and find out more information re: the Binax project i'm working on (see previous posts). while touring the lab at Nakhon Phanom provincial hospital today (~350 beds), it occurred to me that i've never toured the lab at UMHS or any US-based hospital. perhaps this is something i'll look into when i'm back on my path/ID elective at Michigan.

Nakhon Phanom is a border town and very chill. after we arrived at the airport around 5:30 pm yesterday, we took an hour-long 'boat cruise' in the Mekong River, complete with karaoke and fried pork balls. it was striking to compare the two riverbanks, with the Thai side being much more developed than the Lao side. from the river, you can see many temples (wats) and also this huge church that runs a school (on the Thai side). the lao side is mostly small huts and also a small fisherie where it seems that fish swim in (but then can't swim out). at the big pier on the lao side, i was notified that there was a Lao Duty-Free store which primarily sells liquor. Thai and Lao people can freely cross the border but can't spend the night (same as Cambodia, and they can only stay in the province bordering the country of origin).

after the cruise, we ate dinner at this pub/restaurant named O-HI-O with live music (basically two dudes with guitars singing cheesy thai songs - common throughout the North, and also Chiang Mai). the local staff we were with were amused that i was actually born in Ohio. across the street, this huge long tent was set up with a stage for a wedding. it appeared as if some sort of talent show was going on, but i was informed that was part of the wedding, which got me to thinking that it would be amusing (albeit somewhat painful) if our weddings were talent shows as well.

after dinner, we got coffee at this cute coffee house and i got a nighttime tour of the 'city' which included a stop at the movie theater (which was closed for the night) - a movie is 40 baht (a little more than a dollar) and there are two screens. although i love bangkok, i could see why it would be appealing to live in the provinces, and appreciate the slower pace of life here.

this afternoon, i'm going to visit a famous temple in the area (wat that phanom) and also Ho Chi Minh's house in this Vietnamese farming community here. who knew that Ho Chi Minh spent years hiding as a farmer underground on the Thai-Laos border while plotting Vietnam's independence from France? apparently, the original wooden hut was eaten by termites, but they've rebuilt it. border history is really fascinating!

ok, off to lunch now. more soon!

Tuesday, May 20, 2008

working at the ministry

it's a little ironic that the shortest amount i have in thailand is the one where my mentors have given me the most (defined) project and work. due to crazy scheduling issues brought about by my own disorganized life last year, im only here for barely six weeks on the OC Hubert Fellowship, a program sponsored by the CDC Foundation. i am learning a ton and really wish i could stay here way longer! a short run-down of the project:

the project im working on is looking at the utility of Binax testing to detect Strep pneumoniae. S. pneumo. is one of the leading causes of death in children under five (a vaccine is available, but it's expensive for this part of the world) and also affects tons of adults. unfortunately, it's a tricky bug and hard to culture because it likes to autolyse itself after 24 hrs (or less). enter the Binax test, which is an immunochromatographic assay (think pregnancy test, with two lines - one control, one appearing if it's positive) that was created to detect S. pneumo. in cerebrospinal fluid (CSF, or spinal tap fluid) and urine. however, someone came up with the idea to try and use it with the blood they were already getting for blood cultures here as part of a larger pneumonia surveillance study. preliminary results show that the Binax test is really sensitive at detecting S. pneumo. and often will be able to find cases that have negative subcultures. today i'm visiting a provincial lab near the thai-cambodia border and got to tour the hospital and facilities, see how the lab is run, and collect some important information. i also got the chance to speak with some research nurses about hiv/aids, answer their questions, and watch them consent and enroll some patients in this other respiratory pathogen study. it was refreshing to see that they respected patients' wishes to refuse enrollment, although i still find it much more difficult to say no here as a patient (especially if you're hospitalized and don't have a lot of money).

in any case, i really like the office where i'm working as a whole. i have two mentors, an epidemiologist and a physician with an MPH, and they're very supportive and task-oriented, which i find refreshing after previous experiences here. i usually meet with at least one of my mentors everyday or every other day, am learning some basic SPSS skills to analyze data, and feel helpful because i can help bridge the thai-english divide (although most of the staff speak excellent English). the office where i work is housed in the Thai Ministry of Public Health (Thai MOPH) but it's part of the International Emerging Infections Program (IEIP) within the Thai-US CDC collaboration. TUC seems pretty cool to me so far and has made a big difference in these two provinces where the pneumonia surveillance activities are occurring by building lab capacity - the hospital im visiting in Sa Kaeo today just got a PCR machine last month! i'd be interested in seeing how the improvement in diagnostics have impacted clinical care, as the head lab person i talked to today noted that their ability to diagnose a common pathogen like S. pneumo. has increased dramatically (they used to only successfully culture one or two cases a year, and now it's close to 3% of all blood cultures done! i very much appreciate the chance to visit the sites in the provinces and am getting a much better global view of the work that's going on with the Thai-US projects (and hope to be more involved in the future!)

more work updates later. last random fact: did you know S. pneumo. is really prevalent in the Arctic Circle? me neither, but apparently the poster we're preparing is being held in Iceland this year because it's heavily affected by S. pneumo. (and they always pick locations based on where the pathogen they're focusing on is super prevalent). kinda cool, though iceland seems to be a super pricy place to have a meeting!

Sunday, May 18, 2008

back in bangkok

after a year filled with ups and downs, i returned to bangkok & thailand. the last time i was here, i was leaving my fogarty site in chiang mai, feeling super nervous (but excited) about returning to clinical medicine as an M5, and looking forward to the match. it seems that things do indeed come full circle as i am in a similar position this time around, although i am only spending six weeks here instead of many months. when i return to the US in a month, i will be an M6, looking forward to my last (real) clinical elective, ER at Henry Ford, and getting ready for the match (again). i feel like this scenario may repeat itself again before i start my intern year, but we'll see.

since my fulbright year, thailand has been a bedrock for me. it was the place where i found a connection to my past, where i became proud of my cultural heritage instead of trying to hide it, and where i experienced a small sense of loss and disappointment that our generation was no longer made up of families with eight or nine siblings (as my parents' was). thailand was also the first place where chris and i really spent time together, where we traveled, where we ate a ton of food. thailand was also the first place where i really started to understand the human effects of poverty, of HIV/AIDS, of the tragedy when people died of preventable illness. thailand made me realize that difficult issues like drug use and commercial sex work and corruption were real and affected real people, people that i knew and respected and loved. thailand made me appreciate lots and lots of shades of gray. thailand made me wonder why it was so physically easy to move back and forth between the Global North and Global South all within a block or a city or from the capital to the provinces or especially to a neighboring country. bangkok reminds me of what it is to have so much and so little, exemplified by a series of thoughts i've had since being back:

1) Bus fare

bus fare has gone up a lot since i started coming to thailand, and another fare hike was recently approved, drawing outrage from the working poor who need to use the bus system to get around. to put it into perspective, the cheapest buses used to cost 3.5 baht for a trip, but now will cost 8.5 baht (up 1 baht from previous fare increases), and because most poor people need to transfer at least two or three times, this seemingly innocuous price increase can easily amount to over 100 baht a month.

the subway and skytrain, both of which i often use, are quite expensive compared to the bus system & don't reach a lot of areas of bangkok. although i often try to take the bus, it is definitely a choice for me and i can easily take a taxi to get where i need to go. for example, i usually take a taxi to work since it's most convenient and it costs me 80 baht for the fare and 50 baht for the tollway (necessary to save about an hr's time sitting in traffic). to put this into perspective, the minimum daily wage in Bangkok (which is the highest in Thailand) is 194 baht a day, or a little over $6.

2) women and children

the friend im staying with works in the field of child protection and we've known each other since our fulbright days. during her fulbright, she helped set up this income generation project in one of the biggest slums in bangkok, klongtoey, and it continues successfully to this day! it's basically a women's group that makes really cool (mostly silver) jewelry (amalee buys all the supplies from jatujak, one of the largest open air markets in Asia, and they work together to identify and make new designs). amalee meets with the group every weekend to collect the pieces that the women have made the previous week, distribute new materials for pieces to be made in the coming week, and pay the women for their work (they can also take out small loans). the women also work on finishing up jewelry pieces it's meant to be supplemental income, and it was cool to meet many of the girls and women who participate (ranging from age 12-13? to 40's). it's also a forum for the women to discuss issues in their lives, which mirror many women the world over must deal with - domestic violence, child care, raising children alone, patience, silence, love.... next week there is a thai craft show where they will go and sell their jewelry. i will post pics and other info later!

3) natural disaster

within days of my arrival both cyclone nargis and the earthquake in beichuan devastated burma and china. if the burmese haven't suffered enough under military junta rule, the (lack of) response to those affected by the cyclone only highlights their plight and the continuing human rights abuses that continue to happen under this regime. to help people that have been working in burma (and also support the free border clinic run in mae sot), please click here.


4) the english expectation

as a native english speaker, i often feel that i become immediately more credible just because of my ability to express myself in a langjuage that i'm comfortable with. in thailand (and much of asia) people often don't want to 'interrupt' or 'cause trouble' by asking questions or saying they don't understand. the first week i started at my internship i wasn't sure what was going on, but we had an epi talk about the roll-out of influenza vaccine to people ages 65 and older throughout thailand and nobody wanted to contribute (even though i'm sure they were far more qualified than me to do so). sometimes i think it's unfair that many meetings aren't conducted in thai...after all, we are in thailand.

there's also a divide in development work and agencies between local hires and those who come to work from elsewhere. my friend has noticed this in the UN and ive also noticed it in various agencies - all admin staff (secretaries, etc) are thai, but there are few professionals that are thai - or even speak it. this leads to a thai-non-thai divide, resentment, and difficulty trying to navigate being thai-american in a western vs thai environment. more thoughts on this later!

ok, im going to try and be better about blogging. next update: work and play in bangkok!